Epstein-Barr virus and inflammatory bowel disease: a systematic review of its clinical significance and potential pathogenic role.

What To Know

This article pooled and assessed studies that used serology, molecular, and tissue-based methods to detect EBV in people with IBD. Across 45 included studies, EBV appeared more common in intestinal biopsies from patients with active or treatment-refractory IBD, while blood-based and serologic findings were inconsistent.

The authors describe biologically plausible mechanisms (for example, EBV-infected B cells, molecular mimicry, and altered cytokine signaling) but emphasize these remain unproven in IBD.

They also note that certain treatments (corticosteroids, and combination infliximab plus azathioprine) have been associated with higher EBV loads in some studies, though confounding by disease severity is likely.

The review concludes that current evidence supports an association between EBV and IBD—especially severe or refractory cases—but cannot determine whether EBV is causal, a disease modifier, or simply a marker of immune dysregulation. The authors call for prospective mechanistic studies.