Hepatobiliary manifestations in inflammatory bowel disease: The gut, the drugs and the liver

Table 1 Phases of chronic hepatitis B infection

Phase	Characteristics	HBVDNA	ALT	Liver histology
Immune tolerant	HBeAg positive	> 2000000 UI/mL	Normal	Normal or mild inflammation
Immune active	HBeAg positive	> 200000 UI/mL	Elevated	Chronic hepatitis
				Active cirrhosis
Inactive carrier	HBeAg negative	< 2000 UI/mL	Normal	Normal or mild inflammation
	Anti-HBe positive			Mild fibrosis
				Inactive cirrhosis
HBeAg negative chronic hepatitis	HBeAg negative	> 20000 UI/mL	Elevated	Chronic hepatitis
	Anti-HBe positive		(fluctuating)	Active cirrhosis
Remission	HBsAg negative	Indetectable in serum and detectable in liver	Normal	Normal
	Anti-HBc positive			Mild fibrosis
				Inactive cirrhosis

HBV: Hepatitis B virus; ALT: Alanine aminotransferase; HBeAg: Hepatitis B e antigen.

Table 2 Drug induced hepatobiliary manifestations in inflammatory bowel disease

Manifestation	Drug
Drug induced hepatitis	Azathioprine
	6-mercaptopurine
	Methotrexate
	Cyclosporine
	Infliximab
Reactivation of hepatitis B	Anti-TNF therapy
	Corticosteroids
Drug induced pancreatitis	Azathioprine
	6-mercaptopurine
	Methotrexate
Hepatosplenic T-cell lymphoma	Combination of anti-TNF and immunosuppressive therapy

TNF: Tumor necrosis factor.