Despite multiple studies, the role of CMV infection in exacerbating the severity of inflammation in ulcerative colitis (UC) and its response to treatment remains debatable. Additionally, the optimal diagnostic tests for CMV infection in the setting of UC relapse and timing of antiviral treatment initiation remain unclear. The challenge faced by gastroenterologists is to differentiate between an acute UC flare and true CMV colitis. It seems that the presence of CMV colitis as defined by the presence of intranuclear or intracellular inclusion bodies on haematoxylin and eosin (H&E) and/or positive immunohistochemistry (IHC) assay on histology is associated with more severe colitis. Patients with CMV infection and acute severe colitis are more resistant to treatment with corticosteroids than non-infected patients. This refractoriness to steroids is related to colonic tissue CMV viral load and number of inclusion bodies (high-grade CMV infection) that may have a pronounced effect on clinical outcomes and colectomy rates. Whereas many studies showed no effect for antiviral treatment on colectomy rates in CMV infected UC patients , there was a significant difference in colectomy rates of patients with high-grade infection who received anti-viral therapy compared to those who did not receive treatment. It was therefore proposed that high-grade CMV disease indicates that the virus is acting as a pathogen, whereas in those with low-grade CMV disease, the severity of IBD itself is more likely to influence outcome. The different algorithms that have been put forward for the management of patients with UC and concomitant CMV infection are discussed.

中文翻译：

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溃疡性结肠炎和巨细胞病毒感染：从A到Z。

尽管进行了多项研究，但CMV感染在加剧溃疡性结肠炎（UC）中炎症的严重性及其对治疗的反应方面的作用仍有待商bat。此外，尚不清楚在UC复发和抗病毒治疗启动时机中CMV感染的最佳诊断测试。胃肠病学家面临的挑战是区分急性UC耀斑和真正的CMV结肠炎。似乎由苏木精和曙红（H＆E）上存在核内或细胞内包涵体（H＆E）和/或组织学上呈阳性免疫组织化学（IHC）检测所定义的CMV结肠炎与更严重的结肠炎有关。与未感染的患者相比，患有CMV感染和急性重度结肠炎的患者对糖皮质激素治疗的抵抗力更高。对类固醇的难治性与结肠组织CMV病毒载量和包涵体数量（高级别CMV感染）有关，可能对临床结局和结肠切除率产生明显影响。尽管许多研究表明抗病毒治疗对CMV感染的UC患者的结肠切除率没有影响，但是接受抗病毒治疗的高度感染患者的结肠切除率与未接受抗病毒治疗的结肠切除率有显着差异。因此，有人提出，高等级CMV疾病表明该病毒是病原体，而在低等级CMV疾病中，IBD本身的严重程度更可能影响预后。讨论了已提出的用于治疗UC和伴随CMV感染的不同算法。