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移植患者与非移植患者上消化道巨细胞病毒病的内镜特征

Endoscopic features of cytomegalovirus disease of the upper gastrointestinal tract between transplant and non-transplant patients.

作者信息

Kim Yuri, Kim Do Hoon, Seo Myeongsook, Na Hee Kyong, Jung Kee Wook, Ahn Ji Yong, Lee Jeong Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong

机构信息

Division of Gastroenterology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

出版信息

Korean J Intern Med. 2025 May;40(3):394-403. doi: 10.3904/kjim.2024.250. Epub 2025 Mar 25.

Abstract

BACKGROUND/AIMS: Cytomegalovirus (CMV) disease in the upper gastrointestinal (UGI) tract frequently occurs in immunocompromised patients. However, data regarding UGI CMV disease in non-transplant patients compared with those in transplant recipients are limited. Therefore, we compared the clinical characteristics, endoscopic findings, and outcomes of UGI CMV disease in non-transplant patients with those in transplant recipients.

METHODS

We reviewed the medical records of patients diagnosed with UGI CMV disease between May 1999 and January 2022. UGI CMV disease was defined as symptoms or signs of gastrointestinal disease with typical findings of CMV inclusion body and positive immunochemistry stain or CMV polymerase chain reaction from the endoscopic biopsy specimen.

RESULTS

Among the 219 eligible patients, 132 (60.3%) were transplant patients. Age, male sex, and Charlson Comorbidity Index were significantly higher in the non-transplant group than in the transplant group. The most common symptoms were pain and odynophagia (43.8%). Transplant recipients more frequently experienced UGI CMV disease in the stomach than non-transplant patients, typically presenting as erosions or mucosal hyperemia. However, non-transplant patients more commonly experienced UGI CMV disease in the esophagus than transplant recipients, typically presenting as ulcers. The transplant group had a significantly higher clinical response than the non-transplant group.

CONCLUSION

UGI CMV disease in transplant patients can be present in the stomach in various forms, including ulcers or erosions. In transplant patients suspected of UGI CMV disease, conducting an esophagogastroduodenoscopy with tissue biopsy in any area where even the slightest mucosal abnormality is observed is essential to facilitate a prompt diagnosis.

摘要

背景/目的:上消化道(UGI)巨细胞病毒(CMV)疾病常见于免疫功能低下患者。然而,与移植受者相比,非移植患者UGI CMV疾病的数据有限。因此,我们比较了非移植患者与移植受者UGI CMV疾病的临床特征、内镜检查结果及预后。

方法

我们回顾了1999年5月至2022年1月期间诊断为UGI CMV疾病患者的病历。UGI CMV疾病定义为具有CMV包涵体典型表现、免疫化学染色阳性或内镜活检标本CMV聚合酶链反应阳性的胃肠道疾病症状或体征。

结果

在219例符合条件的患者中,132例(60.3%)为移植患者。非移植组的年龄、男性比例和Charlson合并症指数显著高于移植组。最常见的症状是疼痛和吞咽痛(43.8%)。与非移植患者相比,移植受者胃内UGI CMV疾病更为常见,典型表现为糜烂或黏膜充血。然而,非移植患者食管UGI CMV疾病比移植受者更常见,典型表现为溃疡。移植组的临床反应显著高于非移植组。

结论

移植患者的UGI CMV疾病可表现为胃内多种形式,包括溃疡或糜烂。对于怀疑有UGI CMV疾病的移植患者,在观察到哪怕最轻微黏膜异常的任何区域进行食管胃十二指肠镜检查并取组织活检,对于及时诊断至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6910/12081102/8c558a731df9/kjim-2024-250f1.jpg

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