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Sandström, Olof
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Publications (10 of 33) Show all publications
Myléus, A., Stenhammar, L., Högberg, L., Browaldh, L., Daniels, I.-M., Fagerberg, U. L., . . . Ivarsson, A. (2019). Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease. Acta Paediatrica, 108(6), 1140-1143
Open this publication in new window or tab >>Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease
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2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 6, p. 1140-1143Article in journal (Refereed) Published
Abstract [en]

Aim: In 2012, revised criteria for diagnosing childhood coeliac disease were published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and incorporated into the revised Swedish guidelines the same year. These made it possible, in certain cases, to diagnose coeliac disease without taking small bowel biopsies. This survey assessed the extent to which the new guidelines were implemented by Swedish paediatric clinics two years after their introduction.

Methods: In October 2014, we distributed a paper questionnaire including five questions on diagnostic routines to the 40 paediatric clinics in university or regional hospitals in Sweden that perform small bowel biopsies.

Results: All 36 (90%) clinics that responded used anti-tissue transglutaminase antibodies as the initial diagnostic test and some also used serological markers. Most clinics (81%) used endoscopy and took multiple duodenal biopsies, whereas only a few (19%) occasionally employed a suction capsule. Almost all clinics (86%) omitted taking small bowel biopsies in symptomatic children with repeatedly high coeliac serology and positive genotyping, thereby avoiding the need for invasive endoscopy under anaesthesia.

Conclusion: The 2012 Swedish Paediatric Coeliac Disease Diagnostic Guidelines had been widely accepted and implemented in routine health care two years after their introduction.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Coeliac disease, Diagnosis, Guidelines, Small bowel biopsies, Survey
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-154663 (URN)10.1111/apa.14669 (DOI)000467867900026 ()30496613 (PubMedID)2-s2.0-85058447406 (Scopus ID)
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-06-19Bibliographically approved
Pietz, G., De, R., Hedberg, M., Sjöberg, V., Sandström, O., Hernell, O., . . . Hammarström, M.-L. (2017). Immunopathology of childhood celiac disease: Key role of intestinal epithelial cells. PLoS ONE, 12(9), Article ID e0185025.
Open this publication in new window or tab >>Immunopathology of childhood celiac disease: Key role of intestinal epithelial cells
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 9, article id e0185025Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Celiac disease is a chronic inflammatory disease of the small intestine mucosa due to permanent intolerance to dietary gluten. The aim was to elucidate the role of small intestinal epithelial cells in the immunopathology of celiac disease in particular the influence of celiac disease-associated bacteria.

METHODS: Duodenal biopsies were collected from children with active celiac disease, treated celiac disease, and clinical controls. Intestinal epithelial cells were purified and analyzed for gene expression changes at the mRNA and protein levels. Two in vitro models for human intestinal epithelium, small intestinal enteroids and polarized tight monolayers, were utilized to assess how interferon-γ, interleukin-17A, celiac disease-associated bacteria and gluten influence intestinal epithelial cells.

RESULTS: More than 25 defense-related genes, including IRF1, SPINK4, ITLN1, OAS2, CIITA, HLA-DMB, HLA-DOB, PSMB9, TAP1, BTN3A1, and CX3CL1, were significantly upregulated in intestinal epithelial cells at active celiac disease. Of these genes, 70% were upregulated by interferon-γ via the IRF1 pathway. Most interestingly, IRF1 was also upregulated by celiac disease-associated bacteria. The NLRP6/8 inflammasome yielding CASP1 and biologically active interleukin-18, which induces interferon-γ in intraepithelial lymphocytes, was expressed in intestinal epithelial cells.

CONCLUSION: A key factor in the epithelial reaction in celiac disease appears to be over-expression of IRF1 that could be inherent and/or due to presence of undesirable microbes that act directly on IRF1. Dual activation of IRF1 and IRF1-regulated genes, both directly and via the interleukin-18 dependent inflammasome would drastically enhance the inflammatory response and lead to the pathological situation seen in active celiac disease.

National Category
Immunology
Identifiers
urn:nbn:se:umu:diva-139860 (URN)10.1371/journal.pone.0185025 (DOI)000411339900076 ()28934294 (PubMedID)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2018-06-09Bibliographically approved
Namatovu, F., Olsson, C., Lindkvist, M., Myléus, A., Högberg, U., Ivarsson, A. & Sandström, O. (2016). Maternal and perinatal conditions and the risk of developing celiac disease during childhood.. BMC Pediatrics, 16, Article ID 77.
Open this publication in new window or tab >>Maternal and perinatal conditions and the risk of developing celiac disease during childhood.
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2016 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, article id 77Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood.

METHODS: Using Sweden's national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period.

RESULTS: Regardless of sex, a reduction in CD risk was observed in children born to mothers aged ≥35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7-0.9) and with high maternal income (OR 0.9; 95 % CI 0.8-0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0-1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2-0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0-1.2).

CONCLUSIONS: Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-122411 (URN)10.1186/s12887-016-0613-y (DOI)000377535900001 ()27267234 (PubMedID)
Available from: 2016-06-17 Created: 2016-06-17 Last updated: 2019-06-05Bibliographically approved
Namatovu, F., Lindkvist, M., Olsson, C., Ivarsson, A. & Sandström, O. (2016). Maternal and perinatal conditions and the risk of developing celiac disease during childhood. BMC Pediatrics
Open this publication in new window or tab >>Maternal and perinatal conditions and the risk of developing celiac disease during childhood
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2016 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110044 (URN)DOI 10.1186/s12887-016-0613-y (DOI)
Available from: 2015-10-14 Created: 2015-10-14 Last updated: 2019-12-05
Sandström, O., Rosén, A. & Ivarsson, A. (2016). Role of HLA-DQ Genotyping in Celiac Disease [Letter to the editor]. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 62(3), E30-E31
Open this publication in new window or tab >>Role of HLA-DQ Genotyping in Celiac Disease
2016 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. E30-E31Article in journal, Letter (Refereed) Published
Keywords
Celiac Disease, Mass Screening
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118786 (URN)000371308000003 ()
Available from: 2016-04-22 Created: 2016-04-04 Last updated: 2018-06-07Bibliographically approved
Sandström, O., Rosén, A. & Ivarsson, A. (2016). Role of HLA-DQ Genotyping in Celiac Disease [Letter to the editor]. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 62(3), E30-E31
Open this publication in new window or tab >>Role of HLA-DQ Genotyping in Celiac Disease
2016 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. E30-E31Article in journal, Letter (Refereed) Published
Keywords
pediatrics
National Category
Pediatrics Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-118790 (URN)10.1097/MPG.0000000000001037 (DOI)000371308000003 ()26594829 (PubMedID)
Available from: 2016-04-11 Created: 2016-04-04 Last updated: 2018-06-07Bibliographically approved
Namatovu, F., Lindkvist, M., Olsson, C., Ivarsson, A. & Sandström, O. (2016). Season and region as risk factors for celiac disease: a key to the etiology?. Archives of Disease in Childhood
Open this publication in new window or tab >>Season and region as risk factors for celiac disease: a key to the etiology?
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2016 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044Article in journal (Refereed) Published
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110045 (URN)DOI:10.1136/archdischild-2015-310122 (DOI)
Available from: 2015-10-14 Created: 2015-10-14 Last updated: 2019-12-05
Namatovu, F., Lindkvist, M., Olsson, C., Ivarsson, A. & Sandström, O. (2016). Season and region of birth as risk factors for coeliac disease a key to the aetiology?. Archives of Disease in Childhood, 101(12), 1114-1118
Open this publication in new window or tab >>Season and region of birth as risk factors for coeliac disease a key to the aetiology?
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2016 (English)In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 101, no 12, p. 1114-1118Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.

METHODS: A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0-14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.

RESULTS: Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2-14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991-1996 had increased CD risk if born during spring, for the 1997-2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003-2009 the risk was increased if born during autumn.

CONCLUSIONS: Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gastroenterology and Hepatology Pediatrics
Identifiers
urn:nbn:se:umu:diva-124646 (URN)10.1136/archdischild-2015-310122 (DOI)000388822900011 ()27528621 (PubMedID)
Available from: 2016-08-19 Created: 2016-08-19 Last updated: 2018-06-07Bibliographically approved
Webb, C., Norström, F., Myléus, A., Ivarsson, A., Halvarsson, B., Högberg, L., . . . Carlsson, A. (2015). Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 60(6), 787-791
Open this publication in new window or tab >>Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening
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2015 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 6, p. 787-791Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate any potential correlation between anti-tissue transglutaminase antibodies of type immunoglobulin A (tTG-IgA) and the degree of gluten induced enteropathy in children participating in a screening study for celiac disease (CD) and to assess to what extent the revised ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) guidelines cover this group of patients.

METHODS: This is a sub-study of a cross-sectional CD screening study, ETICS (Exploring the Iceberg of Celiacs in Sweden), a two-phased study performed during 2005-2006 and 2009-2010. The 13,279 participating children had a blood test obtained and those with positive tTG-IgA were recommended a small intestinal biopsy. The tTG-IgA levels at the time of biopsy were compared with the assessment of the biopsy.

RESULTS: There were 267 children included, of whom 230 were diagnosed with CD. Out of all children, 67 children had low tTG-IgA levels (<5 U/mL), whereof 55% had Marsh 3 lesions. All children with tTG-IgA levels exceeding 10 times the upper limit of normal values of 5 U/mL, i.e. 50 U/mL, were diagnosed with CD. Lowering the cut-off to 3 U/mL, all but one child with 30 U/mL got CD diagnosis.

CONCLUSION: By adapting the revised ESPGHAN criteria, biopsies could have been omitted in a fourth of all cases. Our results indicate, that the criteria might be useful even on screened children. Further studies are needed to confirm whether the 2012 ESPGHAN guidelines should be revised to also apply to the populations being screened.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Keywords
celiac disease, diagnosis, enteropathy, screening, serological markers
National Category
Gastroenterology and Hepatology Pediatrics Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-97984 (URN)10.1097/MPG.0000000000000688 (DOI)000355242100016 ()25564816 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-12 Last updated: 2018-06-07Bibliographically approved
Webb, C., Myléus, A., Norström, F., Hammarroth, S., Högberg, L., Lagerqvist, C., . . . Carlsson, A. (2015). High adherence to a gluten-free diet in adolescents with screening-detected celiac disease. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 60(1), 54-59
Open this publication in new window or tab >>High adherence to a gluten-free diet in adolescents with screening-detected celiac disease
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2015 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 1, p. 54-59Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the gluten-free diet (GFD) adherenceafter one year of follow-up in children with screening-detected celiac disease (CD) in a general population. METHODS: A total of 18,325 12 year olds were invited to participate in apopulation-based CD screening (ETICS- Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This sub-study included the 210 children with TG2-IgAevaluated both at the initialbiopsy occasion and at the one-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193). RESULTS: After one year, 83% (179/210) had normalizedTG2-IgA levels (<5U/mL). Among those who had >50 U/mL at diagnosis,25% (16/63) still had elevated TG2-IgA but for the majority their initial values were more than halved. Most reported a high level ofGFD adherence ('always' 75%(158/193) and 'often' 14%(30/193)), and 75% (145/193) reported always adhereingcombined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely, however, a majority of these initially had the highestTG2-IgA levels. CONCLUSIONS: GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12yearolds. Almost all had normalized serology and reported GFD adherenceat the one-year follow-up. However, a few adolescents whoreported GFD adherence still had elevated TG2-IgA levelssuggesting more severe disease and/or non-adherence.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Keywords
adolescents, anti-tissue transglutaminase antibodies, celiac disease, gluten-free diet, screening
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology Gastroenterology and Hepatology Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-93535 (URN)10.1097/MPG.0000000000000571 (DOI)000348460100017 ()25238121 (PubMedID)
Available from: 2014-09-24 Created: 2014-09-24 Last updated: 2018-06-07Bibliographically approved
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