Maladies inflammatoires chroniques intestinales et hépatites B et C

Patients suffering from inflammatory bowel diseases (IBD) have long-been regarded to be at risk for B and C hepatitis. The two main risk factors may include blood transfusion and surgery, suggesting the role of nosocomial transmission. However, recent epidemiologic surveys find similar or even lower prevalence rates in IBD patients than in general population. HBV vaccination on one hand and blood transfusion secure for HCV may partly explain these recent data. Viral reactivations, sometimes fatal, have been associated with immunosuppressive therapy. Two periods have to be distinguished under immunosuppressive drugs: during therapy, a rise of viremia associated with a decrease of immune-mediated hepatic lesions; after cessation of therapy, an immunologic rebound with a destruction of virus-infected hepatocytes. For HBV, preemptive strategy consisting of an antiviral analog is efficient in chronic HBs antigen carriers. For HCV, the impact of immunosuppressives on its natural history is unclear. Most studies provide comfort although no biopsies were performed before and after immunosuppressive treatment. Every physician managing IBD patients should be concerned by screening program and preventive measures for B and C hepatitis.