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The detection of the cytomegalovirus DNA in the colonic mucosa of patients with ulcerative colitis is associated with increased long-term risk of proctocolectomy: results from an outpatient IBD clinic

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Abstract

Purpose

Cytomegalovirus (CMV) infection has been found to be associated with a reactivation of ulcerative colitis (UC) and with an impaired response to medical therapy. In the past, only limited data were available on the long-term outcome for UC patients with positive tissue CMV-PCR in the colonic mucosa.

Methods

Between January 2010 and April 2015, we performed a qualitative PCR screening for CMV DNA in one biopsy from most actively inflamed rectal mucosa (tCMV-PCR). All tCMV-PCR-positive patients received 900 mg of valganciclovir b.i.d. for at least 15 days. We analyzed the association of the tCMV-PCR status with the time to steroid-free remission (SFR) and with the risk of proctocolectomy during the further course.

Results

One hundred eight consecutive patients (50 women, 58 men, median age 41 years, median UC duration 6 years) with active UC not responding to anti-inflammatory medication were analyzed. Eight of the 24 tCMV-PCR-positive patients (33.3%) compared to ten of the 84 tCMV-PCR-negative patients (11.9%) underwent proctocolectomy during a median follow-up of 52 months (p < 0.005). The median time from CMV diagnosis to colectomy was 501 days (median, interquartile range (IQR): 170, 902 days) in tCMV-PCR-positive and 958 days (IQR: 287, 1328 days) in tCMV-PCR-negative patients (p < 0.01). The median time to SFR was 126 days in tCMV-PCR-positive patients vs. 63 days in tCMV-PCR-negative patients (p < 0.01).

Conclusions

The detection of the CMV DNA in the colonic mucosa of patients with active UC is associated with a longer time to steroid-free UC remission and with an increased rate and earlier need of proctocolectomy.

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Funding

Gesellschaft für Klinische Studien Leipzig, Germany.

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Authors and Affiliations

  1. Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig und Schkeuditz, Leipzig, Germany

    Wiebke Schenk, Tobias Klugmann, Annett Borkenhagen, Chris Klecker, Peter Dietel & Niels Teich

  2. Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena, Germany

    Wiebke Schenk, Tony Bruns & Andreas Stallmach

  3. MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany

    Ralf Kirschner

  4. Gemeinschaftspraxis für Pathologie, Leipzig, Germany

    Eckhardt Schneider

  5. Medizinische Fakultät der Friedrich-Schiller-Universität Jena, Jena, Germany

    Niels Teich

Authors
  1. Wiebke Schenk
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  2. Tobias Klugmann
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  3. Annett Borkenhagen
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  4. Chris Klecker
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  5. Peter Dietel
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  6. Ralf Kirschner
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  7. Eckhardt Schneider
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  8. Tony Bruns
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  9. Andreas Stallmach
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  10. Niels Teich
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Contributions

TK, AB, PD, CK, and NT developed the standard of care, cared for all patients, and did the endoscopic biopsies. RK did the PCRs. ES did the immunohistochemistry. WS did the retrospective chart analysis and provided raw data for statistical analysis. This study is part of the doctorate thesis of WS. TB, AS, and NT conceived the study. TB and NT did the statistical analyses. AS conducted the doctorate thesis procedure of WS. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Niels Teich.

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The authors declare that they have no conflict of interest.

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Schenk, W., Klugmann, T., Borkenhagen, A. et al. The detection of the cytomegalovirus DNA in the colonic mucosa of patients with ulcerative colitis is associated with increased long-term risk of proctocolectomy: results from an outpatient IBD clinic. Int J Colorectal Dis 34, 393–400 (2019). https://doi.org/10.1007/s00384-018-3210-8

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  • DOI: https://doi.org/10.1007/s00384-018-3210-8

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