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| 2. |
- Bohr, Johan
(författare)
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Collagenous colitis : A study of epidemiology, etiology, clinical features and treatment
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Collagenous colitis (CC) is characterised clinically by chronic watery diarrhoea and histopathologically by an increased submucosal collagen layer. An epidemiologic study of CC during 1984 to 1993 showed a female:male ratio of 9:1. The median age at diagnosis was 64 (28-78) years. The prevalence was 15.7/105 on December 31, 1993, and the mean annual incidence was 1.8/1()5 inhabitants. Age specific incidence showed a peak of 14.6/105 in females 70-79 years old, which approaches the incidence for ulcerative colitis in the same age group. Faecal stream diversion in 9 patients with severe, medically intractable CC induced histologic and clinical remission. This observation indicates that a noxious agent in the faecal stream constitutes an etiologic factor in CC. Faecal stream diversimi offers a treatment alternative in patients with severe CC who do not respond to medical treatment. Sera from 38 patients with CC and matched controls were analysed for specific autoantibodies, immunoglobulins and complement. The mean value of I gM was significantly increased in patients; 2.5 g!L compared to 1.4 gn ... in controls (p=0.002). ANA and pANCA occurred more frequently in patients, although the difference did not reach statistical significance. The result.;; of all other immunoglobulins, complement factors, and specific antiboctles were similar in patients and controls. The findingsof an increased IgM level in patients, might give some support to a hypothesis of autoimmunity in CC. The ANA- and pANCA positive patients could constitute a subpopulation among CC patients. Procollagen III propeptide (P-III-NP) is a product of collagen Ill metabolism. No significant difference between the serum level of P-III-NP in 38 patients (3.8±2.0 P-g!L) and 38 matched controls (3.7±1.3 ~g!L) was found, and P-III-NP did not correlate to clinical activity. There was a significant correlation, however, between P-III-NP and age in both patients and controls. The study showed that colonoscopy is still required to diagnose CC and cam~-9t be replaced, at present, by a simple blood test. A register of patients with CC was set up at the Örebro Medical Center Hospital. Twenty five Swedish hospitals contributed with patient records to this register which comprised of data from 163 patients. Data showed that CC usually followed a chronic intermittent benign course. The onset was sudden in up to 42% of the patients. The most common symptoms were chronic watery diarrhoea, sometimes nocturnal, abdominal pain and weight loss. Routine laboratory data were most often normaL Evaluation of the treatment showed a response rate of 59% for sulphasalazine, and 40% respectively SO% for olsalazine and mesalazine. Prednisolone was effective in about 80% of the patients, but the required dosage was often high, and the effect not sustained after withdrawal. Metronidazole, erythromycin and penicillin had response rates from 55% to 100%. Cholestyramine and loperamide offer treatmentalternatives of which about two thirds of the patients benefit.
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- Danielsson, Åke, et al.
(författare)
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A controlled randomized trial of budesonide versus prednisolone retention enemas in active distal ulcerative colitis
- 1987
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 22:8, s. 987-992
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-four patients with active distal ulcerative colitis participated in a multicentre, randomized, investigator-blind trial to compare the effect of budesonide enema, 2 mg/100 ml, with prednisolone disodium phosphate enema, 31.25 mg/100 ml. Budesonide is a new potent corticosteroid with a rapid first-pass elimination. The patients were treated for 4 weeks, and the efficacy of the drugs were evaluated by sigmoidoscopy, histology, and subjective symptoms after 2 and 4 weeks. After 4 weeks of treatment 16 of 31 patients (52%) receiving budesonide enema had healed endoscopically, compared with 8 of 33 (24%) (p = 0.045) receiving prednisolone enema. Budesonide was superior to prednisolone in terms of both significantly improved sigmoidoscopic and histologic scores and subjective symptoms evaluated by visual analogue scales. The patients receiving prednisolone had a significant depression of endogenous cortisol levels during the treatment period, but not the patients receiving budesonide. Budesonide enema seems to be a promising therapy for active distal ulcerative colitis and causes no adverse reactions
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- Einarsdottir, Elisabet, et al.
(författare)
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IL23R in the Swedish, Finnish, Hungarian and Italian populations : association with IBD and psoriasis, and linkage to celiac disease
- 2009
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Ingår i: BMC Medical Genetics. - : Springer Science and Business Media LLC. - 1471-2350. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Association of the interleukin-23 receptor (IL23R) with inflammatory bowel disease (IBD) has been confirmed in several populations. IL23R also associates with psoriasis, suggesting that the gene may be an important candidate for many chronic inflammatory diseases.METHODS: We studied association of single-nucleotide variants in IL23R with IBD in Swedish patients, in both Crohn's disease (CD) and ulcerative colitis (UC) subsets. The same genetic variants were also studied in Finnish patients with psoriasis or celiac disease, and in Hungarian and Italian patients with celiac disease.RESULTS: Association of IL23R with IBD was replicated in our Swedish patients, and linkage and association of the IL23R region with psoriasis was found in the Finnish population. The IL23R region was also linked to celiac disease in Finnish families, but no association of IL23R variants with celiac disease was found in the Finnish, Hungarian or Italian samples.CONCLUSION: Our study is the first to demonstrate association of IL23R with CD and UC in Swedish patients with IBD. It is also the first study to report linkage and association of the IL23R region with psoriasis in the Finnish population. Importantly, this is the first report of linkage of the IL23R region to celiac disease, a chronic inflammatory condition in which IL23R has not been previously implicated.
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- Hertervig, Erik, et al.
(författare)
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[Colitis cancer--myth or reality?]
- 2009
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 106:45, s. 3000-3002
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Forskningsöversikt (refereegranskat)abstract
- Det finns specifika grupper av patienter med ulcerös kolit och crohnkolit som har ökad risk för att utveckla kolorektal cancer. Mycket tyder dock på att risken har reducerats under senare tid. Prognosen vid manifest kolorektal cancer har också förbättrats. Inflammation i sig har visat sig vara en oberoende riskfaktor för kolorektal cancer. Den förbättrade antiinflammatoriska terapin med framför allt 5-aminosalicylsyra har visat sig vara en plausibel förklaring till den minskade risken. Koloskopisk övervakning och förbättrad terapi vid manifest kolorektal cancer är faktorer som sannolikt ligger bakom en kraftigt förbättrad prognos.
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| 7. |
- Hertervig, Erik, et al.
(författare)
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Kolitcancer - mer myt än verklighet?
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:45, s. 3000-3002
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Tidskriftsartikel (refereegranskat)abstract
- Patients with ulcerative colitis (UC) and Crohn´s colitis are at increased of developing colorectal cancer (CRC). However, recent studies suggest that the risk is now less than previously thought. Well established risk factors include extent and duration of disease, primary sclerosing cholangitis (PSC) and a family history of CRC. Recently inflammation (both microscopic and macroscopic) has been shown to represent an important independent risk factor for CRC development. Thus one likely explanation for the decreased risk of CRC observed in UC patients is the use of agents that inhibit the inflammatory process, particularly 5-ASA. Ursodeoxycholic acid has been found to be chemopreventive in UC patients with PSC. Evidence from case series and case-control studies suggest that surveillance colonoscopy also reduces the risk of CRC. Prospective randomized controlled trials will never be done because of ethical and logistical concerns. Thus, in the absence of these studies, our knowledge will have to rely on biologic and observational studies
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- Kurth, Thomas, et al.
(författare)
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Electron Microscopy of the Amphibian Model Systems Xenopus laevis and Ambystoma mexicanum
- 2010
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Ingår i: Methods in Cell Biology. - 0091-679X. ; 96, s. 395-423
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Forskningsöversikt (refereegranskat)abstract
- In this chapter we provide a set of different protocols for the ultrastructural analysis of amphibian (Xenopus, axolotl) tissues, mostly of embryonic origin. For Xenopus these methods include: (1) embedding gastrulae and tailbud embryos into Spurr's resin for TEM, (2) post-embedding labeling of methacrylate (K4M) and cryosections through adult and embryonic epithelia for correlative LM and TEM, and (3) pre-embedding labeling of embryonic tissues with silver-enhanced nanogold. For the axolotl (Ambystoma mexicanum) we present the following methods: (1) SEM of migrating neural crest (NC) cells; (2) SEM and TEM of extracellular matrix (ECM) material; (3) Cryo-SEM of extracellular matrix (ECM) material after cryoimmobilization; and (4) TEM analysis of hyaluronan using high-pressure freezing and HABP labeling. These methods provide exemplary approaches for a variety of questions in the field of amphibian development and regeneration, and focus on cell biological issues that can only be answered with fine structural imaging methods, such as electron microscopy.
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- Ljung, Tryggve, et al.
(författare)
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Granulocyte, monocyte/macrophage apheresis for inflammatory bowel disease : the first 100 patients treated in Scandinavia
- 2007
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Ingår i: Scandinavian Journal of Gastroenterology. - Oslo : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 42:2, s. 221-227
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Selective leukocyte apheresis is a new type of non-pharmacological treatment for patients with active ulcerative colitis and Crohn's disease. Preliminary data have indicated that this type of therapy is safe and efficacious, and large sham-controlled studies are currently in progress. In Scandinavia, a substantial number of patients with chronic inflammatory bowel disease have already received leukocyte apheresis on a compassionate use basis and the aim of this study was to report the clinical outcome and adverse events in the first patients treated. MATERIAL AND METHODS: Clinical details of the first consecutive 100 patients with inflammatory bowel disease treated with granulocyte, monocyte/macrophage (Adacolumn) apheresis in Scandinavia were prospectively registered. Median length of follow-up was 17 months, (range 5-30). RESULTS: The study population comprised 52 patients with ulcerative colitis, 44 patients with Crohn's disease and 4 patients with indeterminate colitis. In 97 patients the indication for Adacolumn treatment was steroid-refractory or steroid-dependent disease. Clinical remission was attained in 48% of the patients with ulcerative colitis, and an additional 27% had a clinical response to the apheresis treatment. The corresponding figures for patients with Crohn's disease were 41% and 23%, respectively. Complete steroid withdrawal was achieved in 27 out of the 50 patients taking corticosteroids at baseline. Adverse events were reported in 15 patients and headache was most frequently reported (n=7). CONCLUSIONS: Granulocyte, monocyte/macrophage apheresis treatment seems to be a valuable adjuvant therapy in selected patients with refractory inflammatory bowel disease. The risk for toxicity or severe adverse events appears to be low.
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