title: Long-term outcomes of cytomegalovirus reactivation in patients with moderate to severe ulcerative colitis: a multicenter study.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) reactivations are frequently observed in patients with active ulcerative colitis (UC), and ganciclovir therapy is effective in patients with steroid-refractory UC. This study aimed to determine the long-term outcomes of CMV reactivation and the long-term therapeutic efficacy of ganciclovir treatment.
  
  
  METHODS
  This retrospective multicenter study included a cohort of 72 patients with moderate-to-severe UC who were evaluated for CMV reactivation at the time of their initial UC flare. Colectomy, disease relapse, and the recurrence rate of CMV reactivation were investigated.
  
  
  RESULTS
  The mean duration of follow-up for the 72 patients was 43.16±19.78 months (range, 1 to 67 months). The cumulative colectomy (log-rank, p=0.025) and disease flare-up rates (log-rank, p=0.048) were significantly higher in the CMV-positive group. Of the 11 patients who were successfully treated with ganciclovir in the initial treatment, three patients (27.3%) experienced CMV reactivation, and six patients (54.5%) experienced poor outcomes, such as the need for colectomy or a steroid-dependent state.
  
  
  CONCLUSIONS
  The patients who had CMV-reactivated UC showed poor outcomes at the long-term follow-up, and the long-term efficacy of ganciclovir therapy was marginal. Careful assessment is necessary for patients who exhibit evidence of CMV reactivation.
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: You Sun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Sungkyunkwan University School of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Seoul National University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Jeong
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Soo Jeong
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
authors.affiliation: University of Ulsan College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Byong Duk
authors.initials: BD
authors.lastname: Ye
authors.affiliation: Ewha Womans University School of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Sung-Ae
authors.initials: SA
authors.lastname: Jung
authors.affiliation: Eulji University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Young Sook
authors.initials: YS
authors.lastname: Park
authors.affiliation: Chung-Ang University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Yeungnam University College of Medicine, Daegu, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Kyeung Ok
authors.initials: KO
authors.lastname: Kim
authors.affiliation: Yeungnam University College of Medicine, Daegu, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Jang
authors.affiliation: Hanyang University College of Medicine, Guri, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Han
authors.affiliation: University of Ulsan College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.affiliation: Yonsei University College of Medicine, Seoul, Korea ; IBD Study Group of the Korean Association for the Study of Intestinal Diseases, Seoul, Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
keywords: Colectomy; Colitis; Cytomegalovirus; Ganciclovir; ulcerative