title: Review article: cytomegalovirus and inflammatory bowel disease.
abstract: BACKGROUND
  The association between ulcerative colitis and cytomegalovirus (CMV) has been recognised for over 50 years; and the role of CMV in ulcerative colitis in general, and steroid resistance in particular, remains a topic of ongoing controversy. The outcome for patients with CMV reactivation appears worse than that for patients without reactivation, but it is not entirely clear whether CMV is a contributor or a bystander and if treatment with anti-virals alters the course of inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  To review the role of CMV associated with IBD, including epidemiology, clinical features, diagnosis and management strategies.
  
  
  METHODS
  By reviewing literature available on CMV associated with IBD in adult patients. A PubMed literature search was performed using the following terms individually or in combination: CMV colitis, cytomegalovirus colitis, IBD and CMV, CMV treatment.
  
  
  RESULTS
  Cytomegalovirus reactivation is common in patients with severe colitis, with a reported prevalence of 4.5-16.6%, and as high as 25% in patients requiring colectomy for severe colitis. The outcome for this group of patients appears worse than that for patients without reactivation; however, reported remission rates following treatment with anti-viral therapy are as high as 71-86%.
  
  
  CONCLUSIONS
  Evidence, although not conclusive, supports testing for CMV colonic disease in cases of moderate to severe colitis, by processing biopsies for haematoxylin and eosin staining with immunohistochemistry and/or, CMV DNA real-time polymerase chain reaction; and if present treating with ganciclovir.
authors: Department of Gastroenterology, Royal Liverpool University Teaching Hospital, Liverpool, UK.
authors: K
authors: K
authors: Sager
authors: S
authors: S
authors: Alam
authors: A
authors: A
authors: Bond
authors: L
authors: L
authors: Chinnappan
authors: C S
authors: CS
authors: Probert
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000453:epidemiology; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D004351:Drug Resistance; D006801:Humans; D007150:Immunohistochemistry; D007165:Immunosuppression Therapy; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D009000:Monocytes / Q000276:immunology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012720:Severity of Illness Index; D013256:Steroids / Q000494:pharmacology
chemical_list: D000998:Antiviral Agents; D013256:Steroids