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Biomedical subjects

Robert Löfberg

Publications and source records attributed to Robert Löfberg.

9 recordsLinked to original sources
PubMed2005

Budesonide for maintenance of remission in patients with Crohn's disease in medically induced remission: a predetermined pooled analysis of four randomized, double-blind, placebo-controlled trials.

OBJECTIVES: To evaluate the efficacy and safety of oral budesonide for maintenance of remission in patients with mild to moderately active Crohn's disease (CD) of the ileum and/or ascending colon. METHODS: Four double-blind, placebo-controlled trials with identical protocols were combined according to a predetermined analysis plan. Three hundred eighty patients with CD in medically induced remission (CD activity index [CDAI]< or =150) were randomized to receive oral budesonide 3 mg, 6 mg, or placebo daily for 12 months. The primary outcome measure was time to relapse (increase in CDAI of 60 points above baseline and >150). RESULTS: The median time to relapse was 268, 170, and 154 days for budesonide 6 mg, budesonide 3 mg, and placebo groups, respectively (p= 0.0072). The frequency of adverse events and glucocorticosteroid side effects were similar in all groups. CONCLUSION: Budesonide 6 mg/day is effective for prolonging time to relapse and for significantly reducing rates of relapse at 3 and 6 months but not 12 months in patients with CD in medically induced remission.

Adolescent↗
PubMed2004

Pouchitis.

PURPOSE OF REVIEW: Total proctocolectomy with ileal pouch-anal anastomosis has become the preferred surgical procedure for ulcerative colitis. Although most patients report a good functional outcome and significant improvement in their quality of life after ileal pouch-anal anastomosis, pouchitis remains the most common long-term complication. This review highlights significant reports on the diagnosis, treatment, and complications of pouchitis in former ulcerative colitis. RECENT FINDINGS: The diagnosis of pouchitis is based on clinical symptoms including increased stool frequency, urgency, rectal bleeding, abdominal cramping, or pelvic discomfort and should be verified by typical findings at endoscopy. Antibiotics such as metronidazole and ciprofloxacin are effective treatments for acute attacks of pouchitis, and for those patients with recurrent or chronic refractory pouchitis, prophylactic therapy with long-term use of the VSL#3 combination of probiotics has now been proved to be highly effective in controlled trials. Most patients with an ileal pouch-anal anastomosis experience a good quality of life, and the risk for removal of the pelvic pouch because of intractable pouchitis is low. Previous reports of neoplastic transformation in certain subgroups of pouch patients have not been substantiated. SUMMARY: Pouchitis is in important clinical entity among ulcerative colitis patients having undergone ileal pouch-anal anastomosis. Diagnosis has become more straightforward, and treatment modalities encompass a variety of remedies, including probiotics. The long-term prognosis is good, and the risk of malignant transformation appears to be very low.

Journal Article↗
PubMed2004

Anxiety, functional health status, and coping ability in patients with ulcerative colitis who are undergoing colonoscopic surveillance.

BACKGROUND: Patients with long-standing extensive ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). High-risk UC patients are nowadays enrolled in surveillance programs to decrease CRC incidence and mortality, although little is known about patients' concerns and anxiety when subjected to colonoscopic surveillance. The aims of this study were to evaluate functional health status, general state of health, anxiety, and coping ability in patients with UC taking part in such a program in a university hospital setting. METHODS: Forty-one patients with long-standing, extensive/total UC in remission (median disease duration, 21.0 years) undergoing surveillance comprised the study group. Twenty patients with extensive disease but with shorter disease duration (median, 8.0 years) and 19 patients with only distal involvement UC acted as controls. Four different self-administered questionnaires (SAQs) were used. The SAQ assessments were made twice in the study group and once in the controls. RESULTS: No statistically significant differences were found in any of the SAQ assessments. The median scores obtained were well within the ranges seen in normal healthy subjects. CONCLUSIONS: Colonoscopic surveillance in long-standing UC does not seem to generate increased anxiety or impairment of functional or general health status among participating patients. Rather, UC patients in clinical remission seem to cope just as well as healthy individuals irrespective of the CRC risk or surveillance procedures.

Adaptation, Psychological↗
PubMed2002

Cancer risk assessment in long-standing pouchitis. DNA aberrations are rare in transformed neoplastic pelvic pouch mucosa.

BACKGROUND: In a small subgroup of patients with ulcerative colitis (UC) undergoing proctocolectomy and restorative ileal pouch-anal anastomosis (IPAA), a colonic-like pouch mucosa with severe and persistent villous atrophy (type C pattern) develops. Neoplastic transformation of the mucosa in the neorectum may occur in these patients. We hypothesized that genetic alterations associated with colorectal carcinoma (CRC) could be an early finding in this transformational process and thus potentially useful as clinical monitors in carcinoma risk assessment. METHODS: In six patients with long-standing severe pouchitis and a type C-pattern mucosa, biopsies were obtained from five different locations of the pouches. DNA was PCR-amplified and analyzed by automated fragment analysis for loss of heterozygosity (LOH) at chromosome 5q14-22, 17p12-13, and 18q12-22. Point mutations of the K-ras and adenomatous polyposis coli (APC) genes were studied by sequencing. RESULTS: The patients had varying degrees of dysplasia and one displayed DNA aneuploidy. Loss of heterozygosity at 5q15-22 was detected in three of five biopsies in one patient. This particular patient had no signs of dysplasia or DNA aneuploidy and a normal exon 15 sequence of the APC gene. No alterations of either the K-ras or the APC genes or LOH of 5q, 17p, or 18q were seen in any of the other patients. CONCLUSION: Dysplasia, aneuploidy, and LOH in 5q may all reflect different parts of an atrophic mucosa-dysplasia-carcinoma sequence, in line with current concepts of carcinogenesis for CRC in long-standing pouchitis. Further studies of histological and molecular events in IPAA patients with severe atrophy are warranted.

Adult↗
PubMed2002

Chronic colitis is associated with a reduction of mucosal alkaline sphingomyelinase activity.

BACKGROUND AND AIMS: The hydrolysis of sphingomyelin (SM) generates key molecules regulating cell growth. Animal cancer studies support an inhibitory role for this pathway in the malignant transformation of the colonic mucosa. The activity of a specific intestinal alkaline sphingomyelinase (SMase), which hydrolyzes SM, is reduced in colorectal tumors. In this study we measured alkaline SMase activity in patients with longstanding colitis and assessed if a reduction can be used as a marker in surveillance of high risk patients. METHODS: Alkaline SMase activity was measured in 139 colonic biopsies from 34 patients with longstanding, extensive colitis and from 11 controls. Fifteen patients had earlier diagnosis of dysplasia or DNA aneuploidy. Alkaline SMase activity was related to histologic dysplasia and DNA aneuploidy assessed by flow cytometry, patient age, and duration of disease. RESULTS: Alkaline SMase activity was significantly lower in the patient group with and without dysplasia compared with controls (p = 0.006). In biopsies, an association was not found between alkaline SMase activity, dysplasia, or DNA ploidy. However, alkaline SMase activity decreased with age both in patients and controls (p = 0.008). CONCLUSIONS: Reduction of alkaline SMase activity seen in colorectal cancer and adenomas is also present in patients with chronic colitis. It is not complementary to dysplasia or DNA-aneuploidy in the identification of high risk patients. The age-associated decrease of alkaline SMase activity seems to be a general phenomenon indicating premature senescence of the mucosa in longstanding colitis.

Adenoma↗
PubMedDate not supplied

Ursodeoxycholic acid treatment in IBD-patients with colorectal dysplasia and/or DNA-aneuploidy: a prospective, double-blind, randomized controlled pilot study.

BACKGROUND & AIMS: There is an increased risk of colorectal carcinoma (CRC) in patients with longstanding, extensive colonic inflammatory bowel disease (IBD). Primary sclerosing cholangitis, family history of CRC, mucosal dysplasia and DNA-aneuploidy are other risk factors. Recently, results from animal studies have shown that the bile acid ursodeoxycholic acid (UDCA) has a favourable impact on experimentally-induced CRC/neoplasia in rats. The aim of this proof of the concept study was to explore the possible preventive/reverting effects of UDCA in patients with colorectal IBD with existing findings of low grade dysplasia and/or DNA-aneuploidy. PATIENTS AND METHODS: Nineteen patients (13 UC, 6 CD, median age 43 years) with long-standing, extensive IBD (median duration 21 years), with previous findings of low-grade dysplasia and/or DNA-aneuploidy, were randomized to receive either UDCA (500 mg b.i.d) (n=10) or placebo (n=9) in a controlled, double-blind, two-year study. Colonoscopy with multiple biopsies for histopathology and for DNA-flow cytometry was performed at the start and at six-month intervals during the study period. The primary outcome was the need for colectomy due to progression of dysplasia. Changes in dysplasia and DNA-aneuploidy scores were also assessed. RESULTS: There were no significant differences in the overall composed score between the two groups, either at study start or during the study period. In the placebo group one patient had a progression of dysplasia into high-grade and one patient developed DALM with low-grade dysplasia; both had a colectomy. In contrast, no UDCA-treated patient had progression of dysplasia. CONCLUSION: UDCA may prevent further progression of manifest low-grade dysplasia in colorectal IBD. Prolonged treatment or an increased dose may be needed to fully exploit the chemopreventive properties of this compound.

Adult↗