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Biomedical subjects

L Stenhammar

Publications and source records attributed to L Stenhammar.

At least 37 records · Page 2Linked to original sources
PubMed2000

Epidemic of coeliac disease in Swedish children.

Coeliac disease has emerged as a public health problem. The aim of the present study was to analyse trends in the occurrence of symptomatic coeliac disease in Swedish children from 1973 to 1997, and to explore any temporal relationship to changes in infant dietary patterns. We established a population-based prospective incidence register of coeliac disease in 1991, and, in addition, retrospective data from 1973 were collected. A total of 2151 cases fulfilled the diagnostic criteria. Furthermore. We collected national data on a yearly basis on duration of breastfeeding, intake of gluten-containing cereals and recommendations on when and how to introduce gluten into the diet of infants. From 1985 to 1987 the annual incidence rate in children below 2 y of age increased fourfold to 200-240 cases per 100000 person years, followed from 1995 by a sharp decline to the previous level of 50-60 cases per 100000 person years. This epidemic pattern is quite unique for a chronic disease of immunological pathogenesis, suggesting that prevention could be possible. The ecological observations made in this study are compatible with the epidemic being the result, at least in part, of a change in and an interplay among three factors within the area of infant feeding, i.e. amount of gluten given, age at introduction of gluten, and whether breastfeeding was ongoing or not when gluten was introduced. Other factor(s) may also have contributed, and the search for these should be intensified.

Adolescent↗
PubMed1999

[Oats can be included in gluten-free diet].

In the management of coeliac disease, it has been widely accepted that oats must also be excluded from the diet, along with wheat, rye and barley. The article consists in a review of published reports, and an account of our experience of including oats in the gluten-free diets of adults. Oats were found to be safe and well tolerated by adults with coeliac disease and dermatitis herpetiformis, though the risk of wheat contamination of commercial oat products remains a cause of concern. Similar findings were reported from a study of adolescents, but no such studies have been made of small children. Thus, the inclusion of oats, known to be a fibre-rich, naturally gluten-free food, would broaden the range of foodstuffs tolerable to coeliac patients, though for safety reasons they should be used only by adults until more information is available.

Adult↗
PubMed1999

Diarrhoea following contamination of drinking water with copper.

Three cases of children with suspected copper intoxication from the drinking water are described. The children presented with protracted diarrhoea, which promptly disappeared, when they were given drinking water of low copper concentration but reappeared when given their domestic water. It is concluded that the use of copper tubing in the water pipes may under certain circumstances result in the presence of copper in the drinking water and the risk of intoxication, especially in small children.

Child, Preschool↗
PubMed1998

[Proposed criteria for diagnosis of celiac disease in children].

At a seminar arranged in September 1997 by the Swedish Paediatric Working Group for Coeliac Disease, a diagnostic protocol proposed by the working group was approved by a majority of the paediatricians present, representing almost all paediatric units in Sweden. Briefly, a small bowel biopsy is called for in all children, both at presentation and as a control during gluten-free dieting. Subsequent gluten challenge and biopsy are mandatory only in cases of atypical presentation or if the diagnosis is questioned at some future date. Serum antigliadin and anti-endomysial antibody tests are complementary tools. Agreement was also reached regarding the institution of a national coeliac disease registry.

Antibodies↗
PubMed1998

Children with celiac disease express inducible nitric oxide synthase in the small intestine during gluten challenge.

BACKGROUND: Childhood celiac disease in Sweden is presently seen at an incidence of around 1/250 and is thus one of the commonest chronic diseases in children. It has recently been shown that children with untreated celiac disease have increased levels of nitrate/nitrite in the urine, most likely reflecting an increased production of nitric oxide in the inflamed mucosa. Nitric oxide is produced from L-arginine by an inducible or a constitutive nitric oxide synthase. The inducible nitric oxide synthase (iNOS) can be stimulated in various cells by, for instance, inflammatory mediators. The present study has been done to find a possible source of nitric oxide in the small intestine that could result in the increased levels of nitrate/nitrite in the urine in children with active celiac disease. METHODS: Small-intestinal biopsy specimens from children with active celiac disease were labeled with rabbit-anti-human antibodies to iNOS and visualized with fluorescent pig anti-rabbit antibodies. The specimens were then analyzed with confocal microscopy to assess the labeling pattern. RESULTS: In all of seven specimens from children with increased levels of nitrate/nitrite in the urine, we detected antibodies to iNOS, whereas in five of six control specimens--that is, from children with normal nitrate/nitrite levels--we could not detect any iNOS. CONCLUSIONS: Children with active celiac disease have a gluten-induced nitric oxide production in the small intestine reflected by increased urine levels of nitrate/nitrite and iNOS expression in the intestine. We conclude that the increased production of nitric oxide could presumably, directly or indirectly, result in injury of the small-intestinal tissue.

Adolescent↗
PubMed1998

Significantly increased levels of nitric oxide products in urine of children with celiac disease.

BACKGROUND: Celiac disease is characterized by morphologic and functional aberrations of the small intestinal mucosa, i.e., crypt hyperplasia, villous atrophy, infiltration of intraepithelial lymphocytes, and alteration of permeability. Nitric oxide has been shown to affect mucosal permeability after ischemia-reperfusion, but little is known about the regulatory role of nitric oxide in celiac disease. The purpose of this study was to assess nitric oxide production in children with celiac disease and in control subjects. METHODS: The sum of nitrite and nitrate in the urine was measured with a colorimetric method in 137 children with a median age of 3 years, 84 patients and 53 reference children, all of whom underwent a small intestinal biopsy to confirm or overrule suspicion of celiac disease. RESULTS: Median urinary nitrite-nitrate concentration in celiac children was 3323 microM (4147 +/- 1102; mean +/- SEM) at first clinical examination and 2501 microM (2939 +/- 386) after gluten challenge, which was significantly higher than concentrations in reference children (1029 microM; 1174 +/- 116) and in children with celiac disease on a gluten-free diet (882 microM; 1369 +/- 360) (p < 0.0001). CONCLUSIONS: A gluten-containing diet is associated with an increased nitrite-nitrate secretion in the urine in children with celiac disease, presumably as a result of nitric oxide synthase activation and nitric oxide production in the diseased small intestinal mucosa.

Adolescent↗
PubMed1997

Oral immunoglobulin treatment in Crohn's disease.

Two patients with severe Crohn's disease who failed to respond to traditional medical treatment were given immunoglobulin orally. We used the 6-h urinary recovery of mixture of polyethyleneglycols PEG 400 and 1000 (molecular weight range 282-1250 Da) to test the intestinal permeability. Both patients showed a similar permeability pattern with an increased leakage of large-sized PEGs before treatment and a lower urinary recovery of probes after treatment with immunoglobulin. This might indicate that the inflammatory process in Crohn's disease can be affected from the luminal side of the mucosa.

Administration, Oral↗
PubMed1996

Infant feeding history shows distinct differences between Swedish celiac and reference children.

Infant feeding history was investigated in 72 celiac and 288 age-matched reference children in a retrospective questionnaire study. The reply rate was 100% in celiac and 91.6% in reference children. The celiac children were breast-fed for a significantly shorter time than reference children, and they were less often breast-fed at the introduction of gluten. The age of the children at gluten introduction was similar, but the celiac children were significantly more often introduced by a gluten-containing follow-up formula, while the reference children more often started on a gluten-containing porridge. The results can be interpreted in two ways. First, it could be argued that breast milk per se protects against symptoms of celiac disease in childhood. It could, however, also be claimed that breast-feeding merely modulates the gluten introduction, causing a less abrupt introduction of gluten in the baby diet and thereby fewer overt symptoms of the disease.

Breast Feeding↗
PubMed1996

Small bowel biopsy in Swedish paediatric clinics.

The capsule technique for small bowel biopsy performed at Swedish paediatric clinics was evaluated using two questionnaires in 1990 and 1993, respectively. Replies were received from all 45 centres which together perform approximately 2300 biopsies per year. Clotting function tests prior to biopsy were carried out in 42% of the centres. The biopsies were performed under intubation anaesthesia in 13% of the centres. The most striking difference between the answers to the two questionnaires was the mode of sedation. The use of intravenous sedatives increased from 40% of the centres in the first questionnaire to 59% in the second one. The use of the oral, rectal and intramuscular routes decreased correspondingly. The most frequently used drugs for intravenous sedation were benzodiazepines, in the first questionnaire diazepam and in the second one midazolam. The failure rate was approximately 5%. In the first questionnaire, no complication was encountered. In the second questionnaire, three cases of intramural duodenal haematoma were reported, one of which led to pancreatitis. We conclude that by focusing on questions of sedation these rather simple questionnaires may have resulted in more effective sedation of children undergoing small bowel biopsy.

Biopsy↗