60 results on '"Asle W. Medhus"'
Search Results
2. Humoral immune response to SARS-CoV-2 vaccination in patients with inflammatory bowel disease on immunosuppressive medication: association to serum drug levels and disease type
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Kristin Kaasen Jørgensen, Marte Lie Høivik, Adity Chopra, Jūratė Šaltytė Benth, Petr Ricanek, Prof Bjørn Moum, Ingrid Jyssum, Nils Bolstad, David John Warren, Prof John T. Vaage, Prof Ludvig A. Munthe, Prof Knut E.A Lundin, Karoline Anisdahl, Silje Watterdal Syversen, Guro Løvik Goll, Fridtjof Lund-Johansen, Asle W. Medhus, and Prof Jørgen Jahnsen
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Gastroenterology - Abstract
Immune responses following SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD) are not well characterized. The aims of this study were to explore the serological response associated with IBD, and immunosuppressive medications including serum concentrations of biologics and thiopurine metabolites. This prospective, observational study included adult patients with ulcerative colitis (UC) and Crohn’s disease (CD), and healthy controls. Antibodies to the receptor-binding domain of SARS-CoV-2 spike proteins, and serum concentrations of ongoing biologic and immunomodulatory medications were assessed prior to, and 2-5 weeks after the second vaccine dose. Serologic response was defined as anti-Spike antibodies ≥70 AU/ml. In 958 IBD patients (380 UC, 578 CD) and 323 healthy controls, the median (Q1; Q3) anti-Spike antibody level (AU/ml) was lower in patients (618 (192; 4370)) compared to controls (3355 (896; 7849)) (p < 0.001). The antibody levels were lower in CD (439 (174; 3304)) compared to UC (1088 (251; 5975)) (p < 0.001). No associations were demonstrated between antibody levels and serum drug concentrations for TNF inhibitor (TNFi), vedolizumab and ustekinumab. Patients receiving TNFi + thiopurines with a subtherapeutic 6-thioguanine nucleotide (6-TGN) level had higher response rate (93%) compared to patients with 6-TGN within the therapeutic range (53%) (p = 0.003). A diagnosis of UC, mRNA-1273 vaccine, and other treatments than TNFi + thiopurines were associated with humoral response. Patients with CD had an attenuated humoral response to SARS-COV-2 vaccination as compared to patients with UC. The lack of association between serum levels of biologics and serologic response indicates vaccination regardless of proximity to drug administration.
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- 2023
3. Author Correction: Titers of antibodies against ancestral SARS-CoV-2 correlate with levels of neutralizing antibodies to multiple variants
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Trung The Tran, Eline Benno Vaage, Adi Mehta, Adity Chopra, Lisa Tietze, Anette Kolderup, Aina Anthi, Marton König, Gro Nygaard, Andreas Lind, Fredrik Müller, Lise Sofie Nissen-Meyer, Per Magnus, Lill Trogstad, Siri Mjaaland, Arne Søraas, Karsten Midtvedt, Anders Åsberg, Andreas Barratt-Due, Asle W. Medhus, Marte Lie Høivik, Knut Lundin, Randi Fuglaas Karlsen, Reidun Dahle, Karin Danielsson, Kristine Stien Thomassen, Grete Birkeland Kro, Rebecca J. Cox, Fan Zhou, Nina Langeland, Pål Aukrust, Espen Melum, Tone Lise Åvitsland, Kristine Wiencke, Jan Cato Holter, Ludvig A. Munthe, Gunnveig Grødeland, Jan-Terje Andersen, John Torgils Vaage, and Fridtjof Lund-Johansen
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Pharmacology ,Infectious Diseases ,Immunology ,Pharmacology (medical) - Published
- 2023
4. Titers of antibodies against ancestral SARS-CoV-2 correlate with levels of neutralizing antibodies to multiple variants
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Trung The Tran, Eline Benno Vaage, Adi Mehta, Adity Chopra, Lisa Tietze, Anette Kolderup, Aina Anthi, Marton König, Gro Nygaard, Andreas Lind, Fredrik Müller, Lise Sofie Nissen-Meyer, Per Magnus, Lill Trogstad, Siri Mjaaland, Arne Søraas, Karsten Midtvedt, Anders Åsberg, Andreas Barratt-Due, Asle W. Medhus, Marte Lie Høivik, Knut Lundin, Randi Fuglaas Karlsen, Reidun Dahle, Karin Danielsson, Kristine Stien Thomassen, Grete Birkeland Kro, Rebecca J. Cox, Fan Zhou, Nina Langeland, Pål Aukrust, Espen Melum, Tone Lise Åvitsland, Kristine Wiencke, Jan Cato Holter, Ludvig A. Munthe, Gunnveig Grødeland, Jan-Terje Andersen, John Torgils Vaage, and Fridtjof Lund-Johansen
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Pharmacology ,Infectious Diseases ,Immunology ,Pharmacology (medical) - Abstract
Diagnostic assays currently used to monitor the efficacy of COVID-19 vaccines measure levels of antibodies to the receptor-binding domain of ancestral SARS-CoV-2 (RBDwt). However, the predictive value for protection against new variants of concern (VOCs) has not been firmly established. Here, we used bead-based arrays and flow cytometry to measure binding of antibodies to spike proteins and receptor-binding domains (RBDs) from VOCs in 12,000 serum samples. Effects of sera on RBD-ACE2 interactions were measured as a proxy for neutralizing antibodies. The samples were obtained from healthy individuals or patients on immunosuppressive therapy who had received two to four doses of COVID-19 vaccines and from COVID-19 convalescents. The results show that anti-RBDwt titers correlate with the levels of binding- and neutralizing antibodies against the Alpha, Beta, Gamma, Delta, Epsilon and Omicron variants. The benefit of multiplexed analysis lies in the ability to measure a wide range of anti-RBD titers using a single dilution of serum for each assay. The reactivity patterns also yield an internal reference for neutralizing activity and binding antibody units per milliliter (BAU/ml). Results obtained with sera from vaccinated healthy individuals and patients confirmed and extended results from previous studies on time-dependent waning of antibody levels and effects of immunosuppressive agents. We conclude that anti-RBDwt titers correlate with levels of neutralizing antibodies against VOCs and propose that our method may be implemented to enhance the precision and throughput of immunomonitoring.
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- 2022
5. Reply: The mucosal gut signature in primary sclerosing cholangitis before and after liver transplantation. Is the dysbiosis index really predictive for the recurrence of PSC?
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Mikal J. Hole, Kristin K. Jørgensen, Kristian Holm, Peder R. Braadland, Malin H. Meyer-Myklestad, Asle W. Medhus, Dag H. Reikvam, Alexandra Götz, Krzysztof Grzyb, Kirsten M. Boberg, Tom H. Karlsen, Martin Kummen, and Johannes R. Hov
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Hepatology - Published
- 2023
6. First-line biologic treatment of inflammatory bowel disease during the first 12 months after diagnosis from 2010 to 2016: a Norwegian nationwide registry study
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Hans Olav Melberg, Asle W. Medhus, Sandre Svatun Lirhus, Karoline Anisdahl, Bjørn Moum, and Marte Lie Høivik
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medicine.medical_specialty ,education.field_of_study ,Crohn's disease ,business.industry ,Population ,Gastroenterology ,Inflammatory Bowel Diseases ,medicine.disease ,Ulcerative colitis ,Inflammatory bowel disease ,Infliximab ,Crohn Disease ,Internal medicine ,Cohort ,Epidemiology ,Adalimumab ,medicine ,Humans ,Colitis, Ulcerative ,Registries ,business ,education ,Biosimilar Pharmaceuticals ,medicine.drug - Abstract
Objectives The use of biologic therapy in inflammatory bowel disease (IBD) is likely to increase with lower costs and more biologics and biosimilars becoming available. Our aim was to estimate the trends in use of first-line biologics during the first year after diagnosis in a Norwegian IBD population from 2010 to 2016. Methods Data were collected from the Norwegian National Patient Registry and Norwegian Prescription Database. Patients defined as incident IBD cases between 2010 and 2016 were included and followed for 12 months. Patients were stratified by year of diagnosis to examine change over time. Chi-square test was used for calculations on proportions. Time from diagnosis to first biologic was calculated by Kaplan-Meier failure estimates. Results 14,645 patients were included, 5283 (36%) with Crohn’s disease (CD) and 9362 (64%) with ulcerative colitis (UC). In the 2010 and 2016 cohort, the proportion initiating biologics increased from 17% to 33% (p
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- 2021
7. Human Immunodeficiency Virus–Infected Immunological Nonresponders Have Colon-Restricted Gut Mucosal Immune Dysfunction
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Anne Ma Dyrhol-Riise, Marius Trøseid, Malin Holm Meyer-Myklestad, Birgitte Stiksrud, Martin Kummen, Asle W. Medhus, Kristina Berg Lorvik, Johannes R. Hov, Kristian Holm, Dag Henrik Reikvam, Ingebjørg Seljeflot, Dag Kvale, and Simen Hyll Hansen
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CD4-Positive T-Lymphocytes ,biology ,Colon ,Enterocyte ,business.industry ,T cell ,HIV ,Sigmoid colon ,HIV Infections ,Gut flora ,biology.organism_classification ,Immune Dysfunction ,Phenotype ,Infectious Diseases ,medicine.anatomical_structure ,Immune system ,Mucosal immunology ,Immunology ,medicine ,Humans ,Immunology and Allergy ,Intestinal Mucosa ,business ,Immunity, Mucosal - Abstract
Background Human immunodeficiency virus (HIV)–infected immunological nonresponders (INRs) fail to reconstitute their CD4+ T-cell pool after initiation of antiretroviral therapy, and their prognosis is inferior to that of immunological responders (IRs). A prevailing hypothesis is that the INR phenotype is caused by a persistently disrupted mucosal barrier, but assessments of gut mucosal immunology in different anatomical compartments are scarce. Methods We investigated circulating markers of mucosal dysfunction, immune activation, mucosal Th17 and Th22 cells, and mucosa-adherent microbiota signatures in gut mucosal specimens from sigmoid colon and terminal ileum of 19 INRs and 20 IRs in addition to 20 HIV-negative individuals. Results INRs had higher blood levels of the enterocyte damage marker intestinal fatty acid–binding protein than IRs. In gut mucosal biopsies, INRs had lower fractions of CD4+ T cells, higher fractions of interleukin 22, and a tendency to higher fractions of interleukin 17–producing CD4+ T cells. These findings were all restricted to the colon and correlated to circulating markers of enterocyte damage. There were no observed differences in gut microbial composition between INRs and IRs. Conclusions Restricted to the colon, enterocyte damage and mucosal immune dysfunction play a role for insufficient immune reconstitution in HIV infection independent of the gut microbiota.
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- 2020
8. Laser Doppler Flowmetry and Visible Light Spectroscopy of the Gastric Tube During Minimally Invasive Esophagectomy
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Hans Olaf Johannessen, Nathkai Safi, Tom Mala, Asle W. Medhus, and Syed Sajid Hussain Kazmi
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Tube formation ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Public Health, Environmental and Occupational Health ,Ischemia ,Hematology ,General Medicine ,030204 cardiovascular system & hematology ,Anastomosis ,Laser Doppler velocimetry ,Esophageal cancer ,medicine.disease ,Microcirculation ,03 medical and health sciences ,0302 clinical medicine ,Esophagectomy ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Perfusion - Abstract
Introduction Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube's tissue perfusion and circulation. Patients and methods Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test. Results A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%-28%) and 42% (range, 35%-52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks. Conclusion Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.
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- 2020
9. Letter to the Editor regarding the article «Gerd symptoms after laparoscopic Roux-en-Y gastric bypass: an emerging scenario» by Antonella Santonicola, Luigi Ruggiero, Rossella Palma, Luigi Angrisani and Paola Iovino. International Journal of Obesity (2022) 46:1076–1078
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Jolanta Lorentzen, Asle W. Medhus, Dag Hofsø, Marius Svanevik, Birgitte Seip, and Jøran Hjelmesæth
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Nutrition and Dietetics ,Endocrinology, Diabetes and Metabolism ,Gastric Bypass ,Gastroesophageal Reflux ,Humans ,Medicine (miscellaneous) ,Laparoscopy ,Obesity, Morbid - Published
- 2022
10. Titers of antibodies the receptor-binding domain (RBD) of ancestral SARS-CoV-2 are predictive for levels of neutralizing antibodies to multiple variants
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Trung The Tran, Eline Benno Vaage, Adi Mehta, Adity Chopra, Anette Kolderup, Aina Anthi, Marton König, Gro Nygaard, Andreas Lind, Fredrik Müller, Lise Sofie Nissen-Meyer, Per Magnus, Lill Trogstad, Siri Mjaaland, Arne Søraas, Karsten Midtvedt, Anders Åsberg, Andreas Barratt-Due, Asle W. Medhus, Marte Lie Høivk, Knut Lundin, Randi Fuglaas Karlsen, Reidun Dahle, Karin Danielsson, Kristine Stien Thomassen, Grete Birkeland Kro, Rebecca J. Cox, Fan Zhou, Nina Langeland, Pål Aukrust, Espen Melum, Tone Lise Åvitsland, Kristine Wiencke, Jan Cato Holter, Ludvig A. Munthe, Gunnveig Grødeland, Jan-Terje Andersen, John Torgils Vaage, and Fridtjof Lund-Johansen
- Abstract
Diagnostic assays currently used to monitor the efficacy of COVID-19 vaccines measure levels of antibodies to the receptor-binding domain of ancestral SARS-CoV-2 (RBDwt). However, the predictive value for protection against new variants of concern (VOCs) has not been firmly established. Here, we used bead-based arrays and flow cytometry to measure binding of antibodies to spike proteins and receptor-binding domains (RBDs) from VOCs in 12,000 sera. Effects of sera on RBD-ACE2 interactions were measured as a proxy for neutralizing antibodies. The samples were obtained from healthy individuals or patients on immunosuppressive therapy who had received two to four doses of COVID-19 vaccines and from COVID-19 convalescents. The results show that anti-RBDwt titers correlate with the levels of binding- and neutralizing antibodies against the Alpha, Beta, Gamma, Delta, Epsilon and Omicron variants. The benefit of multiplexed analysis lies in the ability to measure a wide range of anti-RBD titers using a single dilution of serum for each assay. The reactivity patterns also yield an internal reference for neutralizing activity and binding antibody units per milliliter (BAU/ml). Results obtained with sera from vaccinated healthy individuals and patients confirmed and extended results from previous studies on time-dependent waning of antibody levels and effects of immunosuppressive agents. We conclude that anti-RBDwt titers correlate with levels of neutralizing antibodies against VOCs and propose that our method may be implemented to enhance the precision and throughput of immunomonitoring.
- Published
- 2022
11. Quality of life in patients with achalasia: Associations with Eckardt score and objective treatment outcomes after peroral endoscopic myotomy
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Helge, Evensen, Marianne Jensen, Hjermstad, Milada, Cvancarova, Vendel, Kristensen, Lene, Larssen, Jorunn, Skattum, Truls, Hauge, Olav, Sandstad, and Asle W, Medhus
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Pharmacology (medical) - Abstract
Background and study aims Knowledge on self-reported quality of life (QoL) in achalasia and QoL improvements after peroral endoscopic myotomy (POEM) is limited. Furthermore, the clinical role of QoL in achalasia follow-up has not been evaluated. The present study aimed to examine QoL in achalasia patients before and after POEM and assess associations between QoL, Eckardt score (ES) and objective results. Patients and methods This was a single-center prospective study of treatment-naïve achalasia patients with 12-month follow-up after POEM including manometry, upper endoscopy, 24-hour pH registration, and timed barium esophagogram. QoL data were registered using European Organisation for Research and Treatment of Cancer core questionnaire (QLQ-C30) and esophageal module (QLQ-OES18). Comparison with a reference population was performed to assess impact of achalasia on QoL and effect of therapy. Mixed models for repeated measures were applied. Results Fifty patients (26 females) with a median age of 47 years (18–76) were included. Before treatment, all QoL domains were significantly impaired compared with an age- and gender-adjusted reference population (P Conclusions Achalasia is associated with severe QoL impairment. Following POEM, a significant and clinically relevant QoL improvement is observed. QoL is associated with ES, but not with objective results after POEM.
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- 2022
12. Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study
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Tor-Ivar Karlsen, Dag Hofsø, Rune Sandbu, Asle W. Medhus, Marius Svanevik, Jøran Hjelmesæth, Ronette L. Kolotkin, Jolanta Lorentzen, Birgitte Seip, Heidi Borgeraas, Daniel Sifrim, and Jens Kristoffer Hertel
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Adult ,medicine.medical_specialty ,endocrine system diseases ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,Population ,030209 endocrinology & metabolism ,Type 2 diabetes ,Asymptomatic ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,education ,education.field_of_study ,Nutrition and Dietetics ,Norway ,business.industry ,Reflux ,nutritional and metabolic diseases ,Heartburn ,Middle Aged ,medicine.disease ,digestive system diseases ,Obesity, Morbid ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Gastroesophageal Reflux ,GERD ,Female ,030211 gastroenterology & hepatology ,Surgery ,medicine.symptom ,business ,Esophagitis - Abstract
Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM. Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry. A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m2, and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m2, were included. The proportions of patients reporting GERD-symptoms were low (
- Published
- 2020
13. A Short Series of Laparoscopic Mesenteric Bypasses for Chronic Mesenteric Ischemia
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Simen Tveten Berge, Mehdi Sahba, Asle W. Medhus, Syed Sajid Hussain Kazmi, and Jon Otto Sundhagen
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Splenic artery ,Revascularization ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Superior mesenteric artery ,Laparoscopy ,medicine.diagnostic_test ,business.industry ,Public Health, Environmental and Occupational Health ,Hematology ,General Medicine ,Perioperative ,Vascular surgery ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Mesenteric ischemia ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Background Laparoscopic aortomesenteric bypass may be performed to treat the chronic mesenteric ischemia patients who are not suitable for endovascular treatment. This study presents an initial experience with a limited series of laparoscopic mesenteric artery revascularization for the treatment of mesenteric ischemia. Methods Chronic mesenteric ischemia (CMI) patients with previous unsuccessful endovascular treatment or with arterial occlusion and extensive calcification precluding safe endovascular treatment were offered laparoscopic mesenteric revascularization. From October 2015 until November 2018, nine patients with CMI underwent laparoscopic revascularization. In addition to demographic data and perioperative results of the treatment, graft patency was assessed with Duplex ultrasound at 1, 3, 6 and 12 months, and annually thereafter. A descriptive analysis of the data was performed. Results All bypasses were constructed with an 8 mm ring enforced expanded polytetrafluoroethylene graft in a retrograde fashion (from infrarenal aorta or iliac artery) to either superior mesenteric artery or splenic artery (2 cases). Median operation time was 356 mins (range 247-492 mins). Five patients had a history of unsuccessful endovascular treatment. Laparoscopic technical success was 78%, and the primary open conversion rate was 22%. All laparoscopic revascularization procedures remained patent after discharge during a median follow-up time of 26 months (range 18-49 months). The primary graft patency at 30 days was 78%. Primary assisted, and secondary graft patency was 78% and 100%, respectively. Median weight gain was 2 kg (range 2-18 kg), and all patients achieved relief from postprandial pain and nausea. No mortality was observed during the follow-up period. Conclusion Laparoscopic aortomesenteric revascularization procedures for chronic mesenteric ischemia are feasible but require careful patient selection. These procedures should only be performed at referral centers by vascular surgeons with prior experience in laparoscopic vascular surgery.
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- 2020
14. Probiotics to HIV-Infected Immunological Nonresponders: Altered Mucosal Immunity and Microbial Diversity Restricted to Ileum
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Simen Hyll Hansen, Malin Holm Meyer-Myklestad, Martin Kummen, Birgitte Stiksrud, Dag Henrik Reikvam, Kristina Berg Lorvik, Ingebjørg Seljeflot, Marius Trøseid, Dag Kvale, Johannes R. Hov, Asle W. Medhus, Kristian Holm, and Anne Margarita Dyrhol-Riise
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CD4-Positive T-Lymphocytes ,Microbial diversity ,Probiotics ,Ileum ,HIV Infections ,Biology ,Infectious Diseases ,medicine.anatomical_structure ,Hiv infected ,RNA, Ribosomal, 16S ,Immunology ,medicine ,Humans ,Pharmacology (medical) ,Intestinal Mucosa ,Mucosal immunity ,Immunity, Mucosal - Abstract
HIV-infected immunological nonresponders (INRs) have increased risk of non-AIDS morbidity and compromised gut barrier immunity. Probiotics are widely used to improve health. We assessed the effects of probiotics in INRs with a comprehensive analysis of gut immunity and microbiome in terminal ileum and sigmoid colon.The study involved clinical intervention with five-strain probiotic capsules (1.2 × 1010 CFUs/d) for 8 weeks in 20 INRs with CD4+ T-cell counts400 cells/µL and plasma HIV RNA50 copies/mL for more than 3.5 years. Colonoscopy with sampling of gut biopsies from terminal ileum and sigmoid colon and fecal and blood sampling were performed before and after the intervention. Flow cytometry (cytokine production, immune activation, and exhaustion), ELISA (inflammation, microbial translocation, and enterocyte damage), and 16S rRNA sequencing analyses were applied.In the terminal ileum, increased alpha diversity, increased abundance of Bifidobacterium sp., and decreased frequencies of IL-22+ CD4+ T cells were observed. The increased abundance of Bifidobacterium sp. in the terminal ileum correlated with increased fraction of CD4+ T cells in the same compartment (r = 0.54, P = 0.05) and increased CD4/CD8 ratio in peripheral blood (r = 0.49, P = 0.05). There were no corresponding changes in the sigmoid colon and no changes in fecal microbiome. Probiotic intervention did not affect peripheral blood CD4 count, viral load, or soluble markers of inflammation and microbial translocation.Probiotics induced segment-specific changes in the terminal ileum but did not affect systemic CD4 counts in INRs. Further clinical studies are warranted to recommend probiotics to INRs.
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- 2021
15. Real world data on effectiveness, safety and therapeutic drug monitoring of vedolizumab in patients with inflammatory bowel disease. A single center cohort
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Bjørn Moum, Marte Lie Høivik, Asle W. Medhus, David J. Warren, Milada Cvancarova, Nils Bolstad, and Lydia C T Buer
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Antibodies, Monoclonal, Humanized ,Single Center ,Inflammatory bowel disease ,Vedolizumab ,Hemoglobins ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Aged ,Crohn's disease ,medicine.diagnostic_test ,Norway ,Tumor Necrosis Factor-alpha ,business.industry ,Remission Induction ,Gastroenterology ,Middle Aged ,Inflammatory Bowel Diseases ,medicine.disease ,Ulcerative colitis ,Clinical trial ,C-Reactive Protein ,Treatment Outcome ,Therapeutic drug monitoring ,030220 oncology & carcinogenesis ,Cohort ,Female ,030211 gastroenterology & hepatology ,Drug Monitoring ,business ,Biomarkers ,medicine.drug - Abstract
The efficacy of vedolizumab (VDZ) has been demonstrated in clinical trials. The aim of this report is to evaluate the long-term effectiveness and safety of VDZ in a real-world cohort and to explore possible associations between concentration measurements of VDZ and treatment effectiveness.This is a prospective clinical follow-up including all adult patients with ulcerative colitis (UC) and Crohn's disease (CD) treated with VDZ from October 2014 until September 2017 at a single center in Norway. The patients were followed for at least 14 weeks or until termination of treatment. Clinical and biochemical activity were obtained at every infusion throughout follow-up. Plasma measurements of VDZ (p-VDZ) were performed before every infusion during maintenance therapy.In total, 71 patients received VDZ. Improvement of CRP and hemoglobin was observed in CD but not in UC, whereas Partial Mayo Score improved in UC while no change in Harvey Bradshaw Index was revealed in CD. Furthermore, CRP at baseline was negatively correlated with p-VDZ at week 14 in CD but not in UC patients.Improvement of biochemical markers of inflammation was observed in CD while clinical activity scores improved in UC patients. For CD, baseline CRP was correlated with lower concentrations of p-VDZ at week 14.
- Published
- 2019
16. Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway
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Jens Pallenschat, Ole Høie, Bjørn Christian Elias Grova Olsen, Tahir Riaz Ahmad, Petr Ricanek, Emma Elisabeth Løvlund, Arnt Sagosen, Øistein Hovde, Florin B. Vikskjold, Stein Dahler, Stephan Brackmann, Batool Aballi, Jon Berggren Rove, Erik Skogestad, Carl Magnus Ystrøm, Gøri Perminow, Roald Torp, Aina Pedersen, Randi Opheim, Tone Bergene Aabrekk, Marte Lie Høivik, Tor Tønnessen, May-Bente Bengtson, Christine Olbjørn, Raziye Boyar Cetinkaya, Svein Oskar Frigstad, Magne Henriksen, Simen Vatn, Svend Andersen, Asle W. Medhus, Vendel Ailin Kristensen, Gert Huppertz-Hauss, Katharina Schmidt, Charlotte K. Munthe Lund, Trond Espen Detlie, Hans Kristian Holm, Ingunn Johansen, Audun Hasund, and Hussain Ali Ghalib Yassin
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Adult ,Crohn’s disease ,medicine.medical_specialty ,Inflammatory bowel disease ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,inflammatory bowel disease ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Child ,skin and connective tissue diseases ,ulcerative colitis ,Crohn's disease ,Medisinske Fag: 700::Klinisk medisinske fag: 750::Gasteroenterologi: 773 [VDP] ,Norway ,business.industry ,Gold standard ,Gastroenterology ,Inflammatory Bowel Diseases ,medicine.disease ,Ulcerative colitis ,INCEPTION COHORT ,New population ,digestive system diseases ,030220 oncology & carcinogenesis ,Colitis, Ulcerative ,030211 gastroenterology & hepatology ,sense organs ,business ,South eastern ,Follow-Up Studies - Abstract
Background and aim: Modern treatment strategies for inflammatory bowel disease (IBD) are postulated to change the natural disease course. Inception cohort studies are the gold standard for investigating such changes. We have initiated a new population-based inception cohort study; Inflammatory bowel disease in South Eastern Norway III (IBSEN III). In this article, we describe the study protocol and baseline characteristics of the cohort. Methods: IBSEN III is an ongoing, population-based observational inception cohort study with prospective follow-up. Adult and pediatric patients with suspected IBD in the South-Eastern Health Region of Norway (catchment area of 2.95 million inhabitants in 2017), during the 3-year period from 2017 to 2019, were eligible for inclusion. Comprehensive clinical, biochemical, endoscopic, demographic, and patient-reported data were collected at the time of diagnosis and throughout standardized follow-up. For a portion of the patients, extensive biological material was biobanked. Results: The study included 2168 patients, of whom 1779 were diagnosed with IBD (Crohn's disease: 626, ulcerative colitis: 1082, IBD unclassified: 71). In 124 patients, there were subtle findings indicative of, but not diagnostic for, IBD. The remaining 265 patients were classified as symptomatic non-IBD controls. Conclusion: We have included patients in a comprehensive population-based IBD cohort from a catchment population of 2.95 million, and a unique biobank with materials from newly diagnosed and treatment-naïve IBD patients and symptomatic non-IBD controls. We believe this cohort will add important knowledge about IBD in the years to come.
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- 2021
17. One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy
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Anselm Schulz, Truls Hauge, Jorunn Skattum, Asle W. Medhus, Vendel Ailin Kristensen, Olav Sandstad, Lene Larssen, Helge Evensen, and Milada Cvancarova Småstuen
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Adult ,Male ,Natural Orifice Endoscopic Surgery ,Myotomy ,objective outcome evaluation ,Treatment response ,Pediatrics ,medicine.medical_specialty ,Time Factors ,gastroesophageal reflux disease ,medicine.medical_treatment ,Achalasia ,Gastroesophageal reflux disease ,Esophageal Sphincter, Lower ,otorhinolaryngologic diseases ,medicine ,Humans ,Peroral endoscopic myotomy ,Prospective Studies ,Stage (cooking) ,Prospective cohort study ,Evaluation ,High resolution manometry ,Aged ,predictive outcome factors ,Gastroenterology & Hepatology ,business.industry ,Objective variables ,General Medicine ,Middle Aged ,medicine.disease ,peroral endoscopic myotomy ,Esophageal Achalasia ,Treatment Outcome ,Barium ,Female ,Esophagoscopy ,Objective evaluation ,business ,Research Article ,Follow-Up Studies - Abstract
Background and aims Peroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM. Methods This single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome. Results Fifty patients were included with a drop-out rate of 3 cm after POEM was associated with treatment failure assessed by ES (p = .04) and TBE (p = .03). Advanced achalasia stage (p = .02) and long symptom duration (p = .04) were identified as independent predictive factors for poor outcome assessed by TBE. Conclusions The present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure.Key messagesPeroral endoscopic myotomy (POEM) is established as a safe and effective therapy for achalasia.Timed barium esophagogram offers objective variables that are valuable in treatment response evaluation.Advanced achalasia stage and long symptom duration are predictive factors for poor objective treatment response after POEM.
- Published
- 2021
18. A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial
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Christer Julseth Tønnesen, Asle W. Medhus, Tor Erik Mathisen, Magnus Løberg, Michael Bretthauer, Dag Hofsø, Lars Aabakken, Paulina Wieszczy, Jens Kristoffer Hertel, Eli Heggen, Line Kristin Johnson, Mette Kalager, Jøran Hjelmesæth, and Serena Tonstad
- Subjects
medicine.medical_specialty ,Pilot Projects ,Type 2 diabetes ,Balloon ,Body Mass Index ,Weight loss ,Diabetes mellitus ,medicine ,Humans ,Obesity ,Adverse effect ,Gastric Balloon ,business.industry ,Gastroenterology ,Gastric outlet obstruction ,VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710 ,medicine.disease ,VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710 ,Surgery ,Obesity, Morbid ,Clinical trial ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Vomiting ,Feasibility Studies ,medicine.symptom ,business - Abstract
Background and aims: Obesity with type-2 diabetes is a global challenge. Lifestyle interventions have limited effect for most patients. Bariatric surgery is highly effective, but resource-demanding, invasive and associated with serious complications. Recently, a new intragastric balloon was introduced, not requiring endoscopy for placement or removal (Elipse™, Allurion Inc., Natick, MA). The balloon is swallowed in a capsule and filled with water once in the stomach. The balloon self-deflates after 4 months and is naturally excreted. The present trial investigated balloon feasibility, safety and efficacy in patients with obesity and type-2 diabetes. Patients and methods: We treated 19 patients, with type-2 diabetes and body mass index (BMI) of 30.0-39.9 kg/m2 at two Norwegian centers with the Elipse balloon. Patient follow-up during balloon treatment mimicked real-world clinical practice, including dietary plan and outpatient visits. The primary efficacy endpoints were total body weight loss (TBWL) and HbA1c at weeks 16 and 52. Results: All patients underwent balloon insertion uneventfully as out-patients. Mean TBWL and HbA1c reduction after 16 and 52 weeks of balloon insertion was 3.9% (95%CI 2.1-5.7) and 0.8% (95%CI 1.9-3.5); and 7 (95%CI 4-10), and 1 (95%CI -6 to 9) mmol/mol, respectively. Adverse events occurred in two patients (10.5%): one developed gastric outlet obstruction, managed by endoscopic balloon removal; the other excessive vomiting and dehydration, managed conservatively. Conclusions: This first Scandinavian real-world clinical trial with a new minimally invasive intragastric balloon system demonstrated good feasibility, but did not confirm expected efficacy for weight loss and diabetes control.
- Published
- 2021
19. Sleeve gastrectomy confers higher risk of gastroesophageal reflux disease than gastric bypass. A Randomized Controlled Trial From the Oseberg Reflux Working Group
- Author
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Asle W. Medhus, Jolanta Lorentzen, Marius Svanevik, Birgitte Seip, Daniel Sifrim, Dag Hofsø, Rune Sandbu, Milada Cvancarova Småstuen, Jøran Hjelmesæth, Heidi Borgeraas, and Jens Kristoffer Hertel
- Subjects
Sleeve gastrectomy ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine.medical_treatment ,Esophago gastro duodenoscopy ,Gastric bypass ,Gastroenterology ,Reflux ,Disease ,Type 2 diabetes ,medicine.disease ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,medicine ,business ,Esophagitis - Published
- 2021
20. The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators
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Geir Hoff, Birgitte Seip, Asle W. Medhus, Jan-Magnus Kvamme, Gert Huppertz-Hauss, Lars Aabakken, Stein Dahler, Øyvind Holme, Per Sandvei, Øystein Kjellevold, Ole Darre-Næss, Ingrid M. Blomgren, and Edoardo Botteri
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medicine.medical_specialty ,medicine.diagnostic_test ,Trainer ,business.industry ,Gastroenterology ,Cecal intubation ,Colonic Polyps ,Colonoscopy ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Physical therapy ,medicine ,Humans ,Severe pain ,Female ,030211 gastroenterology & hepatology ,Bowel cleansing ,Observational study ,Detection rate ,business ,Cecum ,Generalized estimating equation ,Quality Indicators, Health Care - Abstract
Background Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of “training-the-colonoscopy-trainer” (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators. Methods This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used. Results 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period. Conclusions Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.
- Published
- 2021
21. P475 Real world data on treatment success and drug persistence in anti-TNF therapy for ulcerative colitis
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Asle W. Medhus, Marte Lie Høivik, K. Anisdahl, J A Lundekvam, and Bjørn Moum
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Drug ,business.industry ,media_common.quotation_subject ,Gastroenterology ,General Medicine ,medicine.disease ,Ulcerative colitis ,Infliximab ,Persistence (computer science) ,Anti-Tumor Necrosis Factor Therapy ,Immunology ,Adalimumab ,Medicine ,Anti-TNF therapy ,business ,Adverse effect ,medicine.drug ,media_common - Abstract
Background The efficacy and safety of anti-TNF treatment for ulcerative colitis (UC) have been well documented in clinical trials. More data are required to increase knowledge on treatment success in a real world setting. This study reports real world data on treatment success, drug persistence and safety of anti-TNF treatment in patients with UC. Methods Patients with UC starting anti-TNF treatment with infliximab (IFX) or adalimumab (ADA) between January 2014 and December 2019 at Oslo University Hospital in Norway were included in a retrospective review of medical records. Eligible patients were biologically naïve adults (≥18 years) with no history of UC-related surgery. Follow-up was 12 months. Drug persistence was defined as the proportion of patients still receiving first-line anti-TNF treatment without addition of a second biologic agent. Remission was defined as i) clinical remission (six-point Mayo Score Results In total, 116 patients were included (mean age 35.5 ±13.9 years (SD), 58% male), of which 95 received IFX treatment and 21 ADA. Drug persistence was 74%. Treatment success by different definitions of remission and remission rates for drug persistent patients according to these definitions are reported in the table. SAEs were recorded on 18 occasions (four immediate infusion reactions, two colectomies, five infections and seven other events). Conclusion Treatment success by the strictest definition of remission was 40%. Of drug persistent patients, 44% were not in remission when applying the same definition. Whether these results reflect inadequacies in definitions of remission, a tendency for clinicians to let other variables guide treatment or a delay in drug switching warrants further investigation.
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- 2021
22. Perioperative Microcirculatory Changes Detected with Gastroscopy Assisted Laser Doppler Flowmetry and Visible Light Spectroscopy in Patients with Median Arcuate Ligament Syndrome
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Nathkai Safi, Jon Otto Sundhagen, Syed Sajid Hussain Kazmi, Jonny Hisdal, Simen Tveten Berge, and Asle W. Medhus
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Male ,Abdominal pain ,Duplex ultrasonography ,Time Factors ,Decompression ,Endocrinology, Diabetes and Metabolism ,030204 cardiovascular system & hematology ,vascular surgery ,0302 clinical medicine ,Median Arcuate Ligament Syndrome ,Celiac Artery ,Celiac artery ,Mesenteric Vascular Occlusion ,Laser-Doppler Flowmetry ,Pharmacology (medical) ,Prospective Studies ,Splanchnic Circulation ,030212 general & internal medicine ,Original Research ,Aged, 80 and over ,medicine.diagnostic_test ,Stomach ,Hematology ,General Medicine ,Middle Aged ,Decompression, Surgical ,Treatment Outcome ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Median arcuate ligament syndrome ,Blood Flow Velocity ,Adult ,medicine.medical_specialty ,Duodenum ,functional test ,Young Adult ,03 medical and health sciences ,Predictive Value of Tests ,medicine.artery ,Gastroscopy ,medicine ,Humans ,endoscopy ,Aged ,mesenteric ischemia ,business.industry ,Microcirculation ,Spectrum Analysis ,abdominal pain ,Public Health, Environmental and Occupational Health ,Recovery of Function ,Perioperative ,medicine.disease ,Endoscopy ,Surgery ,Vascular Health and Risk Management ,Mesenteric ischemia ,Case-Control Studies ,Quality of Life ,Laparoscopy ,business - Abstract
Simen Tveten Berge,1 Nathkai Safi,2 Asle W Medhus,3 Jon O Sundhagen,1 Jonny Hisdal,1,2 Syed SH Kazmi1,2 1Department of Vascular Surgery, Oslo University Hospital HF, Oslo, Norway; 2Faculty of Medicine, University in Oslo, Oslo, Norway; 3Department of Gastroenterology, Oslo University Hospital HF, Oslo, NorwayCorrespondence: Simen Tveten BergeDepartment of Vascular Surgery, Oslo University Hospital HF, Aker, Mail box: 4959 Nydalen, Oslo 0424, NorwayTel +47 97 72 32 20Email simen_berge@outlook.comSyed SH KazmiDepartment of Vascular Surgery, Oslo University Hospital HF, Oslo 0586, NorwayTel +47 92468309Email sshkazmi@gmail.comPurpose: Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients.Patients and Methods: In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively.Results: Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO2 76± 6), as compared to healthy individuals (SO2 81± 4), p=0.02. An overall significant improvement in SO2 after surgical decompression of the celiac artery was found (SO2 81± 3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4– 24 months). Four of the five dimensions investigated with EQ-5D-5L improved.Conclusion: VLS detected a significantly lower baseline transmucosal SO2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.Keywords: mesenteric ischemia, functional test, endoscopy, vascular surgery, abdominal pain
- Published
- 2020
23. Switching from originator to biosimilar infliximab – real world data of a prospective 18 months follow-up of a single-centre IBD population
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David J. Warren, Bjørn Moum, Lydia C T Buer, Asle W. Medhus, Nils Bolstad, Marte Lie Høivik, and Milada Cvancarova
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Population ,Severity of Illness Index ,Feces ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Biosimilar Pharmaceuticals ,medicine ,Humans ,Prospective Studies ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,Drug Substitution ,Norway ,business.industry ,Gastroenterology ,Follow up studies ,Antibodies, Monoclonal ,Inflammatory Bowel Diseases ,Biosimilar ,Middle Aged ,Infliximab ,Single centre ,C-Reactive Protein ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business ,Leukocyte L1 Antigen Complex ,Real world data ,Follow-Up Studies ,medicine.drug - Abstract
Long-term data regarding switching from originator infliximab to biosimilar CT-P13 are sparse. Concerns about increased immunogenicity after switching have been raised. We aimed to study the effectiveness, safety and immunogenicity after switching from originator infliximab to CT-P13 in a real-world IBD population with 18 months prospective follow-up.All adult IBD patients treated with originator infliximab at the Department of Gastroenterology, Oslo University Hospital, were switched to CT-P13 and followed prospectively for 18 months. The primary endpoints were (i) the proportion of patients remaining on CT-P13 18 months after switching and (ii) immunogenicity during 18 months after switching. The secondary endpoints included (i) adverse events, (ii) changes in disease activity, C-reactive protein, anaemia, faecal calprotectin, infliximab dose and interval and p-infliximab.In total, 143 IBD patients were switched, 99 with Crohn's disease and 44 with ulcerative colitis. Altogether, 130 (91%) remained on CT-P13 throughout 18 months. Two patients developed ADAs at moderate level and discontinued CT-P13. Another 10 patients discontinued CT-P13 (two due to loss of response without ADAs, four due to adverse events, and four in remission and a personal wish to stop). There was no overall change in disease activity scores or in the other studied variables except for p-infliximab, which increased significantly.The present study provides valuable evidence for the safety and effectiveness of switching from originator to biosimilar infliximab over a prolonged period of 18 months and demonstrates that switching was well tolerated and did not affect the long term clinical outcome.
- Published
- 2018
24. Preoperative liquid gastric emptying rate does not predict outcome after fundoplication
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J G Fjeld, Lars Aabakken, Heidi Kjosbakken, Kristin Bjørnland, Asle W. Medhus, Ragnhild Emblem, Are Hugo Pripp, Bjørn Edwin, Thomas J. Fyhn, and Charlotte Kristensen Knatten
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Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Fundoplication ,Scintigraphy ,Nissen fundoplication ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,medicine ,Animals ,Humans ,Retching ,Postoperative Period ,Prospective Studies ,Child ,Radionuclide Imaging ,Prospective cohort study ,Meal ,medicine.diagnostic_test ,Gastric emptying ,business.industry ,Infant ,General Medicine ,medicine.disease ,digestive system diseases ,Surgery ,Milk ,Treatment Outcome ,Gastric Emptying ,Child, Preschool ,030220 oncology & carcinogenesis ,Preoperative Period ,Pediatrics, Perinatology and Child Health ,Gastroesophageal Reflux ,GERD ,Vomiting ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Aim of the study Preoperative gastric emptying (GE) rate in patients with gastrointestinal reflux disease (GERD) was evaluated as a predictor of outcome after antireflux surgery. Methods and patients GE was assessed using radionuclide scintigraphy and a standardized meal with cow's milk. GE half time (T1/2), patient demographics and GERD symptoms including vomiting (>4days/week), retching (>4days/week), prolonged feeding time (>3h/day), and discomfort after meals were recorded pre- and postoperatively. A standardized follow-up included a 24-h pH-monitoring and an upper gastrointestinal contrast study. Of 74 patients undergoing Nissen fundoplication between 2003 and 2009, 35 underwent a preoperative GE study. The remaining 39 patients were not examined owing to volume intolerance, cow's milk intolerance or allergy, inability to lie still, or parents refusing participation. Main results Median age at fundoplication was 4.9 [range 1.1–15.4] years, and follow-up time was median 4.3 [1.9–8.9] years. GERD recurred in 7 (20%) patients. Preoperative T1/2 in the seven patients with recurrent GERD was median 45 [21–87] min compared to 44 [16–121] min in the 28 patients without recurrent GERD (p=0.92). There was no significant difference between the one third of patients with the slowest GE [T1/2 54–121min] and the remaining patients [T1/2 16–49min] regarding GERD recurrence or postoperative vomiting, retching, prolonged feeding time, or discomfort after meals. Conclusion Preoperative GE rate did not predict outcome after antireflux surgery, as slow GE was not associated with recurrent GERD or postoperative troublesome symptoms such as vomiting, retching, or meal discomfort.
- Published
- 2017
25. Gastroscopy assisted laser Doppler flowmetry and visible light spectroscopy in patients with chronic mesenteric ischemia
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Syed Sajid Hussain Kazmi, Simen Tveten Berge, Kim Vidar Ånonsen, Asle W. Medhus, Jon Otto Sundhagen, Nathkai Safi, and Jonny Hisdal
- Subjects
Male ,Clinical Biochemistry ,030204 cardiovascular system & hematology ,complex mixtures ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Acute mesenteric ischemia ,Gastroscopy ,Laser-Doppler Flowmetry ,Medicine ,Humans ,In patient ,Prospective Studies ,Spectroscopy ,Aged ,Aged, 80 and over ,Ultrasonography, Doppler, Duplex ,integumentary system ,business.industry ,Spectrum Analysis ,Upper endoscopy ,General Medicine ,Laser Doppler velocimetry ,Middle Aged ,Chronic mesenteric ischemia ,ROC Curve ,Case-Control Studies ,Mesenteric Ischemia ,Chronic Disease ,030211 gastroenterology & hepatology ,Female ,Nuclear medicine ,business ,Visible spectrum - Abstract
Mucosal pathology due to chronic mesenteric ischemia (CMI) is rarely seen during upper endoscopy. Combining Laser Doppler Flowmetry (LDF) and Visible Light Spectroscopy (VLS) may aid in detection of CMI at an early stage. We aimed to investigate the utility of LDF and VLS in detecting microcirculatory changes in patients with CMI during upper endoscopy. In a single center, prospective study, 104 patients were evaluated for mesenteric ischemia during a 24 months period. Patients with a consensus diagnosis of CMI (n = 40) were examined with LDF and VLS. Thirty-two were successfully treated and had a definitive diagnosis of CMI. Results were compared with controls (n = 38) with normal intestinal circulation evaluated with duplex ultrasonography (DUS). Treatment response was evaluated clinically and with DUS at 1 month and with VLS and LDF at 3 months. A significant reduction in mucosal capillary hemoglobin oxygen saturation (SO2) was found in CMI patients compared to controls before treatment: mean ± SD: 67 ± 9%, 81 ± 4%, respectively (p
- Published
- 2019
26. Plasma cytokine levels in patients with chronic alcohol overconsumption: Relations to gut microbiota markers and clinical correlates
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Håvard Aanes, Jørgen G. Bramness, Asle W. Medhus, Jørgen Valeur, Steinar Traae Bjørkhaug, Viggo Skar, and Sudan Prasad Neupane
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,medicine.medical_treatment ,Interleukin-1beta ,Inflammation ,Butyrate ,Gut flora ,Toxicology ,medicine.disease_cause ,Hospital Anxiety and Depression Scale ,Biochemistry ,Gastroenterology ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,Immune system ,Internal medicine ,medicine ,Humans ,Aged ,Aged, 80 and over ,biology ,business.industry ,Tumor Necrosis Factor-alpha ,General Medicine ,Immune dysregulation ,Middle Aged ,biology.organism_classification ,030227 psychiatry ,Gastrointestinal Microbiome ,Alcoholism ,Overconsumption ,Cytokine ,Neurology ,Case-Control Studies ,Cytokines ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Biomarkers - Abstract
Background Alcohol-related morbidity may involve changes in the gut microbiota and immune dysregulation. We have previously demonstrated alterations in gut microbiota composition and functions in patients with alcohol overconsumption, and now aimed to investigate possible associations between cytokine levels, gut microbiota, and clinical symptoms. Methods We included hospital inpatients with a history of chronic alcohol overconsumption. For comparison, we included control patients with a low alcohol intake. Cytokine levels (TGF-β1, TNF-α, IL-10, IL-8, IL-6, IFN-γ, MCP-1, IL-1RA, IL-1β, and IL-17) were determined using a customized V-plex assay. We then examined associations of cytokine levels with the abundance of Proteobacteria and Faecalibacterium, percentage of the short-chain fatty acid butyrate, psychiatric symptoms (Hospital Anxiety and Depression Scale), and biochemical liver variables. Results We included 28 patients with alcohol overconsumption (79% men), and 25 control patients (72% men). Patients with alcohol overconsumption had higher levels of IL-6 (p = 0.002), IFN-γ (p = 0.018), and MCP-1 (p = 0.006), and lower levels of TGF-β1 (p = 0.017) compared with control patients. Inverse correlations were found between Proteobacteria abundance and TNF-α (Rs = −0.55, p = 0.02) and IL-8 (Rs = −0.58, p = 0.014), and between Faecalibacterium and MCP-1 levels (Rs = −0.56, p = 0.02) in the control patients, but not in patients with alcohol overconsumption. Patients with alcohol overconsumption reported more psychiatric symptoms, and these symptoms were inversely correlated with IL-10 levels. There were positive correlations between several of the assessed cytokines and biochemical liver variables, and negative correlations between cytokine levels and albumin. Conclusion Patients with alcohol overconsumption had a cytokine profile suggestive of increased systemic inflammatory activity, with higher levels of pro-inflammatory cytokines (IL-6, IFN-γ, and MCP-1) and lower levels of anti-inflammatory cytokines (TGF-β1). The findings may represent a link between alcohol use and alcohol-related morbidity.
- Published
- 2019
27. Response to letter to the editor: 'Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review'
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Helge Evensen and Asle W. Medhus
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Myotomy ,medicine.medical_specialty ,Letter to the editor ,integumentary system ,Poetry ,business.industry ,medicine.medical_treatment ,General surgery ,education ,Gastroenterology ,Endoscopy ,Outcome (game theory) ,Therapy naive ,Esophageal Achalasia ,medicine ,Humans ,Review process ,skin and connective tissue diseases ,business ,human activities - Abstract
We would like to thank for the interest and comments on our review [1] by Tan et al. They express some concerns regarding the studies included in the review and the review process. We will respond ...
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- 2019
28. Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review
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Olav Sandstad, Lene Larssen, Asle W. Medhus, Vendel Ailin Kristensen, Helge Evensen, and Truls Hauge
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Myotomy ,Natural Orifice Endoscopic Surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Achalasia ,Heller Myotomy ,digestive system ,Esophageal Sphincter, Lower ,Therapy naive ,03 medical and health sciences ,0302 clinical medicine ,otorhinolaryngologic diseases ,medicine ,Humans ,Esophagus ,High resolution manometry ,Esophageal physiology ,business.industry ,Gastroenterology ,Motility disorder ,medicine.disease ,digestive system diseases ,Surgery ,Esophageal Achalasia ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Esophageal sphincter ,030211 gastroenterology & hepatology ,Esophagoscopy ,business - Abstract
Objectives: Achalasia is a primary motility disorder of the esophagus characterized by aperistalsis and failure of lower esophageal sphincter (LES) relaxation. Treatment of achalasia aims at reducing LES pressure. The common treatment modalities are laparoscopic Heller myotomy and pneumatic dilatation, but during the last decade, a promising treatment, per oral endoscopic myotomy (POEM), has been introduced. The aim of the present study was to perform a systematic review of the literature to assess the outcome of POEM in treatment-naive patients. Materials and methods: A systematic literature search in PubMed, Embase and Cochrane databases was performed using the terms ‘Achalasia AND (POEM OR peroral endoscopic myotomy OR per-oral endoscopic myotomy)’. Inclusion criteria were: original article; English language; n ≥ 20 with ≥90% treatment-naive patients; follow-up ≥3 months; and outcome evaluation of POEM including symptom score and objective tests. Exclusion criteria were: reviews and meta-analyses; pediatric data; duplicates; and articles with overlapping data material. Results: Of the 1641 articles identified, seven were included. The included studies all reported a short-term clinical success of >90%. Clinical success including post-POEM reflux was mainly estimated by symptom scorings. There were few procedure-related complications. Conclusions: The studies of treatment-naive patients indicate a high rate of clinical success. Nevertheless, a more systematic and standardized evaluation is recommended to improve the reports on outcome of POEM. The follow-up rate should be high and the evaluation protocol should include both symptom scoring and objective testing with predefined treatment goals.
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- 2019
29. Characterization of gut microbiota composition and functions in patients with chronic alcohol overconsumption
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Christine Henriksen, Jørgen Valeur, Steinar Traae Bjørkhaug, Sudan Prasad Neupane, Håvard Aanes, Asle W. Medhus, Viggo Skar, Stine Malvik, and Jørgen G. Bramness
- Subjects
0301 basic medicine ,Male ,Physiology ,Alcohol ,Ascorbic Acid ,Gut flora ,chemistry.chemical_compound ,Feces ,Holdemania ,0302 clinical medicine ,Clostridium ,RNA, Ribosomal, 16S ,Nutritional screening ,Aged, 80 and over ,Hand Strength ,Gastroenterology ,PICRUSt ,Vitamins ,Middle Aged ,VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710 ,Alcoholism ,Infectious Diseases ,Overconsumption ,030211 gastroenterology & hepatology ,Female ,Proteobacteria ,Microbiology (medical) ,Adult ,short-chain fatty acids ,Biology ,Sutterella ,Microbiology ,03 medical and health sciences ,Bacterial Proteins ,Humans ,Faecalibacterium ,Aged ,Vitamin C ,Bacteria ,VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710 ,biology.organism_classification ,Fatty Acids, Volatile ,Gastrointestinal Microbiome ,030104 developmental biology ,Nutrition Assessment ,chemistry ,Research Paper/Report ,Metagenomics - Abstract
Excessive alcohol intake can alter the gut microbiota, which may underlie the pathophysiology of alcohol-related diseases. We examined gut microbiota composition and functions in patients with alcohol overconsumption for >10 years, compared to a control group of patients with a history of no or low alcohol intake. Faecal microbiota composition was assessed by 16S rRNA sequencing. Gut microbiota functions were evaluated by quantification of short-chain fatty acids (SCFAs) and predictive metagenome profiling (PICRUSt). Twenty-four patients, mean age 64.8 years (19 males), with alcohol overconsumption, and 18 control patients, mean age 58.2 years (14 males) were included. The two groups were comparable regarding basic clinical variables. Nutritional assessment revealed lower total score on the screening tool Mini Nutritional Assessment, lower muscle mass as assessed by handgrip strength, and lower plasma vitamin C levels in the alcohol overconsumption group. Bacteria from phylum Proteobacteria were found in higher relative abundance, while bacteria from genus Faecalibacterium were found in lower relative abundance in the group of alcohol overconsumers. The group also had higher levels of the genera Sutterella, Holdemania and Clostridium, and lower concentration and percentage of butyric acid. When applying PICRUSt to predict the metagenomic composition, we found that genes related to invasion of epithelial cells were more common in the group of alcohol overconsumers. We conclude that gut microbiota composition and functions in patients with alcohol overconsumption differ from patients with low consumption of alcohol, and seem to be skewed into a putative pro-inflammatory direction. © 2019 The Author(s). Published with license by Taylor & Francis Group, LLC. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
- Published
- 2019
30. A106 Gastroesophageal reflux disease in patients with severe obesity and type 2 diabetes one year after sleeve gastrectomy or Roux-en-Y gastric bypass. A randomized controlled trial
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Marius Svanevik, Jolanta Lorentzen, Rune Sandbu, Dag Hofsø, Tor-Ivar Karlsen, Asle W. Medhus, Jens Kristoffer Hertel, Jøran Hjelmesæth, Heidi Borgeraas, and Birgitte Seip
- Subjects
Sleeve gastrectomy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastric bypass ,Reflux ,Type 2 diabetes ,Disease ,medicine.disease ,Roux-en-Y anastomosis ,law.invention ,Surgery ,Randomized controlled trial ,law ,Medicine ,In patient ,business - Published
- 2019
31. Endoscopy assistants influence the quality of colonoscopy
- Author
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Lars Aabakken, Anita Jørgensen, Asle W. Medhus, Tom Glomsaker, Magnus Løberg, Øystein Kjellevold, Michael Bretthauer, Birgitte Seip, Geir Hoff, Jan-Magnus Kvamme, Thomas de Lange, Ina Borgenheim Pedersen, Siv Furholm, and Øyvind Holme
- Subjects
Male ,medicine.medical_specialty ,Quality Assurance, Health Care ,Sedation ,medicine.medical_treatment ,media_common.quotation_subject ,Allied Health Personnel ,Colonoscopy ,Colonic Diseases ,03 medical and health sciences ,Key quality indicators ,0302 clinical medicine ,medicine ,Humans ,Intubation ,Quality (business) ,Registries ,Quality Indicators, Health Care ,media_common ,medicine.diagnostic_test ,Norway ,business.industry ,General surgery ,Gastroenterology ,Patient Preference ,Middle Aged ,Quality Improvement ,Endoscopy ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Clinical Competence ,medicine.symptom ,Detection rate ,business ,Quality assurance - Abstract
Background Colonoscopy performance varies between endoscopists, but little is known about the impact of endoscopy assistants on key performance indicators. We used a large prospective colonoscopy quality database to perform an exploratory study to evaluate differences in selected quality indicators between endoscopy assistants. Methods All colonoscopies reported to the Norwegian colonoscopy quality assurance register Gastronet can be used to trace individual endoscopy assistants. We analyzed key quality indicators (cecum intubation rate, polyp detection rate, colonoscopies rated as severely painful, colonoscopies with sedation or analgesia, and satisfaction with information) for colonoscopies performed between 1 January 2013 and 31 December 2014. Differences between individual assistants were analyzed by fitting multivariable logistic regression models, with the best performing assistant at each participating hospital as reference. All models were adjusted for the endoscopist. Results 63 endoscopy assistants from 12 hospitals assisted in 15 365 colonoscopies. Compared with their top performing peers from the same hospital, one assistant was associated with cecum intubation failure, four with poor polyp detection, nine with painful colonoscopy, 16 with administration of sedation or analgesics during colonoscopy, and three with patient dissatisfaction about information given relating to the colonoscopy. The number of procedures during the study period or lifetime experience as an endoscopy assistant were not associated with any quality indicator. Conclusion In this exploratory study, there was little variation on important colonoscopy quality indicators between endoscopy assistants. However, there were differences among assistants that may be clinically important. Endoscopy assistants should be subject to quality surveillance similarly to endoscopists.
- Published
- 2018
32. P710 The use of first-line biologics in patients with Crohn’s disease in Norway from 2011 to 2016
- Author
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S. Svatun Lirhus, Hans Olav Melberg, Asle W. Medhus, Karoline Anisdahl, Bjørn Moum, M Lie Høivik, and Lydia C T Buer
- Subjects
Crohn's disease ,medicine.medical_specialty ,business.industry ,Internal medicine ,First line ,Gastroenterology ,Medicine ,In patient ,General Medicine ,business ,medicine.disease - Published
- 2019
33. Combining Anti-TNF-α and Vedolizumab in the Treatment of Inflammatory Bowel Disease: A Case Series
- Author
-
Lydia C T Buer, Bjørn Moum, Marte Lie Høivik, Asle W. Medhus, and David J. Warren
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Combination therapy ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Inflammatory bowel disease ,Severity of Illness Index ,Vedolizumab ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pharmacotherapy ,Internal medicine ,Severity of illness ,medicine ,Immunology and Allergy ,Humans ,Prospective Studies ,Prospective cohort study ,Adverse effect ,business.industry ,Tumor Necrosis Factor-alpha ,Remission Induction ,Middle Aged ,medicine.disease ,Inflammatory Bowel Diseases ,Ulcerative colitis ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Drug Therapy, Combination ,Female ,business ,medicine.drug - Abstract
Background Anti-tumor necrosis factor α (anti-TNF-α) is important in the treatment of inflammatory bowel disease, but some patients experience only a partial response. In these patients, a combination of anti-TNF-α and vedolizumab (VDZ) may act as a bridge until the full VDZ effect occurs. At present, clinical data on combination treatment with anti-TNF-α and VDZ are not available. The aim of this case series was to evaluate the safety and clinical response of combination therapy with anti-TNF-α and VDZ in clinical practice. Methods All patients started on combination treatment with anti-TNF-α and VDZ from November 2015 to July 2016 were prospectively followed for at least 12 months. Results Six patients with ulcerative colitis and four patients with Crohn's disease received combination treatment. These patients were followed for a median of 1712-20 months. No more adverse events than expected with anti-TNF-α alone were observed during combination treatment. At the end of follow-up, all patients were in clinical remission, and 8 patients could discontinue anti-TNF-α treatment and receive VDZ monotherapy. Two of the patients with Crohn's disease required combination treatment throughout follow-up to obtain sustained remission. Conclusion Our findings suggest that combination treatment with anti TNF-α and VDZ is safe and might represent a long-term treatment option in selected patients.
- Published
- 2017
34. Does the Introduction of Biosimilars Change Our Understanding about Treatment Modalities for Inflammatory Bowel Disease?
- Author
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Asle W. Medhus, Marte Lie Høivik, Bjørn Moum, and Lydia C T Buer
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Inflammatory bowel disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Gastrointestinal Agents ,Internal medicine ,medicine ,Humans ,European Union ,Biosimilar Pharmaceuticals ,business.industry ,Norway ,Antibodies, Monoclonal ,Biosimilar ,General Medicine ,medicine.disease ,Inflammatory Bowel Diseases ,Ulcerative colitis ,Infliximab ,030104 developmental biology ,Treatment modality ,030211 gastroenterology & hepatology ,Tumor necrosis factor alpha ,business ,medicine.drug - Abstract
Background: Biological agents, mainly tumor necrosis factor-α inhibitors, play an important role in the treatment of inflammatory bowel disease (IBD). These drugs are expensive and constitute a major cost in the IBD care. In 2013, the first biosimilar monoclonal antibody, infliximab (IFX), was approved in the EU. Key Messages: There has been considerable skepticism regarding the use of biosimilars. Both clinicians and patients have questioned the safety and efficacy of these new drugs. In particular, the extrapolation of treatment effects between patients with different diagnoses has been debated. Due to national negotiations, the price reductions vary considerably between countries. In Norway, the biosimilars Remsima® and Inflectra® come at a very favourable price, and have supplanted the originator Remicade® almost completely. The total sale of IFX has also increased, indicating that extended indications and increased doses are being implemented in clinical use. Conclusions: The introduction of biosimilars has raised questions not only about the efficacy and safety but also about health politics. There is reason to believe that the introduction of cheaper biosimilars will change the clinical use of biologics.
- Published
- 2017
35. Correction to: Small intestinal malabsorption in chronic alcoholism: a retrospective study of alcoholic patients by the
- Author
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Håvar, Hope, Viggo, Skar, Olav, Sandstad, Einar, Husebye, and Asle W, Medhus
- Published
- 2017
36. P705 Switching from originator to biosimilar infliximab—real-world data from 18 months prospective follow-up of a single-centre IBD population
- Author
-
Asle W. Medhus, Nils Bolstad, Lydia C T Buer, Bjørn Moum, and Marte Lie Høivik
- Subjects
education.field_of_study ,Pediatrics ,medicine.medical_specialty ,business.industry ,Population ,Gastroenterology ,Biosimilar ,General Medicine ,Infliximab ,03 medical and health sciences ,Single centre ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,education ,business ,Real world data ,Infliximab-dyyb ,medicine.drug - Published
- 2018
37. P516 The use of first-line biologics in patients with ulcerative colitis in Norway from 2011 to 2016
- Author
-
Hans Olav Melberg, Karoline Anisdahl, Bjørn Moum, Asle W. Medhus, Lydia C T Buer, M Lie Høivik, and S. Svatun Lirhus
- Subjects
medicine.medical_specialty ,business.industry ,First line ,Gastroenterology ,medicine ,In patient ,General Medicine ,medicine.disease ,business ,Dermatology ,Ulcerative colitis - Published
- 2019
38. Diagnostic accuracy of the GerdQ questionnaire in the assessment of erosive esophagitis in patients preparing for bariatric surgery
- Author
-
Jolanta Lorentzen, Tor-Ivar Karlsen, Marius Svanevik, Daniel Sifrim, Rune Sandbu, Jøran Hjelmesæth, Asle W. Medhus, Ronette L. Kolotkin, Jens Kristoffer Hertel, Heidi Borgeraas, Dag Hofsø, and Birgitte Seip
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,medicine ,030211 gastroenterology & hepatology ,030209 endocrinology & metabolism ,Surgery ,In patient ,Diagnostic accuracy ,business ,Erosive esophagitis - Published
- 2017
39. Gastric emptying in children with gastroesophageal reflux and in healthy children
- Author
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Tone Lise Åvitsland, Kristin Bjørnland, Ragnhild Emblem, Charlotte Kristensen Knatten, Are Hugo Pripp, J G Fjeld, and Asle W. Medhus
- Subjects
Male ,medicine.medical_specialty ,Esophageal pH Monitoring ,Adolescent ,Developmental Disabilities ,Fundoplication ,Scintigraphy ,Ph monitoring ,Gastroenterology ,Enteral Nutrition ,Esophagus ,Internal medicine ,Supine Position ,Animals ,Humans ,Medicine ,In patient ,Child ,Radionuclide Imaging ,medicine.diagnostic_test ,Gastric emptying ,business.industry ,Stomach ,fungi ,Reflux ,Infant ,General Medicine ,Milk ,Gastric Emptying ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Gastroesophageal Reflux ,Female ,Surgery ,business ,Half time - Abstract
Purpose The aim of this report is to examine whether children with gastroesophageal reflux (GER) have delayed gastric emptying compared to healthy children. Methods All patients had GER verified by 24-hour pH monitoring. Gastric emptying of cow’s milk was examined by radionuclide scintigraphy in 51 patients with GER and in 24 controls. Gastric emptying rate was expressed as exponential half time (T1/2). Results Median age was 4.4 years [range 0.1–15.4] in patients and 6.1 years [range 2.5–10.0] in controls (p = .10). A wide range of gastric emptying rates was observed both in GER patients [range 16–121] and controls [range 29–94]. One GER patient (2%) had slower gastric emptying (T1/2 = 121 min) than the healthy child with the longest T1/2 (94 min). Mean T1/2 was 49 minutes (SD 20.1) and 46 minutes (SD 14.2) in GER patients and controls, respectively (p = .51). Conclusions Gastric emptying rate of milk was not significantly different between children with GER and healthy children. A wide range of gastric emptying rates was observed in both groups.
- Published
- 2013
40. Nissen fundoplication in children with cerebral palsy: Influence on rate of gastric emptying and postprandial symptoms in relation to protein source in caloric liquid meals
- Author
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Beint S. Bentsen, Groa B. Johannesdottir, Asle W. Medhus, Vibeke Fossum, Ketil Størdal, and Anne C. Brun
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Fundoplication ,Critical Care and Intensive Care Medicine ,Nissen fundoplication ,Gastroenterology ,Cerebral palsy ,Double-Blind Method ,Internal medicine ,Dietary Carbohydrates ,medicine ,Humans ,Child ,Meals ,Breath test ,Meal ,Nutrition and Dietetics ,Gastric emptying ,medicine.diagnostic_test ,business.industry ,Cerebral Palsy ,digestive, oral, and skin physiology ,Caseins ,Postprandial Period ,medicine.disease ,Dietary Fats ,Gastrostomy ,surgical procedures, operative ,Postprandial ,Breath Tests ,Gastric Emptying ,Child, Preschool ,Female ,Dumping syndrome ,Dietary Proteins ,Caprylates ,business - Abstract
Summary Background & aims The aim was to study the influence of Nissen fundoplication on rate of gastric emptying and postprandial symptoms in relation to protein source in liquid meals in children with cerebral palsy. Methods Ten children with cerebral palsy and Nissen fundoplication and ten with cerebral palsy without Nissen fundoplication were studied. Patients had gastrostomy and received two meals, double-blinded, in random order, on separate days. Meals contained a standardised carbohydrate and fat base plus one of two protein modules (Meal A: 100% casein; Meal B: 40% casein/60% whey). The 13 C octanoic acid breath test was used to assess gastric emptying. Postprandial symptoms were recorded. Results are given as median. Results For meal A and B, respectively, time until 50% of the meal had emptied ( T 1/2 ) was 110 in the Nissen fundoplication- and 181 min in the non-Nissen fundoplication group, ( p = 0.35) and 50 and 85 min ( p = 0.25). Seven in the Nissen fundoplication group reported postprandial symptoms to meal B, none in the non-Nissen fundoplication group ( p Conclusions Compared with cerebral palsy-children without Nissen fundoplication, those with Nissen fundoplication have postprandial symptoms more frequently after receiving a rapid emptying meal. Gastric emptying alone, however, does not seem to explain the symptom occurrence. ClinicalTrials.gov: UUSKBK 28200706.
- Published
- 2013
41. Small intestinal malabsorption in chronic alcoholism: a retrospective study of alcoholic patients by the14C-<scp>d</scp>-xylose breath test
- Author
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Håvar Hope, Viggo Skar, Olav Sandstad, Einar Husebye, and Asle W. Medhus
- Subjects
Gastroenterology - Published
- 2012
42. P514 Combination treatment with vedolizumab and anti-TNF-α in inflammatory bowel disease: safety data
- Author
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Marte Lie Høivik, Asle W. Medhus, Lydia C T Buer, and Bjørn Moum
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,General Medicine ,medicine.disease ,Inflammatory bowel disease ,Golimumab ,Vedolizumab ,03 medical and health sciences ,0302 clinical medicine ,Combined treatment ,Anti tnf α ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,030211 gastroenterology & hepatology ,business ,medicine.drug - Published
- 2017
43. Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study
- Author
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Knut Skreden, Arild Nesbakken, Truls Hauge, Lene Larssen, Marianne Jensen Hjermstad, Tom Glomsaker, Dagfinn Gleditsch, Hartwig Kørner, Taran Søberg, Øistein Hovde, Jan K. Tholfsen, and Asle W. Medhus
- Subjects
Male ,Quality of life ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,MEDLINE ,Statistics, Nonparametric ,Article ,Gastrointestinal cancer ,Medical disciplines: 700::Clinical medical disciplines: 750::Oncology: 762 [VDP] ,Postoperative Complications ,Biliary tract neoplasm ,Surveys and Questionnaires ,medicine ,Health Status Indicators ,Humans ,Gastrointestinal Stenting ,Intensive care medicine ,Prospective cohort study ,Aged ,Gastrointestinal Neoplasms ,Cholestasis ,Norway ,business.industry ,General surgery ,Palliative Care ,Stent ,medicine.disease ,Outcome assessment ,Biliary Tract Neoplasms ,Treatment Outcome ,Fluoroscopy ,Female ,Stents ,Surgery ,business ,Intestinal Obstruction ,Abdominal surgery - Abstract
Background The clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians. Methods Between November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction. Results A total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P\0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms ([20 on the 0–100 scale, P\0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment. Conclusion SEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patientreported outcomes is important in evaluating SEMS treatment. publishedVersion
- Published
- 2011
44. Reduced13C-<scp>d</scp>-xylose absorption in alcoholics is more likely caused by alterations in small intestinal mucosa than delayed gastric emptying
- Author
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Haavar Blich Hope, Christine Raaheim Borge, Asle W. Medhus, Viggo Skar, and Olav Sandstad
- Subjects
Test meal ,Breath test ,medicine.medical_specialty ,Malabsorption ,Gastric emptying ,medicine.diagnostic_test ,business.industry ,digestive, oral, and skin physiology ,Gastroenterology ,medicine.disease ,Xylose absorption ,Small intestine ,Small intestinal mucosa ,medicine.anatomical_structure ,Internal medicine ,Chronic alcoholism ,Medicine ,business - Abstract
Objective. Alterations of the small intestinal absorptive surface are a probable cause of d-xylose malabsorption in chronic alcoholism. Delayed gastric emptying, however, may influence the 13C-d-xylose breath test, which is used to study intestinal function in alcoholics. The aim of this study was to measure gastric emptying in alcoholics to elucidate whether retention of the test meal could explain the malabsorptive pattern of the 13C-d-xylose breath test observed in alcoholics. Material and methods. Fifteen alcoholics performed the 13C-octanoic acid and the 13C-d-xylose breath tests on consecutive days in a random order. The 13CO2 expired was measured every 30 or 15 min for 4 h in the 13C-d-xylose and the 13C-octanoic acid breath tests, respectively, using a mass spectrometer equipped with a gas chromatograph. Test meals consisted of 100 mg of 13C-d-xylose and 5 g of unmarked d-xylose dissolved in 250 ml water and 91 mg 13C-octanoic acid embedded in a one-egg omelette served with white bread wi...
- Published
- 2011
45. Liquid and solid gastric emptying in adults treated for Hirschsprung's disease during early childhood
- Author
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Ragnhild Emblem, Einar Husebye, Asle W. Medhus, and Kristin Bjørnland
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Adolescent ,Analgesic ,Gastroenterology ,Internal medicine ,medicine ,Animals ,Humans ,Insulin ,Hirschsprung Disease ,Antipyretic ,Esophagus ,Child ,Hirschsprung's disease ,Breath test ,Meal ,Gastric emptying ,medicine.diagnostic_test ,business.industry ,Stomach ,digestive, oral, and skin physiology ,medicine.disease ,Solutions ,Milk ,medicine.anatomical_structure ,Breath Tests ,Gastric Emptying ,Food ,Female ,business ,medicine.drug - Abstract
Dysmotility of the upper gastrointestinal tract has been reported in children with Hirschsprung's disease. In the present study, gastric emptying was studied in adult patients with Hirschsprung's disease to elucidate whether there is a persisting involvement of the upper gastrointestinal tract in this group of patients.Gastric emptying of caloric liquids and solids was studied in 16 adult patients with surgically treated Hirschsprung's disease during early childhood and in age-matched controls. To examine liquid emptying, the paracetamol absorption test was applied using a meal containing glucose, lactose, maize oil, water (2020 kJ) and paracetamol. To examine solid emptying, the 13C gastric emptying breath test was applied using a meal containing white bread, margarine, a one-egg omelette (1050 kJ) and [13C]-octanoic acid. Gastrointestinal symptoms were recorded according to a standardized questionnaire.For liquid meal emptying, the time until emptying commenced was 8.1+/-1.9 and 2.9+/-0.9 min (mean+/-SE) in patients and controls, respectively (p=0.02). Thereafter, the first 25% of the meal emptied in 6.8+/-0.8 and 12.1+/-1.1 min in patients and controls, respectively (p=0.0005). The overall emptying rate tended to be delayed in patients compared with controls (p=0.06). For the solid meal, a delay in emptying was evident (p=0.02). The patients reported more symptoms from the upper gastrointestinal tract than the controls, but the symptoms were not significantly related to the emptying pathology demonstrated.The present study demonstrates that adult patients with Hirschsprung's disease have an abnormal pattern of gastric emptying, indicating persisting involvement of the upper gastrointestinal tract.
- Published
- 2007
46. Secular reduction of excess mortality in hip fracture patients > 85 years
- Author
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Trine Finnes, Haakon E. Meyer, Jan A. Falch, C. M. Lofthus, Asle W. Medhus, and Tore Wentzel-Larsen
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Population ,Osteoporosis ,Cohort Studies ,Statistical significance ,Medicine ,Humans ,education ,Survival rate ,Aged ,Aged, 80 and over ,education.field_of_study ,Hip fracture ,VDP::Medisinske fag: 700::Klinisk medisinske fag: 750::Geriatri: 778 ,business.industry ,Hip Fractures ,Incidence (epidemiology) ,Middle Aged ,medicine.disease ,Surgery ,VDP::Midical sciences: 700::Clinical medical sciences: 750::Geriatrics: 778 ,Log-rank test ,Survival Rate ,Female ,Geriatrics and Gerontology ,business ,Cohort study ,Follow-Up Studies ,Research Article - Abstract
Background More than 20% of the hip fracture patients die within the first year after the incident. Few data are available on the trends in mortality following a hip fracture. The present aim was to study changes in excess mortality after hip fracture from 1978/79 up to 1996/97. Methods Data on 5180 hip fracture patients aged ≥ 50 years, identified in three earlier, well validated, incidence studies from Oslo were used. The studies took place in the two years periods 1978–79 and 1989–89 and in a one year period from 1st of May 1996 to 30th of April 1997. The study was designed as a historic cohort study. Exposure was sustaining a hip fracture in the registration periods. Outcome was death of all causes. Age- and sex-specific one year-mortality rates were provided by Statistics Norway. Standardized mortality ratios (SMR) were calculated for the three cohorts for each sex and age-group, for the 0–6 months, 6–12 months, 0–1 year, 1–5 years and 5–10 years intervals after fracture. To assess the duration of the excess mortality in hip fracture patients, time-framed Kaplan-Meier curves for consecutive 5-years intervals were conducted for the hip fracture patients and the corresponding background population. Only patients still alive at the start of the time interval were included. One sample log rank tests were used to test for statistical significance. Results The one-year SMR ranged from 3.64 (2.82 – 4.61) to 4.53 (3.67 – 5.54) in men and from 2.78 (2.39 – 3.19) to 3.60 (3.19 – 4.05) in women. In the 0–6 months interval a reduction in SMR from 1978/79 to 1996/97 was observed in women aged ≥85 years. The duration of excess mortality ranged from two years in men ≥85 years to more than ten years in men and women aged 65–84 years. Conclusion Excess mortality among hip fracture patients remains high. Over the decades, a reduced excess mortality was mainly seen in the oldest patients, suggesting that specific efforts intending to improve prevention and treatment of osteoporosis and osteoporotic fractures in the youngest elderly are required.
- Published
- 2013
47. Long-term outcome of palliative treatment with self-expanding metal stents for malignant obstructions of the GI tract
- Author
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Truls Hauge, Asle W. Medhus, Taran Søberg, Arild Nesbakken, Jan K. Tholfsen, Lene Larssen, Øistein Hovde, Tom Glomsaker, Hartwig Kørner, Knut Skreden, and Dagfinn Gleditsch
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Palliative care ,Time Factors ,Palliative treatment ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Stent patency ,Patient Readmission ,Endoscopy, Gastrointestinal ,Statistics, Nonparametric ,Neoplasms ,medicine ,Humans ,Intestinal obstruction surgery ,Aged ,Aged, 80 and over ,Cholestasis ,medicine.diagnostic_test ,business.industry ,Norway ,Palliative Care ,Gastroenterology ,Follow up studies ,Stent ,Middle Aged ,Surgery ,Endoscopy ,Prosthesis Failure ,Stent placement ,Disease Progression ,Esophageal Stenosis ,Female ,Stents ,Radiology ,business ,Intestinal Obstruction ,Follow-Up Studies - Abstract
Self-expanding metal stents (SEMS) are commonly used in the palliative treatment of malignant gastrointestinal (GI) obstructions with favorable short-term outcome. Data on long-term outcome are scarce, however.To evaluate long-term outcome after palliative stent treatment of malignant GI obstruction.Between October 2006 and April 2008, nine Norwegian hospitals included patients treated with SEMS for malignant esophageal, gastroduodenal, biliary, and colonic obstructions. Patients were followed for at least 6 months with respect to stent patency, reinterventions, and readmissions.Stent placement was technically successful in 229 of 231 (99%) and clinically successful after 1 week in 220 of 229 (96%) patients. Long-term follow-up was available for 219 patients. Of those, 72 (33%) needed reinterventions. Stent occlusions or migrations (92%) were the most common reasons. Esophageal stents required reinterventions most frequently (41%), and had a significantly (p = 0.02) shorter patency (median 152 days) compared to other locations (gastroduodenal, 256 days; colon, 276 days; biliary, 460 days). Eighty percent of reinterventions were repeated endoscopic procedures that successfully restored patency. Readmissions were required for 156 (72%) patients. Progression of the underlying cancer was the most common reason, whereas 24% were readmitted due to stent complications.Long-term outcome after palliative treatment with SEMS for malignant GI and biliary obstruction shows that 70% had a patent stent until death, and that most reobstructions could be solved endoscopically. Hospital readmissions were mainly related to progression of the underlying cancer disease.
- Published
- 2012
48. Switching from Remicade® to Remsima® is well tolerated and feasible: a prospective, open-label study
- Author
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Asle W. Medhus, Lydia C T Buer, David J. Warren, Marte Lie Høivik, Milada Cvancarova, and Bjørn Moum
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Population ,Severity of Illness Index ,Inflammatory bowel disease ,Antibodies ,Feces ,Hemoglobins ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Internal medicine ,medicine ,Humans ,Prospective Studies ,education ,Adverse effect ,Biosimilar Pharmaceuticals ,Aged ,Aged, 80 and over ,Crohn's disease ,education.field_of_study ,Drug Substitution ,business.industry ,Gastroenterology ,Antibodies, Monoclonal ,General Medicine ,Middle Aged ,medicine.disease ,Ulcerative colitis ,Faecal calprotectin ,Infliximab ,Surgery ,C-Reactive Protein ,030220 oncology & carcinogenesis ,Feasibility Studies ,Colitis, Ulcerative ,Female ,030211 gastroenterology & hepatology ,Calprotectin ,business ,Leukocyte L1 Antigen Complex ,Follow-Up Studies ,medicine.drug - Abstract
Background and aims: A biosimilar version of infliximab (CT-P13/Remsima®) recently entered the European market. The clinical data on its use in inflammatory bowel disease are sparse, especially on switching from the originator Remicade®. In this study, we aimed to prospectively investigate the feasibility, safety and immunogenicity of switching from Remicade® to Remsima® in a real-life IBD population. Methods: All adult patients who were treated with Remicade® in the Department of Gastroenterology at Oslo University Hospital were switched to Remsima®. The follow-up lasted for 6 months. In addition, a retrospective registration was performed with a start time of 6 months before switching drugs. The primary endpoints were i) the proportion of patients remaining on medication 6 months after switching and ii) adverse events during the 6 months after switching. The secondary endpoints included i) disease activity scores (Harvey-Bradshaw Index and Partial Mayo Score), C-reactive protein, haemoglobin, faecal calprotectin, Infliximab dose and interval, p-infliximab and ii) the development of antidrug antibodies. Results: In total, 143 IBD patients were switched, 99 with Crohn’s disease and 44 with ulcerative colitis. The large majority (97%) remained on the medication throughout follow-up. A low number of adverse events were observed. No change in disease activity, C-reactive protein, haemoglobin, faecal calprotectin, Infliximab dose and interval or p-Infliximab was detected. Three patients developed new detectable antidrug antibodies. Conclusions: Our study demonstrated that switching from Remicade® to Remsima® was feasible and with few adverse events, including very limited antidrug antibody formation and loss of response.
- Published
- 2016
49. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival
- Author
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Truls Hauge, Asle W. Medhus, and Lene Larssen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nausea ,Duodenum ,medicine.medical_treatment ,Gastroenterology ,Satiety Response ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,Aged ,Aged, 80 and over ,Gastric emptying ,business.industry ,Gastric Outlet Obstruction ,digestive, oral, and skin physiology ,Anastomosis, Surgical ,Palliative Care ,Stent ,Gastric outlet obstruction ,Hepatology ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,Treatment Outcome ,Gastric Emptying ,Area Under Curve ,Vomiting ,Female ,Stents ,medicine.symptom ,business ,Abdominal surgery - Abstract
Advanced pancreatic cancer and other malignancies located proximal to the small bowel might cause gastric outlet obstruction (GOO) resulting in nausea, vomiting, dehydration, and malnutrition. Self-expandable metal stents (SEMS) to a large extent have replaced surgical treatment, with gastro-entero-anastomosis as palliative treatment for GOO. The aim of the present study was to evaluate the effect of duodenal stenting on the rate of gastric emptying, symptoms, and survival. Patients with endoscopically verified malignant obstruction of the proximal duodenum were included. Gastric emptying rate was measured prior to and within 1 week after stent placement using a meal containing 13C-octanoic acid as a marker. Symptoms related to GOO were assessed by the patients before and 2 weeks after stent treatment and during the gastric emptying tests. All patients were followed up until death. In the patients included (n = 17), all studied variables of gastric emptying improved significantly following treatment, and a reduction in self-reported obstructive symptoms was observed. There was no correlation between survival and the rate of gastric emptying before or after, or the change in the rate of emptying. The present study demonstrated that treatment with SEMS results in improved gastric emptying in most patients with GOO and a corresponding reduction in self-reported obstruction symptoms. However, survival and emptying were not related. The present findings provide further evidence that treatment with stents is an effective palliative treatment in patients with GOO.
- Published
- 2011
50. The effect of protein composition in liquid meals on gastric emptying rate in children with cerebral palsy
- Author
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Asle W. Medhus, Ketil Størdal, Groa B. Johannesdottir, Beint S. Bentsen, and Anne C. Brun
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Gastrointestinal Diseases ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Cerebral palsy ,Double-Blind Method ,Internal medicine ,Casein ,medicine ,Humans ,Amino Acids ,Child ,Breath test ,Gastrostomy ,Meal ,Carbon Isotopes ,Nutrition and Dietetics ,Gastric emptying ,medicine.diagnostic_test ,business.industry ,Cerebral Palsy ,digestive, oral, and skin physiology ,Caseins ,medicine.disease ,Milk Proteins ,Postprandial Period ,Diet ,Postprandial ,Whey Proteins ,Breath Tests ,Gastric Emptying ,Vomiting ,Female ,medicine.symptom ,Caprylates ,business ,Energy Intake - Abstract
Dysmotility, nausea and vomiting are common among children with cerebral palsy. This study aimed to evaluate influence of protein composition on rate of gastric emptying and study the relation between gastric emptying and postprandial gastrointestinal symptoms.15 children with cerebral palsy, using gastrostomy, received four liquid test meals on separate days in random order. The meals contained a standard carbohydrate and fat base plus one of four protein modules (100% casein (A), hydrolysed whey (B), amino acids (C) and 40% casein/60% whey (D)) with a total energy of 1 kcal/ml. The (13)C octanoic acid breath test was applied to assess gastric emptying.When comparing half emptying time (T(1/2)) of the fast emptying meals (meal B, C and D) with the slowest emptying meal (meal A), more rapid emptying was demonstrated for meal D (p 0.001). For meal D, emptying was significantly faster in children with postprandial symptoms than in those without (p 0.01).In children with cerebral palsy using gastrostomy, gastric emptying is influenced by type of protein in the meal. The present results also suggest that there is a relation between rapid gastric emptying and postprandial gastrointestinal symptoms. CLINICALTRIALS.GOV: UUSKBK 28200706.
- Published
- 2010
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