Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry.

BACKGROUND: Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments. AIMS: Our primary objective was to evaluate the effectiveness and safety of MMF in IBD. METHODS: IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented. RESULTS: A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5). CONCLUSION: Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.

Aspergilose sistêmica em um cavalo - relato de caso / Systemic aspergilosis in a horse - case report

O presente trabalho relata o caso de aspergilose sistêmica em um cavalo da raça Quarto de Milha. O animal apresentava quadro de emagrecimento progressivo e alopecia. Os parâmetros avaliados durante o exame clínico encontravam-se de acordo com os valores normais para a espécie. No hemograma verificou-se leucocitose por neutrofilia, sem desvio à esquerda, proteínas plasmáticas totais elevadas e aumento do fibrinogênio, indicando um processo inflamatório acompanhado de desidratação. Os exames bioquímicos séricos demonstraram aumento no valor da ureia. Apesar dos exames realizados e da terapia instituída com antibióticos de amplo espectro e suporte nutricional, após 51 dias de internamento o quadro clínico evoluiu para caquexia e decúbito permanente do paciente, o qual foi submetido à eutanásia seguida de necropsia. Com base nos achados nos exames necroscópico e histopatológico, diagnosticou-se infecção sistêmica por Aspergillus sp., acometendo pulmões, fígado, rins, peritônio parietal e encéfalo. Dentre os fatores predisponentes à relatada infecção fúngica sistêmica, destaca-se o status imunológico debilitado do paciente, possivelmente proporcionado por tratamentos prolongados com antibióticos e anti-inflamatórios esteroidais. O presente trabalho relata o primeiro caso descrito de arpergilose sistêmica no Brasil. O diagnóstico definitivo só foi possível após necropsia e histopatologia, visto que os sinais clínicos inespecíficos não foram determinantes para o diagnóstico em vida.(AU)

This paper reports the case of systemic aspergillosis on a Quarter Horse. The animal had progressive weight loss and alopecia. The parameters evaluated during the clinical examination were in agreement with the normal values for the species. The hemogram showed neutrophilic leukocytosis, without left-sided, elevated total plasma proteins and an increase in fibrinogen, indicating an inflammatory process accompanied by dehydration. Serum biochemical tests showed an increase in the value of urea. Despite the performed tests and established therapy with broad spectrum antibiotics and nutritional support, after 51 days of hospitalization the clinical condition evolved into cachexia and permanent decubitus of the patient which underwent to euthanasia and necropsy. From the findings of necropsy and histopathology, systemic infection was diagnosed by Aspergillus sp., affecting the lungs, liver, kidneys, parietal peritoneum and encephalon. Among the factors predisposing to the reported systemic fungal infection, the patient's weakened immune status is highlighted, possibly due to prolonged antibiotic and steroidal anti-inflammatory treatments. This paper reports the first case described of systemic aspergillosis in Brazil. Definitive diagnosis was only possible after necropsy and histopathology, since nonspecific clinical signs were not determinant for the diagnosis in life.(AU)

Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®. METHODS: Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®. RESULTS: A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05]. CONCLUSIONS: Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.

Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry.

BACKGROUND: Despite the increased use of rescue medical therapies for steroid refractory acute severe ulcerative colitis, mortality related to this entity still remains high. We aimed to assess the mortality and morbidity related to colectomy and their predictive factors in steroid refractory acute severe ulcerative colitis, and to evaluate the changes in mortality rates, complications, indications of colectomy, and the use of rescue therapy over time. METHODS: We performed a multicenter observational study of patients with steroid refractory acute severe ulcerative colitis requiring colectomy, admitted to 23 Spanish hospitals included in the ENEIDA registry (GETECCU) from 1989 to 2014. Independent predictive factors of mortality were assessed by binary logistic regression analysis. Mortality along the study was calculated using the age-standardized rate. RESULTS: During the study period, 429 patients underwent colectomy, presenting an overall mortality rate of 6.3% (range, 0-30%). The main causes of death were infections and post-operative complications. Independent predictive factors of mortality were: age ≥50 years (OR 23.34; 95% CI: 6.46-84.311; p < 0.0001), undergoing surgery in a secondary care hospital (OR 3.07; 95% CI: 1.01-9.35; p = 0.047), and in an emergency setting (OR 10.47; 95% CI: 1.26-86.55; p = 0.029). Neither the use of rescue medical treatment nor the type of surgical technique used (laparoscopy vs. open laparotomy) influenced mortality. The proportion of patients undergoing surgery in an emergency setting decreased over time (p < 0.0001), whereas the use of rescue medical therapy prior to colectomy progressively increased (p > 0.001). CONCLUSIONS: The mortality rate related to colectomy in steroid refractory acute severe ulcerative colitis varies greatly among hospitals, reinforcing the need for a continuous audit to achieve quality standards. The increasing use of rescue therapy is not associated with a worse outcome and may contribute to reducing emergency surgical interventions and improve outcomes.

Sondagem da pelve renal guiada por cistoscopia em éguas / Catheterization of the renal pelvis guided by cistoscopy in mare

O objetivo deste trabalho foi padronizar a técnica de acesso à pelve renal por meio de sondagem ureteral guiada por cistoscopia em éguas. Foram utilizados oito animais, de raças variadas, com peso médio de 439kg. As éguas foram sedadas e mantidas em tronco de contenção para a realização da cistoscopia com endoscópio flexível. Após identificação do óstio ureteral esquerdo, uma sonda de polietileno foi introduzida em seu lume, até a pelve renal. A localização da sonda no rim foi confirmada por meio de ultrassonografia transcutânea. Foram coletados 3mL de urina, de forma asséptica, para citologia e cultura bacteriana. Todas as amostras obtiveram resultados negativos na cultura e análise do sedimento urinário. Nenhum dos animais apresentou quaisquer complicações após a sondagem. Este estudo demonstrou que a coleta de urina diretamente da pelve renal em éguas, com auxílio da cistoscopia na realização da sondagem ureteral, consiste em um procedimento viável e seguro.(AU)

The objective of this study was to standardize the technique of access to the renal pelvis by means of ureteral catheterization guided by cystoscopy in mares. Eight animals of different races were used, with an average weight of 439kg. The mares were sedated and contained in containment trunk for the accomplishment of cystoscopy with flexible endoscope. After the identification of the left ureteral ostium, from where inside a catheter was introduced, which went through the entire extension of the ureter up to the renal pelvis. After identification of the left ureteral ostium, from where inside a catheter was introduced, into its lumen until reaching the renal pelvis. The location of the probe in the kidney was confirmed by transcutaneous ultrasonography. Three ml of urine was aspirated aseptically for cytology and microbiological culture. All the samples obtained negative results in the culture and sedimentation. None of the animals had any complications after catheterization. This study demonstrated that the collection of urine directly from the renal pelvis in mares, with the assistance of cystoscopy in the realization of the ureteral catheter, consists of a viable and safe procedure.(AU)

Inseminação em ovelhas por videolaparoscopia por meio de acesso único: relato de caso / Videolaparoscopic insemination in sheeps: case report

A inseminação artificial (IA) proporciona melhoramento genético, intensifica o manejo animal e possibilita a utilização de sêmen de reprodutores que se encontram em diferentes regiões do país, bem como de animais de alto valor zootécnico que já morreram ou de machos que possuem subfertilidade. Por peculiaridades anatômicas das ovelhas, a inseminação artificial intrauterina transcervical é dificultosa. Dessa forma, bons resultados na IA são alcançados quando há deposição do sêmen diretamente dentro do útero, realizada por meio de laparoscopia. Atualmente, diversas técnicas laparoscópicas são utilizadas para inseminação; os métodos rotineiramente empregados são realizados através de dois ou três portais de acesso. O presente trabalho tem o objetivo de verificar a viabilidade de uma nova técnica de inseminação videolaparoscópica intrauterina em ovelhas, com o uso de um acesso único, visando a um procedimento mais eficaz, mais rápido, com menor trauma tecidual e com menor contaminação bacteriana, a fim de minimizar o desconforto pós-operatório. A média do tempo cirúrgico foi de 5,92 minutos. Não foram encontradas dificuldades para realização dos procedimentos, e os animais recuperaram-se sem nenhuma complicação. A utilização de um único acesso mostrou-se eficaz, pois reduziu o tempo cirúrgico e não apresentou complicações.(AU)

Artificial Insemination (AI) provides genetic gain, enhances animal management and enables the use of semen from rams that are in different regions of the country, high-value livestock animals that have died or males who have subfertility. Because of anatomical peculiarities of sheep, transcervical intrauterine insemination is troublesome, thus good results in IA are achieved when there is deposition of semen directly into the uterus, performed by laparoscopy. Currently, various techniques are used for laparoscopic insemination, those routinely employed are conducted using two or three access portals. This study aims to verify the feasibility of a new laparoscopic intrauterine insemination in sheep using a single access, aiming at a more effective and faster procedure with less tissue trauma, minimizing post-operative discomfort and lower bacterial contamination. The mean operative time was 5,92 minutes, there were no difficulties in the procedures and the animals recovered without complications. The use of a single access was effective, reducing the time of the surgery and complications weren't observed.(AU)

Compressão de medula espinhal ocasionada por melanoma em cavalo de pelagem castanha / Spinal cord compression caused by melanoma in brown coat horse

This paper describes a case of malignant melanoma in brown coat horse, which had ataxia and proprioceptive deficits in hind limbs, progressing to permanent decubitus. The animal was euthanized and the final diagnosis was based on necropsy and histopathology. At necropsy different masses and / or nodules in skeletal muscle, bone, abdominal cavity, lungs, heart, spleen, liver, adrenal gland, lymph nodes, brain and cerebellum were found. Neurological clinical signs presented by the animal were justified by spinal cord compression caused by melanocytic mass invading the medullary canal of the flow segment of the thoracic spine (between 15th and 18th thoracic vertebrae). This is the first case report of melanoma leading to spinal cord compression in a non-gray horse. Thus, it is important to include this neoplasm in the differential diagnosis list of cutaneous and subcutaneous masses and / or nodules, and in suspected cases of spinal cord compression in horses of any coat.(AU)

Long-Term Efficacy and Safety of Cyclosporine in a Cohort of Steroid-Refractory Acute Severe Ulcerative Colitis Patients from the ENEIDA Registry (1989-2013): A Nationwide Multicenter Study.

OBJECTIVES: To determine the efficacy and safety of cyclosporine (CyA) in a large national registry-based population of patients with steroid-refractory (SR) acute severe ulcerative colitis (ASUC) and to establish predictors of efficacy and adverse events. METHODS: Multicenter study of SR-ASUC treated with CyA, based on data from the ENEIDA registry. SR-ASUC patients treated with infliximab (IFX) or sequential rescue therapy (CyA-IFX or IFX-CyA) were used as comparators. RESULTS: Of 740 SR-ASUC patients, 377 received CyA, 131 IFX and 63 sequential rescue therapy. The cumulative colectomy rate was higher in the CyA (24.1%) and sequential therapy (32.7%) than in the IFX group (14.5%; P=0.01) at 3 months and 5 years. There were no differences in early and late colectomy between CyA and IFX in patients treated after 2005. 62% of patients receiving CyA remained colectomy-free in the long term (median 71 months). There were no differences in mortality between CyA (2.4%), IFX (1.5%) and sequential therapy (0%; P=0.771). The proportion of patients with serious adverse events (SAEs) was lower in CyA (15.4%) than in IFX treated patients (26.5%) or sequential therapy (33.4%; P<0.001). This difference in favor of CyA was maintained when only patients treated after 2005 were analyzed. CONCLUSIONS: Treatment with CyA showed a lower rate of SAE and a similar efficacy to that of IFX thereby supporting the use of either CyA or IFX in SR-ASUC. In addition, the risk-benefit of sequential CyA-IFX for CyA non-responders is acceptable.

Vitamin E nanoemulsion activity on stored red blood cells.

BACKGROUND: Stored red blood cells (RBCs) undergo numerous changes that have been termed RBC storage lesion, which can be related to oxidative damage. Vitamin E is an important antioxidant, acting on cell lipids. Thus, this study aimed to investigate vitamin E activity on stored RBCs. METHODS: We prepared a vitamin E nanoemulsion that was added to RBC units and stored at 4 °C. Controls, without vitamin E, were kept under the same conditions. Reactive oxygen species (ROS) production was monitored for up to 35 days of storage. RBC elasticity was also evaluated using an optical tweezer system. RESULTS: Vitamin E-treated samples presented a significant decrease in ROS production. Additionally, the elastic constant for vitamin E-treated RBCs did not differ from the control. CONCLUSION: Vitamin E decreased the amount of ROS in stored RBCs. Because vitamin E acts on lipid oxidation, results suggest that protein oxidation should also be considered a key factor for erythrocyte elastic properties. Thus, further studies combining vitamin E with protein antioxidants deserve attention, aiming to better preserve overall stored RBC properties.

The use of a potential novel tool in virtual crossmatching for platelet transfusion in platelet refractoriness.

BACKGROUND AND OBJECTIVES: Transfusion support for immune-mediated platelet refractoriness (PR) is clinically challenging, technically laborious and costly. The development of 'EpHLA/EpVix software' has been used successfully to select kidney donors. Here, we sought to evaluate this new software as a tool for platelet virtual crossmatch (VxM). MATERIALS AND METHODS: This is a prospective study from 2007 to 2014 of PR patients in a tertiary hospital. Platelet components selected by HLAMatchmaker program were crossmatched by EpHLA/EpVix, anti-human globulin complement-dependent lymphocytotoxicity test (AHG-CDC), flow cytometry platelet crossmatch (FCxM) and then compared. Effectiveness of platelet components transfused was evaluated by CCI. RESULTS: Ninety-seven crossmatched platelet transfusions for 27 patients were enrolled. Partial matches were analysed for 75 transfusions by the 3 methods, and 22% showed discrepant results among the assays. After further analysis, data showed that all divergent cases could be explained by HPA alloimmunization, prozone effect (FCxM), low sensitivity of AHG-CDC and possible interference in FCxM/AHG-CDC assays. Notably, sensitivity and specificity of VxM analysis was excellent (100%). Satisfactory CCI counts were obtained for the majority (22/30) of the transfusions. CONCLUSION: The new EpHLA/EpVix method showed to be effective, feasible and fast for VxM at no cost and able to minimize labour on donor identification. However, platelet crossmatching may be a necessary step because EpHLA/EpVix does not formally exclude HPA alloimmunization.

The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials.

BACKGROUND: Inotropes and vasopressors are frequently administered to critically ill patients in order to improve haemodynamic function and restore adequate organ perfusion. However, some studies have suggested a possible association between inotrope administration and increased mortality. We therefore performed a meta-analysis of randomized trials published in the last 20 yr to investigate the effect of these drugs on mortality. METHODS: BioMedCentral, PubMed, Embase and the Cochrane Central Register were searched (all updated April 8th, 2015). Inclusion criteria were: random allocation to treatment, at least one group receiving an inotropic or vasopressor drug compared with at least one group receiving a non-inotropic/vasopressor treatment, study published after 1st January 1994, and systemic drug administration. Exclusion criteria were overlapping populations, studies published as abstract only, crossover studies, paediatric studies and lack of data on mortality. RESULTS: A total of 28 280 patients from 177 trials were included. Overall, pooled estimates showed no difference in mortality between the group receiving inotropes/vasopressors and the control group [4255/14 036 (31.7%) vs. 4277/14 244 (31.8%), risk ratio=0.98 (0.96-1.01), P for effect=0.23, P for heterogeneity=0.30, I2=6%]. A reduction in mortality was associated with inotrope/vasopressor therapy use in settings of vasoplegic syndromes, sepsis and cardiac surgery. Levosimendan was the only drug associated with improvement in survival. Subgroup analysis did not identify any groups with increased mortality associated with inotrope/vasopressor therapy. CONCLUSIONS: Our systematic review found that inotrope/vasopressor therapy is not associated with differences in mortality in the overall population and in the majority of subsettings.

Histopathological hoof laminar changes in horses with pituitary pars Intermedia adenoma: cases report / Alterações histopatológicas do tecido laminar do casco em cavalos com adenoma da pars intermedia da hipófise: relato de casos

Laminitis in horses is often associated with endocrine disorders, especially the pituitary pars intermedia dysfunction (PPID) in older animals. Morphologic exams of the laminar tissue of the hoof were performed in two horses with suspected PPID, with no clinical signs of laminitis. Changes compatible with laminitis of endocrine origin were observed, such as rounding of the nuclei of the basal cells, thinning and stretching of the secondary epidermal laminae and tissue proliferation. PPID horses with no clinical signs of laminitis may be affected by lesions of the laminar tissue of the hoof that compromise the integrity of the dermal-epidermal junction and may develop clinical symptoms of the disease. It has been suggested that the development stage of endocrine laminitis is longer, but further studies should be conducted to confirm it.

A laminite em cavalos está frequentemente associada a distúrbios endócrinos, como a disfunção da pars intermedia da pituitária (PPID) em animais mais velhos. Exames morfológicos do tecido laminar do casco foram realizados em dois cavalos com suspeita de PPID após o óbito, os quais não apresentaram sinais clínicos de laminite. Alterações compatíveis com a laminite de origem endócrina foram observadas, como arredondamento da núcleo das células basais, alongamento e afilamento das lâminas epidérmicas secundárias e proliferação tecidual. Cavalos com PPID sem sinais clínicos de laminite podem estar acometidos por lesões do tecido laminar do casco que comprometam a integridade das interdigitações dérmico-epidérmicas e podem desenvolver a sintomatologia clínica da doença. Sugere-se que o período de desenvolvimento da laminite endócrina seja mais longo, porém estudos adicionais devem ser realizados para confirmar essa hipótese.

The effect of different dietary levels of canola meal on growth performance, nutrient digestibility, and gut morphology of broiler chickens.

This study evaluated the effects of different levels of canola meal in broiler diets on growth performance, nutrient digestibility, and duodenal morphometry. A total of 320 one-day-old Cobb broilers were used in a 35-d experiment. A completely randomized design with 5 levels of canola meal (0, 10, 20, 30, and 40%) as a substitute for soybean meal was used with 8 replicates of 8 birds each. The basal diets were formulated based on corn and soybean meal to meet nutrient requirements of broiler chickens. The levels of canola meal were evaluated with a polynomial regression at 5% of significance. Weight gain and average BW showed a quadratic response (P = 0.03 and P = 0.04, respectively), decreasing with the addition of 40% canola meal. The apparent nutrient digestibility of DM (P < 0.0001), CP (P < 0.0001), and nitrogen-free extract (P < 0.0001) decreased linearly with increased levels of canola meal. A quadratic effect was observed for villus height (P = 0.003), decreasing up to a 20% inclusion of canola meal in the diet and increasing beyond that level. In conclusion, canola meal can be added up to 16.7% in diets for broilers without affecting the key variables of growth performance. It can be added up to 20% with no negative effect on the CP digestibility, but there was a linear decrease in the digestibility of DM and nitrogen-free extract with increased inclusion of canola meal. Additionally, a quadratic response to canola was observed for villus height with a maximum at 23.6% canola meal.

[Adherence and fidelity in patients treated with intragastric balloon]. / Adherencia y fidelidad en el paciente tratado con balon intragastrico.

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.

Uso de pinças ópticas para avaliação do potencial zeta de hemácias em EDTA, CPD-SAGM e estocadas / Use of optical tweezers for evaluation of szeta potential of red blood cells in EDTA, CPD-SAGM and stored in blood banks

A hemácia é carregada negativamente, principalmente devido ao ácido siálico que gera um potencial elétrico denominado Potencial Zeta que impede a aglutinação intravascular. Os testes de hemaglutinação na rotina transfusional, necessitam de substâncias potencializadoras, das quais muitas agem diminuindo o Potencial Zeta para se ter maior sensibilidade. Através da pinça óptica, ferramenta capaz de capturar células utilizando a luz, foi proposta uma metodologia para quantificar o potencial zeta e aplicar em hemácias coletadas com EDTA e estocadas em CPD-SAGM (visando avaliar alterações de cargas da membrana relacionadas a lesões de armazenamento. Os potenciais zeta em CPD-CAGM foram superiores (-14,8 mV) aos em EDTA (-7,9 mV) e decrescentes a partir do primeiro dia de armazenamento, estabilizando-se a partir da terceira semana com potencial zeta -7,6 mV. Hemácias com CPD-SAGM apresentaram potencial zeta maior, pois possivelmente este conservante evitou lesões mais significativas da membrana que poderiam alterar as cargas. A redução do potencial zeta no armazenamento pode ser consequência de enzimas liberadas de leucócitos lisados que tenham alterado as glicoforinas da membrana. A metodologia permitiu avaliar o potencial zeta em diferentes condições e poderá contribuir na padronização de técnicas de hemaglutinação com diferentes meios potencializadores e no melhor conhecimento das lesões de estocagem para fins transfusionais.

A comparative study of two histological techniques for the identification of cytomegalovirus infection in colorectal biopsies from patients with chronic inflammatory bowel disease.

BACKGROUND: the role that cytomegalovirus (CMV) plays in inflammatory bowel disease (IBD) is controversial. The diagnosis of CMV infection in IBD depends on viral identification with hematoxylin-eosin (HE) or immunohistochemistry (IHC). Our aim was to compare the sensitivity of HE and IHC for this diagnosis in IBD patients. PATIENTS AND METHODS: a case-control study. Our database was searched for IBD patients with HE- or IHC-based CMV-positivity from 1997 to 2007. Controls were selected among IBD inpatients matched for age and year of diagnosis with CMV. Their clinical characteristics were analyzed. HE and IHC were performed on biopsies from cases and controls at 6 months before and after inclusion in the study. In the statistical analysis, p values below 0.05 were considered significant. RESULTS: ten IBD patients with CMV infection were identified. IBD-CMV patients were more steroid-resistant or steroid-dependent (p = 0.03), and underwent a higher number of colonic biopsies (p = 0.03). From 97 biopsies analyzed, 12 were HE-negative and IHC-positive, and 3 showed reversed results. The sensitivity of HE was 58.6%, 95% CI (38.9-78.3), and that of IHC was 89.7%, 95% CI (76.8-100). We did not find a good level of agreement between both techniques: kappa value 0.55, 95% CI (0.36-0.75). CMV positivity with IHC was associated with the use of more than one immunosuppressant drug, OR 13.5, 95%CI (1.2-152.2). Antiviral treatment was useful for CMV patients with steroid-dependent and steroid-refractory IBD. CONCLUSIONS: IHC shows a 30% higher sensitivity than HE for the diagnosis of CMV infection in IBD patients. There is no good level of agreement between both histological techniques.