The Prevalence and Efficacy of Ganciclovir on Steroid-refractory Ulcerative Colitis With Cytomegalovirus Infection
- 1 January 2012
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Clinical Gastroenterology
- Vol. 46 (1), 51-56
- https://doi.org/10.1097/mcg.0b013e3182160c9c
Abstract
It remains controversial whether or not cytomegalovirus infection in patients with active ulcerative colitis reflects a nonpathogenic colonization or a pathogenic disease warranting antiviral therapy. The aim of this study was to determine the prevalence of cytomegalovirus infection in patients with active ulcerative colitis and the therapeutic efficacy of ganciclovir against cytomegalovirus infection in patients with steroid-refractory ulcerative colitis. A prospective, multicenter study was conducted in 72 patients with moderate-to-severe ulcerative colitis who were treated with intravenous steroids. The presence of cytomegalovirus was evaluated serologically and histopathologic examination, including immunohistochemical staining. In patients with steroid-refractory ulcerative colitis, cytomegalovirus infections were treated with intravenous ganciclovir. In patients with steroid-responsive ulcerative colitis, steroid therapy was continued irrespective of cytomegalovirus infection. The evidence of cytomegalovirus infection was found in 31 patients (43%) with moderate-to-severe active ulcerative colitis. In patients with steroid-refractory ulcerative colitis, the cytomegalovirus infection rate increased to 67% (14 of 21). No significant clinical and endoscopic differences existed between patients with and without a cytomegalovirus infection; however, the amount of steroids used during the flare-up period was significantly higher in patients with a cytomegalovirus infection (P = 0.013). Eleven of 14 patients (79%) with steroid-refractory ulcerative colitis and a cytomegalovirus infection improved with ganciclovir treatment. Cytomegalovirus infections in the steroid-responsive group (17 of 31) did not require ganciclovir therapy. Cytomegalovirus infections are frequently observed in patients with moderate-to-severe ulcerative colitis, especially steroid-refractory ulcerative colitis. Ganciclovir was effective in patients with steroid-refractory ulcerative colitis who had a cytomegalovirus infection.Keywords
This publication has 18 references indexed in Scilit:
- Cytomegalovirus infection in ulcerative colitis: A prospective, comparative study on prevalence and diagnostic strategyInflammatory Bowel Diseases, 2008
- Basiliximab for the treatment of steroid‐resistant ulcerative colitis: further experience in moderate and severe diseaseAlimentary Pharmacology & Therapeutics, 2006
- Clinical and Immunologic Aspects of Cytomegalovirus Infection in Solid Organ Transplant RecipientsTransplantation, 2005
- Severe acute colitis associated with CMV: a prevalence studyDigestive and Liver Disease, 2004
- Combined-Modality Therapy in Locally Advanced Primary Rectal CancerDiseases of the Colon & Rectum, 2003
- The treatment of cytomegalovirus infectionJournal of Antimicrobial Chemotherapy, 2002
- Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitisThe American Journal of Gastroenterology, 2001
- Gastrointestinal Cytomegalovirus DiseaseAnnals of Internal Medicine, 1993
- Coated Oral 5-Aminosalicylic Acid Therapy for Mildly to Moderately Active Ulcerative ColitisNew England Journal of Medicine, 1987
- Variation Between Observers in Describing Mucosal Appearances in ProctocolitisBMJ, 1964