| 1. |
- Chaireti, Roza, et al.
(författare)
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Increased thrombin generation in splanchnic vein thrombosis is related to the presence of liver cirrhosis and not to the thrombotic event
- 2014
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Ingår i: Thrombosis Research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 134:2, s. 455-461
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent years there have been increasing evidence associating liver disease with hypercoagulability, rather than bleeding.Aims: To evaluate the haemostatic potential in patients with liver disease.Methods: We measured thrombin generation in the presence and absence of thrombomodulin in patients with portal vein thrombosis (PVT, n=47), Budd-Chiari syndrome (BCS, n=15) and cirrhosis (n=24) and compared the results to those obtained from healthy controls (n=21). Fifteen patients with PVT and 10 patients with BCS were treated with warfarin and were compared with an equal number of patients with atrial fibrillation matched for prothrombin time-international normalized ratio. We assessed resistance to thrombomodulin by using ratios [marker measured in the presence]/[marker measured in the absence of thrombomodulin].Results: There were no differences between patients with BCS, patients on warfarin treatment and controls. Cirrhotic patients generated more thrombin in the presence of thrombomodulin and exhibited thrombomodulin resistance compared with controls [p=0.006 for endogenous thrombin potential (ETP) and p<0.001 for peak thrombin. P<0.001 for both ratios ETP and peak] and patients with non-cirrhotic PVT (p=0.001, p=0.006, p<0.001, p<0.001 for ETP, peak, ratio ETP, ratio peak). The patients with cirrhotic PVT exhibited higher ETP (p=0.044) and peak (p=0.02) in the presence of thrombomodulin than controls, as well as thrombomodulin resistance (ETP ratio: p=0.001, peak ratio: p=0.001).Conclusions: Hypercoagulability and thrombomodulin resistance in patients with cirrhosis were independent of the presence of splanchnic vein thrombosis. The hypercoagulability in patients with cirrhotic PVT could have implications for considering longer treatment with anticoagulants in this group.
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| 2. |
- Jaghult, Susanna, et al.
(författare)
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Stress as a trigger for relapses in IBD : A case-crossover study
- 2013
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Ingår i: Gastroenterology Research. - : Elmer Press, Inc.. - 1918-2805 .- 1918-2813. ; 6:1, s. 10-16
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease.Methods: Sixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study.Results: The analysis showed an effect for high level of perceived stress. Being exposed to “quite a lot” of stress, yield an increase in risk for relapse during the forthcoming day (OR = 4.8, 95% CI 1.09 - 21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for “some” stress.Conclusion: This study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.
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| 3. |
- Janczewska, Izabella, et al.
(författare)
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Clinical application of the multigene analysis test in discriminating between ulcerative colitis and Crohn's disease : a retrospective study
- 2012
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:2, s. 162-9
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Methods. The newly described - multigene analysis test (DiBiCol) identifying 7 inflammatory bowel disease (IBD)-specific genes in colonic mucosal biopsy differentiating between ulcerative colitis (UC) and Crohn's disease (CD) with active inflammation - is a new addition to existing methods with a higher stated sensitivity and specificity. Method biopsy material from 78 patients with a complicated course diagnosed as most probably UC in 38, CD in 18 and inflammatory bowel disease unclassified (IBDU) in 22 were investigated by DiBiCol. Results. DiBiCol showed a pattern consistent with CD in 13 patients with UC and led to change of diagnosis in 3 patients and a strong suggestion of CD in 8 patients. A total of 2 patients remained as UC. DiBiCol showed a pattern of UC in 4 patients of 18 with CD leading to a changing of diagnosis to UC in 3 patients, but the fourth remained as CD. In 22 patients with IBDU DiBiCol showed a pattern consistent with UC in 7 cases and with CD in 13 cases. A new evaluation 1 year after the DiBiCol allowed the assessment of clinical diagnosis in 10 patients confirmed in 9 of 10 patients by DiBiCol. In patients with acute flare of colitis the clinical diagnosis corresponded in 10 of 12 UC and in 5 of 6 CD cases. Summary. Adopting the DiBiCol test led to a change of the primary diagnosis in a significant number of patients with the initial diagnosis of UC and CD and suggested a clinically probable diagnosis in most of the patients with IBDU and in those with an acute flare of colitis.
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| 4. |
- Jäghult, Susanna, et al.
(författare)
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A multiprofessional education programme for patients with inflammatory bowel disease : a randomized controlled trial
- 2007
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 42:12, s. 1452-1459
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation. The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease, and to investigate whether the programme could improve their health-related quality of life.MATERIAL AND METHODS: Ninety-three patients with inflammatory bowel disease in remission were included and randomized to an intervention group or a control group. The intervention group attended a multiprofessional education programme while the control group received regular information. Four questionnaires were used for measuring health-related quality of life. Both groups completed the questionnaires at baseline and after 6 months. The intervention group also completed the questionnaires after 1 month.RESULTS: No significant differences were found when comparing the two groups at 6 months. However, the multi-professional education programme was highly appreciated by the patients.CONCLUSIONS: In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group. This might be due to the fact that the questionnaires were not sensitive enough or that some patients were not in clinical remission. The patients' enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic.
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| 5. |
- Jäghult, Susanna, et al.
(författare)
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Factor structures of the Swedish version of the RFIPC : investigating the validity of measurements of IBD patient's worries and concerns
- 2010
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Ingår i: Gastroenterology Research. - : Elmer Press, Inc.. - 1918-2805. ; 3:5, s. 191-200
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Tidskriftsartikel (refereegranskat)abstract
- Background: Worries and concerns of patients with IBD comprise an important negative factor in their HRQOL. The Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) was developed to describe the nature and degree of the worries and concerns of IBD patients. In the original version, the specific issues of worries are divided into four separate factors. These factors provide useful information about HRQOL and the kind of worries and concerns which are most important to the patient. However, the Swedish version of the RFIPC is often scored using a single sum score, implying that all the specific issues of worries stem from a single general worry factor. The aim of this study was to validate the factor structure of the Swedish version of the RFIPC.Methods: A sample consisting of 195 patients with IBD filled out the RFIPC. Confirmatory factor analysis was performed to examine fit of three hypothesized models of factor structure. Spearman’s correlation and Mann-Whitney analysis were used to follow up the results.Results: The single-factor model displayed poor fit indices. The four-factor model marked substantive improvement, but still remains inadequate. The final four-factor model permitting correlated error terms between some items displayed the most adequate fit. Conclusions: The factorial structure of the RFIPC, as suggested in the original version, was able to be replicated with a slight modification in the Swedish version. The separate factors identified in this structure provide more detailed information about the worries and concerns of IBD patients as these components of worries are different related to HRQOL and general health.
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| 6. |
- Jäghult, Susanna, et al.
(författare)
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Identifying predictors of low health-related quality of life among patients with inflammatory bowel disease : comparison between Crohn's disease and ulcerative colitis with disease duration
- 2011
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 20:11-12, s. 1578-1587
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To identify predictors of low health-related quality of life among patients with inflammatory bowel disease and make a comparison between Crohn's disease and ulcerative colitis with disease duration. Background. Studies have shown that patients with inflammatory bowel disease rate their health-related quality of life lower, as compared with a general population. Design. Survey. Methods. In this study, 197 patients in remission were included and divided into a Crohn's disease group and an ulcerative colitis group. Each group was also divided into separate groups whether the patients had short disease duration or long disease duration. Generic instruments, combined with disease-specific questionnaires, were used for measuring health-related quality of life. Results. The analysis showed a non-significant effect for diagnosis, but a significant effect for disease duration showing that the patients with short disease duration had lower scores of health-related quality of life compared with patients with long disease duration. A significant interaction between diagnosis and disease duration was also revealed. Conclusion. Patients with longer disease duration experienced a better health-related quality of life than patients with short disease duration. Patients with Crohn's disease and short disease duration have the lowest health-related quality of life and are in greatest need of education and support. Relevance to clinical practice. It is important to identify which patients' are in the greatest need of education and support.
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| 7. |
- Kapraali, Marjo
(författare)
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Prostaglandin E2 influences the gastrointestinal endocrine cell system in the rat
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous studies suggest that prostaglandin E2 may interact with gastrointestinal endocrine cells. Our aim was to examine whether erogenous and endogenous prostaglandins - particularly prostaglandin E2 - influence the endocrine cell system in the rat gastrointestinal tract. Indomethacin was used to inhibit the synthesis of endogenous prostaglandins in order to gain information about a potential modulator role of the prostanoids on the endocrine cells. Sprague-Dawley rats were treated with oral prostaglandin E2 or a methyl- analogue for four weeks, or with subcutaneous indomethacin or indomethacin and prostaglandin E2 for eight weeks. The total volume of immunoreactive endocrine cells was evaluated quantitively using stereological methods and the tissue and plasma concentrations of neuroendocrine peptides were analysed with radioimmunoassay. The epithelial DNA synthesis was evaluated with the labelling index. In the upper gastrointestinal tract, endogenous prostaglandins, particularly prostaglandin E2, induced an inhibitory tonus on the total volume of ECL and somatostatin cells and on the tissue concentration of somatostatin in the gastric fundus, as shown by the increased total volumes of immunoreactive cells and increased tissue concentrations of the peptide observed in the rats given indomethacin. In contrast. endogenous prostaglandins, particularly prostaglandin E2, induced a stimulatory tonus on the total volume of enterochromaffin cells in the antnim and on the total volumes of duodenal enterochromaffin cells and CCK and GIP-producing cells. The simultaneous administration of prostaglandin E2 reversed - partially or completely - the changes elicited by indomethacin. Exogenous E2 prostaglandins influenced the ECL cells and the somatostatin cell population in the fundic mucosa and increased the plasma levels of somatostatin. Exogenous E2 prostaglandins increased the total volume of serotonin and gastiin/CCK-immunoreactive cells in the duodenum. In the lower gastrointestinal tract, endogenous prostaglandins, particularly prostaglandin E2, induced an inhibitory tonus on the synthesis and/or release of tissue somatostatin in the ileum. DNA synthesis was increased in the small intestinal crypts in animals depleted of prostaglandins, which was associated with increased tissue concentrations of neurokinin A, neurotensin and glucagon. Exogenous E2 prostaglandins influenced the total volume of glucagon/glicentin-immunoreactive cells in the jejunum. and the tissue concentration of somatostatin and glucagon. E2 prostaglandins influenced the total volume of glucagon/glicentin- and somatostatin-immunoreactive cells in the colonic mucosa. In conclusion, the modulation and/or influence of endogenous and erogenous prostaglandins, particularly prostaglandin E2, on the ECL, enterochromaffin, CCK, glucagon and somatostatin cell in the gastrointestinal tract - including synthesis and/or release of neuroendocrine peptides - suggest that endogenous and erogenous prostaglandins may indirectly participate in important biological functions that are modified by neuroendocrine peptides. Taken together with other observations, our findings indicate that the regulation of the the gastrointestinal endocrine cell system is multifactorial and that intraluminal factors, particularly the colonic microflora, may mask and/or modify the actions of endogenous prostaglandins on endocrine cells.
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| 8. |
- Rajani, Rupesh, et al.
(författare)
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High prevalence of the germline JAK2 46/1 haplotype and V617-mutationin Swedish patients with Budd-Chiari syndrome and Portal Vein Thrombosis
- 2010
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background & Aims: To determine the prevalence of the somatic JAK2 V617F mutation and distribution of the germline JAK2 46/1 haplotype in Budd-Chiari Syndrome (BCS) and portal vein thrombosis (PVT). Methods: Real-time PCR was performed to genotype for the JAK2V 617F mutation and the 46/1 haplotype (tag-SNPs rs12343867, T>C and rs12340895, C>G) in blood samples of 19 BCS and 91 PVT patients (without intra-abdominal malignancy), and 283 controls from a background population. Results: The prevalence of JAK2 V617F-mutation was 63% in BCS and 14% in PVT patients. 10% in BCS and 2% in PVT had V617F negative MPD. Conversely, V617F positive subjects without known MPD was found in 5% of the BCS and in 1% of PVT patients. The frequency of the JAK2 46/1 haplotype was significantly higher in BCS (53%) and PVT (36%) patients compared to controls (27%) (p=0.02; OR=3.0; 95% CI 1.5-5.9 and OR=1.51; 95% CI 1.1-2.1, respectively). In PVT patients the JAK2 haplotype was highly enriched in non-cirrhotic patients (41%) (p <0.01 ; OR=1.8; 95% CI 1.2-2.6) but not in cirrhotic patients (23%) (p=0.53 ; OR= 0.8; 95% CI 0.4-1.7). An increased JAK2 46/1 haplotype frequency was evident only in V617F mutation positive patients. Conclusions: The prevalence of JAK2 V617F was high in BCS (63%) and non-cirrhotic PVT (14%), facilitating detection of latent MPD. A negative result dose not rule out MPD. The occurrence of the JAK2 46/1 haplotype was significantly higher in V617F mutation positive patients but not in mutation negative patients, suggesting that the haplotype may not have an independent role separated from the V617F mutation in BCS and PVT patients.
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