oru.sePublikationer
Ändra sökning
Avgränsa sökresultatet
1 - 45 av 45
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    Almon, Ricardo
    et al.
    Örebro universitet, Hälsoakademin.
    Engfeldt, Peter
    Örebro universitet, Hälsoakademin.
    Tysk, Curt
    Örebro universitet, Hälsoakademin.
    Sjöström, Michael
    Nilsson, Torbjörn K.
    Örebro universitet, Hälsoakademin.
    Prevalence and trends in adult-type hypolactasia in different age cohorts in Central Sweden diagnosed by genotyping for the adult-type hypolactasia-linked LCT -13910C > T mutation2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 2, s. 165-170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Adult-type hypolactasia (AtH) can be diagnosed by genotyping in addition to functional tests or intestinal biopsy. The aims of this study were to estimate the prevalence of AtH by genotyping and to investigate whether AtH prevalence has changed in Sweden during the 20th century. MATERIAL AND METHODS: Schoolchildren (n=690) born in 1983 and 1989, and elderly individuals (n=392) born between 1920 and 1932 were genotyped for AtH using Pyrosequencing technology. RESULTS: The overall prevalence of AtH among children was 14.1%. The majority of children (92%, n=635) were Caucasians with genotype prevalences: CC, 61 (10%); CT, 259 (41%); TT, 307 (49%). The frequency of the mutated allele q was 0.300 in this cohort. The prevalence of AtH estimated from the Hardy-Weinberg equilibrium (HWE) (q 2), was 9.0% (95% CI: 6.7-11.2%). Eight percent (n=55) of the children were non-Caucasian; genotype prevalences were CC, 36 (66%); CT, 15 (27%); TT, 4 (7%). The prevalence of AtH in these children estimated from HWE was 62.5% (95% CI: 49.7-75.3%). The elderly subjects were all Caucasians. Their genotype prevalences were: CC, 20 (5%); CT, 166 (42%); TT, 206 (53%); the frequency of the mutated allele q was 0.262 and their AtH prevalence estimated from HWE was 6.8% (95% CI: 4.3-9.2%). CONCLUSIONS: The overall prevalence of AtH in children (14%) was higher than previously thought. Among Caucasians, higher figures were seen in children than in the elderly (9% versus 6.8%). The prevalence thus seems to be increasing and this may be due to the immigration of both non-Caucasian and Caucasian groups with a higher prevalence of AtH.

  • 2.
    Amcoff, Karin
    et al.
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Zhulina, Yaroslava
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Lampinen, Maria
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Carlson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Prognostic significance of faecal eosinophil granule proteins in inflammatory bowel disease2019Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Non-invasive markers for predicting relapse would be a useful tool for the management of patients with inflammatory bowel disease. Eosinophil granulocytes and their granule proteins eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) have previously been shown to reflect disease activity in Crohn's disease and ulcerative colitis.

    Aim: To examine the capacity of faecal ECP and EDN to predict relapse in ulcerative colitis and Crohn's disease, and to compare these proteins with faecal calprotectin.

    Methods: Patients with Crohn's disease (n=49) and ulcerative colitis (n=55) were followed prospectively until relapse or end of the two-year study period. Faecal samples were obtained every third month. The predictive value of ECP and EDN was assessed in Cox regression models.

    Results: In ulcerative colitis, a doubled EDN or ECP concentration was associated with a 31% and 27% increased risk of relapse, respectively. EDN levels were increased both at relapse and three months prior. By contrast, in Crohn's disease, the concentration of EDN was higher among patients in remission than in those who relapsed. Correlations between faecal calprotectin, ECP and EDN were observed in both diseases.

    Conclusions: We demonstrate that the risk of relapse in ulcerative colitis can be predicted by consecutively measuring faecal EDN every third month, and suggest EDN as a complementary faecal marker to calprotectin to predict future relapse in ulcerative colitis. Our finding of higher EDN in Crohn's disease-patients staying in remission than in those who relapsed indicates different functions of the protein in ulcerative colitis and Crohn's disease.

  • 3.
    Amcoff, Karin
    et al.
    Department of Gastroenterology, Örebro University Hospital, Örebro, sweden.
    Stridsberg, Mats
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lampinen, Maria
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Magnuson, Anders
    linical EpiSchool of Medical Sciences, Örebro University, Örebro, Sweden.
    Carlson, Marie
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Clinical implications of assay specific differences in f-calprotectin when monitoring inflammatory bowel disease activity over time2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 3, s. 344-350Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: With several faecal calprotectin (FC) assays on the market, it has been difficult to define a uniform threshold for discriminating between remission and active disease in patients with inflammatory bowel disease (IBD). We aimed to compare the results of different FC-assays in IBD patients, followed over time.

    Material and methods: IBD patients provided faecal samples and reported clinical activity every third month prospectively over a two year period. FC was measured with two ELISA - (Bühlmann and Immunodiagnostik) and one automated fluoroimmunoassay (Phadia).

    Results: In total, 13 patients provided 91 faecal samples. The median (IQR) concentration of FC was higher at active disease than at remission for all assays: Bühlmann 845 (1061-226) μg/g versus 62 (224-39) μg/g, Phadia 369 (975-122) μg/g versus 11 (52-11) μg/g, and Immundiagnostik 135 (302-69) μg/g versus 8 (56-4) μg/g. The Bühlmann assay produced the largest absolute difference but the corresponding relative difference seemed to be more pronounced when analysed by the Phadia - (ratio of means 8.5; 95% CI 3.3-21.9) or the Immundiagnostik assay (ratio of means 7.4; 95% CI 3.1-17.6) than by the Bühlmann assay (ratio of means 5.3; 95% CI 2.7-10.6). Consequently, the specificity for discriminating active disease from remission varied between assays (34-75%) when the cut-off 50 μg/g was used, whereas the differences in sensitivity were less pronounced.

    Conclusions: Cross-comparisons revealed overall poor agreement between the assays as well as differences in the dynamics of FC. These findings suggest that standardisation of the method is needed to implement FC as a disease monitoring tool at large-scale.

  • 4.
    Björkqvist, Olle
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Repsilber, Dirk
    Orebro Univ, Sch Med Sci, Orebro, Sweden..
    Seifert, Maike
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Brislawn, Colin
    Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland WA, USA.
    Jansson, Janet
    Earth and Biological Sciences Directorate, Pacific Northwest National Laboratory, Richland WA, USA.
    Engstrand, Lars
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Rangel, Ignacio
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Alterations in the relative abundance of Faecalibacterium prausnitzii correlate with changes in fecal calprotectin in patients with ileal Crohn's disease: a longitudinal study2019Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Crohn's disease is characterized by a gut dysbiosis with decreased abundance of butyrate producers such as Faecalibacterium prausnitzii. Although F. prausnitzii secretes anti-inflammatory molecules, few studies have addressed the importance of F. prausnitzii in a longitudinal setting. We aimed to examine the relationship between temporal profiles of F. prausnitzii, the C. leptum group, overall butyrate production, and inflammatory activity.

    Material and methods: Fecal samples (n = 59) were collected every third month from nine patients with ileal Crohn's disease. The abundance of F. prausnitzii and C. leptum was quantified relative to the total amount of bacteria using quantitative-PCR. To assess butyrate production of gut microbiota, gene copy numbers of the butyryl-CoA:acetate-CoA transferase (BCoAT) gene were quantified by qPCR. The inflammatory activity was defined by fecal (f)-calprotectin.

    Results: No correlation between the relative abundance of F. prausnitzii, the C. leptum group, or copy numbers of the BCoAT gene, and f-calprotectin was observed in the total sample set. By analyzing alterations between consecutive samples, a negative correlation between changes in the relative abundance of F. prausnitzii and f-calprotectin was observed (R = -0.39; p = .009). Changes in C. leptum (R = -0.18, p = .23) and number of copies of the BCoAT gene (R = -0.12; p = .42) did not correlate with f-calprotectin.

    Conclusions: There was an inverse correlation between temporal changes in the relative abundance of F. prausnitzii, but not overall butyrate producing capacity, and changes in inflammatory activity in ileal Crohn's disease. These findings indicate that F. prausnitzii may play a role in gut homeostasis, even though causality is still to be demonstrated.

  • 5.
    Borssen, Åsa Danielsson
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Marschall, Hanns-Ulrich
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Bergquist, Annika
    Department of Medicine, Section of Hepatology and Gastroenterology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Rorsman, Fredrik
    Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden.
    Weiland, Ola
    Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Kechagias, Stergios
    Department of Gastroenterology and Hepatology, University Hospital, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Verbaan, Hans
    Department of Clinical Sciences, Gastroenterology Division, Lund University, University Hospital Skane, Malmö, Sweden.
    Nilsson, Emma
    Department of Clinical Sciences, Gastroenterology Division, Lund University, University Hospital Skane, Lund, Sweden.
    Werner, Mårten
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 9, s. 1022-1028Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.

    Objective: To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort.

    Material and methods: Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Vasterbotten in Northern Sweden.

    Results: AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<.001) and died younger than women (p=.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.

    Conclusions: Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.

  • 6.
    Büsch, Katharina
    et al.
    AbbVie AB, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Waldenström, Jesper
    Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lagging, Martin
    Department of Infectious Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Weiland, Ola
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kövamees, Jan
    AbbVie AB, Stockholm, Sweden.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Infectious Diseases, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderholm, Jonas
    AbbVie AB, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Prevalence and comorbidities of chronic hepatitis C: a nationwide population-based register study in Sweden2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 1, s. 61-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to estimate the prevalence of physician-diagnosed and registered chronic hepatitis C (CHC), and to estimate the reported frequencies of Charlson comorbidities compared with matched comparators from the general population.

    Materials and methods: Patients were identified according to ICD codes for CHC in the Swedish National Patient Register (1997-2013). Prevalence was estimated according to different patient identification algorithms and for different subgroups. Charlson comorbidities were ascertained from the same register and compared with age/sex/county of residence matched general population comparators.

    Results: A total of 34,633 individuals with physician-diagnosed CHC were alive in Sweden in 2013 (mean age, 49 years; 64% men), corresponding to a physician-diagnosed prevalence of 0.36%. The prevalence varied by case definition (0.22%-0.36%). The estimate dropped to 0.14% for monitored CHC disease (defined as ≥1 CHC-related visit in 2013). Overall, 41.3% of the CHC patients had ≥1 physician-registered Charlson comorbidity; the most common was liver diseases (22.1%). Compared with matched comparators from the general population (n = 171,338), patients with CHC had more physician-diagnosed and registered diseases such as chronic pulmonary disease (10.2% vs. 4.0%), diabetes (10.6% vs. 5.5%) and liver-related cancer (1.3% vs. 0.2%; all p < .01). No information on behavioural factors, such as smoking, alcohol consumption or on-going illicit drug use, was available.

    Conclusion: The physician-diagnosed prevalence of CHC was slightly lower than previously reported estimates, and varied by case definition. The additional comorbidities observed in the CHC group should be taken into consideration, as these comorbidities add to the disease burden.

  • 7.
    Duberg, Ann-Sofi
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Infectious Diseases, , Örebro University Hospital, Örebro, Sweden.
    Blach, Sarah
    Center for Disease Analysis (CDA), Louisville CO, USA.
    Falconer, Karolin
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kåberg, Martin
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, , Stockholm, Sweden.
    Razavi, Homie
    Center for Disease Analysis (CDA), Louisville CO, USA.
    Aleman, Soo
    Department of Medicine Huddinge, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Medicine Huddinge, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    The future disease burden of hepatitis C virus infection in Sweden and the impact of different treatment strategies2015Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 50, nr 2, s. 233-244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Recently, new highly effective direct-acting antivirals (DAAs) against hepatitis C virus (HCV) were introduced. Whether these will alleviate the anticipated increase of liver disease burden in Sweden is unknown, partly because high costs may restrict the use. The objectives were to model the HCV epidemic in Sweden, the burden of disease, and the potential impact of different treatment strategies.

    Material and methods: HCV disease progression was modeled to 2030. Scenarios were simulated using new DAAs with sustained annual treatment rate (n = 1130), reduced treatment rate (n = 380) to maintain budget, and increased treatment rates (n = 1430 or 2260) to reduce HCV infections.

    Results: With today's triple therapies, the estimated number of serious liver complications and death are expected to peak in 2021. Using new DAAs among F0-F4 patients, an unchanged annual treatment rate can reduce the number of HCV infections by 10% by 2030; however, hepatocellular carcinoma (HCC) and mortality will remain unchanged. By reducing to 380 treatments annually and focusing on patients with advanced fibrosis (F3-F4), serious complications will remain constant but the total number of HCV infections will increase. By doubling the number of DAA treatments, HCC-incidence and liver-related deaths would decrease by 65-70% by 2030.

    Conclusion: Mortality and HCC can be reduced with new DAAs and sustained treatment uptake when restricted to F2-F4 patients, or with increased uptake in F0-F4 patients. Treatment restrictions to limit cost may reduce the positive effects and increase the burden of HCV infection. These results may be important for the future strategies of HCV management.

  • 8.
    Emilsson, Louise
    et al.
    Institute of Health and Society, University of Oslo, Oslo, Norway; Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA.
    Løberg, Magnus
    Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine and K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
    Bretthauer, Michael
    Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Department of Transplantation Medicine and K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
    Holme, Øyvind
    Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jodal, Henriette C.
    Institute of Health and Society, University of Oslo, Oslo, Norway.
    Adami, Hans-Olov
    Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kalager, Mette
    Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA.
    Colorectal cancer death after adenoma removal in Scandinavia2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 12, s. 1377-1384Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Improved understanding of the subsequent risk death from colorectal cancer (CRC) among individuals who had adenomas removed is needed. We aimed to quantify this risk using prospectively collected data from population-based cohorts.

    MATERIALS AND METHODS: Using Norwegian and Swedish registries, a cohort of 90,864 individuals with colorectal adenomas removed between 1980 and 2013 was identified. Surveillance was only recommended for high-risk adenomas. The validity of the registry data did not allow classification into low- and high-risk adenomas. Virtually complete follow-up was achieved through linkage to nationwide registers. We calculated incidence-based standardised mortality ratios (SMRs) with 95% confidence intervals (CI).

    RESULTS: The median follow-up was 7.2 years; 48,058 individuals were followed for more than 10 years. We observed 819 deaths (0.9%) from CRC and expected 731 CRC deaths (0.8%), corresponding to an absolute excess risk of 88 cases (0.1%) and a relative risk of 12% (SMR 1.12; 95%CI 1.05-1.20). The relative risk of CRC death following adenoma removal was slightly higher in Sweden (SMR 1.22; 95%CI 1.11-1.34) than in Norway (SMR 1.03; 95%CI 0.93-1.14), and higher in women (SMR 1.24; 95%CI 1.12-1.36) than in men (SMR 1.02; 95%CI 0.93-1.13). Among individuals with more than 10 years of follow-up, the estimates were similar to the overall cohort, absolute excess risk 0.1% (SMR 1.15; 95%CI 1.06-1.24).

    CONCLUSION: The excess risk of CRC death following adenoma removal is small. Optimal surveillance recommendations should be tested in randomised trials.

  • 9.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Faculty of Medicine and Health, Örebro university, Örebro, Sweden.
    Marsal, Jan
    Immunology Section, Lund University, Lund, Sweden; Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Vigren, Lina
    Department of Internal Medicine, Ystad Hospital, Ystad, Sweden.
    Björk, Jan
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Eberhardson, Michael
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Karling, Pontus
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Söderman, Charlotte
    Department of Internal Medicine, St Göran Hospital, Stockholm, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University and Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjöberg, Daniel
    Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Thörn, Mari
    Department of Medical Sciences, Section of Gastroenterology and Hepatology, Uppsala University, Uppsala, Sweden.
    Karlén, Per
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Hertervig, Erik
    Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Almer, Sven
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institutet Solna, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 6-7, s. 722-729Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness.

    Materials and methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index<5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index<3 in ulcerative colitis (UC).

    Results: Two-hundred forty-six patients (147CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p<.0001 in both groups). Faecal-calprotectin decreased in CD (p<.0001) and in UC (p=.001), whereas CRP decreased in CD (p=.002) but not in UC (p=.11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48).

    Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.

  • 10.
    Everhov, Åsa H.
    et al.
    Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Sachs, Michael C
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Malmborg, Petter
    Department of Clinical Science and Education , Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Nordenvall, Caroline
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Disease, Div. of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
    Myrelid, Pär
    Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping, Sweden; University and Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden.
    Khalili, Hamed
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Crohn's and Colitis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
    Elmberg, Maria
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Askling, Johan
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Jakobsson, Gustav
    Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
    Olén, Ola
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of pediatric gastroenterology and nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden.
    Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients2019Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, nr 1, s. 55-63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time.

    METHODS: We examined International Classification of Diseases coding in patients with ≥2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302).

    RESULTS: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children).

    CONCLUSIONS: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.

  • 11.
    Gustafsson, Ulf O.
    et al.
    Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Segelman, Josefin
    Department of Molecular Medicine and Surgery, Ersta Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Thorell, Anders
    Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nygren, Jonas
    Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Can nutritional supplements and rectal enema be used as bowel cleansing for colonoscopy?: results of a randomized controlled pilot study2014Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 49, nr 4, s. 485-491Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Currently available preparations for colonoscopy have low tolerability and may cause fluid and electrolyte shifts. An alternative method of bowel cleansing is required.

    Material and methods. Preparation of the gut using oral nutritional supplements (ONS) and rectal enema was tested as an alternative method of bowel cleansing. During 2008-2012, patients were randomized to oral nutritional supplements (n = 27) for 5 days and rectal enema or polyethylene glycol (PEG) (n = 23) prior to colonoscopy. Blinded endoscopists rated the degree of bowel cleansing according to the Ottawa bowel preparation scale (OBS) (primary outcome). Tolerability of either preparation was also assessed (ClinicalTrials.gov. Identifier no: NCT00123456).

    Results. Due to a high rate of bowel cleansing failure among patients receiving ONS, the study was interrupted prematurely. Colonoscopies were incomplete due to stools in 6 of 27 patients in the ONS group compared to 1 of 23 in the PEG group (ns). The mean total OBS were 8.3 +/- 3.3 and 5.3 +/- 2.8, respectively (p = 0.002). Four patients (15%) in the ONS group and eight patients (35%) receiving PEG had an OBS score <= 4 (good preparation) (ns). ONS was better tolerated than PEG with more patients reporting acceptable taste (27 of 27 [100%] vs. 15 of 23 [65%], p = 0.001), and fewer reporting difficulties with the intake (0 of 27 [0%] vs. 10 of 23 [43%], p < 0.001) and nausea (5 of 27 [19%] vs. 13 of 23 [57%], p < 0.008).

    Conclusions. For routine use, ONS with enema instead of traditional preparation for colonoscopy with PEG cannot be generally recommended.

  • 12. Halfvarson, Jonas
    What determines the disease course, Scandinavian twin data2010Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, nr S247, s. 35-36Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The varying clinical course of Crohns disease (CD) and ulcerative colitis (UC) emphasizes the need toclassify patients according to clinical characteristics. Accurate classifi cation is important regarding prognosis and stratifyingpatients with respect to therapy. Whether longitudinal changes of clinical characteristics are caused by externalfactors only, or if genetics predispose is unknown. Twin studies can be of help in this respect. The aim was to evaluatethe concordance for longitudinal changes of clinical characteristics among monozygotic twins with IBD.

    Methods: Twins derived from previous known Swedish and Danish population-based cohorts. After consent, the medicalnotes were scrutinized to classify clinical characteristics, at diagnosis and after 10 years, according to the Montrealclassifi cation. Acute colectomy due to unresponsive colitis was used as a proxy marker for severe UC. Twin pairs withconfi rmed diagnosis were assembled in a combined Scandinavian cohort. 158 twins with ulcerative colitis (UC) (18 be-Scand J Gastroenterol Downloaded from informahealthcare.com by University of Orebro on 08/21/14For personal use only.36longing to 9 concordant monozygotic pairs) and 141 twins with Crohn’s disease (CD) (34 belonging to 17 concordantmonozygotic pairs) were enrolled. Using the binominal distribution, we tested the hypothesis that clinical characteristicswere independent within individuals in disease concordant monozygotic pairs.

    Results: In CD, difference in age at diagnosis was < 5 years within 14 of 17 pairs (p<0.00001). Location was identicalin 11/17 monozygotic concordant pairs at diagnosis (p=0.008) and in 11/16 pairs after 10 years (p=0.02). Behavior atdiagnosis was identical in 13/17 pairs (p=0.03) and in 11/16 pairs after 10 years (p=0.01). Monozygotic UC twins wereconcordant (within 5 years) for age at diagnosis (6/9 pairs; p<0.001) and symptomatic onset (4/9 pairs; p=0.02) but notfor extent of disease at diagnosis or after 10 years. Concordance for “colectomy or not”, was observed in 7 of 9 pairs(p=0.15).

    Conclusion: The high phenotypic concordance, both at diagnosis and longitudinally, in monozygotic twins with CDsupports a genetic infl uence not only on disease occurrence but also on disease course. This contrasts to UC, wherethe genetic impact appears less.

  • 13.
    Halfvarson, Jonas
    et al.
    Division of Gastroenterology, Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Munkholm, Pia
    University of Copenhagen, Herlev, Denmark.
    Biologics forever2010Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, s. 90-90Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The introduction of biologics has changed the concept of treating IBD and especially CD. TNF-inhibitors have been shown to reduce hospitalization and the need of surgery. Furthermore, the benefi t of TNF-inhibitors seem to be more pronounced in fairly newly diagnosed patients, than in patients that have suffered from CD for many years. However, it is still unknown whether early ”aggressive” treatment with biologics can change the natural course of IBD, including achieving a deep long-term remission and in CD avoiding progression to complicated disease behaviour. The aims of the talk are to discuss different potential treatment strategies with respect to biologics and to examine the evidence for continuing or stopping treatment with biologics.

    Methods: Literature search of the topic was performed using Medline/Pubmed and the Cochrane database.

    Results: Recent studies suggest that mucosal healing is associated with longstanding remission also in CD. Evidence comes from both epidemiological studies and randomized control trials. In the population based IBSEN study, patients diagnosed with IBD 1990-1994, before the introduction of biologics, were included. Patients with CD achieving mucosal healing after one year, had less infl ammation and need of steroids at follow up. In the follow up of the ”Step-up and Top-down” trial, complete mucosal healing after 2 years of therapy predicted sustained, steroid-free remission through out the 2 years follow up, independently of initial treatment. Preliminary data from the GETAID study, suggest that approximately 40% of patients in remission for at least 6 months on combination therapy with immunomodulator and infl iximab, relapse within 1 year after stopping infl iximab. However, patients in ”deep remission”, i.e. clinical remission in combination with endoscopic remission and normal f-Calprotectin had a much lower risk of relapse.

    Conclusion: Studies analyzing if early introduction of biologics can decrease bowel damage and change the disease course are warranted. The question when biologics can be stopped or interrupted with sustained remission is of utmostimportance and needs to be addressed.

  • 14. Hildebrand, Hans
    et al.
    Malmborg, Petter
    Askling, Johan
    Ekbom, Anders
    Montgomery, Scott M.
    Örebro universitet, Institutionen för klinisk medicin.
    Early-life exposures associated with antibiotic use and risk of subsequent Crohn's disease2008Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, nr 8, s. 961-966Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. An inappropriate immune response to normal bowel flora is implicated in the etiology of Crohn's disease. Tolerance to bowel flora develops in infancy, so factors disrupting normal patterns of bowel colonization may increase the risk of Crohn's disease. The aim of this study was to test the hypothesis that antibiotic therapy between birth and age 5 years may disrupt the pattern of bowel colonization and increase the risk of Crohn's disease.

    Material and methods. Some 1098 patients with Crohn's disease and 6550 controls matched by delivery unit, year of birth, sex, and born between 1973 and 1997 were identified through the Swedish population registers. Seven inpatient diagnoses between birth and age 5 years associated with antibiotic therapy were identified by prospectively recorded data.

    Results. Of the seven diagnoses, only pneumonia and otitis media were sufficiently common for use in the analyses. Pneumonia and otitis media were not independent of each other in their association with Crohn's disease and the more important association was with pneumonia. Pneumonia by age 5 years was statistically significantly associated with both pediatric- and adult Crohn's disease, with odds ratios (and 95% CI) of 2.74 (1.04–7.21) and 4.94 (1.83–13.23), respectively. Pneumonia after age 5 years was not statistically significantly associated with Crohn's disease.

    Conclusions. Pneumonia prior to age 5 years, but not later, was associated with subsequent Crohn's disease and this may represent either susceptibility or causation. The results are consistent with early exposures influencing immune function, such as through disruption of bowel colonization, and thus increasing the risk of Crohn's disease.

  • 15. Hjortswang, Henrik
    et al.
    Järnerot, Gunnar
    Curman, Bengt
    Sandberg-Gertzén, Hanna
    Tysk, Curt
    Örebro universitet, Hälsoakademin.
    Blomberg, Björn
    Almer, Sven
    Ström, Magnus
    The Short Health Scale: a valid measure of subjective health in ulcerative colitis2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 10, s. 1196-1203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Assessment of health-related quality of life (HRQOL) is important in both clinical practice and clinical trials, and several multi-item questionnaires are currently in use. We have devised and evaluated a simplified four-item questionnaire, the Short Health Scale (SHS), representing each of four health dimensions: (a) symptom burden, (b) social function, (c) disease-related worry and (d) general well-being. MATERIAL AND METHODS: Three hundred patients with ulcerative colitis completed the SHS and three other HRQOL questionnaires (IBDQ, RFIPC and PGWB). Half of the patients repeated the questionnaires after 6 months - or earlier if disease activity changed. Test-retest reliability was derived from measurements of the SHS questions, 2 weeks apart, on 18 patients in remission. RESULTS: Patients in relapse scored higher on each of the four SHS questions than patients in remission (p < 0.001). Each of the four SHS scores were associated with results of their corresponding health dimension obtained with the other three questionnaires (rs=0.57-0.78, p < 0.001) (validity). The results of the SHS proved stable on repeated measurement with a 2-week interval in patients in remission (rs=0.71-0.91, p < 0.01) (test-retest reliability). Patients with a change in disease activity had a significant change in their SHS scores (p < 0.05) (responsiveness). CONCLUSIONS: The SHS is a valid, reliable and responsive measure of subjective health in patients with ulcerative colitis. It is simple to administer, quickly completed and the results do not need further calculations. The SHS can be used in clinical trials and in clinical practice to identify the patient's main problems affecting health.

  • 16.
    Hörer, Tal M.
    et al.
    Örebro universitet, Hälsoakademin. Department of Surgery.
    Norgren, Lars
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Jansson, Kjell
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Intraperitoneal glycerol levels and lactate/pyruvate ratio: early markers of postoperative complications2011Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, nr 7-8, s. 913-919Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: We have previously presented microdialysis findings of early intraperitoneal (ip) metabolic disturbances, mainly an increased lactate/pyruvate (l/p) ratio, in surgical patients developing postoperative complications. The aim of the present study was to investigate ip glycerol and l/p ratio after major surgery with and without complications.

    Material and methods :Sixty patients were followed with microdialysis for 48 h after major abdominal surgery, 44 patients without postoperative complications and 16 patients with major surgical complications. Intraperitoneal and subcutaneous (sc) measurements of glycerol, lactate, pyruvate and glucose were performed, and the l/p ratio was calculated.

    Results: Intraperitoneal glycerol was significantly lower in the complication group compared with the control group (64 vs. 94.6 μM; p = 0.0015), while the ip l/p ratio was significantly higher in the complication group compared with the control group (13.7 vs. 11.1; p = 0.0073).

    Conclusions: In this study, ip glycerol levels were lower and ip l/p ratio was higher in the immediate postoperative period in a group of patients with complications. These results might indicate early ip disturbances in fat and carbohydrate metabolism in patients who later developed symptoms of postoperative major complications.

  • 17.
    Jakobsson, Gustav L.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sternegård, Emil
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Olén, Ola
    Department of Pediatric Gastroenterology, Sachs’ Children’s Hospital, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Ljung, Rickard
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs sjukhus, Borås, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ludvigsson, Jonas F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Validating inflammatory bowel disease (IBD) in the Swedish National Patient Register and the Swedish Quality Register for IBD (SWIBREG)2017Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 2, s. 216-221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Both the Swedish National Patient Register (NPR) and the Swedish Quality Register for inflammatory bowel disease (IBD, SWIBREG) are important sources of research data and information. However, the validity of a diagnosis of IBD in these registers is unknown.

    Methods: Medical charts of 129 randomly selected patients from the NPR and 165 patients registered both in SWIBREG and the NPR were reviewed. Patients were classified according to standardized criteria for ulcerative colitis (UC), Crohn's disease (CD), or IBD unclassified (IBD-U). Positive predictive values (PPVs) for UC, CD, IBD-U (only SWIBREG), or having any form of IBD were then calculated.

    Results: For cases with ≥2 diagnoses of IBD in the NPR (hospitalizations or non-primary care outpatient visits), the PPV was 93% (95% CI: 87-97) for any IBD, 79% (66-88) for UC and 72% (60-82) for CD. In UC patients with ≥2 UC diagnoses but never a CD diagnosis, the PPV increased to 90% (77-97). The PPV for CD in patients with ≥2 CD diagnoses but never a UC diagnosis was 81% (67-91)). Combining data from SWIBREG (≥1 record) and the NPR (≥1 record), the PPV was 99% for any IBD (97-100), 96% (89-99) for UC, and 90% (82-96) for CD.

    Conclusion: The validity of the UC, CD, and IBD diagnoses is high in the NPR but even higher when cases were identified both in SWIBREG and the NPR. These results underline the need for a well-functioning Swedish Quality Register for IBD as a complement to the NPR.

  • 18.
    Jansson, Kjell
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Redler, B.
    Truedsson, L.
    Magnuson, A.
    Ungerstedt, U.
    Norgren, L.
    Postoperative on line monitoring with intraperitoneal microdialysis is a sensitive clinical method for measuring increased anaerobic metabolism that correlates to the cytokine response2004Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 39, nr 5, s. 434-439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Visceral ischaemia and cytokine release are early stages in the development of shock and multiorgan failure. Because of lack of methods to measure anaerobic metabolism or visceral hypoxia in the early phase, diagnosis is not usually established until shock and organ failure are evident. Methods: Nineteen patients were studied postoperatively after major abdominal gastrointestinal surgery. A microdialysis catheter was placed intraperitoneally before closure of the abdomen. Analysis of glucose, pyruvate and lactate was performed every second hour and the ratio between lactate and pyruvate was calculated. Peritoneal fluid was collected from a peritoneal drainage for analysis of tumour necrosis factor alpha (TNF‐α) and interleukin 10 (IL‐10). Results: Sixteen of the patients had a normal postoperative course; the lactate/pyruvate ratio started at the level of 20 immediately postoperatively and decreased significantly during the first 45 postoperative hours (P = 0.007). A similar pattern was recorded for peritoneal TNF‐α, which decreased correspondingly (P = 0.003). A correlation coefficient of 0.303 (P < 0.001) between lactate/pyruvate ratio and TNF‐α was found. After an initial short increase, IL‐10 decreased over time (P < 0.001). Three of the patients had abnormalities in the microdialysis results, cytokines and clinical outcome. These patients are presented separately. Conclusions: A normal postoperative course results in a decrease in the intraperitoneal lactate/pyruvate ratio, TNF‐α and IL‐10. A correlation between the intraperitoneal lactate/pyruvate ratio and TNF‐α was found which suggests that intraperitoneal microdialysis is a sensitive, indirect method in analysing the postoperative intraperitoneal inflammatory response. A complicated postoperative course was preceded by increase of the peritoneal lactate/pyruvate ratio interpreted as splanchnic hypoxia and also an increased TNF‐α level.

  • 19.
    Jansson, Kjell
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Ungerstedt, J.
    Jonsson, T.
    Redler, B.
    Andersson, M.
    Ungerstedt, U.
    Norgren, L.
    Human intraperitoneal microdialysis: increased lactate/pyruvate ratio suggests early visceral ischaemia2003Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 38, nr 9, s. 1007-1011Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous studies suggest that visceral ischaemia precedes shock and multiple organ failure, though methods for studying humans are lacking. We aimed to evaluate intraperitoneal microdialysis, a new technique for detecting splanchnic ischaemia in clinical practice. Methods: Right-sided hemicolectomy was performed in eight patients who were studied by microdialysis postoperatively for glucose, lactate, pyruvate and glycerol levels. Results: Six of the eight patients showed a normal postoperative course and had lactate/pyruvate ratios between 7.1 and 21.7, glucose between 4.5 and 14.3 &#114 mmol/L and glycerol between 10.4 and 296 &#114 &#55 mol/L. In one patient, intraperitoneal lactate/pyruvate ratio and glycerol increased and glucose decreased 5 &#114 h before low oxygenation appeared. Another patient exhibited a period of increased lactate/pyruvate ratio before a period of atrial fibrillation. Conclusion: Intraperitoneal microdialysis was performed safely. Two out of the eight patients exhibited changes of metabolic markers followed by clinical symptoms that were probably related to transient visceral ischaemia. Our findings suggest that intraperitoneal microdialysis may become a useful tool for monitoring splanchnic ischaemia in clinical practice.

  • 20.
    Jäghult, Susanna
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    Larson [Windahl], Jenny
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Wredling, Regina
    Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Kapraali, Marjo
    Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden.
    A multiprofessional education programme for patients with inflammatory bowel disease: a randomized controlled trial2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 12, s. 1452-1459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation. The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease, and to investigate whether the programme could improve their health-related quality of life.

    MATERIAL AND METHODS: Ninety-three patients with inflammatory bowel disease in remission were included and randomized to an intervention group or a control group. The intervention group attended a multiprofessional education programme while the control group received regular information. Four questionnaires were used for measuring health-related quality of life. Both groups completed the questionnaires at baseline and after 6 months. The intervention group also completed the questionnaires after 1 month.

    RESULTS: No significant differences were found when comparing the two groups at 6 months. However, the multi-professional education programme was highly appreciated by the patients.

    CONCLUSIONS: In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group. This might be due to the fact that the questionnaires were not sensitive enough or that some patients were not in clinical remission. The patients' enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic.

  • 21.
    Kileng, Hege
    et al.
    Department of Clinical Medicine, Gastroenterology and Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Kjellin, Midori
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Akaberi, Dario
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Bergfors, Assar
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Infectious Diseases.
    Wesslén, Lars
    Gävle Hospital, Gävle, Sweden.
    Danielsson, Astrid
    Falun Hospital, Falun, Sweden.
    Gangsøy Kristiansen, Magnhild
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT The Artic University of Tromsø, Bodø, Norway.
    Gutteberg, Tore
    Department of Medical Biology, Research Group for Host-Microbe Interactions, UiT The Arctic University of Norway, Tromsø, Norway; Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Goll, Rasmus
    Department of Clinical Medicine, Gastroenterology and Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Lannergård, Anders
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden.
    Lennerstrand, Johan
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Personalized treatment of hepatitis C genotype 1a in Norway and Sweden 2014-2016: a study of treatment outcome in patients with or without resistance-based DAA-therapy2018Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, nr 10-11, s. 1347-1353Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Resistance-associated substitutions (RASs) may impair treatment response to direct-acting antivirals (DAA) in hepatitis C virus (HCV) treatment. We investigated the effects of baseline NS3-RASs (Q80K and R155K) and clinically relevant NS5A-RASs in patients with HCV genotype (GT) 1a infection on treatment outcome, with or without resistance-based DAA-treatment. This multi-center study was carried out between 2014 and 2016.

    PATIENTS/METHODS: Treatment in the intervention group (n = 92) was tailored to baseline resistance. Detection of NS3-RAS led to an NS5A-inhibitor-based regimen and detection of NS5A-RAS to a protease-inhibitor regimen. Patients without baseline RAS in the intervention group and all patients in the control group (n = 101) received recommended standard DAA-treatment.

    RESULTS: The sustained virologic response rates (SVR) in the intervention and control groups were 97.8% (90/92) and 93.1% (94/101), respectively (p = .174). A trend toward higher SVR-rate in cirrhotic patients (p = .058) was noticed in the intervention group compared to the control group with SVR-rates 97.5% (39/40) and 83.3% (35/42), respectively. All patients with baseline NS3 (Q80K/R155K) or NS5A-RASs in the intervention group achieved SVR with personalized resistance-based treatment. In the control group, five patients with Q80K or R155K at baseline were treated with simeprevir + sofosbuvir and treatment failed in two of them. Furthermore, one of three patients who failed ledipasvir + sofosbuvir treatment had NS5A-RASs at baseline.

    CONCLUSIONS: In line with the findings of the OPTIMIST-2 trial for Q80K and the EASL-guidelines 2016 for NS5A-RASs, baseline RASs appeared to have an impact on treatment outcome albeit a statistical significance was not observed in this low-prevalence population.

  • 22.
    Kjellin, Midori
    et al.
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Kileng, Hege
    Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Akaberi, Dario
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Palanisamy, Navaneethan
    Institute of Biology II, University of Freiburg, Freiburg, Germany; Institute of Biology II, University of Freiburg, Freiburg, Germany.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Infectious Diseases.
    Danielsson, Astrid
    Department of Infectious Diseases, Falun Hospital, Falun, Sweden.
    Kristiansen, Magnhild Gangsøy
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø, Tromsø, Norway.
    Nöjd, Johan
    Nordlandssykehuset Bodø, Department of Clinical Medicine (IKM), UiT the Artic University of Tromsø, Tromsø, Norway.
    Aleman, Soo
    Department of Infectious Diseases, Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden.
    Gutteberg, Tore
    Research Group for Host-Microbe Interactions, Department of Medical Biology, UiT the Arctic University of Norway, Tromsø, Norway; Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Goll, Rasmus
    Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Medicine, University Hospital of North Norway, Tromsø, Norway.
    Lannergård, Anders
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala, Sweden.
    Lennerstrand, Johan
    Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden.
    Effect of the baseline Y93H resistance-associated substitution in HCV genotype 3 for direct-acting antiviral treatment: real-life experience from a multicenter study in Sweden and Norway2019Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The NS5A resistance-associated substitution (RAS) Y93H is found quite frequently (5-10%) at baseline in direct-acting antiviral agents (DAA) treatment-naive genotype (GT) 3a patients when studied by the population-sequencing method (cut-off 20%). This RAS may impair HCV DAA treatment response, since it possesses a high fold in vitro resistance to daclatasvir (DCV) and velpatasvir (VEL) in GT 3. We investigated the effect of baseline Y93H in patients with GT 3a infection on treatment outcome, with or without resistance-based DAA-treatment during 2014-2017.

    Patients/Methods: Treatment in the intervention group (n = 130) was tailored to baseline resistance-findings by population-sequencing method. Detection of baseline Y93H above 20% prompted a prolonged treatment duration of NS5A-inhibitor and sofosbuvir (SOF) and/or addition of ribavirin (RBV). Patients without baseline Y93H in the intervention group and all patients in the control group (n = 78) received recommended standard DAA-treatment.

    Results: A higher sustained virologic response rate (SVR) in the intervention group was shown compared to the control group at 95.4% (124/130) and 88.5% (69/78), respectively (p = .06). All five patients with baseline Y93H in the intervention group achieved SVR with personalised treatment based on results from resistance testing; either with the addition of RBV or prolonged treatment duration (24w). In the control group, 2/4 patients with Y93H at baseline treated with ledipasvir/SOF/RBV or DCV/SOF without RBV, failed treatment.

    Conclusion: The results from this real-life study are in accordance with the findings of the randomised controlled trials in 2015 and the EASL-guidelines of 2016, thus, baseline Y93H impacts on DCV and VEL treatment outcome.

  • 23. Ljung, Tryggve
    et al.
    Thomsen, Ole Østergaard
    Vatn, Morten
    Karlén, Per
    Karlsen, Lars Norman
    Tysk, Curt
    Örebro universitet, Hälsoakademin.
    Nilsson, Stefan U.
    Kilander, Anders
    Gillberg, Rolf
    Grip, Olof
    Lindgren, Stefan
    Befrits, Ragnar
    Löfberg, Robert
    Granulocyte, monocyte/macrophage apheresis for inflammatory bowel disease: the first 100 patients treated in Scandinavia2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 2, s. 221-227Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Selective leukocyte apheresis is a new type of non-pharmacological treatment for patients with active ulcerative colitis and Crohn's disease. Preliminary data have indicated that this type of therapy is safe and efficacious, and large sham-controlled studies are currently in progress. In Scandinavia, a substantial number of patients with chronic inflammatory bowel disease have already received leukocyte apheresis on a compassionate use basis and the aim of this study was to report the clinical outcome and adverse events in the first patients treated. MATERIAL AND METHODS: Clinical details of the first consecutive 100 patients with inflammatory bowel disease treated with granulocyte, monocyte/macrophage (Adacolumn) apheresis in Scandinavia were prospectively registered. Median length of follow-up was 17 months, (range 5-30). RESULTS: The study population comprised 52 patients with ulcerative colitis, 44 patients with Crohn's disease and 4 patients with indeterminate colitis. In 97 patients the indication for Adacolumn treatment was steroid-refractory or steroid-dependent disease. Clinical remission was attained in 48% of the patients with ulcerative colitis, and an additional 27% had a clinical response to the apheresis treatment. The corresponding figures for patients with Crohn's disease were 41% and 23%, respectively. Complete steroid withdrawal was achieved in 27 out of the 50 patients taking corticosteroids at baseline. Adverse events were reported in 15 patients and headache was most frequently reported (n=7). CONCLUSIONS: Granulocyte, monocyte/macrophage apheresis treatment seems to be a valuable adjuvant therapy in selected patients with refractory inflammatory bowel disease. The risk for toxicity or severe adverse events appears to be low.

  • 24.
    Ludvigsson, Jonas F.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital , Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
    Andersson, Marie
    Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden.
    Bengtsson, Jonas
    Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Eberhardson, Michael
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fagerberg, Ulrika L.
    Center for Clinical Research, Västmanland Hospital, Västerås, Sweden and Uppsala University, Uppsala, Sweden; Department of Pediatrics, Västmanland Hospital, Västerås, Sweden; Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden.
    Grip, Olof
    Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Hjortswang, Henrik
    Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Jäghult, Susanna
    Stockholm Gastro Center, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden.
    Karling, Pontus
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Nordenvall, Caroline
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Colorectal Cancer, Karolinska University Hospital, Stockholm, Sweden.
    Olén, Ola
    Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Olsson, Malin
    Department of Surgery, County Council of Östergötland, Linköping, Sweden.
    Rejler, Martin
    Department of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, Sweden; Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden.
    Myrelid, Pär
    Department of Surgery, County Council of Östergötland, Linköping, Sweden; Department of Clinical and Experimental Medicine, Faculty of Health, Linköping University, Linköping, Sweden.
    Swedish Inflammatory Bowel Disease Register (SWIBREG): a nationwide quality register2019Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Inflammatory bowel disease (IBD) is a chronic, inflammatory relapsing disease with increasing incidence. IBD research and long-term follow-up of patients have, however, been hampered by lack of detailed data on disease phenotype, patient-reported outcome measures, Physician Global Assessment, disease activity, and hospital-administered drugs.

    Aim: To review the Swedish IBD quality register (SWIBREG).

    Methods: Review of SWIBREG including questionnaire data from users and patients.

    Results: SWIBREG was launched in 2005, and as of April 2019, contains 46,400 patients with IBD (Crohn's disease: n = 15,705, ulcerative colitis: n = 21,540, IBD unclassified and other colitis (including e.g., microscopic colitis): n = 9155). Of these IBD patients, 7778 had been diagnosed in childhood (16.8%). Earlier research has shown that combining SWIBREG and the Swedish National Patient Register (NPR) yields a positive predictive value of 100% (95%CI = 95-100%) for having a diagnosis of IBD. Moreover, out of all patients in the NPR with a diagnosis of IBD plus either IBD-related surgery or immunomodulatory/biological treatment during the past 18 months, SWIBREG covers 59.0%. SWIBREG records not only information on conventional therapies but also on biological treatment, surgery, smoking, disease activity, patient-reported outcome measures (PROMs), and patient-experienced measures (PREMs). Data are presented through a graphical decision support system.

    Conclusion: SWIBREG benefits patients with IBD, and offers an ideal opportunity for healthcare personnel and researchers to examine disease phenotype and activity, PROMs/PREMs, and hospital-administered drugs in patients with IBD.

  • 25.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Coll Med, Div Gastroenterol & Hepatol, Dept Med, Mayo Clin, Rochester MN, USA; Coll Med, Div Gastroenterol & Hepatol, Dept Immunol, Mayo Clin, Rochester MN, USA.
    Aro, Pertti
    Ctr Family & Community Med, Dept NVS, Karolinska Inst, Stockholm, Sweden.
    Walker, Marjorie M.
    Fac Hlth, Univ Newcastle, Newcastle NSW, Australia.
    Vieth, Michael
    Inst Pathol, Bayreuth, Germany.
    Agreus, Lars
    Ctr Family & Community Med, Dept NVS, Karolinska Inst, Stockholm, Sweden.
    Talley, Nicholas J.
    Fac Hlth, Newcastle NSW, Australia.
    Murray, Joseph A.
    Coll Med, Div Gastroenterol & Hepatol, Dept Med, Mayo Clin, Rochester MN, USA; Coll Med, Div Gastroenterol & Hepatol, Dept Immunol, Mayo Clin, Rochester MN, USA.
    Ronkainen, Jukka
    Ctr Family & Community Med, Dept NVS, Karolinska Inst, Stockholm, Sweden; Primary Hlth Care Ctr Tornio, Tornio, Finland; Inst Hlth Sci, Univ Oulu, Oulu, Finland.
    Celiac disease, eosinophilic esophagitis and gastroesophageal reflux disease, an adult population-based study2013Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, nr 7, s. 808-814Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Celiac disease (CD) has been linked to gastroesophageal reflux disease (GORD) and eosinophilic esophagitis (EoE), but population-based studies of the prevalence of CD in these conditions are lacking, that is, the aim of this study. Materials and methods. An endoscopic study was carried out in 1000 randomly selected adults from the general population. CD was defined on the basis of positive serology in parallel with mucosal abnormalities of the small intestine. Any eosinophil infiltration of the esophageal epithelium was defined as esophageal eosinophilia and EoE was defined as having at least 15 eosinophils/high-power field in biopsies from the distal esophagus. We used Fisher's exact test to compare the prevalence of GORD, esophageal eosinophilia, and EoE in subjects with CD versus controls. Results. Four hundred subjects (40%) had gastroesophageal reflux symptoms (GORS), 155 (15.5%) had erosive esophagitis, 16 (1.6%) had Barrett's esophagus, 48 (4.8%) had esophageal eosinophilia, and 11 (1.1%) had EoE. CD was diagnosed in 8/400 (2.0%) individuals with GORS (vs. controls: 10/600 (1.7%), p = 0.81), in 3/155 (1.9%) with erosive esophagitis (vs. 15/845 controls (1.8%), p = 0.75), and in 2/48 (4.2%) individuals with esophageal eosinophilia (controls: 16/952 (1.7%), p = 0.21), but in none of those 16 with Barrett's esophagus (vs. 18/984 controls (1.8%), p = 1.0) or of the 11 individuals with EoE (controls: 18/989 (1.8%), p = 1.0). Conclusions. This population-based study found no increased risk of CD among individuals with GORD, esophageal eosinophilia, or EoE. CD screening of individuals with GORD or EoE of individuals with CD cannot be recommended.

  • 26.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Eylert, Maike
    Ilonen, Jorma
    Ludvigson, Johnny
    Vaarala, Outi
    Effect of HLA DQ2, dietary exposure and coeliac disease on the development of antibody response to gliadin in children2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 8, s. 919-928Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the effect of HLA DQ2, dietary history and development of coeliac disease (CD) on the induction of antibody response to wheat gliadin and cow's milk, beta-lactoglobulin between 1 and 2.5 years of age in children who developed CD and in healthy children. MATERIAL AND METHODS: Infants participating in a birth cohort study (the ABIS study) in Sweden were studied. Thirty-nine children developed CD (=cases), confirmed through biopsy, during follow-up until 2.5-5 years of age. A total of 181 healthy control children were matched for duration of exclusive breast-feeding, birth-weight, gender, maternal smoking and season of birth. IgG and IgA antigliadin and anti-beta-lactoglobulin antibodies were measured using enzyme immunoassay (EIA). The effects of HLA-risk genotypes, DQ2 and DQ8, on CD were also considered. RESULTS: Children who developed CD had higher IgG and IgA antigliadin and anti-beta-lactoglobulin antibody levels at 1 year of age than controls (all comparisons: p<0.001). Similar differences were seen between cases with as yet undiagnosed CD by 1 year of age and controls, and also when cases were compared with HLA-matched controls. Higher levels of IgG and IgA antibodies to beta-lactoglobulin (p=0.003; p=0.001), but not to gliadin, were found in treated cases versus controls at 2.5 years of age. HLA-DQ2-positive healthy children had lower levels of IgG and IgA antigliadin antibodies than HLA-DQ2 negative controls at 1 year of age (p=0.004; p=0.012). CONCLUSIONS: Enhanced humoral response emerging not only to gliadin, but also to other food antigens seems to be primarily associated with CD. Poor induction of antibody response to wheat gliadin in healthy children with the HLA-DQ2 risk molecule could at least partly explain the genetic predisposition to gluten intolerance and CD.

  • 27.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Montgomery, Scott M.
    Örebro universitet, Institutionen för klinisk medicin.
    Ekbom, Anders
    Coeliac disease in the father and risk of adverse pregnancy outcome: a population-based cohort study2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 2, s. 178-185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    The risk of adverse foetal outcomes was investigated in offspring to men with coeliac disease (CD) diagnosed prior to infant birth and in offspring to men who did not receive a diagnosis of CD until after the delivery.

    MATERIAL AND METHODS:

    A cohort study was based on national registry data restricted to women aged 15-44 years with singleton live-born infants, with linkage between the Swedish national birth registry (1973-2001) and the national inpatient registry (1964-2001). A total of 1059 offspring to men who had received a diagnosis of CD were included: 554 offspring to men diagnosed prior to birth and 505 offspring to men diagnosed after infant birth.

    RESULTS:

    Undiagnosed CD in the father was associated with an increased risk of caesarean section (adjusted odds ratio (AOR)=1.83; 95% confidence interval (CI) for AOR=1.13-2.95; p=0.014) but was otherwise not linked to adverse pregnancy outcome: (intrauterine growth retardation (OR=1.37; 95% CI=0.91-2.07), low birth-weight (OR=1.41; 95% CI=0.93-2.12), very low birth-weight (OR=1.21; 95% CI=0.39-3.77), preterm birth (OR=1.10; 95% CI=0.74-1.62), and very preterm (OR=0.62; 95% CI=0.09-4.40)). A paternal diagnosis of CD made before infant birth was not associated with adverse foetal outcome.

    CONCLUSIONS:

    CD in the father is not a risk factor for unfavourable foetal outcome. The increased risk for caesarean section in offspring to men with undiagnosed CD in this study may be due to multiple comparisons.

  • 28.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Paediat, Örebro University Hospital, Örebro, Sweden; Dept Med, Clin Epidemiol Unit, Karolinska Instute, Stockholm, Sweden; Coll Med, Div Gastroenterol & Hepatol, Dept Med, Mayo Clin, Rochester MN, USA; Coll Med, Div Gastroenterol & Hepatol, Dept Immunol, Mayo Clin, Rochester MN, USA.
    Murray, Joseph A.
    Mayo Clin, Coll Med, Div Gastroenterol & Hepatol, Dept Med, Mayo Clin, Rochester MN, USA; Coll Med, Div Gastroenterol & Hepatol, Dept Immunol, Mayo Clin, Rochester MN, USA.
    Adams, Paul C.
    Div Gastroenterol, Dept Med, London Hlth Sci Ctr, London ON, Canada.
    Elmberg, Maria
    Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Does hemochromatosis predispose to celiac disease?: A study of 29,096 celiac disease patients2013Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, nr 2, s. 176-182Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aim. Case reports suggest an association between hereditary hemochromatosis (HH) and celiac disease (CD), but estimates of association are lacking. We estimated the association between HH and CD in a population-based study. Material and methods. Case-control study. We identified 29,096 individuals with biopsy-verified CD (equal to villous atrophy, Marsh stage III) through biopsy reports from all 28 pathology departments in Sweden. We then investigated the risk of a clinical diagnosis of HH in CD and in 144,522 controls matched for age, sex, county and calendar year. Conditional logistic regression was used to calculate odds ratios (ORs) for CD in patients with HH. Results. HH was seen in 30 patients with CD and in 60 matched controls. HH was hence associated with an increased risk of CD (OR = 2.30; 95% CI = 1.53-3.45). Restricting HH to individuals with at least two records of HH, the OR for CD was 2.54 (95% CI = 1.57-4.11), with a similar risk estimate when we only looked at HH diagnosed before CD (and matched date in controls) (OR = 2.64; 95% CI = 1.24-5.60). Conclusion. HH seems to be associated with an increased risk of CD.

  • 29.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Hälsoakademin.
    Osby, Urban
    Ekbom, Anders
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Coeliac disease and risk of schizophrenia and other psychosis: a general population cohort study2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 2, s. 179-185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Several case reports and a recent study on coeliac disease (CD) and family history of schizophrenia indicate a link between CD and schizophrenia. The objective of our study was to determine the risk of non-affective psychosis in patients with CD in a national general population cohort. Material and methods. We identified 14,003 individuals with a diagnosis of CD in the Swedish national inpatient register between 1973 and 2003. From the population register, Statistics Sweden then identified five reference individuals matched for age and calendar year at diagnosis, gender and county (n=68,125). Only individuals with more than one year of follow-up after the CD diagnosis was first recorded or a corresponding date in reference individuals were included in the analyses. The risk of subsequent non-affective psychosis in individuals with CD was estimated by Cox regression. Results. CD was associated with a statistically significant increased risk of any non-affective psychosis (hazard ratio (HR) =1.55; 95% CI =1.16-2.06; p=0.003) (65 positive events in 14,003 individuals with CD and 216 positive events in 68,125 individuals without CD); this increased risk was largely due to the association with non-schizophrenic non-affective psychosis (HR =1.61; 95% CI =1.19-2.20; p=0.002: 56 positive events in individuals with CD and 180 among reference individuals). There was no statistically significant association with subsequent schizophrenia (HR =1.43; 95% =0.77-2.67; p=0.261: 14 positive events in individuals with CD and 50 among reference individuals). Conclusions. Individuals with CD may be at increased risk of non-affective psychosis.

  • 30.
    Mohammadi, M.
    et al.
    Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Song, H.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Unit of Biostatistics, Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Glimelius, I.
    Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Ekbom, A.
    Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Ye, W.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Smedby, K. E.
    Department of Medicine, Clinical Epidemiology Unit, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
    Risk of lymphoid neoplasms in a Swedish population-based cohort of 337,437 patients undergoing appendectomy2016Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, nr 5, s. 583-589Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Appendectomy remains one of the most common surgical procedures, but possible long-term consequences for health and disease are incompletely investigated. The appendix forms part of the secondary lymphoid system and appendectomy has been associated with increased risks of hematolymphoproliferative malignancies in some studies.

    Materials and methods: We examined the risk of lymphoid neoplasms in a large cohort of 337,437 appendectomised patients <60 years of age in Sweden 1975-2009. We estimated relative risks of non-Hodgkin lymphoma (NHL) and major subtypes, Hodgkin lymphoma (HL), chronic lymphocytic leukaemia (CLL), myeloma, and acute lymphoblastic leukaemia (ALL) versus the general population using standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).

    Results: There was no increased risk of NHL (SIR = 0.97, 95%CI 0.88-1.06), major NHL subtypes, CLL (SIR = 0.87, 95%CI 0.70-1.06), myeloma (SIR = 1.14, 95%CI 0.96-1.33) or ALL (SIR = 1.10, 95%CI 0.80-1.47) following appendectomy. An increased risk of HL was observed among patients diagnosed with appendicitis (SIR = 1.29, 95%CI 1.07-1.54, p=0.007), especially individuals aged <20 years at surgery (SIR = 1.43, 95%CI 1.11-1.82), and for the nodular sclerosis subtype of HL (SIR = 1.55, 95%CI 1.01-2.27). A marginally increased risk of myeloma was noted among men, but the association was limited to the first few years of follow-up.

    Conclusion: Appendectomy is not associated with any notable increase in risk of lymphoid neoplasms. A small increased risk of HL following appendicitis (rather than appendectomy per se) could reflect a true association, or shared susceptibility to infection/inflammation among individuals prone to develop HL. The association observed for myeloma may be explained by chance or surveillance bias.

  • 31.
    Montgomery, Madeleine
    et al.
    Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Håkanson, Bengt
    Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Ljungqvist, Olle
    Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Ahlman, Bo
    Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Thorell, Anders
    Division of Surgery, CLINTEC, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm; Centre of Gastrointestinal Disease, Ersta Hospital, Stockholm.
    Twelve months' follow-up after treatment with the EndoCinch endoscopic technique for gastro-oesophageal reflux disease: a randomized, placebo-controlled study2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 12, s. 1382-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The Bard EndoCinch plication technique has been reported to improve symptoms and reduce oesophageal acid exposure in patients with gastro-oesophageal reflux disease (GORD). However, no placebo-controlled studies have been published as yet. The purpose of this study was to evaluate the effects of the EndoCinch plication technique in a randomized, placebo-controlled setting.

    Material and methods: Forty-six otherwise healthy subjects with objectively verified GORD requiring regular use of proton-pump inhibitors (PPIs) were enrolled in the study. Patients were randomized to the EndoCinch plication technique or a sham procedure. Pre- and post-procedure assessments included gastro-oesophageal endoscopy, oesophageal manometry and 24-h pH recording, quality of life (QoL) assessment and use of PPIs.

    Results: Reflux-specific symptoms and use of PPIs (total intake as well as number of patients not taking PPIs) improved in both groups at 6 weeks and at 3 and 12 months post-procedure (p<0.05) with an increased improvement in the treatment group at 3 months compared to controls (p<0.05 versus sham). There were no inter- or intra-group differences in endoscopic findings, oesophageal manometry or acid exposure before or at 3 or 12 months post-procedure. Gastro-oesophageal endoscopy showed that 71% and 67% of sutures remained at 3 and 12 months, respectively.

    Conclusions: Although some short-term effects were achieved, it was found that there were no differences between the treatment and control groups after 12 months and the lack of reduction of oesophageal acid exposure suggests that, in its present form, the EndoCinch plication technique is not to be recommended for use in clinical practice. It is suggested that the lack of long-term effects is primarily due to detachment of the sutures.

  • 32. Olén, Ola
    et al.
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Ekbom, Anders
    Bollgren, Ingela
    Ludvigsson, Jonas F.
    Örebro universitet, Hälsoakademin.
    Urinary tract infections in pregnant women with coeliac disease2007Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, nr 2, s. 186-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Previous research has indicated a link between coeliac disease (CD) and urinary tract infection (UTI). The objective of this study was to assess the risk of UTI and repeated episodes of UTI before the current pregnancy in women with diagnosed or undiagnosed CD. Material and methods. A national registry-based cohort study restricted to pregnant women was used in this investigation, with linkage between the Swedish National Medical Birth Registry and the National Inpatient Registry. We analysed the risk of UTI during pregnancy from 1973 to 1989 in 212 pregnancies to women who had received a diagnosis of CD prior to giving birth and in 786 pregnancies to women diagnosed after giving birth. We also assessed the risk of repeated episodes of UTI before the current pregnancy according to data in the national birth records of 1990-2001 in 617 women with CD diagnosed prior to giving birth and 109 women diagnosed after giving birth. Results. UTI during pregnancy: UTI occurred during 19,139/1,678,304 pregnancies to women who had never had a diagnosis of CD, compared with in 12/786 pregnancies to women with undiagnosed CD (adjusted odds ratio (AOR) =1.37; 95% CI =0.78-2.43; p=0.276) and in 0/212 pregnancies to women with diagnosed CD (AOR =0.06; 95% CI =0.00-8.94; p=0.277) (ORs adjusted for maternal age, parity, nationality and calendar period). Repeated episodes of UTI before the current pregnancy: among 692,991 women who had never had a diagnosis of CD, 74,776 reported repeated episodes of UTI, compared with 14/101 women with undiagnosed CD (AOR =1.39; 95% CI =0.79-2.45; p=0.255) and 69/566 women with diagnosed CD (AOR =1.02; 95% CI =0.79-1.32; p=0.864) (ORs adjusted for maternal age, parity, nationality, calendar period and civil status). Adjustment for smoking in a subset of patients with available data did not change the risk estimates. Conclusions. It cannot be ruled out that undiagnosed CD in pregnant women is associated with a small, increased risk of UTI. In pregnant women with diagnosed CD, there seems to be no increased risk of UTI.

  • 33. Olén, Ola
    et al.
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Elinder, Göran
    Ekbom, Anders
    Ludvigsson, Jonas F.
    Örebro universitet, Hälsoakademin.
    Increased risk of immune thrombocytopenic purpura among inpatients with coeliac disease2008Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 43, nr 4, s. 416-422Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Case reports have indicated a link between coeliac disease (CD) and immune thrombocytopenic purpura (ITP). Two national, register-based studies were carried out to investigate a possible association between CD and ITP and vice versa. MATERIAL AND METHODS: In a cohort study of 14,347 individuals with inpatient diagnoses of CD and 69,967 reference individuals matched for age, gender, calendar year and county, the Cox regression was used to estimate the risk of subsequent inpatient diagnoses of ITP (of any type or chronic). In a case control design, conditional logistic regression was used to assess the risk of exposure (diagnosis of ITP prior to CD) in 15,382 cases (individuals with diagnoses of CD) and 76,824 matched controls. Diagnoses of CD and ITP were identified through the Swedish National Inpatient Register. RESULTS: Individuals with CD were at increased risk of both subsequent ITP of any type (hazard ratio (HR)=1.91; 95% CI=1.19-3.11; p=0.008) and subsequent chronic ITP (HR 2.77; 95% CI=1.09-7.04; p=0.033). Risk estimates were similar when reference individuals were restricted to inpatients. There was also a positive association between CD and prior ITP of any type (odds ratio (OR)=2.96; 95% CI=1.60-5.50; p=0.001) or with prior chronic ITP (OR=6.00; 95% CI=1.83-19.66; p=0.003). CONCLUSIONS: We found a positive association between CD and both ITP of any type and chronic ITP, irrespective of which disease came first, and suggest there should be increased awareness of CD in patients with ITP

  • 34. Olén, Ola
    et al.
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Marcus, Claude
    Ekbom, Anders
    Ludvigsson, Jonas F.
    Örebro universitet, Hälsoakademin.
    Coeliac disease and body mass index: a study of two Swedish general population-based registers2009Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 44, nr 10, s. 1198-1206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine the relationship between body mass index (BMI) and an inpatient diagnosis of coeliac disease (CD) in two independent Swedish national registers. MATERIAL AND METHODS: Study 1: Cohort study of women. The relationship between (pre-pregnancy) BMI and CD in pregnant women was evaluated (174 undiagnosed CD (at time of pregnancy), 550 diagnosed CD, 787,986 without a diagnosis of CD). The association between BMI and undiagnosed CD was estimated by Cox regression. Study 2: Case-control study of men. The relationship between BMI and CD in male conscripts was evaluated (70 undiagnosed CD, 1,047 diagnosed CD and 6,887 without a diagnosis of CD). The association between BMI and undiagnosed CD was estimated by logistic regression. Prevalence of underweight, normal weight and overweight was compared between diagnosed CD, undiagnosed CD and no diagnosis of CD. RESULTS: The prevalence of underweight (BMI <18.5) in women was: reference individual: 5.2%; undiagnosed CD: 16.7% and prior diagnosis of CD: 6.4%. In men, the corresponding figures were 6.5%; 14.3% and 9.8%, respectively. Underweight was associated with undiagnosed CD (future diagnosis of CD) in both women (hazard ration (HR) = 2.5; 95% CI = 1.6-3.7) and men (odds ratio (OR) = 2.4; 95% CI = 1.2-4.9). In women, overweight was negatively associated with undiagnosed CD (HR = 0.6; 95% CI = 0.4-0.9), but not in men (OR = 1.1; 95% CI = 0.6-2.2). 9.2% of women with undiagnosed CD and 14.3% of men with undiagnosed CD were overweight. CONCLUSIONS: Underweight individuals are at increased risk of having undiagnosed CD. However, overweight does not rule out CD.

  • 35.
    Rundquist, Sara
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Eriksson, Carl
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Nilsson, Linda
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Angelison, Leif
    Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.
    Jäghult, Susanna
    Stockholm Gastro Center, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Björk, Jan
    Department of Medicine, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Grip, Olof
    Department of Gastroenterology, Skåne University Hospital Malmö, Malmö, Sweden.
    Hjortswang, Henrik
    Department of Gastroenterology, Linköping University, Linköping, Sweden.
    Strid, Hans
    Department of Internal Medicine, Södra Älvsborgs Sjukhus, Borås, Sweden.
    Karlén, Per
    Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Clinical effectiveness of golimumab in Crohn's disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG)2018Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, nr 10-11, s. 1257-1263Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The effectiveness of golimumab in Crohn's disease (CD) is largely unknown as it is not approved for the treatment of the disease. We aimed to identify the population of CD patients treated with golimumab in Sweden, to assess the effectiveness of golimumab (defined as the drug retention rate), and to identify predictors of drug discontinuation.

    METHODS: Patients with CD who received at least one injection of golimumab were identified through the Swedish National Quality Registry for Inflammatory Bowel Disease, which includes prospectively collected clinical information. Cox regression models were used to identify predictors of golimumab discontinuation.

    RESULTS: The study cohort involved 94 patients of whom the majority (96.8%) had previously discontinued at least one anti-tumour necrosis factor (anti-TNF) agent. The drug retention rate at 12 weeks was 85.1%. Predictors of golimumab discontinuation at 12 weeks were previous surgery (adjusted HR = 7.52, 95% CI: 1.12-50.36), concomitant corticosteroid use at baseline (adjusted HR = 5.70, 95% CI: 1.13-28.68) and female sex (adjusted HR = 6.59; 95% CI: 1.04-41.62). The median duration of follow-up was 89 (IQR: 32-158) weeks. The drug retention at the most recent follow-up was 35.1%. Predictors of golimumab discontinuation at the most recent follow-up were corticosteroid use at baseline (adjusted HR = 2.60, 95% CI: 1.17-5.79) and female sex (adjusted HR = 2.24; 95% CI: 1.19-4.23).

    CONCLUSION: Patients with CD treated with golimumab were a treatment-refractory group. Despite this, more than one-third of the patients appeared to have had clinical benefit after a median follow-up of more than 1.5 years.

  • 36. Stjernman, Henrik
    et al.
    Grännö, Christer
    Bodemar, Göran
    Järnerot, Gunnar
    Ockander, Leif
    Tysk, Curt
    Örebro universitet, Institutionen för klinisk medicin.
    Blomberg, Björn
    Almer, Sven
    Ström, Magnus
    Hjortswang, Henrik
    Evaluation of the inflammatory bowel disease questionnaire in Swedish patients with Crohn's disease2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 8, s. 934-943Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Health-related quality of life (HRQoL) is an important measure of inflammatory bowel disease (IBD) health outcome. The Inflammatory Bowel Disease Questionnaire (IBDQ) comprising 32 items grouped into four dimensions is a widely used IBD-specific HRQoL instrument. The purpose of this study was to evaluate the validity, reliability and responsiveness of the Swedish translation of the IBDQ in patients with Crohn's disease (CD). MATERIAL AND METHODS: Four hundred and forty-eight patients with CD completed the IBDQ and three other HRQoL questionnaires (Rating Form of IBD Patient Concerns; Short Form-36; and the Psychological General Well-Being Index) in connection with their regular visit at the outpatient clinic. Disease activity was assessed by the physician on a 4-point Likert scale. Thirty-two patients who were stable in remission completed the questionnaires a second time, 4 weeks later. A total of 418 patients repeated all measurements after 6 months. RESULTS: The dimensional scores were highly correlated with other measures of corresponding aspects of HRQoL and were significantly better in remission than in relapse. High test-retest correlations indicated good reliability. Responsiveness was confirmed in patients whose disease activity changed over time. However, high correlations between the dimensions, poor correlations between items within each dimension, and factor analysis all indicated that the original grouping of the items is not valid for Swedish CD patients. CONCLUSIONS: Although the Swedish IBDQ has good external validity, reliability and responsiveness for patients with CD, our results did not support the original grouping of the items.

  • 37.
    Stjernman, Henrik
    et al.
    Dept Med, Div Gastroenterol, Cty Hosp Ryhov, Jönköping, Sweden.
    Tysk, Curt
    Örebro universitet, Hälsoakademin. Örebro University Hospital, Örebro, Sweden.
    Almer, Sven
    Dept Clin & Expt Med, Div Gastroenterol & Hepatol, Linkoping Univ Hosp, Linkoping, Sweden.
    Strom, Magnus
    Dept Clin & Expt Med, Div Gastroenterol & Hepatol, Linkoping Univ Hosp, Linkoping, Sweden.
    Hjortswang, Henrik
    Dept Clin & Expt Med, Div Gastroenterol & Hepatol, Linkoping Univ Hosp, Linkoping, Sweden.
    Worries and concerns in a large unselected cohort of patients with Crohn's disease2010Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, nr 6, s. 696-706Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Disease-related worries constitute an important dimension of patient-reported perception of health status in inflammatory bowel disease (IBD). The Rating Form of IBD Patient Concerns (RFIPC) questionnaire is purported to measure IBD-related worries. This study evaluated the psychometric properties of a Swedish translation of RFIPC in an unselected population of Crohn's disease (CD) patients. The degree and nature of the worries were characterized and predictive factors for outcome of RFIPC and underlying dimensions were identified. Material and Methods. The RFIPC was completed by 447 CD patients in conjunction with regular visits. A physician global assessment of disease activity and four other health-related quality of life (HRQL) questionnaires were used for construct validity. Reliability and responsiveness were evaluated with follow-up visits. Underlying dimension and predictive factors were identified with factor analysis and multiple linear regression analysis. Results. Test-retest reliability was 0.90, correlation with corresponding HRQL measures 0.60-0.80 and responsiveness ratio 0.84. Median RFIPC sum score was lower than in previous studies. Top three concerns were ostomy, energy level and bowel control. Four dimensions were identified in descending order of concern: disease-related complications, daily-life achievements, intimacy, and stigmatization. Predictors of RFIPC score were disease activity, gender, and BMI (p < 0.001-0.008). Conclusions. The Swedish version of RFIPC exhibited an adequate psychometric performance in CD patients, but was less sensitive to change in disease activity. The patients were more concerned about complications and achievement than intimacy and stigmatization. The strongest predictors of more worry were active disease, female gender and higher BMI.

  • 38.
    Sundin, Johanna
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Rangel, Ignacio
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro universitet, Institutionen för läkarutbildning.
    Kumawat, Ashok K
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hultgren-Hörnquist, Elisabeth
    Örebro universitet, Institutionen för läkarutbildning.
    Brummer, Robert J
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län.
    Aberrant mucosal lymphocyte number and subsets in the colon of post-infectious irritable bowel syndrome patients2014Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 49, nr 9, s. 1068-1075Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Irritable bowel syndrome (IBS) is characterized by chronic abdominal symptoms such as pain, discomfort, and altered bowel habits. A subset of IBS patients, denoted as post-infectious IBS (PI-IBS) patients, develop symptoms after an enteric infection. Distinct abnormalities in the gut mucosa, including mucosal inflammation, have been proposed to contribute to or be the cause of PI-IBS. This study investigated lymphocyte subsets in PI-IBS patients compared to healthy controls.

    Materials and methods: Ten PI-IBS patients and nine healthy controls participated. All PI-IBS patients met the Rome III diagnostic criteria for IBS and reported sustained symptoms at least 1 year after an episode of acute gastroenteritis. Intraepithelial lymphocytes and lamina propria lymphocytes (LPLs), isolated from mucosal tissue samples, were stained and analyzed for a comprehensive set of cell markers using flow cytometry.

    Results: The number of LPLs in PI-IBS was significantly increased compared to those in healthy controls (p < 0.05). PI-IBS patients showed significantly increased proportions of CD45RO(+) CD4(+) activated/memory T cells (p < 0.05) and double-positive CD4(+) CD8(+) cells (p < 0.05), respectively, in the lamina propria. The number of CD19(+) LPLs was decreased in PI-IBS patients compared to healthy controls (p < 0.001).

    Conclusion: This study presents new evidence that PI-IBS is associated with a sustained aberrant mucosal immune response and support future studies of anti-inflammatory or immune-modulating treatments in these patients.

  • 39.
    Svensson, Magnus
    et al.
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bergman, David
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Olén, Ola
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Bohr, Johan
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wickbom, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Khalili, Hamed
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit , Crohn's and Colitis Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
    Münch, Andreas
    Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Public Health School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
    Validating microscopic colitis (MC) in Swedish pathology registers2018Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Microscopic colitis (MC), encompassing collagenous colitis (CC) and lymphocytic colitis (LC), is a diagnosis which relies on histopathologic criteria. This report examines the validity of having a diagnosis of MC in Swedish pathology registers.

    METHODS: We reviewed patient charts from 215 randomly selected individuals from 15 pathology departments in five healthcare regions in Sweden with a relevant histopathology code for MC on colon biopsies. Information on clinical symptoms and laboratory data were obtained from medical chart review. We obtained sufficient data on 211 individuals for calculating positive predictive values (PPVs) for MC.

    RESULTS: In total, 200/211 patients with a histopathology diagnosis of MC were confirmed as also having a clinical diagnosis of MC after chart review, yielding a PPV of 95% (95%CI =91-97%). The PPV for CC was 95% (95%CI =87-98%) and 85% for LC (95%CI =78-90%). The median age at biopsy was 67 years (range 17-90 years), and 72% (n = 154) were women. The most common symptoms in patients with MC histopathology were diarrhea (96% of patients), weight loss (24%) and abdominal pain (13%). Four percent (4/111) of patients with available data on stool culture were positive for gastrointestinal pathogens (none had Clostridium difficile). In 81 patients with available celiac serology, five (6%) were positive. Twenty-six percent of all patients had at least one other autoimmune disease, the most frequent being hypothyroidism (8%) and celiac disease (6%).

    CONCLUSIONS: This study found a high validity for MC as recorded in Swedish pathology registers.

  • 40.
    Vigren, Lina
    et al.
    Div Gastroenterol, Dept Clin Sci, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Sjöberg, Klas
    Div Gastroenterol, Dept Clin Sci, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Benoni, Cecilia
    Div Gastroenterol, Dept Clin Sci, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Tysk, Curt
    Örebro universitet, Hälsoakademin.
    Bohr, Johan
    Örebro universitet, Hälsoakademin.
    Kilander, Anders
    Dept Med, Div Gastroenterol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Larsson, Lasse
    Dept Med, Div Gastroenterol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Ström, Magnus
    Fac Hlth Sci, Dept Clin & Expt Med, Div Gastroenterol Inflammatory Med, Linköping Univ, Linköping, Sweden; Dept Gastroenterol & Endocrinol, Linköping Univ Hosp, Linköping, Sweden.
    Hjortswang, Henrik
    Fac Hlth Sci, Dept Clin & Expt Med, Div Gastroenterol Inflammatory Med, Linköping Univ, Linköping, Sweden; Dept Gastroenterol & Endocrinol, Linköping Univ Hosp, Linköping, Sweden.
    Is smoking a risk factor for collagenous colitis?2011Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, nr 11, s. 1334-1339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The association between smoking and idiopathic inflammatory bowel disease is well known; smoking seems to have a diverse effect. Crohn's disease is associated with smoking, while ulcerative colitis is associated with non-smoking. Data on smoking inmicroscopic colitis of the collagenous type (CC) are lacking. The aim of this investigation was to study smoking habits in CC and to observe whether smoking had any impact on the course of the disease. Materials and methods. 116 patients (92 women) with median age of 62 years (interquartile range 55-73) answered questionnaires covering demographic data, smoking habits and disease activity. As control group we used data from the general population in Sweden retrieved from Statistics Sweden, the central bureau for national socioeconomic information. Results. Of the 116 CC patients, 37% were smokers compared with 17% of controls (p < 0.001, odds ratio (OR) 2.95). In the age group 16-44 years, 75% of CC patients were smokers compared with 15% of controls (p < 0.001, OR 16.54). All CC smoker patients started smoking before the onset of disease. Furthermore, smokers developed the disease earlier than non-smokers - at 42 years of age (median) compared with 56 years in non-smokers (p < 0.003). Although the proportion with active disease did not differ between smokers and nonsmokers, there was a trend indicating that more smokers received active treatment (42% vs. 17%, p = 0.078). Conclusions. Smoking is a risk factor for CC. Smokers develop their disease more than 10 years earlier than non-smokers.

  • 41.
    Vigren, Lina
    et al.
    Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Tysk, Curt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Ström, Magnus
    Department of Clinical and Experimental Medicine, Division of Gastroenterology Within Inflammatory Medicine, Faculty of Health Sciences, Linköping, Sweden .
    Kilander, Anders F.
    Department of Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden .
    Hjortswang, Henrik
    Department of Clinical and Experimental Medicine, Division of Gastroenterology Within Inflammatory Medicine, Faculty of Health Sciences, Linkøping, Sweden.
    Bohr, Johan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Benoni, Cecilia
    Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Malmö, Sweden .
    Larson, Lasse
    Department of Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sjöberg, Klas
    Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Celiac disease and other autoimmune diseases in patients with collagenous colitis2013Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, nr 8, s. 944-950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims. Collagenous colitis (CC) is associated with autoimmune disorders. The aim of the present study was to investigate the relationship between CC and autoimmune disorders in a Swedish multicenter study. Methods. Patients with CC answered questionnaires about demographic data and disease activity. The patient's files were scrutinized for information about autoimmune diseases. Results. A total number of 116 CC patients were included; 92 women, 24 men, median age 62 years (IQR 55-73). In total, 30.2% had one or more autoimmune disorder. Most common were celiac disease (CeD; 12.9%) and autoimmune thyroid disease (ATD, 10.3%), but they also had Sjogren's syndrome (3.4%), diabetes mellitus (1.7%) and conditions in skin and joints (6.0%). Patients with associated autoimmune disease had more often nocturnal stools. The majority of the patients with associated CeD or ATD got these diagnoses before the colitis diagnosis. Conclusion. Autoimmune disorders occurred in one-third of these patients, especially CeD. In classic inflammatory bowel disease (IBD), liver disease is described in contrast to CC where no cases occurred. Instead, CeD was prevalent, a condition not reported in classic IBD. Patients with an associated autoimmune disease had more symptoms. Patients with CC and CeD had an earlier onset of their colitis. The majority of the patients with both CC and CeD were smokers. Associated autoimmune disease should be contemplated in the follow-up of these patients.

  • 42.
    Wickbom, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bohr, Johan
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Anders
    Department of Medicine, Emergency and Geriatrics, Sahlgrenska University Hospital East, Gothenburg, Sweden.
    Lapidus, Annika
    Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden.
    Münch, Andreas
    Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Ung, Kjell-Arne
    Department of Internal Medicine, Sahlgrenska University Hospital Mölndal, Gothenburg, Sweden.
    Vigren, Lina
    Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden..
    Öst, Åke
    Department of Pathology and Cytology, Aleris Medilab, Täby, Sweden.
    Tysk, Curt
    Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Microscopic colitis in patients with ulcerative colitis or Crohn's disease: a retrospective observational study and review of the literature2018Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, nr 4, s. 410-416Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohn's disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature.

    METHODS: Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed.

    RESULTS: We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n = 16) or lymphocytic colitis (LC) (n = 5); nine CD patients developed CC (n = 5) or LC (n = 4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients.

    CONCLUSIONS: Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.

  • 43. Wickbom, Anna
    et al.
    Lindqvist, Magnus
    Bohr, Johan
    Ung, Kjell-Arne
    Bergman, Jan
    Eriksson, Sune
    Tysk, Curt
    Örebro universitet, Institutionen för klinisk medicin.
    Colonic mucosal tears in collagenous colitis2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 6, s. 726-729Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In general, the colonic mucosa is macroscopically normal in collagenous colitis, although minor, non-specific abnormalities may be found. Significant endoscopic abnormalities, "mucosal tears" representing longitudinal mucosal lacerations, have been reported in a few patients with collagenous colitis. We report the cases of three women with collagenous colitis and mucosal tears detected at the index colonoscopy in order to illustrate the endoscopic characteristics and review the literature. Including the present cases, a total of 12 patients with mucosal tears and collagenous colitis have been reported. In 10 patients, the mucosal lacerations involved the ascending or the transverse colon. Three of the 12 patients had a colonic perforation immediately after the colonoscopy. The colonoscopist should be aware that the risk of perforation is likely to be increased when mucosal tears are present.

  • 44.
    Yakymenko, Olena
    et al.
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Schoultz, Ida
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Sciences.
    Gullberg, Elisabeth
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Ström, Magnus
    Department of Gastroenterology and Hepatology, Linköping University, Linköping, Sweden.
    Almer, Sven
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden; GastroCentrum, Karolinska University Hospital, Stockholm, Sweden.
    Wallon, Conny
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Wang, Arthur
    Gastrointestinal Research Group, Cumming School of Medicine, University of Calgary, Calgary, Canada.
    Keita, Åsa V.
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Campbell, Barry J.
    Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK.
    McKay, Derek M.
    Gastrointestinal Research Group, Cumming School of Medicine, University of Calgary, Calgary, Canada.
    Söderholm, Johan D.
    Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Infliximab restores colonic barrier to adherent-invasive E. coli in Crohn's disease via effects on epithelial lipid rafts2018Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, nr 6, s. 677-684Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Infliximab is important in the therapeutic arsenal of Crohn's disease (CD). However, its effect on mucosal barrier function is not fully understood. Adherent-invasive Escherichia coli (AIEC) are important in CD pathophysiology, but the transmucosal uptake routes are partly unknown. We investigated effects of infliximab on uptake of colon-specific AIEC HM427 across CD colonic mucosa.

    MATERIALS AND METHODS: Cr-EDTA) and transmucosal passage of GFP-expressing HM427 were studied. Mechanisms of HM427 transepithelial transport were investigated in Caco-2 monolayers treated with TNF, in the presence of infliximab and/or endocytosis inhibitors.

    RESULTS: Cr-EDTA permeability were increased in CD (p < .05), but were restored to control levels by infliximab (CD: 150 (18.8-1069)). In TNF-exposed Caco-2 monolayers HM427 transport and lipid rafts/HM427 co-localization was decreased by infliximab. The lipid raft inhibitor methyl-β-cyclodextrin decreased HM427 transport.

    CONCLUSION: Infliximab restored the colonic barrier to AIEC in CD; an effect partially mediated by blocking lipid rafts in epithelial cells. This ability likely contributes to infliximab's clinical efficacy in colonic CD.

  • 45.
    Zhulina, Yaroslava
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för läkarutbildning. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-20052016Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, nr 3, s. 304-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Changes in medical therapy and surgery might have influenced the natural history Crohn’s disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis.

    Material and Methods: A population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis.

    Results: The proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, non-penetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001).

    Conclusions: We observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that the introduction of new treatments alone does not explain the reduction in surgery rates, the increasing proportion of patients with inflammatory disease at diagnosis also play an important role.

1 - 45 av 45
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf