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  • 1.
    Berhan, Yonas T.
    et al.
    Umeå University, Sweden.
    Mollsten, Anna
    Umeå University, Sweden.
    Carlsson, Annelie
    Lund University, Sweden.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Ivarsson, Anneli
    Umeå University, Sweden.
    Dahlquist, Gisela
    Umeå University, Sweden.
    Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, 1078-1082 p.Article in journal (Refereed)
    Abstract [en]

    AimChildhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13years of age. MethodsBody mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25kg/m(2) at 18years of age (ISO-BMI 25, n=1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI 25. Children with a Diabetes Control and Complications Trial aligned HbA1c 6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis. ResultsOf 1126 children with ISO-BMI 25, 24 (2.1%) had at least one HbA1c value 6.1%. Three of them had HbA1c 6.1% on two occasions, and all of them had a normal OGTT. ConclusionIn this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.

  • 2. Grant, C
    et al.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Grodzinsky, Ewa
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology .
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    The clinical relevance of duodenal intraepithelial lymphocyte counts in children treated for disease2008In: Acta Paediatrica, ISSN 0803-5253Article in journal (Refereed)
    Abstract [en]

      

  • 3.
    Grodzinsky, Ewa
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Högberg, Lotta
    Norrköping Hospital, Norrköping, Sweden.
    Jansson, Gunnar
    Motala Hospital, Motala, Sweden.
    Laurin, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    IgA endomysium antibodies: an early predictor for celiac disease in children without villous atrophy2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, 972-976 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate possible differences between children with anti-endomysium antibodies (EMA) positivity and normal small bowel mucosa and children with positive EMA and an enteropathy diagnosed as celiac disease (CD).

    Methods: Children with suspected CD and positive EMA (≥1/10) undergoing small bowel biopsy during 1996 to 2002, were investigated (n = 133). Data registered were: year and month of birth, timing of the first biopsy, sex, heredity for CD, dermatitis herpetiformis and diabetes mellitus and outcome of the anti-gliadin antibody test (AGA). The case group, with EMA positivity and normal histology (n = 39; 59% female, mean age at the first biopsy 7.3 years, range 1.4–16), was compared with the disease control group, with positive EMA and a biopsy suggestive and further on diagnosed as CD (n = 94; 56% female; mean age 7.6 years at the first biopsy, range 0.70–17).

    Results: AGA positivity and heredity for CD were found to predict the outcome of a pathological jejunal mucosa. Nineteen of the 39 children in the case group were rebiopsied of whom 11 had developed an enteropathy during a follow-up period of 2–7 years (median 4.5 years).

    Conclusions: EMA positivity in the absence of small bowel enteropathy could be a very early predictor for later overt CD, and necessitates further follow-up, especially if the child is AGA positive and there is a family history of CD.

  • 4.
    Hollén, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Forslund, Tony
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Laurin, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Urinary nitric oxide during one year of gluten-free diet with or without oats in children with coeliac disease2006In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 41, no 11, 1272-1278 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Although in both adults and children with coeliac disease (CD) it is now recommended that oats be added to their gluten-free diet, there is still some controversy concerning the possible harmful effects of oats in some individuals. In this study concentrations of nitric oxide metabolites were repeatedly measured in the urine of children under investigation for CD, when on a gluten-free diet with or without oats.

    Material and methods. The study included 116 children, randomized to a standard gluten-free diet (GFD-std) or a gluten-free diet supplemented with wheat-free oat products (GFD-oats), over a one-year period. Small-bowel biopsy was performed at the beginning and end of the study. Morning urine samples were collected from 87 children and urinary nitrite/nitrate concentrations were monitored at 0, 3, 6, 9 and 12 months.

    Results. All patients were in clinical remission after the study period. There was a rapid decline in urinary nitrite/nitrate concentrations in both groups as early as after 3 months. No differences were seen between the study groups at any of the checkpoints. However, at the end of the study, the nitrite/nitrate values of 9 children in the GFD-oats group and 8 children in the GFD-std group had not normalized.

    Conclusions. Children with CD on a gluten-free diet with oats display a similar reduction in urinary nitrite/nitrate as those on a traditional gluten-free diet. Some children, however, still demonstrate high nitrite/nitrate excretion after one year on either diet, indicating that long-term follow-up studies of children on an oats-containing diet are needed.

  • 5.
    Hollén, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Holmgren Peterson, Kajsa
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Laurin, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres2006In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 41, no 1, 42-47 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Recent studies report negligible toxicity of oats in the majority of coeliac disease (CD) patients. It has previously been shown that children with untreated CD have circulating antibodies to oats avenin. In this study we performed serial assessments of anti-avenin antibodies in children under investigation for CD on a gluten-free diet with or without oats.

    Material and methods. The study involved 116 children, randomized to a standard gluten-free diet or a gluten-free diet supplemented with oats. Sera were obtained from 86 children, 48 in the standard gluten-free group and 38 in the gluten-free oats group, of which 33 consumed at least 10 g of oats daily. IgA and IgG anti-avenin antibodies were monitored at 0, 3, 6 and 12 months. Nitric oxide metabolites were measured in 7 patients, with deviating antibody results.

    Results. There was a significant decrease in anti-avenin antibodies in both groups at the end as compared to the beginning of the study, (p<0.001), but no difference was found between the two groups. IgA titres already declined after 3 months. IgG titres, although significantly decreased, remained high in the majority of patients in both groups. Nitric oxide levels were high in four of the analysed samples.

    Conclusions. Oats per se, do not seem to produce a humoral immune reaction in children with CD when given in an otherwise gluten-free diet, indicating that the reaction requires gluten challenge. Anti-avenin antibodies were equal in the two study groups, and these findings strengthen the clinical impression that oats can be tolerated by the majority of patients with CD.

  • 6.
    Hollén, Elisabet
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Antibodies to oat prolamines (avenins) in children with coeliac disease2003In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 38, no 7, 742-746 p.Article in journal (Refereed)
    Abstract [en]

    Background: The use of oats in a gluten-free diet for children with coeliac disease is presently under investigation. In this study we measured the content of antibodies to oat prolamines (avenin) in sera from coeliac children and reference children.

    Methods: Crude avenin was prepared by extraction with ethanol and salt-solution and used as antigen in a three-step ELISA. Sera from 81 children, including 34 children with verified coeliac disease, were analysed for both IgA and IgG antibodies to avenin and gliadin. Sera were also incubated with gliadin before exposure to avenin, and vice versa, to assess a possible cross-reaction between the species. Keyhole limpet hemocyanin (KLH) was used as a negative control.

    Results: Children with coeliac disease on a normal diet had significantly higher levels of antibodies to avenin, both IgG and IgA, than reference children ( P < 0.001) and the levels correlated positively with gliadin antibodies, especially of IgA-type ( r = 0.798). Both anti-avenin and anti-gliadin antibodies were only absorbed by the corresponding protein.

    Conclusions: Children with coeliac disease have antibodies to oat proteins at significantly higher levels than reference children. The absorption test did not indicate a cross-reactivity between the prolamines of wheat and oats. The method will be employed for repeated sampling of anti-avenin antibodies during a prospective interventional study with a gluten-free diet supplemented with oats.

  • 7.
    Högberg, Lotta
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Childhood coeliac disease: clinical aspects of heredity, diagnosis and dietary therapy2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Childhood coeliac disease (CD) is defined as a lifelong disorder, in which the small bowel mucosa is abnormal as a result of exposure to gluten in the diet. The mucosal damage improves on treatment with a gluten-free diet, but recurs within two years of reintroduction of gluten. If there is no mucosal relapse within two years of gluten challenge the condition is called transient gluten intolerance. We describe a case of CD, in whom small bowel biopsy performed yearly demonstrated that mucosal relapse took 14 years of gluten challenge. This is an exceptionally long time questioning the existence of the condition transient gluten intolerance.

    Small bowel biopsy is the golden standard in diagnosing CD but an uncomfortable investigation in a child. An effective sedation of the child is necessary. In a randomised study of intranasal versus intravenous midazolam as sedation of children undergoing small bowel biopsy we showed that both administration routes are effective and safe. Intranasal midazolam produced nasal discomfort. Thus, the intravenous route of administration is to be preferred.

    In a previous study at our clinic 20-25 years ago all first-degree relatives (n=100) of 32 index patients with CD were investigated with small bowel biopsy. Two cases of CD were found. In the present reinvestigation of the relatives (n=120) using serological screening, 8 new cases of CD were found. The overall prevalence of CD in the first-degree relatives is 8.3%. Six of the new cases were children of the index patients. The remaining 2 newly diagnosed cases had had some enteropathy, not classified as CD, in the previous study. This is the first study of first-degree relatives of coeliacs followed for as long as 20-25 years. The study shows that there is a strong genetic component in the aetiopathogenesis of CD.

    The compliance to gluten-free diet, among 29 adult coeliacs, who had been diagnosed in childhood (one group before and one group after 4 years of age) was assessed by dietmy questionnaire and serological markers. The compliance was 80% in the patients diagnosed before 4 years and 36% in those diagnosed later in childhood. This significant difference indicates that a diagnosis in early childhood makes it easier for a coeliac patient to keep to a strict gluten-free diet. This is a clinically important observation.

    In a double-blind randomised multi-centre study of oats in the gluten-free diet during a study period of one year, children with CD were carefully monitored using small bowel biopsy and serological markers. The results indicate that oats are tolerated by coeliac children. This is important, since additional oats improve the palatability and fibre content of the fairly low-fibre standard glutenfree diet. This makes it easier for a patient with CD to adhere to the gluten-free diet, which is very important in order to minimise the risk for potential complications.

    List of papers
    1. Very late mucosal relapse in a girl with coeliac disease
    Open this publication in new window or tab >>Very late mucosal relapse in a girl with coeliac disease
    1993 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 82, no 10, 887-889 p.Article in journal (Refereed) Published
    Abstract [en]

    Small bowel biopsy in a 4–year-old girl with symptoms suggestive of coeliac disease revealed subtotal villous atrophy. The mucosa healed on a gluten-free diet. From the age of 7 years, the girl was challenged with gluten. Annual biopsies showed normal or nearly normal mucosa specimens. At 21 years of age, after 14 years of gluten challenge, a mucosal relapse was found and a gluten-free diet was reinstituted. A biopsy one year later showed a normal mucosa. From this case report it is apparent that a patient with a past history of subtotal villous atrophy, which after a preceding period of gluten-free diet does not recur within two years of gluten challenge, must be followed carefully, so as not to miss a late relapse.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84482 (URN)10.1111/j.1651-2227.1993.tb17636.x (DOI)
    Available from: 2012-10-09 Created: 2012-10-09 Last updated: 2012-10-09Bibliographically approved
    2. Anti-endomysium and anti-gliadin antibodies as serological markers for a very late mucosal relapse in a coeliac girl
    Open this publication in new window or tab >>Anti-endomysium and anti-gliadin antibodies as serological markers for a very late mucosal relapse in a coeliac girl
    1997 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 86, no 3, 335-336 p.Article in journal, Letter (Refereed) Published
    Abstract [en]

    No abstract is available for this article.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84483 (URN)10.1111/j.1651-2227.1997.tb08905.x (DOI)
    Available from: 2012-10-09 Created: 2012-10-09 Last updated: 2012-10-09Bibliographically approved
    3. Intranasal versus intravenous administration of midazolam to children undergoing small bowel biopsy
    Open this publication in new window or tab >>Intranasal versus intravenous administration of midazolam to children undergoing small bowel biopsy
    1995 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 84, no 12, 1429-1431 p.Article in journal (Refereed) Published
    Abstract [en]

    Sixty-three children under the age of 9 years were randomized to receive intravenous (group A, n= 33) or intranasal (group B, n= 30) midazolam as sedation for small bowel biopsy. Mean doses of midazolam given to produce adequate sedation were 0.31 mg (kg body weight)−1 in group A and 0.34 mg (kg body weight)−1 in group B (NS). Four children in group A and 10 children in group B required additional doses to maintain adequate sedation throughout the biopsy procedure (p <0.05). There was no significant difference between the groups regarding the median procedure time (7 min in group A, 8.5 min in group B) or median fluoroscopy time (5 s in group A, 4 s in group B). All children in group B showed signs of discomfort from the nose when given midazolam intranasally. In conclusion, this study indicates that intravenous administration of midazolam is preferable to the intranasal route.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84484 (URN)10.1111/j.1651-2227.1995.tb13582.x (DOI)
    Available from: 2012-10-09 Created: 2012-10-09 Last updated: 2012-10-09Bibliographically approved
    4. Familial prevalence of coeliac disease: a twenty-year follow-up study
    Open this publication in new window or tab >>Familial prevalence of coeliac disease: a twenty-year follow-up study
    2003 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 38, no 1, 61-65 p.Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    The genetic predisposition of coeliac disease (CD) is well known. Previous studies of first-degree relatives of coeliac patients have shown that as many as 10% have the disease. In 1981, we published a study in which all first-degree relatives of 32 index patients with CD were investigated by small-bowel biopsy. We found 2 relatives (2%) with CD. The present study is a re-investigation of all first-degree relatives of the same index patients performed 20-25 years after the first study to reveal any new cases of CD in this high-risk population.

    METHODS:

    All 120 first-degree relatives were screened for CD by means of serological markers of CD. The relatives with positive markers were submitted to small-bowel biopsy.

    RESULTS:

    Eight new cases of CD were found among the relatives. Two had been investigated by small-bowel biopsy 20 years previously, when they had only minor mucosal changes not classified as CD. The other six new cases of CD were found among offspring of the index patients and were born after completion of the previous study. Thus no new case of CD was found among those relatives who had a completely normal small-bowel biopsy 20-25 years previously.

    CONCLUSIONS:

    The high prevalence of CD among first-degree relatives of coeliac patients (8.3% in this study) supports the need to screen for CD in this high-risk population. Even relatives with only mild enteropathy should be followed carefully, since some may subsequently develop CD.

    Keyword
    Coeliac disease, Family study, Serological markers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-46758 (URN)10.1080/00365520310000456 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2012-10-09Bibliographically approved
    5. Better dietary compliance in patients with coeliac disease diagnosed in early childhood
    Open this publication in new window or tab >>Better dietary compliance in patients with coeliac disease diagnosed in early childhood
    2003 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 38, no 7, 751-754 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: In coeliac disease (CD) there is a permanent gluten intolerance requiring life-long adherence to a strict gluten-free diet (GFD). An inadequate diet increases the risk for long-term complications. Coeliac patients often have great difficulty in maintaining a strictly GFD. We aimed to study whether young adults with CD diagnosed before the age of 4 years have a better dietary compliance than patients diagnosed later in life.

    Method: Twenty-nine adults with CD diagnosed in childhood were studied. They had had CD for 17-24 (mean 20) years. Their compliance to GFD was assessed using a questionnaire and serological markers (IgA and IgG anti-endomysium antibodies and IgA anti-tissue transglutaminase antibodies).

    Results: At least 80% of the coeliac patients who had been diagnosed before the age of 4 years complied with the GFD compared to 36% of the CD patients older than 4 years at diagnosis ( P &#114 < &#114 0.05).

    Conclusion: This is the first study to show that patients with CD diagnosed before 4 years of age keep to a GFD significantly better than patients diagnosed after 4 years. It is thus important to diagnose childhood CD as early as possible in order to minimize the risk for reduced well-being and other potentially serious complications in coeliac individuals on an inadequate diet.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26571 (URN)10.1080/00365520310003318 (DOI)11136 (Local ID)11136 (Archive number)11136 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-09Bibliographically approved
    6. Oats to children with newly diagnosed coeliac disease: a randomised double blind study
    Open this publication in new window or tab >>Oats to children with newly diagnosed coeliac disease: a randomised double blind study
    Show others...
    2004 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 53, no 5, 649-654 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed.

    Aim: To determine if children with CD tolerate oats in their GFD.

    Patients and methods: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months.

    Results: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5–40) g at the six month control and 15 (0–43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew.

    Conclusions: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-22329 (URN)10.1136/gut.2003.026948 (DOI)1529 (Local ID)1529 (Archive number)1529 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-09Bibliographically approved
  • 8.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Danielsson, Lars
    Norrtälje Hospital.
    Jarleman, Stefan
    Astrid Lindgren's Children Hospital.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Serum zinc in small children with coeliac disease2009In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 2, 343-345 p.Article in journal (Refereed)
    Abstract [en]

    In coeliac disease (CD) there is a gluten-induced small bowel enteropathy leading to malabsorption of various nutrients, vitamins and trace elements. Low levels of serum zinc have been reported in adults with untreated CD. In the present study we related the serum concentration of zinc to the morphology of the small bowel mucosa in 58 children, all under 4 years of age and under investigation for coeliac disease. The mean serum concentration of zinc (mean +/- SD; mu mol/L) was significantly lower in children with untreated CD (9.7 +/- 2.0) (n = 11) compared to non-coeliac children without enteropathy (15.1 +/- 2.3) (n = 16) (p &lt; 0.001), coeliac children on a gluten-free diet without enteropathy (14.2 +/- 1.6) (n = 14) (p &lt; 0.001), coeliac children on gluten challenge with enteropathy (14.1 +/- 2.1) (n = 12) (p &lt; 0.001) and coeliac children on gluten challenge without enteropathy (13.8 +/- 1.9) (n = 6) (p &lt; 0.005).

    Conclusion: Serum zinc concentration is decreased in untreated coeliac children with enteropathy and normalizes on gluten-free diet. A low serum zinc value in a child being investigated for possible CD on clinical grounds can thus be used as a complementary marker for enteropathy indicating further investigation with small bowel biopsy. The hypothetical role of zinc in the pathogenesis of CD is discussed.

  • 9.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Familial prevalence of coeliac disease: a twenty-year follow-up study2003In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 38, no 1, 61-65 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The genetic predisposition of coeliac disease (CD) is well known. Previous studies of first-degree relatives of coeliac patients have shown that as many as 10% have the disease. In 1981, we published a study in which all first-degree relatives of 32 index patients with CD were investigated by small-bowel biopsy. We found 2 relatives (2%) with CD. The present study is a re-investigation of all first-degree relatives of the same index patients performed 20-25 years after the first study to reveal any new cases of CD in this high-risk population.

    METHODS:

    All 120 first-degree relatives were screened for CD by means of serological markers of CD. The relatives with positive markers were submitted to small-bowel biopsy.

    RESULTS:

    Eight new cases of CD were found among the relatives. Two had been investigated by small-bowel biopsy 20 years previously, when they had only minor mucosal changes not classified as CD. The other six new cases of CD were found among offspring of the index patients and were born after completion of the previous study. Thus no new case of CD was found among those relatives who had a completely normal small-bowel biopsy 20-25 years previously.

    CONCLUSIONS:

    The high prevalence of CD among first-degree relatives of coeliac patients (8.3% in this study) supports the need to screen for CD in this high-risk population. Even relatives with only mild enteropathy should be followed carefully, since some may subsequently develop CD.

  • 10.
    Högberg, Lotta
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Better dietary compliance in patients with coeliac disease diagnosed in early childhood2003In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 38, no 7, 751-754 p.Article in journal (Refereed)
    Abstract [en]

    Background: In coeliac disease (CD) there is a permanent gluten intolerance requiring life-long adherence to a strict gluten-free diet (GFD). An inadequate diet increases the risk for long-term complications. Coeliac patients often have great difficulty in maintaining a strictly GFD. We aimed to study whether young adults with CD diagnosed before the age of 4 years have a better dietary compliance than patients diagnosed later in life.

    Method: Twenty-nine adults with CD diagnosed in childhood were studied. They had had CD for 17-24 (mean 20) years. Their compliance to GFD was assessed using a questionnaire and serological markers (IgA and IgG anti-endomysium antibodies and IgA anti-tissue transglutaminase antibodies).

    Results: At least 80% of the coeliac patients who had been diagnosed before the age of 4 years complied with the GFD compared to 36% of the CD patients older than 4 years at diagnosis ( P &#114 < &#114 0.05).

    Conclusion: This is the first study to show that patients with CD diagnosed before 4 years of age keep to a GFD significantly better than patients diagnosed after 4 years. It is thus important to diagnose childhood CD as early as possible in order to minimize the risk for reduced well-being and other potentially serious complications in coeliac individuals on an inadequate diet.

  • 11.
    Högberg, Lotta
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Laurin, Pia
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Grant, C.
    Laboratory Medicine Östergötland, Pathology, Norrköping Hospital, Sweden.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Jansson, Gunnar
    Department of Paediatrics, Motala Hospital, Sweden .
    Ascher, H.
    Department of Paediatrics, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden .
    Browaldh, L.
    Department of Paediatrics, Sachsska Hospital, Stockholm, Sweden .
    Hammersjö, Jan-Åke
    Department of Paediatrics, Västervik Hospital, Sweden .
    Lindberg, E.
    Department of Paediatrics, Örebro University Hospital, Sweden .
    Myrdal, U.
    Department of Paediatrics, Västerås Hospital, Sweden.
    Stenhammar, Lars
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Oats to children with newly diagnosed coeliac disease: a randomised double blind study2004In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 53, no 5, 649-654 p.Article in journal (Refereed)
    Abstract [en]

    Background: Treatment of coeliac disease (CD) requires lifelong adherence to a strict gluten free diet (GFD) which hitherto has consisted of a diet free of wheat, rye, barley, and oats. Recent studies, mainly in adults, have shown that oats are non-toxic to CD patients. In children, only open studies comprising a small number of patients have been performed.

    Aim: To determine if children with CD tolerate oats in their GFD.

    Patients and methods: In this double blind multicentre study involving eight paediatric clinics, 116 children with newly diagnosed CD were randomised to one of two groups: one group was given a standard GFD (GFD-std) and one group was given a GFD with additional wheat free oat products (GFD-oats). The study period was one year. Small bowel biopsy was performed at the beginning and end of the study. Serum IgA antigliadin, antiendomysium, and antitissue transglutaminase antibodies were monitored at 0, 3, 6, and 12 months.

    Results: Ninety three patients completed the study. Median (range) daily oat intake in the GFD-oats group (n = 42) was 15 (5–40) g at the six month control and 15 (0–43) g at the end of the study. All patients were in clinical remission after the study period. The GFD-oats and GFD-std groups did not differ significantly at the end of the study regarding coeliac serology markers or small bowel mucosal architecture, including numbers of intraepithelial lymphocytes. Significantly more children in the youngest age group withdrew.

    Conclusions: This is the first randomised double blind study showing that the addition of moderate amounts of oats to a GFD does not prevent clinical or small bowel mucosal healing, or humoral immunological downregulation in coeliac children. This is in accordance with the findings of studies in adult coeliacs and indicates that oats, added to the otherwise GFD, can be accepted and tolerated by the majority of children with CD.

  • 12.
    Högberg, Lotta
    et al.
    Östergötlands Läns Landsting.
    Nordvall, M.
    Östergötlands Läns Landsting.
    Tjellström, L.
    Östergötlands Läns Landsting.
    Stenhammar, Lars
    Östergötlands Läns Landsting.
    Intranasal versus intravenous administration of midazolam to children undergoing small bowel biopsy1995In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 84, no 12, 1429-1431 p.Article in journal (Refereed)
    Abstract [en]

    Sixty-three children under the age of 9 years were randomized to receive intravenous (group A, n= 33) or intranasal (group B, n= 30) midazolam as sedation for small bowel biopsy. Mean doses of midazolam given to produce adequate sedation were 0.31 mg (kg body weight)−1 in group A and 0.34 mg (kg body weight)−1 in group B (NS). Four children in group A and 10 children in group B required additional doses to maintain adequate sedation throughout the biopsy procedure (p <0.05). There was no significant difference between the groups regarding the median procedure time (7 min in group A, 8.5 min in group B) or median fluoroscopy time (5 s in group A, 4 s in group B). All children in group B showed signs of discomfort from the nose when given midazolam intranasally. In conclusion, this study indicates that intravenous administration of midazolam is preferable to the intranasal route.

  • 13.
    Högberg, Lotta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Nordwall, Maria
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    One thousand small-bowel biopsies in children: A single-port versus a double-port capsule2001In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 36, no 11, 1230-1232 p.Article in journal (Refereed)
    Abstract [en]

    Background: Small-bowel biopsy is a well-established technique in the evaluation of children with intestinal malabsorption, e.g. coeliac disease. The biopsy is performed endoscopically or with a peroral capsule instrument. The aim of the present retrospective study was to compare the single-port Watson capsule with the double-port Storz capsule with regard to procedure and fluoroscopy time, complications and failure rate. Methods: All 1,078 peroral small-bowel biopsies performed at our department during 1989-99 were studied. In 387 of these, the Watson capsule was used and in the remaining 691 the Storz capsule. Median age of the children was 2.5 years. About one-third of the children were premedicated with the prokinetic drug cisapride and as sedatives alimemazine or diazepam orally. Two-thirds of the children were given metoclopramide along with midazolam intravenously. The biopsies were performed under intermittent fluoroscopy. Results: The median biopsy procedure time was significantly shorter with the Storz capsule (7 min) compared to the Watson capsule (10 min) (P<0.05). The median fluoroscopy time was 5 sec with the Storz capsule and 8 sec with the Watson capsule (P<0.01). The failure rate did not differ significantly between the two capsule types: 10.3% (Watson) and 7.7% (Storz). One potential but no serious complication occurred. Conclusions: Providing that effective sedation is available, small-bowel biopsy with a peroral capsule, and the Storz double-port multibiopsy capsule in particular, is a safe and fast method exposing the child to a minimal radiation dose.

  • 14.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Sokolski, Jan
    Department of Dermatology, Norrköping Hospital, Norrköping, Sweden.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Chronic Bullous Dermatosis of Childhood Associated with Coeliac Disease in a 6-year-old Boy2004In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 2, 158-159 p.158-159 p.Article in journal (Other academic)
    Abstract [en]

    [No abstract available]

  • 15.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Diagnosis criteria in young children2009In: Nature Reviews Gastroenterology & Hepatology, ISSN 1759-5045, E-ISSN 1759-5053, Vol. 6, no 8, 447-448 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 16.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Pediatric celiac disease-is a diagnostic biopsy necessary?2012In: Nature Reviews Gastroenterology & Hepatology, ISSN 1759-5045, E-ISSN 1759-5053, Vol. 9, no 3, 127-128 p.Article in journal (Other academic)
    Abstract [en]

    A small-bowel biopsy is currently required in the diagnosis of celiac disease in children. The European Society for Pediatric Gastroenterology, Hepatology and Nutrition has now presented new guidelines for the diagnosis of celiac disease, which indicate that small-bowel biopsy could be avoided in certain cases.

  • 17.
    Högberg, Lotta
    et al.
    Östergötlands Läns Landsting.
    Stenhammar, Lars
    Östergötlands Läns Landsting.
    Fälth-Magnusson, Karin
    Östergötlands Läns Landsting.
    Grodzinsky, Ewa
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Anti-endomysium and anti-gliadin antibodies as serological markers for a very late mucosal relapse in a coeliac girl1997In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 86, no 3, 335-336 p.Article in journal (Refereed)
    Abstract [en]

    No abstract is available for this article.

  • 18.
    Högberg, Lotta
    et al.
    Östergötlands Läns Landsting.
    Stenhammar, Lars
    Östergötlands Läns Landsting.
    Wågermark, J.
    Östergötlands Läns Landsting.
    Very late mucosal relapse in a girl with coeliac disease1993In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 82, no 10, 887-889 p.Article in journal (Refereed)
    Abstract [en]

    Small bowel biopsy in a 4–year-old girl with symptoms suggestive of coeliac disease revealed subtotal villous atrophy. The mucosa healed on a gluten-free diet. From the age of 7 years, the girl was challenged with gluten. Annual biopsies showed normal or nearly normal mucosa specimens. At 21 years of age, after 14 years of gluten challenge, a mucosal relapse was found and a gluten-free diet was reinstituted. A biopsy one year later showed a normal mucosa. From this case report it is apparent that a patient with a past history of subtotal villous atrophy, which after a preceding period of gluten-free diet does not recur within two years of gluten challenge, must be followed carefully, so as not to miss a late relapse.

  • 19.
    Högberg, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Webb, C
    Lund University.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Forslund, Tony
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Danielsson, L
    Norrtalje Hospital.
    Ivarsson, A
    Umea University.
    Sandstrom, O
    Umea University.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine2011In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 100, no 7, 1023-1027 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern. Methods: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied. Results: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p andlt; 0.001). Conclusion: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.

  • 20.
    Ivarsson, A
    et al.
    Umeå University.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    The Swedish Childhood Coeliac Disease Working Group after 20 years: history and future2010In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 99, no 9, 1429-1431 p.Article in journal (Refereed)
    Abstract [en]

    n/a

  • 21.
    Ivarsson, Anneli
    et al.
    Umeå University, Sweden .
    Myleus, Anna
    Umeå University, Sweden .
    Norstrom, Fredrik
    Umeå University, Sweden .
    van der Pals, Maria
    Lund University, Sweden .
    Rosen, Anna
    Umeå University, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Danielsson, Lars
    Norrtalje Hospital, Sweden .
    Halvarsson, Britta
    Aleris Medilab, Sweden .
    Hammarroth, Solveig
    Norrtalje Hospital, Sweden .
    Hernell, Olle
    Umeå University, Sweden .
    Karlsson, Eva
    Vaxjo Hospital, Sweden .
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Webb, Charlotta
    Lund University, Sweden .
    Sandstrom, Olof
    Umeå University, Sweden .
    Carlsson, Annelie
    Lund University, Sweden .
    Prevalence of Childhood Celiac Disease and Changes in Infant Feeding2013In: Pediatrics, ISSN 0031-4005, Vol. 131, no 3, E687-E694 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Between 1984 and 1996, Sweden experienced an "epidemic" of clinical celiac disease in children andlt;2 years of age, attributed partly to changes in infant feeding. Whether infant feeding affects disease occurrence and/or the clinical presentation remains unknown. We investigated and compared the total prevalence of celiac disease in 2 birth cohorts of 12-year-olds and related the findings to each cohorts ascertained infant feeding. less thanbrgreater than less thanbrgreater thanMETHODS: A 2-phase cross-sectional screening study was performed in which 13 279 children from 2 birth cohorts participated: children born during the epidemic (1993) and children born after the epidemic (1997). Previously diagnosed cases were reported and confirmed. Blood samples were analyzed for serological markers and children with positive values were referred for small intestinal biopsy. Infant feeding practices in the cohorts were ascertained via questionnaires. Prevalence comparisons were expressed as prevalence ratios. less thanbrgreater than less thanbrgreater thanRESULTS: The total prevalence of celiac disease was 29 in 1000 and 22 in 1000 for the 1993 and 1997 cohorts, respectively. Children born in 1997 had a significantly lower risk of having celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% confidence interval: 0.60-0.93; P = .01). The cohorts differed in infant feeding (specifically, in the proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding). less thanbrgreater than less thanbrgreater thanCONCLUSIONS: A significantly reduced prevalence of celiac disease in 12-year-olds indicates an option for disease prevention. Our findings suggest that the present infant feeding recommendation to gradually introduce gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, is favorable. Pediatrics 2013;131:e687-e694

  • 22.
    Kautto, E.
    et al.
    Umeå University, Sweden Umeå University, Sweden .
    Ivarsson, A.
    Umeå University, Sweden .
    Norstrom, F.
    Umeå University, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Carlsson, A.
    Lund University, Sweden .
    Hornell, A.
    Umeå University, Sweden .
    Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries2014In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 27, no 1, 41-53 p.Article in journal (Refereed)
    Abstract [en]

    BackgroundFood habits, nutrient needs and intakes differ between males and females, although few nutritional studies on patients with coeliac disease (CD) have reported results stratified by gender. ObjectivesTo compare energy and nutrient intakes among 13-year olds diagnosed with CD in early childhood with those of a non-coeliac (NC) age- and gender-matched control group, and also with estimated average requirements (EAR). MethodsA case-control study was conducted in Sweden 2006-2007 within the coeliac screening study ETICS (Exploring The Iceberg of Coeliacs in Sweden). Dietary intake was assessed among 37 adolescents (23 girls) diagnosed with CD at median age 1.7years (CD group) and 805 (430 girls) NC controls (NC group) using a food-frequency questionnaire covering 4weeks. Reported energy intake was validated by comparison with the calculated physical activity level (PAL). ResultsRegardless of CD status, most adolescents reported an intake above EAR for most nutrients. However, both groups had a low intake of vitamin C, with 13% in the CD-group and 25% in the NC-group below EAR, and 21% of boys in the CD-group below EAR for thiamine. The intake of fatty acids was unbalanced, with a high intake of saturated and a low intake of unsaturated fats. Girls and boys in the CD-group had an overall lower nutrient density in reported food intake compared to girls and boys in the NC-group. ConclusionsNutrient intake of adolescent girls and boys with CD was mostly comparable to intakes of NC controls. Dietitians should take the opportunity to reinforce a generally healthy diet when providing information about the gluten-free diet.

  • 23.
    Kuchinskaya, Ekaterina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Grigelioniene, Giedre
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Hammarsjo, Anna
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Lee, Hye-Ran
    Seoul National University, South Korea.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Faculty of Medicine and Health Sciences.
    Grigelionis, Gintautas
    Karolinska Institute, Sweden.
    Kim, Ok-Hwa
    Woorisoa Childrens Hospital, South Korea.
    Nishimura, Gen
    Tokyo Metropolitan Childrens Medical Centre, Japan.
    Cho, Tae-Joon
    4 Division of Pediatric Orthopaedics, Seoul National University Children’s Hospital, Seoul, Republic of Korea.
    Extending the phenotype of BMPER-related skeletal dysplasias to ischiospinal dysostosis2016In: Orphanet Journal of Rare Diseases, ISSN 1750-1172, E-ISSN 1750-1172, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Ischiospinal dysostosis (ISD) is a polytopic dysostosis characterized by ischial hypoplasia, multiple segmental anomalies of the cervicothoracic spine, hypoplasia of the lumbrosacral spine and occasionally associated with nephroblastomatosis. ISD is similar to, but milder than the lethal/semilethal condition termed diaphanospondylodysostosis (DSD), which is associated with homozygous or compound heterozygous mutations of bone morphogenetic protein-binding endothelial regulator protein (BMPER) gene. Here we report for the first time biallelic BMPER mutations in two patients with ISD, neither of whom had renal abnormalities. Our data supports and further extends the phenotypic variability of BMPER-related skeletal disorders.

  • 24.
    Lahdenperä, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Hölttä, V
    National Institute for Health and Welfare, Finland.
    Ruohtula, T
    National Institute for Health and Welfare, Finland.
    Salo, H M
    National Institute for Health and Welfare, Finland.
    Orivuori, L
    National Institute for Health and Welfare, Finland.
    Westerholm-Ormio, M
    Hospital for Children and Adolescents, University of Helsinki,.
    Savilahti, E
    Hospital for Children and Adolescents, University of Helsinki,.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Vaarala, O
    National Institute for Health and Welfare, Finland.
    Up-regulation of small intestinal interleukin-17 immunity in untreated coeliac disease but not in potential coeliac disease or in type 1 diabetes2012In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 167, no 2, 226-234 p.Article in journal (Refereed)
    Abstract [en]

    Up-regulation of interleukin (IL)-17 in small intestinal mucosa has been reported in coeliac disease (CD) and in peripheral blood in type 1 diabetes (T1D). We explored mucosal IL-17 immunity in different stages of CD, including transglutaminase antibody (TGA)-positive children with potential CD, children with untreated and gluten-free diet-treated CD and in children with T1D. Immunohistochemistry was used for identification of IL-17 and forkhead box protein 3 (FoxP3)-positive cells and quantitative polymerase chain reaction (qPCR) for IL-17, FoxP3, retinoic acid-related orphan receptor (ROR)c and interferon (IFN)-γ transcripts. IL-1β, IL-6 and IL-17 were studied in supernatants from biopsy cultures. Expression of the apoptotic markers BAX and bcl-2 was evaluated in IL-17-stimulated CaCo-2 cells. The mucosal expression of IL-17 and FoxP3 transcripts were elevated in individuals with untreated CD when compared with the TGA-negative reference children, children with potential CD or gluten-free diet-treated children with CD (P andlt; 0·005 for all IL-17 comparisons and P andlt; 0·01 for all FoxP3 comparisons). The numbers of IL-17-positive cells were higher in lamina propria in children with CD than in children with T1D (P andlt; 0·05). In biopsy specimens from patients with untreated CD, enhanced spontaneous secretion of IL-1β, IL-6 and IL-17 was seen. Activation of anti-apoptotic bcl-2 in IL-17-treated CaCo-2 epithelial cells suggests that IL-17 might be involved in mucosal protection. Up-regulation of IL-17 could, however, serve as a biomarker for the development of villous atrophy and active CD.

  • 25.
    Lahdenperä, Anne
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Vaarala, Outi
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    The effect of gluten-free diet on Th1--Th2--Th3-associated intestinal immune responses in celiac disease2011In: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, ISSN 0036-5521, Vol. 46, no 5, 538-549 p.Article in journal (Refereed)
    Abstract [en]

    Objective. To study T-helper (Th)1--Th2--Th3 gene activation profile in the small intestine and peripheral blood of children with celiac disease (CD) with special interest in the response to the gluten-free diet (GFD) treatment in order to elucidate an immune dysregulation not triggered by gluten. Material and methods. Small intestinal biopsies and venous blood were taken from seven children with CD (mean age: 8 years, four girls) at presentation and after 1 year of strict GFD. The Th1--Th2--Th3 gene expression profile was examined by real-time PCR arrays. The findings were compared with the corresponding expressions in peripheral blood and small intestinal biopsies from six reference children without CD (mean age: 6 years, four girls). Results. The Th1 gene expression profile including interferon (IFN)-gamma gamma, signal transducer and activator of transcription (STAT) 1 and interferon regulatory factor (IRF) 1 together with reduced interleukin (IL)-2 expression was pronounced in small intestinal biopsies from children with untreated CD. A downregulation of IFN-gamma gamma transcripts was seen after 1 year of GFD, but there was still increased expression of STAT1 and IRF1 in association with low IL-2 expression in spite of eliminated exposure to wheat gluten. By contrast, the decreased intestinal expression of Th2 gene markers observed at presentation was normalized with GFD. The alterations in the mucosal gene expression profile were not reflected in peripheral blood. Conclusion. The GFD did not correct the increased activation of the IFN-gamma gamma signaling pathway related markers and reduced IL-2 expression, suggesting that they represent an immune dysregulation not dependent on gluten exposure.

  • 26.
    Myleus, A.
    et al.
    Umeå University.
    Ivarsson, A.
    Umeå University.
    Webb, C.
    Lund University Hospital.
    Danielsson, L.
    Norrtälje Hospital.
    Hernell, O.
    Umeå University.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Karlsson, E.
    Växjö Hospital.
    Lagerqvist, C.
    Umeå University.
    Norstrom, F.
    Umeå University.
    Rosen, A.
    Umeå University.
    Sandstrom, O.
    Umeå University.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Stenlund, H.
    Umeå University.
    Wall, S.
    Umeå University.
    Carlsson, A.
    Umeå University.
    Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic2009In: Journal of Pediatric Gastroenterology and Nutrition, ISSN 0277-2116, Vol. 49, no 2, 170-176 p.Article in journal (Refereed)
    Abstract [en]

    Objective:: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases. Patients and Methods:: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease. Results:: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33). Conclusions:: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.

  • 27.
    Myleus, Anna
    et al.
    Umeå University, Sweden .
    Petersen, Solveig
    Umeå University, Sweden Umeå University, Sweden .
    Carlsson, Annelie
    Lund University, Sweden .
    Hammarroth, Solveig
    Norrtalje Hospital, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Ivarsson, Anneli
    Umeå University, Sweden .
    Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study2014In: BMC Public Health, ISSN 1471-2458, Vol. 14, no 425Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge regarding the health-related quality of life (HRQoL) of children with celiac disease remains limited and inconclusive. We investigated the HRQoL of three groups of 12-year-olds with: i) undetected celiac disease ii) clinically diagnosed celiac disease, and iii) without celiac disease. Methods: A school-based cross-sectional multicenter screening study invited 18 325 children, whereof 68% consented to participate. Participants provided a blood sample, which was later analyzed for anti-tissue-tranglutaminase antibodies, and alongside filled in a questionnaire. When anti-tissue-tranglutaminase antibodies were elevated, a small intestinal biopsy verified the screening-detected celiac disease diagnosis. Self-reported HRQoL was measured using Kidscreen, a generic 52 items instrument with proven reliability and validity. Scores were linearly transformed into a 0-100 scale with higher values indicating better HRQoL. Mean values with standard deviations (mean +/- SD) were compared, and uni- and multivariate logistic regression models tested the odds of a low HRQoL among children with undetected or diagnosed celiac disease, respectively. Results: Children with undetected celiac disease (n = 238) reported similar HRQoL as children without celiac disease (n = 12 037) (83.0 +/- 11.0 vs. 82.5 +/- 11.3, P = 0.51), and also similar HRQoL (82.2 +/- 12.2, P = 0.28) to that of children with diagnosed celiac disease (n = 90), of whom 92% were adherent to treatment. Having undetected celiac disease did not increase the odds of low overall HRQoL, independent of sex, area of residence, study year and occurrence of gastrointestinal symptoms (adjusted odds ratio 0.77, 95% CI 0.54-1.10). Comparable results were seen for diagnosed celiac disease cases (adjusted odds ratio 1.11, 95% CI 0.67-1.85). Conclusion: Children with undetected celiac disease reported comparable HRQoL as their peers with diagnosed celiac disease, and those without celiac disease, when reporting prior to receiving the diagnosis through screening. Thus, children with celiac disease, both untreated and diagnosed, perceive their HRQoL as unimpaired by their disease.

  • 28.
    Nordyke, Katrina
    et al.
    Umeå University.
    Myleus, Anna
    Umeå University.
    Ivarsson, Anneli
    Umeå University.
    Carlsson, Annelie
    Lund University Hospital.
    Danielsson, Lars
    Norrtalje Hospital.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Karlsson, Eva
    Växjö Hospital.
    Emmelin, Maria
    Umeå University.
    How do children experience participating in a coeliac disease screening? A qualitative study based on childrens written narratives2010In: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH, ISSN 1403-4948, Vol. 38, no 4, 351-358 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To explore how 12-year-old Swedish children experienced being involved in a coeliac disease (CD) screening. Methods: A qualitative approach was used to analyse short narratives written by children who had taken part in a school-based CD screening. Narratives were written after blood sampling, but prior to learning of the test results. Through an oscillation between the texts, codes, subcategories and four categories, a theme was generated describing the childrens experience. Results: The theme "A Journey towards Confidence" captures the overall experience of the screening. It illustrates that, although some children faced fear or anxiety, overall they had or were provided tools allowing them to cope well and experience a journey towards confidence. The categories describe conditions that contributed to the experience. The first, being involved, reflects the importance of involvement in receiving information and deciding to participate. Being a "good citizen" refers to feeling a duty to help and a trust to be treated fairly. Being able to cope with the screening was influenced by the childrens ability to manage sensations and support received. The last category, being able to balance risk, illustrates that the children were able to balance the risks of screening when they had a realistic understanding of the disease and their vulnerability and had tamed their anxiety. Conclusions: This study increases the understanding of how 12-year-old Swedish children experienced participating in a CD screening and describes conditions important for a positive experience. We show that, although some children faced anxiety, they had, or were provided with, tools allowing them to cope well and gain confidence.

  • 29. Popat, S
    et al.
    Hearle, N
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Braegger, CP
    O'Donoghue, D
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Barn.
    Holmes, GKT
    Howdle, PD
    Jenkins, H
    Johnstone, S
    Kennedy, NP
    Kumar, PJ
    Logan, RFA
    Marsh, MN
    Mulder, CJ
    Torinsson, A
    Sjöberg, Kenneth
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Barn.
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Barn.
    Walters, JRF
    Jewell, DP
    Houlston, RS
    Variation in the CTLA4/CD28 gene region confers an increased risk of coeliac disease2002In: Annals of Human Genetics, ISSN 0003-4800, E-ISSN 1469-1809, Vol. 66, no 2, 125-137 p.Article in journal (Refereed)
    Abstract [en]

    Susceptibility to coeliac disease involves HLA and non-HLA-linked genes. The CTLA4/CD28 gene region encodes immune regulatory T-cell surface molecules and is a strong candidate as a susceptibility locus. We evaluated CTLA4/CD28 in coeliac disease by genetic linkage and association and combined our findings with published studies through a meta-analysis. 116 multiplex families were genotyped across CTLA4/CD28 using eight markers. The contribution of CTLA4/CD28 to coeliac disease was assessed by non-parametric linkage and association analyses. Seven studies were identified that had evaluated the relationship between CTLA4/CD28 and coeliac disease and a pooled analysis of data undertaken. In our study there was evidence for a relationship between variation in the CTLA4/CD28 region and coeliac disease by linkage and association analyses. However, the findings did not attain formal statistical significance (p = 0.004 and 0.039, respectively). Pooling findings with published results showed significant evidence for linkage (504 families) and association (940 families): p values, 0.0001 and 0.0014 at D2S2214, respectively, and 0.0008 and 0.0006 at D2S116, respectively. These findings suggest that variation in the CD28/CTLA4 gene region is a determinant of coeliac disease susceptibility. Dissecting the sequence variation underlying this relationship will depend on further analyses utilising denser sets of markers.

  • 30.
    Rosen, Anna
    et al.
    Umea University.
    Ivarsson, Anneli
    Umea University.
    Nordyke, Katrina
    Umea University.
    Karlsson, Eva
    Vaxjo Hospital.
    Carlsson, Annelie
    Lund University.
    Danielsson, Lars
    Norrtalje Hospital.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Emmelin, Maria
    Umea University.
    Balancing health benefits and social sacrifices: A qualitative study of how screening-detected celiac disease impacts adolescents quality of life2011In: BMC Pediatrics, ISSN 1471-2431, Vol. 11, no 32Article in journal (Refereed)
    Abstract [en]

    Background: Celiac disease often goes undiagnosed. Mass screening might be an option to reduce the public health burden of untreated celiac disease. However, mass screening is still controversial since it is uncertain whether the benefits of early detection outweigh the possible negative consequences. Before implementation of screening programs, the experiences of those being identified as cases should be considered. The aim of our study was to explore how screening-detected celiac disease impacts adolescents quality of life, as perceived by themselves and their parents. Methods: All adolescents (n = 145) with screening-detected celiac disease found in a Swedish screening study, and their parents, were invited to share their experiences in a qualitative follow-up study. In total, we have information on 117 (81%) of the adolescents, either from the adolescents themselves (n = 101) and/or from their parent/s (n = 125). Written narratives were submitted by 91 adolescents and 105 parents. In addition, 14 focus group discussions involving 31 adolescents and 43 parents were conducted. Data was transcribed verbatim and analyzed based on a Grounded Theory framework. Results: The screening-detected celiac disease diagnosis had varying impact on quality of life that related both to changes in perceived health and to the adolescents experiences of living with celiac disease in terms of social sacrifices. Changes in perceived health varied from "healthy as anyone else with no positive change" to "something was wrong and then changed to the better", whereas experiences of living with celiac disease ranged from "not a big deal" to "treatment not worth the price". Perceptions about living with celiac disease and related coping strategies were influenced by contextual factors, such as perceived support from significant others and availability of gluten-free products, and were developed without a direct relation to experiencing changes in perceived health. Conclusions: Screening-detected celiac disease has varying impact on adolescents quality of life, where their perceived change in health has to be balanced against the social sacrifices the diagnosis may cause. This needs to be taken into account in any future suggestion of celiac disease mass screening and in the management of these patients.

  • 31.
    Rosen, Anna
    et al.
    Umeå University, Sweden.
    Sandstrom, Olof
    Umeå University, Sweden.
    Carlsson, Annelie
    Lund University, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Olen, Ola
    Karolinska Institute, Sweden Sachs Children and Youth Hospital, Sweden .
    Stenlund, Hans
    Umeå University, Sweden .
    Ivarsson, Anneli
    Umeå University, Sweden .
    Usefulness of Symptoms to Screen for Celiac Disease2014In: Pediatrics, ISSN 0031-4005, Vol. 133, no 2, 211-218 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the frequency of symptoms and associated conditions among screening-detected celiac disease (CD) cases and non-CD children and to evaluate questionnaire-based case-finding targeting the general population. METHODS: In a population-based CD screening of 12-year-olds, children and their parents completed questionnaires on CD-associated symptoms and conditions before knowledge of CD status. Questionnaire data for those who had their CD detected in the screening (n = 153) were compared with those of children with normal levels of CD markers (n = 7016). Hypothetical case-finding strategies were also evaluated. Questionnaires were returned by 7054 ( 98%) of the children and by 6294 ( 88%) of their parents. RESULTS: Symptoms were as common among screening-detected CD cases as among non-CD children. The frequency of children with screening-detected CD was similar when comparing the groups with and without any CD-related symptoms (2.1% vs 2.1%; P =.930) or CD-associated conditions (3.6% vs 2.1%; P =.07). Case-finding by asking for CD-associated symptoms and/or conditions would have identified 52 cases (38% of all cases) at a cost of analyzing blood samples for 2282 children (37%) in the study population. CONCLUSIONS: The current recommended guidelines for finding undiagnosed CD cases, so-called active case-finding, fail to identify the majority of previously undiagnosed cases if applied in the general population of Swedish 12- year-olds. Our results warrant further studies on the effectiveness of CD case-finding in the pediatric population, both at the clinical and population-based levels.

  • 32.
    Sjöberg, Veronika
    et al.
    Department of Clinical Microbiology, Immunology, Umeå University, Umeå, Sweden.
    Hollén, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Pietz, Grzegorz
    ology, Immunology, Umeå University, Umeå, Sweden.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sundström, Mia
    Department of Clinical Microbiology, Immunology, Umeå University, Umeå, Sweden.
    Holmgren Peterson, Kajsa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Sandström, Olof
    Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
    Hernell, Olle
    Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
    Hammarström, Sten
    Department of Clinical Microbiology, Immunology, Umeå University, Umeå, Sweden.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Hammarström, Marie-Louise
    Department of Clinical Microbiology, Immunology, Umeå University, Umeå, Sweden.
    Noncontaminated dietary oats may hamper normalization of the intestinal immune status in childhood celiac disease.2014In: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 5, no e58Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Life-long, strict gluten-free diet (GFD) is the only treatment for celiac disease (CD). Because there is still uncertainty regarding the safety of oats for CD patients, the aim was to investigate whether dietary oats influence the immune status of their intestinal mucosa.

    METHODS: Paired small intestinal biopsies, before and after >11 months on a GFD, were collected from children with CD who were enrolled in a randomized, double-blind intervention trial to either of two diets: standard GFD (GFD-std; n=13) and noncontaminated oat-containing GFD (GFD-oats; n=15). Expression levels of mRNAs for 22 different immune effector molecules and tight junction proteins were determined by quantitative reverse transcriptase (RT)-PCR.

    RESULTS: The number of mRNAs that remained elevated was higher in the GFD-oats group (P=0.05). In particular, mRNAs for the regulatory T cell (Treg) signature molecules interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1), the cytotoxicity-activating natural killer (NK) receptors KLRC2/NKG2C and KLRC3/NKG2E, and the tight junction protein claudin-4 remained elevated. Between the two groups, most significant differences were seen for claudin-4 (P=0.003) and KLRC3/NKG2E (P=0.04).

    CONCLUSIONS: A substantial fraction of pediatric CD patients seem to not tolerate oats. In these patients, dietary oats influence the immune status of the intestinal mucosa with an mRNA profile suggesting presence of activated cytotoxic lymphocytes and Tregs and a stressed epithelium with affected tight junctions. Assessment of changes in levels of mRNA for claudin-4 and KLC3/NKG2E from onset to after a year on oats containing GFD shows promise to identify these CD patients.

  • 33.
    Stenhammar, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Ascher, Henry
    Avd för Pediatrik, Sahlgrenska sjukhuset Göteborg.
    Danneus, Anders
    Avd för Pediatrik, Universitetssjukhuset, Uppsala .
    Hernell, Olle
    Avd för Pediatrik, Universitetssjukhuset, Umeå .
    Ivarsson, Anneli
    Avd för Pediatrick, Universitetssjukhuset, Umeå .
    Lindberg, Eva
    Avd för Pediatrik, Universitetssjukhuset, Örebro .
    Lindquist, Bo
    Barnmottagningen, Odenplan, Stockholm .
    Nivenius, Kerstin
    Avd för Pediatrik, Universitetssjukhuset, Lund .
    How do Swedish paediatric clinics diagnose coeliac disease? Results of a nationwide questionnaire study2006In: Acta Paediatrica, ISSN 0803-5253, Vol. 95, no 11, 1495-1497 p.Article in journal (Refereed)
    Abstract [en]

    Background and aim: Diagnosis of coeliac disease is based on the demonstration of enteropathy in a small bowel biopsy. Correct diagnosis is of utmost importance, since the need for dietary management is life long, and inadequate treatment may lead to potentially serious complications. The Swedish Working Group for Paediatric Coeliac Disease has published guidelines for the diagnosis of childhood coeliac disease. The present questionnaire was designed in order to create the basis for revision of those guidelines. Methods: In 2004, a nationwide questionnaire concerning current diagnostic routines was sent to all 45 paediatric clinics performing small bowel biopsy. All clinics responded. Results: All clinics base their diagnosis on small bowel biopsy findings at presentation. Furthermore, in 24 (53%) of the clinics, children with suspected coeliac disease are investigated by small bowel biopsy both at presentation and follow-up while on a gluten-free diet. Eighteen (40%) of the clinics employ a different diagnostic routine for children under 2 y of age than for those older than 2 y. All clinics use coeliac serological testing at various stages of the diagnostic procedure. Conclusion: All Swedish paediatric clinics perform a small bowel biopsy at presentation in children with suspected coeliac disease, and the majority of clinics perform a second biopsy when the child is on a gluten-free diet. Serological testing is frequently used as a diagnostic aid and in the monitoring of the disease while on a gluten-free diet. © 2006 Taylor & Francis.

  • 34.
    Stenhammar, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Hallert, Claes
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies. Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Genmodifierade sädesslag - alternativ för patienter med celiaki2006In: Läkartidningen, ISSN 0023-7205, Vol. 103, no 10, 740-740 p.Article in journal (Other academic)
  • 35.
    Stenhammar, Lars
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Ivarsson, Anneli
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Laurin, Pia
    Myléus, Anna
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Letter: Coeliac disease and socio-economic status2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 8, e328- p.Article in journal (Refereed)
  • 36.
    Stenhammar, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Nordwall, Maria
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Strömberg, Leif
    Barnkliniken, Vrinnevisjukhuset, Norrköping.
    Moderate dose inhaled budesonide disguising symptoms of Addison's disease in an asthmatic boy with silent celiac disease2005In: Journal of pediatric pharmacology and therapeutics, ISSN 1551-6776, Vol. 10, no 3, 108-111 p.Article in journal (Refereed)
  • 37.
    Sundqvist, Tommy
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Tjellström, Bo
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Karolinska Institute, Sweden.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Forslund, Tony
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Oral immunoglobulin treatment improved intestinal permeability in children with active Crohns disease2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 4, 647-653 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Crohns disease (CD) is a chronic mucosal inflammation that affects the intestinal barrier function, for example, by altering the intestinal permeability. This pilot clinical study investigated the impact of oral human immunoglobulin (OHIG) treatment on permeability characteristics in children with active luminal Crohns disease. Methods: The study was performed at the Department of Paediatrics, Norrkoping Hospital, Sweden. Intestinal permeability was studied in three boys aged 13, 15 and 18 years with active CD, before and after a six-week treatment programme with OHIG, using different-sized polyethylene glycols as the test molecules. Three age-and sex-matched children with active CD treated with exclusive enteral nutrition (EEN) were also studied. Results: OHIG and EEN resulted in virtually similar reductions in the signs and symptoms of mucosal inflammation. However, OHIG, unlike EEN, appeared to normalise mucosal transfer leading to a normalisation of the maximum permeation of the small PEG molecules, as well as less restrictions of the larger PEG molecules. Conclusion: Our study found that OHIG appeared to normalise the mucosal barrier. This suggests that it could offer a new additional and versatile treatment for paediatric CD patients, with a minimal risk of adverse effects.

  • 38.
    Tapsas, Dimitrios
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Forslund, Tony
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Hollén, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Urinary nitric oxide metabolites in children with celiac disease after long-term consumption of oats-containing gluten-free diet2014In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 49, no 11, 1311-1317 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Oats are accepted in the gluten-free diet (GFD) for children with celiac disease (CD). Some reports have indicated, however, that not all celiac patients tolerate oats. We have previously shown that some children still have high levels of urinary nitric oxide (NO) metabolites as markers of intestinal inflammation after 1 year on GFD with oats. In this study, we measured urinary NO metabolites in CD children who had been consuming oats-containing GFD for an extended, 2-6-year period, also taking into consideration ordinary consumption of nitrite/nitrate-rich foods close to the urine sampling. Materials and Methods. Morning urinary nitrite/nitrate concentrations were measured in 188 pediatric CD patients. A questionnaire was used to elucidate factors possibly affecting the urinary levels, for example, dietary factors, asthma, or urinary tract infection. Results. Oats were consumed by 89.4% of the patients for a median time of 3 years. The median nitrite/nitrate level was 980 mu M. The majority (70.2%) who consumed oats had low levels of urinary nitrite/nitrate, that is, less than 1400 mu M, while 29.8% demonstrated high levels, that is, greater than 1400 mu M. Nitrite/nitrate-rich foods did not significantly influence the urinary concentrations. Conclusion. The urinary levels of NO metabolites revealed two subpopulations, one with high and one with low levels. The high levels could be possibly due to poor adherence to the GFD, sensitivity to oats, or some unknown factor(s). Nitrate-rich foods, asthma, or urinary tract infection did not affect the result. The elevated levels of NO metabolites could indicate mucosal inflammation and pinpoint the need of careful follow-up of children on oats-containing GFD.

  • 39.
    Tapsas, Dimitrios
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Hammersjö, Jan-Åke
    Västervik Hospital, Sweden.
    Hollén, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Swedish children with celiac disease comply well with a gluten-free diet, and most include oats without reporting any adverse effects: a long-term follow-up study2014In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 34, no 5, 436-441 p.Article in journal (Refereed)
    Abstract [en]

    The only known treatment for celiac disease is a gluten-free diet (GFD), which initially meant abstention from wheat, rye, barley, and oats. Recently, oats free from contamination with wheat have been accepted in the GFD. Yet, reports indicate that all celiac disease patients may not tolerate oats. We hypothesized that celiac children comply well with a GFD and that most have included oats in their diet. A food questionnaire was used to check our patients; 316 questionnaires were returned. Mean time on the GFD was 6.9 years, and 96.8% of the children reported that they were trying to keep a strict GFD. However, accidental transgressions occurred in 263 children (83.2%). In 2 of 3 cases, mistakes took place when the patients were not at home. Symptoms after incidental gluten intake were experienced by 162(61.6%) patients, mostly (87.5%) from the gastrointestinal tract. Small amounts of gluten (less than4 g) caused symptoms in 38% of the cases, and 68% reported symptoms during the first 3 hours after gluten consumption. Oats were included in the diet of 89.4% of the children for a mean of 3.4 years. Most (81.9%) ate purified oats, and 45.3% consumed oats less than once a week. Among those who did not consume oats, only 5.9% refrained because of symptoms. General compliance with the GFD was good. Only the duration of the GFD appeared to influence adherence to the diet. Most patients did not report adverse effects after long-term consumption of oats.

  • 40.
    Tjellstrom, B.
    et al.
    Karolinska Institute, Sweden Norrkoping Hospital, Sweden .
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Hollén, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Norin, E.
    Karolinska Institute, Sweden .
    Midtvedt, T.
    Karolinska Institute, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    The effects of oats on the function of gut microflora in children with coeliac disease2014In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 39, no 10, 1156-1160 p.Article in journal (Refereed)
    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.

  • 41.
    Tjellstrom, Bo
    et al.
    Karolinska Institute, Sweden Norrkoping Hospital, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Midtvedt, Tore
    Karolinska Institute, Sweden .
    Norin, Elisabeth
    Karolinska Institute, Sweden .
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Effect of exclusive enteral nutrition on gut microflora function in children with Crohns disease2012In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 47, no 12, 1454-1459 p.Article in journal (Refereed)
    Abstract [en]

    Objective. Exclusive enteral nutrition (EEN) is a first-line treatment in children with active Crohns disease (CD) but is seldom used in adults with active disease. The mode of action of EEN in suppressing mucosa] inflammation is not fully understood, but modulation of intestinal microflora activity is one possible explanation. The aim of this study was to investigate the effect of 6-week EEN in children with active CD, with special reference to intestinal microflora function. Materials and methods. Fecal samples from 18 children (11 boys, 7 girls; median age 13.5 years) with active CD (13 children with small bowel/colonic and 5 with perianal disease) were analyzed for short chain fatty acid (SCFA) pattern as marker of gut microflora function. The children were studied before and after EEN treatment. Results from 12 healthy teenagers were used for comparison. Results. Eleven (79%) of the children with small bowel/colonic CD responded clinically positively to EEN treatment showing decreased levels of pro-inflammatory acetic acid as well as increased concentrations of anti-inflammatory butyric acids and also of valeric acids, similar to the levels in healthy age-matched children. In children with active perianal CD, however, EEN had no positive effect on clinical status or inflammatory parameters. Conclusions. The authors present new data supporting the hypothesis that the well-documented anti-inflammatory effect of EEN in children with active small bowel/colonic CD is brought about by modulation of gut microflora activity, resulting in an anti-inflammatory SCFA pattern. By contrast, none of the children with perianal disease showed clinical or biochemical improvement after EEN treatment.

  • 42.
    Tjellstrom, Bo
    et al.
    Karolinska Institute, Sweden.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. County Council Ostergotland, Sweden.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. County Council Ostergotland, Sweden.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Midtvedt, Tore
    Karolinska Institute, Sweden.
    Norin, Elisabeth
    Karolinska Institute, Sweden.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Letter: A Role for Bacteria in Celiac Disease? in DIGESTIVE DISEASES AND SCIENCES, vol 61, issue 7, pp 2140-21402016In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 61, no 7, 2140-2140 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 43.
    Tjellström, Bo
    et al.
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Magnusson, Karl-Erik
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Norin, Elisabeth
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
    Midtvedt, Tore
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.
    Faecal short-chain fatty acid pattern in childhood coeliac disease is normalised after more than one year's gluten-free diet2013In: Microbiological Ecology in Health and Disease, ISSN 0891-060X, E-ISSN 1651-2235, Vol. 24Article in journal (Refereed)
    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.

  • 44.
    Tjellström, Bo
    et al.
    Dept of Microbiology KS, Stockholm.
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Magnusson, Karl-Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Midtvedt, Tore
    Dept of Microbiology KS, Stockholm.
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Houlston, Richard
    Section of Cancer Genetics Inst of Cancer Research, Sutton, UK.
    Popat, Sanjay
    Section of Cancer Genetics Inst of Cancer Research, Sutton, UK.
    Norin, Elisabeth
    Dept of Microbiology KS, Stockholm.
    Gut microflora associated characteristics in first-degree relatives of children with celiac disease2007In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 42, no 10, 1204-1208 p.Article in journal (Refereed)
    Abstract [en]

    Objective. In celiac disease (CD), enteropathy of the small bowel results from a T-cell-mediated reaction to gluten in the diet. In addition to gluten, other environmental and genetic factors participate in the disease pathogenesis. We have recently reported the finding of a significantly different short-chain fatty acid (SCFA) profile in fecal samples from children with CD compared to healthy controls reflecting an aberrant gut microflora. The aim of the present study was to make a functional evaluation of the gut microflora status in non-celiac 1st degree relatives of children with CD. Material and methods. Fecal samples from 76 symptom-free, non-celiac, 1st degree CD relatives and from 91 aged-matched healthy controls were analyzed for fecal tryptic activity (FTA) and a number of SCFAs. Results. There was a significantly lower level of acetic acid and total SCFAs as well as a significantly increased level of i-butyric acid and FTA in relatives compared to healthy controls. Conclusions. The FTA and the SCFA profiles in fecal samples from 1st degree relatives of children with CD are different from those of healthy individuals. The implication of this observation provides insight into the pathogenesis of CD and opens up the possibility of future new diagnostic, therapeutic and prophylactic strategies. © 2007 Taylor & Francis.

  • 45.
    Tjellström, Bo
    et al.
    Microbiology and Tumour biology center, Karolinska Institutet, Stockholm.
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Högberg, Lotta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Fälth-Magnusson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Magnusson, Karl-Eric
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Midtvedt, Tore
    Microbiology and Tumour biology center, Karolinska Institutet, Stockholm.
    Sundqvist, Tommy
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Medical Microbiology.
    Norin, E
    Microbiology and Tumour biology center, Karolinska Institutet, Stockholm.
    Gut microflora associated characteristics in children with celiac disease2005In: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 100, no 12, 2784-2788 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to investigate the metabolic function of intestinal microflora in children with celiac disease (CD) in order to find out if there is a deviant gut flora in CD patients compared to healthy controls. METHODS: The study group comprised children with CD, consecutively diagnosed according to current criteria given by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition. Thirty-six children were studied at presentation, i.e., on a normal gluten-containing diet, with clinical symptoms and signs indicative of CD, positive celiac serology markers, and a small bowel biopsy showing severe enteropathy. Forty-seven patients were studied when they had been on a gluten-free diet (GFD) for at least 3 months. For comparison, a group of 42 healthy controls (HC) were studied. The functional status of the intestinal microflora was evaluated by gas-liquid chromatography of short chain fatty acids (SCFAs) in fecal samples. RESULTS: There was a significant difference between untreated CD children and HC as well as between treated CD children and HC regarding acetic, i-butyric, i-valeric acid, and total SCFAs. The propionic and n-valeric acids differed significantly between CD children on GFD and HC. Moreover, there was a strong correlation between i-butyric and i-valeric acids in all study groups. CONCLUSIONS: This is the first study of the SCFA pattern in fecal samples from children with CD. The results indicate that there is a difference in the metabolic activity of intestinal microbial flora in children with CD compared to that in HC. The finding of a different pattern of some SCFAs in celiacs both at presentation and during treatment with GFD indicates that it is a genuine phenomenon of CD not affected by either the diet, the inflammation, or the autoimmune status of the patient. © 2005 by Am. Coll. of Gastroenterology Published by Blackwell Publishing.

  • 46.
    Tjellström, Bo
    et al.
    Karolinska Institute.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Norrköping.
    Fälth-Magnusson, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Midtvedt, Tore
    Karolinska Institute.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology . Linköping University, Faculty of Health Sciences.
    Norin, Elisabeth
    Karolinska Institute.
    Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics2010In: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, ISSN 0036-5521, Vol. 45, no 9, 1059-1062 p.Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to investigate the metabolic function of intestinal microflora in children with screening-detected celiac disease (CD) to see if there is an aberrant gut flora in screening-detected CD similar to symptomatic CD and contrary to healthy controls. Materials and methods. As part of a Swedish multicenter screening for CD, 912 12-year-old children were screened with serum anti-human tissue transglutaminase-IgA. Small bowel biopsy specimens from children with positive serology revealed 17 individuals with CD. The functional status of the intestinal microflora was evaluated by gas liquid chromatography of short chain fatty acids (SCFAs) in fecal samples. Our previously published findings in children with symptomatic CD and healthy controls were used as comparison. Results. The children with screening-detected CD had a similar fecal SCFA profile to children with symptomatic CD, but differed significantly from that in healthy children. Conclusions. This is the first study on SCFA patterns in fecal samples from children with screening-detected CD. The similarity of the fecal SCFA profile in screening-detected and symptomatic CD indicates common pathogenic mechanisms. This could open the way for new therapeutic or prophylactic measures based on novel biological principles.

  • 47.
    Tjellström, Bo
    et al.
    Karolinska Institute, Sweden.
    Stenhammar, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Magnusson, Karl-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Midtvedt, Tore
    Karolinska Institute, Sweden.
    Norin, Elisabeth
    Karolinska Institute, Sweden.
    Sundqvist, Tommy
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    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-E42015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 61, no 1, E4-E4 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 48.
    Van der Pals, Maria
    et al.
    Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Ivarsson, Anneli
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Norström, Fredrik
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Svensson, Johan
    Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Carlsson, Annelie
    Department of Pediatrics, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Prevalence of thyroid autoimmunity in children with celiac disease compared to healthy 12-year olds2014In: Autoimmune Diseases, ISSN 2090-0430, Vol. 2014, no 417356Article in journal (Refereed)
    Abstract [en]

    Objectives. Studies have suggested a correlation between untreated celiac disease and risk for other autoimmune diseases. We investigated the prevalence of thyroid autoimmunity in 12-year-old children (i) with symptomatic celiac disease diagnosed and treated with a gluten-free diet, (ii) with screening-detected untreated celiac disease, and (iii) without celiac disease. Methods. Blood samples from 12632 children were collected. All celiac disease cases, previously diagnosed and newly screening-detected, were identified. Per case, 4 referents were matched. Blood samples were analyzed for autoantibodies against thyroid peroxidase (TPOAb). The cut-off value for TPO positivity was set to 100 U/mL. Results. Altogether, 335 celiac disease cases were found. In the entire celiac disease group, 7.2% (24/335) had elevated titers of TPOAb compared to 2.8% (48/1695) of the referents. Among the previously diagnosed celiac disease cases, 7.5% (7/93, OR 2.8, 95% CI 1.2-6.4) was TPOAb positive and among screening-detected cases, 7.0% (17/242, OR 2.6, 95% CI 1.5-4.6) was TPOAb positive. Conclusion. Children with celiac disease showed a higher prevalence of thyroid autoimmunity. We could not confirm the hypothesis that untreated celiac disease is associated with increased risk of developing thyroid autoimmunity. Early initiation of celiac disease treatment might not lower the risk for other autoimmune diseases.

  • 49.
    van der Pals, Maria
    et al.
    Lund University, Sweden .
    Myleus, Anna
    Umeå University, Sweden .
    Norström, Fredrik
    Umeå University, Sweden .
    Hammarroth, Solveig
    Norrtälje Hospital, Sweden .
    Högberg, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Rosen, Anna
    Umeå University, Sweden .
    Ivarsson, Anneli
    Umeå University, Sweden .
    Carlsson, Annelie
    Lund University, Sweden .
    Body mass index is not a reliable tool in predicting celiac disease in children2014In: BMC Pediatrics, ISSN 1471-2431, Vol. 14, no 165Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Untreated celiac disease is traditionally believed to be associated with malabsorption and underweight. However, studies describing body mass index (BMI) in individuals at the time of diagnosis have shown contradictory results. We investigated the differences in weight, height, and BMI in 12- year-old children with screening-detected celiac disease compared to their healthy peers.

    METHODS:

    In a population-based screening study of 12,632 12-year-old children, blood samples were analyzed for markers of celiac disease. Children with elevated markers were referred for a small bowel biopsy. Weight and height were measured in 239 out of 242 children with screening-detected celiac disease (57.3% girls) and in 12,227 children without celiac disease (48.5% girls). BMI was categorized according to the International Obesity Task Force. Age- and sex-specific cut-off points for underweight, normal weight, and overweight were used.

    RESULTS:

    Children with celiac disease weighed less and were shorter than their peers (median weight 45.2 kg, interquartile range (IQR) 40.2-52.2 kg vs. 47.0 kg, IQR 41.1-54.4 kg, respectively, p = 0.01; median height 156.5 cm, IQR 151.0-162.0 cm vs. 157.5 cm, IQR 152.0-163.0 cm, respectively, p = 0.04). In comparing those with celiac disease to their healthy peers, 4.2% vs. 5.2% were underweight, 82.0% vs. 72.8% were normal weight, and 13.8% vs. 21.9% were overweight, respectively. There was no association between being underweight and the risk of having undiagnosed celiac disease (Odds ratio (OR) 1.3, 95% CI 0.7-2.4), but the risk was significantly lower among overweight children (OR 0.56, 95% CI 0.4-0.8). Median BMI was slightly lower among the children with screening-detected celiac disease compared to their healthy peers (18.6 kg/m2, IQR 17.1-19.8 kg/m2 vs. 18.8 kg/m2, IQR 17.2-21.1 kg/m2, respectively, p = 0.05), but most of the celiac disease cases had a normal BMI.

    CONCLUSIONS:

    At a population level, children with celiac disease weigh less, are shorter, and have a lower BMI compared to their peers without celiac disease, and this emphasizes the importance of early recognition and treatment of the condition. However, at an individual level, growth parameters are not reliable in establishing the diagnosis.

  • 50.
    Webb, Charlotta
    et al.
    Lund University, Sweden.
    Myleus, Anna
    Umeå University, Sweden.
    Norstrom, Fredrik
    Umeå University, Sweden.
    Hammarroth, Solveig
    Norrtalje Hospital, Sweden.
    Högberg, Lotta
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Lagerqvist, Carina
    Umeå University, Sweden.
    Rosen, Anna
    Umeå University, Sweden.
    Sandstrom, Olof
    Umeå University, Sweden.
    Stenhammar, Lars
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Ivarsson, Anneli
    Umeå University, Sweden.
    Carlsson, Annelie
    Lund University, Sweden.
    High Adherence to a Gluten-Free Diet in Adolescents With Screening-Detected Celiac Disease2015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 1, 54-59 p.Article in journal (Refereed)
    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.

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