Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 25, 2016; 8(6): 301-309
Published online Mar 25, 2016. doi: 10.4253/wjge.v8.i6.301
Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis
Yutaka Hirayama, Takafumi Ando, Yoshiki Hirooka, Osamu Watanabe, Ryoji Miyahara, Masanao Nakamura, Takeshi Yamamura, Hidemi Goto
Yutaka Hirayama, Takafumi Ando, Osamu Watanabe, Ryoji Miyahara, Masanao Nakamura, Hidemi Goto, Department of Gastroenterology and Hepatolgy, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Yoshiki Hirooka, Takeshi Yamamura, Department of Endoscopy, Nagoya University Hospital, Nagoya 466-8550, Japan
Author contributions: Hirayama Y contributed to planning, data collection, clinical examination, statistical analysis, and drafting the manuscript; Ando T contributed to planning, data collection, statistical analysis, clinical examination, and drafting the manuscript; Miyahara R contributed to data collection and clinical examination; Watanabe O, Nakamura M and Yamamura T contributed to planning, data collection, and clinical examination; Hirooka Y contributed to clinical examination; Goto H contributed to manuscript direction, and critical review of the manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the institutional review board of Nagoya University Graduate School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to examination, treatment, and data sharing by written consent.
Conflict-of-interest statement: No conflict of interest exists for any authors with regard to the content of this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takafumi Ando, MD, PhD, Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. takafumiando-gi@umin.ac.jp
Telephone: +81-52-7442144 Fax: +81-52-7442175
Received: June 20, 2015
Peer-review started: June 25, 2015
First decision: August 31, 2015
Revised: December 16, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: March 25, 2016
Processing time: 275 Days and 18.8 Hours
Abstract

AIM: To identify characteristic endoscopic findings and risk factors for cytomegalovirus (CMV)-associated colitis in patients with active ulcerative colitis (UC).

METHODS: A total of 149 UC patients admitted to the Department of Gastroenterology, Nagoya University Hospital, from January 2004 to December 2013 with exacerbation of UC symptoms were enrolled in this retrospective study. All medical records, including colonoscopy results, were reviewed. CMV infection was determined by the presence of CMV antigen, CMV inclusion bodies in biopsy specimens, or positive specific immunohistochemical staining for CMV. Multivariate analysis was used to identify independent risk factors for CMV colitis.

RESULTS: Multivariate analysis indicated independent associations with the extent of disease (pancolitis) and use of > 400 mg corticosteroids for the previous 4 wk. In contrast, no association was seen with sex, age at UC diagnosis, immunomodulator use, or infliximab use. Punched-out ulceration was also significantly associated with CMV infection in patients with active UC (odds ratio = 12.672, 95%CI: 4.210-38.143).

CONCLUSION: Identification of a total corticosteroid dose > 400 mg for 4 wk, extensive colitis and a specific endoscopic finding of punched-out ulcer might facilitate the more rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with active UC.

Keywords: Colonoscopy; Risk factor; Ulcerative colitis; Antigenemia; Cytomegalovirus

Core tip: It has been reported that cytomegalovirus (CMV) infection can be associated with steroid resistance and be an exacerbating factor in ulcerative colitis (UC). This paper provides important information regarding characteristic endoscopic findings and risk factors for CMV-associated colitis in patients with active UC. A total corticosteroid dose > 400 mg for 4 wk and extensive colitis are associated with an increased risk of CMV-associated colitis. In addition, punched-out ulceration appears predictive of CMV-associated colitis in active UC.