P191 The endoscopic and pathological features of cytomegalovirus colitis in ulcerative colitis
h. yang*1, H. LV2, j. qian1
1Peking Union Medical College Hospital, Department of Gastroenterology, Beijing, China, 2Peking Union Medical College Hospital, Beijing, China
Human Cytomegalovirus (HCMV) infections are common in the general population. The high rate of viral latency of CMV makes immunocompromised patients vulnerable to virus reactivation. This is especially true in inflammatory bowel disease (IBD) patients who take immunosuppressive drugs such as corticosteroids or thiopurines. It has been reported that CMV is presented 21%–34% in the colonic tissue of ulcerative colitis (UC) patients and 33%–36% in steroid-refractory patients. The optimal treatment strategy for CMV infection in patients with UC is controversial, with most evidence suggesting that antiviral therapy should be initiated. However, the endoscopic and pathologic characteristics of CMV colitis in patients with UC are still controversial. The aim of this study was to evaluate the clinical, endoscopic, and pathological characteristics of CMV colitis in Chinese UC patients.
In total, 50 UC patients admitted to Peking Union College Hospital from 2010 to 2015 were enrolled in this study. All patients were evaluated for CMV infection, and the diagnosis of infection was made based on positive findings of CMV IgM, CMV pp65, and/or CMV DNA. The diagnosis of colonic CMV colitis was confirmed by haematoxylin and eosin staining and immunohistochemistry.
Twenty-five UC patients with CMV infection (50%) developed CMV colitis. There were no differences between the patients with or without CMV infection in symptoms, including abdominal pain, diarrhoea, haematochezia, etc. More severe colitis was noticed in the patients with CMV colitis than in the patients without CMV colitis at the time of CMV infection. Significantly higher proportions of punched-out ulcerations, irregular ulcerations and a cobblestone-like appearance were observed amongst the UC patients with CMV colitis (52% vs 20%, 60% vs 16%, and 20% vs 0%, p < 0.05). The number of inclusion bodies per high power field was significantly higher in the patients with punched-out ulcerations, irregular ulcerations, and a cobblestone-like appearance (p < 0.05). However, there was no significant difference in the pathological grade between the CMV colitis group and the non-CMV colitis group.
Although the severity score was higher in the UC patients with CMV colitis, the inflammatory activity was significantly but not associated with worsening of colon mucosal inflammatory activity between the UC patients with and without CMV colitis. Typical endoscopic imaging and CMV DNA test may be useful for predicting the presence of CMV colitis.