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  • 1.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Bai, Julio C.
    Dept Med, Dr C Bonorino Udaondo Gastroenterol Hosp, Salvador Univ, Buenos Aires DF, Argentina.
    Biagi, Federico
    Dept Internal Med 1, Coeliac Ctr, IFdn IRCCS Policlin San Matteo, Univ Pavia, Pavia, Italy.
    Card, Timothy R.
    Dept Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England..
    Ciacci, Carolina
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Ciclitira, Paul J.
    Div Nutr Sci, Rayne Inst, St Thomas Hosp, Kings College, London, England.
    Green, Peter H. R.
    Coeliac Dis Ctr, Columbia Univ, New York NY, USA.
    Hadjivassiliou, Marios
    Royal Hallamshire Hosp, Dept Neurol, Royal Hallamshire Hosp, Sheffield, England.
    Holdoway, Anne
    British Dietet Assoc, Bath, England.
    van Heel, David A.
    Blizard Inst, Barts & London Sch Med & Dent, Queen Mary Univ, London, England.
    Kaukinen, Katri
    Sch Med, Univ Tampere, Tampere, Finland; Dept Gastroenterol & Alimentary Tract Surg, Tampere Univ Hosp, Tampere, Finland; Dept Med, Seinajoki Cent Hosp, Seinajoki, Finland.
    Leffler, Daniel A.
    Beth Israel Deaconess Med Ctr, Sch Med, Div Gastroenterol, Harvard Univ, Boston MA, USA.
    Leonard, Jonathan N.
    Dept Dermatol, St Marys Hosp, Imperial Coll NHS Healthcare Trust, London, England.
    Lundin, Knut E. A.
    Dept Gastroenterol,Ctr Immune Regulat, Oslo Univ Hosp, Univ Oslo, Oslo, Norway.
    McGough, Norma
    Apollo Ctr, Coeliac UK, London, England..
    Davidson, Mike
    Coeliac UK, Sheffield, England.
    Murray, Joseph A.
    Dept Immunol, Div Gastroenterol & Hepatol, Mayo Clin, Rochester MN, USA.
    Swift, Gillian L.
    Dept Gastroenterol, Univ Hosp, Llandough, UK.
    Walker, Marjorie M.
    Fac Hlth & Med, Sch Med & Publ Hlth, Univ Newcastle, Callaghan NSW, Australia.
    Zingone, Fabiana
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Sanders, David S.
    Gastroenterol & Liver Unit, Royal Hallamshire Hosp, Sheffield, England; Univ Sheffield, Sheffield, England.
    Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology2014Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 63, nr 8, s. 1210-1228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.

  • 2.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Card, Tim
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England.
    Ciclitira, Paul J.
    Rayne Inst London, Div Nutr Sci, Kings Coll London, London, England.
    Swift, Gillian L.
    Dept Gastroenterol, Cardiff & Vale Univ Hlth Board, Cardiff, UK.
    Nasr, Ikram
    Rayne Inst London, Div Nutr Sci, Kings Coll London, London, England.
    Sanders, David S.
    Reg GI & Liver Unit, Royal Hallamshire Hosp, Sheffield, England..
    Ciacci, Carolina
    Dept Med & Surg, Gastroenterol, Univ Salerno, Salerno, Italy.
    Support for patients with celiac disease: A literature review2015Ingår i: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, nr 2, s. 146-159Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives: We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods: Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results: There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion: Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD.

  • 3.
    Ludvigsson, Jonas F.
    et al.
    Region Örebro län. Dept Paediat, Örebro University Hospital, Örebro, Sweden; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Card, Timothy R.
    Dept Epidemiol & Publ Hlth, Univ Nottingham, Nottingham, England.
    Kaukinen, Katri
    Sch Med, Univ Tampere, Tampere, Finland; Dept Internal Med, Tampere Univ Hosp, Tampere, Finland;Dept Internal Med, Seinajoki Cent Hosp, Seinajoki, Finland.
    Bai, Julio
    Dept Med, C Bonorino Udaondo Gastroenterol Hosp,Univ Salvador, Buenos Aires DF, Argentina.
    Zingone, Fabiana
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Sanders, David S.
    Reg GI & Liver Unit, Royal Hallamshire Hosp, Sheffield, England.
    Murray, Joseph A.
    Coll Med, Dept Immunol, Dept Med, Mayo Clin, Rochester MN, USA.
    Screening for celiac disease in the general population and in high-risk groups2015Ingår i: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, nr 2, s. 106-120Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Celiac disease (CD) occurs in approximately 1% of the Western population. It is a lifelong disorder that is associated with impaired quality of life (QOL) and an excessive risk of comorbidity and death. Objectives: To review the literature on screening for CD in relation to the current World Health Organization (WHO) criteria for mass screening. Methods: We performed a PubMed search to identify indexed papers on CD screening with a publication date from 1900 until 1 June 2014. When we deemed an abstract relevant, we read the corresponding paper in detail. Results: CD fulfills several WHO criteria for mass screening (high prevalence, available treatment and difficult clinical detection), but it has not yet been established that treatment of asymptomatic CD may reduce the excessive risk of severe complications, leading to higher QOL nor that it is cost-effective. Conclusions: Current evidence is not sufficient to support mass screening for CD, but active case-finding may be appropriate, as we recognize that most patients with CD will still be missed by this strategy. Although proof of benefit is still lacking, screening for CD may be appropriate in high-risk groups.

  • 4.
    Ludvigsson, Jonas F.
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    West, Joe
    Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham, Nottingham, United Kingdom.
    Card, Tim
    Division of Epidemiology and Public Health, Nottingham City Hospital, University of Nottingham,Nottingham, United Kingdom; Department of Gastroenterology, Kings Mill Hospital, Sutton in Ashfield, United Kingdom.
    Appelros, Peter
    Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Risk of Stroke in 28,000 Patients with Celiac Disease: A Nationwide Cohort Study in Sweden2012Ingår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 21, nr 8, s. 860-867Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Earlier studies on stroke in celiac disease (CD) have been underpowered, but a recent study suggested that childhood CD is associated with a 10-fold increased risk of death from stroke, although it was based on small numbers. We examined the risk of stroke in patients with biopsy-verified CD.

    Methods: We collected biopsy data from all 28 pathology departments in Sweden and identified 28,676 individuals with CD diagnosed between 1969 and 2007 (Marsh 3: villous atrophy). In the main analyses, we used Cox regression to estimate hazard ratios (HRs) for stroke in patients with CD compared with HRs for stroke in 141,806 sex-and age-matched controls.

    Results: During follow-up, there were 785 first-stroke diagnoses in patients with CD and 2937 in reference individuals. Patients with CD were at increased risk of stroke (HR 1.10; 95% confidence interval [CI] 1.01-1.19). HRs were similar for ischemic stroke and brain hemorrhage and were not affected by adjustment for type 1 diabetes, rheumatoid arthritis, use of medication against hypertension, or dyslipidemia. The absolute risk of stroke in patients with CD was 267 per 100,000 person-years (excess risk 24/100,000). The highest risk estimates occurred in the first year, with virtually no increased risk after more than 5 years of follow-up after CD diagnosis. The HR for stroke in childhood CD was 1.10 (95% CI 0.37-3.22).

    Conclusions: Patients with CD are at only a small increased risk of stroke, which persists only for a brief period after diagnosis. CD does not seem to be a major risk factor for stroke.

  • 5.
    Marild, Karl
    et al.
    Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden; Astrid Lindgren Childrens Hosp, Solna, Sweden.
    Ye, Weimin
    Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Lebwohl, Benjamin
    Columbia Univ Med Ctr, Celiac Dis Ctr, Dept Med, Columbia Univ, New York NY, USA.
    Green, Peter H. R.
    Columbia Univ Med Ctr, Celiac Dis Ctr, Dept Med, Columbia Univ, New York NY, USA.
    Blaser, Martin J.
    Dept Med, Langone Med Ctr, New York University, New York NY, USA.
    Card, Tim
    Div Epidemiol & Publ Hlth, City Hosp, Univ Nottingham, Nottingham, England..
    Ludvigsson, Jonas F.
    Region Örebro län. Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden; Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Antibiotic exposure and the development of coeliac disease: a nationwide case-control study2013Ingår i: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 13, artikel-id 109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce. Methods: In this population-based case-control study we linked nationwide histopathology data on 2,933 individuals with CD (Marsh stage 3; villous atrophy) to the Swedish Prescribed Drug Register to examine the association between use of systemic antibiotics and subsequent CD. We also examined the association between antibiotic use in 2,118 individuals with inflammation (Marsh 1-2) and in 620 individuals with normal mucosa (Marsh 0) but positive CD serology. All individuals undergoing biopsy were matched for age and sex with 28,262 controls from the population. Results: Antibiotic use was associated with CD (Odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.27-1.53), inflammation (OR = 1.90; 95% CI = 1.72-2.10) and normal mucosa with positive CD serology (OR = 1.58; 95% CI = 1.30-1.92). ORs for prior antibiotic use in CD were similar when we excluded antibiotic use in the last year (OR = 1.30; 95% CI = 1.08-1.56) or restricted to individuals without comorbidity (OR = 1.30; 95% CI = 1.16-1.46). Conclusions: The positive association between antibiotic use and subsequent CD but also with lesions that may represent early CD suggests that intestinal dysbiosis may play a role in the pathogenesis of CD. However, non-causal explanations for this positive association cannot be excluded.

  • 6.
    Zingone, Fabiana
    et al.
    Dept Med & Surg, Univ Salerno, Salerno, Italy.
    Swift, Gillian L.
    Dept Gastroenterol, Univ Hosp Llandough, Cardiff, UK.
    Card, Timothy R.
    Div Epidemiol & Publ Hlth, City Hosp Nottingham, Univ Nottingham, Nottingham, England.
    Sanders, David S.
    Dept Gastroenterol, Royal Hallamshire Hosp, Sheffield, England; Univ Sheffield, Sheffield, England.
    Ludvigsson, Jonas F.
    Region Örebro län. Dept Pediat, Örebro University Hospital, Örebro, Sweden; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Bai, Julio C.
    Dept Med, C Bonorino Udaondo Gastroenterol Hosp, Univ Salvador, Buenos Aires DF, Argentina.
    Psychological morbidity of celiac disease: A review of the literature2015Ingår i: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 3, nr 2, s. 136-145Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Celiac disease has been linked to decreased quality of life and certain mood disorders. The effect of the gluten free diet on these psychological aspects of the disease is still unclear. Objectives: The objective of this article is to review the literature on psychological morbidity of celiac disease. Methods: We performed a PubMed search for the time period from 1900 until June 1, 2014, to identify papers on psychological aspects of celiac disease looking specifically at quality of life, anxiety, depression and fatigue. Results: Anxiety, depression and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life. While aspects of these conditions may improve within a few months after starting a gluten-free diet, some patients continue to suffer from significant psychological morbidity. Psychological symptoms may affect the quality of life and the dietary adherence. Conclusion: Health care professionals need to be aware of the ongoing psychological burden of celiac disease in order to support patients with this disease.

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