title: The prevalence and efficacy of ganciclovir on steroid-refractory ulcerative colitis with cytomegalovirus infection: a prospective multicenter study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Gaegeum-dong, Busan, Korea.
authors.forename: You Sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.forename: Sung-Ae
authors.initials: SA
authors.lastname: Jung
authors.forename: Young Sook
authors.initials: YS
authors.lastname: Park
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Choi
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000503:physiopathology; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology; D004351:Drug Resistance; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D015774:Ganciclovir