Possible role of human cytomegalovirus in pouchitis after proctocolectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis.
OBJECTIVE
To detect the presence of human cytomegalovirus (HCMV) proteins and genes on the ileal pouch of patients with ulcerative colitis who have undergone proctocolectomy with ileal pouch-anal anastomosis (IPAA).


METHODS
Immunohistochemistry, polymerase chain reaction (PCR) and PCR sequencing methods were utilized to test the presence of HCMV in pouch specimens taken from 34 patients in 86 endoscopies.


RESULTS
HCMV genes and proteins were detected in samples from 12 (35.2%) patients. The rate of detection was significant in the endoscopies from patients diagnosed with pouchitis (5 of 12, 41.6%), according to the Japanese classification of pouchitis, in comparison to patients with normal pouch (7 of 62, 11.2%; P = 0.021). In all patients with pouchitis in which the HCMV was detected, it was the first episode of pouchitis. The virus was not detected in previous biopsies taken in normal endoscopies of these patients. During the follow-up, HCMV was detected in one patient with recurrent pouchitis and in 3 patients whose pouchitis episodes improved but whose positive endoscopic findings persisted.


CONCLUSIONS
HCMV can take part in the inflammatory process of the pouch in some patients with ulcerative colitis who have undergone proctocolectomy with IPAA.
Casadesus
Damian
D
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan.
Tani
Tatsuo
T
Wakai
Toshifumi
T
Maruyama
Satoshi
S
Iiai
Tsuneo
T
Okamoto
Haruhiko
H
Hatakeyama
Katsuyoshi
K
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery*; D003587:Cytomegalovirus / Q000235:genetics / Q000472:pathogenicity*; D004279:DNA, Viral / Q000032:analysis / Q000378:metabolism; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000821:virology; D019449:Pouchitis / Q000209:etiology / Q000473:pathology / Q000821:virology*; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods
D004279:DNA, Viral