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Stenhammar, Lars
Publications (10 of 65) Show all publications
Tjellstrom, B., Högberg, L., Stenhammar, L., Magnusson, K.-E., Midtvedt, T., Norin, E. & Sundqvist, T. (2016). Letter: A Role for Bacteria in Celiac Disease? in DIGESTIVE DISEASES AND SCIENCES, vol 61, issue 7, pp 2140-2140 [Letter to the editor]. Digestive Diseases and Sciences, 61(7), 2140-2140
Open this publication in new window or tab >>Letter: A Role for Bacteria in Celiac Disease? in DIGESTIVE DISEASES AND SCIENCES, vol 61, issue 7, pp 2140-2140
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2016 (English)In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 61, no 7, p. 2140-2140Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
SPRINGER, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-130728 (URN)10.1007/s10620-016-4131-4 (DOI)000379013300046 ()27017223 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2017-11-28
Tapsas, D., Hollén, E., Stenhammar, L. & Fälth-Magnusson, K. (2016). The clinical presentation of celiac disease in 1030 Swedish children: changing features over the past 41 years: a long-term follow-up study. Digestive and Liver Disease, 48(1), 16-22
Open this publication in new window or tab >>The clinical presentation of celiac disease in 1030 Swedish children: changing features over the past 41 years: a long-term follow-up study
2016 (English)In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 48, no 1, p. 16-22Article in journal (Refereed) Published
Abstract [en]

Background- Aims

The features of pediatric celiac disease have changed in recent decades. We hypothesized that the age at diagnosis continued to increase, whereas the severity of symptoms should decrease.

Methods

In the present study, filed data about 1030 pediatric patients diagnosed with celiac disease between 1973 and 2013 were analysed. Available information covered 99.8% of the small bowel biopsies, and included information on sex, age, and clinical symptoms.

Results

The age at diagnosis increased significantly, from a mean of 2.2 years during the first 10 years to 8.2 years the current years. The proportion of children with severe symptoms declined from 92.8% to 78%, as did the proportion of biopsies characterized by severe pathology. In recent years, the monosymptomatic form of celiac disease has been more common, and the number of patients detected at screening has increased. The frequency of patients with gastrointestinal symptoms, extra-intestinal symptoms, and failure to thrive and/or short stature at presentation decreased.

Conclusions

The mean age of newly diagnosed patients increased the last 15 years. Currently celiac disease shows a less severe picture in terms of symptoms and intestinal pathology. Younger children suffer primarily from gastrointestinal symptoms and growth failure, and adolescents from extra-intestinal manifestations.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Clinical Medicine Microbiology in the medical area
Identifiers
urn:nbn:se:liu:diva-122369 (URN)10.1016/j.dld.2015.09.018 (DOI)000368761300004 ()
Note

Funding agencies: Medical Research Council of Southeast Sweden; County Council of Ostergotland; Swedish Research Council

Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2018-01-10Bibliographically approved
Webb, C., Norstrom, F., Myleus, T., 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: The aim of the present study was 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 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines cover this group of patients. Methods: The present study is a substudy of a cross-sectional CD screening study, Exploring the Iceberg of Celiacs in Sweden, a2-phased study performed during 2005 to 2006 and 2009 to 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 those at the assessment of the biopsy. Results: There were 267 children included, of whom 230 were diagnosed as having CD. Of all of the children, 67 children had low tTG-IgA levels (<5 U/mL), of whom 55% had Marsh 3 lesions. All of the children with tTG-IgA levels exceeding 10 times the upper limit of normal values of 5 U/mL, that is, 50 U/mL, were diagnosed as having CD. Lowering the cutoff to 3 U/mL, all but 1 child with 30 U/mL got CD diagnosis. Conclusions: By adopting the revised ESPGHAN criteria, biopsies could have been omitted in one-fourth of all of the patients. Our results indicate that the criteria may be useful even in screened children. Further studies are needed to confirm whether the 2012 ESPGHAN guidelines should be revised to also apply to the populations being screened.

Keywords
celiac disease; diagnosis; enteropathy; screening; serological markers
National Category
Gastroenterology and Hepatology Pediatrics
Identifiers
urn:nbn:se:liu:diva-126337 (URN)10.1097/MPG.0000000000000688 (DOI)000355242100016 ()25564816 (PubMedID)
Available from: 2016-03-22 Created: 2016-03-22 Last updated: 2017-11-30
Webb, C., Myleus, A., Norstrom, 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:The aim of the study was to evaluate the gluten-free diet (GFD) adherence after 1 year of follow-up in children with screening-detected celiac disease (CD) in a general population.Methods:A total of 18,325 twelve-year-olds were invited to participate in a population-based CD screening (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 substudy included 210 children with TG2-IgA, evaluated both at the initial biopsy occasion and at 1-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n=193).Results:After 1 year, 85% (179/210) had normalized TG2-IgA levels (less than5 U/mL). Among those who had greater than50 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 of GFD adherence (always 82% [158/193] and often 16% [30/193]), and 75% [145/193] reported always adhering combined 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 highest TG2-IgA levels.Conclusions:GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12-year-olds. Almost all of them had normalized serology and reported GFD adherence at the 1-year follow-up. A few adolescents who reported GFD adherence, however, had elevated TG2-IgA levels, suggesting more severe disease and/or nonadherence.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins, 2015
Keywords
adolescents; anti-tissue transglutaminase antibodies; celiac disease; gluten-free diet; screening
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-114593 (URN)10.1097/MPG.0000000000000571 (DOI)000348460100017 ()25238121 (PubMedID)
Note

Funding Agencies|FORTE, the Swedish Research Council for Health, Working Life and Welfare; European Union [FP6-2005-FOOD-4B-36383-PREVENTCD]; Swedish Research Council [521-2004-7093, 521-2007-2953]; Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning [222-2004-1918, 222-2007-1394]; Swedish Council for Working Life and Social Research [2005-0802]

Available from: 2015-02-27 Created: 2015-02-26 Last updated: 2017-12-04
Tjellström, B., Stenhammar, L., Magnusson, K.-E., Midtvedt, T., Norin, E., Sundqvist, T. & Högberg, L. (2015). Letter: Exclusive Enteral Nutrition Does Not Normalize Gut Microflora Function in Pediatric Perianal Crohn Disease in JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, vol 61, issue 1, pp E4-E4 [Letter to the editor]. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 61(1), E4-E4
Open this publication in new window or tab >>Letter: Exclusive Enteral Nutrition Does Not Normalize Gut Microflora Function in Pediatric Perianal Crohn Disease in JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, vol 61, issue 1, pp E4-E4
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2015 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 61, no 1, p. E4-E4Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120654 (URN)10.1097/MPG.0000000000000831 (DOI)000358168800001 ()25905542 (PubMedID)
Available from: 2015-08-20 Created: 2015-08-20 Last updated: 2017-12-04
Tapsas, D., Hollén, E., Stenhammar, L. & Fälth-Magnusson, K. (2015). Unusually High Incidence of Paediatric Coeliac Disease in Sweden during the Period 1973 – 2013: a long-term follow-up study. PLoS ONE, 10(12)
Open this publication in new window or tab >>Unusually High Incidence of Paediatric Coeliac Disease in Sweden during the Period 1973 – 2013: a long-term follow-up study
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12Article in journal (Refereed) Published
Abstract [en]

Objective

The prevalence of coeliac disease in Sweden during the “epidemic period” (1984−1996) was one of the highest in the world. The aim of this study was to assess the coeliac disease incidence in our region over the 41-year period, and how diagnostic activity and diagnostic accuracy were affected by the introduction of antibody testing. We also looked into how patients with mild enteropathy were evaluated.

Methods

In the county of Östergötland in Sweden, 2790 paediatric patients were investigated for suspected coeliac disease between 1973 and 2013. Notes were scrutinised for data on sex, age, histopathological reports and final diagnosis. For comparative purposes this period was divided into three sub-periods (1973−1983, 1984−1996 and 1997−2013) named pre-epidemic, epidemic and post-epidemic.

Results

Coeliac disease diagnosis was received by 1,030 patients. The peak incidence rate, 301 cases/100,000 in 1994 for the age group 0−1.9 years is the highest figure ever reported. The other age groups, 2−4.9, 5−14.9, and 15−17.9 years, also had high incidence rates. After the 1984−1996 “epidemic period” the incidence decreased for the youngest group but continued to increase for the other groups. The cumulative incidence at 18 years-of-age for children born 1994 reached 14 cases/1000 births, the highest figure hitherto reported. Diagnostic activity differed significantly between the three sub-periods (p<0.001) increasing gradually from 1984 and reaching a peak value of 0.87 in 2012. Cases of mild enteropathy were more frequently regarded as non-coeliac disease cases, decreasing significantly in the “postepidemic” period (p<0.001).

Conclusions

The incidence rate and cumulative incidence of coeliac disease among children were possibly the highest ever reported. Changes in diagnostic activity and accuracy could not be attributed to the introduction of new antibody tests, possibly because of other changes e.g. variations in the symptoms at presentation and improved knowledge of the disease among parents and health professionals.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2015
National Category
Clinical Medicine Microbiology in the medical area
Identifiers
urn:nbn:se:liu:diva-122370 (URN)10.1371/journal.pone.0144346 (DOI)000366903600037 ()
Note

Funding agencies: Medical Research Council of Southeast Sweden; County Council of Ostergotland; Swedish Research Council

Vid tidpunkten för disputation förelåg publikation som manuskript

Available from: 2015-10-30 Created: 2015-10-30 Last updated: 2018-01-10Bibliographically approved
Browaldh, L., Sandstrom, O., Agardh, D., Stenhammar, L. & Ivarsson, A. (2014). Celiaki är en vanlig sjukdom som är lätt att missa. Läkartidningen (11), 484-488
Open this publication in new window or tab >>Celiaki är en vanlig sjukdom som är lätt att missa
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2014 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 11, p. 484-488Article in journal (Other academic) Published
Abstract [sv]

Celiaki ansågs länge som en ovanlig barnsjukdom, men är en vanlig sjukdom som drabbar alla åldrar.

Genomförda screeningar av normalbefolkningen visar att merparten inte fått dia­gnos eller behandling.

Den kliniska bilden varierar: alltifrån diffusa besvär eller inga symtom alls till allvarliga gastrointestinala symtom med grav avmagring och tillväxtrubbning till följd av malabsorption.

Klinisk misstanke om eller hereditet för celiaki bör föranleda analys av specifika serologiska markörer. Gastroskopi med tunntarmsbiopsi bör övervägas för att bekräfta eller utesluta diagnosen.

Place, publisher, year, edition, pages
Swedish Medical Association, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117086 (URN)2-s2.0-84898053881 (Scopus ID)
Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2017-12-04
Stenhammar, L., Högberg, L., Ivarsson, A., Laurin, P., Myléus, A. & Fälth-Magnusson, K. (2014). Letter: Coeliac disease and socio-economic status [Letter to the editor]. Acta Paediatrica, 103(8), e328
Open this publication in new window or tab >>Letter: Coeliac disease and socio-economic status
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 8, p. e328-Article in journal, Letter (Refereed) Published
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-116359 (URN)10.1111/apa.12665 (DOI)24766430 (PubMedID)
Available from: 2015-03-26 Created: 2015-03-26 Last updated: 2017-12-04
Tjellstrom, B., Stenhammar, L., Sundqvist, T., Fälth-Magnusson, K., Hollén, E., Magnusson, K.-E., . . . Högberg, L. (2014). The effects of oats on the function of gut microflora in children with coeliac disease. Alimentary Pharmacology and Therapeutics, 39(10), 1156-1160
Open this publication in new window or tab >>The effects of oats on the function of gut microflora in children with coeliac disease
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2014 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, no 10, p. 1156-1160Article in journal (Refereed) Published
Abstract [en]

Background Faecal short chain fatty acids (SCFAs) are produced by the gut microflora. We have previously reported high faecal SCFA levels in children with coeliac disease (CD), indicating alteration in gut microfloral metabolism. Data accumulated over recent decades by us and others suggest that wheat-free oats can safely be included in a gluten-free diet (GFD). However, concerns have been raised with respect to the safety of oats in a subset of coeliacs. Aim To describe faecal SCFA patterns in children with newly diagnosed CD treated for 1year with a GFD with or without oats. Methods This report is part of a randomised, double-blind study on the effect of a GFD containing oats (GFD-oats) vs. a standard GFD (GFD-std). Faecal samples were received from 34 children in the GFD-oats group and 37 in the GFD-std group at initial diagnosis and/or after 1year on a GFD. Faecal SCFAs were analysed. Results The GFD-std group had a significantly lower total faecal SCFA concentration at 12months compared with 0months (Pless than0.05). In contrast, total SCFA in the GFD-oats group remained high after 1year on the GFD. The children in the GFD-oats group had significantly higher acetic acid (Pless than0.05), n-butyric acid (Pless than0.05) and total SCFA concentration (Pless than0.01) after 1-year diet treatment compared to the GFD-std group. Conclusions Our results indicate that oats do affect the gut microflora function, and that some coeliac children receiving oats may develop gut mucosal inflammation, that may present a risk for future complications.

Place, publisher, year, edition, pages
Wiley, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-106829 (URN)10.1111/apt.12707 (DOI)000334304200013 ()
Available from: 2014-05-28 Created: 2014-05-23 Last updated: 2017-12-05
Tjellström, B., Högberg, L., Stenhammar, L., Fälth-Magnusson, K., Magnusson, K.-E., Norin, E., . . . Midtvedt, T. (2013). Faecal short-chain fatty acid pattern in childhood coeliac disease is normalised after more than one year's gluten-free diet. Microbiological Ecology in Health and Disease, 24
Open this publication in new window or tab >>Faecal short-chain fatty acid pattern in childhood coeliac disease is normalised after more than one year's gluten-free diet
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2013 (English)In: Microbiological Ecology in Health and Disease, ISSN 0891-060X, E-ISSN 1651-2235, Vol. 24Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Recent work indicates that the gut microflora is altered in patients with coeliac disease (CD). Faecal short-chain fatty acids (SCFAs) are produced by the gut microflora. We have previously reported a high SCFA output in children with symptomatic and asymptomatic CD at presentation, as well as in CD children on a gluten-free diet (GFD) for less than 1 year, indicating deviant gut microfloral function. In this report, we focus on faecal SCFA production in coeliacs on GFD for more than 1 year.

MATERIALS AND METHODS: Faecal samples were collected from 53 children with CD at presentation, 74 coeliac children on GFD for less than 1 year, and 25 individuals diagnosed with CD in childhood and on GFD for more than 1 year. The control group comprised 54 healthy children (HC). The faecal samples were analysed to show the SCFA pattern taken as a marker of gut microflora function. We applied a new fermentation index, reflecting the inflammatory activity of the SCFAs (amount of acetic acid minus propionic acid and n-butyric acid, together divided by the total amount of SCFAs).

RESULTS: In coeliacs on GFD for more than 1 year, the individual SCFAs, total SCFA, and fermentation index did not differ significantly from the findings in controls. In contrast, the faecal SCFA level was clearly higher in coeliacs treated with GFD for less than 1 year compared to those more than 1 year.

CONCLUSIONS: This is the first study on SCFA patterns in faecal samples from individuals with CD on GFD for more than 1 year. Our study indicates that the disturbed gut microflora function in children with CD at presentation and after less than 1 year of GFD, previously demonstrated by us, is normalised on GFD for more than 1 year.

Place, publisher, year, edition, pages
Järfälla, Sweden: Co-Action Publishing, 2013
Keywords
children; coeliac disease; gluten free diet; faecal short chain fatty acids; gut microflora
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-107042 (URN)10.3402/mehd.v24i0.20905 (DOI)24082880 (PubMedID)
Available from: 2014-06-04 Created: 2014-06-04 Last updated: 2017-12-05Bibliographically approved
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