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Biomedical subjects

E Hylander

Publications and source records attributed to E Hylander.

At least 19 recordsLinked to original sources
PubMed1999

Gender, age, and body weight are the major predictive factors for bone mineral density in Crohn's disease: a case-control cross-sectional study of 113 patients.

OBJECTIVE: We conducted this study to assess bone mineral density and to evaluate conceivable predictive factors for bone loss in patients with Crohn's disease. METHODS: One hundred-thirteen patients with Crohn's disease and 113 healthy subjects, individually matched for gender, age, and body weight were investigated. The group consisted of 68 women and 45 men. The median duration of Crohn's disease was 6 yr. Two-thirds of the patients had been subjected to intestinal resection. Seventy-seven percent had at some time been treated with corticosteroids. Bone mineral density in the lumbar spine, the hip, and the total body skeleton was measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: In patients with Crohn's disease bone mineral density was not different from that of healthy controls except for a regional decrease in bone mineral density of the hip in female patients. The strongest predictors of bone mineral density were gender, age, and body weight. Corticosteroid use was only a weak predictor of diminished bone density. Duration of disease and intestinal resection had no predictive value for bone mineral density. CONCLUSIONS: Gender, age, and body weight are the major determinants of bone mineral density in patients with Crohn's disease. As in healthy individuals, the combined effect of these factors account for up to 50% of the variability in bone mineral density.

Absorptiometry, Photon↗
PubMed1998

Selenium depletion in patients with gastrointestinal diseases: are there any predictive factors?

BACKGROUND: Patients with intestinal disease are at risk of developing selenium deficiency due to impaired intestinal absorption. The aim of the present study was to evaluate selenium status and to identify predictive factors of selenium depletion in patients with gastrointestinal disease. METHODS: The concentration of selenium and the activity of glutathione peroxidase in plasma and erythrocytes were measured by fluorometry and by spectrophotometry. Eighty-six patients with Crohn's disease, 40 patients with ulcerative colitis, and 39 patients with various other gastrointestinal diseases were studied. Twenty-seven patients (16%) received home parenteral nutrition. Stool mass, faecal fat, and vitamin B12 absorption were analysed in 100 patients. RESULTS: The plasma selenium concentration was decreased in 85% of the patients receiving supplementary parenteral nutrition and in 20% of the patients receiving oral nutrition, among them in 26% of the patients with Crohn's disease. Almost all patients with ulcerative colitis had normal selenium levels. A statistically significant correlation was found between plasma selenium and vitamin B12 absorption, stool mass, faecal fat excretion, body mass index, P-albumin, P-zinc, and the length of the remaining small bowel. Stepwise regression analyses showed that the strongest predictors of selenium deficiency were stool mass, vitamin B12 absorption, and the length of the small-bowel resection. CONCLUSION: Selenium deficiency is common in patients with severe gastrointestinal disorders. The deficiency is mainly related to malabsorption, and a low selenium level was almost invariably present in patients who needed parenteral supplementation due to gut failure.

Adult↗
PubMed1997

Self-reported food intolerance in chronic inflammatory bowel disease.

BACKGROUND: Although suggested, it has never been convincingly documented that food sensitivity is of pathogenetic importance in chronic inflammatory bowel disease. However, many patients may relate their gastrointestinal symptoms to specific food items ingested and may restrict their diet accordingly. METHODS: A questionnaire was sent to all patients with chronic inflammatory bowel disease who attended the outpatient clinic, Medical Dept., Roskilde County Hospital in Køge, Denmark, in the year 1993. The patients were asked whether they had problems with any particular food item and, if so, to describe the symptoms experienced from it. A control group of 70 healthy persons were included. RESULTS: Among 189 patients, 132 (70%) responded. One hundred and thirty had completed the questionnaire, 52 males and 78 females aged 13-89 years (median, 43 years). Fifty-three (41%) had Crohn's disease (CD), 69 (53%) ulcerative colitis (UC), and 8 (6%) unclassified colitis. Forty-one patients (31 CD, 10 UC) were-operated on; 51 (19 CD, 32 UC) had disease activity. Sixty-five per cent of the patients and 14% of the controls reported being intolerant to one or more food items (P < 0.0001). The intolerance covered a wide range of food products. The commonest symptoms among patients were diarrhoea, abdominal pain, and meteorism and among controls, regurgitation. Food intolerance was equally common in CD (66%) and UC (64%) and was not related to previous operation, disease activity or disease location. CONCLUSION: Most patients with chronic inflammatory bowel intolerance disease feel intolerant to different food items and may restrict their diet accordingly. The frequency and pattern of food intolerance did not differ between patients with CD and UC. The food intolerance was probably unspecific rather than of pathogenetic importance.

Adult↗
PubMed1993

Selenium depletion in patients on home parenteral nutrition. The effect of selenium supplementation.

Severe selenium (Se) depletion was found in nine patients receiving long-term home parenteral nutrition because of short bowel syndrome. Plasma Se ranged from 0-0.51 (median 0.21 mumol/L), and erythrocyte Se ranged from 0.7-2.6 (median 1.8 mumol/gHgb), which was significantly lower than in the controls. Glutathione peroxidase (GSHPx) in plasma and erythrocytes was also decreased. After bolus injections with 200 micrograms Se/d in the form of sodium selenite for 4 mo, followed by 100 micrograms/d for 8 mo, plasma Se increased to values slightly but significantly higher than in the controls. Erythrocyte Se reached normal levels in most of the patients after 4 mo substitution, but it remained lower than in the controls. Following Se supplementation, plasma and erythrocyte GSHPx did not differ between patients and controls. These data suggest that all patients receiving long-term parenteral nutrition because of short bowel syndrome should receive at least 100 micrograms sodium selenite/d when given as bolus injections to avoid Se depletion.

Adult↗
PubMed1992

Selenium status in patients with Crohn's disease.

Twenty-seven of 66 patients with Crohn's disease had reduced concentrations of selenium and glutathione peroxidase in plasma and erythrocytes. When the patients were subgrouped according to the length of resected small bowel, a significant reduction of selenium and glutathione peroxidase in both plasma and erythrocytes was only found in patients with a resection > 200 cm. A highly significant correlation between selenium and glutathione peroxidase was found in plasma (r = 0.81) as well as in erythrocytes (r = 0.62), but no correlation was observed in the control group. A statistically significant correlation was also found between plasma selenium and the Harvey-Bradshaw score (r = -0.44), body mass index (wt/ht2) (r = 0.47), and plasma albumin (r = 0.29). Patients with a small-bowel resection > 200 cm appear to be at risk of developing severe selenium deficiency. These patients should have their selenium status monitored and probably receive selenium supplementation.

Adult↗
PubMed1991

Absorption studies after ileal J-pouch anastomosis for ulcerative colitis. A prospective study.

Absorption studies were performed in 17 patients with ulcerative colitis operated on with colectomy and an ileal two-limbed J-pouch anastomosis. The patients were studied 3 and greater than or equal to 18 months after closure of the temporary ileostomy. Increased stool mass (median, 609 g/24 h) was found in all patients and was unchanged with time. Moderate steatorrhoea was present in 29% of the patients 3 months postoperatively, but faecal fat excretion normalized with time. Calcium absorption was normal in all but one patient regardless of time after operation. An abnormal bacterial deconjugation, evaluated by a 14C-glycocholic acid breath test was present in 27% of the patients and increased significantly with time. Forty per cent of the patients had increased faecal bile acid excretion. B12 malabsorption was present in 29-35% of the patients. In conclusion, ileal J-pouch anastomosis for ulcerative colitis causes increased stool mass in all patients and produces moderate bile acid deconjugation and malabsorption in about one-third to half. Substitution therapy with vitamin B12 is necessary in about one-third of the patients. Intestinal adaptation as far as absorption is concerned is minimal after the first 3 postoperative months.

Adult↗
PubMed1990

Calcium absorption after intestinal resection. The importance of a preserved colon.

Calcium absorption was studied in 62 patients with Crohn's disease during a 1-week admission on a standardized diet supplying 70 g fat, 800 mg calcium, and 200 mg oxalate. All patients had been subjected to a distal small-bowel resection of at least 50 cm. Twenty-two had an ileostomy, and 40 had at least half of the colon in function. In all patients the disease was inactive. Calcium absorption was determined by the fractional accumulation in the skeleton of the antebrachium of an intravenous and oral dose of 47Ca. Calcium absorption was significantly lower in patients with ileostomy (median, 10%; range, 5-18%) than in patients with part of or the whole colon in function (median, 14%; range, 6-22%). The present study shows that in patients with extensive small-bowel resection preservation of at least half of the colon improves calcium absorption.

Adolescent↗
PubMed1990

Calcium absorption and bone mineral content in patients subjected to ileal bypass because of familial hypercholesterolaemia.

Calcium absorption and bone mineral content were studied prospectively in 30 patients with familial hypercholesterolaemia subjected to partial ileal bypass surgery. One-third of the patients were followed up for 10 years after the operation. Six months postoperatively calcium absorption decreased significantly, from a median of 16% to 13%. The effect persisted up to 5 years of follow-up study. Ten years after the operation the absorption of calcium (median, 14.5%) was not significantly different from the preoperative calcium absorption (median, 16%). Bone mineral content, measured in 76% of the patients, was retained in all patients studied. A significant correlation was present between calcium absorption and urinary calcium. The reduction in calcium absorption did not correlate with increases in faecal fat. Other long-term side effects were persistent diarrhoea and moderate steatorrhoea. A significant weight loss was slowly regained in most patients. An increase of renal oxalate excretion was only small and transient in most patients. The study shows that bypass of the terminal 200 cm of ileum for familial hypercholesterolaemia causes moderate diarrhoea and steatorrhoea in most patients but only a slight reduction of intestinal calcium absorption and apparently no risk of bone demineralization. A benefit of a postoperative calcium and vitamin D supply cannot be excluded.

Adult↗
PubMed1988

Prospective study of malabsorption induced risk of gall stone formation in relation to fall in plasma cholesterol.

The relationship between cholesterol in plasma and risk of gall stone formation was investigated in 210 obese patients who underwent jejunoileal bypass surgery and were free of gall stone disease at the time. Among 185, successfully reexamined on average 19 months after surgery, 26 (14%) developed gall stones. The fall in plasma cholesterol after surgery exhibited a U-shaped relation to risk of gall stone formation with a minimum risk around the average fall (2.6 mmol/l). This was confirmed by multivariate logistic regression analysis (p less than 0.01) taking into account other possible determinants. The relation was not significantly dependent on weight loss or ratio between jejunum and ileum left in function. The study suggests that malabsorption induced fall in plasma cholesterol is related to risk of gall stone formation by two oppositely working mechanisms, one enhancing and one reducing the risk.

Adult↗
PubMed1986

Excretion, deconjugation, and absorption of bile acids after colectomy for ulcerative colitis. Comparative studies in patients with conventional ileostomy and patients with Kock's reservoir.

Bile acid metabolism was studied in 26 patients with a continent ileostomy (Kock's reservoir) and 32 patients with conventional ileostomy. All had been colectomized for ulcerative colitis. In patients with a continent ileostomy the 14C-glycocholic acid breath test showed increased pulmonary 14CO2 excretion as evidence of abnormal bacterial deconjugation of bile acids and increased faecal 14C excretion as evidence of bile acid malabsorption. Faecal bile acid excretion, determined chemically, and, by inference, bile acid synthesis were only moderately increased (median, 1.8 mmol/day). The disturbance of bile acid metabolism was similar to that found in 32 patients with conventional ileostomy, but more pronounced with higher faecal 14C. A significant difference was that no abnormal bacterial deconjugation took place in patients with conventional ileostomy, since their pulmonary 14CO2 excretion was subnormal. Stool mass was almost identical in the two groups, with median values of 665 and 663 g/day, respectively. Faecal fat excretion was normal in most in both groups. Thus bile acid metabolism is slightly more disturbed in patients with a continent ileostomy than in patients with conventional ileostomy. The resulting malabsorption was modest in both groups.

Adolescent↗
PubMed1985

Faecal steroids after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio.

The faecal steroid excretion was assessed after jejunoileal bypass with a 3:1 ratio (n = 14) and with a 1:3 ratio (n = 9) between the jejunal and ileal segment left in continuity. The bile acid excretion with a 1:3 bypass was 49% of that with a 3:1 bypass (P less than 0.01), with a slight predominance of chenodeoxycholic over cholic acid in 1:3 compared with 3:1 bypass. The excretion of neutral steroids of cholesterol origin was slightly but insignificantly higher with a 1:3 bypass. Accordingly, the faecal bile acids contributed significantly less to total faecal steroids with a 1:3 bypass. The net sterol loss was higher, although not significantly so, with a 3:1 than with a 1:3 jejunoileal ratio. The study indicates that the 1:3, compared with the 3:1, jejunoileal ratio of the bypass reduces bile acid excretion considerably, whereas the effect on cholesterol turnover appears to be less pronounced.

Adult↗
PubMed1982

Effects and side-effects of partial ileal by-pass surgery for familial hypercholesterolaemia.

Ten patients with familial hypercholesterolaemia were subjected to partial ileal by-pass surgery. Plasma cholesterol fell by 41 and 38% and low-density lipoprotein cholesterol by 51 and 46% after six and 18 months respectively. High-density and very low-density lipoprotein cholesterol and plasma triglycerides were unaffected. Alanine aminotransferase increased transiently in half of the patients. Diarrhoea and slight steatorrhoea troubled most of the patients for the duration of 18 months' period of observation. Other long-term side effects were slight but significant increase in the renal excretion of oxalic acid and reduction in the intestinal absorption of calcium. The study shows that this operation has metabolic side-effects that warrant continued medical care of these patients.

Adult↗
PubMed1980

The importance of the colon in calcium absorption following small-intestinal resection.

The importance of the colon for the absorption of calcium, fat, and fluid was studied in 118 patients with small-bowel resections of various lengths. The patients fell into two groups: 38 with ileostomy and 80 with part of or the whole colon in function. In patients with ileostomy, but not in patients with the colon preserved, the absorption of 47Ca and fluid was inversely correlated to the length of the resected small intestine. In patients with extreme small-bowel resection (greater than or equal to 150 cm) the 47Ca absorption was significantly higher when colon was preserved. In groups of equal small-bowel resections stool mass was significantly higher in patients with ileostomy, but faecal fat was not. However, in both groups faecal fat was correlated to the length of the resected small bowel. The study shows that colon plays an important role for the absorption of calcium after small-intestinal resection and confirms the importance of colon for fluid absorption.

Adolescent↗
PubMed1980

Calcium treatment of enteric hyperoxaluria after jejunoileal bypass for morbid obesity.

The effect of oral calcium on oxalate absorption was studied in eight patients with secondary hyperoxaluria after jejunoileal bypass for morbid obesity during a standardized diet with a fixed supply of fat, calcium, and oxalate. A supplementary calcium dose of 2000 mg/day reduced renal oxalate excretion from 119 to 60 mg/24 h (median values, p < 0.01). Correspondingly, 14C-oxalate absorption decreased from 28% to 9% (p < 0.01). No statistically significant increase in urinary calcium was observed. The study shows that renal oxalate excretion in patients with enteric hyperoxaluria can be reduced by oral calcium. However, we doubt that it has any practical, clinical importance.

Adolescent↗
PubMed1980

1 alpha-hydroxyvitamin D3 in intestinal calcium malabsorption. A pilot study.

The effect of oral 1 alpha-hydroxyvitamin D3 (1 alpha (OH)D3) was studied in six patients with calcium malabsorption and steatorrhoea due to small-intestinal resection or small-bowel disease. After 3 months of treatment with 1 alpha (OH)D3 a significant increase in calcium absorption, but not in bone mineral content (BMC), was observed. During treatment urinary calcium increased significantly. We conclude that comparative long-term studies should be carried out to determine the effect and side effects of 1 alpha (OH)D3 and conventional vitamin D in calcium malabsorption after small-intestinal resections.

Administration, Oral↗
PubMed1980

Nitrogen absorption following small-intestinal resection.

A nitrogen balance study was performed in 40 patients with various small-bowel resections. Twenty-two patients had part of or the whole colon in function; 18 had an ileostomy. The patients had body weights that were about 95% of their ideal body weight (range, 133% to 71%). Net nitrogen absorption was significantly lower in patients with extensive small-bowel resection (greater than or equal to 150 cm) (median, 8.0 g/day approximately 64% of the dietary nitrogen intake) compared with patients with small-bowel resection less than 150 cm (median, 9.6/day approximately 82% of the dietary nitrogen intake). No difference in nitrogen balance was observed between the two groups. The median nitrogen balance was not significantly different from zero. No difference in nitrogen absorption, nitrogen balance, or body weight could be demonstrated between patients with part of or the whole colon in function and patients with an ileostomy. We conclude that patients with extensive small-bowel resection may have a significant nitrogen absorption, even in the presence of an ileostomy.

Adolescent↗