M1109 Specific Endoscopic Features of Ulcerative Colitis Complicated with Cytomegalovirus Infection

Abstract

OBJECTIVES: Cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients often exacerbates the symptoms of UC. If appropriate antiviral therapy is not given soon after infection, the patient is more likely to need a colectomy. Although there are several examinations to detect CMV infection, infection cannot be detected through analysis of symptoms alone. Because colonoscopy is generally performed in cases of flare-ups in UC patients, specific colonoscopic findings for CMV infection, if any, may facilitate the early diagnosis and treatment of CMV infection. The aim of this study is to identify specific colonoscopic findings of UC patients complicated with CMV infection. METHODS: Among UC patients who were hospitalized in Okayama University Hospital due to exacerbation of symptoms from January 1999 to August 2007, colonoscopic findings were compared between 15 CMVpositive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Endoscopic findings were evaluated by examining recorded colonoscopic images. Two aspects of colonic changes were assessed: mucosal change and ulcerative change. Mucosal change was evaluated according to the following five features: easy bleeding, loss of vascular pattern, mucosal edema, erythema, and mucinous exudates. Ulcerative change was also evaluated according to the following five features: wide mucosal defect, punched-out ulceration, longitudinal ulceration, irregular ulceration, and cobblestone-like appearance. Univariate andmultivariate analyses were applied to five aspects of mucosal change as well as to five aspects of ulcerative change. RESULTS: With the univariate analysis for mucosal change, severe easy bleeding was more frequently seen in the CMV-positive patients than in the CMV-negative patients (P = 0.011). As for ulcerative changes, all five ulcerative features were more frequently observed in CMV-positive patients than in CMV-negative patients (wide mucosal defect: P < 0.0001, punched-out ulceration: P = 0.0002, longitudinal ulceration: P = 0.0004, irregular ulceration: P = 0.0015, and cobblestone-like appearance: P = 0.016). Multivariate analysis revealed wide mucosal defect (RR; 20.85, 95%CI; 1.85-234.98) and punched-out ulceration (RR; 10.12, 95%CI; 1.4570.44) as the independent predictive colonoscopic findings of CMV infection. CONCLUSIONS: Specific colonoscopic findings of UC patients complicated with CMV infection were identified. These findings may facilitate the early diagnosis of CMV infection and reduce the rate of colectomy for UC patients.