The role of CMV in steroid-resistant ulcerative colitis: A systematic review
- 1 September 2009
- journal article
- review article
- Published by Oxford University Press (OUP) in Journal of Crohn's and Colitis
- Vol. 3 (3), 141-148
- https://doi.org/10.1016/j.crohns.2009.03.002
Abstract
Steroid-resistance presents a management challenge in ulcerative colitis. How steroid-resistance occurs is unknown, but cytomegalovirus infection, often unrecognised, may be the cause in some patients. Current evidence and therapeutic recommendations are examined. A systematic review of PubMed and EMBASE databases was performed. Search and exclusion criteria are defined in the text. Heterogeneity of experimental design and definitions of key terms were notable. Criteria for cytomegalovirus disease, infection or detection varied, as did definitions of steroid-resistance. CMV infection defined by antigenaemia or serology was common in patients on steroids and associated with a higher rate of steroid-resistance (41.66-61% versus 0-68% in steroid-responsive patients). Colonic mucosal cytomegalovirus disease detected by histopathology was associated with intravenous steroid-resistance in 5-36%, compared to 0-10% of steroid-responsive patients. CMV colitis has rarely been reported in association with ulcerative colitis without steroids or other immunomodulators. CMV colitis in healthy individuals is so exceptional as to be the topic of case reports. Ulcerative colitis and its treatment put patients at risk of CMV infection or reactivation. A distinction is necessary between CMV disease (colitis) and CMV infection. Only colonic mucosal CMV infection detected by histopathology appears clinically relevant and appropriate for antiviral therapy. CMV antigenaemia may be associated with steroid-resistance, but may also be a self-limiting marker of viral reactivation. The impact of CMV on steroid-resistance is complicated by inconsistencies in the literature. Coherent definitions of clinically relevant CMV infection and steroid-resistance are needed.This publication has 28 references indexed in Scilit:
- Cytomegalovirus infection in inflammatory bowel disease patients undergoing anti-TNFα therapyJournal of Clinical Virology, 2008
- The history of cytomegalovirus and its diseasesMedical Microbiology and Immunology, 2007
- Case 35-2007New England Journal of Medicine, 2007
- Review article: steroid resistance in inflammatory bowel disease – mechanisms and therapeutic strategiesAlimentary Pharmacology & Therapeutics, 2007
- The hazardous burden of Herpesviridae in inflammatory bowel disease: The case of refractory severe ulcerative colitisDigestive and Liver Disease, 2006
- Cytomegalovirus infection in ulcerative colitisScandinavian Journal of Gastroenterology, 2006
- Is Cytomegalovirus Really a Cause of Resistance to Steroids in Ulcerative Colitis?Diseases of the Colon & Rectum, 2005
- Prevalence of Cytomegalovirus Infection in Inflammatory Bowel Disease PatientsDiseases of the Colon & Rectum, 2004
- Significance of human herpesviruses to transplant recipientsCurrent Opinion in Infectious Diseases, 2003
- HIV associated cytomegalovirus colitis as a mimic of inflammatory bowel disease.Gut, 1995