A quick guide to diagnosis and treatment of cytomegalovirus infection in the gut: current dilemmas

Cytomegalovirus is a ubiquitous herpesvirus, which, after often asymptomatic primary infection, establishes a life-long latency in different organs, including gut. As there is a close synergistic relationship between mucosal inflammation and viral expression, particularly in patients suffering from inflammatory bowel disease, it is often challenging to distinguish subclinical cytomegalovirus replication from cytomegalovirus-mediated colitis. The outcome for patients with cytomegalovirus reactivation appears to be worse than that for patients without reactivation, but the true role of cytomegalovirus is not entirely clear, as is the dilemma whether specific treatment with antivirals alters the course of inflammatory bowel disease. This review focuses on gastrointestinal tract cytomegalovirus disease, with special emphasis on diagnostic and treatment considerations of cytomegalovirus colitis in patients with inflammatory bowel disease.