Cytomegalovirus in inflammatory bowel disease: A systematic review

Abstract

Aim: To identify definitions of cytomegalovirus (CMV) infection and intestinal disease, in inflammatory bowel disease (IBD), to determine the prevalence associated with these definitions.

Methods: We conducted a systematic review and interrogated PubMed, EMBASE and Cochrane for literature on prevalence and diagnostics of CMV infection and intestinal disease in IBD patients. As medical headings we used "cytomegalovirus" OR "CMV" OR "cytomegalo virus" AND "inflammatory bowel disease" OR "IBD" OR "ulcerative colitis" OR "colitis ulcerosa" OR "Crohn's disease". Both MeSH-terms and free searches were performed. We included all types of English-language (clinical) trials concerning diagnostics and prevalence of CMV in IBD.

Results: The search strategy identified 924 citations, and 52 articles were eligible for inclusion. We identified 21 different definitions for CMV infection, 8 definitions for CMV intestinal disease and 3 definitions for CMV reactivation. Prevalence numbers depend on used definition, studied population and region. The highest prevalence for CMV infection was found when using positive serum PCR as a definition, whereas for CMV intestinal disease this applies to the use of tissue PCR > 10 copies/mg tissue. Most patients with CMV infection and intestinal disease had steroid refractory disease and came from East Asia.

Conclusion: We detected multiple different definitions used for CMV infection and intestinal disease in IBD patients, which has an effect on prevalence numbers and eventually on outcome in different trials.

Keywords: Crohn’s disease; Cytomegalovirus; Inflammatory bowel disease; Systematic review; Ulcerative colitis.

Figure 1

Algorithm of inclusion. ¹Letters/comments presenting original data were included in the review.

Figure 2

Prevalence cytomegalovirus infection by authors definition. Size of the squares corresponds with the population size in 5 categories (n = 0-25, n = 25-50, n = 50-100, n = 100-250, n > 250). Median depicted as dotted line.

Figure 3

Prevalence cytomegalovirus intestinal disease by authors definition. Size of the squares corresponds with the population size in 5 categories (n = 0-25, n = 25-50, n = 50-100, n = 100-250, n > 250). Median depicted as dotted line.

Figure 4

Prevalence cytomegalovirus infection in different global regions by authors definition. Size of the squares corresponds with the population size in 5 categories (n = 0-25, n = 25-50, n = 50-100, n = 100-250, n > 250). Median depicted as dotted line.

Figure 5

Prevalence cytomegalovirus infection in different sub populations, by authors definition. Size of the squares corresponds with the population size in 5 categories (n = 0-25, n = 25-50, n = 50-100, n = 100-250, n > 250). Median depicted as dotted line.

Figure 6

Cytomegalovirus seroprevalence data in different regions of the world. Size of the squares corresponds with the population size in 5 categories (n = 0-25, n = 25-50, n = 50-100, n = 100-250, n > 250). Median depicted as dotted line.