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Rorsman, Fredrik
Alternative names
Publications (10 of 23) Show all publications
Rosenqvist, K., Sheikhi, R., Nyman, R., Rorsman, F., Sangfelt, P. & Ebeling Barbier, C. (2018). Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population.. Scandinavian Journal of Gastroenterology, 53(1), 70-75
Open this publication in new window or tab >>Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population.
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 1, p. 70-75Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting.

MATERIALS AND METHODS: Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016.

RESULTS: Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE.

CONCLUSIONS: TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.

Keywords
TIPS, TIPS dysfunction, Variceal bleeding, hepatic encephalopathy, liver cirrhosis, portal hypertension, portosystemic gradient, re-bleeding, transjugular intrahepatic portosystemic shunt
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-331785 (URN)10.1080/00365521.2017.1386795 (DOI)000418116300010 ()28990812 (PubMedID)
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2018-05-15Bibliographically approved
Borssen, Å. D., Marschall, H.-U., Bergquist, A., Rorsman, F., Weiland, O., Kechagias, S., . . . Werner, M. (2017). Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis. Scandinavian Journal of Gastroenterology, 52(9), 1022-1028
Open this publication in new window or tab >>Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 9, p. 1022-1028Article in journal (Refereed) Published
Abstract [en]

Background: Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce.Objective To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort.Material and methods: Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Vasterbotten in Northern Sweden.Results: AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p<.001) and died younger than women (p=.002). No gender differences were found concerning transplant-free, overall survival and liver-related death. Cirrhosis at diagnosis was linked to an inferior survival (p<.001). Liver-related death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years.Conclusions: Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Autoimmune hepatitis, epidemiology, causes of death, liver, cirrhosis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-330085 (URN)10.1080/00365521.2017.1335772 (DOI)000404368000016 ()28562110 (PubMedID)
Available from: 2017-10-19 Created: 2017-10-19 Last updated: 2017-10-19Bibliographically approved
Borssen, Å. D., Palmqvist, R., Kechagias, S., Marschall, H.-U., Bergquist, A., Rorsman, F., . . . Werner, M. (2017). Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis A cohort study. Medicine (Baltimore, Md.), 96(34), Article ID e7708.
Open this publication in new window or tab >>Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis A cohort study
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 34, article id e7708Article in journal (Refereed) Published
Abstract [en]

Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis. A total of 258 liver biopsies from 101 patients (72 women, 29 men) were analyzed by a single pathologist and classified according to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased, or stable), and groups were compared. Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in the fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only 5 patients at the last biopsy. Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
autoimmune hepatitis, autoimmune liver disease, cirrhosis, fibrosis, inflammation
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-335251 (URN)10.1097/MD.0000000000007708 (DOI)000408504800012 ()28834875 (PubMedID)
Available from: 2017-12-04 Created: 2017-12-04 Last updated: 2017-12-04Bibliographically approved
Hagström, H., Nasr, P., Ekstedt, M., Kechagias, S., Önnerhag, K., Nilsson, E., . . . Stål, P. (2017). Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease. Scandinavian Journal of Gastroenterology, 52(2), 159-165
Open this publication in new window or tab >>Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 2, p. 159-165Article in journal (Refereed) Published
Abstract [en]

Background and aim: Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD. Methods: We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled. Results: An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p = .017). The lowest risk for fibrosis was found with the lowest odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p = .006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth >= 0.3 mu mol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p = .047). Conclusion: Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.

Keywords
NAFLD, NASH, alcohol, lifetime alcohol consumption, fibrosis stage
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-316134 (URN)10.1080/00365521.2016.1239759 (DOI)000392488000008 ()27650916 (PubMedID)
Available from: 2017-03-03 Created: 2017-03-03 Last updated: 2017-11-29Bibliographically approved
Landegren, N., Pourmousa Lindberg, M., Skov, J., Hallgren, Å., Eriksson, D., Lisberg Toft-Bertelsen, T., . . . Kämpe, O. (2016). Autoantibodies Targeting a Collecting Duct-Specific Water Channel in Tubulointerstitial Nephritis.. Journal of the American Society of Nephrology, 27(10), 3220-3228
Open this publication in new window or tab >>Autoantibodies Targeting a Collecting Duct-Specific Water Channel in Tubulointerstitial Nephritis.
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2016 (English)In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 27, no 10, p. 3220-3228Article in journal (Refereed) Published
Abstract [en]

Tubulointerstitial nephritis is a common cause of kidney failure and may have diverse etiologies. This form of nephritis is sometimes associated with autoimmune disease, but the role of autoimmune mechanisms in disease development is not well understood. Here, we present the cases of three patients with autoimmune polyendocrine syndrome type 1 who developed tubulointerstitial nephritis and ESRD in association with autoantibodies against kidney collecting duct cells. One of the patients developed autoantibodies targeting the collecting duct-specific water channel aquaporin 2, whereas autoantibodies of the two other patients reacted against the HOXB7 or NFAT5 transcription factors, which regulate the aquaporin 2 promoter. Our findings suggest that tubulointerstitial nephritis developed in these patients as a result of an autoimmune insult on the kidney collecting duct cells.

National Category
Rheumatology and Autoimmunity
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-300411 (URN)10.1681/ASN.2015101126 (DOI)000384628500030 ()26984885 (PubMedID)
Funder
Swedish Research CouncilSwedish Research Council FormasSwedish Rheumatism AssociationNovo NordiskTorsten Söderbergs stiftelseRagnar Söderbergs stiftelse
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2017-11-28Bibliographically approved
Rosenqvist, K., Eriksson, L.-G., Rorsman, F., Sangfelt, P. & Nyman, R. (2016). Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver. Acta Radiologica, 57(5), 572-579
Open this publication in new window or tab >>Endovascular treatment of acute and chronic portal vein thrombosis in patients with cirrhotic and non-cirrhotic liver
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2016 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 57, no 5, p. 572-579Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Treatment of patients with portal vein thrombosis (PVT) differs due to different etiology and wide range of symptoms but certain patients seems to benefit from endovascular intervention.

PURPOSE: To assess the safety and efficiency of endovascular treatment of acute and chronic PVT in patients with cirrhotic and non-cirrhotic liver.

MATERIAL AND METHODS: Twenty-one patients with PVT treated with an endovascular procedure in 2002-2013 were studied retrospectively. Data on etiology, onset and extension of thrombus, presenting symptoms, methods of intervention, portal pressure gradients, complications, recurrence of symptoms, re-interventions, clinical status at latest follow-up, and survival were collected.

RESULTS: Four non-cirrhotic patients with acute extensive PVT and bowel ischemia were treated with local thrombolysis, in three combined with placement of a transjugular intrahepatic portosystemic shunt (TIPS) placement. Three recovered and have survived more than 6 years. In six non-cirrhotic patients with chronic PVT and acute or threatening variceal bleeding recanalization and TIPS were successful in three and failed in three. Eleven cirrhotic patients with PVT and variceal bleeding or refractory ascites were successfully treated with recanalization and TIPS. Re-intervention was performed in five of these patients and five patients died, three within 12 months of intervention. Four cirrhotic patients had episodes of shunt-related encephalopathy and three had variceal re-bleeding.

CONCLUSION: TIPS was found to be effective in reducing portal hypertension in patients with PVT. In patients with extensive PVT and bowel ischemia treatment with TIPS combined with thrombolysis should be considered.

Keywords
Portal vein; thrombosis; liver cirrhosis; endovascular procedure; retrospective study
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-261206 (URN)10.1177/0284185115595060 (DOI)000374327600010 ()26253926 (PubMedID)
Available from: 2015-08-31 Created: 2015-08-31 Last updated: 2017-12-04Bibliographically approved
Rosenqvist, K., Sheikhi, R., Eriksson, L.-G., Rajani, R., Rorsman, F., Sangfelt, P. & Nyman, R. (2016). Endovascular treatment of symptomatic Budd-Chiari syndrome - in favour of early transjugular intrahepatic portosystemic shunt.. European Journal of Gastroenterology and Hepathology, 28(6), 656-660
Open this publication in new window or tab >>Endovascular treatment of symptomatic Budd-Chiari syndrome - in favour of early transjugular intrahepatic portosystemic shunt.
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2016 (English)In: European Journal of Gastroenterology and Hepathology, ISSN 0954-691X, E-ISSN 1473-5687, Vol. 28, no 6, p. 656-660Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Treatment of Budd-Chiari syndrome (BCS) has shifted from mainly medical treatment, with surgical shunt and orthotopic liver transplantation (OLT) as rescue, to medical treatment combined with an early endovascular intervention in the past two decades.

PURPOSE: To assess the safety and efficiency of endovascular treatment of symptomatic patients with BCS and to compare mortality with symptomatic BCS patients in the same region treated with only sporadic endovascular techniques.

METHODS: This was a retrospective review of clinical data, treatment and survival in 14 patients diagnosed with BCS and treated with endovascular methods from 2003 to 2015. A national epidemiology study of BCS from 1986 to 2003 was used for comparison.

RESULTS: Thirteen of the 14 patients eventually had transjugular intrahepatic portosystemic shunt (TIPS), four after previous liver vein angioplasty. TIPS were performed with polytetrafluoroethylene-covered stents and technical success was 100%. Calculated preinterventional prognostic indices indicated a high risk of TIPS dysfunction, OLT and death. However, only one patient died and one had an OLT, and the 1- and 2-year primary TIPS-patency was 85 and 67%, respectively. Episodes of de-novo hepatic encephalopathy occurred in three patients. Overall 1- and 5-year transplantation-free survival was 100 and 93% compared with 47 and 28%, respectively, in 1986 to 2003.

CONCLUSION: TIPS seems to be a safe and effective treatment for symptomatic BCS and there is an obvious improvement in transplantation-free survival compared with conservatory medical treatment. It should, therefore, be considered early, as first-line intervention, in patients with insufficient response to medical treatment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-285913 (URN)10.1097/MEG.0000000000000621 (DOI)000375147100008 ()26958788 (PubMedID)
Available from: 2016-04-20 Created: 2016-04-20 Last updated: 2017-11-30Bibliographically approved
Lampinen, M., Fredricsson, A., Vessby, J., Wanders, A., Rorsman, F. & Carlson, M. (2016). Expression of the liver homing receptor CXCR3+on colonic CD8+T lymphocytes in patients with primary sclerosing cholangitis provides a possible link between colonic and biliary duct inflammation. Journal of Crohn's & Colitis, 10, S109-S109
Open this publication in new window or tab >>Expression of the liver homing receptor CXCR3+on colonic CD8+T lymphocytes in patients with primary sclerosing cholangitis provides a possible link between colonic and biliary duct inflammation
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2016 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 10, p. S109-S109Article in journal, Meeting abstract (Other academic) Published
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-299652 (URN)000374496600160 ()
Available from: 2016-07-25 Created: 2016-07-25 Last updated: 2017-11-28Bibliographically approved
Hagström, H., Nasr, P., Ekstedt, M., Kechagias, S., Onnerhag, K., Nilsson, E., . . . Hultcrantz, R. W. (2016). Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease. Paper presented at 67th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD), NOV 11-15, 2016, Boston, MA. Hepatology, 63(1 SUPP), 18A-19A
Open this publication in new window or tab >>Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease
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2016 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 63, no 1 SUPP, p. 18A-19AArticle in journal, Meeting abstract (Refereed) Published
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-313675 (URN)000385493800037 ()
Conference
67th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD), NOV 11-15, 2016, Boston, MA
Available from: 2017-01-24 Created: 2017-01-23 Last updated: 2018-03-12Bibliographically approved
Rönnblom, A., Holmstrom, T., Tanghoj, H., Rorsman, F. & Sjoberg, D. (2015). Appearance of hepatobiliary diseases in a population-based cohort with inflammatory bowel diseases (Inflammatory Bowel Disease Cohort of the Uppsala Region). Journal of Gastroenterology and Hepatology, 30(8), 1288-1292
Open this publication in new window or tab >>Appearance of hepatobiliary diseases in a population-based cohort with inflammatory bowel diseases (Inflammatory Bowel Disease Cohort of the Uppsala Region)
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2015 (English)In: Journal of Gastroenterology and Hepatology, ISSN 0815-9319, E-ISSN 1440-1746, Vol. 30, no 8, p. 1288-1292Article in journal (Refereed) Published
Abstract [en]

Background and AimTo prospectively follow the evolution of hepatobiliary diseases in a population-based cohort of patients with inflammatory bowel diseases. MethodsBetween 2005 and 2009, 790 incident cases of ulcerative colitis and Crohn's disease were registered in the Uppsala Health Region, corresponding to an average incidence of 20.0 and 9.9 new cases/100000 inhabitants/year, respectively. Liver function tests were analyzed in 97.1% and the results of ensuing investigations were summarized. ResultsSeventeen patients with primary sclerosing cholangitis were diagnosed corresponding to an overall prevalence of 2.2% (ulcerative colitis 1.7% and Crohn's disease 3.0%, respectively). The median age at diagnosis was 25 years (interquartile range: 17.0-34.0). Among the 92 patients below 17 years of age, three had autoimmune hepatitis and three primary sclerosing cholangitis, summing up to a prevalence of 6.5% immune-mediated hepatobiliary diseases among the pediatric patients. Three patients have undergone liver transplantation and one died of colonic carcinoma. Ten patients have demonstrated persistent elevation of alkaline phosphatases but had a normal magnetic resonance cholangiopancreatography (two patients) or refused further investigation (one patient). ConclusionIn this first large prospective population-based cohort of 526 patients with ulcerative colitis (UC) and 264 with Crohn's disease, 17 cases of primary sclerosing cholangitis were found, among whom three (17%) so far have been liver transplanted and one has died of colon carcinoma. The average age of those affected by primary sclerosing cholangitis is considerably lower than usually reported. Ten patients had or have had elevated alkaline phosphatase without confirmed liver or biliary disease.

Keywords
autoimmune hepatitis, inflammatory bowel diseases, hepatobiliary diseases, primary sclerosing cholangitis
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-260820 (URN)10.1111/jgh.12947 (DOI)000358436400014 ()25777994 (PubMedID)
Available from: 2015-08-28 Created: 2015-08-25 Last updated: 2017-12-04Bibliographically approved
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