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Inflammatory bowel disease
Cytomegalovirus colitis in inflammatory bowel disease and after haematopoietic stem cell transplantation: diagnostic accuracy, predictors, risk factors and disease outcome
  1. Eirini Mavropoulou,
  2. Kristin Ternes,
  3. Nicolae-Catalin Mechie,
  4. Sebastian Christopher Benjamin Bremer,
  5. Steffen Kunsch,
  6. Volker Ellenrieder,
  7. Albrecht Neesse,
  8. Ahmad Amanzada
  1. Department of Gastroenterology and Gastrointestinal Oncology, Universitatsklinikum Gottingen, Gottingen, Germany
  1. Correspondence to Dr Ahmad Amanzada; ahmad.amanzada{at}med.uni-goettingen.de

Abstract

Background Concurrent cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) and after haematopoietic stem cell transplantation (HSCT) is an important clinical entity associated with high rates of morbidity and mortality.

Methods A retrospective study of 47 patients with IBD and 61 HSCT patients was performed regarding the evaluation of diagnostic accuracy of applied methods, predictors, risk factors for CMV disease manifestation, the proportion of patients with antiviral treatment and disease outcome.

Results The sensitivity of quantitative PCR (qPCR) with a cut-off value of >250 copies/mg for CMV colitis in patients with IBD and HSCT patients was 79% and 92%, respectively. Predictors for CMV colitis in the IBD cohort were anaemia and the presence of endoscopic ulcers. Glucocorticoids, calcineurin inhibitors and >2 concurrent lines of treatment with immunosuppressive drugs could be identified as risk factors for CMV colitis in the IBD cohort with an OR of 7.1 (95% CI 1.7 to 29.9), 21.3 (95% CI 2.4 to 188.7) and 13.4 (95% CI 3.2 to 56.1), respectively. Predictors and risk factors for CMV gastroenteritis in the HSCT cohort was the presence of endoscopic ulcers (OR 18.6, 95% CI 3.3 to 103.7) and >2 concurrent lines of treatment with immunosuppressive drugs. Antiviral therapy was administered in 70% of patients with IBD and 77% of HSCT patients with CMV disease. 71% of antiviral-treated patients with IBD showed an improvement of their disease activity and 14% underwent colectomy. The mortality rate of HSCT patients was 21% irrespective of their CMV status.

Conclusions In addition to the implementation of histological methods, qPCR may be performed in patients with suspected high-risk IBD and HSCT patients for CMV colitis. Independent validations of these results in further prospective studies are needed.

  • cytomegalovirus disease
  • inflammatory bowel disease
  • polymerase chain reaction
  • risk factors
  • diagnostic
  • stem cell transplantation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2018-000258

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    Footnotes

    • EM and KT contributed equally.

    • Contributors AA conceived the study, analysed and interpreted the data and edited the manuscript. EM assisted in data analysis, and wrote the manuscript. KT acquired the data and contributed to the statistical analysis. NCM, SCBB, SK, VE and AN edited significant sections and revised the manuscript. All authors read and approved the final version of the manuscript.

    • Funding This work was supported by the open access fund of the Georg-August-University of Goettingen, Goettingen, Germany.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This retrospective study was approved by the ethics committee of the University of Goettingen (Dok_211_2015), Goettingen, Germany.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available for this article.