A Review of the Bidirectional Impact of Cytomegalovirus Infection and Inflammatory Bowel Disease

Abstract

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease, are characterized by a dysregulated and exaggerated immune response to intestinal microbiota, resulting in chronic and relapsing inflammation. Patients with IBD are frequently immunocompromised due to factors such as dietary influences, immunosuppressive therapy, and the underlying disease itself, all of which create a favorable environment for the reactivation of cytomegalovirus (CMV). Moreover, disease-associated inflammation and the release of pro-inflammatory cytokines further contribute to the reactivation of CMV.

CMV is a notable opportunistic pathogen in immunocompromised individuals and may complicate the clinical course of IBD by contributing to treatment resistance. Although the exact role of CMV in the pathogenesis and exacerbation of IBD remains unclear, evidence suggests that CMV reactivation aggravates mucosal inflammation, particularly in patients with steroid-refractory ulcerative colitis. Several diagnostic modalities are available for detecting CMV in the context of IBD, including serological assays for antibody detection, histopathological examination with specific staining, polymerase chain reaction-based viral DNA detection, immunohistochemical identification of viral antigens, and viral culture. Early diagnosis and appropriate antiviral management of this infection can enhance therapeutic outcomes, guide optimal treatment strategies, and prevent serious complications in patients with IBD.