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Baumeister, S. E., Schlesinger, S., Aleksandrova, K., Jochem, C., Jenab, M., Gunter, M. J., . . . Leitzmann, M. F. (2019). Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study. Journal of Hepatology, 70(5), 885-892
Open this publication in new window or tab >>Association between physical activity and risk of hepatobiliary cancers: A multinational cohort study
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2019 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 70, no 5, p. 885-892Article in journal (Refereed) Published
Abstract [en]

Background & Aims: To date, evidence on the association between physical activity and risk of hepatobiliary cancers has been inconclusive. We examined this association in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC).

Methods: We identified 275 hepatocellular carcinoma (HCC) cases, 93 intrahepatic bile duct cancers (IHBCs), and 164 non-gallbladder extrahepatic bile duct cancers (NGBCs) among 467,336 EPIC participants (median follow-up 14.9 years). We estimated cause-specific hazard ratios (HRs) for total physical activity and vigorous physical activity and performed mediation analysis and secondary analyses to assess robustness to confounding (e.g. due to hepatitis virus infection).

Results: In the EPIC cohort, the multivariable-adjusted HR of HCC was 0.55 (95% CI 0.38–0.80) comparing active and inactive individuals. Regarding vigorous physical activity, for those reporting >2 hours/week compared to those with no vigorous activity, the HR for HCC was 0.50 (95% CI 0.33–0.76). Estimates were similar in sensitivity analyses for confounding. Total and vigorous physical activity were unrelated to IHBC and NGBC. In mediation analysis, waist circumference explained about 40% and body mass index 30% of the overall association of total physical activity and HCC.

Conclusions: These findings suggest an inverse association between physical activity and risk of HCC, which is potentially mediated by obesity.

Lay summary: In a pan-European study of 467,336 men and women, we found that physical activity is associated with a reduced risk of developing liver cancers over the next decade. This risk was independent of other liver cancer risk factors, and did not vary by age, gender, smoking status, body weight, and alcohol consumption.

Keywords
Hepatobiliary cancer, Hepatocellular carcinoma, Liver cancer, Physical activity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158366 (URN)10.1016/j.jhep.2018.12.014 (DOI)000464016500012 ()30582978 (PubMedID)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved
Efe, C., Tascilar, K., Henriksson, I., Lytvyak, E., Alalkim, F., Trivedi, H., . . . Wahlin, S. (2019). Validation of Risk Scoring Systems in Ursodeoxycholic Acid-Treated Patients With Primary Biliary Cholangitis. American Journal of Gastroenterology, 114(7), 1101-1108
Open this publication in new window or tab >>Validation of Risk Scoring Systems in Ursodeoxycholic Acid-Treated Patients With Primary Biliary Cholangitis
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2019 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 114, no 7, p. 1101-1108Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-162014 (URN)10.14309/ajg.0000000000000290 (DOI)000476563000018 ()31241547 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Efe, C., Al Taii, H., Ytting, H., Aehling, N., Bhanji, R. A., Hagstrom, H., . . . Wahlin, S. (2018). Tacrolimus and Mycophenolate Mofetil as Second-Line Therapies for Pediatric Patients with Autoimmune Hepatitis. Digestive Diseases and Sciences, 63(5), 1348-1354
Open this publication in new window or tab >>Tacrolimus and Mycophenolate Mofetil as Second-Line Therapies for Pediatric Patients with Autoimmune Hepatitis
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2018 (English)In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 63, no 5, p. 1348-1354Article in journal (Refereed) Published
Abstract [en]

We studied the efficacy and safety of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy in pediatric patients with autoimmune hepatitis (AIH) who were intolerant or non-responders to standard therapy (corticosteroid and azathioprine). We performed a retrospective study of data from 13 centers in Europe, USA, and Canada. Thirty-eight patients (< 18 years old) who received second-line therapy (18 MMF and 20 tacrolimus), for a median of 72 months (range 8-182) were evaluated. Patients were categorized into two groups: Group 1 (n = 17) were intolerant to corticosteroid or azathioprine, and group 2 (n = 21) were non-responders to standard therapy. Overall complete response rates were similar in patients treated with MMF and tacrolimus (55.6 vs. 65%, p = 0.552). In group 1, MMF and tacrolimus maintained a biochemical remission in 88.9 and 87.5% of patients, respectively (p = 0.929). More patients in group 2 given tacrolimus compared to MMF had a complete response, but the difference was not statistically significant (50.0 vs. 22.2%, p = 0.195). Biochemical remission was achieved in 71.1% (27/38) of patients by tacrolimus and/or MMF. Decompensated cirrhosis was more commonly seen in MMF and/or tacrolimus non-responders than in responders (45.5 vs. 7.4%, p = 0.006). Five patients who received second-line therapy (2 MMF and 3 tacrolimus) developed side effects that led to therapy withdrawal. Long-term therapy with MMF or tacrolimus was generally well tolerated by pediatric patients with AIH. Both MMF and tacrolimus had excellent efficacy in patients intolerant to corticosteroid or azathioprine. Tacrolimus might be more effective than MMF in patients failing previous therapy.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Autoimmune hepatitis, Mycophenolate mofetil, Tacrolimus, Second-line, Cirrhosis, Pediatric, Liver transplantation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-150718 (URN)10.1007/s10620-018-5011-x (DOI)000429816400035 ()29569003 (PubMedID)2-s2.0-85044335493 (Scopus ID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2019-05-23Bibliographically approved
Stepien, M., Hughes, D. J., Hybsier, S., Bamia, C., Tjønneland, A., Overvad, K., . . . Jenab, M. (2017). Circulating copper and zinc levels and risk of hepatobiliary cancers in Europeans. British Journal of Cancer, 116(5), 688-696
Open this publication in new window or tab >>Circulating copper and zinc levels and risk of hepatobiliary cancers in Europeans
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2017 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 116, no 5, p. 688-696Article in journal (Refereed) Published
Abstract [en]

Background: Copper and zinc are essential micronutrients and cofactors of many enzymatic reactions that may be involved in liver-cancer development. We aimed to assess pre-diagnostic circulating levels of copper, zinc and their ratio (Cu/Zn) in relation to hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBD) and gall bladder and biliary tract (GBTC) cancers. Methods: A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. Serum zinc and copper levels were measured in baseline blood samples by total reflection X-ray fluorescence in cancer cases (HCC n = 106, IHDB n = 34, GBTC n = 96) and their matched controls (1: 1). The Cu/Zn ratio, an indicator of the balance between the micronutrients, was computed. Multivariable adjusted odds ratios and 95% confidence intervals (OR; 95% CI) were used to estimate cancer risk. Results: For HCC, the highest vs lowest tertile showed a strong inverse association for zinc (OR = 0.36; 95% CI: 0.13-0.98, Ptrend = 0.0123), but no association for copper (OR = 1.06; 95% CI: 0.45-2.46, Ptrend = 0.8878) in multivariable models. The calculated Cu/ Zn ratio showed a positive association for HCC (OR = 4.63; 95% CI: 1.41-15.27, Ptrend = 0.0135). For IHBC and GBTC, no significant associations were observed. Conclusions: Zinc may have a role in preventing liver-cancer development, but this finding requires further investigation in other settings.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2017
Keywords
copper, zinc, hepatocellular carcinoma, prospective cohort, nested case-control study, cancer risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-133525 (URN)10.1038/bjc.2017.1 (DOI)000395696200017 ()28152549 (PubMedID)
Available from: 2017-05-15 Created: 2017-05-15 Last updated: 2018-06-09Bibliographically approved
Efe, C., Hagström, H., Ytting, H., Bhanji, R. A., Müller, N. F., Wang, Q., . . . Wahlin, S. (2017). Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis. Clinical Gastroenterology and Hepatology, 15(12), 1950-1956
Open this publication in new window or tab >>Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy for Patients With Autoimmune Hepatitis
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2017 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 15, no 12, p. 1950-1956Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Predniso(lo) ne, alone or in combination with azathioprine, is the standard-of-care (SOC) therapy for autoimmune hepatitis (AIH). However, the SOC therapy is poorly tolerated or does not control disease activity in up to 20% of patients. We assessed the efficacy of mycophenolate mofetil (MMF) and tacrolimus as second-line therapy for patients with AIH. METHODS: We performed a retrospective study of data (from 19 centers in Europe, the United States, Canada, and China) from 201 patients with AIH who received second-line therapy (121 received MMF and 80 received tacrolimus), for a median of 62 months (range, 6-190 mo). Patients were categorized according to their response to SOC. Patients in group 1 (n = 108) had a complete response to the SOC, but were switched to second-line therapy as a result of side effects of predniso(lo) ne or azathioprine, whereas patients in group 2 (n = 93) had not responded to SOC. RESULTS: There was no significant difference in the proportion of patients with a complete response to MMF (69.4%) vs tacrolimus (72.5%) (P = .639). In group 1, MMF and tacrolimus maintained a biochemical remission in 91.9% and 94.1% of patients, respectively (P = .682). Significantly more group 2 patients given tacrolimus compared with MMF had a complete response (56.5% vs 34%, respectively; P = .029) There were similar proportions of liver-related deaths or liver transplantation among patients given MMF (13.2%) vs tacrolimus (10.3%) (log-rank, P = .472). Ten patients receiving MMF (8.3%) and 10 patients receiving tacrolimus (12.5%) developed side effects that required therapy withdrawal. CONCLUSIONS: Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Autoimmune Liver Disease, Simplified Criteria, Liver Failure, Liver Transplantation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-142448 (URN)10.1016/j.cgh.2017.06.001 (DOI)000415165200027 ()28603052 (PubMedID)
Available from: 2017-12-05 Created: 2017-12-05 Last updated: 2018-06-09Bibliographically approved
Danielsson Borssén, Å., Marschall, H.-U., Bergquist, A., Rorsman, F., Weiland, O., Kechagias, S., . . . Werner, M. (2017). Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis. Scandinavian Journal of Gastroenterology, 52(9), 1022-1028
Open this publication in new window or tab >>Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 9, p. 1022-1028Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.

Objective To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort.

Material and methods: Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Vasterbotten in Northern Sweden.

Results: AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<.001) and died younger than women (p=.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.

Conclusions: Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.

Keywords
Autoimmune hepatitis, epidemiology, causes of death, liver, cirrhosis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137902 (URN)10.1080/00365521.2017.1335772 (DOI)000404368000016 ()28562110 (PubMedID)
Available from: 2017-07-26 Created: 2017-07-26 Last updated: 2018-06-09Bibliographically approved
Fedirko, V., Tran, H. Q., Gewirtz, A. T., Stepien, M., Trichopoulou, A., Aleksandrova, K., . . . Jenab, M. (2017). Exposure to bacterial products lipopolysaccharide and flagellin and hepatocellular carcinoma: a nested case-control study. BMC Medicine, 72(15)
Open this publication in new window or tab >>Exposure to bacterial products lipopolysaccharide and flagellin and hepatocellular carcinoma: a nested case-control study
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2017 (English)In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 72, no 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Leakage of bacterial products across the gut barrier may play a role in liver diseases which often precede the development of liver cancer. However, human studies, particularly from prospective settings, are lacking.

METHODS: We used a case-control study design nested within a large prospective cohort to assess the association between circulating levels of anti-lipopolysaccharide (LPS) and anti-flagellin immunoglobulin A (IgA) and G (IgG) (reflecting long-term exposures to LPS and flagellin, respectively) and risk of hepatocellular carcinoma. A total of 139 men and women diagnosed with hepatocellular carcinoma between 1992 and 2010 were matched to 139 control subjects. Multivariable rate ratios (RRs), including adjustment for potential confounders, hepatitis B/C positivity, and degree of liver dysfunction, were calculated with conditional logistic regression.

RESULTS:  = 0.021). This finding did not vary substantially by time from enrollment to diagnosis, and did not change after adjustment for chronic infection with hepatitis B and C viruses.

CONCLUSIONS: These novel findings, based on exposures up to several years prior to diagnosis, support a role for gut-derived bacterial products in hepatocellular carcinoma development. Further study into the role of gut barrier failure and exposure to bacterial products in liver diseases is warranted.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Endotoxins, Flagellin, Hepatocellular carcinoma, Lipopolysaccharide, Prospective studies
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-146516 (URN)10.1186/s12916-017-0830-8 (DOI)000398034900001 ()28372583 (PubMedID)
Funder
Swedish Cancer SocietyRegion SkåneVästerbotten County Council
Available from: 2018-04-11 Created: 2018-04-11 Last updated: 2018-10-16Bibliographically approved
Danielsson Borssén, Å., Palmqvist, R., Kechagias, S., Marschall, H.-U., Bergquist, A., Rorsman, F., . . . Werner, M. (2017). Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: a cohort study. Medicine (Baltimore, Md.), 96(34), Article ID e7708.
Open this publication in new window or tab >>Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis: a cohort study
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 34, article id e7708Article in journal (Refereed) Published
Abstract [en]

Objectives Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis.

Methods Two hundred fifty-eight liver biopsies from 101 patients (72 women, 29 men) were analysed by a single pathologist and classified accordingly to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased or stable), and groups were compared.

Results Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only five patients at the last biopsy.

Conclusions Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

Keywords
autoimmune hepatitis, autoimmune liver disease, cirrhosis, fibrosis, inflammation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-134616 (URN)10.1097/MD.0000000000007708 (DOI)000408504800012 ()
Note

Originally included in thesis in manuscript form 

Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2019-05-10Bibliographically approved
Alaish, R., Lundgren, D., Suhr, O. B., Werner, M. & Karling, P. (2017). Safety of azathioprine and 6-mercaptopurine in patients with inflammatory bowel disease naive to thiopurine treatment. International journal of clinical pharmacology and therapeutics, 55(7), 594-600
Open this publication in new window or tab >>Safety of azathioprine and 6-mercaptopurine in patients with inflammatory bowel disease naive to thiopurine treatment
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2017 (English)In: International journal of clinical pharmacology and therapeutics, ISSN 0946-1965, Vol. 55, no 7, p. 594-600Article in journal (Refereed) Published
Abstract [en]

Objectives: To determine if 6-mercaptopurine (MP) is better tolerated than azathioprine (AZA) as the initial thiopurine treatment in patients suffering from inflammatory bowel disease (IBD). Switching patients with IBD from AZA to MP is advocated in patients intolerant to AZA. However, no study has determined if MP is more suited than AZA as a first-line treatment for patients who are naive to thiopurine treatment. Study: The tolerance of AZA and MP treatments in clinical practice was retrospectively evaluated from start to 12 months after initiating treatment in 113 patients with IBD who were all naive to thiopurines (82 patients treated with AZA and 31 patients with MP). Results: 65% of the patients treated with AZA and 61% of the patients treated with MP tolerated their treatment during 12 months (i.e., no group difference, p = 0.742). No difference in reported side effects between the two treatments was observed. The mean equivalent initial dose (0.92 vs. 0.61 mg/kg; p < 0.001) and the mean equivalent dose at 12 months (1.98 vs. 1.65 mg/kg; p = 0.014) was significantly higher in the MP group vs. the AZA group. The proportion of patients with.MCV = 7 at 12 months was numerically higher in the MP group than in the AZA group (53% vs. 31%; p = 0.090). Conclusions: In this retrospective observational study, no differences in tolerance or adherence between AZA and MP were observed in patients naive to thiopurines. However, MP treatment was at a higher equivalent thiopurine dose than AZA treatment, which tended to be associated with better treatment response.

Place, publisher, year, edition, pages
DUSTRI-VERLAG DR KARL FEISTLE, 2017
Keywords
azathioprine, Crohn's disease, inflammatory bowel disease, mercaptopurine, ulcerative colitis
National Category
Gastroenterology and Hepatology Rheumatology and Autoimmunity Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:umu:diva-137974 (URN)10.5414/CP202962 (DOI)000404885900007 ()28406092 (PubMedID)
Available from: 2017-08-02 Created: 2017-08-02 Last updated: 2018-06-09Bibliographically approved
Ibrahim, A., Dahlqvist, P., Olsson, T., Lundgren, D., Werner, M., Suhr, O. B. & Karling, P. (2017). The clinical course after glucocorticoid treatment in patients with inflammatory bowel disease is linked to suppression of the hypothalamic-pituitary-adrenal axis: a retrospective observational study. Therapeutic Advances in Gastroenterology, 10(11), 829-836
Open this publication in new window or tab >>The clinical course after glucocorticoid treatment in patients with inflammatory bowel disease is linked to suppression of the hypothalamic-pituitary-adrenal axis: a retrospective observational study
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2017 (English)In: Therapeutic Advances in Gastroenterology, ISSN 1756-283X, E-ISSN 1756-2848, Vol. 10, no 11, p. 829-836Article in journal (Refereed) Published
Abstract [en]

Background: Adrenal insufficiency (AI) secondary to treatment with glucocorticoids (GCs) is common in patients with inflammatory bowel disease (IBD), but little is known about the relationship between AI and the clinical course in IBD. The aim of the study was to compare the clinical course in IBD patients with normal adrenal function versus patients with subnormal adrenal function.

Methods: A retrospective observational study on 63 patients with IBD who had performed a low-dose short Synacthen test (LDSST) (1 μg) immediately (1-7 days) after a standard course of GCs. A subnormal LDSST was defined as serum cortisol <550 nmol/L. Outcomes were time to next flare and fecal calprotectin levels.

Results: Sixty-three percent (n = 40) of the IBD patients had a subnormal LDSST. Patients who were steroid-free (n = 41) after the LDSST were observed for 3 years. Patients with a peak serum cortisol <400 nmol/L immediately after GC treatment had significantly longer time until the next flare-up of their IBD and tended to use a lower cumulative prednisolone dose during the study period in comparison to the other subgroups. Fecal calprotectin levels were significantly lower in patients with a peak s-cortisol <550 nmol/L versus patients with peak s-cortisol ⩾550 nmol/L (median 336 µg/g (IQR 521) versus 955 µg/g (IQR 1867); p = 0.012).

Conclusions: GC-induced AI is common in patients with IBD and is associated with lower disease activity. This suggests a link between responsiveness to GC treatment and suppression of the hypothalamic-pituitary-adrenal axis in IBD.

Place, publisher, year, edition, pages
London: Sage Publications, 2017
Keywords
Crohn’s disease, adrenal insufficiency, clinical pharmacology, immunosuppression, inflammatory bowel disease, ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:umu:diva-142067 (URN)10.1177/1756283X17730748 (DOI)000414470200002 ()29147134 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-06-09Bibliographically approved
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