REVIEW ARTICLE Approach and Management of Patients with Chronic Hepatitis B and C During the Course of Inflammatory Bowel Disease Sahin Coban, MD,* Murat Kekilli, MD, † and Seyfettin Köklü, MD ‡ Abstract: Inflammatory bowel disease and chronic viral hepatitis are 2 distinct but common conditions throughout the world. Mostly, both need life- long follow-up. Since immunosuppressive drugs remain corner stones of inflammatory bowel disease management, one should be aware of the concomitant presence of chronic viral hepatitis in such patients to prevent serious (even fatal) outcomes. Recently, new treatment options have become available in the treatment of both inflammatory bowel disease and chronic viral hepatitis. In this review, we have discussed and summarized current treatment and follow-up strategies for those 2 important public health issues in light of available literature. (Inflamm Bowel Dis 2014;20:2142–2150) Key Words: inflammatory bowel disease, ulcerative colitis, Crohn’s disease, hepatitis B, hepatitis c INFLAMMATORY BOWEL DISEASE AND HEPATITIS B Viral hepatitis B is a common health problem all over the world. It has been estimated that about 3 billion people have been exposed to the hepatitis B virus (HBV), and over 350 million people have chronic HBV infection. 1 Chronic HBV infection can be divided into 3 stages according to laboratory and histopathol- ogy findings: active, inactive HBV carriers, and resolved HBV. 2 Active chronic HBV is defined as HBV DNA levels $2000 IU/L with elevated alanine aminotransferase levels. Inactive HBV carriers are defined by HBV DNA levels # 2 IU/L and normal alanine aminotransferase levels, and antiviral therapy is not indi- cated at this stage. Treatment is indicated if the patient is in active stage irrespective of the immune status. Antiviral prophylaxis has to be given to patients treated with immunosuppressant drugs because viral reactivation may occur regardless of DNA levels. Antiviral therapy is not needed for patients with resolved HBV but they have to be monitored during the course of immunosuppressant therapy, and prophylactic therapy should be given as needed based on DNA levels. Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract. The major types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). In recent years, treatment of these two conditions has been markedly improved with the use of immunosuppressants and biological therapies. Over time, these drugs have been used earlier and more extensively for longer duration. Subsequently, concerns associated with immunosup- pressive treatment have grown among physicians working in the field of IBD care. 3 One of these concerns is the reactivation of HBV infection. Immunosuppresants and biological therapies have a consid- erable impact on the natural course of HBV infection, and there are many questions that need to be answered to explain the association between IBD and HBV. In this article, we reviewed the management of patients with IBD and viral hepatitis B or C. Prevalence of HBV Infection in Patients with IBDs In some prior studies, a significantly higher prevalence of HBV infection has been reported in patients with IBD than in controls; thus, patients with longstanding IBD seem to be at higher risk for viral hepatitis compared with general population because of the need for endoscopic procedures, surgery, and blood transfusions, suggesting nosocomial transmission of the virus. Consistent with this argument, Biancone et al 4 reported that antibodies to hepatitis B core protein (anti-HBc) were present in 11% of the patients with IBD, a rate that was statistically signif- icantly higher than in controls. However, in a recent study reported by Loras et al, 5 the risk of hepatitis B reactivation has been established in patients with IBD in Spain. In that prospective cross-sectional nationwide study, the prevalence of current and/or past hepatitis B biologic markers was similar to that of general population but lower than reported in studies. Similarly, in a recent study from France, it was observed that HBcAb positivity among IBD patients was comparable with that of the general French population. 6 Therefore, decreasing prevalence of viral hepatitis B in patients with IBD reported by studies from both countries suggests that preventative measures such as vaccination, use of Received for publication May 1, 2014; Accepted May 28, 2014. From the *Department of Gastroenterology, Diskapi Research and Training Hospital, Ankara, Turkey; † Department of Gastroenterology, Ankara Research and Training Hospital, Ankara, Turkey; and ‡ Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey. The authors have no conflicts of interest to disclose. Reprints: Seyfettin Köklü, MD, Baglarbasi Mahallesi, Duman Sokak, 55/11, Kec ¸iören, Ankara, Turkey 06300 (e-mail: gskoklu@yahoo.com). Copyright © 2014 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1097/MIB.0000000000000126 Published online 28 July 2014. 2142 | www.ibdjournal.org Inflamm Bowel Dis  Volume 20, Number 11, November 2014