Hepatitis E Infection in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Hepatology
• Infectious Diseases

Background:

• Opportunistic infections are a growing concern in inflammatory bowel disease (IBD), especially with immunosuppressive therapies.
• Hepatitis E virus (HEV) is a significant cause of viral hepatitis globally, but its role in IBD is not well-defined.

Purpose of the Study:

• To systematically review and meta-analyze the association between HEV infection and IBD.
• To determine the prevalence of HEV infection markers in IBD patients and compare them to the general population.

Main Methods:

• A comprehensive literature search was conducted in PubMed/MEDLINE and Google Scholar up to May 2025.
• Six studies with 1316 IBD patients were included, assessing HEV infection markers (anti-HEV IgG, IgM, HEV-RNA).
• Study quality was evaluated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies.

Main Results:

• The pooled prevalence of anti-HEV IgG in IBD patients was 13.5% (heterogeneous).
• Anti-HEV IgM and HEV-RNA positivity rates were low (1.9% and 0.03%, respectively).
• HEV prevalence in IBD patients was similar to the general population, but higher in immunocompromised transplant recipients and those with intensified immunosuppression.

Conclusions:

• HEV prevalence in IBD patients generally mirrors the general population.
• Unexplained liver enzyme elevations in IBD patients warrant consideration of HEV infection.
• Severe immunosuppression in IBD may increase susceptibility to persistent HEV infection and complications, suggesting routine testing.