Natural history of cytomegalovirus infection in a series of patients diagnosed with moderate-severe ulcerative colitis

AIM:To evaluate the natural history of human cytomegalovirus(HCMV) infection in a series of 28 ulcerative colitis patients in whom the search for HCMV was positive.METHODS:A series of 85 patients with moderate-severe ulcerative colitis flare-up were evaluated for a HCMV search by performing a haematoxylin and eosin stain,immunohistochemical assay and nested polymerase chain reaction on rectal biopsies.Among 85 screened patients(19 of whom were steroid resistant/dependant),28 were positive for HCMV;after remission the patients were followed up clinically and histologically.RESULTS:Among the 22 patients with complete followup,in 8(36%) patients HCMV-DNA persisted in the intestinal specimens.Among the HCMV positive patients,4(50%) experienced at least one moderate-severe flare-up of colitis without evidence of peripheral HCMV.Among the 14 HCMV negative patients,3 with pouches developed pouchitis and 5 out of 11(45%) experienced a colitis flare-up.CONCLUSION:Our preliminary results suggest that HCMV may remain in the colon after an acute colitis flareup despite remission;it seems that the virus is not responsible for the disease relapse.

Methodology for high-quality studies on course and prognosis of inflammatory bowel disease

Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.

Cytomegalovirus and inflammatory bowel disease: Is there a link?

这份报告的目的是在煽动性的肠疾病(IBD ) 给 Cytomegalovirus (CMV ) 感染的流行病学、临床、诊断、治疗学的特征的一个全面看法。这个话题上的出版报告的评论被执行，与对在研究和采用的诊断方法包括的病人的选择给予的特别注意。CMV 经常与 IBD 被联系。在一些情况中， CMV 感染与差的结果被联系，但是哪个病人是更可能的被假装，不是清楚的并且在哪个疾病的舞台。在 IBD 的抗病毒的治疗的使用是争论的，有控制的实验研究被需要。与 IBD 的发展和治疗有关的 CMV 感染的自然科学没被澄清，但是因为病毒的坚持的可能性，在免疫在考虑拿它是重要的有免疫系统的损害主人和病毒的相互作用。

Gastrointestinal lesions associated with spondyloarthropathies

Subclinical gut inflammation has been described in up to twothirds of patients with spondyloarthropathies(SpA).Arthritis represents an extraintestinal manifestation of several gastrointestinal diseases, including inflammatory bowel disease(IBD), Whipple's disease, Behcet's disease, celiac disease, intestinal bypass surgery, parasitic infections of the gut and pseudomembranous colitis.Moreover about two thirds of nonsteroidal antiinflammatory drug users demonstrate intestinal inflammation.Arthritis may manifest as a peripheral or axial arthritis.The spondyloarthropathy family consists of the following entities:ankylosing spondylitis, undifferentiated spondyloarthritis, reactive arthritis, psoriatic arthritis, spondyloarthritis associated with IBD, juvenile onset spondyloarthritis.This topic reviews the major gastrointestinal manifestations that can occur in patients with SpA and in nonsteroidal anti inflammatory drugs users.

Could JC virus provoke metastasis in colon cancer?

AIM: To evaluate the prevalence of John Cunningham virus(JC virus) in a small cohort of patients with colon cancer and to assess its presence in hepatic metastasis.METHODS: Nineteen consecutive patients with histologically diagnosed colon cancer were included in our study, together with ten subjects affected by histologically and serologically diagnosed hepatitis C virus infection. In the patients included in the colon cancer group, JC virus was searched for in the surgical specimen; in the control group, JC virus was searched for in the hepatic biopsy. The difference in the prevalence of JC virus in the hepatic biopsy between the two groups was assessed through the χ2 test.RESULTS: Four out of 19 patients with colon cancer had a positive polymerase chain reaction(PCR) test for JC virus, and four had liver metastasis. Among the patients with liver metastasis, three out of four had a positive PCR test for JC virus in the surgical specimen and in the liver biopsy; the only patient with liver metastasis with a negative test for JC virus also presented a negative test for JC virus in the surgical specimen. In the control group of patients with hepatitis C infection, none of the ten patients presented JC virus infection in the hepatic biopsy. The difference between the two groups regarding JC virus infection was statistically significant(χ2 = 9.55, P = 0.002).CONCLUSION: JC virus may play a broader role than previously thought, and may be mechanistically involved in the late stages of these tumors.