Intest Res.  2023 Jul;21(3):392-405. 10.5217/ir.2022.00094.

Prevalence of hepatitis B virus and hepatitis C virus infection in patients with inflammatory bowel disease: a systematic review and meta-analysis

• Giri S
• Agrawal D
• Afzalpurkar S
• Kasturi S
• Gopan A
• Sundaram S
• Kale A

• KMID: 2544762
• DOI: http://doi.org/10.5217/ir.2022.00094

Abstract

Background/Aims
The data on the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in patients with inflammatory bowel disease (IBD) are conflicting. The present systematic review was thus conducted to study the prevalence of HBV and HCV markers in patients with IBD.
Methods
A comprehensive literature search of 3 databases was conducted from 2000 to April 2022 for studies evaluating the prevalence of HBV or HCV in patients with IBD. Pooled prevalence rates across studies were expressed with summative statistics.
Results
A total of 34 studies were included in the final analysis. The pooled prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B core antibodies were 3.3% and 14.2%, respectively. In HBsAg positive IBD patients, hepatitis B e antigen positivity and detectable HBV DNA were seen in 15.3% and 61.0% of patients, respectively. Only 35.6% of the IBD patients had effective HBV vaccination. The pooled prevalence of anti-HCV and detectable HCV RNA were 1.8% and 0.8%, respectively. The pooled prevalence of markers of HBV infection was higher in Asian studies, while the prevalence of markers of HCV infection was higher in European studies. The prevalence of viral hepatitis markers was similar between IBD patients and the general population and that between ulcerative colitis and Crohn’s disease.
Conclusions
The prevalence of markers of viral hepatitis remains same as the general population with significant regional variations, although the quality of evidence remains low due to publication bias. Only a small proportion of IBD patients had an effective HBV vaccination, requiring improvement in screening and vaccination practices.

Keyword

Inflammatory bowel disease; Colitis, ulcerative; Crohn disease; Hepatitis B; Hepatitis C

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart showing the study screening and selection process. IBD, inflammatory bowel disease.

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  Fig. 2. Forest plot showing the pooled prevalence of hepatitis B surface antigen (HBsAg) in patients with inflammatory bowel disease with subgroup analysis based on the continent of study. DL, DerSimonian and Laird method; CI, confidence interval.

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  Fig. 3. Geographic heat map for prevalence of (A) hepatitis B surface antigen and (B) anti-HCV in patients with inflammatory bowel disease. HBV, hepatitis B virus; HCV, hepatitis C virus.

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  Fig. 4. Forest plot comparing the prevalence of hepatitis B core antibody in patients with ulcerative colitis (UC) and Crohn's disease (CD). M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 5. Forest plot showing the pooled prevalence of anti-hepatitis C virus (HCV) in patients with inflammatory bowel disease with subgroup analysis based on the continent of study. DL, DerSimonian and Laird method; CI, confidence interval.

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  Fig. 6. Meta-regression for the assessment of the source of heterogeneity concerning anti-hepatitis C virus (HCV) in patients with inflammatory bowel disease analyzing (A) year of publication, (B) study continent, (C) sample size, and (D) mean age. CI, confidence interval.

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