Brief Article
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World J Gastroenterol. Jan 14, 2014; 20(2): 509-517
Published online Jan 14, 2014. doi: 10.3748/wjg.v20.i2.509
Long-term follow-up of ulcerative colitis patients treated on the basis of their cytomegalovirus antigen status
Toshihiro Inokuchi, Jun Kato, Sakiko Hiraoka, Hideyuki Suzuki, Asuka Nakarai, Tomoko Hirakawa, Mitsuhiro Akita, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto
Toshihiro Inokuchi, Sakiko Hiraoka, Hideyuki Suzuki, Asuka Nakarai, Tomoko Hirakawa, Mitsuhiro Akita, Sakuma Takahashi, Keita Harada, Hiroyuki Okada, Kazuhide Yamamoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
Jun Kato, Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
Author contributions: Inokuchi T performed the research; Nakarai A, Hirakawa T, Akita M, Takahashi S and Harada K collected the data; Suzuki H, Kato J and Hiraoka S designed the research study; Inokuchi T wrote the paper; Okada H and Yamamoto K contributed to the design of the study.
Correspondence to: Toshihiro Inokuchi, MD, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan. toshpi@yahoo.co.jp
Telephone: +81-86-2357219 Fax: +81-86-2255991
Received: August 5, 2013
Revised: September 29, 2013
Accepted: October 19, 2013
Published online: January 14, 2014
Processing time: 168 Days and 6.3 Hours
Abstract

AIM: To clarify the impact of cytomegalovirus (CMV) activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis (UC) patients.

METHODS: UC patients with flare-up were divided into CMV-positive and -negative groups according to the CMV antigenemia assay. The main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ganciclovir.

RESULTS: The median number of days to initial remission was significantly greater for the patients in the CMV-positive group (21 d vs 16 d, P = 0.009). However, the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two groups. Multivariate analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive group.

CONCLUSION: CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy.

Keywords: Ulcerative colitis; Cytomegalovirus; Cytomegalovirus antigenemia assay

Core tip: Cytomegalovirus (CMV) reactivation has a deleterious effect in patients with ulcerative colitis (UC). Although antiviral therapy for CMV antigen-positive UC patients may be effective in the short-term, the long-term prognosis of UC patients with CMV treated by antiviral agents remains unknown. Our study revealed that positive CMV antigen status is likely to prolong time to remission in the treatment of flare-up of UC; however, long-term prognosis, including colectomy rate, was not affected by CMV antigen status treated with antiviral agents. Ganciclovir use is an independent factor for avoidance of colectomy in CMV antigen-positive UC patients.