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* = Presenting author

P290. CMV in IBD patients – does it matter?

M. Thörn1, A. Rönnblom1, B.-M. Eriksson1, F. Rorsman1, P. Sangfelt1, A. Wanders2, K. Bondeson3, 1Uppsala University, Dept of Medical Sciences, Uppsala, Sweden, 2Uppsala University, Dept of Immunology, Genetics and Pathology, Uppsala, Sweden, 3Uppsala University, Dept of Medical Biochemistry and Microbiology, Uppsala, Sweden

Background

CMV infection has been found in cases of severe inflammatory bowel disease (IBD), especially in steroid refractory ulcerative colitis. It has been suggested that gut inflammation is caused or worsened by reactivation of CMV, facilitated by the immunosuppressive medication. In some cases CMV treatment seemed to reduce the inflammation. CMV as a factor for pathophysiology and prognostic marker in IBD has been a matter of debate.

Methods

Patients referred to the unit for an endoscopic evaluation for IBD were asked to participate in the study. As a control group patients with irritable bowel syndrome (IBS) or rectal bleeding were included. A smaller group of patients with steroid refractory and/or steroid dependent IBD were included as well. CMV-DNA was analysed in blood, biopsies from inflamed bowel and faeces. Biopsies were taken for histopathology including CMV immunohistochemistry.

Results

Findings indicating active CMV infection were found in 50% of patients with steroid treated IBD. In addition to this, about 10% (6/53) of the patients with newly diagnosed IBD were positive for CMV-DNA despite that they had not been treated with steroids or other immunosuppressants. Four of the CMV postive patients needed urgent surgery. All positive cases demonstrated CMV-DNA in one or more of the virological tests.

 CMV positiveCMV negativeFisher's exact test, one-tailed
IBD all, n = 631152P = 0.0055
Controls, n = 34 34 
IBD steroid treatment, n = 1055P = 0.01
IBD, no steroids, n = 53647 
IBD urgent surgery, n = 44 P = 0.0006
IBD, no urgent surgery, n = 59752 
IBD steroid-naive, n = 53647P = 0.045
Controls, n = 34 34 

Conclusion

Earlier observations of highly prevalent findings of CMV in severe forms of IBD were confirmed, but CMV was also found in newly diagnosed steroid naïve patients. This may imply that CMV may have a role in the pathophysiology in a subset of patients with IBD. In addition to this CMV may be a risk factor for urgent colectomy.