P033 Cytomegalovirus colitis: Does concomitant inflammatory bowel disease lead to worse clinical outcomes? Descriptive study from a single-centre experience
Authors: Jana Hashash , David Binion , Afif Kraitem , Mohamad Hosni , Jabra Zarka , Ramez Kouzi , Zeina Kanafani 
Published: July 2019

BACKGROUND:
The association between cytomegalovirus (CMV) colitis and inflammatory bowel diseases (IBD) is well documented. Current studies estimate a 2% risk of CMV reactivation in the gastrointestinal tract of IBD patients. The effect of CMV colitis on clinical outcomes of IBD patients remains unclear. Our aims are to compare the clinical characteristics of CMV colitis patients with IBD compared to those without IBD and to determine if CMV colitis leads to worse clinical outcomes amongst IBD patients compared to those patients with no IBD.

METHODS:
All patients diagnosed with CMV colitis based on colonic tissue biopsies between 1/2002 and 5/2018 were included in this retrospective study. Patient demographics were obtained from patient's medical charts including age, gender, presence of concomitant IBD, other comorbid illnesses, review of medication list, namely current or recent steroid use, as well as patient symptoms that prompted the colonoscopy. Outcomes pertaining to length of hospital stay, need for colectomy, escalation of IBD medications, readmission rates, and mortality rates were obtained. Duration of anti-viral therapy was also recorded for those patients. Simple statistics (percentages and means) were reported for the descriptive data, the student's t-test was used to assess associations for continuous variables.

RESULTS:
A total of 22 patients were found to have CMV colitis based on colonic tissue diagnosis. Most of these patients (n = 14; 63.6%) were males, and the mean age of the sample was 52 ± 19 years. Only 5 (22.7%) of the 22 patients had concomitant IBD; 4 patients had ulcerative colitis while 1 patient had Crohn’s disease. Of the remaining 17 patients with CMV colitis, 10 had a history of bone marrow transplantation, 1 had acute lymphoblastic leukemia, 1 had chronic lymphocytic leukemia, 1 had common variable immunodeficiency, and 4 suffered from a chronic illness such as diabetes mellitus, Parkinson’s disease, and iatrogenic Cushing's syndrome, amongst others. Of the 22 patients, 8 (36.4%) developed CMV colitis during their hospitalization for an unrelated issue while the remaining 14 (63.6%) were admitted for the management of symptomatic CMV colitis. Most of the patients were receiving an immunosuppressive medication including an immunomodulator such as azathioprine or cyclosporine (n = 9; 40.9%), or corticosteroid therapy (n = 9; 40.9%). Most of the patients had been receiving valacyclovir prior to admission (66.7%). The average length of hospital stay for CMV colitis patients was 35 ± 23 days. Comparing IBD to non-IBD patients, IBD patients tend to have a shorter hospital stay (17 ± 8.5 vs 39.5 ± 23.9; P = 0.077). When comparing the 2 groups, those with IBD were more likely to be on 5-ASA or immunomodulators.

CONCLUSION(S):
CMV reactivation in the gastrointestinal tract is a common condition in IBD patients due to their immunosuppressed status. From this series, it was found that non-IBD patients who developed CMV colitis were also immunosuppressed due to a different co-morbid condition strengthening the available data that associates concomitant CMV of the gastrointestinal tract with immunosuppression.