P0652 Norovirus Infection May Be Responsible For More Severe Flares of Ulcerative Colitis

Background

Viral infections are known to cause exacerbations of inflammatory bowel disease (IBD). Norovirus is responsible for highly contagious infections presenting with variable digestive tract symptoms. We checked the hypothesis that norovirus infection contributes to IBD flare.

Methods

A total of 58 IBD patients (18 with Crohn’s disease; CD, 40 with ulcerative colitis; UC) hospitalized from April to August 2024 for exacerbation of IBD, after exclusion of common bacterial and viral infections, were tested for the presence of norovirus in their stool specimen by one step combo card test.

Results

Norovirus infection was detected in 37% of IBD patients (42,5% with UC, 22,2% with CD).

Patients with UC infected with norovirus had higher CRP serum level (95,6±98,3 vs. 35,8±63,2 mg/l, p=0,004), required higher volume of i.v. fluids (45,5±36,8 vs.10,6±12,1 of 500 ml i.v. drips, p<0,001), were in need of greater number of abdominal x-rays (64,7% vs. 21,74%, p=0,016), CT scans (70,6% vs. 30,4%, p=0,028) and longer hospitalization time (20,7±14,4 vs. 9,5±10,7 days, p=0,003) than patients not infected.

Moreover, norovirus positive patients showed higher total Mayo score (9,94±1,82 vs. 6,83±3,57, p=0,004) with higher patients’ self-reported subscores (stool frequency 3,00±0,00 vs. 2,04±1,26, p=0,021; rectal bleeding 2,41±1,00 vs. 1,65±1,22, p=0,043) and the physician-rated subscore (2,71±0,59 vs. 1,65±0,98, p<0,001). Respective comparison of in the endoscopic subscore was: 2,81±0,40 vs. 2,07±1,10 (p=0,052).

Four (23,5%) norovirus positive UC patients required colectomy due to pharmacological treatment failure vs. single (5,88%) norovirus negative patient.

Previously used biological, immunosuppressive and steroid therapies were not associated with risk factors for norovirus infection (p>0,05).

In CD norovirus infection had no significant impact on investigated parameters. Crohn’s Disease Activity Index was 208±133,21 vs. 259,07±125,45 (p=0,4250) in infected and not infected patients, respectively.

Conclusion

Norovirus infection was responsible for more severe flare in UC but not in CD, characterized by higher Mayo score, increased need for intravenous hydration, imaging examinations and surgery resulting in longer hospitalization time. Norovirus infection seems to be independent on biological, immunosuppressive or steroid therapy.

References

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