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Cytomegalovirus colitis complicating inflammatory bowel disease
1Center for Inflammatory Bowel Disease, Department of Gastroenterology/Hepatology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Insights
Cytomegalovirus (CMV) infection is common in severe colitis flares among inflammatory bowel disease (IBD) patients. Antiviral therapy can lead to remission in most cases, but not all CMV infections require treatment.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Inflammatory bowel disease (IBD) patients with acute severe colitis flares are often evaluated for concurrent cytomegalovirus (CMV) infection.
- Immunosuppression in IBD patients increases the risk of active CMV infection and disease.
- Accurate diagnosis of CMV is crucial for appropriate management.
Purpose of the Study:
- To review the diagnostic methods for CMV infection in IBD patients with acute severe colitis.
- To determine the prevalence of CMV infection in this patient population.
- To evaluate the efficacy of antiviral therapy for CMV-associated colitis in IBD.
Main Methods:
- Review of diagnostic techniques including endoscopy, histology, serology, viral culture, antigen testing, and DNA testing.
- Focus on immunohistochemistry (IHC) using monoclonal antibodies against CMV immediate early antigen as the gold standard.
- Analysis of prevalence data and treatment outcomes from existing literature.
Main Results:
- The prevalence of CMV infection in acute severe colitis ranges from 21-34%, and 33-36% in steroid-refractory cases.
- Immunohistochemistry (IHC) on colon biopsies is the gold standard for diagnosing CMV infection.
- Colitis remission rates after antiviral therapy are high (67-100%), but CMV presence alone doesn't always indicate steroid resistance or necessitate treatment.
Conclusions:
- Cytomegalovirus (CMV) infection is a significant consideration in hospitalized inflammatory bowel disease (IBD) patients experiencing acute severe colitis flares.
- While immunohistochemistry (IHC) is the gold standard for diagnosis, not all CMV infections require antiviral therapy, as steroid resistance is not always linked to viral presence.
- Antiviral treatment demonstrates high remission rates in CMV-positive IBD patients, underscoring the importance of accurate diagnosis and tailored management strategies.
Abstract:
When patients with inflammatory bowel disease (IBD) are admitted to the hospital with a flare of acute severe colitis, the possibility of a concurrent cytomegalovirus (CMV) infection causing or worsening the colitis is often considered. IBD patients are usually immunosuppressed, and therefore presumably at increased risk for active CMV infection and disease. Multiple techniques are used to diagnose CMV infection, including endoscopy, histology, serology, viral culture, CMV antigen testing, and CMV DNA testing. Immunohistochemistry (IHC) performed on colon biopsy specimens with monoclonal antibodies directed against CMV immediate early antigen is considered by most to be the current gold standard for diagnosis. The prevalence of CMV infection in acute severe colitis appears to be 21-34%, and the prevalence of CMV infection in the steroid refractory subgroup of these patients is 33-36%. After antiviral therapy, colitis remission rates in IBD patients with CMV infection range from 67% to 100%, though CMV histological infection or the presence of circulating virus alone is not always associated with steroid resistance, and may not require antiviral therapy.
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