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Sökning: L773:0257 2753 OR L773:1421 9875

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1.
  • Agréus, Lars, et al. (författare)
  • Predictors and non-predictors of symptom relief in dyspepsia consultations in primary care
  • 2008
  • Ingår i: Digestive Diseases. - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 26:3, s. 248-255
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. DESIGN, SETTING AND PATIENTS: Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). MAIN OUTCOME MEASURE: Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. RESULTS: Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2-19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1-10.9). CONCLUSION: Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia
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2.
  • Andersson, Peter, et al. (författare)
  • Surgery in ulcerative colitis : indication and timing.
  • 2009
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 27:3, s. 335-340
  • Tidskriftsartikel (refereegranskat)abstract
    • Surgery continues to play an important role in the therapeutic arsenal in ulcerative colitis. In acute colitis, close collaboration between the gastroenterologist and the surgeon is pertinent. Absolute indications for surgery include toxic megacolon, perforation, and severe colorectal bleeding. In addition, surgery should always be considered upon deterioration during medical therapy. The recommended operation in acute colitis is colectomy and ileostomy, with the rectum left in situ; reconstruction is not an option in the acute setting. In chronic continuous colitis, often with long-term steroid therapy, healing conditions are poor. A staged procedure is preferred also in these cases. In cases with dysplasia, surgery should be done after verifying the dysplasia since these patients often have little symptoms from their colitis. The proctocolectomy should in these cases include total mesorectal excision. Ileal pouch-anal anastomosis is the standard bowel reconstruction in ulcerative colitis. The various options should, however, always be thoroughly discussed, considering the pros and cons in each individual patient, before a choice is made. Ileorectal anastomosis is a temporary alternative in select cases (e.g. young women not having had children). Reconstructive surgery is best done approximately 6 months after primary surgery. Surgery for ulcerative colitis should be seen as complementary to medical treatment and may prevent complications, improve the patients' quality of life and occasionally be life-saving. Correct assessment and optimised medical treatment are prerequisites for surgery on accurate indications and good surgical results. Therefore, close interactions between gastroenterologists and colorectal surgeons are mandatory for optimal patient outcome.
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3.
  • Bolling-Sternevald, E, et al. (författare)
  • Do gastrointestinal symptoms fluctuate in the short-term perspective? The Kalixanda study
  • 2008
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 26:3, s. 256-263
  • Tidskriftsartikel (refereegranskat)abstract
    • <i>Background/Aim:</i> Short-term fluctuation of gastrointestinal symptoms in the general population is largely unknown. We aimed to determine gastrointestinal symptom fluctuation in an random adult population using a validated questionnaire assessing gastrointestinal symptoms. <i>Methods:</i> A representative sample (n = 2,860) of the population (n = 21,610, 20–81 years of age; mean age 50.4 years) in Northern Sweden was studied. The subjects were asked to complete the questionnaire on two occasions [mean 2.5 months (range 1–6)], firstly via mail and secondly at a visit to the clinic. An upper endoscopy was performed after the last assessment of symptoms. <i>Results:</i> 2,122 individuals (74.2%) completed the initial questionnaire; 1,001 of these (mean age 54.1 years, 48.8 males) completed the second questionnaire. On the first occasion, 40% of the subjects were symptom-free (20.2%) or could not be classified according to their symptom pattern, of those with symptoms 39% reported troublesome reflux symptoms, 40% dyspeptic symptoms and 30% irritable bowel symptoms. Symptom overlap occurred in more than two thirds of the subjects. At the second visit 75% of the subjects who had reported dyspeptic complaints still reported such complaints. <i>Conclusions:</i> In this population-based study, gastrointestinal symptoms were common. Some symptom fluctuation occurred in the shorter term, but troublesome gastrointestinal complaints remained in approximately 90% of subjects over a 1–6-month period.
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4.
  • Bolling-Sternevald, Elisabeth, et al. (författare)
  • Self-administered symptom questionnaires in patients with dyspepsia and their yield in discriminating between endoscopic diagnoses
  • 2002
  • Ingår i: Digestive diseases. - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 20:2, s. 191-198
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND/AIMS: Symptoms are generally considered to be poor predictors of organic findings in patients with dyspepsia. We aimed at evaluating whether specific gastrointestinal symptoms, identified by self-administered questionnaires, correlate with specific endoscopic diagnoses and discriminate organic from functional dyspepsia. METHODS: Adult patients with pain or discomfort centred in the upper abdominal region were consecutively enrolled. Patients with heartburn, acid regurgitation, or defaecation and bowel habit problems as their predominant symptoms were excluded. Three self-administered questionnaires were applied before an oesophagogastroduodenoscopy was performed. RESULTS: Among the 799 patients, 50.6% had a normal endoscopy. Endoscopic diagnoses comprised: non-erosive oesophagitis (7.5%), erosive oesophagitis (11.1%), Barrett's oesophagus (1.1%), gastritis/duodenitis (8.4%), gastric ulcer (4.5%), duodenal ulcer (8.3%), and cancer (1.3%). Non-dominant heartburn and acid regurgitation were significantly more common in patients with organic dyspepsia, whereas hunger pains and rumbling occurred more often in those with functional dyspepsia. Multivariate analyses demonstrated that younger age, female gender, high scores for hunger pain, rumbling, hard stools, low scores for heartburn, and acid regurgitation predicted functional dyspepsia. CONCLUSIONS: Self-administered questionnaires revealed differences in the symptom patterns between patients with functional and organic dyspepsia. Furthermore, the health-related well-being in patients with functional and organic dyspepsia centred was impaired to the same extent.
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5.
  • Bouma, Gerd, et al. (författare)
  • Microscopic Colitis
  • 2015
  • Ingår i: Digestive Diseases. - : Karger. - 0257-2753 .- 1421-9875. ; 33:2, s. 208-214
  • Tidskriftsartikel (refereegranskat)abstract
    • Microscopic colitis (MC) is the common denominator for lymphocytic and collagenous colitis (CC). It is now recognized as a relatively frequent cause of diarrhea that equals the prevalence of inflammatory bowel disease. Patients are typically middle-aged women, but disease may occur at every age. Patients with MC report watery, non-bloody diarrhea in the absence of endoscopic and radiologic abnormalities. Lymphocytic colitis is characterized by an increased number of intraepithelial lymphocytes, and CC by a thickened subepithelial collagen band, whereas in both an increased mononuclear infiltration of the lamina propria is found. The pathogenesis of MC is largely unknown, but may relate to autoimmunity, adverse reactions to drugs or (bacterial) toxins, and abnormal collagen metabolism in the case of CC. Budesonide is so far the only drug that has proven efficacy in randomized controlled trials both for the induction and maintenance of remission. Patients who are nonresponsive, dependent or who experience side effects on budesonide may benefit from thiopurine or anti-TNF treatment, but these options are still experimental. The long-term prognosis of MC is good; it does not appear to predispose to malignancies and can in some cases be self-limiting. Further research and randomized clinical trials are required to expand our understanding of the natural course and the pathogenesis of MC.
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6.
  • Danese, Silvio, et al. (författare)
  • Unmet Medical Needs in Ulcerative Colitis : An Expert Group Consensus
  • 2019
  • Ingår i: Digestive Diseases. - : S. Karger. - 0257-2753 .- 1421-9875. ; 37:4, s. 266-283
  • Forskningsöversikt (refereegranskat)abstract
    • BACKGROUND: The authors aimed to conduct an extensive literature review and consensus meeting to identify unmet needs in ulcerative colitis (UC) and ways to overcome them. UC is a relapsing and remitting inflammatory bowel disease with varied, and changing, incidence rates worldwide. UC has an unpredictable disease course and is associated with a high health economic burden. During 2016 and 2017, a panel of experts was convened to identify, discuss and address areas of unmet need in UC.METHODS: PubMed and Cochrane Library databases were searched for relevant articles describing studies performed in patients with UC. These findings were used to generate a set of statements relating to unmet needs in UC. Consensus on these statements was then sought from a panel of 9 expert gastroenterologists using a modified Delphi review process that consisted of anonymous surveys followed by live meetings.RESULTS: In 2 literature reviews, over 5,000 unique records were identified and a total of 138 articles were fully reviewed. These were used to consider 26 areas of unmet need, which were explored in 2 face-to-face meetings, in which the statements were debated and amended, resulting in consensus on 30 final statements. The unmet needs identified were categorised into 7 areas: impact of UC on patients' daily life; importance of early diagnosis and treatment; drawbacks of existing treatments; urgent need for new treatments; and disease-, practice- or patient-focused unmet needs.CONCLUSIONS: These expert group meetings found a number of areas of unmet needs in UC, which is an important first step in tackling them in the future. Future research and development should be focused in these areas for the management of patients with UC.
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7.
  • Ekbom, A (författare)
  • Is diverticular disease associated with colonic malignancy?
  • 2012
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 30:1, s. 46-50
  • Tidskriftsartikel (refereegranskat)abstract
    • Colon cancer and diverticular disease have common characteristics; there are increases in the incidences in both disease entities and these diseases are more common in the westernized world. There is also an increase in the age-specific incidence with advancing age. Similar dietary features have been implicated for both diseases and already during the 1960s it was postulated by Burkitt that there is an association. Observational studies initially were able to demonstrate that patients with a history of diverticular disease of the colon had an increased risk of colon cancer, especially in the left side. However, the results from these studies have not been consistent, and problems like selection bias and confounding by indication have been major drawbacks in order to interpret the results and infer causality. Recent studies, which have had a better assessment of diverticular disease by new diagnostic methods, do not support such an association to the same extent as previously. Moreover, surveillance bias has become an increasing problem as patients with diverticular disease of the colon are subjected to a higher diagnostic intensity than other individuals in a population-based setting. A critical evaluation of the studies published so far therefore clearly indicates that the proposed association between diverticular disease and colonic malignancy is not evidence based, which should have an impact on clinical practice as well as on how to deal with these patient groups within the realms of a screening program.
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8.
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9.
  • Gasslander, T, et al. (författare)
  • Cystic tumors of the pancreas
  • 2001
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 19:1, s. 57-62
  • Tidskriftsartikel (refereegranskat)abstract
    • The discovery of a cystic lesion in the pancreas implies a challenge for the physician. Approximately 10% are cystic tumors, benign to highly malignant, or true cysts, showing all stages of cellular differentiation, from benign to highly malignant tumors. Malignant cystic tumors are rare and comprise only about 1% of all pancreatic malignancies, they are potentially curable. Therefore, correct diagnosis and treatment of these lesions are of great importance. It is usually not possible to separate a pseudocyst from a benign cyst or a cystic tumor, but there are some signs and findings that could be helpful in the clinical decision. The diagnosis of a cystic pancreatic tumor requires different imaging techniques, including ultrasonography, computerized tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, but to distinguish a pseudocyst or a benign cyst from a potentially malignant lesion can be very difficult. The usefulness of blood tests and investigations of cyst fluid can be questionable. Today, surgical treatment of cystic pancreatic tumors can be performed with low morbidity. Therefore, we conclude that an active strategy with resection of cystic tumors of the pancreas should be recommended.
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10.
  • Gerold, Gisa, 1979-, et al. (författare)
  • The HCV life cycle : in vitro tissue culture systems and therapeutic targets
  • 2014
  • Ingår i: Digestive Diseases. - : S. Karger. - 0257-2753 .- 1421-9875. ; 32:5, s. 525-537
  • Tidskriftsartikel (refereegranskat)abstract
    • Hepatitis C virus (HCV) is a highly variable plus-strand RNA virus of the family Flaviviridae. Viral strains are grouped into six epidemiologically relevant genotypes that differ from each other by more than 30% at the nucleotide level. The variability of HCV allows immune evasion and facilitates persistence. It is also a substantial challenge for the development of specific antiviral therapies effective across all HCV genotypes and for prevention of drug resistance. Novel HCV cell culture models were instrumental for identification and profiling of therapeutic strategies. Concurrently, these models revealed numerous host factors critical for HCV propagation, some of which have emerged as targets for antiviral therapy. It is generally assumed that the use of host factors is conserved among HCV isolates and genotypes. Additionally, the barrier to viral resistance is thought to be high when interfering with host factors. Therefore, current drug development includes both targeting of viral factors but also of host factors essential for virus replication. In fact, some of these host-targeting agents, for instance inhibitors of cyclophilin A, have advanced to late stage clinical trials. Here, we highlight currently available cell culture systems for HCV, review the most prominent host-targeting strategies against hepatitis C and critically discuss opportunities and risks associated with host-targeting antiviral strategies.
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11.
  • Johansson, Malin E V, 1971, et al. (författare)
  • Mucus and the Goblet Cell
  • 2013
  • Ingår i: Digestive Diseases. - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 31:3-4, s. 305-309
  • Tidskriftsartikel (refereegranskat)abstract
    • The discovery of an inner mucus layer normally impervious to bacteria has changed our way of understanding the interaction between commensal bacteria and the host epithelial cells. This inner colon mucus layer is rapidly renewed and converted into the outer mucus layer by host controlled endogenous proteolytic processing. The mucus characteristics esteem from the properties of the main protein component of these layers, the MUC2 mucin. This forms an enormously large net-like structure that builds the laminated inner mucus layer that largely acts as a size exclusion filter excluding bacteria. In the absence of MUC2 mucin, there is no inner mucus layer and bacteria reach the epithelial cell surface, penetrate the crypts and are also found inside epithelial cells, something that leads to severe inflammation. Other mouse models that spontaneously develop colitis due to different defects, like an absent ion channel (Nhe3) or immunological mediators (TIr5, IL-10), all also have a defective inner colon mucus layer. Human patients with active ulcerative colitis have this layer penetrable to bacteria and beads the size of bacteria. Some of the ulcerative colitis patients in remission have a normal mucus layer whereas others have a penetrable inner mucus layer. Together, this suggests that the inner mucus layer and its integrity is important for the protection of the colon epithelium and inhibiting activation of the immune system as in ulcerative colitis. (C) 2013 S.Karger AG, Basel
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12.
  • Lohr, JM, et al. (författare)
  • Conservative treatment of chronic pancreatitis
  • 2013
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 31:1, s. 43-50
  • Tidskriftsartikel (refereegranskat)abstract
    • <b><i>Background:</i></b> Chronic pancreatitis is a progressive inflammatory disease giving rise to several complications that need to be treated accordingly. Because pancreatic surgery has significant morbidity and mortality, less invasive therapy seems to be an attractive option. <b><i>Aim:</i></b> This paper reviews current state-of-the-art strategies to treat chronic pancreatitis without surgery and the current guidelines for the medical therapy of chronic pancreatitis. <b><i>Results:</i></b> Endoscopic therapy of complications of chronic pancreatitis such as pain, main pancreatic duct strictures and stones as well as pseudocysts is technically feasible and safe. The long-term outcome, however, is inferior to definitive surgical procedures such as resection or drainage. On the other hand, the medical therapy of pancreatic endocrine and exocrine insufficiency is well established and evidence based. <b><i>Conclusions:</i></b> Endoscopic therapy may be an option to bridge for surgery and in children/young adolescents and those unfit for surgery. Pain in chronic pancreatitis as well as treatment of pancreatic exocrine insufficiency follows established guidelines.
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13.
  • Lundell, L (författare)
  • Acid secretion and gastric surgery
  • 2011
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 29:5, s. 487-490
  • Tidskriftsartikel (refereegranskat)abstract
    • It was long believed that there were major differences in the pathophysiology between the three major categories of peptic ulcers. The unifying feature was that all peptic ulcers occurred in a mucosal compartment exposed to acid-pepsin secretions. All ulcers tended to heal more rapidly when acid secretion was more readily neutralized or inhibited. Decreased local resistance was considered to be present in primarily acute and chronic gastric ulcer. Surgery for peptic ulcer intended to reduce acid secretion, which also resulted in a diminished pepsin enzyme activity. The corresponding reduction could be accomplished either by gastric resection, different vagotomies or a combination of resections and vagotomies. Most of the procedures were basically abandoned at the time of introduction of modern medical therapeutic strategies. For duodenal ulcer and prepyloric ulcer diseases, various vagotomies were generally recommended or combined with antrectomy. Partial gastrectomy or antrectomy with gastroduodenostomy was the standard procedure for treatment of type 1 gastric ulcer. The great caveat associated with surgical procedures for elective treatment of uncomplicated peptic ulcer disease is confined to operative mortality, postoperative morbidity, and late postoperative metabolic sequelae. The only remaining indication today of remedial gastric surgery for peptic ulcer disease is when there is a defined risk for gastric cancer in an unhealed gastric ulcer and very seldom in a case with recurrent or therapy-resistant peripyloric ulcer.
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14.
  • Lundell, L (författare)
  • Borderline indications and selection of gastroesophageal reflux disease patients: 'Is surgery better than medical therapy'?
  • 2014
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 32:1-2, s. 152-155
  • Tidskriftsartikel (refereegranskat)abstract
    • Modern medical therapies for gastroesophageal reflux disease (GERD) are totally dedicated to the control of the acid component of the refluxate. In chronic erosive GERD, antireflux surgery has proven to be very efficacious and superior to traditional medical therapies, such as H<sub>2</sub> blockers. The introduction of proton pump inhibitors (PPIs), however, substantially improved medical therapy. Still, treatment failures are inevitable regardless of which of these two effective therapies is chosen. Some recent reports have presented conflicting results from trials comparing antireflux surgery and PPIs. This may be due to differences in trial designs as well as in the structure and content of the therapeutic strategies that are compared. The study with the longest clinical follow-up by far is the SOPRAN study comparing open antireflux surgery and omeprazole. The protocol provides for a follow-up period of more than a decade and the clinical outcomes have recently been published. There has always been concern about the long-term effectiveness of reflux prevention whether by surgery or PPI therapy. It is likely that a marker for an emerging risk for recurrence of GERD is abnormal acid reflux as assessed by ambulatory 24-hour pH-metry. The LOTUS trial compared maintenance therapy provided by esomeprazole (dose-adjusted when required) with standardized laparoscopic antireflux surgery in patients with good response to acid suppressive therapy. An operation is suitable when symptoms are poorly controlled despite medication, especially for patients who suffer large-volume regurgitation and those who wake at night coughing and choking and who regurgitate acidic fluid or food into their throat and airways. Regurgitation into the throat upon stooping or exercising can limit a patient's ability to work, play sports or even do simple housework. A few patients cannot tolerate medical treatment. If surgery is to be a good option, it must be ensured that the right surgeon performs a standardized operation for the right indications on the right patient and provides good preoperative counseling and testing along with postoperative support. When a patient is refractory to medical treatment, the diagnosis of GERD should be reconsidered before surgery is advised; extradigestive manifestations should be accounted for with care. <b><i>Conclusions:</i></b> Laparoscopic fundoplication (LF) substantially improves GERD symptoms, although in some individuals symptoms return and acid-suppressive medication use increases. Limited data suggest that LF is less effective at reducing symptoms in partial responders to medical therapy than in complete responders. This may affect cost arguments for using fundoplication surgery rather than acid-suppressive medications, as data are based largely on complete responders.
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15.
  • Lundell, L (författare)
  • Principles and results of bariatric surgery
  • 2012
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 30:2, s. 173-177
  • Tidskriftsartikel (refereegranskat)abstract
    • Bariatric surgery is followed by substantial and durable weight loss and associated with it favorable metabolic effects far beyond those achieved by lifestyle modifications and pharmacological treatments. The perioperative and postoperative morbidity and mortality have decreased significantly over the years to the level that bariatric surgery now can compare with other frequently recommended and well-accepted procedures such as cholecystectomy and hysterectomy. In fact, the postoperative mortality risk of bariatric surgery is far lower than that of coronary artery bypass surgery but with significantly greater improvement in long-term mortality. Much of the improvement in perioperative morbidity and mortality can be attributed to advances in many components of the care chain such as the introduction of laparoscopic surgery, as well as establishment of a nationwide center of excellence network and required outcome reporting. Extensive evidence on safety and efficacy supports bariatric surgery as the standard of care for treatment of severe obesity. Bariatric surgery reduces the risk of global mortality, all-cause mortality and cardiovascular mortality when compared to obese control patients. Both gastric banding and gastric bypass seem to reduce mortality risk.
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16.
  • Lundell, L (författare)
  • Reflux Symptoms: Functional and Structural Diseases and the Approach from the GI Specialist
  • 2021
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 39:6, s. 590-597
  • Tidskriftsartikel (refereegranskat)abstract
    • The GI specialist has an important role to play in the long-term management of gastroesophageal reflux disease (GERD) patients to secure a proper diagnosis and the selection of best possible therapeutic strategy. Through intensified information and education, the implementation of national and international guidelines can be more effectively processed, whereupon a significant improvement in cost-effectiveness of the current management will be fostered. Regarding the more specific group of GERD patients, as represented by the so-called PPI-refractory patients, data have now emerged to guide us into the future. Noteworthy is that the majority of the alleged PPI-refractory GERD patients do not, after careful investigations, have GERD. Based on recently published RCT data, a clinically highly relevant difference in treatment success was noted in favor of laparoscopic antireflux surgery as compared to a variety of medical treatment alternatives. Likewise, it can be concluded that it seems as if the latter can only offer a limited effect. Whenever a corresponding powerful clinical difference in therapeutic outcome between different strategies and treatment alternatives is detected, this will have a huge impact on treatment algorithms and clinical management.
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17.
  • Lundell, L (författare)
  • Therapy of gastroesophageal reflux: evidence-based approach to antireflux surgery
  • 2007
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 25:3, s. 188-196
  • Tidskriftsartikel (refereegranskat)abstract
    • <i>Background:</i> Due to the chronic, relapsing nature of gastroesophageal reflux disease, lifelong therapeutic options have to be considered and recommended in many patients. Accordingly, surgical repair has to be evaluated based on modern, evidence-based methodologies. <i>Methods:</i> A careful review has been carried out of the relevant surgical literature also including trials incorporating direct comparisons between medical and surgical therapies. The outcome of such a survey has been structured according to the grading of evidence from highest grade I to the lowest III. <i>Results:</i> Grade I evidence exists to show that antireflux surgery is more effective than proton pump inhibition in the control of reflux-related symptoms. Side effects are burdening surgical repair, many of which do not decrease over time. Data are not consistent to show any benefit of surgery whenever health economic outcomes are required. Minor differences are in favor of laparoscopic operations and it does matter who is doing the operation and how the repair is completed. Better data are requested to assess the true long-term efficacy (>10 years) of corresponding operations. <i>Conclusion:</i> Antireflux surgery is an effective and durable therapeutic modality in the long-term management of gastroesophageal reflux disease.
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18.
  • Lundell, L (författare)
  • Use of probiotics in abdominal surgery
  • 2011
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 29:6, s. 570-573
  • Tidskriftsartikel (refereegranskat)abstract
    • Several clinical trials have demonstrated that the use of probiotics and synbiotics in patients undergoing abdominal surgery might be beneficial in preventing postoperative infectious complications. However, other investigators report that there is no evidence supporting any benefits from preoperative use of pre- and probiotics (synbiotics) in patients undergoing elective abdominal surgery, and that in some cases there is even an increased risk of mortality. Possible explanations behind these controversies may be found in the postoperative period of administration (median time of 4 days), the oral (instead of jejunal) route of administration with the accompanying unclear survival rate of the probiotics in the stomach due to low pH, and the high-risk operations such as complicated colectomies resulting in a high overall rate of bacterial translocation and infections. In recent years, three important randomized studies on the effects of probiotics in patients undergoing colorectal surgery have reported that the use of probiotics markedly improved intestinal microbial populations and significantly decreased the incidence of further infectious complications. Furthermore, the patients’ quality of life was also improved by shortening the duration of postoperative hospital stay and the period needed for antibiotics administration. Improvements in infection-related complications and gut defecation function have also been reported in patients receiving perioperative oral probiotics treatment, suggesting that the use of probiotics could reduce the extent of damage to colon mucosa after surgery. Probiotics can improve the integrity of the gut mucosal barrier as well as the balance of the gut microbiota, and they play a role in decreasing the rate of infection. This area, however, requires more research before preoperative oral intake of probiotics combined with postoperative treatment can be recommended for patients in need of gastrointestinal surgery.
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19.
  • Marschall, Hanns-Ulrich, 1954, et al. (författare)
  • Ursodeoxycholic acid for treatment of fatty liver disease and dyslipidemia in morbidly obese patients.
  • 2011
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 29:1, s. 117-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Bile acids have recently been identified as major integrators of hepatic fatty acid and triglyceride metabolism. We explored potential mechanism(s) of action of ursodeoxycholic acid (20 mg/kg/day in 3 weeks) in 40 morbidly obese patients (mean BMI >40 kg/m(2)) with suggested fatty liver disease awaiting bariatric surgery. At follow-up half a year after surgery, patients had decreased their BMI by approximately 10 kg/m(2), which resulted in significant improvements of liver function tests, insulin sensitivity and glucose tolerance.
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20.
  • Rudling, M, et al. (författare)
  • Stimulation of apical sodium-dependent bile acid transporter expands the bile acid pool and generates bile acids with positive feedback properties
  • 2015
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9875 .- 0257-2753. ; 33:3, s. 376-381
  • Tidskriftsartikel (refereegranskat)abstract
    • <b><i>Background:</i></b> Bile acid synthesis has been considered a prototype for how a physiological process is controlled by end product feedback inhibition. By this feedback inhibition, bile acid concentrations are kept within safe ranges. However, careful examination of published rodent data strongly suggests that bile acid synthesis is also under potent positive feedback control by hydrophilic bile acids. <b><i>Key Messages:</i></b> Current concepts on the regulation of bile acid synthesis are derived from mouse models. Recent data have shown that mice have farnesoid X receptor (FXR) antagonistic bile acids capable of quenching responses elicited by FXR agonistic bile acids. This is important to recognize to understand the regulation of bile acid synthesis in the mouse, and in particular to clarify if mouse model findings are valid also in the human situation. <b><i>Conclusions:</i></b> In addition to classic end product feedback inhibition,<b> </b>regulation of bile acid synthesis in the mouse largely appears also to be driven by changes in hepatic levels of murine bile acids such as α- and β-muricholic acids. This has not been previously recognized. Stimulated bile acid synthesis or induction of the apical sodium-dependent bile acid transporter in the intestine, increase the availability of chenodeoxycholic acid in the liver, thereby promoting hepatic conversion of this bile acid into muricholic acids. Recognition of these mechanisms is essential for understanding the regulation of bile acid synthesis in the mouse, and for our awareness of important species differences in the regulation of bile acid synthesis in mice and humans.
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21.
  • STAL, P (författare)
  • Iron as a hepatotoxin
  • 1995
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 13:4, s. 205-222
  • Tidskriftsartikel (refereegranskat)
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22.
  • Söderholm, Johan D (författare)
  • Mast Cells and Mastocytosis
  • 2009
  • Ingår i: DIGESTIVE DISEASES. - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 27, s. 129-136
  • Tidskriftsartikel (refereegranskat)abstract
    • Mast cells (MCs) typically reside at barrier sites of the body, including the intestinal mucosa, and play a vital role in innate host defence. Activated MCs release a wide variety of bioactive mediators. These include preformed mediators stored in the granules (e. g. histamine and tryptase) and newly synthesised mediators (e. g. prostaglandins, leukotrienes and cytokines). MCs are present in all layers throughout the gastrointestinal (GI) tract and there is a close bi-directional connection between MCs and enteric nerves that is of vital importance in the regulation of GI functions. Some gain-of-function mutations in c-kit, encoding the tyrosine kinase-receptor for stem cell factor, are associated with the rare disease entity, systemic mastocytosis. These patients present symptoms arising from MC mediator release or infiltration. GI manifestations are common in this patient group, mainly abdominal pain and diarrhoea. Endoscopy with biopsies reveals MC infiltration in the mucosa. Other diagnostic tools include bone marrow biopsy and serum tryptase. Treatment is symptomatic with antihistamines or cromoglycate in mild cases, whereas severe cases need cytoreductive therapy that should be managed with expert haematologists. From a day-to-day clinical perspective, the important role of MCs in neuroimmune interaction has been implicated in the intestinal response to stress, in alterations of mucosal and neuromuscular function in irritable bowel syndrome or inflammatory bowel disease, and in the pathogenesis of nonerosive oesophageal reflux disease. Thus, MCs have important regulatory and protective roles in innate defence, in addition to being a potential mediator of mucosal pathophysiology in GI diseases. We need to learn how to balance the response of these volatile cells to be able to benefit from their versatility.
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23.
  • Vieth, M, et al. (författare)
  • Radial distribution of dilated intercellular spaces of the esophageal squamous epithelium in patients with reflux disease exhibiting discrete endoscopic lesions.
  • 2004
  • Ingår i: Digestive diseases (Basel, Switzerland). - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 22:2, s. 208-12
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Dilatation of intercellular spaces of the esophageal squamous epithelium has been suggested as a marker of early acid reflux-induced damage. This change is a potentially useful addition to histomorphological changes that represent so called minimal endoscopic lesions. We have assessed dilatation of intercellular spaces with regard to: (1) interobserver variability, and (2) whether the incidence of this varies between 'red streaks' and the adjacent normal looking squamous epithelium. METHODS: Esophageal biopsies from 44 patients with chronic gastro-esophageal reflux (GERD) were evaluated. At endoscopy, these patients had one or more red streaks on the tops of the mucosal folds in the distal esophagus. Biopsies were taken from the red streaks and from the normal-appearing mucosa 1 cm lateral to the red streaks. Biopsies were assessed in a blinded fashion by two independent pathologists (MV & RF). Criteria for assessing intercellular space dilatation were evaluated and agreed on prior to the study. RESULTS: Good interobserver agreement was recorded (kappa = 0.82 at the streaks and 0.77 for the control tissues) for absence/presence of intercellular space dilatation. Red streak and control biopsies differed significantly (p = 0.0001), with respect to presence of dilated intercellular spaces, with 90.5 % of the former demonstrating this as present compared to 56.1% in the controls. CONCLUSION: This study supports the concept that esophageal mucosal minimal changes due to reflux is localised and that dilatation of intercellular spaces is an early sign of reflux-induced epithelial damage. The low interobserver variability in the assessment of intercellular space dilatation suggests that this may be a useful variable for assessment of early signs of acid-reflux induced damage to the squamous epithelium of the esophagus by use of light microscopy.
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24.
  • Wahlström, Annika, 1975, et al. (författare)
  • Crosstalk between Bile Acids and Gut Microbiota and Its Impact on Farnesoid X Receptor Signalling
  • 2017
  • Ingår i: Digestive Diseases. - : S. Karger AG. - 0257-2753 .- 1421-9875. ; 35:3, s. 246-250
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The gut microbiota has a substantial impact on health and disease. The human gut microbiota influences the development and progression of metabolic diseases; however, the underlying mechanisms are not fully understood. The nuclear farnesoid X receptor (FXR), which regulates bile acid homeostasis and glucose and lipid metabolism, is activated by primary human and murine bile acids, chenodeoxycholic acid and cholic acid, while rodent specific primary bile acids tauromuricholic acids antagonise FXR activation. The gut microbiota deconjugates and subsequently metabolises primary bile acids into secondary bile acids in the gut and thereby changes FXR activation and signalling. Key Message: Mouse models have been used to study the crosstalk between bile acids and the gut microbiota, but the substantial differences in bile acid composition between humans and mice need to be considered when interpreting data from such studies and for the development of so-called humanised mouse models. Conclusion: It is of special importance to elucidate how a human gut microbiota influences bile acid composition and FXR signalling in colonised mice. © 2017 S. Karger AG, Basel.
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