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Gustavsson, Anders
Publications (10 of 13) Show all publications
Gustavsson, A., Magnuson, A., Blomberg, B., Andersson, M. V., Halfvarson, J. & Tysk, C. (2013). Letter: the impact of smoking on clinical outcomes after endoscopic dilatation in Crohn's disease - authors' reply [Letter to the editor]. Alimentary Pharmacology and Therapeutics, 37(4), 500-501
Open this publication in new window or tab >>Letter: the impact of smoking on clinical outcomes after endoscopic dilatation in Crohn's disease - authors' reply
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2013 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 37, no 4, p. 500-501Article in journal, Letter (Refereed) Published
Keywords
smoking, Crohns disease
National Category
Gastroenterology and Hepatology
Research subject
Internal Medicine
Identifiers
urn:nbn:se:oru:diva-36013 (URN)10.1111/apt.12191 (DOI)000313891900025 ()
Available from: 2014-08-21 Created: 2014-08-21 Last updated: 2018-05-22Bibliographically approved
Gustavsson, A., Magnuson, A., Blomberg, B., Andersson, M. V., Halfvarson, J. & Tysk, C. (2013). Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease. Alimentary Pharmacology and Therapeutics, 37(4), 430-437
Open this publication in new window or tab >>Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease
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2013 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 37, no 4, p. 430-437Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn's disease (CD). Factors predicting outcome of the procedure are not well described.

AIM: To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation. The endpoint was requirement of a new intervention such as dilation or surgery with intestinal resection or strictureplasty.

METHODS: Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.

RESULTS: After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (adjusted HR: 2.50, 95% CI: 1.14-5.50, P = 0.022). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95% CI: 0.07-0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67 of those without azathioprine (HR: 0.46, 95% CI: 0.21-1.03, P = 0.06). After adjustment for other variables, the association was even weaker (HR: 0.80, 95% CI: 0.29-2.18, P = 0.668). Sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.

CONCLUSIONS: Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
National Category
Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-27422 (URN)10.1111/apt.12176 (DOI)000313891900007 ()23205619 (PubMedID)2-s2.0-84872687028 (Scopus ID)
Note

Funding Agency:

Foundation for Clinical Research in Inflammatory Bowel Disease, United States 

Uppsala-Örebro Regional Research Council, Sweden 

Available from: 2013-02-06 Created: 2013-02-06 Last updated: 2018-05-17Bibliographically approved
Zhulina, Y., Hahn-Strömberg, V., Shamikh, A., Peterson, C. G. B., Gustavsson, A., Nyhlin, N., . . . Halfvarson, J. (2013). Subclinical Inflammation with Increased Neutrophil Activity in Healthy Twin Siblings Reflect Environmental Influence in the Pathogenesis of Inflammatory Bowel Disease. Inflammatory Bowel Diseases, 19(8), 1725-1731
Open this publication in new window or tab >>Subclinical Inflammation with Increased Neutrophil Activity in Healthy Twin Siblings Reflect Environmental Influence in the Pathogenesis of Inflammatory Bowel Disease
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2013 (English)In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, no 8, p. 1725-1731Article in journal (Refereed) Published
Abstract [en]

Background: The mechanisms behind increased fecal calprotectin (FC) in healthy relatives of patients with inflammatory bowel disease (IBD) are unknown. Our aims were to explore if there is a subclinical inflammation with increased neutrophil activity in healthy twin siblings in discordant twin pairs with IBD and to assess the influence of genetics in this context.

Methods: Nuclear factor kappa B (NF-B) and neutrophil activity, based on myeloperoxidase (MPO) and FC, were analyzed in healthy twin siblings in discordant twin pairs with IBD and compared with healthy controls. NF-B and MPO were assessed by immunohistochemistry and FC by enzyme-linked immunosorbent assay.

Results: In total, 33 of 34 healthy twin siblings were histologically normal. Increased NF-B was more often observed in healthy twin siblings in discordant twin pairs with Crohn's disease (13/18 [73%]) and with ulcerative colitis (12/16 [75%]) than in healthy controls (8/45 [18%]). MPO was more often increased in healthy twin siblings in discordant pairs with Crohn's disease (12/18 [67%]) than in healthy controls (11/45 [24%]) and FC more often in healthy twin siblings in discordant pairs with ulcerative colitis (14/21 [67%]) than in healthy controls (6/31 [19%]). Interestingly, the observed differences remained when healthy monozygotic and dizygotic twin siblings were analyzed separately.

Conclusions:We observed increased NF-B, MPO, and FC in healthy twins in both monozygotic and dizygotic discordant pairs with IBD. These novel findings speak for an ongoing subclinical inflammation with increased neutrophil activity in healthy first-degree relatives.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2013
Keywords
Inflammatory bowel disease, twins, genetics, subclinical activity, nuclear factor-kappa B, myeloperoxidase, F-calprotectin
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-33716 (URN)10.1097/MIB.0b013e318281f2d3 (DOI)000329363800019 ()23669399 (PubMedID)2-s2.0-84884574092 (Scopus ID)
Funder
Swedish Research Council
Note

Funding Agencies:

Bengt Ihre's foundation  

Nanna Svartz' foundation  

Orebro University Hospital Research Foundation  

Orebro County Research Foundation  

Swedish Foundation for Gastrointestinal research

Available from: 2014-02-12 Created: 2014-02-12 Last updated: 2018-09-11Bibliographically approved
Gustavsson, A., Magnuson, A., Blomberg, B., Andersson, M. V., Halfvarson, J. & Tysk, C. (2012). Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease. Alimentary Pharmacology and Therapeutics, 36(2), 151-158
Open this publication in new window or tab >>Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease
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2012 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 36, no 2, p. 151-158Article in journal (Refereed) Published
Abstract [en]

Background: Bowel strictures are a major cause of morbidity, hospitalisation and surgery in Crohn's disease.

Aim: We report short- and long-term efficacy and safety of endoscopic balloon dilation of strictures due to Crohn's disease.

Methods: Retrospective study of patients who underwent endoscopic balloon dilation between 1987 and 2009.

Results: We performed 776 dilations, of which 621 (80%) were on anastomotic strictures, in 178 patients (94 women) with Crohn's disease. At first dilation, median (IQR) age of patients was 45 (37-56) years and disease duration 16 (8-22) years. Technical success rate was 689/776 (89%). A subset of 75 patients from the primary catchment area, with >5-year follow-up, underwent a total of 246 dilations. At 1-year follow-up, 60/75 (80%) patients had undergone no further intervention or one additional dilation only. At 3 and 5 years, corresponding figures were 43/75 (57%) and 39/75 (52%). Cumulative proportions of patients undergoing surgery at 1, 3 and 5 years were 13%, 28% and 36%. Complication rate per procedure for all 178 patients was 41/776 (5.3%), bowel perforation (n = 11, 1.4%), major bleeding requiring blood transfusion (n = 8, 1.0%), minor bleeding (n = 10, 1.3%) and abdominal pain or fever (n = 12, 1.5%). Ten patients underwent surgery due to complications (perforation n = 8, bleeding n = 2). There was no procedure-related mortality.

Conclusion: Endoscopic balloon dilation is an efficacious and safe alternative to surgical resection of intestinal strictures in Crohn's disease. At 5-year follow-up, 52% of patients required no further or one additional dilation only, whereas 36% had undergone surgical resection. Complication frequency was low.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2012
National Category
Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-24220 (URN)10.1111/j.1365-2036.2012.05146.x (DOI)000305329000008 ()22612326 (PubMedID)2-s2.0-84862508948 (Scopus ID)
Note

Funding Agencies:

Foundation for Clinical Research in Inflammatory Bowel Disease, United States 

Uppsala-Örebro Regional Research Council, Sweden 

Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
Sjöberg, M., Walch, A., Meshkat, M., Gustavsson, A., Järnerot, G., Vogelsang, H., . . . Tysk, C. (2012). Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: a retrospective observational study. Inflammatory Bowel Diseases, 18(2), 212-218
Open this publication in new window or tab >>Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: a retrospective observational study
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2012 (English)In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 18, no 2, p. 212-218Article in journal (Refereed) Published
Abstract [en]

Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. Results: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. Conclusions: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.

Place, publisher, year, edition, pages
John Wiley & Sons, 2012
Keywords
Ulcerative colitis, cyclosporine, infliximab, rescue therapy, colectomy
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-21631 (URN)10.1002/ibd.21680 (DOI)000298957800004 ()21438096 (PubMedID)2-s2.0-84855698480 (Scopus ID)Malden, USA (Local ID)Malden, USA (Archive number)Malden, USA (OAI)
Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2018-08-28Bibliographically approved
Gustavsson, A. (2012). Therapy in inflammatory bowel disease. (Doctoral dissertation). Örebro: Örebro universitet
Open this publication in new window or tab >>Therapy in inflammatory bowel disease
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis is to study treatment of inflammatory bowel disease with respect to an acute severe attack of ulcerative colitis and endoscopic balloon dilation in stricturing Crohn’s disease.

A retrospective follow-up was made in 158 patients who were given intensive intravenous corticosteroid treatment due a severe, moderate, or mild attack of ulcerative colitis between 1975 and 1982. After 10 years, the colectomy frequency in the severe disease group was 64%, and 49% and28% in the moderate and mild groups, respectively. Severity of the original attack did not influence the subsequent clinical course with respect to colectomy.

In 2005, a controlled Swedish–Danish trial of infliximab as rescue therapy in an acute severe attack of steroid refractory ulcerative colitis showed that colectomy frequencies after 3 months were lower in infliximab-treated patients (29%) compared to placebo-treated patients (67%). After 3 years, a statistically significantly lower colectomy frequency remained in patients treated with infliximab (50%) compared to placebo (76%).

Between 1989 and 2009, 178 patients underwent endoscopic balloon dilation due to intestinal strictures in Crohn’s disease. Seventy-five patients,with a follow-up of 5 years or longer, underwent dilations due to symptomatic strictures only. After 5 years of follow-up, 39/75 (52%) of the patients had undergone no further intervention or one additional dilation only, and 36% had had surgery. The complication frequency was 5.3%, of which 10 patients (1.3%) required surgery. In 83 patients, we studied whether smoking at diagnosis affected the outcome after index dilation. In the group of active smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) in never smokers (HR 2.18, 95% CI: 1.22-3.93,p = 0.01). Clinical parameters such as sex, age at diagnosis, age at first dilation, balloon size, localisation of stricture, treatment with azathioprine and treatment period did not influence outcome.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 75
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-25599 (URN)978-91-7668-897-7 (ISBN)
Public defence
2012-11-23, Wilandersalen, Universitetssjukhuset (USÖ), Örebro, 09:00 (Swedish)
Opponent
Available from: 2012-08-30 Created: 2012-08-30 Last updated: 2017-10-17Bibliographically approved
Gustavsson, A., Magnuson, A., Blomberg, B., Andersson, M. V., Halfvarson, J. & Tysk, C. (2011). Endoscopic Balloon Dilation of Intestinal Strictures in Crohn's Disease. Paper presented at Conference on Digestive Disease Week 2011, MAY 07-10, 2011, Chicago, IL, USA. Gastroenterology, 140(5), S140-S140
Open this publication in new window or tab >>Endoscopic Balloon Dilation of Intestinal Strictures in Crohn's Disease
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2011 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 140, no 5, p. S140-S140Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Saunders Elsevier, 2011
National Category
Gastroenterology and Hepatology
Research subject
Internal Medicine
Identifiers
urn:nbn:se:oru:diva-36871 (URN)10.1016/S0016-5085(11)60569-6 (DOI)000290167300570 ()
Conference
Conference on Digestive Disease Week 2011, MAY 07-10, 2011, Chicago, IL, USA
Available from: 2014-09-17 Created: 2014-09-17 Last updated: 2019-04-10Bibliographically approved
Eriksson, C., Gustavsson, A., Kronvall, T. & Tysk, C. (2011). Hepatotoxicity by bosentan in a patient with portopulmonary hypertension: a case-report and review of the literature. Journal of Gastrointestinal and Liver Diseases, 20(1), 77-80
Open this publication in new window or tab >>Hepatotoxicity by bosentan in a patient with portopulmonary hypertension: a case-report and review of the literature
2011 (English)In: Journal of Gastrointestinal and Liver Diseases, ISSN 1841-8724, E-ISSN 1842-1121, Vol. 20, no 1, p. 77-80Article in journal (Refereed) Published
Abstract [en]

Bosentan is an endothelin receptor antagonist approved for treatment of pulmonary arterial hypertension. Mild liver reactions occur in about 10% of treated patients but severe hepatotoxicity is rare. We present clinical data and treatment outcome of a severe drug induced liver injury due to bosentan in a patient with non-cirrhotic portopulmonary hypertension. After 18 months of uncomplicated therapy with bosentan 125 mg b.i.d., the patient developed a severe mixed hepatic injury. Serum levels of bilirubin were 316 µmol/l (ref. value <20 micromol/l), AST 14 µkat/l (ref. value < 0.9 µkat/l), ALT 10 µkat/l (ref. value < 0.9 µkat/l), ALP 8 µkat/l (ref. value <1.8 µkat/l) and INR 1.8 (ref. value 0.9-1.1). Complete diagnostic work-up disclosed no other cause of hepatotoxicity. Treatment with prednisolone 40 mg/day in tapering doses was ultimately added and the patient made a full recovery. Subsequent treatment with sildenafil and ambrisentan for pulmonary arterial hypertension was well tolerated and liver function tests have remained normal during 12 months' follow-up. A review of the literature revealed three other women with severe hepatotoxicity due to bosentan. Bosentan may cause severe liver injury, even after long uneventful therapy, and current recommendations on regular monitoring of liver function tests are reinforced. Ambrisentan may be a therapeutic alternative in patients with pulmonary arterial hypertension and hepatotoxicity by bosentan.

Place, publisher, year, edition, pages
Cluj: Medical University Press, 2011
National Category
Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-24212 (URN)000289044100014 ()21451802 (PubMedID)
Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2019-03-04Bibliographically approved
Gustavsson, A., Järnerot, G., Hertervig, E., Friis-Liby, I., Blomquist, L., Karlén, P., . . . Tysk, C. (2010). Clinical trial: colectomy after rescue therapy in ulcerative colitis-3-year follow-up of the Swedish-Danish controlled infliximab study. Alimentary Pharmacology and Therapeutics, 32(8), 984-989
Open this publication in new window or tab >>Clinical trial: colectomy after rescue therapy in ulcerative colitis-3-year follow-up of the Swedish-Danish controlled infliximab study
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2010 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 32, no 8, p. 984-989Article in journal (Refereed) Published
Abstract [en]

Background The long-term efficacy of infliximab as rescue therapy in steroid-refractory ulcerative colitis is not well described. Aim To examine the long-term efficacy of infliximab as a rescue therapy through a 3-year follow-up of a previous placebo-controlled trial of infliximab in acute steroid-refractory ulcerative colitis. Method In the original study, 45 patients were randomized to a single infusion of infliximab 5 mg/kg or placebo, and at 3 months, 7/24 patients given infliximab were operated vs. 14/21 patients given placebo. Three years or later, patients were asked to participate in a clinical follow-up. Results Another seven patients underwent colectomy during follow-up: five in the infliximab group and two in the placebo group. After 3 years, a total of 12/24 (50%) patients given infliximab and 16/21 (76%) given placebo (P = 0.012) had a colectomy. None of eight patients in endoscopic remission at 3 months later had a colectomy compared with 7/14 (50%) patients who were not in remission (P = 0.02). There was no mortality. Conclusion The benefit of rescue therapy with infliximab in steroid-refractory acute ulcerative colitis remained after 3 years. The main advantage of infliximab treatment occurred during the first 3 months, whereas subsequent colectomy rates were similar in the two groups. Mucosal healing at 3 months influenced later risk of colectomy.

National Category
Medical and Health Sciences Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-12877 (URN)10.1111/j.1365-2036.2010.04435.x (DOI)000282221200004 ()20937043 (PubMedID)
Available from: 2011-01-05 Created: 2011-01-03 Last updated: 2018-04-23Bibliographically approved
Rajani, R., Melin, T., Björnsson, E., Broomé, U., Sangfelt, P., Danielsson, Å., . . . Almer, S. H. C. (2009). Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival - an 18-year experience. Liver international (Print), 29(2), 253-259
Open this publication in new window or tab >>Budd-Chiari syndrome in Sweden: epidemiology, clinical characteristics and survival - an 18-year experience
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2009 (English)In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 29, no 2, p. 253-259Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The exact incidence and prevalence of Budd-Chiari syndrome (BCS) is unknown in the general population. Published reports differ in terms of the clinical characteristics, effects of therapy and survival. AIMS: To investigate the epidemiology, clinical presentation and survival in patients with BCS. METHODS: Retrospective multicentre study in Sweden reviewing the medical records of all patients with BCS 1986-2003, identified from the computerised diagnosis database of 11 hospitals, including all university hospitals and liver transplantation centres. RESULTS: Forty-three patients with BCS were identified, of whom nine (21%) had concomitant portal vein thrombosis. The mean age-standardised incidence and prevalence rates in 1990-2001 were calculated to be 0.8 per million per year and 1.4 per million inhabitants respectively. Myeloproliferative disorders (38%), thrombophilic factors (31%) and oral contraceptives (30%) were common aetiological factors. Two or more risk factors were present in 44%. In 23%, no risk factor was evident. The median follow-up time was 2.7 years. Seventy-two percent were on anticoagulant therapy during follow-up. Transjugular intrahepatic portosystemic shunting, surgical shunting procedures and liver transplantation were performed in 4, 6 and 18 patients respectively. Nineteen patients died. The overall transplantation-free survival at 1, 5 and 10 years was 47, 28 and 17% respectively. CONCLUSIONS: Budd-Chiari syndrome is a rare disorder; the mean age-standardised incidence and prevalence rates in Sweden in 1990-2001 were calculated to be 0.8 per million per year and 1.4 per million inhabitants respectively. The presence of a myeloproliferative disorder was a common aetiological factor in our cohort and about half of the patients had a multifactorial aetiology. The transplantation-free survival was poor.

Place, publisher, year, edition, pages
Oxford: Blackwell Munksgaard, 2009
National Category
Medical and Health Sciences Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-6968 (URN)10.1111/j.1478-3231.2008.01838.x (DOI)18694401 (PubMedID)
Available from: 2009-05-27 Created: 2009-05-27 Last updated: 2017-12-13Bibliographically approved
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