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Vujasinovic M, Öst Å, Bark R, Brismar T, Hynning B, Lindblad M, Elbe P. Metastasis to the gastrostomy site in a patient with pharynx cancer after percutaneous endoscopic gastrostomy: a case report. Scand J Gastroenterol 2020; 55:1002-1004. [PMID: 32634343 DOI: 10.1080/00365521.2020.1789209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A stenosing tumour in the throat region is a common indication for percutaneous endoscopic gastrostomy (PEG), which may be used for enteral nutrition in palliative cases or placed prior to curative treatment (surgery, radiotherapy and/or chemotherapy) and removed when the patient has recovered and has a reliable and adequate oral intake. Major complications related to PEG are rare, but their treatment poses a challenge. We are presenting a case of the transmission of metastasis to the gastrostomy site in a patient with pharynx cancer after percutaneous endoscopic gastrostomy.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Åke Öst
- Medilab - Täby, Sweden Medilab, Täby, Sweden
| | - Rusana Bark
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Torkel Brismar
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Boel Hynning
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Keita ÅV, Lindqvist CM, Öst Å, Magana CDL, Schoultz I, Halfvarson J. Gut Barrier Dysfunction-A Primary Defect in Twins with Crohn's Disease Predominantly Caused by Genetic Predisposition. J Crohns Colitis 2018; 12:1200-1209. [PMID: 29659773 PMCID: PMC6225972 DOI: 10.1093/ecco-jcc/jjy045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The aetiology of Crohn's disease is poorly understood. By investigating twin pairs discordant for Crohn's disease, we aimed to assess whether the dysregulated barrier represents a cause or a consequence of inflammation and to evaluate the impact of genetic predisposition on barrier function. METHODS Ileal biopsies from 15 twin pairs discordant for Crohn's disease [monozygotic n = 9, dizygotic n = 6] and 10 external controls were mounted in Ussing chambers to assess paracellular permeability to 51Chromium [Cr]-EDTA and trancellular passage to non-pathogenic E. coli K-12. Experiments were performed with and without provocation with acetylsalicylic acid. Immunofluorescence and ELISA were used to quantify the expression level of tight junction proteins. RESULTS Healthy co-twins and affected twins displayed increased 51Cr-EDTA permeability at 120 min, both with acetylsalicylic acid [p < 0.001] and without [p < 0.001] when compared with controls. A significant increase in 51Cr-EDTA flux was already seen at 20 min in healthy monozygotic co-twins compared with controls [p≤0.05] when stratified by zygosity, but not in healthy dizygotic co-twins. No difference in E. coli passage was observed between groups. Immunofluorescence of the tight junction proteins claudin-5 and tricellulin showed lower levels in healthy co-twins [p < 0.05] and affected twins [p < 0.05] compared with external controls, while ELISA only showed lower tricellulin in Crohn's disease twins [p < 0.05]. CONCLUSION Our results suggest that barrier dysfunction is a primary defect in Crohn's disease, since changes were predominantly seen in healthy monozygotic co-twins. Passage of E. coli seems to be a consequence of inflammation, rather than representing a primary defect.
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Affiliation(s)
- Åsa V Keita
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden,Corresponding author: Åsa V. Keita, PhD, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics & Oncology, Medical Faculty, Linköping University, 581 85 Linköping, Sweden. Tel: 46-101-038-919;
| | - Carl Mårten Lindqvist
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Åke Öst
- Department of Pathology and Cytology, Aleris Medilab, Täby, Sweden
| | - Carlos D L Magana
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ida Schoultz
- Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Correia-Varela-Almeida A, Öst Å, Baldaque-Silva F. A Sweet Discovery. Gastroenterology 2018; 155:e13-e14. [PMID: 30031134 DOI: 10.1053/j.gastro.2018.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/02/2022]
Affiliation(s)
| | - Åke Öst
- Pathology Department, Karolinska University Hospital & Karolinska Institute, Stockholm, Sweden
| | - Francisco Baldaque-Silva
- Endoscopy Unit, Department of Upper Abdominal Diseases, Karolinska University Hospital & Karolinska Institute, Stockholm, Sweden
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Wickbom A, Bohr J, Nyhlin N, Eriksson A, Lapidus A, Münch A, Ung KA, Vigren L, Öst Å, Tysk C. Microscopic colitis in patients with ulcerative colitis or Crohn's disease: a retrospective observational study and review of the literature. Scand J Gastroenterol 2018; 53:410-416. [PMID: 29546806 DOI: 10.1080/00365521.2018.1430252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohn's disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature. METHODS Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed. RESULTS We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n = 16) or lymphocytic colitis (LC) (n = 5); nine CD patients developed CC (n = 5) or LC (n = 4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients. CONCLUSIONS Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.
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Affiliation(s)
- Anna Wickbom
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Johan Bohr
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Nils Nyhlin
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Anders Eriksson
- b Department of Medicine, Emergency and Geriatrics , Sahlgrenska University Hospital/East Hospital , Gothenburg , Sweden
| | - Annika Lapidus
- c Department of Gastroenterology , Ersta Hospital , Stockholm , Sweden
| | - Andreas Münch
- d Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Faculty of Health Sciences , Linköping University , Linköping , Sweden
| | - Kjell-Arne Ung
- e Department of Internal Medicine , Sahlgrenska University Hospital/Mölndal , Gothenburg , Sweden
| | - Lina Vigren
- f Department of Medicine , Trelleborg Hospital , Trelleborg , Sweden
| | - Åke Öst
- g Department of Pathology and Cytology , Aleris Medilab , Täby , Sweden
| | - Curt Tysk
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
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Thorlacius H, Björk J, Öst Å, Wurm Johansson G, Nemeth A, Toth E. [Not Available]. Lakartidningen 2017; 114:ERXD. [PMID: 28696488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Henrik Thorlacius
- Skanes universitetssjukhus Malmo - Kirurgi Malmo, Sweden - Skånesuniversitetssjukhus Malmö, Sweden
| | - Jan Björk
- Karolinska Universitetssjukhuset - Gastroenterologi Stockholm, Sweden Karolinska Universitetssjukhuset - Gastroenterologi Stockholm, Sweden
| | - Åke Öst
- Medilab - Täby, Sweden Medilad - Täby, Sweden
| | - Gabriele Wurm Johansson
- Skåne University Hospital, Lund University - Department of Clinical Sciences, Malmö Malmö, Sweden Skåne University Hospital, Lund University - Department of Clinical Sciences, Malmö Malmö, Sweden
| | - Artur Nemeth
- Skåne University Hospital, Lund University - Department of Clinical Sciences, Malmö Malmö, Sweden Skåne University Hospital, Lund University - Department of Clinical Sciences, Malmö Malmö, Sweden
| | - Ervin Toth
- Skåne University Hospital, Lund University - Department of Clinical Sciences, Section of Gastroenterology Malmö, Sweden Skåne University Hospital, Lund University - Department of Clinical Sciences, Section of Surgery Malmö, Sweden
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Thorlacius H, Björk J, Öst Å, Toth E. [Endoscopic surveillance after colorectal polypectomy]. Lakartidningen 2017; 114:EHD6. [PMID: 28510242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Endoscopic surveillance after colorectal polypectomy These guidelines for endoscopic surveillance after colorectal polypectomy are based on the recommendations published by European Society of Gastrointestinal Endoscopy (ESGE) in 2013. A precondition for the guidelines is that patients have undergone a high-quality colonoscopy, including complete removal and histopathological evaluation of all detected neoplastic lesions. Current research has made it possible to stratify patients into a low-risk and a high-risk group in terms of metachronous cancer. Low-risk group patients (1-2 tubular adenomas <10 mm in size) are recommended a surveillance colonoscopy 10 years after the index colonoscopy if the patient is less than 50 years old, otherwise not. High-risk group patients (adenomas with villous histology or high grade dysplasia or ≥10 mm in size, or ≥ 3 adenomas), should undergo a repetition colonoscopy 3 years after the index colonoscopy. If high-risk adenomas are detected at first or subsequent surveillance colonoscopy, a 3-year repetition of the next endoscopic examination is recommended. If a high-risk patient has no high-risk adenomas at the first surveillance colonoscopy, a 5-year period is recommended until the second surveillance colonoscopy. ESGE recommends termination of the follow-up at 80 years of age although individualised recommendations should consider general health and co-morbidity of the patients as well as findings at previous colonoscopies.
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Affiliation(s)
- Henrik Thorlacius
- Skanes universitetssjukhus Malmo - Kirurgi Malmo, Sweden - Skånesuniversitetssjukhus Malmö, Sweden
| | - Jan Björk
- Karolinska Universitetssjukhuset - Gastroenterologi Stockholm, Sweden Karolinska Universitetssjukhuset - Gastroenterologi Stockholm, Sweden
| | - Åke Öst
- Medilab - Täby, Sweden Medilad - Täby, Sweden
| | - Ervin Toth
- Skåne University Hospital, Lund University - Department of Clinical Sciences, Section of Gastroenterology Malmö, Sweden Skåne University Hospital, Lund University - Department of Clinical Sciences, Section of Surgery Malmö, Sweden
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Mellander MR, Ekbom A, Hultcrantz R, Löfberg R, Öst Å, Björk J. Microscopic colitis: a descriptive clinical cohort study of 795 patients with collagenous and lymphocytic colitis. Scand J Gastroenterol 2016; 51:556-62. [PMID: 26679722 DOI: 10.3109/00365521.2015.1124283] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Microscopic colitis is a common cause of chronic diarrhoea in the Scandinavian countries. This report comprises demographic data, clinical and endoscopic features, and occurrence of coeliac and inflammatory bowel disease (IBD) in a large urban cohort of patients with lymphocytic colitis (LC) and collagenous colitis (CC). MATERIALS AND METHODS A total of 795 patients with microscopic colitis from two hospitals in Stockholm were included. Medical records were reviewed and clinical data, including endoscopic and histological findings, were compiled. RESULTS Forty-three percent had CC (female:male ratio 3.7:1) and 57% had LC (female:male ratio 2.7:1). The mean age at diagnosis of CC was 63 years and of LC was 59 years (p = 0.005). Clinical features were similar in both entities, but the intensity of symptoms differed. Watery diarrhoea was reported in 55% in CC patients versus in 43% in LC patients (p = 0.0014), and nocturnal diarrhoea in 28% versus 18% (p = 0.002). Subtle endoscopic mucosal findings were reported in 37% of the CC patients and in 25% of the LC patients (p = 0.0011). Colorectal adenomatous polyps were found in 5.3% of all patients. Coeliac disease occurred in 6% and IBD occurred in 2.1% of all patients. CONCLUSIONS Clinical features of LC and CC are similar but not identical. CC seems to be a more severe type of bowel inflammation and LC tends to occur earlier in life. Both forms might indeed feature endoscopic findings despite the designation 'microscopic'. Our study confirms the strong association with coeliac disease.
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Affiliation(s)
- Marie-Rose Mellander
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Anders Ekbom
- b Epidemiology Unit, Department of Medicine , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Rolf Hultcrantz
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
| | - Robert Löfberg
- c IBD Unit, Karolinska Institute, Sophiahemmet , Stockholm , Sweden
| | - Åke Öst
- d Department of Pathology and Cytology , Medilab , Täby , Sweden
| | - Jan Björk
- a Department of Gastroenterology and Hepatology , Karolinska Institute, Karolinska University Hospital , Solna , Sweden
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Dlugosz A, Barakat AM, Björkström NK, Öst Å, Bergquist A. Diagnostic yield of endomicroscopy for dysplasia in primary sclerosing cholangitis associated inflammatory bowel disease: a feasibility study. Endosc Int Open 2016; 4:E901-11. [PMID: 27540581 PMCID: PMC4988862 DOI: 10.1055/s-0042-111203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/13/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Primary sclerosing cholangitis associated inflammatory bowel disease (PSC-IBD) is characterized by a high risk of colorectal dysplasia. Surveillance colonoscopies with random biopsies have doubtful power for dysplasia detection. Our aim was to prospectively investigate the feasibility and efficacy of pCLE in surveillance colonoscopies in patients with PSC-IBD. PATIENTS AND METHODS Sixty-nine patients with PSC-IBD underwent colonoscopy in 2 steps. On the way from rectum to cecum, the mucosa was inspected with high definition endoscopy (HDE) and random biopsies were taken according to the standard routine. On the way from cecum to rectum, fluorescein-enhanced pCLE and chromoendoscopy were performed. Regions where random biopsies had been taken, as well as visible lesions, were examined with pCLE and targeted biopsies were taken of lesions suspicious for dysplasia. Two investigators, blinded to histology and endoscopy results, analyzed all pCLE videos off-line. RESULTS Nineteen biopsies obtained in 13 patients (17 targeted biopsies, 2 random biopsies) revealed the presence of low-grade dysplasia. Thirteen lesions with dysplasia were endoscopically visible but by using pCLE-targeted biopsies, additional endoscopically invisible dysplasias in 4 biopsies obtained from 3 patients were detected. The sensitivity, specificity, and accuracy of pCLE in predicting dysplasia were respectively 89 % (95 % CI: 65 - 98), 96 % (95 % CI: 94 - 97), and 96 % (95 % CI: 94 - 97). pCLE showed a good performance for differentiating neoplastic from non-neoplastic mucosa with negative predictive value of 99 %. CONCLUSIONS pCLE in PSC-IBD surveillance is feasible and may be a good complement to HDE. Future research should aim at elucidating whether real-time pCLE is applicable in PSC-IBD surveillance.
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Affiliation(s)
- Aldona Dlugosz
- Department of Medicine Huddinge and Center for Digestive Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Corresponding author Aldona Dlugosz, MD, PhD Karolinska Institutet, Department of MedicineKarolinska University Hospital, HuddingeCenter for Digestive DiseasesSE-14186 StockholmSweden+46 8 585 823 43+46 8 585 823 35
| | - Ammar Mohkles Barakat
- Department of Medicine Huddinge and Center for Digestive Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Niklas K. Björkström
- Department of Medicine Huddinge and Center for Digestive Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Department of Medicine Huddinge and Center for Infectious Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Åke Öst
- Department of Pathology Huddinge, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Annika Bergquist
- Department of Medicine Huddinge and Center for Digestive Diseases, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Münch A, Bohr J, Miehlke S, Benoni C, Olesen M, Öst Å, Strandberg L, Hellström PM, Hertervig E, Armerding P, Stehlik J, Lindberg G, Björk J, Lapidus A, Löfberg R, Bonderup O, Avnström S, Rössle M, Dilger K, Mueller R, Greinwald R, Tysk C, Ström M. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut 2016; 65:47-56. [PMID: 25425655 PMCID: PMC4717436 DOI: 10.1136/gutjnl-2014-308363] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/11/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This 1-year study aimed to assess low-dose budesonide therapy for maintenance of clinical remission in patients with collagenous colitis. DESIGN A prospective, randomised, placebo-controlled study beginning with an 8-week open-label induction phase in which patients with histologically confirmed active collagenous colitis received budesonide (Budenofalk, 9 mg/day initially, tapered to 4.5 mg/day), after which 92 patients in clinical remission were randomised to budesonide (mean dose 4.5 mg/day; Budenofalk 3 mg capsules, two or one capsule on alternate days) or placebo in a 12-month double-blind phase with 6 months treatment-free follow-up. Primary endpoint was clinical remission throughout the double-blind phase. RESULTS Clinical remission during open-label treatment was achieved by 84.5% (93/110 patients). The median time to remission was 10.5 days (95% CI (9.0 to 14.0 days)). The maintenance of clinical remission at 1 year was achieved by 61.4% (27/44 patients) in the budesonide group versus 16.7% (8/48 patients) receiving placebo (treatment difference 44.5% in favour of budesonide; 95% CI (26.9% to 62.7%), p<0.001). Health-related quality of life was maintained during the 12-month double-blind phase in budesonide-treated patients. During treatment-free follow-up, 82.1% (23/28 patients) formerly receiving budesonide relapsed after study drug discontinuation. Low-dose budesonide over 1 year resulted in few suspected adverse drug reactions (7/44 patients), all non-serious. CONCLUSIONS Budesonide at a mean dose of 4.5 mg/day maintained clinical remission for at least 1 year in the majority of patients with collagenous colitis and preserved health-related quality of life without safety concerns. Treatment extension with low-dose budesonide beyond 1 year may be beneficial given the high relapse rate after budesonide discontinuation. TRIAL REGISTRATION NUMBERS http://www.clinicaltrials.gov (NCT01278082) and http://www.clinicaltrialsregister.eu (EudraCT: 2007-001315-31).
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Affiliation(s)
- Andreas Münch
- Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Johan Bohr
- Department of Gastroenterology, Örebro University Hospital, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Cecilia Benoni
- Department of Gastroenterology, University Hospital, Malmö, Sweden
| | - Martin Olesen
- Department of Pathology, University Hospital, Malmö, Sweden
| | - Åke Öst
- Department of Pathology and Cytology, Aleris Medilab, Täby, Sweden
| | | | - Per M Hellström
- Department of Medical Sciences, Uppsala University,Uppsala, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, University Hospital, Lund, Sweden
| | | | - Jiri Stehlik
- Department of Gastroenterology, Regional Hospital, Usti nad Labem, Czech Republic
| | - Greger Lindberg
- Centre for Digestive Diseases, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Björk
- Centre for Digestive Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Annika Lapidus
- Department of Gastroenterology, Ersta Hospital, Stockholm, Sweden
| | - Robert Löfberg
- IBD Unit, Department of Gastroenterology, Sophiahemmet, Stockholm, Sweden
| | - Ole Bonderup
- Department of Gastroenterology, Regional Hospital, Silkeborg, Denmark
| | - Sören Avnström
- Department of Gastroenterology, Amager Hospital, Copenhagen, Denmark
| | - Martin Rössle
- Gastroenterology, Private Practice, Freiburg, Germany
| | | | | | | | - Curt Tysk
- Department of Gastroenterology, Örebro University Hospital, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Magnus Ström
- Division of Gastroenterology and Hepatology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Walker MM, Talley NJ, Inganäs L, Engstrand L, Jones MP, Nyhlin H, Agréus L, Kjellstrom L, Öst Å, Andreasson A. Colonic spirochetosis is associated with colonic eosinophilia and irritable bowel syndrome in a general population in Sweden. Hum Pathol 2015; 46:277-83. [DOI: 10.1016/j.humpath.2014.10.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 12/21/2022]
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Lund M, Ny L, Malmström RE, Lundberg JO, Öst Å, Björnstedt M, Lundell L, Tsai JA. Nitric oxide and endothelin-1 release after one-lung ventilation during thoracoabdominal esophagectomy. Dis Esophagus 2012; 26:853-8. [PMID: 22882570 DOI: 10.1111/j.1442-2050.2012.01388.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
One-lung ventilation (OLV) is applied during esophagectomy to improve exposure during the thoracic part of the operation. Collapse of lung tissue, shunting of pulmonary blood flow, and changes in alveolar oxygenation during and after OLV may possibly induce an ischemia-reperfusion response in the lung, which may affect the pulmonary endothelium. Such a reaction might thereby contribute to the frequently occurring respiratory complications among these patients. In this small trial, 30 patients were randomized to either OLV (n= 16) or two-lung ventilation (TLV, n= 14) during esophagectomy. Central venous and arterial plasma samples were taken before and after OLV/TLV for analysis of nitrite and a metabolite of nitric oxide (NO), and also during the 1st, 2nd, 3rd, and 10th postoperative day for analysis of endothelin, another endothelium-derived vasoactive mediator. Lung biopsies were taken before and after OLV or TLV, and analyzed regarding immunofluorescence for isoform of NO synthase, a protein upregulated during inflammatory response and also vascular congestion. No changes in lung isoform of NO synthase immunofluorescence or vascular congestion were registered after neither OLV nor TLV. Plasma nitrite and endothelin levels were similar in the two study groups. We conclude that OLV does not seem to have any influence on key regulators of pulmonary vascular tone and inflammation, i.e. NO and endothelin. From this perspective, OLV seems to be a safe method, which defends its clinical position to facilitate surgical exposure during thoracoabdominal esophagectomy.
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Affiliation(s)
- M Lund
- Division of Anaesthesia, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Division of Surgery, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Pharmacology Unit, Department of Medicine Solna, CLINTEC, Karolinska Institute, Stockholm, Sweden Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden Department of Oncology, Gothenburg University, Gothenborg, Sweden
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Söderlund S, Tribukait B, Öst Å, Broström O, Karlén P, Löfberg R, Askling J, Sjöqvist U. Colitis-associated DNA aneuploidy and dysplasia in Crohn's disease and risk of colorectal cancer. Inflamm Bowel Dis 2011; 17:1101-7. [PMID: 20853434 DOI: 10.1002/ibd.21477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Accepted: 08/03/2010] [Indexed: 12/09/2022]
Abstract
BACKGROUND There is uncertainty about how patients with Crohn's colitis should be monitored for colorectal cancer (CRC). By analogy to ulcerative colitis, regular colonoscopy with biopsies for dysplasia has been used. We describe the occurrence of dysplasia and DNA aneuploidy in a cohort of patients with Crohn's colitis. METHODS In all, 245 patients with extensive colitis (225 with a firm diagnosis of Crohn's disease, and 20 diagnosed as indeterminate colitis) at Stockholm Söder Hospital and Karolinska University Hospital, Huddinge were included. They were followed with regular colonoscopies with biopsies both for dysplasia and DNA aneuploidy. The cumulative occurrence of DNA aneuploidy and dysplasia was estimated using Kaplan-Meier curves. Time sequences and interactions between DNA aneuploidy, dysplasia, and CRC were studied using Cox regression analysis, adjusted for age, sex, and age at diagnosis. RESULTS During a median follow-up time of 9.2 person-years, DNA aneuploidy was found in 53 patients (22%), with 10 patients having multifocal aneuploidy and high S-phase values. Dysplasia was found in 42 patients (17%), 10 having multifocal dysplasia. Relative risk (RR) of dysplasia given DNA aneuploidy was 5.3 (95% confidence interval [CI] 2.3-12). RR of CRC given dysplasia was 10 (95% CI 2-50), and RR of CRC given aneuploidy was 1.5 (95% CI 0.3-9.3). CONCLUSIONS Dysplasia and DNA aneuploidy including S-phase analysis may complement stratification of patients with Crohn’s
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Affiliation(s)
- Sverre Söderlund
- Department of Medicine, Karolinska Institutet, Stockholm Söder Hospital, Stockholm, Sweden.
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Muratov V, Lundahl J, Mandic-Havelka A, Elvin K, Öst Å, Shizume Y, Furuya K, Löfberg R. Safety and tolerability of a modified filter-type device for leukocytapheresis using ACD-A as anticoagulant in patients with mild to moderately active ulcerative colitis. Results of a pilot study. J Clin Apher 2010; 25:287-93. [DOI: 10.1002/jca.20255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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von Stein P, Kouznetsov N, Gielen A, Öst Å, von Stein O, Löfberg R. P032 MULTI-GENE APPROACH TO DISCRIMINATE FOR ULCERATIVE COLITIS, CROHN'S DISEASE AND IRRITABLE BOWEL SYNDROME. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1873-9954(07)70044-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hellström-Lindberg E, Carlsson M, Carneskog J, Dahl I, Dybedal I, Grimfors G, Lindemalm C, Linder O, Löfvenberg E, Nilsson-Ehle H, Tangen J, Turesson I, Winquist I, Öberg G, Begin Y, Öst Å. Synergistic effect of G-CSF and epo on the anaemia in patients with MDS. Evidence for increased erythropoietic effectiveness rather than expansion. Leuk Res 1994. [DOI: 10.1016/0145-2126(94)90150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kimby E, Björkholm M, Gahrton G, Glimelius B, Hagberg H, Johansson B, Johansson H, Juliusson G, Järnmark M, Löfvenberg E, Killander A, Lerner R, Lindemalm C, Pettersson U, Robért KH, Simonsson B, Stalfelt AM, Sundström C, Svedmyr E, Udén AM, Wadman B, Wahlin A, Öst Å, Mellstedt H. Chlorambucil/prednisone vs. CHOP in symptomatic low-grade non-Hodgkin's lymphomas: A randomized trial from the Lymphoma Group of Central Sweden. Ann Oncol 1994. [DOI: 10.1093/annonc/5.suppl_2.s67] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hellström-Lindberg E, Negrin R, Stein R, Krantz S, Vardiman J, Öst Å, Greenberg P. Prediction of response to G-CSF and epo treatment for the anaemia of myelodysplastic syndromes (MDS). Leuk Res 1994. [DOI: 10.1016/0145-2126(94)90240-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Porwit A, Christensson B, Palucka AK, Wickman C, Petrén AL, Öst Å, Biberfeld P. Reactivity of the Endothelial Cell Marker EN4 With Malignant B-Cells in Low-Grade Malignant Lymphomas and with Subpopulations of B- and T-Cells in Blood and Reactive Lymphoid Tissue. Leuk Lymphoma 1992. [DOI: 10.3109/10428199209064899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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