Viral hepatitis and inflammatory bowel disease

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http://www3.interscience.wiley.com/journal/123354792/abstract?CRETRY=1 & SRETRY=0

Inflammatory Bowel Diseases

Early View (Articles online in advance of print)

Published Online: 15 Apr 2010

Crohn's & Colitis Foundation of America, Inc.

Clinical Guidelines

Viral hepatitis and inflammatory bowel disease

K. Hou, MD 1, Velayos, MD 2, Norah Terrault, MD 2, Uma Mahadevan,

MD 2 *

1Baylor College of Medicine, Houston, Texas

2University of California San Francisco, San Francisco, California

email: Uma Mahadevan (uma.mahadevan@...)

*Correspondence to Uma Mahadevan, Associate Professor of Medicine, University of

California, San Francisco, 2330 Post Street #610, San Francisco, CA 94115

Abstract

Viral hepatitis is common worldwide and in the United States. Inflammatory bowel

disease (IBD) patients with chronic hepatitis B virus (HBV) with active disease

(elevated alanine aminotransferase level and viral replication) should receive

HBV treatment. HBV reactivation is associated with significant morbidity and

mortality in patients receiving immunosuppression. IBD patients may require

long-term immunosuppression, and therefore should be considered candidates for

vaccination against new HBV infection as well as prophylaxis against HBV

reactivation prior to immunosuppressive therapy. Tumor necrosis factor alpha

antagonists and immunomodulators appear compatible with use in IBD patients with

HCV, although prednisone may increase viral replication. HCV treatment with

peg-interferon and ribavirin may exacerbate gastrointestinal symptoms, and

therefore the decision to treat HCV needs to be individualized. Management of

IBD patients with viral hepatitis is addressed in this review. (Inflamm Bowel

Dis 2010;)

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Received: 5 February 2010; Accepted: 15 February 2010

Digital Object Identifier (DOI)

10.1002/ibd.21284