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- Almer, Sven, 1953-
(författare)
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Ulcerative colitis : Imaging of inflammation
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ulcerative colitis is a chronic inflannnatory disorder of unknown origin engaging the large bowel. Based on the need for accurate assessment of inflammation, three different non-invasive techniques, two leukocyte scintigraphy techniques and one radiological method, were evaluated in the assessment of active inflammation in altogether 131 patients with ulcerative colitis. Results were compared to those of endoscopy with biopsy, and with histopathological grading of depth of ulceration in colectomy specimens. Nine non-inflamed controls were also includedLeukoeyte scintigraphy using technetium-99m exarnetazime-labelled lenkocytes was found to reliably differ between patients with and without colonic inflammation. A good correlation existed between a simple visual scoring system of lenkocyte scans and colonic inflannnation viewed endoscopically and histologically in ulcerative colitis. In active disease, inflammation was better visualized with technetiurn-99m exametazimelabelled leukocytes than with technetium-99m anti-granulocyte antibody BW 250/183.Air enema radiology was of value in estimating severe mucosal inflammation in acute ulcerative colitis. Presence of faecal residue or a normal air enema film were associated with normal or only mildly inflamed mucosa at colonoscopy, i.e. a friable or ulcerated mucosa can be excluded. The absence of faecal residue or an abnormal finding at air enema X-ray were predictive of endoscopically inflamed mucosa. Air enema radiology underestimated the extent of inflannnation compared to endoscopy or lenkocyte scintigraphy. Air enema radiology was able to demonstrate presence of deep histopathological ulceration in the colectomy specimens from patients with an acute attack of ulcerative colitis.In conclusion, scintigraphy with technetium-99m exarnetazime-labelled lenkocytes can be applied in excluding or confirming bowel inflammation in individual patients, and, in assessing intensity and extent of ulcerative colitis. Air enema radiology should be a first-line investigation in acute colitis to assess the presence of mucosal or deeper ulceration.
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| 2. |
- Halfvarson, Jonas, et al.
(författare)
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Environmental factors in inflammatory bowel disease : a co-twin control study of a Swedish-Danish twin population
- 2006
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 12:10, s. 925-933
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Genetics and environmental factors are implicated in the etiology of inflammatory bowel disease (IBD). We studied environmental factors in a population-based Swedish-Danish twin cohort using the co-twin control method.SUBJECTS AND METHODS:A questionnaire was sent to 317 twin pairs regarding markers of exposures in the following areas: infections/colonization and diet as well as smoking, appendectomy, and oral contraceptives. Odds ratios (OR) were calculated by conditional logistic regression. When confounding appeared plausible, multivariate conditional logistic regression was added. The questions were also divided into topic groups, and adjustment was made for multiple testing within each of the groups.RESULTS:The response rate to the questionnaire was 83%. In consideration of the study design, only discordant pairs were included (Crohn's disease [CD], n = 102; ulcerative colitis [UC], n = 125). Recurrent gastrointestinal infections were associated with both UC (OR, 8.0; 95% confidence interval [CI], 1.0-64) and CD (OR, 5.5; 95% CI, 1.2-25). Hospitalization for gastrointestinal infections was associated with CD (OR, 12; 95% CI, 1.6-92). Smoking was inversely associated with UC (OR, 0.4; 95% CI, 0.2-0.9) and associated with CD (OR, 2.9; 95% CI, 1.2-7.1).CONCLUSIONS:The observed associations indicate that markers of possible infectious events may influence the risk of IBD. Some of these effects might be mediated by long-term changes in gut flora or alterations in reactivity to the flora. The influence of smoking in IBD was confirmed.
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| 3. |
- Halfvarson, Jonas, 1970-, et al.
(författare)
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Longitudinal concordance for clinical characteristics in a Swedish-Danish twin population with inflammatory bowel disease
- 2007
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Ingår i: Inflammatory Bowel Diseases. - New York, NY : Raven Press. - 1078-0998 .- 1536-4844. ; 13:12, s. 1536-1544
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The genetic influence on disease course in inflammatory bowel disease (IBD) remains unknown. We therefore aimed to study longitudinal concordance for clinical characteristics and longitudinal stability using the Montreal Classification in an IBD twin population. METHODS: A total of 158 twins with ulcerative colitis (UC) (18 belonging to 9 concordant monozygotic pairs) and 141 twins with Crohn's disease (CD) (34 belonging to 17 concordant monozygotic pairs) were enrolled. Medical notes were scrutinized for clinical characteristics at diagnosis and after 10 years. Using the binominal distribution, we tested the hypothesis that clinical characteristics were independent within individuals in disease concordant monozygotic pairs. RESULTS: In CD, location was identical in 11/17 monozygotic concordant pairs at diagnosis (P = 0.008) and in 11/16 pairs after 10 years (P = 0.02). Behavior at diagnosis was identical in 13/17 pairs (P = 0.03) and in 11/16 pairs after 10 years (P = 0.01). Monozygotic UC twins were concordant (within 5 years) for age at diagnosis (6/9 pairs; P < 0.001) and symptomatic onset (4/9 pairs; P = 0.02) but not for extent of disease at diagnosis or after 10 years. The Montreal Classification did not demonstrate longitudinal stability, either regarding location or behavior of CD or extent of UC. CONCLUSIONS: The high phenotypic concordance, both at diagnosis and longitudinally, in monozygotic twins with CD supports a genetic influence not only on disease occurrence but also on disease course. This contrasts with UC, where the genetic impact appears less. Montreal Classification characteristics changed over time and should be used cautiously.
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| 4. |
- Hjortswang, Henrik, 1966-
(författare)
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A strategy for health assessment : the case of ulcerative colitis
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of a patient's experience of disease impact on daily life and well-being (health-related quality of life (HRQOL)) is broadly acknowledged. Scepticism still remains about how HRQOL should be measured and the usefulness of standardised HRQOL questionnaires in medical research and everyday clinical practice. The lack of definitions, and the unclear relationship between disease activity and HRQOL makes it difficult to interpret results.The main purpose of this thesis was to determine a strategy for health assessment that is useful in daily practise and meaningful for clinicians and patients. The results are based on measurements of HRQOL and disease activity in a total of 511 patients with ulcerative colitis.The first aim of this thesis was to identify the major health dimensions and study their relationship in order to determine a strategy for health assessment. Based on theoretical reasoning and the pattern of association between measures of different areas of health status, the health concept was arranged into two categories, disease activity and HRQOL. Disease activity was further divided into biological variables and symptoms, and HRQOL into fimction, disease-related worry, and general well being. There was a poor association between these health dimensions. Measurement of health status is therefore better understood if it is divided into and interpreted as separate dimensions. It is then possible to see which dimensions are impaired and changes that have occurred.The second aim was to evaluate two disease-specific HRQOL questionnaires, the RFIPC and the IBDQ in Swedish patients with ulcerative colitis. The RFIPC was found to be a valid, reliable and responsive measure of disease-related worry and concern. The IBDQ had external validity and was shown to be a reliable and responsive measure of HRQOL. There are however some concerns regarding the internal validity of the IBDQ. The use of an overall sum score was not supported and the original four IBDQ dimensions showed considerable overlap.The third aim was to study HRQOL in patients with ulcerative colitis and analyse the influence of disease-related and demographic factors. Patients in remission reported a health-related quality of life similar to that of a Swedish background population. Patients with an ongoing relapse showed a considerable impairment in all health dimensions except physical function compared to patients in remission. Besides the current disease activity, co-existing disease and female gender was found to weigh heavily on the HRQOL. These factors must therefore be taken into account when interpreting and comparing HRQOL results.The fourth aim was to develop and evaluate a new abbreviated measure of subjective health status. The construction of this new measure was based on a previously developed strategy where the health concept is divided into five main dimensions. Each of the dimensions for symptoms, fimction, disease-related worry and general well-being were covered by one item. This new four-item questionnaire, the Short Health Scale (SHS) was shown to be a valid and sensitive measure of subjective health status in ulcerative colitis.
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| 6. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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