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World J Gastroenterol. Jan 7, 2013; 19(1): 17-25
Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.17
Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease
Elena Garrido, Elisa Carrera, Rebeca Manzano, Antonio Lopez-Sanroman
Elena Garrido, Antonio Lopez-Sanroman, Inflammatory Bowel Disease Clinic, Department of Gastroenterology, University Hospital Ramón y Cajal, 28034 Madrid, Spain
Elisa Carrera, Department of Gastroenterology, University Hospital of Guadalajara, 19002 Guadalajara, Spain
Rebeca Manzano, Department of Gastroenterology, Hospital Sureste, 28500 Madrid, Spain
Author contributions: Garrido E, Carrera E, Manzano R and Lopez-Sanroman A contributed equally to this work; and all authors have approved the final version of the manuscript.
Correspondence to: Dr. Elena Garrido, Inflammatory Bowel Disease Clinic, Department of Gastroenterology, University Hospital Ramón y Cajal, Carretera Colmenar K9.100, 28034 Madrid, Spain.
Telephone: +34-913-368305 Fax: +34-913-368354
Received: May 29, 2012
Revised: August 3, 2012
Accepted: August 14, 2012
Published online: January 7, 2013

Cytomegalovirus (CMV) infection is common in humans. The virus then enters a “latency phase” and can reactivate to different stimuli such as immunosuppression. The clinical significance of CMV infection in inflammatory bowel disease is different in Crohn’s disease (CD) and ulcerative colitis (UC). CMV does not interfere in the clinical course of CD. However, CMV reactivation is frequent in severe or steroid-resistant UC. It is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe disease. Different methods are used to diagnose CMV colitis. Diagnosis is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry, other tests on blood or tissue samples are currently being investigated. Polymerase chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease; further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic mucosa. Specific endoscopic features have not been described in active UC and CMV infection. CMV colitis is usually treated with ganciclovir for several weeks, there are different opinions about whether or not to stop immunosuppressive therapy. Other antiviral drugs may be used. Multicenter controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.

Keywords: Cytomegalovirus, Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Hematoxylin and eosin, Immunohistochemical, Polymerase chain reaction, Ganciclovir, Infectious colitis