Gastrointestinal tract cytomegalovirus disease in southwestern Taiwan: a clinical study of 1950 endoscopic biopsies.
BACKGROUND
Gastrointestinal (GI) cytomegalovirus (CMV) disease occurs in adult patients with immune suppression. This study reviews and discusses the clinical settings, endoscopic features, and locations of GI CMV lesions.


METHODS
In total, 1950 endoscopic biopsy reports for all GI tract lesions in Chang Gung Memorial Hospital, Kaohsiung were retrospectively reviewed for CMV disease from 1999 to 2002. Only those patients found to be positive for viral inclusion bodies in tissue specimens, with further confirmation by special immunohistochemical staining, were enrolled in this study.


RESULTS
Our series showed that all 5 patients were immunosuppressed when attacked by the virus. The esophagus (n = 2) and colon (n = 2) were infected in 4 patients, while stomach was involved in one patient. Those patients with lesions of the esophagus and stomach followed a more-benign clinical course. Endoscopic examination showed 1 or more prominent ulcers in the distal esophagus and at the antrum of the stomach. Rare endoscopic findings of diffuse esophageal CMV disease and severe and extensive colitis were presented. The overall mortality rate was 20%, and all but 1 patient responded well to ganciclovir treatment.


CONCLUSIONS
We emphasize that GI CMV disease is still rare in Taiwan. A high degree of suspicion for CMV disease is important when diagnosing immunosuppressed patients suffering from GI symptoms.
Chuah
Seng-Kee
SK
Division of Hepato-Gastroenterology, Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Changchien
Chi-Sin
CS
Kuo
Chung-Mou
CM
Wu
Keng-Liang
KL
Chiu
King-Wah
KW
Chiu
Yi-Chun
YC
Liu
Jien-Wei
JW
Eng
Hock-Liew
HL
Chiou
Shue-Shian
SS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged