CMV - gastroenteritis/colitis

  • Definition
  • Alternative Names
    • Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV disease

  • Causes
    • Cytomegalovirus (CMV) is a herpes-type virus. It is related to the virus that causes chickenpox.

      Infection with CMV is very common. It is spread by saliva, urine, respiratory droplets, sexual contact, and blood transfusions. Most people are exposed at some point, but most of the time, the virus produces mild or no symptoms in healthy people.

      Serious CMV infections can occur in people with weakened immune systems due to:

      • AIDS
      • Chemotherapy treatment for cancer
      • During or after bone marrow or organ transplant
      • Ulcerative colitis or Crohn disease

      Rarely, serious CMV infection involving the GI tract has occurred in people with a healthy immune system.

  • Symptoms
    • Gastrointestinal CMV disease may affect one area or the entire body. Ulcers can occur in the esophagus, stomach, small intestine, or colon. These 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 bowel.

  • Exams and Tests
  • Treatment
    • Treatment is meant to control the infection and relieve symptoms.

      Medicines to fight the virus (antiviral medicines) are prescribed. The medicines may be given through a vein (IV), and sometimes by mouth, for several weeks. The most commonly used medicines are ganciclovir and valganciclovir.

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

      Other medicines may include:

      • Drugs to prevent or reduce diarrhea
      • Painkillers (analgesics)

      Nutritional supplements or nutrition given through a vein (IV) may be used to treat muscle loss due to the disease.

  • Outlook (Prognosis)
    • In people with a healthy immune system, symptoms go away without treatment in most cases.

      Symptoms are more severe in those with a weakened immune system. The outcome depends on how severe the immune system deficiency and the CMV infection are.

      People with AIDS may have a worse outcome than those with a weakened immune system due to another reason.

      CMV infection typically affects the entire body, even if only gastrointestinal symptoms are present. How well a person does depends on how well the antiviral drugs work.

  • Possible Complications
    • 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.

  • When to Contact a Medical Professional
    • Call your health care provider if you have symptoms of CMV gastroenteritis/colitis.

  • Prevention
    • There is a high risk of CMV infection in people who receive an organ transplant from a CMV-positive donor. Taking the antiviral drugs ganciclovir (Cytovene) and valganciclovir (Valcyte) by mouth before the transplant can lower your chance of getting a new infection or reactivating an old infection.

      People with AIDS who are effectively treated with highly active antiretroviral therapy are much less likely to get a CMV infection.

  • References
    • Crumpacker CS. Cytomegalovirus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 140.

      Majhail NS, Weisdorf DJ. Gastrointestinal and hepatic complications of solid organ and hematopoietic cell transplantation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 110.

      Wilcox GM. Gastrointestinal consequences of infection with human immunodeficiency virus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 34.