Gjermund Fluge

Epidemiology of Ulcerative Colitis in Western Norway

The incidence of ulcerative colitis (UC) in the three counties that compose Western Norway was registered in a prospective study during the years 1984 and 1985. Both inpatients and outpatients were included. Five hundred and fifty general practitioners and 12 hospitals participated in the study. A total of 239 patients were diagnosed in this area with 807,000 inhabitants, giving a mean annual incidence of 14.8 per 100,000. For patients between 30 and 35 years of age the age-specific incidence rate was 31.2. The M/F sex ratio was 1.10. Familial occurrence of inflammatory bowel disease was found in 11% of the patients. Patients with rectal involvement only constituted 35% of the patients.

Chronic Inflammatory Bowel Disease in Children in Western Norway

The incidence of Crohns disease (CD) and ulcerative colitis (UC) in children in western Norway was estimated in a prospective epidemiological study during the years 1984 and 1985. The total population in the area was 807,000 and the child population was 198,570 (1984). There were 27 new cases of chronic inflammatory bowel disease (IBD) in children aged 15 years or less, 10 new cases of CD, and 17 of UC. The mean annual incidence of CD in the child population was 2.5/100,000/year, whereas the incidence of UC in the child population was 4.3/100,000/year. Nearly all the children had abdominal symptoms. In this study, we found an incidence of CD in children that is the highest hitherto reported, to our knowledge. To the contrary, the incidence of UC was considerably lower than previously reported from northern Europe.

Epidemiology of Crohn's Disease in Western Norway

The incidence of Crohns disease in western Norway was estimated in a prospective epidemiologic study during the years 1984 and 1985. The total population in the area was 807,000. Both inpatients and outpatients were included. Five hundred and fifty general practitioners and 12 hospitals participated in the study. A total of 86 patients were diagnosed, giving a mean annual incidence of 5.3 per 100,000. For patients between 15 and 19 years of age-specific incidence rate was 16.0 The M/F sex ratio was 0.9. In the same period 240 patients with ulcerative colitis were diagnosed (mean annual incidence, 14.8 per 100,000), giving a ratio of 2.8 between ulcerative colitis and Crohns disease and an annual incidence of 20.1 per 100,000 for inflammatory bowel disease. Familial occurrence of IBD was found for 12% of the patients.

Inverse relation between vitamin D and serum total immunoglobulin G in the Scandinavian Cystic Fibrosis Nutritional Study

Background/Objectives:The hallmark of cystic fibrosis (CF) is chronic lung inflammation. The severity of lung disease is closely correlated with immunoglobulin G (IgG) levels. Beyond its contribution to the bone health, the importance of vitamin D has not been fully recognized owing to the lack of human studies providing evidence of its benefit. In the context of the recently described immunomodulatory functions of vitamin D, we aimed to assess the relationship between vitamin D and IgG levels.Subjects/Methods:Eight hundred and ninety-six CF patients were included (0.53–65.9 years) from seven centers in Denmark, Norway and Sweden. Serum 25-hydroxyvitamin D (25OHD) and total IgG were measured, spirometry was carried out and vitamin D intake data were gathered using a 7-day dietary food record. Multiple linear regression analyses were performed for IgG and forced expiratory volume in 1λs (FEV1) as dependent variables, and serum 25OHD, daily food and supplemented vitamin D sources of intake as independent variables. The model was controlled for age, gender, genotype, CF-related diabetes, season, infection/colonization status, long-term oral corticosteroid treatment, long-term treatment with macrolide antibiotics, pancreatic insufficient phenotype and body mass index z-score.Results:Serum total IgG levels were negatively associated with serum 25OHD (adjusted R 2=0.376; beta=−0.02; P<0.001), supplemented vitamin D intake per kg bodyweight (adjusted R 2=0.375; beta=−0.82; P<0.001) and total vitamin D intake per kg bodyweight (adjusted R 2=0.398; beta=−0.60; P=0.002). Serum 25OHD was positively associated with FEV1 (adjusted R 2=0.308; beta=0.0007; P=0.025).Conclusions:Increasing vitamin D intake may positively modulate inflammation in CF. This study supports the proposed role of vitamin D in the immune system during infection and substantiates prospective studies.

Impaired accommodation of the proximal stomach in children with recurrent abdominal pain

BACKGROUND A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal. METHODS After an overnight fast, 20 patients with recurrent abdominal pain (age, 7-14 years) and 23 healthy control subjects (age, 7-13 years), were scanned by a 5-MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup. RESULTS Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P = 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects. CONCLUSION The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.

Resting energy expenditure and lung disease in cystic fibrosis

Optimal nutritional support is considered to be an integral part in the management of cystic fibrosis (CF). Several factors contribute to increased resting energy expenditure (REE), which itself can lead to energy imbalance and thus contribute to deterioration of the nutritional status. We aimed to assess the impact of lung parenchyma damage on REE and correlated these findings with forced expiratory volume in 1 s (FEV(1)). Twenty patients performed respiratory function testing (FEV(1)), pulmonary high-resolution computed tomography (HRCT) and assessment of REE with open circuit indirect calorimetry. HRCT was scored by using a modified Bhalla method. Mean HRCT score was 8.4 and mean REE value was 108.4% predicted vs. 96.5% predicted of 16 healthy subjects (P<0.01). There was a significant correlation between HRCT score and REE (P<0.01), HRCT score and FEV(1) (P<0.001) and REE and FEV(1) (P<0.05). The correlations demonstrate a close correlation between lung damage and elevated REE in people with CF. Prevention of negative energy balance is an important part in follow-up of patients with CF. Any increase in REE should raise suspicion of progress in lung impairment.

Co-morbidity of cystic fibrosis and celiac disease in Scandinavian cystic fibrosis patients

BACKGROUND The co-morbidity of cystic fibrosis (CF) and celiac disease (CD) has been reported sporadically since the 1960s. To our knowledge, this is the first time a systematic screening is performed in a large cohort of CF patients. METHODS Transglutaminase-IgA (TGA), endomysium-IgA (EMA) and total IgA in serum were measured in 790 CF patients (48% females, 86% with pancreatic insufficiency). Six patients were diagnosed with CD prior to the study, all receiving a gluten-free diet. Patients with elevated TGA (>50 Units/mL) and a positive EMA test were offered a gastroscopy obtaining mucosal biopsies from the duodenum. RESULTS Four new cases of CD were diagnosed. Two additional patients had positive serological tests, but normal biopsies. In total, 10 cases of CD (1.2%, 1:83) indicate a prevalence rate about three times higher than the general prevalence of CD in Norway and Sweden. No CD patients were detected in the Danish CF cohort. Patients diagnosed with untreated CD reported symptoms typical of both CF and CD (poor weight gain, loose and/or fatty stools, fatigue, irritability, abdominal pain). They improved after introduction of a gluten-free diet. CONCLUSIONS Systematic screening for CD in a Scandinavian cohort of CF patients revealed a higher prevalence of CD than in the general population. Clinical signs of CD are difficult to differentiate from CF with malabsorption, and patients may go undiagnosed for a long time. In a population where CD is common we recommend screening for CD in patients with CF.

High resolution CT in cystic fibrosis—the contribution of expiratory scans

INTRODUCTION The use of high-resolution computed tomography (HRCT) is well accepted as an accurate method for evaluation of lung parenchyma in cystic fibrosis (CF). Several scoring methods exist and, in common, all are based on HRCT findings during inspiration alone. OBJECTIVE To examine whether expiratory HRCT scans could add information about the degree of mosaic perfusion in patients with CF. METHODS AND PATIENTS Pulmonary HRCT was performed in 17 CF patients (median age of 12 years) with 1-mm thin sections and 10-mm intervals during inspiration, followed by 1-mm thin sections with 20-mm intervals during expiration. HRCT was scored by using a modified Bhalla method. RESULTS The mean HRCT score was 8.2. Out of 17 patients, 11 (65%) demonstrated a pathological mosaic perfusion in expiration, while only three patients showed mosaic perfusion in inspiration. The degree of expiratory mosaic perfusion was graded as severe in nine patients and moderate in two patients. There was a significant correlation between our modified HRCT score and lung function, as measured by forced expiratory volume in 1 s (FEV1% predicted, P<0.01). CONCLUSION Mosaic perfusion in expiration was a common pathological HRCT finding in our study group. The clinical significance of this finding needs further evaluation.

Shwachman–Kulczycki score and resting energy expenditure in cystic fibrosis

BACKGROUND Disease severity assessed by clinical scores in cystic fibrosis (CF) has been a topic of investigation for many years, although a correlation of clinical scores with resting energy expenditure (REE) has not been described yet. We aimed to assess disease severity as evaluated by the Shwachman-Kulczycki (SK) score and to correlate these findings with REE and forced expiratory volume in 1 s (FEV1). METHODS Twenty-eight patients performed respiratory function testing (FEV1), and assessment of REE with open circuit indirect calorimetry. The SK score was evaluated according to general activity, physical examination, nutrition and conventional chest X-ray findings. RESULTS Mean SK score was 75.3 +/- 15.7. Mean REE was 109.1% of predicted vs. 96.5% predicted in 16 healthy subjects (P = 0.002). There was a significant correlation between the SK score and REE (P = 0.001), the SK score and FEV1 (P < 0.001) and REE and FEV1 (P = 0.034). CONCLUSIONS The correlations between the SK score, REE and FEV1 demonstrate a close connection between disease severity, caloric requirement and lung damage. They confirm the clinical value of the SK score, which is easy to assess in a clinical setting.

Dietary intake and nutritional status in a Scandinavian adult cystic fibrosis-population compared with recommendations

Background Malnutrition is a well-known complication in cystic fibrosis (CF). There is good evidence that maintaining a normal body-weight correlates well with improved survival in CF. Energy intake in excess of 120% of the estimated average requirement (EAR) has been advised since 1980s. Objectives To investigate the nutritional intake and status in the adult Scandinavian CF-population. Subjects/Methods A cross-sectional multi-centre study was used to investigate the nutritional status of 456 adult CF-patients (2003 2006). Height and weight were measured and body mass index (BMI) and z-scores were calculated. Pulmonary function was examined by dynamic spirometry. A 7-day pre-coded food record (FR) obtained energy and nutrient intake data in 180 patients. Results The mean energy intake was 114 (SD 30.0)% of EAR and thus significantly lower than the target of 120% EAR (p< 0.001) for patients with pancreatic insufficiency (PI) (n=136). Mean BMI was 22.0 (SD 2.9), the prevalence of BMI <18 was 13% and the prevalence of BMI ≥25 was 15% (n=136). Mean BMI was 20.8 (SD 2.4) in PI-patients with FEV1 <70% and 23.2% (SD 3.0), in PI-patients with FEV1 ≥70%, mean difference 2.4, (95% CI: 1.5, 3.3) (p<0.001), but there was no difference in energy intake. BMI ≥18.5 and a reported energy intake <120% were revealed in 54% of the PI-patients. Conclusions The energy intake did not reach the recommended 120% EAR, but the prevalence of underweight was lower than reported in other studies. The recommendation may exceed the requirement for a number of CF-patients. The nutritional status must still be closely monitored and nutritional advice and intervention should be individualised and adjusted to actual needs.