Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

• Published in: GE Portuguese journal of gastroenterology Vol. 24; no. 6; pp. 262 - 268
• Main Authors: Marques, Susana, Carmo, Joana, Pinto, Daniel, Bispo, Miguel, Ramos, Sância, Chagas, Cristina
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-11-2017; Karger Publishers
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiviral drugs; Chemotherapy; Cytomegalovirus; Endoscopy; Esophagitis; Esophagus; Gastritis; HIV; Human immunodeficiency virus; Infections; Inflammatory bowel disease; Lymphoma; Medical records; Mortality; Original; Original Article; Patients; Transplants & implants; Ulcers; Esophagitis; Cytomegalovirus; Endoscopy; Gastritis
• ISSN: 2341-4545; 2387-1954
• DOI: 10.1159/000479232

Background and Aims: Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients. The colon is the most commonly affected site, and the literature is scarce regarding CMV disease of the upper GI tract. Therefore, our study aimed to evaluate the clinical and endoscopic features of upper GI CMV disease. Methods: This 10-year retrospective study included all patients with a histopathological diagnosis of upper GI CMV infection. Patients' clinical, endoscopic, therapy, and follow-up data were collected from medical records. Results: Twelve patients with histopathologically proven upper GI CMV disease were identified (age 61 ± 18 years, 50% men). Most of the patients were immunocompromised (75%) due to acquired immunodeficiency syndrome (AIDS), malignancy, and/or immunosuppressive therapy. In the remainder (25%), the disease occurred in the absence of immunodeficiency and immunosuppression. Three patients (all with AIDS) presented with disseminated CMV infection. In the majority of the cases (83%), upper GI CMV disease was symptomatic, and the most common clinical presentations were odynophagia/dysphagia (25%) and nausea/vomiting (25%). Endoscopically, there were 5 cases of esophagitis (42%) and 7 cases of gastritis (58%). The lower esophagus (33%) and the gastric antrum (42%) were the most frequently affected GI sites. Regardless of the location, mucosal ulceration was the most common endoscopic finding (75%) and was associated with very deep ulceration resembling cavitation in 2 cases. Other endoscopic features were mucosal edema, hyperemia, and nodularity (25%). Eleven patients (92%) received antiviral treatment (duration 26 ± 12 days). The 1-month and 1-year mortality rates were 16.7 and 25%, respectively. Conclusions: Upper GI CMV disease can occur in the absence of immunodeficiency and immunosuppression. It is usually symptomatic, and mucosal ulceration is often evident at endoscopy. It is associated with significant mortality; therefore, early diagnosis and adequate antiviral treatment are essential.