| 1. |
- Gustavsson, Anders, 1964-, et al.
(författare)
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Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn's disease
- 2013
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley-Blackwell. - 0269-2813 .- 1365-2036. ; 37:4, s. 430-437
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn's disease (CD). Factors predicting outcome of the procedure are not well described.AIM: To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation. The endpoint was requirement of a new intervention such as dilation or surgery with intestinal resection or strictureplasty.METHODS: Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.RESULTS: After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (adjusted HR: 2.50, 95% CI: 1.14-5.50, P = 0.022). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95% CI: 0.07-0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67 of those without azathioprine (HR: 0.46, 95% CI: 0.21-1.03, P = 0.06). After adjustment for other variables, the association was even weaker (HR: 0.80, 95% CI: 0.29-2.18, P = 0.668). Sex, age at diagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.CONCLUSIONS: Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.
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| 2. |
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| 3. |
- Stjernman, Henrik, et al.
(författare)
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Short health scale : a valid, reliable, and responsive instrument for subjective health assessment in Crohn's disease.
- 2008
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Ingår i: Inflammatory Bowel Diseases. - New York, NY : Raven Press. - 1078-0998 .- 1536-4844. ; 14:1, s. 47-52
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Hjortswang, Henrik, et al.
(författare)
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The Short Health Scale : a valid measure of subjective health in ulcerative colitis
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - Oslo : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:10, s. 1196-1203
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Assessment of health-related quality of life (HRQOL) is important in both clinical practice and clinical trials, and several multi-item questionnaires are currently in use. We have devised and evaluated a simplified four-item questionnaire, the Short Health Scale (SHS), representing each of four health dimensions: (a) symptom burden, (b) social function, (c) disease-related worry and (d) general well-being.Material and methods. Three hundred patients with ulcerative colitis completed the SHS and three other HRQOL questionnaires (IBDQ, RFIPC and PGWB). Half of the patients repeated the questionnaires after 6 months – or earlier if disease activity changed. Test–retest reliability was derived from measurements of the SHS questions, 2 weeks apart, on 18 patients in remission.Results. Patients in relapse scored higher on each of the four SHS questions than patients in remission (p < 0.001). Each of the four SHS scores were associated with results of their corresponding health dimension obtained with the other three questionnaires (rs=0.57–0.78, p < 0.001) (validity). The results of the SHS proved stable on repeated measurement with a 2-week interval in patients in remission (rs=0.71–0.91, p < 0.01) (test–retest reliability). Patients with a change in disease activity had a significant change in their SHS scores (p < 0.05) (responsiveness).Conclusions. The SHS is a valid, reliable and responsive measure of subjective health in patients with ulcerative colitis. It is simple to administer, quickly completed and the results do not need further calculations. The SHS can be used in clinical trials and in clinical practice to identify the patient's main problems affecting health.
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| 5. |
- Stjernman, Henrik, et al.
(författare)
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Evaluation of the inflammatory bowel disease questionnaire in Swedish patients with Crohn's disease
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:8, s. 934-943
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Hjortswang, Henrik, 1966-, et al.
(författare)
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The influence of demographic and disease-related factors on health-related quality of life in patients with ulcerative colitis
- 2003
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Ingår i: European Journal of Gastroenterology and Hepathology. - : Ovid Technologies (Wolters Kluwer Health). - 0954-691X .- 1473-5687. ; 15:9, s. 1011-1020
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aims of this study were to analyse the health-related quality of life of patients with ulcerative colitis and to assess in what way demographic and disease-related factors influence patients' experiences of this, in order to interpret the results of health-related quality of life assessment more correctly.Patients and methods: We carried out a cross-sectional evaluation of 300 consecutive patients with ulcerative colitis from the catchment areas of Linköping University Hospital and Örebro University Hospital in Sweden. Health-related quality of life was measured using four questionnaires: the IBDQ, the RFIPC, the SF-36 and the PGWB. Disease activity was evaluated using a one-week symptom diary, blood tests and rigid sigmoidoscopy. Demographic factors (gender, age, civil status, educational level), disease-related factors (disease duration, disease extent, disease activity) and presence of co-morbidity were obtained.Results: Health-related quality of life was mainly impaired in the psychological and social areas and to a much lesser degree in physical areas. Patients with relapse had significantly more disease-related worries and concerns (the RFIPC), more impaired social functioning (the IBDQ and SF-36), and a lower feeling of well being (the IBDQ, the SF-36 and the PGWB). However, their physical function (SF-36) was no worse than patients in remission. Besides the symptom burden of the current disease, co-morbidity and female gender were associated with a lower health-related quality of life.Conclusion: To correctly interpret health-related quality of life assessments, it is necessary to consider co-morbidity and gender distribution in addition to the symptom burden of the disease studied.
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| 7. |
- Blomberg, Björn, 1948-
(författare)
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Helicobacter pylori : Prevalence, heterogeneity, and ulcerogenic properties
- 1993
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 117. unselected patients H. pylori infection was found in 49.6% by combining culture and acndme orange stammg of hssue sections. Infection was equally common in the gastric body and antrum. The activity of gastritis was generally higher in the antrum. The overallagreement between acridine orange stain and culture was 0.93.Formalin treated H. pylori whole cells were used to immunize rabbits. With the aid of coagglutination and indirect immunofluorescence all H. pylori strains tested were shown to contain cross reactive antigens, but no serum cross-reacted with all strains tested. Multiple, antigenically different, isolates were found in some patients and a provisional serogrouping based on heat-stable antigens was proposed.Acid glycine extracts from four H. pylori strains were prepared. Rabbit antisera against these, and ten further, strains showed extensive cross-reactions with all four extracts. An EIA based on H. pylori strain NCTC 11637 had a sensitivity of 90 % and a specificity of 87 %.In 197 unselected patient culture, histopathology using acridine orange or Giemsa staining, and serology was evaluated. 33.5 % of patients were infected by H. pylori. The sensitivities for culture/acridine orange stain/Giemsa stain were 0.94/0.86/0.91 respectively. The specificities were 1.0/1.0/0.84. For two commercial serologic tests the negative predictive values were 0.93/0.95 respectively. A strategy of serologic screening to avoidunnecessary endoscopies was suggested, but that positive serology be confirmed by histopathology.Sixty-one human gastric isolates of H. pylori were tested for their ability to induce oxidative burst in human neutrophils. A cell bound, heat-labile, property able to induce a strong and rapid oxidative burst in neutrophils in the abscence of opsonins, was found in about one third of strains tested. This property was significantly associated with peptic ulcer disease(p=0.0261, Fisher's exact test).Fifty-four clinical isolates of H. pylori were tested for cytotoxin production and their ability to induce oxidative burst in human neutrophils. Nonopsonised, 20 strains showed a rapid and strong oxidative burst, 30 a slow and weak response, and four remaining gave inconclusive results. Cytotoxin production was seen in 10 of 20 rapid and strong inducers, but only in 3 of 30 with a slow and weak response (p=0.0027, Fisher's exact test). 11/15 of the cytotoxin producing strains (p=0.0135) and 13/20 of the rapid and strong inducers (p=0.0209) were from 22 patients with peptic ulcer disease. The ability of some nonopsonised H. pylori to activate neutrophils showed eo-variation with cytotoxin production, but the two properties seem to be independent markers of peptic ulcer disease.With theuse of electron microscopy the interactions of human neutrophils with four nonopsonised H. pylori strains, two rapid and strong, two slow and weak inducers of neutrophil oxidative burst were studied in morphologic detail. The rapid inducers were phagocytosed within minutes, whereas the slow inducers showed little reaction even after one hour.Conclusions: Histopathology using acridine orange or Giernsa stains correlates well with culture. Serologic screening might be of value to reduce unnecessary endoscopies. A cellbound heat-labile property of some H. pylori strains able to nonopsonised induce a rapid oxidative burst in neutrophils is significantly associated with peptic ulcer disease. This property is also associated with, but independent of, cytotoxin production.
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| 8. |
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| 9. |
- Gustavsson, Anders, et al.
(författare)
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Smoking is a risk factor for recurrence of intestinal stricture after endoscopic dilation in Crohn’s disease
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Endoscopic balloon dilation is an efficacious and safe alternative to surgery as treatment of short intestinal strictures in Crohn’s disease (CD). Factors predicting outcome of the procedure are not well described.Aim: To evaluate whether smoking at diagnosis, treatment with azathioprine, or other clinical variables may affect clinical outcome after endoscopic dilation.Endpoint was requirement of a new intervention such as dilation or surgerywith intestinal resection or strictureplasty.Methods: Retrospective study of 83 patients with CD who underwent endoscopic balloon dilation of an intestinal stricture between 1987 and 2009.Results: After index dilation 55/83 patients underwent a new intervention. Among current smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) among never smokers (HR 2.18, 95%CI 1.22-3.93, P=0.009). After 5 years, cumulative probability of new intervention was 0.81 in smokers compared to 0.52 in never smokers; difference 0.29 (95 % CI 0.07–0.52, P = 0.01). In 16 patients, therapy with azathioprine was initiated before or shortly after the index dilation; 7/16 underwent a new intervention compared to 48/67of those without azathioprine (HR 0.46, 95%CI 0.21-1.03, P=0.06). After adjustment for other variables, the association was even weaker (HR 0.80, 95%CI 0.29-2.18, P=0.668). Sex, age atdiagnosis, age at first dilation, balloon size, location of stricture, and treatment period did not influence outcome.Conclusions: Smoking doubles the risk of recurrent stricture formation requiring a new intervention after index dilation. Maintenance therapy with azathioprine did not influence the subsequent course and need for a new intervention.
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