The diagnosis and management of CMV colitis in IBD patients shows high practice variation: a national survey among gastroenterologists

Figures & data

Table 1. Details of the respondents.

Demographics	n = 73 (%)
Sex
Male	37 (51%)
Female	36 (49%)
Clinician
Gastroenterologist	49 (67%)
Gastroenterology trainee	13 (18%)
Pediatric gastroenterologist	11 (15%)
Type of hospital
Academic	36 (49%)
Non-academic	37 (51%)
Work experience within field of IBD
<5 years	25 (34%)
>5 years	48 (66%)

Figure 1. The general attitude towards the association of CMV infection in patients with IBD on a visual analogue scale, ranges from ‘innocent bystander’ (0) to ‘aggravating factor which requires treatment’ (100). 〇: mild outliers more than 1.5 times outside the IQR; ★: strong outliers more than 3 times outside the IQR.

Table 2. Survey results: indication for diagnostic testing.

	Total (n = 73)
When do you perform diagnostic tests to detect CMV?
Not or rarely	2 (3%)
Every exacerbation	10 (14%)
Severe exacerbations with the need for hospitalization	47 (64%)
Corticosteroid refractory exacerbations	50 (69%)
Immunomodulatory/biological refractory exacerbations	40 (55%)
Exacerbation with the need to perform a colonoscopy	3 (4%)
Other^a	4 (6%)

^aOther indications included: a refractory disease with an unknown cause (n = 1), every exacerbation on immunosuppressant therapy (n = 1), presence of endoscopic ulcers (n = 1), and CMV-positive biopsies (n = 1).

Table 3. Survey results: diagnostic tests for CMV colitis.

	Total (n = 73)
What kind of diagnostic tests do you perform to detect CMV colitis?
Virology
CMV serology	18 (25%)
PCR CMV in blood	44 (60%)
PCR CMV in feces	3 (4%)
PCR CMV in colonic biopsies (n = 62)^a	27 (44%)
If yes to PCR CMV in colonic biopsies, using (n = 27)
Quantitative result	15 (56%)
Qualitative result	8 (30%)
Unknown to the respondent	4 (15%)
Histopathology
Colonic biopsies on CMV, reviewed by a pathologist	64 (88%)
If yes to colonic biopsies, reviewed by a pathologist, using (n = 64)
H&E staining only	5 (8%)
H&E staining and IHC qualitative	25 (39%)
H&E staining and IHC quantitative	17 (27%)
Unknown to the respondent	17 (27%)
Other^b	1 (1%)

^a11 respondents provided inconsistent information on the questions regarding PCR testing in colonic biopsies and were not included in this table. ^bperforms colonic biopsies and if these are positive then they also perform a PCR test to determine the viral load (n = 1).

Table 4. Survey results: indications to start treatment.

	Total (n = 73)
When do you start treatment?
Positive CMV PCR on blood	32 (44%)
Positive CMV PCR on colonic biopsies	18 (25%)
Positive CMV PCR feces	1 (1%)
Positive IHC and/or H&E staining on colonic biopsies	54 (74%)
Other^a	6 (8%)

^aother indications to start treatment included: after consulting the IBD team (n = 1), no response to maximal medical treatment (n = 1), in case of proven systemic disease (n = 1), positive test on colonic biopsies, but PCR or histopathology not specified (n = 2), in case of a positive histopathologic result, after determining viral load (n = 1).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.