In this study, the frequency of HCV infection in PIBD patients was 3% (5/165 patients), while the estimated worldwide prevalence was 2.5% of the population (177.5 million infected adults); this ranges from 1.3% in the Americas to 2.9% in Africa [13].

The prevalence of HCV infection in children and adolescents has been reported to vary from 0.05–0.36% in the USA and Europe to 1.8–5.8% in certain developing countries [14]. However, these reports likely underestimate the true prevalence since current ascertainment practices enable only a small fraction of children expected to be infected with HCV to be identified [15]. Thus, the frequency of HCV infection is similar to that in the normal population; this result is in agreement with the Indian study conducted by Harsh and his colleagues in 2017 [16]. On contrary, Huang with his colleagues in 2014 and Szántó and his colleagues in 2020 reported that none of the patients of inflammatory bowel disease had hepatitis C virus infection [4, 17]. A multicentric study conducted by Martinelli and his colleagues in 2020 revealed that the HCV prevalence is much more higher in the IBD patients than in the normal population [18]. This might be attributed to different factors including duration of disease, time of HCV screening, severity of disease, and frequency of hospital admission.

The mean age of the patients in the present study was 8.65 ± 3.53 years, while Ashton and his collegues in 2019 reported in their study that the mean age of the IBD patients was 13.6 years, and it was 6 years in the study of Tse and his collegues in 2021 [19, 20].

In the present study, the mean age of diagnosis was 5.34 ± 3.45 years, while it was lower than other study of Ledder and his colleagues in 2020 about appraisal of the PIBD-classes criteria, who reported that age of diagnosis was 13 ± 3 years [21] and was 10.2 ± 4.1 years in the study of Velasco Rodríguez-Belvís and his collegues in 2020 [22].

Meanwhile, the mean duration of the disease was 3.31 ± 2.44 years in our study, and Mosli and Saadah in 2021 reported in their study that the mean duration of the disease of PIBD patients was 2.1 ± 2.4 years [23] together with another study of Shawihdi and his collegues in 2021 who reported that the mean duration of the disease was 109.5 months (5–540 months) [24].

Regarding the disease classification in our study, the majority of the patients were diagnosed as UC (64.8%), while 22.4% patients had CD, and 12.7% had IBD unclassified.

This is in agreement with the study of Clough and his colleagues in 2021 who reported that 66.7% were diagnosed with UC, 29.8% with CD, and 3.5% with IBD-U [25] and an Egyptian study of El-Shabrawi and his colleagues in 2020 who had different percentages as it revealed that the most of the cases (50%) had UC, (22.9%) had CD, and (27.1%) had IBD-U [6], together with the study of Hussein and his colleagues in 2020 who reported that out of 18 children diagnosed as IBD, 15 of them were diagnosed as ulcerative colitis (UC) and 3 of them diagnosed as Crohn’s disease (CD) [26] and also the study of Esmat and his colleagues in 2014 who found that among 157 patients, 135 patients were diagnosed with UC (86% of the total) and 22 patients with CD (14% of the total) [27]. This is in contrary to the study of Koumaki and his colleagues in 2021 reporting mucocutaneous manifestations in patients with inflammatory bowel disease, who reported that 441 (54.7%) patients had Crohn’s disease, 352 (43.7%) had ulcerative colitis, and 13 (1.6%) had IBD unclassified (IBD-U) [28]. As regards the PUCAI scoring of the UC patients, most of the patients (91.3%) were in clinical remission during the enrollment, only 2.2% had the disease in the severe form, and 6.5% had moderate disease form. This might be attributed that most of patients were controlled by the treatment. In the present study following the results of Esmat and his colleagues in 2014 who reported that most of the patients (66%) had mild disease, 17% had the disease in the severe form, and 52% had moderate disease form. This is unlike the study of Loras sand his colleagues in 2009 which revealed that 53% of the patients had moderate disease activity and 24% had the severe form, and regarding the course of the disease, the majority of them had a relapsing course (75%) [29]. While the PCDAI scoring of the CD patients, there were two (1.7%) patients who had severe disease, twenty-seven (22.6%) had moderate form and ninety, 75.6% of patients were in clinical remission.

Regarding the risk factors, our study revealed that the patients with positive HCV Abs were more likely to have more number of hospital admissions related or unrelated to IBD than patients with negative HCV Abs with statistically significant difference.

While there was not statistically significant difference between patients with positive HCV Abs and patients with negative HCV Abs as regards age, residence, weight, duration of the disease, and number of endoscopic procedure, the lack of association with endoscopic procedures suggests the existence of adequate preventive measures in centers attending to these patients.

Moreover, patients with −ve HCV were more likely to have history of surgery related to IBD, blood transfusion, and advanced grade of activity than patients with +ve HCV with statistically significant difference

Unlikely, the multicenter Spanish study of Loras and his colleagues (2009) who assessed the factors related to hepatitis B and C in inflammatory bowel disease patients and reported that transfusions and antibiotic use was significantly related to HCV infection [29].

While in the study of Huang and his colleagues (2014), potential risk factors for HCV were not analyzed due to the limited number of HCV-positive patients in the study [4].

Moreover, it was noticed that IBD patients who received steroid and biological treatment were less likely to had HCV +ve antibody than IBD patients who did not receive them. Also, those patients who had repeated courses of steroids were less likely to had positive HCV antibody than patients who did not receive repeated courses of steroids.

This may be explained by the altered immune status of the patients who were already on immunomodulatory and/or anti-TNFα therapy.

These results are in agreement with the Italian study of Losurdo and his colleagues in 2020 which included chronic viral hepatitis in inflammatory bowel disease patients who reported that the patients with HCV +ve antibody were less frequently exposed to infliximab, while no differences were found with other biologic or immunomodulatory drugs [30].

This is not in agreement with the study of Loras and his colleagues (2009) who reported much higher incidence of using steroids (73%) among negative HCV infection patients and (84%) among positive patients and also (79%) of negative patients and (87%) of the positive patients were on immunosuppressive therapy [29].