title: Looking for endoscopic features of cytomegalovirus colitis: a study of 187 patients with active ulcerative colitis, positive and negative for cytomegalovirus.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is frequently detected in ulcerative colitis (UC) lesions of steroid-refractory patients. This has led to the suspicion that CMV might cause colitis and steroid refractoriness.
  
  
  METHODS
  During 2003 and 2011, 187 consecutive patients were divided into group I (n = 105), corticosteroid-free and thiopurine-free in the past 6 months, and group II (n = 82), all corticosteroid refractory. The combination of serum CMV immunoglobulin (Ig)M, CMV IgG, CMV antigenemia (Ag), and real-time polymerase chain reaction assays were performed to identify CMV(+) patients.
  
  
  RESULTS
  In group I, 79 patients were CMV IgG(+) and 26 patients were CMV IgG(-) and CMV IgM(-). In group II, 61 patients were CMV IgG(+), 1 CMV IgM(+), and 20 CMV IgG(-) and CMV IgM(-). All CMV IgG(+) patients were screened for CMV Ag. In group I, 6 of the 79 CMV IgG(+) patients were CMV Ag(+). In group II, 27 patients were CMV Ag(+). Colonoscopy was performed in all patients before screening for CMV. Similar colonoscopic features including punched out ulcers, geographic ulcers, and irregular ulcers were found in both CMV(+) and CMV(-) patients, without any striking difference between the 2 groups.
  
  
  CONCLUSIONS
  CMV reactivation might be encouraged by immunosuppressive drugs, like corticosteroids, immunomodulators, and therefore, patients with UC are at a high risk of CMV reactivation, potentially exacerbating UC. However, this study of 187 patients, CMV(+) and CMV(-), could not find colonoscopic features unique to CMV, except that CMV might be one factor for steroid refractoriness, and UC exacerbation.
authors.affiliation: Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Iida
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ikeya
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Watanabe
authors.forename: Jinro
authors.initials: J
authors.lastname: Abe
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ohata
authors.forename: Shimura
authors.initials: S
authors.lastname: Teruyuki
authors.forename: Ken
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hanai
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D003113:Colonoscopy; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D014775:Virus Activation; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents