RESUMO
Objectives@#Gastrointestinal cytomegalovirus (CMV) disease is a major contributor to mortality in immunocompromised patients. Few studies have discussed upper gastrointestinal CMV (UGICMV) disease in immunocompetent patients. We compared the clinical outcomes of UGI-CMV between immunocompromised and immunocompetent patients. @*Methods@#This retrospective study included patients with UGI-CMV disease from five tertiary hospitals across Korea (2010– 2022). Patients’ clinical data and outcomes were recorded. @*Results@#UGI-CMV was diagnosed in 54 patients; 27 (50.0%) had esophageal, 24 (44.4%) had gastric, and 3 patients (5.6%) had duodenal involvement. Patients’ median age was 64 years (interquartile range 53–75 years), and the most common comorbidities included hypertension (57.4%) and diabetes (38.9%). The predominant symptom was abdominal pain (46.3%), and the most common endoscopic finding was ulcers (70.4%). Antiviral treatment was administered to 31 patients, and 23 patients underwent observation without treatment. We investigated 32 immunocompromised (59.3%) and 22 immunocompetent (40.7%) patients and observed no intergroup differences in comorbidities and in laboratory and endoscopic findings. Immunocompromised patients had longer length of hospitalization (median 46.2 days vs. 20.0 days, p=0.001). However, treatment outcomes, including the need for intensive care unit admission and mortality did not significantly differ. The overall mortality rate was 13.0%; one patient from the immunocompromised group died of UGI-CMV disease. The treatment success rate was higher in immunocompromised patients who received antiviral therapy (p=0.011). @*Conclusions@#UGI-CMV disease is not uncommon in immunocompetent patients, although symptoms are milder than those in immunocompromised patients. Our findings emphasize the importance of clinical vigilance for accurate diagnosis of CMV infection, particularly in susceptible symptomatic patients and highlight the need for active antiviral treatment for management of immunocompromised patients.
RESUMO
Latent tuberculosis (TB) infections (LTBI) impose clinical challenges in terms of the diagnosis and treatment of inflammatory bowel disease (IBD), especially in TB-endemic areas. While steroids and biologics have become increasingly useful in the treatment of patients with moderate-to-severe IBD, the risk of reactivation or developing TB is increased due to their potent immunosuppressive effects. Tumor necrosis factor-alpha inhibition may result in the activation of a latent TB infection, and most cases manifest as more severe forms of disseminated TB. All potential users of immunosuppressive therapy should be screened for LTBI, and appropriate measures for the management of latent and active TB should be undertaken with immediate initiation of anti-TB treatment. Biologics should be withheld during TB treatment, and the proper timing for the resumption of IBD therapy during or after TB treatment should be individualized. This review summarizes the latest knowledge on the risk assessment, detection, and management of latent and active TB infections in patients with IBD.