Cytomegalovirus Infection: An Underrated Target in Inflammatory Bowel Disease Treatment

Abstract

CMV infection is still a matter of concern in IBD patients, especially regarding the disease's relapse management. Why IBD patients, particularly those affected by ulcerative colitis, are more susceptible to CMV reactivation is not totally explained, although a weakened immune system could be the reason. Various techniques, ranging from serology to histology, can be employed to detect intestinal CMV infection; however, there is currently disagreement in the literature regarding the most effective diagnostic test. Furthermore, CMV involvement in steroid resistance has been broadly discussed, but whether CMV infection is a cause or consequence of the disease severity and, consequently, steroid refractoriness is still debated. Its potential contribution to the lack of response to advanced therapy and small molecules must be more valued and wholly explored. In this review, we look at the actual literature on CMV in IBD patients, and we suggest a pragmatic algorithm for clinical practice management of CMV infection.

Keywords: CMV; Crohn’s; IBD; infections; ulcerative colitis.

Figure 1

Algorithm for the diagnosis of CMV infection and selection of patients to treat for clinical practice. UC, ulcerative colitis; H&E, hematoxylin and eosin; IHC, immune histochemistry; PCR, polymerase chain reaction; RSS, rectosigmoidoscopy.