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- Karlen, P, et al.
(författare)
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Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study
- 1998
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Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 42:5, s. 711-714
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Tidskriftsartikel (refereegranskat)abstract
- Background—Colonoscopic surveillance is a standard procedure in many patients with long standing, extensive ulcerative colitis (UC), in order to avoid death from colorectal cancer. No conclusive proof of its benefits has been presented however.Aims—To evaluate the association between colonoscopic surveillance and colorectal cancer mortality in patients with UC.Patients—A population based, nested case control study comprising 142 patients with a definite UC diagnosis, derived from a study population of 4664 patients with UC, was conducted.Methods—Colonoscopic surveillance in all patients with UC who had died from colorectal cancer after 1975 was compared with that in controls matched for age, sex, extent, and duration of the disease. Information on colonoscopic surveillance was obtained from the medical records.Results—Two of 40 patients with UC and 18 of 102 controls had undergone at least one surveillance colonoscopy (relative risk (RR) 0.29, 95% confidence interval 0.06 to 1.31). Twelve controls but only one patient with UC had undergone two or more surveillance colonoscopies (RR 0.22, 95% confidence interval 0.03 to 1.74), indicating a protective dose response relation.Conclusion—Colonoscopic surveillance may be associated with a decreased risk of death from colorectal cancer in patients with long standing UC.
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- Ludvigsson, Jonas F., et al.
(författare)
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Coeliac disease and risk of sepsis
- 2008
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Ingår i: Gut. - London : BMJ Publishing Group Ltd. - 0017-5749 .- 1468-3288. ; 57:8, s. 1074-1080
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the risk of subsequent sepsis in individuals with coeliac disease.Design: We used Swedish national health registers to identify 15 325 individuals with a diagnosis of coeliac disease (1964–2003) and 14 494 inpatient reference individuals. Cox regression estimated the hazard ratios (HRs) for subsequent sepsis.Results: Compared with inpatient reference individuals, individuals with coeliac disease were at increased risk of sepsis (HR = 1.6, 95% confidence interval (95% CI) = 1.2 to 1.9, p<0.001). The highest risk estimates were seen for pneumococcal sepsis (HR = 2.5, 95% CI = 1.2 to 5.1, p = 0.014). Individuals with coeliac disease diagnosed in childhood were not at increased risk of subsequent sepsis (HR = 1.0, 95% CI = 0.6 to 1.9, p = 0.908). When individuals with coeliac disease were compared with reference individuals from the general population, coeliac disease was associated with an increased risk of sepsis (HR = 2.6, 95% CI = 2.1 to 3.0, p<0.001). The HR for pneumococcal sepsis was 3.9 (95% CI = 2.2 to 7.0, p<0.001). In this comparison, children with coeliac disease were also at an increased risk of sepsis (HR = 1.8, 95% CI = 1.2 to 2.7, p = 0.003).Conclusion: This study showed a modestly increased risk of sepsis in patients with coeliac disease with the highest risk for pneumococcal sepsis. This risk increase was limited to those with coeliac disease diagnosed in adulthood. Potential explanations include hyposplenism, increased mucosal permeability and an altered composition of the intestinal glycocalyx in individuals with coeliac disease.
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- Sorensen, HT, et al.
(författare)
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Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data
- 1999
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Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 44:5, s. 736-738
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Tidskriftsartikel (refereegranskat)abstract
- Several case reports, but only a few studies, have examined the coexistence of coeliac disease and primary biliary cirrhosis.AIMTo estimate the risk of primary biliary cirrhosis in two national cohorts of patients with coeliac disease in Denmark and Sweden.METHODSThrough record linkage all Danish patients hospitalised with coeliac disease were followed for possible occurrence of primary biliary cirrhosis from 1 January 1977 until 31 December 1992. All patients hospitalised with coeliac disease in Sweden from 1987 to 1996 were also followed in a separate analysis.RESULTSA total of 896 patients with coeliac disease were identified in Denmark with a median follow up period of 9.1 years for a total of 8040 person-years at risk. Two cases of primary biliary cirrhosis were observed where 0.07 were expected, giving a standardised incidence ratio of 27.6 (95% confidence interval 2.9 to 133.5). A total of 7735 patients with coeliac disease were identified in Sweden with a median follow up period of 5.1 years for a total of 39 284 person-years at risk. Twenty two people with primary biliary cirrhosis were identified compared with 0.88 expected, giving a standardised incidence ratio of 25.1 (95% confidence interval 15.7 to 37.9).CONCLUSIONPatients with coeliac disease are at increased risk of having primary biliary cirrhosis.
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- Stjarngrim, J, et al.
(författare)
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Rates and characteristics of postcolonoscopy colorectal cancer in the Swedish IBD population: what are the differences from a non-IBD population?
- 2019
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Ingår i: Gut. - : BMJ. - 1468-3288 .- 0017-5749. ; 68:9, s. 1588-1596
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Tidskriftsartikel (refereegranskat)abstract
- The rate of postcolonoscopy colorectal cancer (PCCRC) is considered a key quality indicator of colonoscopy; little is known about PCCRC in IBD.DesignA population-based cohort study of colonoscopies in Sweden from 2001 to 2010 was conducted. Individuals with a colorectal cancer (CRC) detected within 36 months after a colonoscopy were identified and stratified on UC, Crohn’s disease (CD) or non-IBD. The CRCs were classified as detected CRCs (dCRC) (0–6 months) or as PCCRCs (6–36 months). PCCRC rates were calculated by the number of false negative/(the number of true positive+the number of false negative) colonoscopies. Poisson regression analysis was employed to examine the association between PCCRC and IBD (CD and UC) diagnosis, age, gender, location, time period and comorbidities.ResultsWe identified 348 232 colonoscopies in 270 918 individuals. Of these, 27 123 were performed on 14 597 individuals with CD, and 51 572 were performed on 26 513 individuals with UC. There were 13 317 CRCs in the non-IBD group, 133 in the CD group and 281 in the UC group. The PCCRC rate in the CD group was 28.3% and 41.0% in the UC group. The RR for a PCCRC was 3.82 (95% CI 2.94 to 4.96) in CD and 5.89 (95% CI 5.10 to 6.80) in UC, compared with non-IBD. The highest risk was observed among rectal cancer location in CD and in younger individuals with UC.ConclusionThe high rates of PCCRC in young patients with UC and for rectal cancer location in CD might affect future performance of IBD surveillance.
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