Journal of Gastroenterology

, Volume 45, Issue 12, pp 1255–1262 | Cite as

The requirement for a sufficient period of corticosteroid treatment in combination with nucleoside analogue for severe acute exacerbation of chronic hepatitis B

  • Keiichi FujiwaraEmail author
  • Shin Yasui
  • Koichiro Okitsu
  • Yutaka Yonemitsu
  • Shigeto Oda
  • Osamu Yokosuka
Original Article—Liver, Pancreas, and Biliary Tract



The prognosis of severe acute exacerbation of chronic hepatitis B is very poor if signs of liver failure appear. We have reported the efficacy of the early introduction of sufficient doses of corticosteroids (CSs) and nucleoside analogues (NAs), but the optimal period of immunosuppressive therapy has not been well demonstrated. In this study, we analyzed patients with severe acute exacerbation of chronic hepatitis B treated with CSs and NAs, prospectively, in order to clarify the factors affecting their outcome.


Ten patients, admitted to our liver unit between 2000 and 2009, were defined as having severe exacerbation of chronic hepatitis B based on our uniform criteria, and were enrolled in this study. NAs and sufficient doses of CS were introduced as soon as possible after making the diagnosis of severe disease prospectively.


Seven of the 10 patients recovered. The absence of fulminant hepatitis on admission, the improvement of prothrombin time (PT) activity and the decline of hepatitis B virus (HBV) DNA during the first 2 and 4 weeks, respectively, were significant in the recovered patients, while the worsening of total bilirubin level during 4 weeks, especially between week 2 and week 4, was significant in those who died.


In severe acute exacerbation of chronic hepatitis B, more than a few weeks of CS treatment in combination with an NA is required in the early stage, whereas a short period of conventional pulse therapy would be insufficient for treating this condition.


Chronic hepatitis B Severe exacerbation Corticosteroid Nucleoside analogue 



Hepatitis B virus




Nucleoside analogue



We are indebted to all our colleagues at the liver units of our hospitals who cared for the patients described herein.

Conflict of interest statement

No conflicts of interest exist.


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Copyright information

© Springer 2010

Authors and Affiliations

  • Keiichi Fujiwara
    • 1
    Email author
  • Shin Yasui
    • 1
  • Koichiro Okitsu
    • 1
  • Yutaka Yonemitsu
    • 1
  • Shigeto Oda
    • 2
  • Osamu Yokosuka
    • 1
  1. 1.Department of Medicine and Clinical Oncology, Graduate School of MedicineChiba UniversityChibaJapan
  2. 2.Department of Emergency and Critical Care Medicine, Graduate School of MedicineChiba UniversityChibaJapan

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