What are the treatment options for CMV enterocolitis?
The natural history of CMV colitis is variable. In untreated patients, it usually has a chronic course characterized by progressive diarrhea and weight loss, although occasionally symptoms and histologic abnormalities remit spontaneously. Unlike CMV retinitis, for which strong evidence supports induction therapy followed by lifelong maintenance therapy, the optimal duration of therapy and the need for maintenance therapy in CMV colitis are undefined. Consensus guidelines recommend 3 to 6 weeks of induction therapy, typically ganciclovir, followed by maintenance therapy if there is a history of relapses. Valganciclovir can be given orally and achieves serum concentrations similar to intravenous ganciclovir. Studies for GI disease are limited. Funduscopic examination at the time of diagnosis of CMV enterocolitis is mandatory, because duration of therapy is considerably longer for disseminated diseases than for disease limited to the GI tract.