CMV - gastroenteritis/colitis

Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV disease

Cytomegalovirus (CMV) is a member of a group of herpes-type viruses. It is related to the virus that causes chickenpox. Infection with CMV is very common.

The infection is spread by saliva, urine, respiratory droplets, sexual contact, and blood transfusions. Most humans are exposed to the virus in their lifetime, but it usually produces no symptoms in healthy people. However, serious CMV infections can occur in people with weakened immune systems. This includes patients receiving chemotherapy for cancer treatment and patients on immune-suppressing medicines following an organ transplant. People with inflammatory bowel disease can develop gastrointestinal CMV infections.

In rare instances, more severe CMV infection involving the GI tract has been reported in people with healthy immune systems. When CMV colitis occurs in patients with normal immune systems, the patients typically have other serious medical conditions such as severe injury, kidney failure, or infection.

The following increase your risk for CMV gastroenteritis/colitis:

• AIDS
• Bone marrow or organ transplant
• Chemotherapy
• Medications that suppress the immune system

Gastrointestinal CMV disease may affect one area or the entire body. Ulcers can occur in the esophagus, stomach, small intestine, or colon. Such ulcers are associated with symptoms such as:

• Abdominal pain
• Difficulty swallowing or pain with swallowing
• Nausea
• Vomiting

When the intestines are involved, the ulcers may cause:

• Abdominal pain
• Bloody stools
• Diarrhea
• Fever
• Weight loss

More severe infections can result in gastrointestinal bleeding or a hole through the wall of the infected organ.

Tests that may be done include:

• Barium enema
• Colonoscopy
• Esophagogastroduodenoscopy (EGD)
• Stool culture to rule out other causes of infection
• Upper GI and small bowel series

Laboratory tests will be done on a sample of tissue taken from your stomach or intestine. The tests, such as a gastric tissue culture, determine if the virus is present in the tissue sample.

A CMV serology test is done to look for the virus in your blood.

The goals of therapy are to control the infection and relieve symptoms.

Medicines to fight the virus (antiviral medications) are prescribed. The medicines may be given through a vein and sometimes by mouth for several weeks.

In some cases, long-term therapy may be needed. A medication called CMV hyperimmune globulin may be used when other drugs don't work.

Other medications may include:

• Drugs to prevent or reduce diarrhea
• Pain killers (analgesics)

Nutritional supplements or intravenous nutrition (putting nutrients directly into the blood stream) may be used to treat muscle loss due to the disease.

In people with healthy immune systems, symptoms usually go away without treatment.

Symptoms are more severe in those with weakened immune systems. The outcome depends upon the severity of the immune system deficiency and the severity of the CMV infection.

People with AIDS may have a worse outcome than those with weakened immune systems due to another reason. CMV infection typically affects the entire body, even if patients only have gastrointestinal symptoms. How well a patient does depends on how well the antiviral drugs work.

The drugs used to fight the virus may cause side effects. The type of side effect depends on the specific drug used. For example, the drug ganciclovir may lower your white blood cell count. Another drug, foscarnet, may lead to kidney problems.

Call for an appointment with your health care provider if you have symptoms of CMV gastroenteritis/colitis.

There is a significant risk of CMV infection in people with no signs of the virus in their blood who receive an organ transplant from a CMV-positive donor. The antiviral drugs ganciclovir (Cytovene) and valacyclovir (Valtrex), taken by mouth before the transplant, can lower your chance of a new infection or reactivation of an old infection in such cases.

People with AIDS who are effectively treated with antiviral therapy are much less likely to get CMV infection.