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P702. Clinical significance of cytomegalovirus (CMV) infection in inflammatory bowel disease

G. Inserra1, M. Mendolaro1, S. Siringo2, G. Scalia3, L. Samperi1, M.C. Conti Bellocchi1, R. Catanzaro1, 1A.O.U. Policlinico-Vittorio Emanuele, U.O. Medicina interna, Catania, Italy, 2ARNAS Garibaldi, Gastroenterogia, Catania, Italy, 3A.O.U. Policlinico-Vittorio Emanuele, Laboratorio di Virologia Clinica, Catania, Italy

Background

The role of CMV in exacerbations of inflammatorybowel disease (IBD) remains a topic of ongoing debate. The aims of this study were to evaluate: the correlation between the presence of CMV in the colon, the clinical activity of the disease and the colonic extent of ulcerative colitis; the role of CMV infection in steroid-dependent/refractory patients; the role of immunosuppressive therapies in CMV reactivation.

Methods

We retrospectively evaluated 44 IBD patients (30 ulcerative colitis, UC; 13 Crohn's disease, CD; 1 pouchitis) who, from 2009 to 2011, were investigated about the presence of CMV on biopsy specimens of colon. In each patient we recorded: clinical activity; endoscopic extent; steroid-dependent/refractory status and ongoing therapies. PCR amplification technique was used for detecting CMV-DNA in colonic tissue. Clinical severity of IBD was assessed according to Mayo Scoring Index for UC and Harvey–Bradshaw Index for CD.

Results

The presence of CMV-DNA in colonic biopsies was detected in 14 out of 44 patients (13 UC; 1 CD), with an overall prevalence of 32%. Seven out of 14 CMV+ patients (50%) and 4 out of 30 CMV patients (13%), showed clinically severe disease (P < 0.05). Twenty-eight patients were resistant/dependent to steroids. CMV was detected in 12 out of these 28 patients (43%), and in 2 out of the 16 (13%) patients steroid-responsive (P < 0.05). Considering the colonic extent of UC, among the 13 CMV+ patients: 2 had a recto­sigmoiditis (16%), 5 had a left-sided colitis (38%) and 6 had a colitis extending beyond the left colonic flexure. Among the 17 CMV patients: 5 had a recto­sigmoiditis (28%), 4 had a left-sided colitis (25%) and 8 had a colitis extending beyond the left colonic flexure (47%). No significant statistical difference was found between these two groups. Sixteen out of 44 patients were under immunosuppressive treatment. Among these 16, 6 were CMV+ (38%) and 10 were CMV (62%); among the other 28 patients, 8 were CMV+ (28%) and 20 were CMV (72%). No significant statistical difference was found between these two groups.

Conclusion

CMV appears to play a role in a subgroup of patients with severe or steroid-dependent/refractory IBD. It is not clear whether the virus causes steroid dependence/refractory or a prolonged steroid use reactivates a latent viral infection. No correlation was found between the extent of UC, the immunosuppressive therapy and the presence of CMV-DNA in colonic tissue.