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P084. The prevalence and efficacy of ganciclovir on steroid-refractory ulcerative colitis with cytomegalovirus infection: A prospective multicenter study

Y. Kim1, Y. Kim2, J. Kim3, J. Cheon4, B. Ye5, S. Jung6, Y. Park7, C. Choi8, B. Jang9, Y. Jeen10, D. Han11, S. Yang5, W. Kim4

1Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 3Seoul National University College of Medicine, Seoul, Republic of Korea; 4Yonsei University College of Medicine, Seoul, Republic of Korea; 5University of Ulsan College of Medicine, Seoul, Republic of Korea; 6Ewha Womans University School of Medicine, Seoul, Republic of Korea; 7Eulji University College of Medicine, Seoul, Republic of Korea; 8Chung-Ang University College of Medicine, Seoul, Republic of Korea; 9Yeungnam University College of Medicine, Daegu, Republic of Korea; 10Korea University College of Medicine, Seoul, Republic of Korea; 11Hanyang University College of Medicine, Guri, Republic of Korea

Aim: It remains controversial whether cytomegalovirus (CMV) infection in active ulcerative colitis (UC) reflects a nonpathogenic colonization or a pathogenic disease warranting antiviral therapy. The aim of this study was to evaluate the prevalence of CMV infection in active UC and the therapeutic efficacy of ganciclovir on CMV infection in steroid-refractory UC.

Materials and Methods: A prospective, multicenter study was conducted in 72 patients with moderate-to-severe active UC who were treated with intravenous steroids. The presence of CMV was evaluated by a serology test and a histopathological examination including immunohistochemical staining. In patients with steroid-refractory UC, CMV infections were treated with intravenous ganciclovir. In case of steroid-responsive UC, steroid therapy was continued regardless of CMV infection.

Results: The evidence of CMV infection was found in 31 (43%) moderate-to-severe active UC patients. In steroid-refractory UC, CMV infection rate increased to 67% (14/21). No significant clinical and endoscopic differences were found between patients with and without CMV infection. However, the amount of steroid used during the flare-up period was significantly higher in patients with CMV infection (p = 0.013). Eleven of 14 (79%) steroid-refractory UC patients with CMV infection improved with ganciclovir treatment. CMV infection in the steroid-responsive group (17/31), however, did not require ganciclovir therapy.

Conclusions: CMV infection is frequently observed in patients with moderate-to-severe active UC, especially steroid-refractory UC. Ganciclovir was very effective in patients with steroid-refractory UC who had CMV infections. However, in steroid-responsive UC patients, CMV infection would be considered as a nonpathogenic bystander.