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P199. Colonic Epstein–Barr-virus involvement in inflammatory bowel disease: A simple bystander

A. Le Gruyer1, D. Veyer2, L. Siproudhis1, J.‑F. Bretagne1, G. Bouguen1

1CHU Pontchaillou, Service des Maladies de l'Appareil Digestif, Rennes, France; 2CHU Pontchaillou, Service de Virologie, Rennes, France

Background: Epstein–Barr virus (EBV) has been detected on colonic mucosa of inflammatory bowel disease (IBD) and its role in altering the clinical course of IBD has been suggested. Our aims were to examine the disease course of IBD patients with a colonic EBV, and to assess the influence of anti‑TNF treatment on EBV positive patients.

Methods: The charts of all IBD patients with colic EBV seen in a referral French centre from December 2001 to March 2011 were first reviewed and then compared to an IBD control group with no colonic EBV. Then we specifically assessed outcomes of patients treated with anti‑TNF treatment and positive for EBV.

Results: Thirty-five IBD EBV positive patients were analyzed (ulcerative colitis, 69%; Crohn's disease, 31%). All patients at baseline (date of the first positive colonic EBV PCR) had an active disease based on clinical and endoscopic data. At short-term follow-up (3 to 12 weeks), 85% of colic EBV PCR became negative (p < 0.05) whereas only 14% received antiviral therapy and despite a significant increase of immunosuppressive therapy. After a median follow-up of 83 weeks, half patients had remission and one third of patients required surgery. Compared to 26 IBD controls (ulcerative colitis, 46%; Crohn's disease, 54%), we didn't find significant difference between the two groups at baseline, except significantly more steroid resistance in the EBV positive group. At long-term, there was no significant difference in terms of remission, treatment with anti‑TNF agents or surgery. A total of 69% of EBV positive patients received anti‑TNF treatment. Patients receiving anti-TNFα tended to have a more severe disease. At long-term the rate of remission and surgery didn't change between patients treated or not.

Conclusions: These results suggest that colonic EBV is a colonic bystander and do not change the clinical course of IBD. It should not be search when relapse or before therapeutic optimization leading not to change therapeutic strategy including immunosuppression and antiviral therapy.