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  • 1.
    Jaghult, Susanna
    et al.
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Saboonchi, Fredrik
    Red Cross University College of Nursing.
    Moller, Jette
    Karolinska Institute, Department of Public Health Sciences, Division of Public Health Epidemiology.
    Johansson, Unn-Britt
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Wredling, Regina
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Kapraali, Marjo
    Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital.
    Stress as a Trigger for Relapses in IBD: A Case-Crossover Study2013In: Gastroenterology Research, ISSN 1918-2805, E-ISSN 1918-2813, Vol. 6, no 1, p. 10-16Article in journal (Refereed)
    Abstract [en]

    Background: It is important to identify factors that influence the risk of relapses in inflammatory bowel disease. Few studies have been conducted and with limited methodology. This prospective case-crossover study, aims to examine whether perceived stress has a short-term acute effect, namely whether it acts as a trigger, on the risk of relapse in inflammatory bowel disease. 

    Methods: Sixty patients with inflammatory bowel disease and in remission were included. The case-crossover design was employed, which is an epidemiological design developed to study  triggers for acute events and diseases. To collect information regarding symptoms and potential trigger factors, such as perceived stress, a structured diary was  constructed. The participants were instructed to fill in the diary daily during six months. Fifty patients completed the study.

    Results: The analysis showed an effect for high level of perceived stress. Being exposed to “quite a lot”  of stress, yield an increase in risk for relapse during the forthcoming day (OR  = 4.8, 95% CI 1.09 -  21.10). No statistically increased risk for lower levels of perceived stress was found, although elevated effect estimates were found for “some” stress.

    Conclusion: This study supports earlier findings regarding perceived stress as an important factor in triggering relapses in IBD. However, this is the first case-crossover study performed to explore the trigger risk of stress in this population. Further investigations with larger patient samples are needed to confirm the findings.

  • 2.
    Janczewska, I.
    et al.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Kapraali, M.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Saboonchi, Fredrik
    Sophiahemmet University College, Stockholm.
    Nekzada, Q.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Wessulv, Å.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Khoshkar, J.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Marouf, F.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Gorsetman, J.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Risberg, D.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Lissing, M.
    Department of Clinical Sciences, Karolinska Institutet, Division of Internal Medicine Danderyd Hospital, Stockholm.
    Wirström, G.
    Division of Medicine, Ersta Hospital, Stockholm.
    Sandstedt, B.
    Karolinska Institutet, Department of Pathology, Danderyd Hospital, Stockholm.
    Clinical application of the multigene analysis test in discriminating between ulcerative colitis and Crohn’s disease: A retrospective study2012In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 47, no 2, p. 162-169Article in journal (Refereed)
    Abstract [en]

    Methods.The newly described – multigene analysis test(DiBiCol) identifying 7 inflammatory bowel disease (IBD)-specific genes incolonic mucosal biopsy differentiating between ulcerative colitis (UC) and Crohn's disease (CD) with active inflammation – is a new addition to existingmethods with a higher stated sensitivity and specificity. Method biopsymaterial from 78 patients with a complicated course diagnosed as most probably UC in 38, CD in 18 and inflammatory bowel disease unclassified (IBDU) in 22 were investigated by DiBiCol. Results. DiBiCol showed a pattern consistent with CD in 13 patients with UC and led to change of diagnosis in 3 patients and a strong suggestion of CD in 8 patients. A total of 2 patients remained as UC. DiBiCol showed a pattern of UC in 4 patients of 18 with CD leading to a changing of diagnosis to UC in 3 patients, but the fourth remained as CD. In 22 patients with IBDU DiBiCol showed a pattern consistent with UC in 7 cases and with CD in 13 cases. A new evaluation 1 year after the DiBiCol allowed the assessment of clinical diagnosis in 10 patients confirmed in 9 of 10 patients by DiBiCol. In patients with acute flare of colitis the clinical diagnosis corresponded in 10 of 12 UC and in 5 of 6 CD cases. Summary. Adoptingthe DiBiCol test led to a change of the primary diagnosis in a significant number of patients with the initial diagnosis of UC and CD and suggested aclinically probable diagnosis in most of the patients with IBDU and in those with an acute flare of colitis.

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