Primary sclerosing cholangitis in Iceland 1992-2012

Publisher Copyright: © 2019 Laeknafelag Islands. All rights reserved.INNGANGUR Frumkomin trefjunargallgangabólga er langvinnur bólgusjúkdómur í gallvegum innan og/eða utan lifrar sem getur valdið skorpulifur, lokastigs lifrarbilun og leitt til lifrarígræðslu. Bólgusjúkdómar í meltingarvegi, fyrst og fremst sáraristilbólga, er algengur áhættuþáttur. Hæsta nýgengi fullorðinna sem hefur verið birt var 1,2- 1,3/100.000 í Noregi og Svíþjóð og 60-76% höfðu bólgusjúkdóm í meltingarvegi. Markmið þessarar fyrstu rannsóknar sjúkdómsins á Íslandi var að kanna faraldsfræði hans frá árunum 1992-2012 og afdrif sjúklinganna. AÐFERÐIR Leit var framkvæmd í gagnagrunnum Landspítala og Sjúkrahússins á Akureyri að sjúkdómsgreiningunni: K83.0, „Gallgangabólga“, frá 1992 til 2012. Að auki var gerð leit að sjúklingum með yfirferð á öllum gallvegaspeglunum og segulómunum af gallvegum sem framkvæmdar voru á Landspítala 1992-2012. Einnig var gerð textaleit bæði í gagnagrunnum beggja spítalanna og í gagnagrunni meinafræðinnar fyrir lifrarsýni. NIÐURSTÖÐUR Alls fundust 42 sjúklingar með sjúkdóminn innan umrædds tímabils. Miðgildi aldurs við greiningu var 34 ára, 67% voru karlkyns og 90% fullorðnir (≥18 ára). Meðalnýgengi á ári var 0,69/100.000 manns á rannsóknartímabilinu. Alls 88% sjúklinga reyndust vera með bólgusjúkdóm í meltingarvegi, þar af 89% sjúklinga með sáraristilbólgu. Sjö sjúklingar hafa verið greindir með krabbamein, þar af fjórir með meinið í gallgöngum og einn í gallblöðru. Innan tímabilsins dóu 5 sjúklingar (12%), 51 mánuði (miðgildi) frá greiningu og þar af þrír úr gallgangakrabbameini 51 mánuðum (miðgildi) frá greiningu. Þrír (7%) þurftu lifrarígræðslu, þar af einn í tvígang. ÁLYKTANIR Nýgengi á Íslandi reyndist lægra en í nágrannalöndum okkar í Skandinavíu. Það er óljóst hvort það stafar af vangreiningu tilfella og/eða að sjúkdómurinn sé sjaldgæfari á Íslandi en í Noregi og Svíþjóð. Alls 7% þurftu á lifrarígræðslu að halda og 12% dóu úr sjúkdómnum, aðallega vegna gallgangakrabbameins. Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation that can lead to cirrhosis, end stage liver failure and liver transplantation. Known risk factors include inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC). Highest reported incidence in an adult population is 1.2- 1.3/100.000 in Norway and Sweden, where 60-76% have IBD. The aim of this study was to investigate epidemiology of PSC in Iceland in the years 1992 to 2012 and the patients outcomes. Methods: A search for the diagnosis “cholangitis“ (ICD-10, K83.0) was performed in the database for hospital records in Landspítali (The National University Hospital of Iceland, LSH) and Akureyri Hospital from 1992 to 2012. We also looked through all ERCP and MRCP imaging done in LSH in the same period along with a text search in both the hospital records and the pathology database for liver biopsies. Data on these patients was collected until the end of 2016. Results: A total of 42 patient got the diagnosis PSC within the period. Median age at diagnosis was 34 years, 67% were male and 90% adults (≥18 years old). Mean incidence per year was 0.69/100.000. Overall 88% of patients had IBD, thereof 89% UC. Seven patients have been diagnosed with cancer, four with cancer in the bile ducts and one in the gallbladder. Within the study period a total of five patients died (12%), 51 months (median) from diagnosis and three from cholangiocarcinoma, 51 months (median) from diagnosis. Three patients (7%) underwent liver transplantation, one required a transplant two times. Conclusions: The incidence of PSC in Iceland turned out to be lower than in our neighbouring countries in Scandinavia. It is unclear if this is due to underdiagnosis or, more likely, that PSC is simply more uncommon in Iceland. Overall 7% underwent liver transplantation and 12% died within the study period, main cause of mortality being cholangiocarcinoma.Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation that can lead to cirrhosis, end stage liver failure and liver transplantation. Known risk factors include inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC). Highest reported incidence in an adult population is 1.2-1.3/100.000 in Norway and Sweden, where 60-76% have IBD. The aim of this study was to investigate epidemiology of PSC in Iceland in the years 1992 to 2012 and the patients outcomes. Methods: A search for the diagnosis “cholangitis“(ICD-10, K83.0) was performed in the database for hospital records in Landspítali (The National University Hospital of Iceland, LSH) and Akureyri Hospital from 1992 to 2012. We also looked through all ERCP and MRCP imaging done in LSH in the same period along with a text search in both the hospital records and the pathology database for liver biopsies. Data on these patients was collected until the end of 2016. Results: A total of 42 patient got the diagnosis PSC within the period. Median age at diagnosis was 34 years, 67% were male and 90% adults (≥18 years old). Mean incidence per year was 0.69/100.000. Overall 88% of patients had IBD, thereof 89% UC. Seven patients have been diagnosed with cancer, four with cancer in the bile ducts and one in the gallbladder. Within the study period a total of five patients died (12%), 51 months (median) from diagnosis and three from cholangiocarcinoma, 51 months (median) from diagnosis. Three patients (7%) underwent liver transplantation, one required a transplant two times. Conclusions: The incidence of PSC in Iceland turned out to be lower than in our neighbouring countries in Scandinavia. It is unclear if this is due to underdiagnosis or, more likely, that PSC is simply more uncommon in Iceland. Overall 7% underwent liver transplantation and 12% died within the study period, main cause of mortality being cholangiocarcinoma.Peer reviewe

Primary sclerosing cholangitis in Iceland 1992-2012

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Frumkomin trefjunargallgangabólga er langvinnur bólgusjúkdómur í gallvegum innan og/eða utan lifrar sem getur valdið skorpulifur, lokastigs lifrarbilun og leitt til lifrarígræðslu. Bólgusjúkdómar í meltingarvegi, fyrst og fremst sáraristilbólga, er algengur áhættuþáttur. Hæsta nýgengi fullorðinna sem hefur verið birt var 1,2-1,3/100.000 í Noregi og Svíþjóð og 60-76% höfðu bólgusjúkdóm í meltingarvegi. Markmið þessarar fyrstu rannsóknar sjúkdómsins á Íslandi var að kanna faraldsfræði hans frá árunum 1992-2012 og afdrif sjúklinganna. AÐFERÐIR Leit var framkvæmd í gagnagrunnum Landspítala og Sjúkrahússins á Akureyri að sjúkdómsgreiningunni: K83.0, „Gallgangabólga“, frá 1992 til 2012. Að auki var gerð leit að sjúklingum með yfirferð á öllum gallvegaspeglunum og segulómunum af gallvegum sem framkvæmdar voru á Landspítala 1992-2012. Einnig var gerð textaleit bæði í gagnagrunnum beggja spítalanna og í gagnagrunni meinafræðinnar fyrir lifrarsýni. NIÐURSTÖÐUR Alls fundust 42 sjúklingar með sjúkdóminn innan umrædds tímabils. Miðgildi aldurs við greiningu var 34 ára, 67% voru karlkyns og 90% fullorðnir (≥18 ára). Meðalnýgengi á ári var 0,69/100.000 manns á rannsóknartímabilinu. Alls 88% sjúklinga reyndust vera með bólgusjúkdóm í meltingarvegi, þar af 89% sjúklinga með sáraristilbólgu. Sjö sjúklingar hafa verið greindir með krabbamein, þar af fjórir með meinið í gallgöngum og einn í gallblöðru. Innan tímabilsins dóu 5 sjúklingar (12%), 51 mánuði (miðgildi) frá greiningu og þar af þrír úr gallgangakrabbameini 51 mánuðum (miðgildi) frá greiningu. Þrír (7%) þurftu lifrarígræðslu, þar af einn í tvígang. ÁLYKTANIR Nýgengi á Íslandi reyndist lægra en í nágrannalöndum okkar í Skandinavíu. Það er óljóst hvort það stafar af vangreiningu tilfella og/eða að sjúkdómurinn sé sjaldgæfari á Íslandi en í Noregi og Svíþjóð. Alls 7% þurftu á lifrarígræðslu að halda og 12% dóu úr sjúkdómnum, aðallega vegna gallgangakrabbameins.Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation that can lead to cirrhosis, end stage liver failure and liver transplantation. Known risk factors include inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC). Highest reported incidence in an adult population is 1.2-1.3/100.000 in Norway and Sweden, where 60-76% have IBD. The aim of this study was to investigate epidemiology of PSC in Iceland in the years 1992 to 2012 and the patients outcomes. Methods: A search for the diagnosis “cholangitis“ (ICD-10, K83.0) was performed in the database for hospital records in Landspítali (The National University Hospital of Iceland, LSH) and Akureyri Hospital from 1992 to 2012. We also looked through all ERCP and MRCP imaging done in LSH in the same period along with a text search in both the hospital records and the pathology database for liver biopsies. Data on these patients was collected until the end of 2016. Results: A total of 42 patient got the diagnosis PSC within the period. Median age at diagnosis was 34 years, 67% were male and 90% adults (≥18 years old). Mean incidence per year was 0.69/100.000. Overall 88% of patients had IBD, thereof 89% UC. Seven patients have been diagnosed with cancer, four with cancer in the bile ducts and one in the gallbladder. Within the study period a total of five patients died (12%), 51 months (median) from diagnosis and three from cholangiocarcinoma, 51 months (median) from diagnosis. Three patients (7%) underwent liver transplantation, one required a transplant two times. Conclusions: The incidence of PSC in Iceland turned out to be lower than in our neighbouring countries in Scandinavia. It is unclear if this is due to underdiagnosis or, more likely, that PSC is simply more uncommon in Iceland. Overall 7% underwent liver transplantation and 12% died within the study period, main cause of mortality being cholangiocarcinoma

Primary sclerosing cholangitis in Iceland 1992-2012

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR Frumkomin trefjunargallgangabólga er langvinnur bólgusjúkdómur í gallvegum innan og/eða utan lifrar sem getur valdið skorpulifur, lokastigs lifrarbilun og leitt til lifrarígræðslu. Bólgusjúkdómar í meltingarvegi, fyrst og fremst sáraristilbólga, er algengur áhættuþáttur. Hæsta nýgengi fullorðinna sem hefur verið birt var 1,2-1,3/100.000 í Noregi og Svíþjóð og 60-76% höfðu bólgusjúkdóm í meltingarvegi. Markmið þessarar fyrstu rannsóknar sjúkdómsins á Íslandi var að kanna faraldsfræði hans frá árunum 1992-2012 og afdrif sjúklinganna. AÐFERÐIR Leit var framkvæmd í gagnagrunnum Landspítala og Sjúkrahússins á Akureyri að sjúkdómsgreiningunni: K83.0, „Gallgangabólga“, frá 1992 til 2012. Að auki var gerð leit að sjúklingum með yfirferð á öllum gallvegaspeglunum og segulómunum af gallvegum sem framkvæmdar voru á Landspítala 1992-2012. Einnig var gerð textaleit bæði í gagnagrunnum beggja spítalanna og í gagnagrunni meinafræðinnar fyrir lifrarsýni. NIÐURSTÖÐUR Alls fundust 42 sjúklingar með sjúkdóminn innan umrædds tímabils. Miðgildi aldurs við greiningu var 34 ára, 67% voru karlkyns og 90% fullorðnir (≥18 ára). Meðalnýgengi á ári var 0,69/100.000 manns á rannsóknartímabilinu. Alls 88% sjúklinga reyndust vera með bólgusjúkdóm í meltingarvegi, þar af 89% sjúklinga með sáraristilbólgu. Sjö sjúklingar hafa verið greindir með krabbamein, þar af fjórir með meinið í gallgöngum og einn í gallblöðru. Innan tímabilsins dóu 5 sjúklingar (12%), 51 mánuði (miðgildi) frá greiningu og þar af þrír úr gallgangakrabbameini 51 mánuðum (miðgildi) frá greiningu. Þrír (7%) þurftu lifrarígræðslu, þar af einn í tvígang. ÁLYKTANIR Nýgengi á Íslandi reyndist lægra en í nágrannalöndum okkar í Skandinavíu. Það er óljóst hvort það stafar af vangreiningu tilfella og/eða að sjúkdómurinn sé sjaldgæfari á Íslandi en í Noregi og Svíþjóð. Alls 7% þurftu á lifrarígræðslu að halda og 12% dóu úr sjúkdómnum, aðallega vegna gallgangakrabbameins.Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease affecting the intra- and/or extrahepatic biliary tree with inflammation and progressive stricture formation that can lead to cirrhosis, end stage liver failure and liver transplantation. Known risk factors include inflammatory bowel diseases (IBD), mainly ulcerative colitis (UC). Highest reported incidence in an adult population is 1.2-1.3/100.000 in Norway and Sweden, where 60-76% have IBD. The aim of this study was to investigate epidemiology of PSC in Iceland in the years 1992 to 2012 and the patients outcomes. Methods: A search for the diagnosis “cholangitis“ (ICD-10, K83.0) was performed in the database for hospital records in Landspítali (The National University Hospital of Iceland, LSH) and Akureyri Hospital from 1992 to 2012. We also looked through all ERCP and MRCP imaging done in LSH in the same period along with a text search in both the hospital records and the pathology database for liver biopsies. Data on these patients was collected until the end of 2016. Results: A total of 42 patient got the diagnosis PSC within the period. Median age at diagnosis was 34 years, 67% were male and 90% adults (≥18 years old). Mean incidence per year was 0.69/100.000. Overall 88% of patients had IBD, thereof 89% UC. Seven patients have been diagnosed with cancer, four with cancer in the bile ducts and one in the gallbladder. Within the study period a total of five patients died (12%), 51 months (median) from diagnosis and three from cholangiocarcinoma, 51 months (median) from diagnosis. Three patients (7%) underwent liver transplantation, one required a transplant two times. Conclusions: The incidence of PSC in Iceland turned out to be lower than in our neighbouring countries in Scandinavia. It is unclear if this is due to underdiagnosis or, more likely, that PSC is simply more uncommon in Iceland. Overall 7% underwent liver transplantation and 12% died within the study period, main cause of mortality being cholangiocarcinoma

Peak bone mass of Icelandic women and associated factors

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: The aim of this study was to evaluate at which age peak bone mass is reached among Icelandic women. Previous studies on this subject have been conflicting indicating that this might be reached sometime between the age of 16 and 35 years. We have also analyzed associated nutritional and physical factors which might be of use for preventive measures against osteoporosis. Material and methods: A random sample of 16, 18, 20 and 25 years old women in Reykjavik were invited, altogether 335 women participated. Bone mineral density (BMD) was analyzed by Dual Energy X-ray Absorptiometry (DEXA) in the lumbar spine, hip, forearm and total skeleton. Calcium, protein and vitamin D intake was assessed by a semiquantitative food frequency questionnaire. The level of 25-OH-vitamin D in serum was measured by a radioimmunoassay. Physical activity was assessed by a questionnaire. Multivariate analysis was performed by multiple linear regression. Results: Maximal bone mineral density was reached for total skeleton, hip and forearm at the age of 20 years, BMD for the lumbar spine was 1% higher at the age of 25 than at 20 years but this was not statistically significant. No significant association was found between the calcium intake and BMD except in the subgroup of 18 years old women with calcium intake below 1000 mg/day. 25-OH-vitamin D levels were low (<25 nmol/L) in 15-18.5% of the groups but still no significant relationship was found with the bone mineral density. The strongest correlation was found between total BMD and the lean mass (0.38-0.53, p<0.01) but physical activity was also a significant factor in the age groups 16-20 years. About 25-30% of BMD variability can be attributed to these modifiable factors. Conclusion: Peak bone mass seems to be reached at the age of 20 and measures to increase it should therefore be emphasized before that age. Our results indicate that modifiable factors, especially lean mass and physical activity, are of considerable importance in the attainment of peak bone mass in women.Tilgangur: Tilgangur þessarar rannsóknar var að kanna hvenær hámarksbeinmagni er náð meðal íslenskra kvenna og hvaða þættir séu því tengdir. Slík vitneskja skiptir máli ef unnt er að auka hámarksbeinmagnið með til dæmis lífsvenjum eða mataræði. Efniviður og aðferðir: Beinmagn í slembihópi íslenskra kvenna, 16, 18, 20 og 25 ára (alls 335) var mælt með DEXA tækni og borið saman við vissa næringarþætti, svo sem kalk, prótín og D-vítamín svo og líkamshreyfingu (metið með stöðluðum spurningalistum). Magn fitu og mjúkvefja (lean mass) mælt með DEXA var einnig borið saman við beinmagnið. Niðurstöður: Hámarksbeinmagni virðist náð um tvítugt. Engin fylgni fannst milli kalkneyslu og beinmagns nema í mjöðm í undirhópi 18 ára kvenna sem neyttu minna en 1000 mg á dag. Engin marktæk fylgni fannst milli þéttni 25-OH-vitamin D í blóði og heild-arbeinmagns. Af hópnum höfðu 15-18,5% lægri gildi (<25 nmól/L) á 25-OH-vítamín D í blóði en æskilegt hefur verið talið fyrir fullorðna. Veruleg fylgni fannst milli magns mjúkvefja (þar með talið vöðva) og beinmagns, 0,38-0,53, p<0,01 en mjúkvefjamagnið var jafnframt í réttu hlutfalli við líkamshreyfingu, r=0,2-0,47, p<0,05. í fjölþáttagreiningu var marktæk fylgni milli líkamshreyfingar og heildarbeinmagns í 16-20 ára hópnum (p<0,01), þannig jókst beinmagnið um 0,45% fyrir hverja klukkustund líkamshreyfingar á viku. Slík fylgni fannst ekki í hópi 25 ára. Magn mjúkvefja skýrði 25,8-28,3% af breyti-leika í heildarbeinmagni þátttakenda. Ályktun: Hámarksbeinmagni kvenna er að mestu náð um tvítugt. Þessi rannsókn bendir til að unnt sé að auka það með æskilegu vöðvamagni sem fæst meðal annars með nægilegri líkamshreyfingu fyrir tvítugt. Meðalkalkneysla reyndist góð og það kann að skýra að lítil fylgni fannst milli hennar og beinmagns. D-vítamínhagur hópsins var hins vegar neðan æskilegra marka (<25 nmól/L) hjá að minnsta kosti 15% þátttakenda án þess að það hefði áhrif á beinmagnið

Peak bone mass of Icelandic women and associated factors

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: The aim of this study was to evaluate at which age peak bone mass is reached among Icelandic women. Previous studies on this subject have been conflicting indicating that this might be reached sometime between the age of 16 and 35 years. We have also analyzed associated nutritional and physical factors which might be of use for preventive measures against osteoporosis. Material and methods: A random sample of 16, 18, 20 and 25 years old women in Reykjavik were invited, altogether 335 women participated. Bone mineral density (BMD) was analyzed by Dual Energy X-ray Absorptiometry (DEXA) in the lumbar spine, hip, forearm and total skeleton. Calcium, protein and vitamin D intake was assessed by a semiquantitative food frequency questionnaire. The level of 25-OH-vitamin D in serum was measured by a radioimmunoassay. Physical activity was assessed by a questionnaire. Multivariate analysis was performed by multiple linear regression. Results: Maximal bone mineral density was reached for total skeleton, hip and forearm at the age of 20 years, BMD for the lumbar spine was 1% higher at the age of 25 than at 20 years but this was not statistically significant. No significant association was found between the calcium intake and BMD except in the subgroup of 18 years old women with calcium intake below 1000 mg/day. 25-OH-vitamin D levels were low (<25 nmol/L) in 15-18.5% of the groups but still no significant relationship was found with the bone mineral density. The strongest correlation was found between total BMD and the lean mass (0.38-0.53, p<0.01) but physical activity was also a significant factor in the age groups 16-20 years. About 25-30% of BMD variability can be attributed to these modifiable factors. Conclusion: Peak bone mass seems to be reached at the age of 20 and measures to increase it should therefore be emphasized before that age. Our results indicate that modifiable factors, especially lean mass and physical activity, are of considerable importance in the attainment of peak bone mass in women.Tilgangur: Tilgangur þessarar rannsóknar var að kanna hvenær hámarksbeinmagni er náð meðal íslenskra kvenna og hvaða þættir séu því tengdir. Slík vitneskja skiptir máli ef unnt er að auka hámarksbeinmagnið með til dæmis lífsvenjum eða mataræði. Efniviður og aðferðir: Beinmagn í slembihópi íslenskra kvenna, 16, 18, 20 og 25 ára (alls 335) var mælt með DEXA tækni og borið saman við vissa næringarþætti, svo sem kalk, prótín og D-vítamín svo og líkamshreyfingu (metið með stöðluðum spurningalistum). Magn fitu og mjúkvefja (lean mass) mælt með DEXA var einnig borið saman við beinmagnið. Niðurstöður: Hámarksbeinmagni virðist náð um tvítugt. Engin fylgni fannst milli kalkneyslu og beinmagns nema í mjöðm í undirhópi 18 ára kvenna sem neyttu minna en 1000 mg á dag. Engin marktæk fylgni fannst milli þéttni 25-OH-vitamin D í blóði og heild-arbeinmagns. Af hópnum höfðu 15-18,5% lægri gildi (<25 nmól/L) á 25-OH-vítamín D í blóði en æskilegt hefur verið talið fyrir fullorðna. Veruleg fylgni fannst milli magns mjúkvefja (þar með talið vöðva) og beinmagns, 0,38-0,53, p<0,01 en mjúkvefjamagnið var jafnframt í réttu hlutfalli við líkamshreyfingu, r=0,2-0,47, p<0,05. í fjölþáttagreiningu var marktæk fylgni milli líkamshreyfingar og heildarbeinmagns í 16-20 ára hópnum (p<0,01), þannig jókst beinmagnið um 0,45% fyrir hverja klukkustund líkamshreyfingar á viku. Slík fylgni fannst ekki í hópi 25 ára. Magn mjúkvefja skýrði 25,8-28,3% af breyti-leika í heildarbeinmagni þátttakenda. Ályktun: Hámarksbeinmagni kvenna er að mestu náð um tvítugt. Þessi rannsókn bendir til að unnt sé að auka það með æskilegu vöðvamagni sem fæst meðal annars með nægilegri líkamshreyfingu fyrir tvítugt. Meðalkalkneysla reyndist góð og það kann að skýra að lítil fylgni fannst milli hennar og beinmagns. D-vítamínhagur hópsins var hins vegar neðan æskilegra marka (<25 nmól/L) hjá að minnsta kosti 15% þátttakenda án þess að það hefði áhrif á beinmagnið