Gastrointestinal cytomegalovirus disease

Area of Science:

• Gastroenterology
• Virology
• Immunology

Background:

• Cytomegalovirus (CMV) infection can manifest as significant gastrointestinal disease.
• This disease primarily affects immunocompromised individuals, including those with acquired immunodeficiency syndrome (AIDS), organ transplant recipients, and patients undergoing chemotherapy or steroid therapy.

Purpose of the Study:

• To comprehensively review the pathogenesis, clinical presentation, and diagnostic and therapeutic strategies for gastrointestinal CMV disease.
• To inform clinicians about the recognition and management of this condition.

Main Methods:

• A systematic literature search of English-language articles published between 1985 and 1992 was conducted using MEDLINE.
• Hand-searching of bibliographies of retrieved articles supplemented the database search.
• Studies documenting human gastrointestinal CMV infection via histological examination of cytomegalic cells were selected for review and categorized by content.

Main Results:

• Gastrointestinal CMV disease presents as erosive or ulcerative lesions anywhere in the digestive tract, from the mouth to the rectum.
• Infection targets epithelial cells, endothelial cells, myocytes, and fibroblasts, leading to tissue destruction and ulceration.
• Diagnosis relies on positive mucosal biopsies demonstrating CMV via histopathology or other techniques; prognosis is poor in persistent immune deficiency, but antiviral treatment with ganciclovir or foscarnet can promote healing.

Conclusions:

• Gastrointestinal CMV disease requires awareness among internists regarding its diverse clinical settings and locations.
• Immunocompromised patients with gastrointestinal symptoms warrant imaging and mucosal biopsies to rule out CMV infection.
• Antiviral chemotherapy offers a significant improvement in patient outcomes.