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Bodemar, Göran
Publications (10 of 39) Show all publications
Ekstedt, M., Franzén, L. E., Holmqvist, M., Bendtsen, P., Mathiesen, U. L., Bodemar, G. & Kechagias, S. (2009). Alcohol consumption is associated with progression of hepatic fibrosis in non-alcoholic fatty liver disease. Scandinavian Journal of Gastroenterology, 44(3), 366-374
Open this publication in new window or tab >>Alcohol consumption is associated with progression of hepatic fibrosis in non-alcoholic fatty liver disease
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2009 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 44, no 3, p. 366-374Article in journal (Refereed) Published
Abstract [en]

Objective: Moderate alcohol consumption has been reported to be inversely associated with cardiovascular disease and total mortality. The importance of non-alcoholic fatty liver disease (NAFLD) is increasing and many NAFLD patients suffer from cardiovascular disease. In these patients, moderate alcohol consumption could be beneficial. The aim of this study was to investigate whether low alcohol intake, consistent with the diagnosis of NAFLD, is associated with fibrosis progression in established NAFLD.

Material and methods: Seventy-one patients originally referred because of chronically elevated liver enzymes and diagnosed with biopsy-proven NAFLD were re-evaluated. A validated questionnaire combined with an oral interview was used to assess weekly alcohol consumption and the frequency of episodic drinking. Significant fibrosis progression in NAFLD was defined as progression of more than one fibrosis stage or development of endstage liver disease during follow-up.

Results: Mean follow-up (SD) was 13.8 (1.2) years between liver biopsies. At follow-up, 17 patients (24%) fulfilled the criteria for significant fibrosis progression. The proportion of patients reporting heavy episodic drinking at least once a month was higher among those with significant fibrosis progression (p=0.003) and a trend towards higher weekly alcohol consumption was also seen (p=0.061). In a multivariate binary logistic regression analysis, heavy episodic drinking (p0.001) and insulin resistance (p0.01) were independently associated with significant fibrosis progression.

Conclusions: Moderate alcohol consumption, consistent with the diagnosis of NAFLD to be set, is associated with fibrosis progression in NAFLD. These patients should be advised to refrain from heavy episodic drinking.

Keyword
Alcoholic liver disease, fatty liver, histopathology, liver fibrosis, non-alcoholic fatty liver disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17133 (URN)10.1080/00365520802555991 (DOI)
Available from: 2009-03-07 Created: 2009-03-07 Last updated: 2017-12-13Bibliographically approved
Walter, S. A., Bodemar, G., Hallböök, O. & Thorell, L.-H. (2008). Sympathetic (electrodermal) activity during repeated maximal rectal distensions in patients with irritable bowel syndrome and constipation. Neurogastroenterology and Motility, 20(1), 43-52
Open this publication in new window or tab >>Sympathetic (electrodermal) activity during repeated maximal rectal distensions in patients with irritable bowel syndrome and constipation
2008 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 20, no 1, p. 43-52Article in journal (Refereed) Published
Abstract [en]

Irritable bowel syndrome (IBS) is associated with visceral hypersensitivity, stress and autonomic dysfunction. Sympathetic activity during repeated events indicates excitatory or inhibitory mechanisms such as sensitization or habituation. We investigated skin conductance (SC) during repetitive rectal distensions at maximal tolerable pressure in patients with IBS and chronic constipation. Twenty-seven IBS patients, 13 constipation patients and 18 controls underwent two sets of isobaric rectal distensions. First, maximal tolerable distension was determined and then it was repeated five times. Skin conductance was measured continuously. Subjective symptom assessment remained steady in all groups. The baseline values of SC were higher in IBS patients than in patients with constipation and significantly lower in constipation patients than in controls. The maximal SC response to repetitive maximal distensions was higher in IBS patients compared with constipation patients. The amplitude of the initial SC response decreased successively with increased number of distensions in patients with IBS and constipation but not in controls. Irritable bowel syndrome and constipation patients habituated to maximal repetitive rectal distensions with decreasing sympathetic activity. Irritable bowel syndrome patients had higher sympathetic reactivity and baseline activity than constipation patients. A lower basal SC in constipation patients compared with controls suggests an inhibition of the sympathetic drive in constipation patients.

Keyword
constipation, irritable bowel syndrome, rectal distensions, skin conductance, sympathetic, visceral hypersensitivity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14183 (URN)10.1111/j.1365-2982.2007.00998.x (DOI)
Available from: 2006-12-07 Created: 2006-12-07 Last updated: 2017-12-13Bibliographically approved
Ekstedt, M., Franzén, L. E., Mathiesen, U. L., Bodemar, G. & Kechagias, S. (2008). The clinical relevance of the Nonalcoholic Fatty Liver Disease Activity Score (NAS) in predicting fibrosis progression.
Open this publication in new window or tab >>The clinical relevance of the Nonalcoholic Fatty Liver Disease Activity Score (NAS) in predicting fibrosis progression
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2008 (English)Article in journal (Other academic) Submitted
Abstract [en]

Objective: The NAFLD activity score (NAS) is a newly proposed system to grade the necroinflammatory activity in liver biopsies of NAFLD patients. This study evaluates the usefulness of the NAS in predicting clinical deterioration and fibrosis progression in NAFLD.

Methods: One hundred and twenty-nine patients with biopsy proven NAFLD were included in a long-term histological follow-up study. Clinical and histological course were compared between NASH, “borderline NASH”, and “not NASH” patients. Significant fibrosis progression in NAFLD was defined as progression of more than one fibrosis stage or development of end-stage liver disease during follow-up.

Results: Eighty-eight patients accepted re-evaluation and 68 underwent repeat liver biopsy. Mean time between biopsies was 13.8 ± 1.2 years (range 10.3-16.3). At baseline, NASH was diagnosed in 2 (1.6%) patients, and at follow-up, in 1 (1.5%) patient. A trend towards higher baseline NAS was seen in patients (n = 7) that developed end-stage liver disease (3.1 ± 0.9 vs. 2.4 ± 1.0; P = 0.062). Baseline NAS was significantly higher in patients with progressive fibrosis (2.9 ± 0.9 vs. 2.2 ± 0.9; P = 0.017), and NAS was independently associated with significant fibrosis progression tested in a multivariate analysis (P = 0.023). However, 18% of patients without NASH progressed significantly in fibrosis stage.

Conclusion: Although the NAS is independently associated with future risk of progressive fibrosis in NAFLD, the clinical usefulness of the score is limited due to the significant overlap in clinical development between NAS-score groups.

Keyword
Steatohepatitis, Fatty liver, Fibrosis progression, Clinical follow-up, Histopathology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17325 (URN)
Available from: 2009-03-18 Created: 2009-03-18 Last updated: 2009-08-17Bibliographically approved
Ekstedt, M., Franzén, L. E., Mathiesen, U. L., Holmqvist, M., Bodemar, G. & Kechagias, S. (2007). Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: a histopathological follow-up study.. Journal of Hepatology, 47(1), 135-141
Open this publication in new window or tab >>Statins in non-alcoholic fatty liver disease and chronically elevated liver enzymes: a histopathological follow-up study.
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2007 (English)In: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 47, no 1, p. 135-141Article in journal (Refereed) Published
Abstract [en]

Background/Aims: The effect of statins on hepatic histology in non-alcoholic fatty liver disease (NAFLD) is not known. This study explores hepatic histology in NAFLD patients before and after initiation of statin therapy and compares histological outcome with NAFLD patients who had not been prescribed statins.

Methods: Sixty-eight NAFLD patients were re-evaluated. Follow-up ranged from 10.3 to 16.3 years. Subjects were clinically investigated and a repeat liver biopsy was obtained. No patient was taking statins at baseline while 17 patients were treated with statins at follow-up.

Results: At baseline, patients that later were prescribed statins had significantly higher BMI and more pronounced hepatic steatosis. At follow-up patients on medication with statins continued to have significantly higher BMI. Diabetes was significantly more common among patients on medication with statins and they had significantly more pronounced insulin resistance. However, they exhibited a significant reduction of liver steatosis at follow-up as opposed to patients not taking statins. Despite exhibiting a high risk profile for progression of liver fibrosis, only four patients on statin treatment progressed in fibrosis stage.

Conclusions: Statins can be prescribed in patients with elevated liver enzymes because of NAFLD.

Keyword
Non-alcoholic fatty liver disease, Histology, Statin, Metabolic syndrome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17324 (URN)10.1016/j.jhep.2007.02.013 (DOI)17400325 (PubMedID)
Available from: 2009-03-18 Created: 2009-03-18 Last updated: 2017-12-13Bibliographically approved
Myrelid, P., Svärm, S., Andersson, P., Almer, S., Bodemar, G. & Olaison, G. (2006). Azathioprine as a postoperative prophylaxis reduces symptoms in aggressive Crohn's disease. Scandinavian Journal of Gastroenterology, 41(10), 1190-1195
Open this publication in new window or tab >>Azathioprine as a postoperative prophylaxis reduces symptoms in aggressive Crohn's disease
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2006 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, no 10, p. 1190-1195Article in journal (Refereed) Published
Abstract [en]

Objective. Recurrence of Crohn's disease (CD) after surgery is common. Azathioprine/6-mercaptopurine (Aza/6-MP) is effective in controlling medically induced remission but, so far, has only been sparsely investigated after surgically induced remission. This study comprises a subset of CD patients considered to have an aggressive disease course and chosen for treatment with Aza postoperatively. Material and methods. In 1989-2000, a total of 100 patients with CD were given Aza/6-MP as a postoperative prophylaxis. Fourteen Aza/6-MP-intolerant patients were compared with 28 Aza-tolerant patients, matched for gender, age, and duration of disease. Patients were prospectively registered for symptoms using a modified Crohn's disease activity index (CDAI) and perceived health was assessed on a visual analogue scale (VAS). The primary outcome variable was the modified CDAI postoperatively integrated over time, other variables were time to first relapse (modified CDAI ≥ 150), time to first repeated surgery, number of courses of steroids, and repeated surgery per year of follow-up. Patients were followed for a median of 84.7months (23.2-140). Results. The modified CDAI integrated over time was 93 for Aza-treated patients compared with 184 for controls (p = 0.01) and time to first relapse was 53 and 24 months, respectively (p < 0.05). Aza-treated patients needed fewer courses of corticosteroids (p = 0.05) compared with controls. Perceived health did not differ between the groups, nor did need of repeated surgery. Time to first repeat operation was 53 and 37 months, respectively. Conclusions. In CD patients considered to have an aggressive disease course, Aza reduced symptoms after surgery and prolonged the time to symptomatic relapse. The findings support a role for Aza as a postoperative maintenance treatment in CD. © 2006 Taylor & Francis.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-35679 (URN)10.1080/00365520600587378 (DOI)28126 (Local ID)28126 (Archive number)28126 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Stjernman, H., Grännö, C., Bodemar, G., Järnerot, G., Ockander, L., Tysk, C., . . . Hjortswang, H. (2006). Evaluation of the Inflammatory Bowel Disease Questionnaire in Swedish patients with Crohn's disease. Scandinavian Journal of Gastroenterology, 41(8), 934-943
Open this publication in new window or tab >>Evaluation of the Inflammatory Bowel Disease Questionnaire in Swedish patients with Crohn's disease
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2006 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, no 8, p. 934-943Article in journal (Refereed) Published
Abstract [en]

Objective. Health-related quality of life (HRQoL) is an important measure of inflammatory bowel disease (IBD) health outcome. The Inflammatory Bowel Disease Questionnaire (IBDQ) comprising 32 items grouped into four dimensions is a widely used IBD-specific HRQoL instrument. The purpose of this study was to evaluate the validity, reliability and responsiveness of the Swedish translation of the IBDQ in patients with Crohn's disease (CD). Material and methods. Four hundred and forty-eight patients with CD completed the IBDQ and three other HRQoL questionnaires (Rating Form of IBD Patient Concerns, Short Form-36, and the Psychological General Well-Being Index) in connection with their regular visit at the outpatient clinic. Disease activity was assessed by the physician on a 4-point Likert scale. Thirty-two patients who were stable in remission completed the questionnaires a second time, 4 weeks later. A total of 418 patients repeated all measurements after 6 months. Results. The dimensional scores were highly correlated with other measures of corresponding aspects of HRQoL and were significantly better in remission than in relapse. High test-retest correlations indicated good reliability. Responsiveness was confirmed in patients whose disease activity changed over time. However, high correlations between the dimensions, poor correlations between items within each dimension, and factor analysis all indicated that the original grouping of the items is not valid for Swedish CD patients. Conclusions. Although the Swedish IBDQ has good external validity, reliability and responsiveness for patients with CD, our results did not support the original grouping of the items. © 2006 Taylor & Francis.

Keyword
Health, Health-related quality of life, Inflammatory bowel disease, Quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50177 (URN)10.1080/00365520500529488 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
Ekstedt, M., Franzén, L. E., Mathiesen, U. L., Thorelius, L., Holmqvist, M., Bodemar, G. & Kechagias, S. (2006). Long-term follow-up of patients with NAFLD and elevated liver enzymes.. Hepatology, 44(4), 865-873
Open this publication in new window or tab >>Long-term follow-up of patients with NAFLD and elevated liver enzymes.
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2006 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 44, no 4, p. 865-873Article in journal (Refereed) Published
Abstract [en]

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes in patients of developed countries. We determined the long-term clinical and histological courses of such patients. In a cohort study, 129 consecutively enrolled patients diagnosed with biopsy-proven NAFLD were reevaluated. Survival and causes of death were compared with a matched reference population. Living NAFLD patients were offered repeat liver biopsy and clinical and biochemical investigation. Mean follow-up (SD) was 13.7 (1.3) years. Mortality was not increased in patients with steatosis. Survival of patients with nonalcoholic steatohepatitis (NASH) was reduced (P = .01). These subjects more often died from cardiovascular (P = .04) and liver-related (P = .04) causes. Seven patients (5.4%) developed end-stage liver disease, including 3 patients with hepatocellular carcinoma. The absence of periportal fibrosis at baseline had a negative predictive value of 100% in predicting liver-related complications. At follow-up, 69 of 88 patients had diabetes or impaired glucose tolerance. Progression of liver fibrosis occurred in 41%. These subjects more often had a weight gain exceeding 5 kg (P = .02), they were more insulin resistant (P = .04), and they exhibited more pronounced hepatic fatty infiltration (P = .03) at follow-up. In conclusion, NAFLD with elevated liver enzymes is associated with a clinically significant risk of developing end-stage liver disease. Survival is lower in patients with NASH. Most NAFLD patients will develop diabetes or impaired glucose tolerance in the long term. Progression of liver fibrosis is associated with more pronounced insulin resistance and significant weight gain.

Keyword
Liver, quantification, steatosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17323 (URN)10.1002/hep.21327 (DOI)17006923 (PubMedID)
Available from: 2009-03-18 Created: 2009-03-18 Last updated: 2017-12-13Bibliographically approved
Walter, S. A., Aardal-Eriksson, E., Thorell, L.-H., Bodemar, G. & Hallböök, O. (2006). Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions. Neurogastroenterology and Motility, 18(12), 1069-1077
Open this publication in new window or tab >>Pre-experimental stress in patients with irritable bowel syndrome: high cortisol values already before symptom provocation with rectal distensions
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2006 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, Vol. 18, no 12, p. 1069-1077Article in journal (Refereed) Published
Abstract [en]

Stress is known to affect symptoms of irritable bowel syndrome (IBS) probably by an alteration of visceral sensitivity. We studied the impact of maximal tolerable rectal distensions on cortisol levels in patients with IBS, chronic constipation and controls, and evaluated the effect of the experimental situation per se. In twenty-four IBS patients, eight patients with chronic constipation and 15 controls salivary cortisol was measured before and after repetitive maximal tolerable rectal balloon distensions and at similar times in their usual environment. Rectal sensitivity thresholds were determined. IBS patients but not controls and constipation patients had higher cortisol levels both before and after the experiment compared with similar times on an ordinary day in their usual environment (P = 0.0034 and 0.0002). There was no difference in salivary cortisol level before compared with after rectal distensions. The IBS patients had significantly lower thresholds for first sensation, urge and maximal tolerable distension than controls (P = 0.0247, 0.0001 and <0.0001) and for urge and maximal tolerable distension than patients with constipation (P = 0.006 and 0.013). IBS patients may be more sensitive to expectancy stress than controls and patients with constipation according to salivary cortisol. Rectal distensions were not associated with a further significant increase in cortisol levels.

Keyword
constipation, cortisol, hypersensitivity, IBS, rectaldistensions, stress
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14182 (URN)10.1111/j.1365-2982.2006.00833.x (DOI)
Available from: 2006-12-07 Created: 2006-12-07 Last updated: 2009-06-08
Walter, S. A., Ragnarsson, G. & Bodemar, G. (2005). New criteria for irritable bowel syndrome based on prospective symptom evaluation. , 100(11)
Open this publication in new window or tab >>New criteria for irritable bowel syndrome based on prospective symptom evaluation
2005 (English)Other (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14181 (URN)10.1111/j.1572-0241.2005.00305_5.x (DOI)
Note
Letter to the editor, in American Journal of Gastroenterology vol. 100, no. 11 (2005), pp 2598-2599Available from: 2006-12-07 Created: 2006-12-07 Last updated: 2010-05-24
Walter, S., Skagerström, E. & Bodemar, G. (2004). Subgroups of irritable bowel syndrome: a new approach. European Journal of Gastroenterology and Hepatology, 16(10), 991-994
Open this publication in new window or tab >>Subgroups of irritable bowel syndrome: a new approach
2004 (English)In: European Journal of Gastroenterology and Hepatology, ISSN 0954-691X (print) 1473-5687 (online), Vol. 16, no 10, p. 991-994Article in journal (Refereed) Published
Abstract [en]

Objectives: The newly revised Rome criteria for the definition of irritable bowel syndrome (IBS), derived from the consensus of experts in the field, were developed in order to identify subgroups of IBS patients for research. The criteria have, to our knowledge, never been validated. Both when trying to include IBS patients in studies and in clinical practice we found it difficult to apply the Rome 2 supportive criteria.

Aim: To study the variation of stool consistency and defecatory symptoms in IBS patients prospectively with diary cards and to validate the Rome 2 supportive criteria.

Methods: Sixty IBS patients, included by interview according to the Rome 1 criteria, recorded their bowel symptoms on diary cards over 40 days. Four subgroups were found, characterised by loose-stool-predominant, hard-stool-predominant, alternating stool consistency, and loose stools only. Urgency, straining and feeling of incomplete evacuation occurred in all but seven individuals, irrespective of subgroup.

Results: The Rome 2 criteria could subclassify seven patients into diarrhoea-predominant IBS based on stool consistency and absence of straining and could subclassify no patients into constipation-predominant IBS, as urge was present in nearly all patients. Fifty-three patients could not be classified according to the Rome 2 criteria, as they had defecatory symptoms of all kinds.

Conclusion: As the Rome 2 supportive criteria use the presence or absence of specific defecatory symptoms as an instrument for categorising IBS patients into diarrhoea- and constipation-predominant subgroups, these criteria could not be used for the majority of IBS patients in this study and should be reconsidered.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14180 (URN)10.1097/00042737-200410000-00007 (DOI)
Available from: 2006-12-07 Created: 2006-12-07 Last updated: 2009-10-31
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