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Liver dysfunction related to hepatitis B and C in patients with inflammatory bowel disease treated with immunosuppressive therapy
  1. C Loras1,
  2. J P Gisbert2,3,
  3. M Mínguez4,
  4. O Merino5,
  5. L Bujanda3,6,
  6. C Saro7,
  7. E Domenech3,8,
  8. J Barrio9,
  9. M Andreu10,
  10. I Ordás3,11,
  11. L Vida12,
  12. G Bastida3,13,
  13. F González-Huix14,
  14. M Piqueras15,
  15. D Ginard16,
  16. X Calvet3,17,
  17. A Gutiérrez3,18,
  18. A Abad19,
  19. M Torres20,
  20. J Panés3,11,
  21. M Chaparro2,3,
  22. I Pascual4,
  23. M Rodriguez-Carballeira21,
  24. F Fernández-Bañares1,
  25. J M Viver1,
  26. M Esteve1,
  27. for the REPENTINA study,
  28. GETECCU (Grupo Español de Enfermedades de Crohn y Colitis Ulcerosa) Group
  1. 1Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Spain
  2. 2Department of Gastroenterology, Hospital de la Princesa, Madrid, Spain
  3. 3Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
  4. 4Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Valencia, Spain
  5. 5Department of Gastroenterology, Hospital de Cruces, Barakaldo-Vizcaya, Spain
  6. 6Department of Gastroenterology, Hospital de Donostia, University of the Basque Country, San Sebastian-Guipúzcoa, Spain
  7. 7Department of Gastroenterology, Hospital de Cabueñes, Gijón, Asturias, Spain
  8. 8Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  9. 9Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
  10. 10Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
  11. 11Department of Gastroenterology, Hospital Clínic, Barcelona, Spain
  12. 12Department of Gastroenterology, Hospital Reina Sofía, Cordoba, Spain
  13. 13Department of Gastroenterology, Hospital la Fe, Valencia, Spain
  14. 14Department of Gastroenterology, Hospital Josep Trueta, Girona, Spain
  15. 15Department of Gastroenterology, Consorci de Terrassa, Catalonia, Spain
  16. 16Department of Gastroenterology, Hospital de Son Dureta, Palma de Mallorca, Spain
  17. 17Department of Gastroenterology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
  18. 18Department of Gastroenterology, Hospital General de Alicante, Alicante, Spain
  19. 19Department of Gastroenterology, Hospital de St Llorenç, Viladecans, Spain
  20. 20Department of Gastroenterology, Hospital de l'Esperit Sant, Barcelona, Spain
  21. 21Internal Medicine, Hospital Universitari Mútua de Terrassa, Fundació per la Recerca Mútua de Terrassa, Terrassa, Spain
  1. Correspondence to Maria Esteve, Department of Gastroenterology, Hospital Mútua de Terrassa, Universitat de Barcelona, Plaça Dr Robert n 5, 08221 Terrassa, Barcelona, Catalonia, Spain; mestevecomas{at}telefonica.net

Abstract

Background There is no information about the frequency of liver dysfunction in patients with inflammatory bowel disease (IBD) treated with immunosuppressants and infected with hepatitis B (HBV) and/or C virus (HCV).

Aim To assess the influence of immunosuppressants on the course of HBV and HCV infection in IBD.

Methods Patients with IBD with HBV and/or HCV infection from 19 Spanish hospitals were included. Clinical records were reviewed for the type of immunosuppressant used, treatment duration, liver function tests and viral markers before, during and after each immunosuppressant. Logistic and Cox regression analysis were used to identify predictors of outcome.

Results 162 patients were included; 104 had HBV markers (25 HBsAg positive) and 74 had HCV markers (51 HCV-RNA positive), and 16 patients had markers of both infections. Liver dysfunction was observed in 9 of 25 HBsAg positive patients (36%), 6 of whom developed hepatic failure. Liver dysfunction in HCV was observed in 8 of 51 HCV-RNA positive patients (15.7%), and only one developed hepatic failure. The frequency and severity of liver dysfunction was significantly higher in HBV-infected patients than in HCV-infected patients (p=0.045 and p=0.049, respectively). Treatment with ≥2 immunosuppressants was an independent predictor of HBV reactivation (OR 8.75; 95% CI 1.16 to 65.66). The majority of patients without reactivation received only one immunosuppressant for a short period and/or prophylactic antiviral treatment. No definite HBV reactivations were found in anti-HBc positive patients lacking HBsAg.

Conclusion Liver dysfunction in patients with IBD treated with immunosuppressants is more frequent and severe in those with HBV than in HCV carriers and is associated with combined immunosuppression.

  • Liver dysfunction
  • hepatitis B
  • hepatitis C
  • inflammatory bowel disease
  • immunosuppressive therapy

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Footnotes

  • Study organisation and investigators from the GETECCU and REPENTINA group of the Spanish Gastroenterological Association who participated in the study: Hospital Universitario Mútua de Terrassa: Montserrat Forné, Mercè Rosinach, Jorge Carlos Espinós, Rocio Temiño, Victoria Gonzalo. Hospital Clínico Universitario de Valencia: Francisco Mora. Hospital de Donostia, San Sebastian-Guipúzcoa: Ana Muñagorri, Maria Belen Irastorza, Ines Gil, Arantxa Iribarren, José R Sáenz. Hospital de Cabueñes, Gijón, Asturias: Cristobal de la Coba Ortiz. Hospital Universitario Germans Trias i Pujol, Badalona: Eduard Cabré, Miriam Mañosa. Hospital Universitario Río Hortega, Valladolid: Jesús Barrio, Paula Gil-Simón, Ramón Atienza. Hospital Reina Sofía, Córdoba: Federico Gómez Camacho, Eva Iglesias Flores, Valle García Sánchez. Hospital la Fe de Valencia: Andrea Nevarez, Cristina Sanchez. Hospital Josep Trueta, Girona: Marcela Perez. Consorci de Terrassa: Jaume Boadas, Jordi Ortiz, David Montfort. Hospital Parc Taulí de Sabadell: Antònia Montserrat, Albert Villòria. Hospital de St Llorenç, Viladecans: Mercè Barenys, Ana Belen Vega. Hospital de l’Esperit Sant, Barcelona: Llúcia Titó Espinagosa.

  • Funding CIBEREHD is funded by the Instituto de Salud Carlos III.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Hospital Universitari Mútua de Terrassa.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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