Exacerbation Of Ulcerative Colitis Research Articles

Causal Association Analysis of Periodontitis and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization Study.

Periodontitis has been reported to be associated with inflammatory bowel disease (IBD), including ulcerative colitis (UC), and Crohn's disease (CD). However, the causality of these 2 diseases remains unclear. We conducted bidirectional Mendelian randomization (MR) to investigate the causal relationship between periodontitis and IBD. We obtained the genome-wide association study (GWAS) summary data of European populations from FinnGen database (for IBD) and a published article (for periodontitis), from which independent single nucleotide polymorphisms were selected as instrumental variables. Inverse variance-weighted (IVW), MR-Egger, and weighted median (WM) methods were utilized for MR analysis. Heterogeneity or pleiotropy was detected through Cochran's Q test and MR-Egger intercept, respectively. Outlier was identified with MR-PRESSO (Mendelian Randomization Pleiotropy RESidual Sum and Outlier) and leave-one-out analysis. All statistical analyses were performed with R 4.2.1 and the packages of TwoSampleMR version 0.5.6. Genetic prediction showed that periodontitis was the risk factor of UC (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = .027), rather than of CD (OR, 0.92; 95% CI, 0.74-1.15; P = .456) and IBD (OR, 0.96; 95% CI, 0.81-1.13; P = .619). To the contrary, CD, not UC or IBD, resulted in exacerbating periodontitis in terms of the results of the IVW (OR, 1.09; 95% CI, 1.01-1.17; P = .021) and WM (OR, 1.10; 95% CI, 1.01-1.20; P = .030) methods. Heterogeneity or pleiotropy was acceptable. Our results indicated that CD was the risk factor for periodontitis; conversely, periodontitis was responsible for the exacerbation of UC, enhancing the existence of mouth-gut axis. Patients with UC should pay more attention to periodontal health, while patients with periodontitis should actively pay close heed to intestinal health.

P972 Short and long-term outcomes after acute severe ulcerative colitis in children: A Canadian single centre experience

Abstract Background The short and long-term course of ulcerative colitis (UC) following an episode of acute severe UC (ASUC) in children is insufficiently characterized. We aimed to assess contemporary outcomes in children hospitalized with ASUC. Methods This was a retrospective cohort study of children aged 2-17 years hospitalized with ASUC between 2010 and 2022 at a tertiary center in London, Ontario, Canada. All data were recorded using standardised Case Report Forms, de-identified, and entered into a central database registry using Research Electronic Data Capture (REDCap) Steroid non-response was defined as requirement of medical rescue therapy or colectomy. Results A total of 58 children hospitalized with ASUC were included (male: 55.2% [n =32], mean age at admission: 12.2 ± 3.5 years). The majority had extensive colitis (82.4% [n = 42]) at the time of diagnosis. 74% (n = 43) presented within one year of symptom onset and 31% (n = 18) had ASUC as their index presentation with UC. 15.5% (n = 9) of patients had prior purine analogues and 20.7% (n = 12) had received biologics prior to ASUC presentation. Median Pediatric Ulcerative Colitis Activity Index (PUCAI) score on admission was 65.0 (IQR: 60.0 – 75.0). After intravenous corticosteroid therapy 68.9% (n = 40) responded to steroids. Of the patients with steroid non-response (31% [n = 18]), 3.4% (2/58) underwent colectomy and 27.6% (16/58) patients received infliximab rescue therapy. Median PUCAI score was significantly lower on day 3 between steroid responders and steroid non-responders (37.5 vs 60, p <0.01). The short term (3 months following discharge) and long-term (3-12 months following discharge) colectomy rates following discharge were 7.4% (4/54) and 8% (4/50) respectively. Short term and long-term hospitalization rates for UC exacerbation following discharge was 25.9% (14/54) and 16% (8/50) respectively. Similar rates of long-term colectomy and hospitalizations were observed between steroid responders and non-responders. On univariate analysis, no statistically significant factors associated with steroid non-response were identified. Conclusion 17% of patients hospitalized for ASUC required colectomy within 12 months of presentation. Despite a high initial response to corticosteroids, long term colectomy rates and re-hospitalization rates are still high. Future research should focus on earlier identification and treatment of children at high risk of exacerbation to prevent complications.

Эффективность трансабдоминальной ультразвуковой диагностики состояния толстой кишки для оценки эндоскопической активности язвенного колита у детей

Transabdominal ultrasound examination of the colon is an informative research method that does not require special training, which is vital in pediatric practice. The purpose of the study was to compare the informativeness of transabdominal ultrasound of the colon vs the colonoscopy using the clinical and laboratory data of pediatric patients with ulcerative colitis (UC). Materials and methods used: a single-center retrospective cohort study was conducted at the Gastroenterology Department of the National Medical Research Center for Children’s Health (Moscow, Russia) in 2021-2023, which included 119 children 7 to 17 years and 11 months old with an established UC diagnosis. All children have undergone clinical and laboratory tests, ultrasound and ileocolonoscopy. The UCEIS scale and the PMI index of clinical activity were used to assess the endoscopic activity. The study of fecal calprotectin was carried out with immunochromatographic method. During transabdominal ultrasound, the thickness of the intestinal wall and blood flow were assessed using the Color Doppler imaging mode. Results: statistically significant increase in the thickness of the intestinal wall against the background of the growth of UCEIS (Rs=0.654; p<0.001), PUCAI (Rs=0.642; p<0.001) and the level of fecal calprotectin (Rs=0.463; p<0.001) was detected. Statistically significant differences in increased blood flow in the intestinal wall of the sigmoid colon were found with the UCEIS, PUCAI index (p<0.001, for both indices) and the level of fecal calprotectin (p=0.014). The area under the ROC curve corresponding to the relationship between the prognosis of the development of ulcerative colitis and the thickness of the sigmoid colon was 0.850±0.054 with 95% CI: 0.745-0.955. The resulting model was statistically significant (p<0.001). The threshold value of the sigmoid colon thickness was 2.05 mm, in case of an increase in this value, a high risk of exacerbation of ulcerative colitis was predicted. The sensitivity and specificity of the method were 84.3% and 72.7%, respectively. When comparing the PUCAI index, the UCEIS index and the level of fecal calprotectin based on the blood flow in the sigmoid colon wall, the statistically significant differences were found (p<0.001, for both indices, and p=0.014 for fecal calprotectin, respectively). Conclusion: transabdominal ultrasound diagnostics showed good correlation with colonoscopy, clinical activity of the disease and the level of fecal calprotectin, as a result of which ultrasound of the colon should be considered as a useful imaging method for assessing inflammatory activity in the colon and follow-up of patients with UC.

Gut microbiota-derived 12-ketolithocholic acid suppresses the IL-17A secretion from colonic group 3 innate lymphoid cells to prevent the acute exacerbation of ulcerative colitis

ABSTRACT Intestinal microbiota dysbiosis and metabolic disruption are well-known as the primary triggers of ulcerative colitis (UC). However, their role in regulating the group 3 innate lymphoid cells (ILC3s), which are essential for intestinal health, remains unexplored during the development of disease severity. Here, our results showed that the microbiota structure of patients with severe UC (SUCs) differed from those with mild UC (MiUCs), moderate UC (MoUCs), and healthy controls (HCs). Microbes producing secondary bile acids (SBAs) and SBAs decreased with the aggravation of UC, and a strong positive correlation existed between them. Next, fecal microbiota transfer was used to reproduce the human-derived microbiota in mice and decipher the microbiota-mediated inflammatory modulation during an increase in disease severity. Mice receiving SUC-derived microbiota exhibited enhancive inflammation, a lowered percentage of ILC3s, and the down-regulated expressions of bile acid receptors, including vitamin D receptor (VDR) and pregnane X receptor (PXR), in the colon. Similar to clinical results, SBA-producing microbes, deoxycholic acids (DCA), and 12-ketolithocholic acids (12-KLCA) were diminished in the intestine of these recipients. Finally, we compared the therapeutic potential of DCA and 12-KLCA in preventing colitis and the regulatory mechanisms mediated by ILC3s. 12-KLCA but not DCA represented a strong anti-inflammatory effect associated with the higher expression of VDR and the lower secretion of IL-17A from colonic ILC3s. Collectively, these findings provide new signatures for monitoring the acute deterioration of UC by targeting gut microbiota and bile acid metabolism and demonstrate the therapeutic and preventive potential of a novel microbiota-derived metabolite, 12-KLCA.

S3226 Multiple Myeloma in a Patient With a Severe Ulcerative Colitis Exacerbation on Ustekinumab

S3226 Multiple Myeloma in a Patient With a Severe Ulcerative Colitis Exacerbation on Ustekinumab

Cytomegalovirus (CMV) as a cause of exacerbation of ulcerative colitis (UC). An approach to diagnosis and management

Cytomegalovirus (CMV) reactivation may be a cause of acute exacerbations in patients with severe ulcerative colitis (UC). Patients with exacerbation of symptoms by CMV have greater morbidity and mortality rate.The present study was conducted to evaluate the prevalence of CMV infection in UC patients by endoscopic examination, histopathological examination and CMV DNA PCR of colonic mucosal biopsy tissue and also to identify the associated risk factors and clinical outcomes.

Hypercoagulation in patient with ulcerative colitis associated with antiphospholipid syndrome and latent inherited thrombophilia after COVID-19: a clinical case

Patients with ulcerative colitis exacerbation associated with COVID-19 infection represent a particular group who require additional attention and follow-up due to an increased risk of thrombosis. The article presents a clinical case of a patient born in 1971 with ulcerative colitis in association with antiphospholipid syndrome. Additionally the patient had a latent inherited thrombophilia, which activation was probably caused by exacerbation of ulcerative colitis. Nevertheless, there may have been additional triggering activity of a COVID-19 infection that the patient suffered before the exacerbation of ulcerative colitis. The patient usually had a fever in the morning during an exacerbation of ulcerative colitis. During current hospitalization, fever was also presented. To clarify the cause of the fever patient’s examination was performed. Infectious and inflammatory processes, neoplasms, connective tissue diseases were excluded. However, genetic testing revealed the presence of an increased risk of thrombosis in the patient (ITGA2 C/T, ITGB3 T/C were presented). At the same time, thrombotic masses in the portal vein, subtotal thrombosis of the right hepatic branch of the portal vein, thrombosis of the upper mesenteric vein up to 30%, lower mesenteric vein up to 70% were detected during ultrasound and computer tomography (CT) examination of the abdominal cavity. It should be noted that the management of patients with exacerbation of ulcerative colitis, especially with association with COVID-19 infection, requires an individual approach considering the risk assessment of thrombotic complications. Comprehensive examination is highly recommended, including genetic testing of patients in the clinical management of such patients.

Tekrarlayan kanlı diyare ile başvuran yetişkin erkek COVID-19 hasta olgusu

Ulcerative colitis is an inflammatory bowel disease presenting with symptoms such as abdominal pain, bloody diarrhea and weight loss. Following courses like COVID-19 infection, respiratory diseases, surgical operations, etc., the duration and severity of symptoms may increase. Although the exact relationship between exacerbation of ulcerative colitis and COVID-19 is not fully understood, and there is scarce literature demonstrating that factors such as local immune deregulation, psychological stress, and the initiation of autoimmunity may play a role. In this case report, we aimed to present a patient with ulcerative colitis complaining of recurrent bloody diarrhea, tenesmus, and abdominal pain after COVID-19 infection.

Cytomegalovirus reactivation in ulcerative colitis patients: Early indicators.

The association of. ytomegalovirus (CMV) infection with ulcerative colitis (UC) still remains a controversial topic for the clinicians. Aim: In this study, we aimed to elucidate the CMV infection related parameters in the exacerbation of UC. In this study, 812 UC patients who have admitted to our institution between June 2008 and November 2020 were analyzed retrospectively. CMV infection was diagnosed by the detection of CMV DNA with polymerase chain reaction (PCR) in tissue biopsies with presence of clinical colitis symptoms. CMV negative UC patient group was defined as UC activation group with negative PCR results. A total of 153 patients met the inclusion criteria during the study period, with a median age of 41.8 years. CMV PCR positivity had been detected in tissue biopsy in 43 (28.1%) UC patients. CMV-positive patients had a statistically significant higher frequency of steroid resistance, treatment with azathioprine, longer disease duration, longer remission, and hospitalization day. The mean C-reactive protein (CRP) level, platelet to lymphocyte ratio (PLR) were higher, and mean albumin level was lower in CMV positive patients, with statistically significance. Also, colectomy and anti-tumor necrosis factor-α (TNF-α) therapy were more frequent in CMV-reactivated group in long-term follow-up. In a multivariable model, steroid resistance, treatment with azathioprine, long disease duration, low albumin value was independently associated with colonic CMV infection. Steroid resistance, treatment with azathioprine, long disease duration, low albumin levels were significant risk factors for CMV colitis, among patients with UC activation.

Ulcerative colitis successfully treated with vedolizumab in the presence of comorbid opportunistic infections: a case report

BackgroundOpportunistic infections associated with immunosuppressive treatments for inflammatory bowel disease pose an important safety concern. Here we report the case of a patient with active ulcerative colitis and cryptococcal pneumonia who was treated with vedolizumab combined with fluconazole.Case presentationA 56-year-old Japanese man with ulcerative colitis and a history of Sweet’s syndrome who was taking prednisolone and azathioprine presented with a moderate exacerbation of ulcerative colitis, abdominal pain, diarrhea, and bloody stools along with cytomegalovirus infection. Increasing the prednisolone dose without using antiviral drugs improved cytomegalovirus infection; however, ulcerative colitis did not improve, and cryptococcal pneumonia occurred. Thus, treatment with fluconazole followed by vedolizumab was initiated for ulcerative colitis. The patient gradually recovered and achieved clinical remission without the exacerbation of pneumonia.ConclusionsWe reported the first case of a patient with ulcerative colitis who was treated with vedolizumab and concomitant fluconazole for active cryptococcal pneumonia. Vedolizumab constitutes a high-potential treatment regimen owing to its safety in inflammatory bowel disease associated with opportunistic infections.

Acute arterial thrombosis in anticoagulated patient for acute pulmonary thromboembolism

Acute limb ischemia is rare in patients with venous thromboembolism who already receive anticoagulation treatment. Inflammation is a risk factor for thrombus formation. Patients with active ulcerative colitis, especially at the time of exacerbation, are more prone to thromboembolism, both venous and arterial. The risk for thrombosis is 18% higher, with a higher risk of bleeding. To date, there is no contraindication to any anticoagulant drug in patients with ulcerative colitis. We represent a case of a 73 year - old woman with ulcerative colitis exacerbation, hospitalized initially for pulmonary thromboembolism, that developed acute arterial thrombosis when switched on a novel oral anticoagulant.

Successful pregnancy of a patient with primary sclerosing cholangitis awaiting liver transplantation

In women, primary sclerotising cholangitis (PSC) associated with ulcerative colitis and intrahepatic cholestasis is a rare disease. To date, there are no data from Hungary on the fertility and pregnancy outcome of women with this chronic liver disease. Our aim is to present the favorable pregnancy outcome of a woman with PSC associated with ulcerative colitis, intrahepatic cholestasis and postpartum colectomy, and review of the literature. A young nulligravida was first diagnosed with ulcerative colitis. Five years later, PSC developed with progressive fibrosis and cholestasis necessitating liver transplantation. While on waiting list, spontaneous conception occurred. Except for pregnancy-induced hypertension, pregnancy uneventfully progressed until the third trimester when 8 g oral cholestyramine/day was administered to lower high maternal (over 100 μmol/L) total bile acid (TBA) level. In the 36th week of gestation acute exacerbation of ulcerative colitis resulted in maternal fever and chorioamnionitis leading to fetal distress. Elective delivery of the eutrophic neonate followed by emergency cesarean section. In the early puerperium, colitis progressed to septic pancolitis resistant to medical treatment. 12 days after laparoscopic subtotal colectomy, the patient was discharged in good health condition. 3 months later, ileostomy was closed and she got back on the transplantation waiting list. Our data correspond with previous reports and suggest that women with PSC with underlying ulcerative colitis and cholestasis have a good chance for favorable pregnancy outcome. However, both PSC and underlying colitis might progress during pregnancy and puerperium. Oral cholestyramin is an effective and safe treatment for high maternal TBA levels. Orv Hetil. 2023; 164(6): 234-240.

How to assess and manage ulcerative colitis exacerbations in the emergency department.

How to assess and manage ulcerative colitis exacerbations in the emergency department.

P339 Zonulin concentration in patients with ulcerative colitis with and without COVID-19 infection

Abstract Background Zonulin is a protein, reversibly increasing the permeability of the intestinal wall by changing the structure of tight junctions of the lateral surfaces of intestinal epithelial cells. Fecal zonulin is used for noninvasive assessment of increased intestinal permeability. Normal values of zonulin in stool (≤ 110 ng/ml) indicate the absence of damage of the intestinal villous mucosal surface and normal density of intercellular contacts. The aim of the study was to determine the level of fecal zonulin (FZ) in the feces of ulcerative colitis (UC) patients with exacerbation of the disease and the presence of COVID-19 in the acute period and without COVID-19 to assess the degree of intestinal permeability. Methods 46 patients with IBD without COVID-19 (Me age — 36 years) and 31 patients with UC with the presence of COVID-19 infection in the acute period (Me age — 42 years) were examined. Untreated stool samples of patients were frozen and stored at a temperature of 80 °C. FZ was measured by ELISA (IDK ® Zonulin ELISA Kit, Immunodiagnostik AG, Germany) in ng/ml. Reference values: < 83.15 ng/ml - a variant of the norm, 83.15-110 ng/ml - an elevated level, 110 ng/ml - a high level Results In the stool samples of patients with UC exacerbation without COVID-19 FZ was detected from 172.6 to 460.8 ng/ml (Me - 316), the average value was 322.4±14.6 ng/ml. In the stool samples of patients with UC exacerbation and COVID-19 infection, FZ was detected from 354.8 to 628.3 ng/ml (Me – 489.9), the average value was 472.9±18.4 ng/ml (p=0.000001). Conclusion FZ concentration in the feces of UC patients is significantly higher in UC patients with the presence of COVID-19 infection in the acute period, which indicates a higher permeability of the intestinal wall.

P368 The presence of extra-intestinal manifestations is associated with poor prognosis in acute severe ulcerative colitis: A KASID multicenter study

Abstract Background Many patients with inflammatory bowel disease experience extra-intestinal manifestations (EIM)s. The presence of EIMs is related to disease activity. Acute severe ulcerative colitis (ASUC) is associated with a high inflammatory burden. However, there are insufficient studies on the relation between the presence of EIMs and the prognosis of exacerbation of ulcerative colitis. This study was conducted to elucidate the correlation between EIMs and ASUC. Methods We retrospectively included patients who were hospitalized at four tertiary medical centers for ASUC management between January 2015 to December 2020, and data on the underlying disease, disease activity, EIMs, colectomy, treatment method, and readmission due to ulcerative colitis aggravation were checked. Results A total of 145 patients (mean age 44.4 years, 68 women) were investigated. The initial partial Mayo score, the Mayo endoscopy sub-score, and the ulcerative colitis endoscopic severity index were 7.6±0.8%, 2.7±0.5, and 6.0±1.4%, respectively. EIMs were expressed in a total of 10.3% (15/145) of patients. The most common type of EIMs was the peripheral articular type (46.7%) followed by skin lesions (20%) and axial articular disease (13.3%). The group with EIMs was younger and had a higher proportion of women than the group without EIMs (39.4 versus 45 years, p=0.03), and had a longer duration of disease (5.8 versus 3.5 years, p=0.02). The Mayo endoscopic sub-score (2.9 vs. 2.7, p<0.01) and partial endoscopic score (7.9 vs. 7.6, p<0.01) were also higher in the EIMs group. The length of hospital stay was also longer in the EIMs group (25.5 days vs. 13.8 days, p<0.01). The response rate to initial treatment was lower in the EIMs group (71.4% vs. 95.5%, p<0.01), and more rescue therapy (28.6% vs. 4.5%, p<0.01) was performed. The rate of colectomy on admission was also higher in the group with EIMs (13.3% vs. 0.8%, p<0.01). Patients with EIMs showed a high tendency to visit the hospital for re-exacerbation of ulcerative colitis after discharge (p=0.07, HR 2.10 CI: 0.93 – 4.76). Conclusion EIMs were expressed in a total of 10.3% of patients with ASUC. The presence of EIMs suggested a poor prognosis in ASUC.

PS-R03-1: A CASE REPORT OF NEUROFIBROMATOSIS TYPE 1 (VON RECKLINGHAUSEN'S DISEASE) WITH HYPERTENSION, ASSOCIATED WITH PHEOCHROMOCYTOMA

The patient is a 75-year-old man, who had multiple neurofibromas on the skin since the age 30 and was clinically diagnosed as neurofibromatosis type 1 (von Recklinghausen's disease) at the age 57, although there was no apparent family history. At the age 70, the patient had excerbated hypertension (home blood pressure 160/90 mmHg) and received amlodipine 5 mg/day. At the age 73, a 35 mm left adrenal tumor was incidentally noted on CT performed with an exacerbation of ulcerative colitis. He was diagnosed with left adrenal pheochromocytoma, due to high levels of urinary metanephrine and normetanephrine shown by urinalysis and an accumulation of 123I on the tumor site shown by 123I-MIBG scintigraphy. After adequate alpha blocking, left adrenal resection was performed. Pathology showed that PASS was 2 points, and MIB1 was 2–3%. Recently, two years after the operation, metanephrine and normetanephrine level has not been increased and keeps in normal range. Hypertension has been improved: Office blood pressure is about 130/70 mm Hg, and home blood pressure 120/70 mmHg, taking doxazosin 2 mg /day only, without amlodipine. Neurofibromatosis type 1 is an autosomal dominant genetic disorder caused by NF1 gene abnormality, characterized by cafe Ole spots and multiple neurofibromas. Pheochromocytomas have been clinically identified in 0.1 to 5.7% of patients with von Recklinghausen's disease (J Urol 1999; 162: 1582). When hypertension is observed in patients with neurofibromatosis type 1 (Recklinghausen's disease), it is important to screen for pheochromocytoma.

The long-term effect of biologics in patients with ulcerative colitis emerging from a large Japanese cohort

To gain a better understanding of the effects of biologics, we evaluated clinical outcomes in patients with moderate to severe exacerbations of ulcerative colitis (UC). This retrospective, multicenter study retrieved the entire clinical courses of UC patients who began treatments between 2004 and 2018. All exacerbations and clinical parameters, including treatment details for exacerbations and both remission and re-exacerbation dates, were identified during the observation period. Two different endpoints, the cumulative incidence rates of surgical resection and re-exacerbation, were evaluated separately in moderate to severe exacerbation events. Among 1401 patients, 1626 exacerbation events were determined according to a partial Mayo score (remission: < 2, mild: 2–4, moderate: 5–7, and severe: > 7). During the observation period, as administration rates of biologics increased, both surgical resection and hospitalization rates decreased, for 959 moderate to severe exacerbation events. We confirmed that biologics significantly reduced the cumulative re-exacerbation rate in moderate to severe exacerbation events during the study period compared with suboptimal therapies (a 0.507-fold decreased risk according to COX regression analysis, P < 0.001). However, they had not enough impact in reducing the cumulative incidence rate of surgical resection in moderate to severe exacerbation events that were corticosteroid-refractory or dependent (a 0.878-fold decreased risk according to COX regression analysis, P = 0.606). Biologics may improve remission duration, but these agents had no significant impact in reducing the risk of surgical resection in moderate to severe active UC.

S2716 CMV in IBD: An Innocent Bystander, or Active Pathogen?

Introduction: Ulcerative Colitis (UC) is a gastrointestinal inflammatory disease that affects over 6 million people worldwide. Clinical manifestations of UC such as bloody diarrhea and abdominal pain can often mimic an infectious colitis, such as cytomegalovirus (CMV) colitis. Often a silent infection, CMV has a worldwide seroprevalence of 83%. We present an interesting case of a UC patient with biopsy positive CMV colitis, who symptomatically improved on steroids and mesalamine alone. Case Description/Methods: A 66 year old African American female with a history of well-controlled UC was evaluated for acute onset bloody diarrhea and abdominal pain. Following negative stool studies for infection, the patient underwent colonoscopic evaluation. Preliminary imaging and results demonstrated a left-sided UC flare extending from the rectum to the splenic flexure. The patient was started on pulse dose steroids with instructions to taper as an outpatient and experienced resolution of symptoms. Biopsy revealed CMV with subsequent serologic testing showing a CMV viral load of < 390 cpy/mL, IgM level of 45.4 AU/mL and negative IgG levels. Interestingly, the patient's acute gastrointestinal symptoms resolved with glucocorticoid treatment. Discussion: CMV reactivation is common in patients with moderate to severe UC. Symptoms of diarrhea, bloody stool, abdominal pain and complications such as megacolon, fulminant colitis and perforation often overlap in both CMV and UC. Endoscopic evaluation can provide a more definitive means of differentiating CMV colitis from an acute exacerbation of UC, however, may not be able to be quickly performed before complications arise. There has been much debate on the role of CMV in UC and whether it is an active pathogen contributing to the inflammatory state or simply a surrogate marker for disease severity. Multiple studies have demonstrated an association of CMV antigenemia with endoscopically significant severe UC. In such patients, after detection of CMV in the colon with biopsy, treatment with antiviral therapy and withdrawal of immunosuppressive agents would be expected to induce clinical response. Continuation of immunosuppressive therapies was associated with adverse events such as fulminant colitis and colectomy. (Figure) Differentiating an active CMV infection versus a UC flare can be challenging given the wide overlap of symptoms. Colonoscopic evaluation is important in supplementing a diagnosis with histopathological confirmation of CMV and can help guide treatment.Figure 1.: Inflammation characterized by friability, loss of vascularity, mucous, pseudopolyps and deep ulcerations was found in a continuous and circumferential pattern in the terminal ileum (1,2), hepatic flexure (3), transverse colon (4,5,6), descending colon (7,8), sigmoid colon (9,10,11), and rectum (12,13,14). This was graded as Mayo Score 3 (severe, with spontaneous bleeding, ulcerations).

Cytomegalovirus Infection in Patients with Inflammatory Bowel Disease

A diagnostic evaluation for cytomegalovirus (CMV) infection is required in patients with inflammatory bowel disease (IBD) who do not respond to steroid or immunomodulatory treatment. However, there is no consensus on an accurate diagnostic method for CMV infection in patients with IBD, and it is difficult to clearly distinguish the exacerbation of ulcerative colitis from CMV colitis. According to several recent studies, the most accurate test method for CMV colitis is quantitative tissue DNA-quantitative PCR, which is recommended as the first-line diagnostic technique along with an immunohistochemistry stain. The benefit of antiviral therapy for CMV infection in patients with IBD is also controversial. Although the definition of viral load is unclear, antiviral therapy can lower the rate of colectomy in CMV infections with a high viral load in patients with IBD. This review presents the latest findings about CMV infections in IBD, based on recently reported studies.

Ulcerative Colitis Exacerbation after Rituximab Treatment in Posttransplant Lymphoproliferative Disease

Ulcerative Colitis Exacerbation after Rituximab Treatment in Posttransplant Lymphoproliferative Disease