The Prevalence and Efficacy of Ganciclovir on Steroid-refractory Ulcerative Colitis With Cytomegalovirus Infection A Prospective Multicenter Study

Title
The Prevalence and Efficacy of Ganciclovir on Steroid-refractory Ulcerative Colitis With Cytomegalovirus Infection A Prospective Multicenter Study
Author(s)
장병익김유선[김유선]김영호[김영호]김주성[김주성]천재희[천재희]예병덕[예병덕]정성애[정성애]박영숙[박영숙]최창환[최창환]한동수[한동수]양석현[양석현]김원호[김원호]
Keywords
INFLAMMATORY-BOWEL-DISEASE; TRANSPLANT RECIPIENTS; CMV
Issue Date
201201
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
JOURNAL OF CLINICAL GASTROENTEROLOGY, v.46, no.1, pp.51 - 56
Abstract
Background: It remains controversial whether or not cytomegalovirus infection in patients with active ulcerative colitis reflects a nonpathogenic colonization or a pathogenic disease warranting antiviral therapy. Goals: The aim of this study was to determine the prevalence of cytomegalovirus infection in patients with active ulcerative colitis and the therapeutic efficacy of ganciclovir against cytomegalovirus infection in patients with steroid-refractory ulcerative colitis. Study: A prospective, multicenter study was conducted in 72 patients with moderate-to-severe ulcerative colitis who were treated with intravenous steroids. The presence of cytomegalovirus was evaluated serologically and histopathologic examination, including immunohistochemical staining. In patients with steroid-refractory ulcerative colitis, cytomegalovirus infections were treated with intravenous ganciclovir. In patients with steroid-responsive ulcerative colitis, steroid therapy was continued irrespective of cytomegalovirus infection. Results: The evidence of cytomegalovirus infection was found in 31 patients (43%) with moderate-to-severe active ulcerative colitis. In patients with steroid-refractory ulcerative colitis, the cytomegalovirus infection rate increased to 67% (14 of 21). No significant clinical and endoscopic differences existed between patients with and without a cytomegalovirus infection; however, the amount of steroids used during the flare-up period was significantly higher in patients with a cytomegalovirus infection (P=0.013). Eleven of 14 patients (79%) with steroid-refractory ulcerative colitis and a cytomegalovirus infection improved with ganciclovir treatment. Cytomegalovirus infections in the steroid-responsive group (17 of 31) did not require ganciclovir therapy. Conclusions: Cytomegalovirus infections are frequently observed in patients with moderate-to-severe ulcerative colitis, especially steroid-refractory ulcerative colitis. Ganciclovir was effective in patients with steroid-refractory ulcerative colitis who had a cytomegalovirus infection.
URI
http://hdl.handle.net/YU.REPOSITORY/30036http://dx.doi.org/10.1097/MCG.0b013e3182160c9c
ISSN
0192-0790
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의과대학 > 내과학교실 > Articles
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