P137 Lesions of Cytomegalovirus and Epstein Barr virus of the proximal gastrointestinal tract in patients with Inflammatory Bowel Disease after COVID-19

Abstract

BackgroundThe problem of opportunistic infections in IBD remains one of the most pressing issues in the diagnosis and treatment of this pathology. Particular attention among opportunistic infections in IBD is given to cytomegalovirus infection(CMV), the Epstein-Barr virus(EBV). Aim: To assess the frequency of detection of CMV and EBV in biopsies taken from the mucous membranes of the proximal gastrointestinal tract (GIT) in patients with IBD who underwent COVID-19.Methods72 patients with CD(40 w/32 m) and 69 patients with UC(39 m/30 w) who underwent COVID-19, in whom CMV and EBV were not previously detected, were examined. The age of the patients was from 18 to 62 years(39.4±2.7). All patients(p.) underwent a standard endoscopic examination(EE), disease activity was assessed in accordance with the ECCO regulations; the determination of CMV and EBV was carried out by PCR in biopsies of mucous membranes from the proximal GIT.ResultsEE in 27 p.with CD revealed deeper and more widespread ulcerative lesions of the gastric mucosa(CMV+11 p.40.7%/15.3%;EBV+12 p.44.4%/16.7 %;CMV and EBV+4 p.14.8%/5.5%), in 16 p.similar changes were detected in the esophagus(CMV+7 p.43.7%/9.7%,EBV+6 p.37.5%/8.3%;CMV and EBV+3 p.18.7%/4.2%),in 49 p.in the duodenal region(CMV+17 p.34.7%/23.6 %,EBV+23 p.46.9%/31.9%;CMV and EBV+9 p.18.4%/12.5%).EE with UC revealed deeper and more widespread ulcerative lesions of the gastric mucosa in 29 p. (CMV+12 p.41.4%/17.4%;EBV+13 p.44.8%/18.8%; CMV and EBV+4 p.3.8%/5.8%),in 19 p. similar changes were detected in the esophagus(CMV+9 p.47.7%/13.1%,EBV+6 p.31.6%/8.7%;CMV and EBV+4 p.21.1%/5.8%),in 44 p. in the duodenal region(CMV+17 p.38.6%/24.6%,EBV+23 p. 52.3%/33.3%;CMV and EBV+4 p.9.1%/5.8%).Thus, in patients with CD, when determining CMV in biopsy materials by PCR,an isolated positive result(48.6%) was obtained in 35 cases,for EBV(isolated)-41 cases(56.9%), in 16 pat. a combined lesion of CMV and EBV was revealed(22.2%); the localization of lesions was dominated by the duodenal region(68.1%),the stomach (37.5%)and the esophagus(22.2%). In patients with UC, when determining CMV in biopsy materials by PCR,an isolated positive result(55.1%) was obtained in 38 cases,for EBV(isolated)-42 cases(60.7%),in 12 pat. a combined damage to CMV and EBV(17.4%); the localization of lesions was dominated by the duodenal region(63.8%),the stomach(42%) and the esophagus(27.5%).The clinical and endoscopic picture indicates a more severe course of IBD in the presence of herpes viruses detected by PCR examination of biopsies taken from the mucous membranes of the proximal GIT.ConclusionThe findings allow us to recommend the need for more thorough inspection during endoscopy in patients with IBD who have undergone COVID-19.