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- Lapidus, Annika
(författare)
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Crohn's disease in Stockholm County : epidemiological panorama and associated gallstone disease
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Crohn's disease is a chronic inflammatory bowel disease of obscure etiology, affecting any part of the gastrointestinal tract but the ileocaecal region in particular. The annual incidence has gradually been increasing, and the clinical pattern has changed; a shift towards colorectal involvement as well as an increasing number of elderly patients has been observed. Gallstone disease has been a common extraintestinal complication among patients with Crohn's disease, but the true relative risk and the pathogenesis remain unclear. The aims of this thesis were to investigate the epidemiological time trends in Crohn's disease in Stockholm County during a 35 year period between 1955-1989, and to evaluate the clinical course of the expanding entity of colorectal Crohn's disease. Furthermore, relative risk and risk factors for developing gallstone disease in patients with Crohn's disease were assessed in patients born 1933-1935 and 1953-1955. An additional aim, in a separate study, was to investigate what type of gallstones these patients may be prone develop, by examining the bile composition in patients having had ileal resections due to Crohn's disease. The annual incidence of Crohn's disease in Stockholm County increased from 1.4 to 4.9 per 100,000 inhabitants between the 1955-1959 and 1985-1989 periods, stabilizing at 4.6 per year during the last two decades. The age specific incidence among those aged 15-29 years decreased, whereas the incidence in those aged > 60 years increased. The median age at diagnosis increased from 25 to 32 years. The annual incidence of colorectal Crohn's disease increased from 0.2 to 1.6 per 100,000 inhabitants between 1955-1959 and 1985-1989. The overall proportion of colorectal Crohn's disease increased from 15% to 32% with a corresponding decrease of ileocaecal disease. The frequency of major surgery at first flare-up of colorectal Crohn's disease decreased over time, although the cumulative probability of resection remained unchanged. Half of the patients with colorectal Crohn's disease had at least one surgical resection within ten years from diagnosis and slightly more than half of those patients ultimately received an ileostomy. Patients with left-sided colorectal Crohn's disease were less likely to undergo major surgery, while patients with perianal and rectal fistulas had the highest probability of surgical intervention. A relapse-free course during the initial five years after the first flare-up implied a high probability of remaining in remission. Around 20% of the patients with colorectal Crohn's disease subsequently developed changes also in the small bowel. Regardless of gender or age, patients with Crohn's disease had almost twice the prevalence of gallstone disease compared to the general population. The number of previous intestinal resections was the only significant risk factor. Site of disease or type of intestinal resection were not found to be associated with an increased risk for gallstone formation. Short or long ileal resections due to Crohn's disease did not have any major influence on the biliary lipid composition. Nevertheless the cholesterol saturation of bile was significantly lower among the patients than the controls. The bile acid pattern after ileal resection was characterized by a significantly decreased proportion of deoxycholic acid and an increased proportion of ursodeoxycholic acid. Patients having undergone short or long ileal resections due to Crohn's disease had a 50% higher ratio of bilirubin to bile acids compared with the controls. Patients with Crohn's disease may therefore develop pigment rather than cholesterol gallstones. It still remains unclear whether the increased prevalence of gallstone disease in patients with Crohn's disease is attributed to secondary morbidity (i.e. surgical management) or Crohn's disease per se. Circumstances at the time of laparotomy, such as use of total parenteral nutrition and/or bowel rest must also be considered in the pathogenesis of gallstone formation in patients with Crohn's disease.
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| 2. |
- Münch, Andreas, et al.
(författare)
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Low-dose budesonide for maintenance of clinical remission in collagenous colitis : a randomised, placebo-controlled, 12-month trial
- 2016
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Ingår i: Gut. - : BMJ Publishing Group. - 0017-5749 .- 1468-3288. ; 65:1, s. 47-56
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Pagoldh, Maria, et al.
(författare)
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Effects of a supplementary diet with specially processed cereals in patients with short bowel syndrome.
- 2008
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Ingår i: European journal of gastroenterology & hepatology. - 1473-5687 .- 0954-691X. ; 20:11, s. 1085-93
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Short bowel syndrome patients frequently experience impaired health-related quality of life. This syndrome is also associated with increased costs for the individuals concerned and the community. Intake of specially processed cereals has been demonstrated to decrease intestinal secretion. This study evaluates the effect of a supplementary diet with specially processed cereals compared with nonprocessed cereals. METHODS: This investigation is a randomized double-blind, cross-over multicentre prospective study of 26 intestinal resected out patients, considered as short bowel syndrome patients. The patients were divided into groups A or B, in accordance with the first allocated treatment. Subgroup analyses of the underlying diagnoses and type of surgical procedure were performed. The studied parameters were faecal volume, nocturnal stools, abdominal pain/discomfort, health-related quality of life, peripheral blood tests and anthropometric data. RESULTS: In both groups, intake of nonprocessed cereals significantly decreased the faecal volume. The subgroup analyses of patients with a history of ulcerative colitis (compared with Crohn's disease) and nonileostomy-operated procedure (compared with ileostomi-operated procedure) showed significantly decreased faecal volume during nonprocessed cereals intake. Peripheral blood tests, quality of life and anthropometry were not affected. CONCLUSION: In this study, nonprocessed cereals seemed to be as effective as specially processed cereals in decreasing faecal volume in general and especially in ulcerative colitis patients (mainly operated with nonileostomy techniques). Our results indicate that use of supplementary cereals is safe for this group of patients, but should optimally include evaluation of the underlying diagnosis and the surgical method used.
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| 6. |
- Wickbom, Anna, 1970-, et al.
(författare)
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Microscopic colitis in patients with ulcerative colitis or Crohns disease: a retrospective observational study and review of the literature
- 2018
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Ingår i: Scandinavian Journal of Gastroenterology. - : TAYLOR & FRANCIS LTD. - 0036-5521 .- 1502-7708. ; 53:4, s. 410-416
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohns disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature.Methods: Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed.Results: We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n=16) or lymphocytic colitis (LC) (n=5); nine CD patients developed CC (n=5) or LC (n=4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients.Conclusions: Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.
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