裸金属支架与PTFE-覆膜支架行TIPSS治疗门静脉高压症患者临床疗效对比研究

目的 使用裸金属支架（BMS）和聚四氟乙烯（PTFE）覆膜支架行经颈静脉肝内门腔静脉支架分流术（TIPSS）治疗门静脉高压症患者临床疗效和技术设备成本对比分析。方法 2010年5月～2015年6月对163例门静脉高压症患者行TIPSS术,患者平均年龄为（56±12） 岁,女性占32.9 %。其中接受BMS支架80例,接受覆膜支架83例。结果 本组技术成功率为97.5%,术后门体梯度压从（16.1±4.8） mmHg下降至（5.1±2.1） mmHg;两组技术成功率和门体梯度压降无显著性差异;Kaplan-Meier分析显示,两组14 d、6 m和2 a一期支架通畅率存在显著性差别,其中PTFE-覆膜支架组通畅率高;两组1 a生存率和肝性脑病发生率无显著性差异;金属支架和覆膜支架总成本分别为66570元和70455元。结论 TIPSS术是一种安全、有效的治疗门静脉高压症的方法。裸金属支架和PTFE-覆膜支架均具有良好的技术和临床效果,并发症发生率低。     

Viatorr支架与双支架技术行经颈静脉肝内门体分流术的临床疗效观察

目的观察Viatorr支架与双支架技术行经颈静脉肝内门体分流术(TIPS)的临床疗效。方法收集2015年5月-2016年12月于安徽医科大学第一附属医院介入放射科行TIPS治疗的62例门静脉高压患者临床资料,主要表现为上消化道出血55例和顽固性腹水7例。根据术中应用覆膜支架类型分为Viatorr支架组(n=22)和双支架组(裸支架+Fluency覆膜支架,n=40)。术后随访6~17个月,观察分流道通畅率、肝性脑病发生率及病死率。计量资料2组间比较采用独立样本t检验,组内比较采用配对样本t检验;计数资料2组间比较采用χ~2检验。结果 62例患者TIPS手术均成功,共置入Viatorr支架22枚,裸支架40枚,Fluency覆膜支架40枚,直径均为8 mm。Viatorr支架组和双支架组门静脉压力分别由术前(28.7±4.9)mm Hg和(27.2±4.3)mm Hg降至(18.7±4.7)mm Hg和(18.8±3.9)mm Hg,差异均有统计学意义(t值分别为9.9、13.5,P值均<0.01)。55例消化道出血患者术后均停止出血,7例顽固性腹水患者腹水消退。Viatorr支架组和双支架组通畅率分别为95.5%、90.0%,肝性脑病发生率分别为9%、15%,随访期间病死率分别为4.5%和12.5%,差异均无统计学意义(P值均>0.05)。结论采用Viatorr支架或双支架技术行TIPS疗效确切,但采用Viatorr建立TIPS分流道近期疗效与双支架技术无明显差别,其较双支架技术的优势需进一步探究。     

43例采用Viatorr支架行经颈静脉肝内门体分流术的临床研究

目的:探讨采用Viatorr支架行经颈静脉肝内门体静脉分流术（TIPS）治疗肝硬化门静脉高压的临床疗效和安全性。方法:2016年3月至2018年8月,43例肝硬化门静脉高压患者在TIPS术中置入Viatorr支架,定期随访血清学指标、彩超、胃镜以及再出血、腹水和肝性脑病情况,门静脉压力、肝肾功能、凝血指标比较采用配对 ...     

Viatorr覆膜支架在经颈静脉肝内门体分流术中的应用现状

经颈静脉肝内门体分流术(TIPS)已广泛应用于治疗门静脉高压并发症,近年来随着对于TIPS认识程度的加深,覆膜支架得到更进一步的发展应用,其中TIPS专用支架(Viatorr覆膜支架)更是成为关注的焦点。综述了Viatorr覆膜支架的应用与效果,指出采用Viatorr覆膜支架建立肝内分流通道能够明显提高分流道通畅率,在未增加肝性脑病的发生率的同时减少了重复干预及再出血的风险,使患者的生活质量得到提高。     

经颈静脉肝内门体分流术在食管胃静脉曲张出血治疗中的进展

经颈静脉肝内门体分流术（TIPS）是食管胃静脉曲张出血重要的治疗措施,既往把它作为肝移植前的桥梁。随着覆膜支架的应用及早期TIPS概念的提出,其在临床中的应用越来越广泛。门静脉高压所致的食管胃静脉曲张出血和腹水是其主要的适应证,近10年来对其获益人群和最佳治疗时机进行了广泛研究。在急性出血中对于内镜不能控制的大出血、标准治疗后早期再出血、Child-Pugh C级（评分<14分）肝功能患者、Child-Pugh B（评分>7分）伴内镜下活动性出血者、严重门静脉高压（HVPG>20 mmHg）者,TIPS治疗可改善预后。TIPS对食管胃静脉曲张出血二级预防的最佳时机和适宜人群尚不明确。术前存在的肝性脑病、肝肾综合征、门静脉血栓、门静脉海绵样变性、肝脏肿瘤等不是行TIPS治疗的绝对禁忌证。     

经颈静脉肝内门体分流术对酒精性肝硬化导致门静脉高压的治疗效果与安全性分析

目的分析经颈静脉肝内门体分流术(TIPS)治疗酒精性肝硬化导致门静脉高压的有效性及安全性。方法回顾性总结2006年6月至2011年6月本院30例接受TIPS治疗的酒精性肝硬化导致门静脉高压的患者资料,记录术前及术后门静脉压力、腹水、脾功能亢进、肝功能等指标。随访终点为术后2 a,观察术后并发症包括消化道再出血、支架堵塞、腹水及肝性脑病发生情况,并分析肝性脑病发生与患者临床参数的关系。穿刺前、后门静脉压力差别采用配对t检验分析;Kaplan-Meier方法用于术后临床参数与肝性脑病发生相关性分析。结果 TIPS手术成功率为100%(30/30),门静脉压力术前(37.27±2.52)cm H2O降为术后(24.6±2.58)cm H2O,差异具有统计学意义(P0.05)。术后2 a内,消化道再出血率为3.3%(1/30);腹水治疗有效率达88.9%(16/18);支架狭窄发生率为6.7%(2/30);肝性脑病发生率为40%(12/30)。Kaplan-Meier分析发现患者术前Child-Pugh分级与术后肝性脑病发生密切相关(P=0.04)。结论 TIPS是治疗酒精性肝硬化门静脉高压相关并发症安全有效的微创方法,术前ChildPugh分级是影响患者肝性脑病发生的重要因素。     

肝硬化门静脉高压患者行经颈静脉肝内门体分流术术中置入Viatorr支架分流门静脉左、右支血流对疗效的影响

目的探讨在经颈静脉肝内门体分流术(TIPS)术中置入Viatorr支架分流门静脉左支或右支血流对肝硬化门静脉高压患者疗效的影响。方法回顾性分析中国人民解放军西部战区总医院2016年3月-2019年12月接受TIPS治疗的肝硬化门静脉高压症120例患者的临床资料,根据术中造影判断穿刺门静脉靶点位置,将患者分为门静脉左支分流组(n=52)和右支分流组(n=68),分析两组患者术后复发出血、支架功能障碍、肝性脑病发生及生存状况。计量资料2组间比较采用t检验。计数资料2组间比较采用χ2检验。Kaplan-Meier曲线分析再出血率、支架通畅率、肝性脑病发生率及生存率。结果 120例患者手术成功率100%,近期止血率100%。门静脉压力术后较术前明显降低[(9.98±2.84) mm Hg vs (24.72±5.11) mm Hg,t=37.76,P 0.01]。累计再出血率术后12、24个月分别为3.2%、11.0%;肝性脑病累计发生率术后3、6、12、24个月分别为10.8%、13.6%、21.2%、24.5%;随访24个月累计29例肝性恼病患者中,Ⅰ+Ⅱ级23例,Ⅲ级6例;支架功能障碍累计发生率术后12、24个月分别为7.1%、21.4%。累计生存率术后12、24个月分别为92.0%、86.5%。门静脉左支分流组与右支分流组比较,患者术后支架通畅率、再出血率、肝性脑病发生率、生存率比较差异均无统计学意义(P值均 0.05)。结论 TIPS是治疗肝硬化门静脉高压安全、有效的方法;术中置入Viatorr支架,无论建立门静脉左支或右支分流,均不会影响患者的临床疗效。     

限流支架治疗经颈静脉肝内门体分流术后复发性或持续性显性肝性脑病的效果和安全性

目的分析限流支架治疗经颈静脉肝内门体分流术(TIPS)后复发性或持续性肝性脑病的效果和安全性。方法选取空军军医大学第一附属医院2013年1月-2018年8月TIPS术后明确诊断为持续性或复发性显性肝性脑病的患者11例。限流支架置入前后选用客观量表对肝性脑病患者进行准确评估。限流支架应尽量选择同类型和合适长度的金属覆膜支架,术中术后常规门静脉造影并测门静脉压力梯度。主要观察终点为肝性脑病的变化情况。采用配对t检验分析手术前后各项检测指标的变化。结果11例患者均成功置入限流支架,限流支架置入后1周内8例患者肝性脑病消失,2例患者降为1级,其中1例患者因肝硬化严重并发肝衰竭,肝性脑病改善不明显。直径4 mm限流支架2例,5 mm 8例,6 mm 1例,限流术后门静脉压力梯度升高[(6. 09±0. 70)mm Hg vs (15. 36±2. 94) mm Hg,t=2. 53,P=0. 003 8]。限流术后数字编码测试所需的时间较术前有显著下降[(269±80) s vs(464±90) s,t=2. 94,P=0. 001]。术后1个月患者Alb改善显著(t=1. 75,P=0. 013)。4 mm限流支架的2例患者分别在术后6个月和12个月因消化道出血死亡; 5 mm限流支架的8例患者有2例在术后3个月再出血,另1例术后15个月发生大量腹水,1例限流术后生存2年后因黄疸、顽固性腹水并发肝衰竭死亡; 6 mm限流支架的1例患者术后25 d并发慢加急性肝衰竭死亡。结论限流支架能够有效改善TIPS术后药物治疗无效的持续性或复发性显性肝性脑病且安全可行,但限流支架直径过小可能会引起支架再狭窄继发门静脉压力升高。     

经颈内静脉肝内门体分流术治疗肝硬化门脉高压症56例

目的:探讨经颈内静脉肝内门体分流术 (transjugular intrahepatic portosystemic shunt, TIPS)治疗肝硬化门脉高压症的临床疗效及并发症．方法:肝硬化并发门脉高压症患者56例,行 TIPS术,支架置入前后测量门静脉主干压力, 测定门静脉、脾静脉内径,测定门静脉、分流道血流速度;检测外周血象．结果:TIPS术成功率100％,门脉主干压 (cmH2O)24．5±4．2(P<0．01 vs 术前的45．8± 3．6),门静脉内径及脾静脉内径(cm)分别为 1．28±0．095和0．96±0．064(P<0．01 vs术前的 1．62±0．074和1．28±0．032),门脉主干血流速度(cm／s)48．0±17．6(P<0．01 vs术前的13．2± 3．5),分流道血流速度(cm／s)164．0±58．8．脾功能亢进患者30例,WBC(×109／L),PLT(× 109/L),HGB(×g／L)分别为3．92±0．76,80．74± 16．82,118．20±10．24(P<0．01 vs术前的2．65± 0．58,42．56±12．34,86．52±12．68)．食道胃底静脉曲张,腹水等临床症状明显好转．常见并发症有肝性脑病,支架狭窄及闭塞．结论:TIPS是一种治疗肝硬化门脉高压症的有效方法,他能有效地降低门脉压,控制食道、胃底静脉曲张破裂出血．     

TIPS治疗门脉高压及其并发的消化道出血2例

目的观察经颈静脉肝内门体分流术(TIPS)治疗肝硬变门脉高压及消化道出血的临床疗效.方法采用TIPS治疗肝硬变门脉高压观察其近期疗效、并发症.结果2例患者门静脉建立有效分流,成功率100%.门静脉压由5.4kPa及5.2kPa分别降至3.2kPa和2.8kPa,分流后食管静脉曲张1例消失,术后腹水1例消失、1例减少,术后2例患者出血均停止,术后1例患者并发肾功能衰竭,最后死亡.结论TIPS可迅速降低门静脉压力,近期疗效满意,中期疗效欠佳,术后可出现腹水再现、肾功能衰竭、支架狭窄闭塞、肝性脑病等.     

Impairment of small airways in COPD patients with frequent exacerbations and effects of treatment with tiotropium

Disease exacerbations are an important aspect of COPD, because they affect its course and are associated with higher lung function decline. On the other hand, data obtained by biopsies have demonstrated that the progression of COPD is related to an increasing impairment of small airways. We sought to evaluate the small airway impairment (FEF25–75) in two groups of COPD patients (each group had 37 subjects) in relation to the frequency of exacerbations and the effectiveness of treatment with tiotropium bromide on the small airway impairment. The mean number of exacerbations was 3.6/year and 1.38/year in frequent and in infrequent exacerbators, respectively (p < 0.001). The mean value of FEF25–75 at baseline was 624 mL and 865 mL in frequent and in infrequent exacerbators respectively (p = 0.002). The changes in respiratory parameters versus baseline showed increases in mean FEV₁, FVC, and FEF25–75 in both groups but only the increase in FEF25–75 in frequent exacerbators was statistically significantly (p = 0.013). During the 3-month period of the study the mean number of exacerbations was 0.66 in frequent and 0.12 in infrequent exacerbators. These findings indicate that COPD patients with frequent exacerbations have a higher impairment of small airways. Treatment with tiotropium in COPD subjects with frequent exacerbations proved to be effective in improving small airway impairment.     

The significance of Babinski signs in children with head trauma

A prospective study was undertaken to investigate the significance of Babinski signs in children with head trauma. Thirty-eight children between the ages of 1 and 15 were studied. Twenty-four of the children were admitted to the hospital for observation; 14 were sent home, with 24-hour follow-up in the pediatrics clinic. Of the 24 children admitted, six were believed to have altered CNS status or other focal findings on examination in the emergency department, and 18 were judged by two independent observers to have Babinski signs, either unilateral or bilateral, as their only neurological finding. Twelve hours after admission, all 18 children who had been admitted on the basis of Babinski signs alone had downgoing toes and they continued to have Babinski signs. The isolated presence of Babinski signs in a child with a history of head injury is not indicative of poor neurological outcome. An otherwise asymptomatic child who presents with a history of head injury and a solitary finding of Babinski sign(s) may be observed safely at home rather than being admitted to the hospital for observation.     

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus简

The incidence of esophageal adenocarcinoma, a poor prognosis neoplasia, has risen dramatically in recent decades. Barrett’s esophagus represents the best-known risk factor for esophageal adenocarcinoma development. Non-steroidal anti-inflammatory drugs through cyclooxygenase-2 inhibition and prostaglandin metabolism regulation could control cell proliferation, increase cell apoptosis and regulate the expression of growth and angiogenic factors. Statins can achieve equivalent effects through prenylation and subsequently control of cellular signaling cascades. At present, epidemiological studies are small and underpowered. Their data could not justify either medication as a chemo-preventive agent. Population based studies have shown a 43% reduction of the odds of developing an esophageal adenocarcinoma, leaving out or stating a 25% reduction in patients consuming non-aspirin nonsteroidal anti-inflammatory drugs and a 50% reduction in those patients consuming aspirin. They have also stated a 19% reduction of esophageal cancer incidence when statins have been used. Observational studies have shown that non-steroidal anti-inflammatory drugs could reduce the adenocarcinoma incidence in patients with Barrett’s esophagus by 41%, while statins could reduce the risk by 43%. The cancer preventive effect has been enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Observational data are equivocal concerning the efficacy of non-steroidal anti-inflammatory drug subclasses. Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. In conclusion, both non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents and deserve further exploration with interventional studies. In the meanwhile, their use is justified only in patients with cardiovascular disease.     

Detection of SHOX Gene Variations in Patients with Skeletal Abnormalities with or without Short Stature

Objective:SHOX gene mutations constitute one of the genetic causes of short stature. The clinical phenotype includes variable degrees of growth impairment, such as Langer mesomelic dysplasia (LMD), Léri-Weill dyschondrosteosis (LWD) or idiopathic short stature (ISS). The aim of this study was to describe the clinical features and molecular results of SHOX deficiency in a group of Turkish patients who had skeletal findings with and without short stature.Methods:Forty-six patients with ISS, disproportionate short stature or skeletal findings without short stature from 35 different families were included. SHOX gene analysis was performed using Sanger sequencing and multiplex ligation-dependent probe amplification analysis.Results:Three different point mutations (two nonsense, one frameshift) and one whole SHOX gene deletion were detected in 15 patients from four different families. While 4/15 patients had LMD, the remaining patients had clinical features compatible with LWD. Madelung’s deformity, cubitus valgus, muscular hypertrophy and short forearm were the most common phenotypic features, as well as short stature. Additionally, hearing loss was detected in two patients with LMD.Conclusion:This study has presented the clinical spectrum and molecular findings of 15 patients with SHOX gene mutations or deletions. SHOX deficiency should be especially considered in patients who have disproportionate short stature or forearm anomalies with or without short stature. Although most of the patients had partial or whole gene deletions, SHOX gene sequencing should be performed in suspected cases. Furthermore, conductive hearing loss may rarely accompany these clinical manifestations.     

伴有肛周疾病的炎症性肠病患者肛门功能及生活质量分析

目的分析肛周疾病对炎症性肠病（IBD）患者肛门直肠功能和生活质量的影响。 方法回顾性分析2018年6月至2020年6月淮安市第二人民医院收治的伴有肛门不适的53例IBD患者（IBD组）。其中CD43例，UC10例。包括肛瘘35例，大便失禁15例，肛门纤维化8例。选择同期来淮安市第二人民医院体检的健康人20名作为健康对照组。通过肛门直肠测压对IBD患者和健康对照组受试者肛门功能进行评估并进行比较。采用炎症性肠病患者生活质量量表（IBDQ）评分对IBD患者生活质量进行评估。 结果IBD患者与健康对照组最大肛门静息压、最大挤压压、直肠容量感觉阈值、最大耐受容量、肛管抑制反射阳性水平差异均无统计学意义（P均>0.05）。大便失禁的IBD患者最大肛门静息压、IBDQ评分均低于非大便失禁的IBD患者，且差异均有统计学意义（P<0.05）。CD与UC患者IBDQ评分差异无统计学意义（P>0.05）；大便失禁IBD患者IBDQ评分低于非大便失禁IBD患者，且差异有统计学意义（P<0.05）。 结论合并肛周疾病的IBD患者肛门直肠功能受损，大便失禁的患者生活质量差。     

Viral co‐infections are associated with increased rates of hospitalization in those with influenza

BackgroundInfluenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co‐infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co‐infections. The objective of this study was to determine rates of viral co‐infections in emergency department (ED) patients with confirmed influenza and association of co‐infection with disease severity.MethodsSecondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014–2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza‐positive patients were tested for viral co‐infections (ePlex, Genmark Diagnostics). Patterns of viral co‐infections were evaluated using chi‐square analysis. The association of viral co‐infection with hospital admission was assessed using univariate and multivariate regression.ResultsThe overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co‐infections was 7.9% (79/999). The most common viral co‐infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01–5.34) increased significantly for those with viral co‐infections (other than RhV/EV) versus those with influenza A infection only.ConclusionPresence of viral co‐infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.     

不同剂量瑞舒伐他汀对于急性脑梗死患者血清相关miRNAs水平的影响研究

目的：探讨急性脑梗死(ACI)患者接受不同剂量瑞舒伐他汀治疗后血清血清脑梗死相关miRNAs水平波动情况。方法：本研究共纳入90例ACI患者,均为2015年2月至2016年12月于与我科住院治疗患者,随机等份分为低剂量组(n=30)、高剂量组(n=30)和对照组(n=30)。所有患者于入组前(T0)和治疗后3个月(T1)两个时间点检测血清miR-182和miR-497水平,评价神经功能缺损评分(NIHSS)和日常生活能力评分(Barthel)。结果：T1时,低剂量组和高剂量组患者血清miR-182明显高于对照组(低剂量组：266.4±25.4fmol/L,高剂量组：302.4±31.9 fmol/L vs. 对照组：156.9±11.7 fmol/L,P<0.05),而miR-497明显低于对照组(低剂量组：311.7±34.5fmol/L,高剂量组：190.8±26.1 fmol/L vs. 对照组：412.5±54.1 fmol/L,P<0.05),同时高剂量组患者T1时miR-182升高和miR-497降低幅度均明显高于低剂量组(P<0.05)。△NIHSS与△miR-182呈负相关(r=-0.669,P<0.05),T1-Barthel评分与T1-miR-182(r=0.612,P<0.05)和△miR-182(r=0.663,P<0.05)呈正相关,与T1-miR-497(r=-0.623,P<0.05)和△miR-497(r=-0.681,P<0.05)呈负相关。瑞舒伐他汀干预治疗与△miR-182呈正相关(r=0.612,P<0.05),与△miR-497呈负相关(r=-0.675,P<0.05),而高剂量瑞舒伐他汀干预治疗的相关性更加密切(r_△miR-182=0.612,r_△miR-497=-0.675,P<0.05)。结论：瑞舒伐他汀干预治疗后可明显调节ACI患者miR-182和miR-497水平,且呈剂量依赖性改变,神经恢复相关miR-182和miR-497可能参与他汀的神经保护作用。     

Prognostic value of RDW alone and in combination with NT‐proBNP in patients with heart failure

BackgroundRed blood cell distribution width (RDW) and N‐terminal pro brain natriuretic peptide (NT‐proBNP) may predict the prognosis of heart failure (HF). However, the impact of combined RDW and NT‐proBNP levels as a prognostic marker of HF remains unclear and the significance of this combination at various time‐points has not been sufficiently studied.HypothesisRDW can predict prognosis in HF at various time‐points and combination with NT‐proBNP improves the prognostic value.MethodsPatients admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) with a diagnosis of HF from November 2008 to November 2018 were analyzed retrospectively.ResultsIn total, 3231 patients with available RDW data at admission were evaluated (median age 58 years, 71.9% males, 39.7% coronary heart disease, 68.6% New York Heart Association [NYHA] III or IV). Median RDW and NT‐proBNP at admission were 13.4% (interquartile range [IQR]: 12.7%–14.5%), and 1723.00 pg/ml (IQR: 754.00–4006.25 pg/ml), respectively. During 2.9‐year median follow‐up, all‐cause death occurred in 1075 (33.27%) patients. Kaplan–Meier survival curve and Cox proportional‐hazard models, showed patients in the top quarter RDW had a 32.0% increased mortality compared to the bottom quarter (hazard ratio: 4.39, 95% confidence interval: 3.59–5.38; p <.001). The top quarter RDW retained independent prognostic value across HF with reduced ejection fraction [HFrEF], HF with mid‐range ejection fraction [HFmrEF], and HF with preserved ejection fraction [HFpEF] subgroups. Patients were subsequently divided into four groups by median RDW and NT‐proBNP. Comparison of Kaplan–Meier survival curves for various groups showed good risk stratification (p < .001).ConclusionsRDW is an independent predictor of mortality among patients with HF in the short‐, medium‐, and long‐term. Combination of RDW and NT‐proBNP improves the prognostic value. This is true across all clinical subtypes of heart failure (HFrEF, HFmrEF, HFpEF), and among most subgroups of patients with various comorbidities (infection, diabetes, hypertension).     

Clinical significance of cytomegalovirus infection in patients with inflammatory bowel disease

Cytomegalovirus(CMV) infection is common in humans.The virus then enters a "latency phase" and can reactivate to different stimuli such as immunosuppression.The clinical significance of CMV infection in inflammatory bowel disease is different in Crohn’s disease(CD) and ulcerative colitis(UC).CMV does not interfere in the clinical course of CD.However,CMV reactivation is frequent in severe or steroid-resistant UC.It is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe disease.Different methods are used to diagnose CMV colitis.Diagnosis is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry,other tests on blood or tissue samples are currently being investigated.Polymerase chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease;further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic mucosa.Specific endoscopic features have not been described in active UC and CMV infection.CMV colitis is usually treated with ganciclovir for several weeks,there are different opinions about whether or not to stop immunosuppressive therapy.Other antiviral drugs may be used.Multicenter controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.