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P267. Chronic viral hepatitis in Asian patients with inflammatory bowel disease

W.-H. Chen, W.-C. Lim, Tan Tock Seng Hospital, Department of Gastroenterology and Hepatology, Singapore, Singapore

Background

Hepatitis B (HBV) reactivation and fatal flares have been reported with the use of immunomodulators and biologic therapy, while interferon-based hepatitis C (HCV) therapy may potentially exacerbate inflammatory bowel disease (IBD) activity. Screening for HBV has been recommended for IBD patients; prophylactic antiviral therapy should be started before commencing immunosuppressive treatment in HBsAg+ patients while HBV vaccination is recommended in seronegative patients. Although the prevalence of HBV and HCV in Singapore is 4.1% and 0.37% respectively, the prevalence of HBV/HCV infection and serological markers in IBD patients is not well characterised. Recent data also suggests a higher prevalence of HBV infection in IBD patients. Our aim is to evaluate the prevalence of HBV/HCV infection and serological markers in Asian patients with IBD in Singapore, a multiracial country in Southeast Asia, consisting mainly of Chinese (CH), Malays (MAL) and Indians (IND).

Methods

Case notes and electronic records of patients with ulcerative colitis (UC) or Crohn's disease (CD) who were treated at our centre from 2002–2013 were retrospectively reviewed. Medical records were extracted for clinical and laboratory data for IBD and HBV/HCV. The diagnoses of HBV and HCV infection were according to international guidelines and definitions. Data was analysed using student's T-test or chi-square test.

Results

Of 152 IBD patients (96 UC, 56 CD), 25 (16%) were not screened for HBV/HCV infection and were excluded. Of 127 included patients (77 UC, 50 CD), 78 were males (61%) and 49 females (39%) with median age of 48 (range 17–90); 78 (61%) were CH, 32 (25%) IND, 14 (11%) MAL and 3% were of other Asian ethnicity. This is a fair representation of local demographics. Past/present HBV infection was found in 13.4% (Anti-HBc+: 10 UC, 7 CD) of which 4.7% were chronic HBV carriers (HBsAg+: 4 UC, 2 CD; 5 inactive carriers, 1 eAg-ve chronic hepatitis B) and only 1 CD patient (0.79%) was diagnosed with Type 1 HCV/HIV coinfection. These were not significantly different from the population prevalence of 4.1% (p = 0.6) and 0.37% (p = 0.4). Anti-HBc+ patients were older (mean age 58 vs 46, p < 0.01), age >40 (18% vs 5%) and more common among CH (21% vs 7% MAL, 0% IND, p = 0.02). Among Anti-HBc-ve patients, only 43 (39%) were anti-HBs+ (vaccinated). A significantly greater proportion of female patients (73% vs 53%, p = 0.03) and a trend for those age >40 (67% vs 51%, p = 0.1) were not vaccinated.

Conclusion

The prevalence of HBV/HCV infection among Asian IBD patients in Singapore is similar to the general population. Physicians should be reminded regarding HBV screening (16% not screened) and vaccination (61% not vaccinated), especially among Chinese/age >40 (HBV infection) and women/age >40 (vaccination).