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  • 51.
    Momozawa, Yukihide
    et al.
    Fac Vet Med, Univ Liege B34, Liege, Belgium.
    Mni, Myriam
    Fac Vet Med, Univ Liege B34, Liege, Belgium.
    Nakamura, Kayo
    Fac Vet Med, Univ Liege B34, Liege, Belgium.
    Coppieters, Wouter
    Fac Vet Med, Univ Liege B34, Liege, Belgium.
    Almer, Sven
    Inst Mol & Klin Med IMK, Div Gastroenterol & Hepatol, Linköpings Univ, Linköping, Sweden .
    Amininejad, Leila
    Dept Gastroenterol, Erasme Hosp, Univ Libre Brussels, Brussels, Belgium .
    Cleynen, Isabelle
    Dept Pathophysiol, Gastroenterol Sect, Catholic Univ Louvain, Louvain, Belgium.
    Colombel, Jean-Frédéric
    Registre MICI Nord Quest France EPIMAD, Hop Calmette, Lille, France.
    de Rijk, Peter
    Dept Mol Genet, Univ Antwerp VIB, Antwerp, Belgium.
    Dewit, Olivier
    Dept Gastroenterol, Clin Univ St Luc, Catholic Univ Louvain, Brussels, Belgium.
    Finkel, Yigael
    Dept Gastroenterol, Karolinska Childrens Hosp, Stockholm, Sweden.
    Gassull, Miquel A.
    Dept Gastroenterol, Hosp Badalona Germans Trias & Pujol, Badalona, Spain.
    Goossens, Dirk
    Dept Mol Genet, Univ Antwerp VIB, Antwerp, Belgium.
    Laukens, Debby
    Dept Gastroenterol, Univ Hosp, Univ Ghent, Ghent, Belgium.
    Lémann, Marc
    AP HP, Dept Gastroenterol, Hop St Louis, Univ Paris 07, Paris, France.
    Libioulle, Cécile
    Fac Vet Med, Univ Liege B34, Liege, Belgium.
    O'Morain, Colm
    Adelaide & Meath Hosp, Dublin, Ireland.
    Reenaers, Catherine
    Fac Med, Univ Liege B34, Liege, Belgium.
    Rutgeerts, Paul
    Dept Pathophysiol, Gastroenterol Sect, Catholic Univ Louvain, Louvain, Belgium.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Zelenika, Diana
    Ctr Natl Genotypage, Evry, France.
    Lathrop, Mark
    Ctr Natl Genotypage, Evry, France.
    Del-Favero, Jurgen
    Dept Mol Genet, Univ Antwerp VIB, Antwerp, Belgium .
    Hugot, Jean-Pierre
    INSERM, U843, Hop Robert Debre, IParis, France.
    de Vos, Martine
    Dept Gastroenterol,Univ Hosp, Univ Ghent, Ghent, Belgium.
    Franchimont, Denis
    Dept Gastroenterol, Erasme Hosp, Univ Libre Brussels, Brussels, Belgium.
    Vermeire, Severine
    Dept Pathophysiol, Gastroenterol Sect, Catholic Univ Louvain, Louvain, Belgium.
    Louis, Edouard
    Fac Med, Univ Liege B34, Liege, Belgium.
    Georges, Michel
    Fac Med, Univ Liege B34, Liege, Belgium.
    Resequencing of positional candidates identifies low frequency IL23R coding variants protecting against inflammatory bowel disease2011In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 43, no 1, p. 43-47Article in journal (Refereed)
    Abstract [en]

    Genome-wide association studies (GWAS) have identified dozens of risk loci for many complex disorders, including Crohn's disease. However, common disease-associated SNPs explain at most ∼20% of the genetic variance for Crohn's disease. Several factors may account for this unexplained heritability, including rare risk variants not adequately tagged thus far in GWAS. That rare susceptibility variants indeed contribute to variation in multifactorial phenotypes has been demonstrated for colorectal cancer, plasma high-density lipoprotein cholesterol levels, blood pressure, type 1 diabetes, hypertriglyceridemia and, in the case of Crohn's disease, for NOD2 (refs. 14,15). Here we describe the use of high-throughput resequencing of DNA pools to search for rare coding variants influencing susceptibility to Crohn's disease in 63 GWAS-identified positional candidate genes. We identify low frequency coding variants conferring protection against inflammatory bowel disease in IL23R, but we conclude that rare coding variants in positional candidates do not make a large contribution to inherited predisposition to Crohn's disease.

  • 52.
    Munch, Andreas
    et al.
    Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Bohr, Johan
    Örebro University Hospital. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Miehlke, Stephan
    Centre for Digestive Disease, Hamburg, Germany.
    Benoni, Cecilia
    Department of Gastroenterology, University Hospital, Malmö, Sweden.
    Olesen, Martin
    Department of Pathology, University Hospital, Malmö, Sweden.
    Öst, Åke
    Department of Pathology and Cytology, Aleris Medilab, Täby, Sweden.
    Strandberg, Lars
    Regional Hospital, Falun, Sweden.
    Hellström, Per M.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hertervig, Erik
    Department of Gastroenterology, University Hospital, Lund, Sweden.
    Armerding, Peter
    Gastroenterology, Private Practice, Berlin, Germany.
    Stehlik, Jiri
    Department of Gastroenterology, Regional Hospital, Usti nad Labem, Czech Republic.
    Lindberg, Greger
    Centre for Digestive Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Björk, Jan
    Centre for Digestive Diseases, Karolinska University Hospital Solna, Stockholm, Sweden.
    Lapidus, Annika
    Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden.
    Löfberg, Robert
    IBD Unit, Department of Gastroenterology, Sophiahemmet, Stockholm, Sweden.
    Bonderup, Ole
    Department of Gastroenterology, Regional Hospital, Silkeborg, Denmark.
    Avnström, Sören
    Department of Gastroenterology, Amager Hospital, Copenhagen, Denmark.
    Rössle, Martin
    Gastroenterology, Private Practice, Freiburg, Germany.
    Dilger, Karin
    Dr Falk Pharma GmbH, Freiburg, Germany.
    Mueller, Ralph
    Dr Falk Pharma GmbH, Freiburg, Germany.
    Greinwald, Roland
    Dr Falk Pharma GmbH, Freiburg, Germany.
    Tysk, Curt
    Örebro University Hospital. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Ström, Magnus
    Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial2016In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 65, no 1, p. 47-56Article in journal (Refereed)
    Abstract [en]

    Objective: This 1-year study aimed to assess low-dose budesonide therapy for maintenance of clinical remission in patients with collagenous colitis.

    Design: A prospective, randomised, placebo-controlled study beginning with an 8-week open-label induction phase in which patients with histologically confirmed active collagenous colitis received budesonide (Budenofalk, 9 mg/day initially, tapered to 4.5 mg/day), after which 92 patients in clinical remission were randomised to budesonide (mean dose 4.5 mg/day; Budenofalk 3 mg capsules, two or one capsule on alternate days) or placebo in a 12-month double-blind phase with 6 months treatment-free follow-up. Primary endpoint was clinical remission throughout the double-blind phase.

    Results: Clinical remission during open-label treatment was achieved by 84.5% (93/110 patients). The median time to remission was 10.5 days (95% CI (9.0 to 14.0 days)). The maintenance of clinical remission at 1 year was achieved by 61.4% (27/44 patients) in the budesonide group versus 16.7% (8/48 patients) receiving placebo (treatment difference 44.5% in favour of budesonide; 95% CI (26.9% to 62.7%), p<0.001). Health-related quality of life was maintained during the 12-month double-blind phase in budesonide-treated patients. During treatment-free follow-up, 82.1% (23/28 patients) formerly receiving budesonide relapsed after study drug discontinuation. Low-dose budesonide over 1 year resulted in few suspected adverse drug reactions (7/44 patients), all non-serious.

    Conclusions: Budesonide at a mean dose of 4.5 mg/day maintained clinical remission for at least 1 year in the majority of patients with collagenous colitis and preserved health-related quality of life without safety concerns. Treatment extension with low-dose budesonide beyond 1 year may be beneficial given the high relapse rate after budesonide discontinuation.

  • 53.
    Münch, A.
    et al.
    Faculty of Health Science, Linköping University, Linköping, Sweden.
    Aust, D.
    Department of Pathology, University Hospital, Dresden, Germany.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Bonderup, O.
    Diagnostic Center, Division of Gastroenterology, Regional Hospital, Silkeborg, Denmark.
    Bañares, F. Fernández
    Department of Gastroenterology, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd,Terrassa, Spain.
    Hjortswang, H.
    Faculty of Health Science, Linköping University, Linköping, Sweden.
    Madisch, A.
    Medical Department I, Academic Teaching Hospital Siloah, Hannover, Germany.
    Munck, L. K.
    Departement of Gastroenterology, Køge University Hospital, Køge, Denmark.
    Ström, M.
    Faculty of Health Science, Linköping University, Linköping, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Miehlke, S.
    Center for Digestive Disease, Cooperation of Internal Medicine, Hamburg, Germany.
    Microscopic colitis: current status, present and future challenges statements of the European microscopic colitis group2012In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 6, no 9, p. 932-945Article in journal (Refereed)
    Abstract [en]

    Microscopic colitis (MC) is an inflammatory bowel disease presenting with chronic, non-bloody watery diarrhoea and few or no endoscopic abnormalities. The histological examination reveals mainly two subtypes of MC, lymphocytic or collagenous colitis. Despite the fact that the incidence in MC has been rising over the last decades, research has been sparse and our knowledge about MC remains limited. Specialists in the field have initiated the European Microscopic Colitis Group (EMCG) with the primary goal to create awareness on MC. The EMCG is furthermore a forum with the intention to promote clinical and basic research. In this article statements and comments are given that all members of the EMCG have considered being of importance for a better understanding of MC. The paper focuses on the newest updates in epidemiology, symptoms and diagnostic criteria, pathophysiology and highlights some unsolved problems. Moreover, a new treatment algorithm is proposed on the basis of new evidence from well-designed, randomized control trials.

  • 54. Münch, A.
    et al.
    Bohr, J.
    Vigren, L.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Ström, M.
    Methotrexate is not effective in budesonide-refractory collagenous colitis2011In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 60, no Suppl 3, p. A406-A406Article in journal (Refereed)
  • 55. Münch, A.
    et al.
    Bohr, J.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Vigren, L.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ström, M.
    Metotrexat vid budesonidrefraktär kollagen kolit2012In: Gastrokuriren, ISSN 1651-0453, Vol. 17, no 34, p. PO-15-PO-15Article in journal (Other academic)
  • 56.
    Ng, Siew C.
    et al.
    Li Ka Shing Inst Hlth Sci, Dept Med & Therapeut, Inst Digest Dis, Chinese Univ, Hong Kong, China.
    Bernstein, Charles N.
    Dept Internal Med, IBD Clin & Res Ctr, University Manitoba, Winnipeg MB, Canada.
    Vatn, Morten H.
    Dept Gastroenterol, Inst Clin Med, EpiGen, University of Oslo, Oslo, Norway.
    Lakatos, Peter Laszlo
    Dept Med 1, Semmelweis University, Budapest, Hungary.
    Loftus, Edward V., Jr.
    Div Gastroenterol & Hepatol, Mayo Clin, Rochester MN, USA.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Gastroenterol.
    O'Morain, Colm
    Dept Gastroenterol, Adelaide & Meath Hosp, Trinity Coll Dublin, Dublin, Ireland.
    Moum, Björn
    Dept Gastroenterol, University of Oslo Hosp, Oslo, Norway; Inst Clin Med, University of Oslo, Oslo, Norway.
    Colombel, Jean-Frederic
    Div Gastroenterol, Mt Sinai Sch Med, New York NY, USA.
    Geographical variability and environmental risk factors in inflammatory bowel disease2013In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 62, no 4, p. 630-649Article in journal (Refereed)
    Abstract [en]

    The changing epidemiology of inflammatory bowel disease (IBD) across time and geography suggests that environmental factors play a major role in modifying disease expression. Disease emergence in developing nations suggests that epidemiological evolution is related to westernisation of lifestyle and industrialisation. The strongest environmental associations identified are cigarette smoking and appendectomy, although neither alone explains the variation in incidence of IBD worldwide. Urbanisation of societies, associated with changes in diet, antibiotic use, hygiene status, microbial exposures and pollution have been implicated as potential environmental risk factors for IBD. Changes in socioeconomic status might occur differently in different geographical areas and populations and, consequently, it is important to consider the heterogeneity of risk factors applicable to the individual patient. Environmental risk factors of individual, familial, community-based, country-based and regionally based origin may all contribute to the pathogenesis of IBD. The geographical variation of IBD provides clues for researchers to investigate possible environmental aetiological factors. The present review aims to provide an update of the literature exploring geographical variability in IBD and to explore the environmental risk factors that may account for this variability.

  • 57. Nyhlin, N.
    et al.
    Bergman, J.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences.
    Gustavsson, A.
    Halfvarson, Jonas
    Salén, E.
    Sandberg Gertzén, H.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Plasmaferes vid svår läkemedelsutlöst kolestas2008In: Gastrokuriren, Vol. 13, no 33, p. PO-16Article in journal (Other (popular science, discussion, etc.))
  • 58. Nyhlin, N.
    et al.
    Bohr, J.
    Eriksson, S.
    Tysk, Curt
    Örebro University, Department of Clinical Medicine.
    Systematic review: microscopic colitis2006In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 23, no 11, p. 1525-1534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Collagenous and lymphocytic colitis are fairly common causes of chronic non-bloody diarrhoea, especially in elderly female. AIM: To present a systematic review of microscopic colitis. METHODS: A PubMed search using the MeSH terms microscopic colitis, collagenous colitis, lymphocytic colitis and chronic diarrhoea was performed. RESULTS: Annual incidence of each disorder is 4-6/100,000 inhabitants. The aetiology is unknown. Clinical characteristics are well described and there is an association with autoimmune diseases. Budesonide is the best-documented short-term treatment of collagenous colitis. In meta-analysis pooled odds ratio for clinical response after 6-8 weeks of treatment was 12.3 (95% CI: 5.5-27.5) in comparison with placebo. The evidence for bismuth subsalicylate is weaker and the effectiveness of other alternatives such as loperamide, cholestyramine, aminosalicylates, probiotics, or Boswellia serrata extract is unknown. Although unproven, in unresponsive severe disease azathioprine or methotrexate may be tried. No controlled trials have been carried out in lymphocytic colitis. The long-term prognosis of microscopic colitis is good, serious complications are rare and there is no increased mortality. CONCLUSIONS: Clinical and epidemiological aspects of microscopic colitis are well described. Budesonide is the best-documented short-term therapy in collagenous colitis, but the optimal long-term strategy needs further study. Controlled treatment data of lymphocytic colitis are awaited for.

  • 59. Nyhlin, Nils
    et al.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences.
    Eriksson, Sune
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Microscopic colitis: a common and an easily overlooked cause of chronic diarrhoea2008In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 19, no 3, p. 181-186Article in journal (Refereed)
    Abstract [en]

    Microscopic colitis, comprising collagenous colitis and lymphocytic colitis, is characterised clinically by chronic watery diarrhoea, a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4–6/100,000 inhabitants, with a peak incidence in 60–70 year old individuals and a noticeable female predominance in collagenous colitis. The aetiology is unknown. Abdominal pain, weight loss, fatigue, and faecal incontinence are common symptoms in addition to chronic diarrhoea that impair the health-related quality of life of the patient. There is an association to other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented short-term treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.

  • 60. Nyhlin, Nils
    et al.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Brummer, Robert
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wickbom, Anna
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Abdominal pain is common in microscopic colitis despite remission: a long-term follow-up of 203 patients2008In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 57, no suppl IArticle in journal (Other academic)
  • 61.
    Nyhlin, Nils
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Wickbom, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Letter: persisting clinical symptoms in microscopic colitis in remission - authors' reply2014In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 40, no 1, p. 118-118Article in journal (Refereed)
  • 62.
    Nyhlin, Nils
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Wickbom, Anna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Tysk, Curt
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Long-term prognosis of clinical symptoms and health-related quality of life in microscopic colitis: a case-control study2014In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, no 9, p. 963-972Article in journal (Refereed)
    Abstract [en]

    Background: Microscopic colitis, comprising collagenous colitis (CC) and lymphocytic colitis (LC), is a common cause of chronic diarrhoea. The long-term prognosis is not well described.

    Aim: To study outcome of symptoms and health-related quality of life (HRQoL).

    Methods: A case-control study using a postal questionnaire with three population-based controls per patient matched for age, sex and municipality. HRQoL was assessed by the Short Health Scale (SHS). Patients in clinical remission, defined as a mean of <3 stools/day, were evaluated separately (CC; n=72, LC; n=60).

    Results: The study included 212 patients and 627 matched controls. Median disease duration was 5.9 (range 0.5-27) years and 6.4 (0.3-14.8) years for CC and LC respectively. Abdominal pain, fatigue, arthralgia, myalgia, faecal incontinence and nocturnal defecation were significantly more prevalent in CC patients compared with controls. These differences persisted in CC patients in clinical remission with respect to abdominal pain (36% vs. 21%), fatigue (54% vs. 34%), arthralgia (61% vs. 41%) and myalgia (53% vs. 37%). In LC patients, abdominal pain, fatigue, faecal incontinence and nocturnal defecation were more prevalent compared with controls. In LC patients in clinical remission, fatigue was more prevalent compared with controls (54% vs. 37%). These differences were statistically significant (P<0.05). All four HRQoL dimensions (symptom burden, social function, disease-related worry, general well-being) were impaired in patients with active CC and LC.

    Conclusions: Although considered to be in clinical remission, patients with microscopic colitis suffer from persisting symptoms such as abdominal pain, fatigue, arthralgia or myalgia several years after diagnosis.

  • 63. Oxelmark, L.
    et al.
    Lindberg, A.
    Löfberg, R.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Lapidus, A. B.
    Eriksson, A. S.
    Sternby, B.
    Benoni, C.
    Almer, S.
    Kilander, A.
    Danielsson, Å.
    SOIBD KAM, Study group
    Complementary and alternative medicine in patients with inflammatory bowel disease2010In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 59, no suppl 3, p. A409-A409Article in journal (Refereed)
  • 64.
    Rathsman, Sandra
    et al.
    Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Sune
    Department of Laboratory Medicine/Pathology, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Olof
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro, Sweden.
    Åberg, Anna-Karin
    Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro, Sweden.
    Olcén, Per
    Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro, Sweden.
    Elution of antitransglutaminase antibodies from duodenal biopsies: a novel approach in the diagnosis of celiac disease2012In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 120, no 8, p. 666-674Article in journal (Refereed)
    Abstract [en]

    Celiac disease (CeD) is a disease more prevalent and multisymptomatic than was earlier recognized. Whereas prompt initiation of gluten-free diet (GFD) is beneficial in relieving the symptoms, an accurate CeD diagnosis is necessary also to avoid years of restricted diet on uncertain grounds. We propose a new diagnostic method, based on elution of deposited antibodies against transglutaminase (anti-tTG) from duodenal biopsies in patients with symptoms and screening serology analyses suggestive of CeD. The eluates were analyzed in a Phadia 250 fluoroimmunoassay, demonstrating elevated concentrations of anti-tTG in CeD patients, corresponding to serology and histopathology findings. In one case histology was inconclusive, displaying only unspecific inflammation, but eluted anti-tTG was positive. This patient has clinically improved following GFD. We conclude that our novel method represents a new tool in the diagnostic work up in CeD. The detection of deposited anti-tTG at the site of inflammation appears to provide a high sensitivity and specificity using a technique that is quick, simple and reliable. Further studies are needed for optimization and elucidation of suitable applications for this elution method.

  • 65.
    Schoultz, Ida
    et al.
    Division of Surgery, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Verma, Deepti
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Halfvarson, Jonas
    Department of Internal Medicine, Division of Gastroenterology,örebro University Hospital ,Örebro , Sweden.
    Törkvist, Leif
    Karolinska Institutet, IBD-Unit at Karolinska University Hospital-Huddinge , Stockholm , Sweden.
    Fredrikson, Mats
    Division of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Sjöqvist, Urban
    Karolinska Institutet, IBD-Unit at Karolinska University Hospital-Huddinge , Stockholm , Sweden.
    Lördal, Mikael
    Karolinska Institutet, IBD-Unit at Karolinska University Hospital-Huddinge , Stockholm , Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences. Department of Internal Medicine, Division of Gastroenterology,örebro University Hospital ,Örebro , Sweden.
    Lerm, Maria
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Söderkvist, Peter
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Söderholm, Johan D.
    Division of Surgery, Department of Clinical and Experimental Medicine, Linköping University , Linköping , Sweden.
    Combined polymorphisms in genes encoding the inflammasome components NALP3 and CARD8 confer susceptibility to Crohn's disease in Swedish men2009In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 104, no 5, p. 1180-1188Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Crohn's disease (CD) is characterized by overproduction of proinflammatory cytokines like interleukin (IL)-1beta. Production of mature IL-1beta is dependent on a caspase-1-activating protein complex called the NALP3 inflammasome, composed of NALP3, ASC, and CARD8. NALP3 shares structural similarities with Nod2, and both of these proteins are required for bacteria-induced IL-1beta secretion. The combination of the polymorphisms CARD8 (C10X)and NALP3 (Q705K) was recently shown to be associated with rheumatoid arthritis.Our aim was to investigate whether these combined polymorphisms play a role in the susceptibility to CD. METHODS: The study included 498 CD patients in two cohorts from different regions and 742 control individuals from a Swedish population. DNA was isolated from whole blood. Polymorphisms of (Q705K) NALP3 and (C10X) CARD8, as well as the Nod2 variants, R702W and G908R, were genotyped using the Taqman single nucleotide polymorphism assay. The Nod2 frameshift mutation, L1007fs, was detected by Megabace SNuPe genotyping. RESULTS: Our results show that men who have both the C10X and Q705K alleles in CARD8 and NALP3, and who express wild-type alleles of Nod2 are at an increased risk of developing CD (odds ratio, OR: 3.40 range: 1.32-8.76); P = 0.011). No association with these polymorphisms was found in women (OR: 0.89 (range: 0.44-1.77); P = 0.74). CONCLUSIONS: We suggest a role for combined polymorphisms in CARD8 and NALP3 in the development of CD in men, with obvious sex differences in the genetic susceptibility pattern. These findings give further support to the importance of innate immune responses in CD.

  • 66. Sjöberg, Mats
    et al.
    Almer, S.
    Befrits, R.
    Benoni, C.
    Carlson, M.
    Eriksson, A.
    Friis Liby, I.
    Halfvarson, Jonas
    Hertervig, E.
    Karlén, P.
    Lapidus, A.
    Magnusson, A.
    Midhagen, G.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Infliximab som “rescue terapi” vid steroidrefraktärt skov av ulcerös kolit: en retrospektiv uppföljningsstudie2011In: Gastrokuriren, ISSN 1651-0453, Vol. 16, no 29, p. PO-14-PO-14Article in journal (Other academic)
  • 67. Sjöberg, Mats
    et al.
    Almer, S.
    Befrits, R.
    Benoni, C.
    Carlson, M.
    Eriksson, A.
    Friis Liby, I.
    Halfvarson, Jonas
    Hertervig, E.
    Karlén, P.
    Lapidus, A.
    Magnusson, A.
    Midhagen, G.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Long-term efficacy of rescue therapy with infliximab in steroid-refractory acute attack of ulcerative colitis2011In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 60, no Suppl 3, p. A48-A48Article in journal (Refereed)
  • 68.
    Sjöberg, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Almer, Sven
    Befrits, Ragnar
    Benoni, Cecilia
    Carlson, Marie
    Eriksson, Anders
    Friis-Liby, Ingalill
    Halfvarson, Jonas
    Örebro University, School of Health and Medical Sciences.
    Hertervig, Erik
    Karlen, Per
    Lapidus, Annika B.
    Magnuson, Anders
    Midhagen, Gunnar
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Infliximab as Rescue Therapy in Steroid-Refractory Acute Ulcerative Colitis: A Retrospective Follow-up Study2011In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 140, no 5, p. S590-S590Article in journal (Other academic)
  • 69.
    Sjöberg, Mats
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Skaraborgs Hospital, Lidköping, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Letter: infliximab in severe ulcerative colitis - is it useful for all patients? Authors' reply2013In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 38, no 11-12, p. 1413-1414Article in journal (Refereed)
  • 70.
    Sjöberg, Mats
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Skaraborgs Hospital, Lidköping, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Bjork, J.
    Department of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.
    Benoni, C.
    Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Almer, S.
    Division of Gastroenterology and Hepatology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friis-Liby, I.
    Division of Gastroenterology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hertervig, E.
    Department of Gastroenterology, Skåne University Hospital, Lund, Sweden.
    Olsson, M.
    Department of Medicine, NÄL Hospital, Trollhättan, Sweden.
    Karlén, P.
    Division of Gastroenterology, Department of Medicine, South Hospital, Stockholm, Sweden.
    Eriksson, A.
    Division of Gastroenterology, Department of Internal Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Midhagen, G.
    Skaraborgs Hospital, Lidköping, Sweden.
    Carlson, M.
    Department of Medical Sciences, Gastroenterology Research Group, University Hospital, Uppsala, Sweden.
    Lapidus, A.
    Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Gastroenterology, Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Infliximab as rescue therapy in hospitalised patients with steroid-refractory acute ulcerative colitis: a long-term follow-up of 211 Swedish patients2013In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 38, no 4, p. 377-387Article in journal (Refereed)
    Abstract [en]

    Background: Rescue therapy with infliximab (IFX) has been proven effective in a steroid-refractory attack of ulcerative colitis (UC). The long-term efficacy is not well described.

    Aim: To present a retrospective study of IFX as rescue therapy in UC. Primary end points were colectomy-free survival at 3 and 12months.

    Methods: In this multicentre study, 211 adult patients hospitalised between 1999 and 2010 received IFX 5mg/kg as rescue therapy due to a steroid-refractory, moderate-to-severe attack of UC. Exclusion criteria were duration of current flare for >12weeks, corticosteroid treatment for >8weeks before hospitalisation, previous IFX therapy or Crohn's disease.

    Results: Probability of colectomy-free survival at 3months was 0.71 (95% CI, 0.64-0.77), at 12months 0.64 (95% CI, 0.57-0.70), at 3years 0.59 (95% CI, 0.52-0.66) and at 5years 0.53 (95% CI, 0.44-0.61). Steroid-free, clinical remission was achieved in 105/211 (50%) and 112/209 (54%) patients at 3 and 12months respectively. Of 75 colectomies during the first year, 48 (64%) were carried out during the first 14days, 13 (17%) on days 15-90 and 14 (19%) between 3 and 12months. There were three (1.4%) deaths during the first 3months.

    Conclusions: Infliximab is an effective rescue treatment, both short- and long-term, in a steroid-refractory attack of UC. Most IFX failures underwent surgery during the first 14days, which calls for studies on how to optimise induction treatment with IFX. Serious complications, including mortality, were rare.

  • 71. Sjöberg, Mats
    et al.
    Walch, A.
    Meshkat, M.
    Gustavsson, A.
    Järnerot, G.
    Vogelsang, H.
    Hertervig, E.
    Novacek, G.
    Friis Liby, I.
    Blomquist, L.
    Angelberger, S.
    Karlén, P.
    Grännö, C.
    Vilien, M.
    Ström, M.
    Verbaan, H.
    Hellström, P. M.
    Magnuson, A.
    Halfvarson, Jonas
    Reinisch, W.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Cyclosporin eller infliximab som rescue terapi vid steroidfraktär ulcerös kolit: en retrospective observationsstudie2010In: Gastrokuriren, ISSN 1651-0453, Vol. 15, no 2, p. 34-34Article in journal (Other academic)
  • 72.
    Sjöberg, Mats
    et al.
    Department of Medicine, Skaraborgs hospital, Lidköping, Sweden.
    Walch, Andrea
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Meshkat, Mina
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Gustavsson, Anders
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Järnerot, Gunnar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Vogelsang, Harald
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Hertervig, Erik
    Department of Gastroenterology, Skåne University Hospital, Lund University, Lund, Sweden.
    Novacek, Gottfried
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Friis-Liby, Ingalill
    Department of Medicine, Division of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Blomquist, Lars
    Department of Gastroenterology and Hepatology, Karolinska University Hospital Solna, Stockholm, Sweden.
    Angelberger, Sieglinde
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Karlén, Per
    Department of Medicine, Division of Gastroenterology, South Hospital, Stockholm, Sweden.
    Granno, Christer
    Department of Medicine, Division of Gastroenterology, Ryhov Hospital, Jönköping, Sweden.
    Vilien, Mogens
    Division of Gastroenterology, Hilleroed Hospital, Hilleroed, Denmark.
    Ström, Magnus
    Division of Gastroenterology and Hepatology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Verbaan, Hans
    Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Hellström, Per M.
    Department of Gastroenterology and Hepatology, Karolinska University Hospital Solna, Stockholm, Sweden.
    Dejaco, Clemens
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Magnuson, Anders
    Clinical epidemiology and biostatistic unit, Örebro University Hospital, Örebro, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Reinisch, Walter
    Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis: a retrospective observational study2012In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 18, no 2, p. 212-218Article in journal (Refereed)
    Abstract [en]

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

  • 73. Soderman, Jan
    et al.
    Noren, Elisabeth
    Christiansson, Malin
    Bragde, Hanna
    Thiebaut, Raphaele
    Hugot, Jean-Pierre
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    O'Morain, Colm A.
    Gassull, Miquel
    Finkel, Yigael
    Colombel, Jean-Frederic
    Lemann, Marc
    Almer, Sven
    Analysis of single nucleotide polymorphisms in the region of CLDN2-MORC4 in relation to inflammatory bowel disease2013In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 19, no 30, p. 4935-4943Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate a possible genetic influence of claudin (CLDN) 1, CLDN2 and CLDN4 in the etiology of inflammatory bowel disease.

    METHODS: Allelic association between genetic regions of CLDN1, CLDN2 or CLDN4 and patients with inflammatory bowel disease, Crohn's disease (CD) or ulcerative colitis were investigated using both a case-control study approach (one case randomly selected from each of 191 Swedish inflammatory bowel disease families and 333 controls) and a family-based study (463 non-Swedish European inflammatory bowel disease-families). A nonsynonymous coding single nucleotide polymorphism in MORC4, located on the same linkage block as CLDN2, was investigated for association, as were two novel CLDN2 single nucleotide polymorphism markers, identified by resequencing.

    RESULTS: A single nucleotide polymorphism marker (rs12014762) located in the genetic region of CLDN2 was significantly associated to CD (case-control allelic OR = 1.98, 95% CI: 1.17-3.35, P = 0.007). MORC4 was present on the same linkage block as this CD marker. Using the case-control approach, a significant association (case control allelic OR = 1.61, 95% CI: 1.08-2.41, P = 0.018) was found between CD and a nonsynonymous coding single nucleotide polymorphism (rs6622126) in MORC4. The association between the CLDN2 marker and CD was not replicated in the family-based study. Ulcerative colitis was not associated to any of the single nucleotide polymorphism markers.

    CONCLUSION: These findings suggest that a variant of the CLDN2-MORC4 region predisposes to CD in a Swedish population.

  • 74.
    Stenberg, Reidun
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Dahle, Charlotte
    Dept. Clinical and Experimental Medicine, Clinical Immunology, Linköping University, Linköping, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden .
    Hellberg, Dan
    Centre for Clinical Research, Falun, Sweden .
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy2013In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 56, no 2, p. 233-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case-control study of IgG antibodies against other dietary antigens, AGA, anti-tTG, and IgE antibodies against wheat and gluten.

    METHODS: Sera from 99 cases with CP and 99 healthy, age- and sex-matched controls were analysed with fluorescence enzyme-linked immunosorbent assay for detection of IgG antibodies against β-lactoglobulin, casein, egg white, IgG- and IgA-AGA, IgA-anti-tTG, and IgE antibodies against gluten and wheat.

    RESULTS: Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β-lactoglobulin was 17.0 (95% confidence interval [CI] 2.3-128), against casein 11.0 (95% CI 2.6-46.8), and against egg white 7.0 (95% CI 1.6-30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA-anti-tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology.

    CONCLUSIONS: Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.

  • 75. Stjernman, H. C. R.
    et al.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Almer, S.
    Ström, M.
    Hjortswang, H.
    Demographic and disease-related factors influencing assessment of disease activity in Crohn's disease2008In: Journal of Crohn's and Colitis Supplements, ISSN 1873-9954, Vol. 2 (Suppl), no 1, p. 28-28Article in journal (Refereed)
  • 76. Stjernman, H.
    et al.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Almer, S.
    Ström, M.
    Hjortswang, H.
    Faktorer som påverkar bedömning av sjukdomsaktivitet vid Crohns sjukdom2008In: Gastrokuriren, Vol. 13, no 27 PO-04Article in journal (Other academic)
  • 77. Stjernman, Henrik
    et al.
    Grännö, Christer
    Bodemar, Göran
    Järnerot, Gunnar
    Ockander, Leif
    Tysk, Curt
    Örebro University, Department of Clinical Medicine.
    Blomberg, Björn
    Almer, Sven
    Ström, Magnus
    Hjortswang, Henrik
    Evaluation of the inflammatory bowel disease questionnaire in Swedish patients with Crohn's disease2006In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, no 8, p. 934-943Article in journal (Refereed)
    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.

  • 78. Stjernman, Henrik
    et al.
    Grännö, Christer
    Järnerot, Gunnar
    Ockander, Leif
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Blomberg, Björn
    Ström, Magnus
    Hjortswang, Henrik
    Short health scale: a valid, reliable, and responsive instrument for subjective health assessment in Crohn's disease.2008In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 14, no 1, p. 47-52Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Health-related quality of life (HRQoL) is an essential part of inflammatory bowel disease (IBD) assessment. The Short Health Scale (SHS), an HRQoL questionnaire in which the patients rate the disease impact on 4 important aspects of subjective health (symptoms, function, worry, and general well-being) was demonstrated in a previous study to be valid, reliable, and responsive in patients with ulcerative colitis. The present study evaluates the SHS in patients with Crohn's disease (CD). METHODS: In all, 367 CD patients completed the SHS and 4 other HRQoL questionnaires (IBDQ, SF-36, RFIPC, and PGWB) at their regular outpatient visits. Then 330 patients completed the questionnaires at a second visit 6 months later. In addition, reliability data were obtained from repeat measurements 4 weeks after the first visit in 40 patients stable in remission. RESULTS: Patients in remission scored better on all 4 questions than those with active disease (P < 0.001). All 4 questions were strongly correlated with the corresponding dimensions of the other HRQoL questionnaires (r(s) = 0.74-0.83). Reliability was confirmed with strong test-retest correlations (r(s) = 0.69-0.82) and intraclass correlation coefficients (0.66-0.77). Patients who changed from remission to active disease or vice versa showed a significant change in all 4 SHS scores (P < 0.005). CONCLUSIONS: SHS is a valid, reliable and responsive HRQoL instrument also in patients with CD. It is easily completed by the patient and requires no further calculation by the investigator. SHS gives a comprehensive overview of the main aspects of the patient's subjective health perception and is a useful tool in both clinical practice and clinical studies.

  • 79.
    Stjernman, Henrik
    et al.
    Dept Med, Div Gastroenterol, Cty Hosp Ryhov, Jönköping, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences. 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 disease2010In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, no 6, p. 696-706Article in journal (Refereed)
    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.

  • 80. Stjernman, Henrik
    et al.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Almer, Sven
    Ström, Magnus
    Hjortswang, Henrik
    Factors predicting the outcome of disease activity assessment in Crohn's disease2009In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 15, no 12, p. 1859-1866Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Crohn's Disease Activity Index (CDAI) has become the gold standard for assessment of disease activity in CD. This study investigated the relationship between CDAI and the physicians' global assessment of disease activity (PGA) and whether different demographic and disease-related factors predict the outcome.

    METHODS: Multiple linear regression analysis was used to investigate the relationship between CDAI and PGA obtained from 405 CD patients. Predictors of the CDAI and the PGA outcome were identified.

    RESULTS: The correlation between CDAI and PGA was moderate. In patients with CDAI >150, 72% of the total score were derived from the subjective variables. The regression coefficients were not significant for 3 of the CDAI variables. In regression analysis, C-reactive protein (CRP), stenosis, smoking, bowel resection, concomitant disease, and gender predicted the CDAI outcome. The PGA outcome was predicted only by CRP, stenosis, and fistula.

    CONCLUSIONS: The correlation between CDAI and PGA was moderate and the subjective variables had a high impact on CDAI. Factors with no obvious relation to inflammatory activity predicted the outcome of CDAI, but not PGA. In trials of CD therapies, separation of subjective (symptoms, well-being) from objective (endoscopy, inflammatory markers) variables should be considered in the assessment of disease activity.

  • 81.
    Stjernman, Henrik
    et al.
    Div Gastroenterol & Hepatol, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Almer, Sven
    Div Gastroenterol & Hepatol, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Ström, Magnus
    Div Gastroenterol & Hepatol, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Hjortswang, Henrik
    Div Gastroenterol & Hepatol, Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Unfavourable outcome for women in a study of health-related quality of life, social factors and work disability in Crohn’s disease2011In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 23, no 8, p. 671-679Article in journal (Refereed)
    Abstract [en]

    Objective The aim was to describe health-related quality of life (HRQL) and social factors, sickness and disability variables in a large population-based cohort of patients with Crohn’s disease (CD). Methods HRQL was measured with Short Form-36 in 497 adult patients with CD at three outpatient clinics. Comparisons were made with age-sex-matched background population and with ulcerative colitis (UC). Social factors, employment, sickness compensation and disability pension for CD were compared with national population registers. Results CD had a greater negative effect on HRQL than did UC. This difference was more pronounced for women. Compared with background population, patients with CD had lower educational level, and had a two-fold rise in long-term sickness and disability pension rate. Women with CD had higher rates of sickness and disability than men with CD and were more often living single, though procreation was not affected. Conclusion This study characterized the burden of CD in a large population-based cohort. CD had higher impact on HRQL, compared with UC. Women with CD had worse outcome in subjective health status, but not in objective assessment of disease activity. Women also had higher rates of sickness, disability pension and single living. The mechanism underlying the sex-related inequalities in outcome for CD warrants further elucidation. Eur J Gastroenterol Hepatol 23: 671-679 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  • 82. Strid, H.
    et al.
    Kumawat, Ashok Kumar
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hultgren Hörnquist, Elisabet
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, J.
    Altered gene expression of IL-6 and rennin in colonic biopsies from collagenous colitis and ulcerative colitis compared to healthy controls2011In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 60, no Suppl. 3, article id A317Article in journal (Refereed)
  • 83. Strid, Hilja
    et al.
    Kumawat, Ashok
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hultgren Hörnquist, Elisabet
    Örebro University, School of Medicine, Örebro University, Sweden.
    Bohr, Johan
    Genuttrycket för Renin och IL-6 i kolonmucosan är förändrad vid kollagen kolit2012Conference paper (Other academic)
  • 84. Thiébaut, R.
    et al.
    Kotti, S.
    Jung, C.
    Merlin, F.
    Colombel, J. F.
    Lemann, M.
    Almer, S.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    O'Morain, M.
    Gassull, M.
    Binder, V.
    Finkel, Y.
    Pascoe, L.
    Hugot, J.-P.
    TNFSF15 polymorphisms are associated with susceptibility to inflammatory bowel disease in a new European cohort2009In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 104, no 2, p. 384-391Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Inflammatory bowel disease (IBD), e.g., Crohn's disease (CD) and ulcerative colitis (UC), is a complex genetic disorder. Tumor necrosis factor (ligand) superfamily, member 15 (TNFSF15) has been previously identified as a susceptibility gene for CD in Japanese and UK cohorts. This replication study was designed in order to confirm and further validate the role of TNFSF15 in IBD. METHODS: A total of 666 IBD families (corresponding to 2,982 relatives) with European ancestry were genotyped for the rs6478108 and rs7869487 polymorphisms, which define the main TNFSF15 haplotypes previously associated with CD. An association between the main haplotypes and CD, UC and IBD was tested using the Genehunter TDT and Unphased statistics. Caspase recruitment domain 15 (CARD15)/TNFSF15 interaction and genotype/phenotype correlations were also studied. RESULTS: The previously reported "high-risk" haplotype (A) was associated with IBD (P=0.001) (OR=1.25 (1.05-1.50)) and CD (P=0.02) (OR=1.31 (1.03-1.67)) whereas the "protective" (B) haplotype was significantly less transmitted to IBD and CD patients. No interaction between CARD15 and TNFSF15 was detected. We also failed to define a clinical subgroup of CD patients specifically associated with TNFSF15 haplotype A. CONCLUSIONS: This study confirms that TNFSF15 or a closely linked gene is involved in the genetic predisposition to CD.

  • 85.
    Théibaut, R.
    et al.
    UMR843, Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique Hopitaux, Paris Université, Paris, France.
    Douchin, V.
    UMR843, Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique Hopitaux, Paris Université, Paris, France.
    Jung, C.
    UMR843, Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique Hopitaux, Paris Université, Paris, France.
    Merlin, F.
    UMR843, Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique Hopitaux, Paris Université, Paris, France.
    Colombel, J. F.
    Registre EPIMAD, Serv Epidemiol & Sante Publ, Hop Calmette, Lille, France.
    Lemann, M.
    GETAID, Serv Gastroenterol, Hop St Louis, Paris, France.
    Almer, Sven
    Inst Klin Expt Med IKE, EM Kliniken, Univ Sjukhuset, Linköping Univ, Linköping, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    O'Morain, C.
    Fac Hlth Sci, Trinity Coll Dublin, Dublin, Ireland.
    Gassull, M.
    Hosp Badalona Germans Trias & Pujol, Badalona, Spain.
    Finkel, Y.
    Dept Clin Sci & Educ, Karolinska Inst, Stockholm, Sweden.
    Zouali, H.
    Centre d'Etude du Polymorphisme Humain (CEPH), Fondation Jean Dausset, Paris, France.
    Pascoe, L.
    Centre d'Etude du Polymorphisme Humain (CEPH), Fondation Jean Dausset, Paris, France.
    Hugot, J. P.
    UMR843, Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique Hopitaux, Paris Université, Paris, France.
    RIP2 polymorphisms in inflammatory bowel diseases2011In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 17, no 4, p. 1055-1055Article in journal (Refereed)
  • 86.
    Tysk, Curt
    Sektionen för Gastroenterologi, Medicinska kliniken, Universitetssjukhuset i Örebro, Örebro, Sverige.
    Ischemisk kolit2012Other (Other academic)
    Abstract [sv]

    Ischemisk kolit är den vanligaste formen av intestinal ischemi. Tillståndet omfattar ett kliniskt spektrum från mild, övergående mukosaischemi (ca 80-85% av fallen) till potentiellt livshotande transmuralt tarmgangrän (ca 15%). Kolon sigmoideum, descendens och vänster flexur är oftast drabbade (75%) medan rektum vanligtvis inte är afficierad. Denna utbredning förklaras av att proximala kolon får sin blodförsörjning via a. mesenterica superior och kolon descendens och sigmoideum via a. mesenterica inferior medan rektum får sin blodförsörjning även via grenar från a. iliaca interna. Området, där de två mesenterialkärlen möts, är hemodynamiskt vulnerabelt med stor variation avseende utvecklade kollateraler. Sjukdomen förekommer framför allt hos äldre personer, men kan ses även hos yngre.

  • 87.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Large intestine: Remission of lymphocytic colitis with budesonide2009In: Nature reviews. Gastroenterology & hepatology, ISSN 1759-5053, Vol. 6, no 9, p. 506-507Article in journal (Refereed)
    Abstract [en]

    Few randomized, controlled trials have investigated the efficacy of pharmacological treatment for lymphocytic colitis. data from a new randomized, placebo-controlled trial have demonstrated the efficacy of budesonide in inducing remission of this disease; this study is an important contribution to this field.

  • 88.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Mikroskopisk kolit2011In: Gastroenterologi och hepatologi / [ed] Rolf Hultcrantz, Annika Bergquist, Stefan Lindgren, Magnus Simrén, Per Stål, Ole B. Suhr, Stockholm: Liber, 2011, p. 315-322Chapter in book (Other academic)
    Abstract [sv]

    Gastroenterologi och hepatologi är den första heltäckande svenska kursboken inom området. Boken ger en helhetssyn på och en samlad kunskap om gastroenterologi och hepatologi. Författarna presenterar pedagogiskt sjukdomarnas patogenes och patofysiologi, hur de yttrar sig kliniskt samt diagnostik och behandling med hjälp av fallbeskrivningar och ett rikt bildmaterial. Boken riktar sig till läkare som genomgår sin specialistutbildning i gastroenterologi och internmedicin i Sverige och Norden, specialister i internmedicin samt vårdpersonal med intresse för området. Boken är även lämplig som referensverk.

  • 89.
    Tysk, Curt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Almer, Sven
    Andersson, Magnus
    Befrits, Ragnar
    Hertervig, Erik
    Kilander, Anders
    Lindgren, Stefan
    Suhr, Ole
    Nationella riktlinjer för handläggning av akut svårt skov av ulcerös kolit: utarbetat av arbetsgrupp fran SGF och SOIBD2008In: Gastrokuriren, ISSN 1651-0453, Vol. 13, no 3, p. 35-36Article in journal (Other academic)
  • 90.
    Tysk, Curt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Almer, Sven
    Andersson, Magnus V.
    Befrits, Ragnar
    Hertervig, Erik
    Kilander, Anders
    Lindgren, Stefan
    Suhr, Ole
    Handläggning av svårt skov av ulcerös kolit2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 45, p. 2994-2998Article in journal (Refereed)
    Abstract [sv]

    Patienter med svårt skov av ulcerös kolit bör vårdas på sjukhus och handläggas av gastroenterolog och kolorektal kirurg i nära samarbete.

    Skovets svårighetsgrad kan underskattas, varför noggrann bedömning av inflammationens utbredning och svårighetsgrad enligt validerade kriterier är viktigt.

    Intravenös behandling med kortikosteroider är en av hörn­stenarna i den akuta behandlingen.

    Patienter som inte förbättras på denna behandling, bör erbjudas medicinsk »rescue-behandling« eller kolektomi.

    Infliximab har visats vara en effektiv rescue-behandling och kan minska behovet av kol­ektomi inom de första 3 månaderna och upp till 3 år. 

  • 91.
    Tysk, Curt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bohr, Johan
    Nyhlin, Nils
    Wickbom, Anna
    Eriksson, Sune
    Diagnosis and management of microscopic colitis2008In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 14, no 48, p. 7280-7288Article in journal (Other academic)
    Abstract [en]

    Microscopic colitis, comprising collagenous and lymphocytic colitis, is characterized clinically by chronic watery diarrhea, and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100,000 inhabitants, with a peak incidence in 60-70-year-old individuals and a noticeable female predominance for collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue and fecal incontinence are common symptoms, which impair the health-related quality of life of the patient. There is an association with other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented short-term treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.

  • 92.
    Tysk, Curt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Wickbom, Anna
    Nyhlin, Nils
    Eriksson, Sune
    Bohr, Johan
    Recent advances in diagnosis and treatment of microscopic colitis2011In: Annals of Gastroenterology, ISSN 1108-7471, E-ISSN 1792-7463, Vol. 24, no 4, p. 253-262Article in journal (Other academic)
    Abstract [en]

    Microscopic colitis, comprising collagenous colitis and lymphocytic colitis, is a common cause of chronic diarrhoea. It is characterised clinically by chronic watery diarrhoea and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100000 inhabitants, with a peak incidence in individuals 60-70 years old and a noticeable female predominance in collagenous colitis. The aetiology is unknown. Chronic diarrhoea, abdominal pain, weight loss, fatigue, and faecal incontinence are common symptoms that impair the health-related quality of life of the patient. There is an association with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. Budesonide is the best-documented treatment, both short-term and long-term. Recurrence of symptoms is common after withdrawal of successful budesonide therapy, and the optimal long-term treatment strategy needs further study. The long-term prognosis is good, and the risk of complications including colonic cancer is low. We review epidemiology, clinical features, diagnosis and treatment of microscopic colitis,

  • 93. Verberkmoes, Nathan C.
    et al.
    Russell, Alison L.
    Shah, Manesh
    Godzik, Adam
    Rosenquist, Magnus
    Halfvarson, Jonas
    Lefsrud, Mark G.
    Apajalahti, Juha
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Hettich, Robert L.
    Jansson, Janet K.
    Shotgun metaproteomics of the human distal gut microbiota2009In: ISME Journal, ISSN 1751-7370, Vol. 3, no 2, p. 179-189Article in journal (Refereed)
    Abstract [en]

    The human gut contains a dense, complex and diverse microbial community, comprising the gut microbiome. Metagenomics has recently revealed the composition of genes in the gut microbiome, but provides no direct information about which genes are expressed or functioning. Therefore, our goal was to develop a novel approach to directly identify microbial proteins in fecal samples to gain information about the genes expressed and about key microbial functions in the human gut. We used a non-targeted, shotgun mass spectrometry-based whole community proteomics, or metaproteomics, approach for the first deep proteome measurements of thousands of proteins in human fecal samples, thus demonstrating this approach on the most complex sample type to date. The resulting metaproteomes had a skewed distribution relative to the metagenome, with more proteins for translation, energy production and carbohydrate metabolism when compared to what was earlier predicted from metagenomics. Human proteins, including antimicrobial peptides, were also identified, providing a non-targeted glimpse of the host response to the microbiota. Several unknown proteins represented previously undescribed microbial pathways or host immune responses, revealing a novel complex interplay between the human host and its associated microbes.

  • 94. Vigren, L.
    et al.
    Sjöberg, K.
    Benoni, C.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, J.
    Kilander, A.
    Larsson, L.
    Ström, M.
    Hjortswang, H.
    Rökning och kollagen kolit2011In: Gastrokuriren, ISSN 1651-0453, Vol. 16, no 29, p. PO-17-PO-17Article in journal (Other academic)
  • 95. Vigren, L.
    et al.
    Sjöberg, K.
    Benoni, C.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, J.
    Kilander, A.
    Larsson, L.
    Ström, M.
    Hjortswang, H.
    Smoking habits in patients with collagenous colitis2010In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 59, no suppl 3, p. A182-A182Article in journal (Other academic)
  • 96.
    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 University, School of Health and Medical Sciences.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences.
    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?2011In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 46, no 11, p. 1334-1339Article in journal (Refereed)
    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.

  • 97.
    Vigren, Lina
    et al.
    Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Malmö, Sweden.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. 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 University, School of Health and Medical Sciences, Örebro University, Sweden. 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 colitis2013In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 48, no 8, p. 944-950Article in journal (Refereed)
    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.

  • 98. Walch, A.
    et al.
    Sjöberg, Mats
    Meshkat, M.
    Gustavsson, A.
    Järnerot, G.
    Vogelsang, H.
    Hertervig, E.
    Novacek, G.
    Friis-Liby, I.
    Blomquist, L.
    Angelberger, S.
    Karlen, P.
    Grännö, C.
    Vilien, M.
    Ström, M.
    Verbaan, H.
    Hellström, P. M.
    Ngo, Y.
    Halfvarson, Jonas
    Reinisch, W.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences.
    Outcome of rescue therapy in steroid-resistant ulcerative colitis: a retrospective study comparing cyclosporine and infliximab2008In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 57(Suppl II), p. A265-Article in journal (Refereed)
  • 99.
    Wickbom, Anna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bohr, Johan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Eriksson, Sune
    Dept Pathology, Örebro Univ Hosp, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clin Epidemiol & Biostat Unit, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nyhlin, Nils
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Tysk, Curt
    Örebro University, School of Health and Medical Sciences. Dept Gastroenterol, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Orebro, Sweden, 1999-2008: A Continuous Epidemiologic Study2013In: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, no 11, p. 2387-2393Article in journal (Refereed)
    Abstract [en]

    Background: The incidence of microscopic colitis (MC) has increased in several centers, but long-term epidemiologic data are missing. We report an epidemiologic study of collagenous colitis (CC) and lymphocytic colitis (LC) during 1999-2008, as a follow-up of our previous studies 1984-1998. Methods: Population-based study of residents of the catchment area of the hospital, with a new diagnosis of MC between 1999 and 2008. Patients were identified by diagnosis registers of the Departments of Medicine and Pathology. Medical files were reviewed, and colonic biopsies were reevaluated. Results: Collagenous colitis was diagnosed in 96 patients (75 females) and LC in 90 patients (74 females). The mean annual age-standardized incidence (per 100,000 inhabitants) was MC 10.2 (95% confidence interval: 8.7-11.7), CC 5.2 (4.2-6.3), and LC 5.0 (4.0-6.0). Age-specific incidence showed a peak in females older than 70 years. Prevalence (per 100,000 inhabitants) on December 31, 2008, was MC 123 (107.6-140.0), CC 67.7 (56.4-80.6), and LC 55.3 (45.2-67.1). A comparison of current study period with 1993-1998 showed unchanged mean incidence of MC, but a 2-fold increase in women older than 60 years with LC (standardized rate ratios 2.2, [1.2-3.7]) and increased female to male ratio (4.6:1 versus 2.1:1; P = 0.02) in LC. Conclusions: After an initial rise during 1980s and early 1990s, annual incidence of CC and LC has been stable during the last 15 years around 5/100,000 inhabitants for each disorder. The increasing incidence in older women with LC may be related to an increasing proportion of older individuals in the background population and increased colonoscopy frequency in elderly.

  • 100.
    Wickbom, Anna
    et al.
    Örebro University, School of Medical Sciences.
    Bohr, Johan
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nyhlin, Nils
    Örebro University, School of Medical Sciences.
    Eriksson, Anders
    Department of Medicine, Emergency and Geriatrics, Sahlgrenska University Hospital/East Hospital, Gothenburg, Sweden.
    Lapidus, Annika
    Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden.
    Münch, Andreas
    Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Ung, Kjell-Arne
    Department of Internal Medicine, Sahlgrenska University Hospital/Mölndal, Gothenburg.
    Vigren, Lina
    Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Microscopic colitis in patients with ulcerative colitis or Crohn’s disease: a retrospective observational study and review of the literatureManuscript (preprint) (Other academic)
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