OBJECTIVE: Although many studies have shown that cytomegalovirus (CMV) infection is an exacerbating factor in patients with ulcerative colitis (UC), there is no valid method to distinguish CMV infection requiring therapy from that disappearing without therapy. The aim of this study was to describe whether or not the endoscopic feature of a large ulcer predicts the necessity of antiviral therapy against CMV infection in active UC patients with positive mucosal viral assay. METHODS: Active UC patients in whom CMV infection was detected by mucosal polymerase chain reaction (PCR) assay were enrolled in this prospective observational clinical study. Patients with a large ulcer (ulcerated group) were treated with antiviral and UC therapy. Patients without a large ulcer (non-ulcerated group) were treated with only UC therapy. We prospectively evaluated the clinical and endoscopic findings in all of the patients 2 months after starting this protocol, and observed their outcomes during one year. RESULTS: In the ulcerated group (n=10), 3 patients still had active disease at 2 months and underwent colectomy. Although the other 7 patients achieved remission at 2 months, 4 of the 7 patients had a flare-up, and the remaining 3 patients maintained remission. All of the patients in the non-ulcerated group (n=10) attained remission without antiviral therapy at 2 months, and maintained remission. CONCLUSION: In active UC patients with positive CMV DNA by mucosal PCR assay, the absence of a large ulcer suggests latent CMV infection, and requires no antiviral therapy.
OBJECTIVE: Although many studies have shown that cytomegalovirus (CMV) infection is an exacerbating factor in patients with ulcerative colitis (UC), there is no valid method to distinguish CMV infection requiring therapy from that disappearing without therapy. The aim of this study was to describe whether or not the endoscopic feature of a large ulcer predicts the necessity of antiviral therapy against CMV infection in active UC patients with positive mucosal viral assay. METHODS: Active UC patients in whom CMV infection was detected by mucosal polymerase chain reaction (PCR) assay were enrolled in this prospective observational clinical study. Patients with a large ulcer (ulcerated group) were treated with antiviral and UC therapy. Patients without a large ulcer (non-ulcerated group) were treated with only UC therapy. We prospectively evaluated the clinical and endoscopic findings in all of the patients 2 months after starting this protocol, and observed their outcomes during one year. RESULTS: In the ulcerated group (n=10), 3 patients still had active disease at 2 months and underwent colectomy. Although the other 7 patients achieved remission at 2 months, 4 of the 7 patients had a flare-up, and the remaining 3 patients maintained remission. All of the patients in the non-ulcerated group (n=10) attained remission without antiviral therapy at 2 months, and maintained remission. CONCLUSION: In active UC patients with positive CMV DNA by mucosal PCR assay, the absence of a large ulcer suggests latent CMV infection, and requires no antiviral therapy.
Authors: Cord Langner; Fernando Magro; Ann Driessen; Arzu Ensari; Gerassimos J Mantzaris; Vincenzo Villanacci; Gabriel Becheanu; Paula Borralho Nunes; Gieri Cathomas; Walter Fries; Anne Jouret-Mourin; Claudia Mescoli; Giovanni de Petris; Carlos A Rubio; Neil A Shepherd; Michael Vieth; Rami Eliakim; Karel Geboes Journal: Virchows Arch Date: 2014-02-01 Impact factor: 4.064