CMV - gastroenteritis/colitis
Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV diseaseCMV gastroenteritis/colitis is inflammation of the stomach or intestine due to infection with cytomegalovirus.
This same virus can also cause:
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Lung infection
Lung infection
Cytomegalovirus (CMV) pneumonia is a viral infection of the lungs that can occur in people who have a suppressed immune system.
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Infection in the back of the eye
Infection in the back of the eye
Cytomegalovirus (CMV) retinitis is a viral infection of the retina of the eye resulting in inflammation.
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Infections of a baby while still in the womb
Infections of a baby while still in the...
Congenital cytomegalovirus is a condition that can occur when an infant is infected with a virus called cytomegalovirus (CMV) before birth. Congenit...
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Causes
Cytomegalovirus (CMV) is a herpes-type virus. It is related to the virus that causes chickenpox.
Infection with CMV is very common. It is spread by saliva, urine, respiratory droplets, sexual contact, and blood transfusions. Most people are exposed at some point, but most of the time, the virus produces mild or no symptoms in healthy people.
Serious CMV infections can occur in people with weakened immune systems due to:
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AIDS
AIDS
Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the ...
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Chemotherapy treatment for cancer
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
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Ulcerative colitis or Crohn disease
Ulcerative colitis
Ulcerative colitis is a condition in which the lining of the large intestine (colon) and rectum become inflamed. It is a form of inflammatory bowel ...
Read Article Now Book Mark ArticleCrohn disease
Crohn disease is a disease where parts of the digestive tract become inflamed. It most often involves the lower end of the small intestine and the be...
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Rarely, serious CMV infection involving the GI tract has occurred in people with a healthy immune system.
Symptoms
Gastrointestinal (GI) CMV disease may affect one area or the entire GI system. Ulcers can occur in the esophagus, stomach, small intestine, or colon. These ulcers are associated with symptoms such as:
Ulcers
An ulcer is a crater-like sore on the skin or mucous membrane. Ulcers form when the top layers of skin or tissue have been removed. They can occur ...
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Abdominal pain
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Nausea
Nausea
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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When the intestines are involved, the ulcers may cause:
- Abdominal pain
- Bloody stools
- Diarrhea
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Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Weight loss
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
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More severe infections can result in gastrointestinal bleeding or a hole through the wall of the bowel (perforation).
Gastrointestinal bleeding
Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract. Bleeding may come from any site along the GI tract, ...
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Tests that may be done include:
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Barium enema
Barium enema
Barium enema is a special x-ray of the large intestine, which includes the colon and rectum.
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Colonoscopy with biopsy
Colonoscopy
A colonoscopy is an exam that views the inside of the colon (large intestine) and rectum, using a tool called a colonoscope. The colonoscope has a sm...
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Upper endoscopy (EGD) with biopsy
Upper endoscopy
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum)....
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Stool culture to rule out other causes of infection
Stool culture
A fecal culture is a lab test to find organisms in the stool (feces) that can cause gastrointestinal symptoms and disease.
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Upper GI and small bowel series
Upper GI and small bowel series
An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test th...
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Laboratory tests will be done on a sample of tissue taken from your stomach or intestine. The tests, such as a gastric or intestinal tissue culture or biopsy, determine if the virus is in the tissue.
Gastric or intestinal tissue culture
Gastric tissue biopsy is the removal of stomach tissue for examination. A culture is a laboratory test that examines the tissue sample for bacteria ...
Read Article Now Book Mark ArticleA CMV serology test is done to look for antibodies to the CMV virus in your blood.
CMV serology test
The CMV blood test determines the presence of substances (proteins) called antibodies to a virus called cytomegalovirus (CMV) in the blood.
Read Article Now Book Mark ArticleAnother blood test that looks for the presence and number of virus particles in the blood can also be done.
Treatment
Treatment is meant to control the infection and relieve symptoms.
Medicines to fight the virus (antiviral medicines) are prescribed. The medicines may be given through a vein (IV), and sometimes by mouth, for several weeks. The most commonly used medicines are ganciclovir, valganciclovir, and foscarnet.
In some cases, long-term therapy may be needed. A medicine called CMV hyperimmune globulin may be used when other drugs don't work.
Other medicines may include:
- Drugs to prevent or reduce diarrhea
- Painkillers (analgesics)
Nutritional supplements or nutrition given through a vein (IV) may be used to treat muscle loss due to the disease.
Outlook (Prognosis)
In people with a healthy immune system, symptoms go away without treatment in most cases.
Symptoms are more severe in those with a weakened immune system. The outcome depends on how severe the immune system deficiency and the CMV infection are.
People with AIDS may have a worse outcome than those with a weakened immune system due to another reason.
CMV infection typically affects the entire body, even if only (GI) symptoms are present. How well a person does depends on how well the antiviral drugs work.
Possible Complications
The drugs used to fight the virus may cause side effects. The type of side effect depends on the specific drug used. For example, the drug ganciclovir may lower your white blood cell count. Another drug, foscarnet, may lead to kidney problems.
When to Contact a Medical Professional
Contact your health care provider if you have symptoms of CMV gastroenteritis/colitis.
Prevention
There is a high risk of CMV infection in people who receive an organ transplant from a CMV-positive donor. Taking the antiviral drugs ganciclovir (Cytovene) and valganciclovir (Valcyte) by mouth before the transplant can lower your chance of getting a new infection or reactivating an old infection.
People with AIDS who are effectively treated with highly active antiretroviral therapy are much less likely to get a CMV infection.
References
Britt WJ. Cytomegalovirus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 137.
DuPont HL, Okhuysen PC. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 267.
Larson AM, Issaka RB, Hockenbery DM. Gastrointestinal and hepatic complications of solid organ and hematopoietic cell transplantation. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 36.
Wilcox CM. Gastrointestinal consequences of infection with human immunodeficiency virus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 35.
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Gastrointestinal anatomy - illustration
The gastrointestinal system is comprised of the stomach, and the small and large intestines.
Gastrointestinal anatomy
illustration
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Stomach and stomach lining - illustration
The stomach connects the esophagus to the small intestines and is where the majority of food digestion takes place.
Stomach and stomach lining
illustration
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CMV (cytomegalovirus) - illustration
Cytomegalovirus is a large herpes-type virus commonly found in humans that can cause serious infections in people with impaired immunity. The infection may result in pneumonia, gastroenteritis, retinitis or encephalitis. Antiviral medicines may stop the replication of the virus, but will not destroy it.
CMV (cytomegalovirus)
illustration
-
Gastrointestinal anatomy - illustration
The gastrointestinal system is comprised of the stomach, and the small and large intestines.
Gastrointestinal anatomy
illustration
-
Stomach and stomach lining - illustration
The stomach connects the esophagus to the small intestines and is where the majority of food digestion takes place.
Stomach and stomach lining
illustration
-
CMV (cytomegalovirus) - illustration
Cytomegalovirus is a large herpes-type virus commonly found in humans that can cause serious infections in people with impaired immunity. The infection may result in pneumonia, gastroenteritis, retinitis or encephalitis. Antiviral medicines may stop the replication of the virus, but will not destroy it.
CMV (cytomegalovirus)
illustration
Review Date: 5/4/2022
Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.