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P203. Toxic megacolon and human cytomegalovirus in a series of severe ulcerative colitis patients

V. Criscuoli1, M.R. Rizzuto2, E. Gallo3, M. Cottone4

1V Cervello Hospital, Palermo, Italy; 2V Cervello Hospital, Italy; 3Pathology, Italy; 4V Cervello Hospital, Instituto di Medicina Generale e Pneumologia, Palermo, Italy

Background and aims: Human Cytomegalovirus (HCMV) infection has been reported to be a cause of refractory ulcerative colitis often complicating the course of disease. Toxic megacolon (TM) is a rare but severe complication of an acute attack of colitis often that require immediate surgery.

Aim of this study is to evaluate in a case–control study the association between HCMV and TM.

Materials and methods: All patients (pts) who were admitted at Medicine Department of V. Cervello Hospital in Palermo (tertiary referral center) for a severe ulcerative colitis (UC) flare-up complicated by TM, using the accepted criteria, between January 1975 and November 2010 were identified through the electronic database. A total of 22 consecutive patients (14 male/8 female) were identified. A non TM control group will be ascertained from a retrospective cohort study of adult patients hospitalized for severe colitis. Each case of TM was individually matched by sex, age, extent of the underlying disease to one severe UC controls. Haematoxilin and Eosin stain, Immunohistochemical procedure and Nested polymerase chain reaction were performed to detect HCMV genes and proteins on rectal biopsies or surgical specimens.

Statistical Analysis: Demographic, clinical, and surgical parameters were compared between patients who did and did not develop TM during follow-up, using chi-square statistics, Fisher's Exact test.

Results: HCMV was detected in histological specimens of 9 patients (41%) with TM compared to 2 (9%) controls (P = 0.033).

In the TM group, 18 of 22 (81%) patients underwent colectomy during the admission, compared with 4 of 22 (18%) controls (P = 0.0001). Among the 9 TM HCMV positive pts, 7 were operated on compared to 11 TM HCMV negative pts. HCMV pts did no show endoscopic or histological virus reactivation in the ileo-anal pouch.

Conclusions: In severe colitis the presence of HCMV is more frequently associated with megacolon, but it is not associated to a higher risk of surgery.

Our observation emphasizes again the importance of early detection of the HCMV during a severe colitis flare-up in order to prevent complications of disease.