Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : March | Volume : 11 | Issue : 3 | Page : EC07 - EC11

Assessment of Disease Severity and Role of Cytomegalo Virus Infection in Patients with Ulcerative Colitis

Nobin Babu Kalappurayil, Jino Thomas, Baburajan Mankuni, Varghese Thomas

1. Assistant Professor, Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India. 2. Consultant, Department of Gastroenterology, Caritas Hospital, Kottayam, Kerala, India. 3. Associate Professor, Department of Pathology, Government Medical College, Idukki, Kerala, India. 4. Professor, Department of Gastroenterology, Government Medical College, Kozhikode, Kerala, India.

Correspondence Address :
Dr. Nobin Babu Kalappurayil,
Assistant Professor, Department of General Pathology, Christian Medical College, Vellore-632004, Tamil Nadu, India.
E-mail: nbk251@gmail.com

Abstract

Introduction: Course of Ulcerative Colitis is characterized by intermittent flares interposed between variable periods of remission. Identification of exacerbating factors and appropriate assessment of disease activity are crucial in deciding the choice of treatment.

Aim: To evaluate various clinical, endoscopic and histological parameters in assessing disease activity and to find out various risk factors involved in the exacerbation of ulcerative colitis especially the role of Cytomegalo Virus (CMV) infection.

Materials and Methods: It was a prospective study of patients diagnosed as ulcerative colitis presenting with acute exacerbation of symptoms (cases) and those who were in remission (controls). A detailed evaluation of the disease history including personal history, treatment compliance and clinical disease severity were noted. Investigations including blood routine, endoscopic examination with biopsy, histopathological examination and immunohistochemistry for CMV were done on the biopsy sample.

Results: A total of 58 patients with ulcerative colitis were studied which included 37 cases and 21 controls. Out of the various clinical and demographic parameters, Good treatment compliance (p =0.0003) and Perceived Stress Scale (PSS) score (p=0.0001) showed significant difference between cases and controls. Basic laboratory parameters {Haemoglobin level, Total Leucocyte Count (TLC) and Erythrocyte Sedimentation Rate (ESR)}, clinical disease severity predictors (Truelove and Witt’s criteria, Mayo score and endoscopic disease severity grade) and Geboes histological scoring showed significant difference between cases and controls. The prevalence of CMV colitis in our study was only 5.4% (two cases).

Conclusion: Clinical and endoscopic disease severity indicators can be used as predictors of histological activity in ulcerative colitis. Poor treatment compliance and stress are important risk factors for acute exacerbation of ulcerative colitis. Clinicians should be aware of the possibility of concurrent CMV infection while treating patients with acute exacerbation of ulcerative colitis not responding to the conventional management. Reduced prevalence of CMV colitis in cases of acute exacerbation of ulcerative colitis in our study may be due to the small sample size, reduced number of steroid dependent cases or reduced severity of our cases.

Keywords

Geboes, Immunohistochemistry, Mayo, Perceived stress

How to cite this article :

Nobin Babu Kalappurayil, Jino Thomas, Baburajan Mankuni, Varghese Thomas. ASSESSMENT OF DISEASE SEVERITY AND ROLE OF CYTOMEGALO VIRUS INFECTION IN PATIENTS WITH ULCERATIVE COLITIS. Journal of Clinical and Diagnostic Research [serial online] 2017 March [cited: 2017 Mar 28 ]; 11:EC07-EC11. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=March&volume=11&issue=3&page=EC07-EC11&id=9332

DOI and Others

DOI: 10.7860/JCDR/2017/22816.9332

Date of Submission: Jul 24, 2016
Date of Peer Review: Sep 19, 2016
Date of Acceptance: Oct 20, 2016
Date of Publishing: Mar 01, 2017

Financial OR OTHER COMPETING INTERESTS: None.

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