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Hellström, Per M.
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Publications (10 of 80) Show all publications
Frigstad, S. O., Hammarlund, P., Bonderup, O., Rannem, T., Haaber, A., Fallingborg, J., . . . Hellström, P. M. (2017). Anaemia and iron deficiency in gastroenterology: a Scandinavian prospective, observational study of iron isomaltoside in clinical practice. Journal of Crohn's & Colitis, 11, S351-S351.
Open this publication in new window or tab >>Anaemia and iron deficiency in gastroenterology: a Scandinavian prospective, observational study of iron isomaltoside in clinical practice
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2017 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, S351-S351 p.Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-328843 (URN)000398606901067 ()28172956 (PubMedID)
Available from: 2017-09-04 Created: 2017-09-04 Last updated: 2017-09-04Bibliographically approved
Webb, D.-L., Abrahamsson, N., Sundbom, M. & Hellström, P. M. (2017). Bariatric surgery - time to replace with GLP-1?. Scandinavian Journal of Gastroenterology, 52(6-7), 635-640.
Open this publication in new window or tab >>Bariatric surgery - time to replace with GLP-1?
2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 6-7, 635-640 p.Article, review/survey (Refereed) Published
Abstract [en]

Obesity with a body mass index (BMI) over 30kg/m(2) represents a significant risk for increased morbidity and mortality, with reduced life expectancy of about 10 years. Until now, surgical treatment has been the only effective longterm intervention. The currently standardized method of bariatric surgery, gastric bypass, means that many gastrointestinal peptide hormones are activated, yielding net reductions in appetite and food intake. Among the most important gut peptide hormones in this perspective is glucagon-like peptide-1 (GLP-1), which rises sharply after gastric bypass. Consistent with outcomes of this surgery, GLP-1 suppresses appetite and reduces food intake. This implies that GLP-1 has the potential to achieve a similar therapeutic outcome as gastric bypass. GLP-1 analogs, which are used for the treatment of type 2 diabetes mellitus, also lead to significant weight loss. Altered hormonal profiles after gastric bypass therefore indicate a logical connection between gut peptide hormone levels, weight loss and glucose homeostasis. Furthermore, combinations of GLP-1 with other gut hormones such as peptide YY (PYY) and cholecystokinin (CCK) may be able to reinforce GLP-1 driven reduction in appetite and food intake. Pharmacological intenvention in obesity by use of GLP-1 analogs (exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, taspoglutide) and inhibitors of dipeptidyl peptidase-IV (DPP-IV) degradation that inactivate GLP-1 (sitagliptin, vildagliptin), leading to reduced appetite and weight with positive effects on metabolic control, are realistically achievable. This may be regarded as a low-risk therapeutic alternative to surgery for reducing obesity-related risk factors in the obese with lower BMIs.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keyword
Gastric bypass, gastric emptying, glucagon-like peptides, glucose homeostasis, weight loss
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-328850 (URN)10.1080/00365521.2017.1293154 (DOI)000399808100004 ()28276830 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
Hellström, P. M., Stålhammar, J., Beydogan, H., Huetson, P., Skup, M. & Agreus, L. (2017). Indirect burden of patients with moderate inflammatory bowel disease in Uppsala County Council, Sweden: a retrospective study using real-world data. Journal of Crohn's & Colitis, 11, S457-S457.
Open this publication in new window or tab >>Indirect burden of patients with moderate inflammatory bowel disease in Uppsala County Council, Sweden: a retrospective study using real-world data
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2017 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, S457-S457 p.Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-328844 (URN)000398606901268 ()
Available from: 2017-09-04 Created: 2017-09-04 Last updated: 2017-09-04Bibliographically approved
Hellström, P. M., Samuelsson, B., Al-Ani, A. N. & Hedström, M. (2017). Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study. BMC Anesthesiology, 17, Article ID 23.
Open this publication in new window or tab >>Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study
2017 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 17, 23Article in journal (Refereed) Published
Abstract [en]

Background: Guidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture. Methods: In a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77-97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45-71 and ten healthy volunteers, age 28-55. Results: The mean gastric half-emptying time in the elderly study group was 53 +/- 5 (39-82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 +/- 4 (41-106) and 59 +/- 5 (33-72) minutes, indicating normal gastric emptying time in elderly with hip fracture. Conclusion: This pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.

Keyword
Aspiration, Carbohydrate loading, Metabolism, Nutrition, Surgery
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-317944 (URN)10.1186/s12871-016-0299-6 (DOI)000394554300001 ()28202056 (PubMedID)
Available from: 2017-04-01 Created: 2017-04-01 Last updated: 2017-11-29Bibliographically approved
Wegeberg, A., Brock, B., Hobson, A. R., Mohammed, S. D., Scott, S. M., Richards, D., . . . Farmer, A. D. (2017). Normative values of regional and sub-regional gastrointestinal motility and contractility parameters using the wireless motility capsule. Paper presented at NeuroGASTRO 2017 Congress, 24-26 August 2017, Cork, Ireland. Neurogastroenterology and Motility, 29(S2), 105-105, Article ID 212.
Open this publication in new window or tab >>Normative values of regional and sub-regional gastrointestinal motility and contractility parameters using the wireless motility capsule
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2017 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 29, no S2, 105-105 p., 212Article in journal, Meeting abstract (Other academic) Published
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-334998 (URN)10.1111/nmo.13180 (DOI)000407643600213 ()
Conference
NeuroGASTRO 2017 Congress, 24-26 August 2017, Cork, Ireland
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2017-11-29Bibliographically approved
Al-Saffar, A., Meijer, C. H., Gannavarapu, V. R., Hall, G., Li, Y., Diaz Tartera, H. O., . . . Dominic-Luc, W. (2017). Parallel Changes in Harvey-Bradshaw Index, TNFα, and Intestinal Fatty Acid Binding Protein  in Response to Infliximab in Crohn’s Disease. Gastroenterology Research and Practice, 1-8, Article ID 1745918.
Open this publication in new window or tab >>Parallel Changes in Harvey-Bradshaw Index, TNFα, and Intestinal Fatty Acid Binding Protein  in Response to Infliximab in Crohn’s Disease
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2017 (English)In: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, 1-8 p., 1745918Article in journal (Refereed) Published
Abstract [en]

Intestinal fatty acid binding protein (I-FABP) indicates barrier integrity. Aims: determine if I-FABP is elevated in active Crohn's disease (CD) and if I-FABP parallels anti-TNF alpha antibody (infliximab) induced lowering of TNF alpha and Harvey-Bradshaw Index (HBI) as potential indicator of mucosal healing. I-FABP distribution along human gut was determined. Serum from 10 CD patients collected during first three consecutive infliximab treatments with matched pretreatment and follow-up samples one week after each treatment and corresponding HBI data were analyzed. I-FABP reference interval was established from 31 healthy subjects with normal gut permeability. I-FABP and TNF alpha were measured by ELISA; CRP was measured by nephelometry. Healthy tissue was used for I-FABP immunohistochemistry. Pretreatment CD patient TNF alpha was 1.6-fold higher than in-house reference interval, while I-FABP was 2.5-fold higher, which lowered at follow-ups. Combining all 30 infusion/follow-up pairs also revealed changes in I-FABP. HBI followed this pattern; CRP declined gradually. I-FABP was expressed in epithelium of stomach, jejunum, ileum, and colon, with the highest expression in jejunum and ileum. I-FABP is elevated in active CD with a magnitude comparable to TNF alpha. Parallel infliximab effects on TNF alpha, HBI, and I-FABP were found. I-FABP may be useful as an intestine selective prognostic marker in CD.

Place, publisher, year, edition, pages
Egypt: Hindawi Publishing Corporation, 2017
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-334232 (URN)10.1155/2017/1745918 (DOI)000413557400001 ()
Funder
Swedish Research Council, 7916The Karolinska Institutet's Research FoundationThe Swedish Medical Association, SLS-411921; SLS-503131
Note

Title in WoS: Parallel Changes in Harvey-Bradshaw Index, TNF alpha, and Intestinal Fatty Acid Binding Protein in Response to Infliximab in Crohn's Disease

Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2017-12-07Bibliographically approved
Hellström, P. M., Hendolin, P., Kaihovaara, P., Kronberg, L., Meierjohann, A., Millerhovf, A., . . . Salaspuro, M. (2017). Slow-release L-cysteine capsule prevents gastric mucosa exposure to carcinogenic acetaldehyde: results of a randomised single-blinded, cross-over study of Helicobacter-associated atrophic gastritis. Scandinavian Journal of Gastroenterology, 52(2), 230-237.
Open this publication in new window or tab >>Slow-release L-cysteine capsule prevents gastric mucosa exposure to carcinogenic acetaldehyde: results of a randomised single-blinded, cross-over study of Helicobacter-associated atrophic gastritis
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 2, 230-237 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Helicobacter-induced atrophic gastritis with a hypochlorhydric milieu is a risk factor for gastric cancer. Microbes colonising acid-free stomach oxidise ethanol to acetaldehyde, a recognised group 1 carcinogen. Objective: To assess gastric production of acetaldehyde and its inert condensation product, non-toxic 2-methyl-1,3-thiazolidine-4-carboxylic acid (MTCA), after alcohol intake under treatment with slow-release L-cysteine or placebo. Methods: Seven patients with biopsy-confirmed atrophic gastritis, low serum pepsinogen and high gastrin-17 were studied in a cross-over single-blinded design. On separate days, patients randomly received 200 mg slow-release L-cysteine or placebo with intragastric instillation of 15% (0.3 g/kg) ethanol. After intake, gastric concentrations of ethanol, acetaldehyde, L-cysteine and MTCA were analysed. Results: Administration of L-cysteine increased MTCA (p < .0004) and decreased gastric acetaldehyde concentrations by 68% (p < .0001). The peak L-cysteine level was 7552 +/- 2687 mu mol/L at 40 min and peak MTCA level 196 +/- 98 mu mol/L at 80 min after intake. Gastric L-cysteine and MTCA concentrations were maintained for 3 h. The AUC for MTCA was 11-fold higher than acetaldehyde, indicating gastric first-pass metabolism of ethanol. With placebo, acetaldehyde remained elevated also at low ethanol concentrations representing 'non-alcoholic' beverages and food items. Conclusions: After gastric ethanol instillation, slow-release L-cysteine eliminates acetaldehyde to form inactive MTCA, which remains in gastric juice for up to 3 h. High acetaldehyde levels indicate a marked gastric first-pass metabolism of ethanol resulting in gastric accumulation of carcinogenic acetaldehyde. Local exposure of the gastric mucosa to acetaldehyde can be mitigated by slow-release L-cysteine capsules.

Keyword
Alcohol, carcinogenesis, ethanol, prophylaxis, stomach
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-316135 (URN)10.1080/00365521.2016.1249403 (DOI)000392488000020 ()27806647 (PubMedID)
Available from: 2017-03-03 Created: 2017-03-03 Last updated: 2017-11-29Bibliographically approved
Diaz Tartera, H. O., Webb, D.-L., Al-Saffar, A., Halim, M. A., Lindberg, G., Sangfelt, P. & Hellström, P. M. (2017). Validation of SmartPill® wireless motility capsule for gastrointestinaltransit time: Intra-subject variability, software accuracy and comparison with video capsule endoscopy.. Neurogastroenterology and Motility, 29(10), Article ID e13107.
Open this publication in new window or tab >>Validation of SmartPill® wireless motility capsule for gastrointestinaltransit time: Intra-subject variability, software accuracy and comparison with video capsule endoscopy.
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2017 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 29, no 10, e13107Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is interest in ultimately combining endoscopy and motility assessments. Gastric emptying (GET), small bowel (SBTT), colon (CTT) and whole gut transit (WGTT) times are conveniently obtained by SmartPill® wireless motility capsule (WMC) that records luminal pH, temperature and pressure. Reproducibility within same subjects and accuracy of software derived times (MotiliGI® ) were investigated for diagnostic application. GET and SBTT were separately measured using video capsule endoscopy (VCE). The aim of this investigation was to assess same subject reproducibility of WMC, accuracy of software derived transit times and relate to Pillcam® SB (small bowel) VCE motility data.

METHODS: Seventy three healthy adults ingested a 260 kcal mixed meal followed by WMC tests. Food intake was permitted after 6 hours. Regional transit data was obtained for GET, SBTT and CTT, the sum yielding WGTT. Nineteen subjects repeated WMC tests 2 or 4 weeks later; a separate 70 underwent VCE while fasted.

KEY RESULTS: Visually derived data from WMC yielded GET 3.46±0.27, SBTT 5.15±0.21, CTT 20.76±1.19 and WGTT 29.53±1.28 hours (mean±SEM). Pearson's correlation coefficients (r) against software derived results were: GET 0.78 (P<.0001), SBTT 0.28 (P<.05), CTT 0.96 (P<.0001), WGTT 0.99 (P<.0001). VCE yielded lower GET (0.71±0.08 hours) and SBTT (4.15±0.13 hours).

CONCLUSIONS AND INFERENCES: GET, SBTT, CTT and WGTT obtained by WMC are commensurate with literature values, including by other methods. Visually and software derived transit times have strongest correlations for CTT and WGTT. WMC yields longer GET and SBTT than VCE, perhaps due to meal related effects on motility.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-322579 (URN)10.1111/nmo.13107 (DOI)000410149700014 ()
Funder
Swedish Society of Medicine, SLS-503131Sven Jerring Foundation
Available from: 2017-05-26 Created: 2017-05-26 Last updated: 2017-11-30Bibliographically approved
Lee, I., Shi, L., Webb, D.-L., Hellström, P. M., Risérus, U. & Landberg, R. (2016). Effects of whole-grain rye porridge with added inulin and wheat gluten on appetite, gut fermentation and postprandial glucose metabolism: a randomised, cross-over, breakfast study. British Journal of Nutrition, 116(12), 2139-2149.
Open this publication in new window or tab >>Effects of whole-grain rye porridge with added inulin and wheat gluten on appetite, gut fermentation and postprandial glucose metabolism: a randomised, cross-over, breakfast study
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2016 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 116, no 12, 2139-2149 p.Article in journal (Refereed) Published
Abstract [en]

Whole-grain rye foods reduce appetite, insulin and sometimes glucose responses. Increased gut fermentation and plant protein may mediate the effect. The aims of the present study were to investigate whether the appetite-suppressing effects of whole-grain rye porridge could be enhanced by replacing part of the rye with fermented dietary fibre and plant protein, and to explore the role of gut fermentation on appetite and metabolic responses over 8 h. We conducted a randomised, cross-over study using two rye porridges (40 and 55 g), three 40-g rye porridges with addition of inulin: gluten (9:3; 6:6; 3:9 g) and a refined wheat bread control (55 g), served as part of complete breakfasts. A standardised lunch and an ad libitum dinner were served 4 and 8 h later, respectively. Appetite, breath hydrogen and methane, glucose, insulin and glucagon-like peptide-1 (GLP-1) responses were measured over 8 h. Twenty-one healthy men and women, aged 23-60 years, with BMI of 21-33 kg/m(2) participated in this study. Before lunch, the 55-g rye porridges lowered hunger by 20% and desire to eat by 22% and increased fullness by 29% compared with wheat bread (P < 0.05). Breath hydrogen increased proportionally to dietary fibre content (P < 0.05). Plasma glucose after lunch was 6% lower after the 55-g rye porridges compared with wheat bread (P< 0.05) and correlated to breath hydrogen (P < 0.001). No differences were observed in ad libitum food intake, insulin or GLP-1. We conclude that no further increase in satiety was observed when replacing part of the rye with inulin and gluten compared with plain rye porridges.

Keyword
Rye, Inulin, Satiety, Metabolic responses, Gluten
National Category
Nutrition and Dietetics Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-316437 (URN)10.1017/S0007114516004153 (DOI)000392726300015 ()28069076 (PubMedID)
Available from: 2017-03-01 Created: 2017-03-01 Last updated: 2017-11-29Bibliographically approved
Hansdotter, I., Björ, O., Andreasson, A., Agreus, L., Hellström, P., Forsberg, A., . . . Wallner, B. (2016). Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction. ENDOSCOPY INTERNATIONAL OPEN, 4(3), E311-E317.
Open this publication in new window or tab >>Hill classification is superior to the axial length of a hiatal hernia for assessment of the mechanical anti-reflux barrier at the gastroesophageal junction
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2016 (English)In: ENDOSCOPY INTERNATIONAL OPEN, ISSN 2364-3722, Vol. 4, no 3, E311-E317 p.Article in journal (Refereed) Published
Abstract [en]

Background and study aims: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial, including the mechanical anti-reflux barrier of the gastroesophageal junction. This barrier can be evaluated endoscopically in two ways: by measuring the axial length of any hiatal hernia present or by assessing the gastroesophageal flap valve. The endoscopic measurement of axial length is troublesome because of the physiological dynamics in the area. Grading the gastroesophageal flap valve is easier and has proven reproducible. The aim of the present study was to compare the two endoscopic grading methods with regard to associations with GERD. Patients and methods: Population-based subjects underwent endoscopic examination assessing the axial length of hiatus hernia, the gastroesophageal flap valve using the Hill classification, esophagitis using the Los Angeles (LA) classification, and columnar metaplasia using the Z-line appearance (ZAP) classification. Biopsies were taken from the squamocolumnar junction to assess the presence of intestinal metaplasia. Symptoms were recorded with the validated Abdominal Symptom Questionnaire. GERD was defined according to the Montreal definition. Results: In total, 334 subjects were included in the study and underwent endoscopy; 86 subjects suffered from GERD and 211 presented no symptoms or signs of GERD. Based on logistic regression, the estimated area under the curve statistic (AUC) for Hill (0.65 [95 % CI 0.59-0.72]) was higher than the corresponding estimate for the axial length of a hiatal hernia (0.61 [95 % CI 0.54-0.68]), although the difference was not statistically significant (P=0.225). Conclusion: From our data, and in terms of association with GERD, the Hill classification was slightly stronger compared to the axial length of a hiatal hernia, but we could not verify that the Hill classification was superior as a predictor. The Hill classification may replace the axial length of a hiatal hernia in the endoscopic assessment of the mechanical anti-reflux barrier of the gastroesophageal junction.

National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-288609 (URN)10.1055/s-0042-101021 (DOI)000372725100014 ()27004249 (PubMedID)
Available from: 2016-05-04 Created: 2016-04-28 Last updated: 2016-05-04Bibliographically approved
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