Danish Society for Gastroenterology and Hepatology 1 ... - fra DSGH

Danish Society for Gastroenterology and Hepatology
1. årsmøde
7.- 8. september 2012
på
Hindsgavl Slot
1

Indholdsfortegnelse
Programoversigt………………………….3
Abstracts til foredragskonkurrence…….4
Abstracts til postere…………………….11
Sponsorer og udstillere…………………37
Stemmeseddel til frie foredrag…….…..38
2

DSGH Årsmøde, Hindsgavl Slot 7.- 8. sept. 2012
Tidspunkt
Aktivitet/Sted
FREDAG 7. sept.
Tranesalen
10.00-10.30 Registrering og kaffe
10.30-10.45 Velkomst, prisuddeling
10.45-11.30
F-Calprotectin, pro et contra
Jens F Dahlerup
Torben Nathan
Chairman: Lars Vinter-Jensen
11.30-12.15
Levertransplatation i Danmark
Allan Rasmussen
Otto Clemmensen
Chairman: Henning Grønbæk
12.15-12.45 Posterpræsentation (walk and talk)
Chairmen: Aleksander Krag, Mark Ainsworth, Lasse
Bremholm, Lars Vinter-Jensen
12.45-14.00 Frokost og besøg på udstilling
14.00-14.45 Clostridium difficile
Et tiltagende problem Også ved IBD
Katharina EP Olsen
Andreas Munk Petersen
Chairman: Henriette Ytting
14.45-15.15 Posterpræsentation (walk and talk)
Chairmen: Aleksander Krag, Mark Ainsworth, Lasse
Bremholm, Lars Vinter-Jensen
15.15-16.00 Kaffe og besøg på udstilling
16.00-17.30 Foredragskonkurrence
Chairmen: Henning Grønbæk og Lise Lotte Gluud
17.30-18.00 DSGH generalforsamling
19.00- Fest
Band: Partyzone
LØRDAG 8 sept.
09.00-09.45 Uddannelse
Samarbejde mellem udbydere og bedømmere
e-learning
Hendrik Vilstrup
Thomas Sandahl
Anders Neuman
Chairman Lars Vinter-Jensen
09.45-10.00 Pause m. kaffe
10.00-12.00 Diskussion af guidelines
Biologisk behandling af IBD (Uddrag af RADS arbejdet)
Alkoholisk hepatitis
Paracetamol
Chairman Anette Mertz
12.00 Frokost (sandwich), afrejse.
3

Foredrag
1. Transcatheter Arterial Embolization after successful endoscopic hemostasis
prevents rebleeding in peptic ulcer bleeding
Stig Borbjerg Laursen, Jane Møller Hansen & Ove B Schaffalitzky de Muckadell
Medicinsk Gastroenterologisk Afdeling S, Odense Universitetshospital
Background & Aims
One of the major challenges in peptic ulcer bleeding (PUB) is rebleeding which is associated with
up to a five-fold increase in mortality. We examined if supplementary transcatheter arterial
embolization (STAE) performed after achieved endoscopic hemostasis improves outcome in
patients with high-risk ulcers.
Methods
The study was designed as a non-blinded, parallel group, randomized controlled trial and
performed in a university hospital setting. Patients admitted with PUB from Forrest Ia-IIb ulcers
controlled by endoscopic therapy were randomized (1:1 ratio) to receive STAE of the bleeding
artery within 24 hours or continue standard treatment. Randomization was stratified according to
stigmata of haemorrhage. Patients were followed for 30 days. Primary outcome was a composite
endpoint. Among secondary outcomes were rebleeding, number of blood transfusions received,
duration of admission, and mortality.
Results
A total of 105 patients were included. Of the 49 patients allocated to STAE 31 underwent
successful STAE. Two versus eight patients re-bled in the STAE and control group respectively
(Per-protocol analysis; P=.10). After adjustment for possible imbalances STAE was associated
with a clear trend of reduced rate of rebleeding (P=.079). Only one of the patients undergoing
successful STAE developed rebleeding, and this patient only had a minor rebleeding without need
of hemostatic intervention.
Conclusions
With a 7.9% risk of performing a Type I error this study demonstrates that STAE is useful in
prevention of rebleeding in patients with PUB from high-risk ulcers. STAE can safely be performed
in selected cases with suspected high risk of rebleeding.
2. Soluble TNFa-receptor p55 as prognostic marker in liver cirrhosis with portal
hypertension and TIPS
Trebicka J*#, Krag A#, Gansweid S*, Sauerbruch T*, Spengler U*
*Department of Internal Medicine I, University of Bonn, Germany
# Department of Gastroenterology, Hvidovre Hospital, University of Kopenhagen, Denmark
Background:
TNFa levels are increased in liver cirrhosis even without obvious infection signs probably by
continuous endotoxin influx in portal blood. Soluble TNFa receptors (p55, p75) are useful tools to
investigate TNFa release, which itself has a short half-life. p75 levels correlate with mortality in
liver cirrhosis (Clin Gastro Hep 2008;6:1255-1262). Here, we investigated p55- and p75-levels in
patients receiving TIPS.
Methods:
41 patients with liver cirrhosis and portal hypertension (12 viral, 29 alcoholic) received TIPS. Portal
and central venous blood was withdrawn in these patients during the TIPS-procedure and in the
invasive control two weeks later. In these samples levels of p55 and p75 were measured via
ELISA.
4

Results:
We found no significant difference of p55- and p75-levels in portal and central venous blood. Both
p55- and p75-levels correlated directly with the MELD-score (p=0.001) and creatinine (p=0.0001),
as well as inversely with albumin (p=0.02) and cholinesterase (p=0.01). The portal pressure
measured during TIPS-procedure did not correlate with p55- and p75-levels. In contrast, portal
pressure during the invasive control two weeks after TIPS correlated directly and systolic arterial
pressure inversely with central venous p55-levels. Survival correlated inversely with central venous
p55-levels (p=0.007).
Discussion:
This study shows that central venous p55 levels correlate with severity of hyperdynamic circulation
as well as with increased mortality in patients receiving TIPS. This parameter could represent a
prognostic marker for patients receiving TIPS.
3. Minimal hepatic encephalopathy and disease specific quality of life in outpatients
with cirrhosis: Results from a prospective cohort
Maja Thiele 1,4 , Gro Askgaard 2 , Hans Bording Timm 3 , Ole Hamberg 2 , Lise Lotte Gluud 4
1 Department of Medicine, Copenhagen University Hospital Køge, Denmark. 2 Department of
Hepatology, Copenhagen University Hospital Rigshospitalet, Denmark. 3 Department of Medicine,
Copenhagen University Hospital Glostrup, Denmark. 4 Department of Medicine, Copenhagen
University Hospital Gentofte, Denmark.
Objective
We analysed predictors of health-related quality of life (HRQoL) among outpatients with cirrhosis.
Methods
A prospective cohort study on patients with cirrhosis was conducted in two Danish liver outpatient
clinics. Patients with clinical or histological cirrhosis and no signs of clinically overt hepatic
encephalopathy (assessed using the West Haven Criteria) were included. At inclusion patients
were evaluated through screening of nutritional parameters (body mass index), blood tests and the
continuous reaction time test, which is a computerized psychometric test validated for the
diagnosis of minimal hepatic encephalopathy (MHE). MHE was defined as an Index Value for the
reaction time variance below 1.900.
The HRQoL was evaluated using the 6 point Chronic Liver Disease Questionnaire (CLDQ). Initially
the questionnaire was backwards and forwards translated into Danish. The questionnaire was pilot
tested among the eligible patient population. The CLDQ score was classed as low (

analysis the Child-Pugh score and BMI (with or without adjustments for ascites) were independent
predictors of a low CDLQ.
Conclusion
We found that patients with a high Child-Pugh score and patients with a low BMI were more likely
to have a low health related quality of life. There was no association between continuous reaction
time scores and HRQoL scores.
4. The role of the calcium-activated potassium channel KCa3.1 in a murine model of
hepatic fibrogenesis
Linda Sevelsted Møller 1-2 , Annette Dam Fialla 2 , Ove B. Schaffalitzky de Muckadell 2 and Ralf
Koehler 3
1 Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 2 Department
of medical gastroenterology, Odense University Hospital, Denmark; 3 Aragin Institute of Health
Sciences, Zaragoza, Spain
INTRODUCTION OG HYPOTHESIS:
Activation and proliferation of the hepatic stellate cell is a hallmark in the fibrotic process leading to
liver cirrhosis. The intermediate conductance Ca 2+ -activated K + -channel KCa3.1 is believed to play
a role in cell proliferation by enhancing intracellular Ca 2+ -signalling and affecting cell cycle
progression. In particular, the channel has been shown to play a role in promoting mitogenesis in
tissue such as endothelium, vascular smooth muscle cells and T lymphocytes, as well as in murine
disease models of kidney fibrosis. The expression of the KCa3.1 channel has not yet been
investigated in liver.
We hypothesized that KCa3.1 activity is involved in activation of the hepatic stellate cell, and that
deficiency of the channel supresses the development of liver fibrosis, and thus could serve as a
potential drug target.
MATERIAL AND METHODS:
Male 3 months old KCa3.1 -/- (IK-KO) (n=40) and KCa3.1 +/+ or +/- (IK-WT) (n=40) mice on a
c57bl/6 background, were injected with the hepatotoxin Carbontetrachloride 1ml/kg diluted in
peanut oil (1:9) ip. twice a week. 5 % ethanol was added to the drinking water to induce the toxic
effect of CCl4. Animals were scarified after 4, 8, 12 and 16 weeks.
At termination blood was drawn from the animals under anaesthesia for analysing protrombin,
bilirubin, albumin and ALAT. Liver and spleen weights were noted, and the right, and largest liver
lobe was fixed in formalin 4%, paraffin embedded, sliced and stained with the Masson-trichrome
staining.
RESULTS:In 4 and 8 weeks treated animals, histology showed severe steatosis and fibrosis
degree 2-3, but no clear difference between knock-out and wildtype mice. However in animals
treated 12 – and in particular 16 weeks, histology showed severe fibrosis and/or cirrhosis in all
animals, but with more preserved trabecular architecture and less steatosis in mice lacking the
KCa3.1 channel. Blood samples did not show any difference in protrombin time, ALAT or albumin,
but a surprisingly statistic significant I difference in bilirubin, with increased levels in knockout.
Spleen weights increased during the trial as sign of portal hypertension.
CONCLUSION:
Deficiency of the intermediate conductance channel KCa3.1 results in less steatosis and fibrosis in
the CCl4 murine model of liver disease. This accounts for animals treated over a longer period.
This suggests a potential antifibrotic role of the KCa3.1 channel.
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5. Hvordan skal diagnosen colon irritabile stilles i almen praksis Et randomiseret
non-inferiority studie. Indflydelse på patientrapporterede effekt mål og
ressourceforbrug.
Begtrup Luise 1,3 , Engsbro Anne Line 2 , Kjeldsen Jens 3 , Schaffalitzky de Muckadell Ove B 3 , Jarbøl
Dorte 1 . Bytzer Peter 2
1 Forskningsenheden for Almen Praksis, Syddansk Universitet, Medicinsk afdeling, Køge Sygehus,
Københavns Universitet, 3 Medicinsk gastroenterologisk afdeling S, Odense Universitetshospital
Formål:
At undersøge om symptom-baseret diagnostik af colon irritabile (IBS) er non-inferiort til at stille
diagnosen som en udelukkelsesdiagnose med hensyn til patienternes helbredsrelaterede
livskvalitet.
Metode:
Et randomiseret, kontrolleret, ublindet studie. Studiet blev gennemført ved medicinsk
ambulatorium, Køge Sygehus og ved Odense Universitetshospital i praksislokaler ved
Forskningsenheden for Almen Praksis. Praktiserende læger på Fyn og Sjælland henviste
patienter til studiet. Målgruppen var patienter i alderen 18-50 år, som henvendte sig til egen læge
med gastrointestinale symptomer, der fik lægen til at mistænke IBS. Patienter der opfyldte ROM III
kriterierne og ikke havde alarmsignaler blev inkluderet og randomiseret til én af to
undersøgelsesprogrammer, der bestod af:
Program A; Eksklusionsdiagnose: Hgb, leukocytter og diff., CRP, ALAT, basisk phosphatase,
albumin , calcium, TSH, tTG, laktase gentest, afføringsprøver til undersøgelse for parasitter og orm
og sigmoideoskopi med biopsi
Program B; Symptombaseret diagnose: leukocytter og diff., CRP.
Primær effekt mål var ændring i helbredsrelateret livskvalitet fra baseline til et års follow-up. Noninferiority
var opfyldt hvis forskellen mellem grupperne var mindre end 3 point på den fysiske
helbredskomponentscore (PCS) i SF-36. Sekundære effekt mål var ændringer i gastrointestinale
symptomer (GSRS-IBS), tilfredshed med undersøgelsesforløbet målt på en 5-punkts Likert skala
og ressourcer i form af forbrug af konsultationer, sygedage og undersøgelser.
Resultater:
302 patienter blev randomiseret og 238 (79%) patienter fuldførte undersøgelsen. 76% var kvinder.
Gennemsnitsalder (SD) var 31,4 år (9,1). Forskellen mellem grupperne med hensyn til
gennemsnitlig forbedring på PCS skalaen var -0,64 point (95% CI [-2,74 - 1,45]), hvor program A
havde den største forbedring. Der blev ikke fundet nogen signifikant forskel mellem grupperne med
hensyn til gennemsnitlig forbedring i gastrointestinale symptomer 0,5 vs. 0,6, p=0,10 (GSRS-IBS,
total score), tilfredshed umiddelbart efter gennemførelse af undersøgelsesprogrammet (p=1), eller
tilfredshed efter et år (p=0,39). Ved brug af program A var der en merudgift på 4960 kr. per patient
Der var ingen forskel mellem grupperne med hensyn til forbrug af ressourcer i
opfølgningsperioden.
Konklusion:
En symptombaseret IBS diagnose er non-inferior til en eksklusionsdiagnose med hensyn til
helbredsrelateret livskvalitet. Der blev ikke fundet nogen forskel mellem de to
undersøgelsesprogrammer angående ændring i patienternes gastrointestinale symptomer,
tilfredshed eller efterfølgende forbrug af ressourcer. Resultatet støtter internationale guidelines om
brug af en symptombaseret diagnostisk strategi ved yngre patienter mistænkt for IBS i almen
praksis.
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6. Kupffer cells exhibit strong inflammatory activation in alcoholic hepatitis
Thomas Damgaard Sandahl 1 , Henning Grønbæk 1 , Sidsel Hyldegaard Støy 1 , Anders Dige 1 , Holger
Jon Møller 2 , Stephen Hamilton Dutoit 3 , Jørgen Agnholt 1 , Steffen Thiel 4 , Hendrik Vilstrup 1
1) Department of Medicine V, Aarhus University Hospital, Denmark; 2) Department of Clinical
Medicine - Clinical Biochemistry, Aarhus University Hospital, Denmark. 3) Department of
pathology, Aarhus University Hospital, Denmark. 4) Department of Biomedicine - Medical
Microbiology and Immunology
Background:
The current understanding of the intense hepatic inflammatory activity in alcoholic hepatitis (AH) is
almost solely based on animal models. It appears that Kupffer cell activation by endotoxin is
essential for developing alcoholic liver injury and the activation seems to be driven by an increased
gut derived endotoxin load. Such activation is dependent on lipopolysaccharide-binding protein
(LBP) to facilitate interaction with the membrane bound CD14/Toll Like Receptor-4 complex. Upon
activation, Kupffer cells shed CD163, a specific marker of Kupffer cell activation, into the circulation
in its soluble form sCD163.
We aimed to investigate human kupffer cell activation and the endotoxin/TLR4 activation pathway
in a cross-sectional study of patients with AH
Methods:
We studied 50 patients with severe AH (Maddrey discriminant function > 32) at diagnosis.
Furthermore, 26 patients with stable alcoholic cirrhosis (AC) and 20 healthy controls (HC) were
included. Plasma soluble (s)CD163, sCD14, and sLBP concentrations were measured by ELISA.
Membrane bound CD163 and CD14 on peripheral monocytes were measured by flow cytometry.
Immunohistochemical staining for CD163 and CD14 was performed in biopsies from 10 patients
with severe AH and 10 controls.
Results:
The sCD163 concentration was markedly increased in AH (AH 17.0, AC 10.9, HC 1.9 mg/L;
p

1 Digestive Disease Centre, Medical Section, Herlev University Hospital, Copenhagen, Denmark, 2
Department of Gastroenterology, Wuhan University Zhongnan Hospital, Wuhan, China., 3
University Hospital Rebro, Division of Gastroenterology and Hepatology, Zagreb, Croatia, 4 Nicosia
private practice, Cyprus, 5 IBD Center ISCARE, Charles University, Prague, Czech Republic, 6
Gastroenterology Department, Hospital eské Budjovice, Ceske Budejovice, Czech Republic, 7
Department of Medicine, Amager Hospital, Amager, Denmark, 8 Department of Medical
Gastroenterology, Gentofte Hospital, Copenhagen, Denmark, 9 Department of Medicine, Herning
Central Hospital, Herning, Denmark, 10 Medical Department, Viborg Regional Hospital, Viborg,
Denmark & Medical Department, SHS Aabenraa, Aabenraa, Denmark, 11 Department of Medicine
V (Hepatology and Gastroenterology), Arhus University Hospital, Arhus, Denmark, 12 Division of
Endocrinology and Gastroenterology, Tartu University Hospital, Tartu, Estonia, 13 Medical
Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands, 14 Department of
Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland, 15
1st Division of Internal Medicine and Hepato-Gastroenterology Unit, University Hospital, Ioannina,
Greece, 16 Medical Department, Dronning Ingrids Hospital, Nuuk, Greenland, 17 Department of
Internal Medicine, Section of Gastroenterology and Hepatology, The National University Hospital,
Reykjavik, Iceland, 18 Department of Gastroenterology, Adelaide and Meath Hospital, TCD, Dublin,
Ireland, 19 Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben
Gurion University of the Negev, Beer Sheva, Israel, 20 On behalf of the EpiCom Northern Italy
center based in Crema, Cremona, Firenze, Forlì, Padova and Reggio Emilia, Italy, 21 Institute for
Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania, 22 Laboratory of
Gastroenterology, Medical Clinic IY, State University of Medicine and Pharmacy, Chisinau,
23
Moldova, Department of Gastroenterology, Hospital de São João, Porto. Institut of
Pharmacology and Therapeutics, Oporto Medical School, Portugal, 24 Clinic of Gastroenterology,
University of Medicine ‘Victor Babes’, Timisoara, Romania, 25 Department of Gastroenterology,
Moscow Regional Research Clinical Institute, Moscow, Russia, 26 Gastroenterology Department,
Complexo Hospitalario Universitario de Vigo, Vigo, Spain, 27 Division of Gastroenterology and
Hepatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping,
Sweden, 28 Department of Medicine, Division of Gastroenterology, Örebro University Hospital and
School of Health and Medical Sciences, Örebro University, Örebro, Sweden, 29 St. Mark's Hospital,
Imperial College London, London, UK, 30 Hull and East Yorkshire NHS Trust & Hull and York
Medical School, Hull Royal Infirmary, Hull, UK, 31 1st Department of Medicine, Semmelweis
University, Budapest, Hungary
Background:
The incidence of inflammatory bowel disease (IBD) is traditionally low in Eastern Europe. It has
however recently become more prevalent in i.e. Hungary and Croatia. The reason for these
changes remains unknown. The EpiCom-study was initiated in 32 centres from 14 Western and 8
Eastern European countries and 1 Asian country to investigate the differences in incidence and
phenotype at diagnosis in Europe.
Methods:
A prospective, uniformly diagnosed by international diagnostic criteria, population-based inception
cohort of patients diagnosed with IBD within 1.1.2010– 31.12.2010 and followed up until 1.1 2012
was created. Patients were entered in a web-based database, www.epicom-ecco.eu. Disease
localization and behaviour was classified according to the Montreal classification.
Results:
In total 1612 patients aged 15 years or older were identified, of whom 879 (55%) were diagnosed
as ulcerative colitis (UC), 562 (35%) as Crohn’s disease (CD), and 171 (10%) as indeterminate
(IC). The median incidence per 100.000 of IBD in Europe was 17.7; UC 7.5, CD 5.6 and IC 1.2.
9

The median incidence rates for IBD, CD and UC of the Western European centres were more than
two times higher than the Eastern European centres (IBD: 21.2 vs. 7.7; UC: 10.8 vs. 3.9; CD: 6.5
vs. 3.1; IC: 2.1 vs. 0). The Chinese incidence rates were for IBD 1.4, for UC 0.9, for CD 0.4 and for
IC 0.0. Disease location and behaviour for CD and UC patients at diagnosis is shown in Table 1;
no difference was found between Eastern and Western Europe. The median number of months
from onset of symptoms to diagnosis of IBD was 3.0 (IQR 1.3-7.3) for Western European centres,
2.6 (IQR 1.3-6.2) for Eastern European centres and 3.9 (IQR 1.3-11.9) for Wuhan, China. For UC,
in Western European centres 10% were smoking at the time of diagnosis while 34% were former
smokers, compared to 12% and 34% in Eastern Europe and 9% and 6% in Wuhan, China. For CD,
in Western European centres 35% were currently smoking while 22% were former smokers,
compared to 35% and 24% in Eastern Europe and 3% and 9% in Wuhan, China.
Conclusion:
Both UC and CD are much more common in Western Europe than Eastern Europe, while no
differences in phenotype at diagnosis, time from onset of symptoms to diagnosis and smoking
status were found. IBD remains rare in China as well as smoking.
10

Posters
1. Endoscopic, transmural drainage and necrosectomy for walled-off pancreatic
necrosis is associated with low mortality - a single-center experience
1 Palle Nordblad Schmidt, 1 Srdan Novovic, 1 Stine Roug, 1 Erik Feldager, 1 Peter Matzen
1 Department of Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark
Background:
Emerging data show that postponed intervention and use of minimally invasive techniques have
substantially reduced mortality and morbidity in necrotizing pancreatitis. Endoscopic transmural
drainage and necrosectomy (ETDN) is a promising alternative to percutaneous drainage and
surgical intervention in the treatment of walled-off necroses.
Methods:
In November 2006, ETDN for walled-off necrotizing pancreatitis was introduced in our tertiary
referral center. During a 5-year period (Nov 2006 – Nov 2011), we retrospectively collected data on
all patients who underwent ETDN.
Results:
Eighty-one patients were treated with ETDN (mean age 51, 52 men, median ASA-score 2).
Gallstones were the predominant etiology (41%), followed by alcohol (33%), idiopathic (17%),
post-ERCP (8%), and hyperlipidemia (1%). Median time from debut of symptoms to first
endoscopic treatment was 44 (9-246) days. Culture proven infected necrosis was found in 69% of
the cases. Twenty-three patients (28%) recquired admission at ICU. In-hospital mortality was 11%.
Serious procedure related complications occurred in 7 (9%) patients, three with
pneumoperitoneum (managed nonoperatively) and four with haemorrhage in the retroperitoneal
cavity.
Conclusion:
ETDN in patients with necrotizing pancreatitis and infected necrosis performed in a single, highvolume
center has an acceptable safety profile and is associated with a low mortality.
2. POSTPARTUM ADHERENCE TO MEDICAL TREATMENT AMONG WOMEN WITH
ULCERATIVE COLITIS
Mette Julsgaard 1 , Mette Nørgaard 2 Christian Lodberg Hvas 1 , Anne Grosen 1 , Sara Hasseriis 2 ,
Lisbet Ambrosius Christensen 1
1 Dept. of Medicine V (Gastroenterology & Hepatology), 2 Dept. of Clinical Epidemiology, Aarhus
University Hospital, Aarhus, Denmark
Introduction:
Adherence to medical treatment of ulcerative colitis (UC) is important for induction and
maintenance of remission. Adherence rates between 20-60% have been reported 1 . Rates of
relapse, predictors and prevalence rates of non-adherence to medical treatment among UC
patients in the postpartum period have not previously been investigated.
Methods:
Women with UC in North Western Denmark, who had given birth between 2000-2005 among a
population of 1.6 million. Diagnoses and birth outcome were confirmed by population-based
medical databases. Predictors for, and extent of non-adherence (less than 80% intake of daily
prescribed dose of medicine) were investigated by questionnaires. We assessed the validity of
self-reported use of medication by comparing the data with data from the regional prescription
11

database.
Results:
Of 115 women with UC, 93 (81%) fulfilled the questionnaire. Overall 62 (67%) women stated to be
in medical treatment in the postpartum period (six months after birth), of whom 53 had fulfilled a
prescription on relevant medication according to the prescription database yielding a positive
predictive value (PPV) of self-reported use of medication on 85.5% (95% CI. 74.2-93.1).
Adherence to medical treatment was stated by 58%. Women who had planned their pregnancy
were less likely to be non-adherent (POR 0.6, 95% CI 0.4-10.1). Remission in UC was stated as
the main reason for non-adherence (50%). Forgetfulness (46%) and fear of medicine in breast milk
(14%) were also stated as reasons for non-adherence. Twenty women (32%), who had never
smoked, experienced a relapse in UC. Ten of those who experienced a relapse reported adhering
to medical treatment, of whom nine were registered in the Danish Prescription Database.
Conclusion:
Adherence to medical treatment in the post-partum period was high. A high PPV for self-reported
medical treatment was found. Remission in UC was most commonly stated as a reason for nonadherence,
whereas planned pregnancy increased adherence. Neither non-adherence nor
smoking cessation could explain the reason for relapse in UC among half of the women who
experienced a relapse during the post-partum period.
References:
1 Julsgaard M, Norgaard M, Hvas CL, Buck D, Christensen LA. Self-reported
adherence to medical treatment prior to and during pregnancy among women with ulcerative
colitis. Inflamm.Bowel.Dis. 2011; 17: 1573-1580.
3. MACROPHAGE ACTIVATION DETERMINED BY SOLUBLE CD163 IS A NON-
INVASIVE MARKER OF PORTAL HYPERTENSION AND A PREDICTOR OF CLINICAL
DECOMPENSATION IN CIRRHOSIS
Anthony Rode 1 , Amanda Nicoll 1 , Holger Jon Møller 2 , Lucy Lim 3 , Peter Angus 3 , Ian Kronborg 4 ,
Niranjan Arachchi 4 , Alexandria Gorelik 5 , Danny Liew 5 , Konstantin Kazankov 6 , Hendrik Vilstrup 6 ,
Henning Grønbæk 6 .
1 Department of Gastroenterology & Hepatology, Royal Melbourne Hospital, Melbourne, Australia, 2
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark, 3 Victorian Liver
Transplant Unit & Department of Gastroenterology, Austin Hospital, Melbourne, Australia,
4 Department of Gastroenterology, Western Hospital, Melbourne, Australia, 5 Epicentre, Royal
Melbourne Hospital, Melbourne, Australia, 6 Department of Hepatology & Gastroenterology, Aarhus
University Hospital, Aarhus, Denmark.
Introduction
Serum soluble CD163 (sCD163), a specific marker of macrophage activation, is elevated in
cirrhosis and portal hypertension, suggesting a pathogenic role of Kupffer cells in the development
of portal hypertension. Our objective was to study sCD163 in a large cohort of chronic liver disease
patients as a predictor of complications from portal hypertension.
Methods
sCD163 was measured in 116 patients with chronic liver disease and 52 control patients. Median
follow up was 7.0 months (IQR, 6.0 – 8.1) and chronic liver disease complications were assessed
at study enrollment and completion. Liver disease severity was determined by the Child-Pugh and
the Model for End Stage Liver Disease scores.
Results
The sCD163 concentration was three times higher in cirrhosis patients than in the controls (median
6.1 mg/l (IQR, 3.6 – 9.6) versus 2.0 mg/l (IQR, 1.5 – 2.7), p < 0.001). High sCD163 levels were
12

elated to increasing liver disease severity, complications from portal hypertension and rapid liver
disease progression. sCD163 >9.5 mg/l had a 97% specificity, a likelihood ratio of 14.5 and a
hazard ratio of 6.5 for predicting disease progression and emergent decompensation.
Conclusion
Activation of Kupffer cells plays an important role in the pathophysiology of liver cirrhosis and
portal hypertension and high sCD163 levels predict an unfavourable clinical course. Thus high
sCD163 levels may be used for screening purposes and early identification of the need for
intervention.
4. Behandlingresultater ved primær duodenal cancer
Buchbjerg T, Fristrup C, Pless T, Mortensen MB.
Kirurgisk afdeling A, Odense Universitetshospital.
Baggrund
Duodenal cancer (DC) er en sjælden cancersygdom som udgør omkring 0,5% af alle maligne
tumorer i gastrointestinal kanalen – altså omkring 20 tilfælde i Danmark årligt. Det er ofte
vanskeligt at skelne DC fra andre karcinomer udgået fra det periampullære område, hvorfor der er
usikkerhed omkring såvel incidens som de reelle behandlingsresultater for patienter med DC.
Formålet med dette studium var at belyse behandlingsresultaterne for en kohorte af DC patienter,
hvor indgangskriteriet var en entydig histopatologisk DC diagnose.
Metode
Retrospektiv opgørelse over alle patienter som i perioden 1997-2011 blev udredt og behandlet for
DC på Kirurgisk afdeling A, Odense Universitetshospital.
Resultater
Femoghalvtreds patienter (32M, 23K) med en gennemsnitsalder på diagnosetidspunktet på 66 år
(range 35-87) opfyldte inklusionskriteriet for DC i perioden 1997-2011. Den patologiske
klassifikation var adenocarcinom (85%), mucinøst adenocarcinom (9%), karcinom (4%) og
signetringscelle karcinom (2%). Efter udredning var intenderet kurativ resektion mulig hos 20
patienter (36%), hvoraf 15 patienter (75%) fik foretaget en Whipple’s procedure og 5 patienter
(25%) fik en lokal resektion af duodenum. Tumors gennemsnitlige størrelse var 54mm (median
50mm, range 20-135). Alle operationer var R0-resektioner og halvdelen af patienterne havde N1-
sygdom. Den postoperative 30-dages morbiditet og mortalitet var henholdsvis 65% og 10% (CI: 1-
32%). Dødsfaldene skyldtes postoperativ blødning (n=1) og abdominalt compartment syndrom
(n=1). Syvogtyve (77%) af de 35 palliativt behandlede patienter fik foretaget operativ aflastning
(GEA+/-galdevejsaflastning), 5 (14%) blev endoskopisk pallieret mens 3 patienter (9%) ikke havde
behov for kirurgisk intervention. Den mediane overlevelse og den estimerede 5-års overlevelse for
de resecerede patienter var henholdsvis 23 måneder (CI: 6-53) og 25% (CI: 8-47). De tilsvarende
tal for de palliativt behandlede var 8 måneder (CI: 3-13) og 0%.
Konklusion
DC er en sjælden sygdom med en relativ dårlig prognose. I en ”ren” DC population fandt vi, at 36%
kunne gennemgå en radikal resektion med en efterfølgende median overlevelse på 23 måneder og
en estimeret 5-års overlevelse på 25%. Den mediane overlevelse for de palliativt behandlede
patienter var 8 måneder, og ingen af disse patienter var i live efter 3 år.
5. Combination of banding ligation and medical intervention for secondary
prevention in esophageal varices; a systematic review and meta-analysis of
randomized trials
Maja Thiele 1,2 , Aleksander Krag 2 , Ulrik Rohde 2 , Lise Lotte Gluud 2
13

1 Department of Medicine, Copenhagen University Hospital Køge, Denmark. 2 Department of
Medicine, Copenhagen University Hospital Gentofte, Denmark.
Background and aims
Meta-analyses on the combination of banding ligation and medical therapy versus monotherapy
with either one have yielded inconsistent results, perhaps because of a low number of randomized
controlled trials. When trials on sclerotherapy were included, combination therapy reduced the risk
of rebleeding, but meta-analyses demonstrated a high level of inter-trial heterogeneity.
Sclerotherapy has since been abandoned due to the associated adverse events.
We therefore conducted a systematic review of randomized trials on the combination of banding
ligation and medical interventions versus monotherapy.
Methods
Electronic and manual searches were combined. Authors of included trials were contacted for
additional information. Two authors extracted data in an independent manner.
Random effects meta-analyses were performed with results expressed as risk ratio and I 2 as a
marker of heterogeneity. Subgroup sensitivity and regression analyses were performed to evaluate
the robustness of the results and sources of intertrial heterogeneity.
Results
Nine trials with a total of 955 patients were included. Six trials compared combination therapy
versus ligation. Two trials compared combination therapy versus medial interventions. One trial
compared combination therapy versus ligation or medical therapy
Combination therapy significantly reduced both overall bleeding (RR 0.68; 95% CI 0.54-0.85, see
figure) and esophageal variceal bleeding (0.61;0.47-0.80) compared to monotherapy. The number
needed to treat with combination therapy to prevent one rebleeding episode was 7.
There was no apparent differences between combination and monotherapy concerning all-cause
mortality (0.89;0.65-1.21), bleeding-related mortality (0.85; 0.41-1.75) or serious adverse events
(1.93; 0.94-3.99). No evidence of intertrial heterogenity was found (I 2 < 25% for all analyses).
Conclusion
The combination of banding ligation and medical therapy reduces the risk of rebleeding compared
with either of the two interventions alone. Additional trials are needed to assess effect on mortality
rates.
6. Decrease of portal pressure via TIPS corrects contractile mechanisms in gastric
mucosa of human cirrhosis.
Trebicka J*#, Krag A#, Wix C*, Granzow M*, Klein S*, Sauerbruch T*
*Department of Internal Medicine I, University of Bonn, Germany
# Department of Gastroenterology, Hvidovre Hospital, University of Kopenhagen, Denmark
Background:
In portal hypertension and cirrhosis vasodilation in splanchnic vessels is maintained despite high
vasoconstrictor levels. Increased beta-arrestin-2 expression and defective vasoconstriction via
RhoA/Rho-kinase are at least partially responsible for this effect. We have previously shown that
changes in contractile pathways are also present in gastric mucosa of these patients (EASL 2010).
Here, we investigated whether this is modified by TIPS insertion.
Methods:
Gastric mucosa biopsies were collected from 52 patients with liver cirrhosis (eighteen with TIPS),
as well as from 12 controls. Mucosal mRNA levels of RhoA, Rho-kinase, eNOS and beta-arrestin-2
were investigated by Taqman-PCR. Activity of eNOS was assessed as its phosphorylation at serin-
14

1177, and activity of Rho-kinase as phosphorylation of its substrate, moesin, at threonine-558,
using Western blot with phospho- and site-specific antibodies.
Results:
In the mucosa of cirrhotic patients we found two-fold increased mRNA levels of eNOS and betaarrestin-2
compared to controls (p

Dept. of Gastroenterology 1 and Centre of Functional Imaging and Research 2 Hvidovre Hospital, Dept.
of Clinical Physiology Nuclear Medicine & PET, Rigshospitalet & Cluster for Molecular Imaging 3 . All
from Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
Background
Presence of cardiac dysfunction including QT interval prolongation in patients with advanced
cirrhosis is widely accepted, but in mild cirrhosis data are limited. Since systolic dysfunction may
only be detectable during severe cardiac stress, we investigated dynamics of QT-interval, systolic
and diastolic function in patients with mild cirrhosis during maximal beta-adrenergic drive.
Methods
Nineteen patients with Child A (n=12) and B cirrhosis (n=7) and 7 matched controls participated.
ECG was recorded at rest and during cardiac stress induced by increasing dosages of dobutamine
and atropine. Cardiac volumes were assessed at rest by gated- myocardial perfusion imaging
(SPECT).
Results
Pharmacological responsiveness was similar in cirrhosis and controls and the HR increased by 66
± 15 vs. 67 ± 8 min -1 . Heart rate-blood pressure product increased equally by 115% in cirrhosis
and controls, NS. However time to resume HR of 100 beats/min was significantly longer in
cirrhosis, p

22- and IL-17A-producing T helper cells and plasma cytokines in patients with AH and to relate
these observations to the short-term disease course.
Methods:
We collected blood samples from 21 consecutive patients with severe AH on days 0, 14 and 30
after diagnosis, and included 10 stable alcoholic cirrhosis patients and 10 healthy subjects as
controls. Analyses were performed using flow cytometry and ELISA.
Results:
We observed higher frequencies of IL-22-producing T helper cells in AH patients (median 1.7%)
than in cirrhosis patients (1.0%, p=0.03) and healthy controls (1.0%, p=0.01), and a 1.5-fold
increase in the plasma concentration of IL-17A in AH compared with healthy controls (p

11. Treatment of patients with Autoimmune Hepatitis (AIH) at Aarhus University
Hospital - a tertiary liver referral center.
Martin Kreutzfeldt 1 , Niels Jessen 2 , Hendrik Vilstrup 1 , Henning Grønbæk 1
1) Department of Medicine V & 2) MOMA, Aarhus University Hospital, Aarhus, Denmark
Introduction:
Autoimmune hepatitis (AIH) is, if insufficiently treated, a severe disease with a high risk of
progression to cirrhosis with increased mortality. Standard maintenance therapy is azathioprine (
100mg/day) with or without prednisolone ( 10mg/day). However, approximately 20% of AIH
patients are non-responders with need for stronger immunosuppressive regimens or experience
severe side effects to standard therapy.
Aim:
To describe a cohort of AIH patients from Aarhus University Hospital (AUH), a tertiary referral liver
center. We studied three groups. 1: Responders of standard therapy 2: Non-responders of
standard therapy 3: Patients with side effect to the standard therapy.
Methods:
A retrospective study of all AIH patients seen at AUH in the period 1992-2012. We collected
clinical, biochemical and histological data for all the patients from patient files with a focus on
treatment response and drug toxicity.
Results:
We identified 103 AIH patients (77 women/ 26 men, mean age 42 ± 18 years). Nineteen patients
(18%) had an overlap syndrome, 13 with PBC and 6 with PSC. Five patients were newly
diagnosed within 6 month leaving a total of 78 AIH patients followed for more than 6 month. Of
these 30 patients (38%) were responders, 24 (31%) were non-responders, and 20 (26%) had side
effects to standard therapy. In 5 cases (6%) we were unable to find sufficient data.
Of Non-responders 6 patients had a liver transplantation, 8 were treated with high-dose aza (>100
mg/day) and/or other immunosuppressive drugs Prograf (n = 11), Budesonide (n = 3), ciclosporin
(n = 2), or Cellcept (n = 1). Non-responders treated with other immunosuppressive drugs were in
clinical and biochemical response by the day of follow-up.
Patients with side effects were treated with Budesonide (n = 3), Prednisolone (n = 14), nihil (n = 1),
Prograf (n = 6), cellcept (n = 5), or ciclosporin (n = 1) and were in clinical and biochemical
remission by the day of follow-up.
Conclusion:
We experienced a high proportion of non-responders and patients with side effects with need for
stronger immunosuppressive treatment regimens. This may reflect referral of patients to the liver
center when not responding to standard therapy.
12. Is laparoscopic assisted ileal pouch-anal anastomosis associated with better
postoperative sexual function compared to open surgery
Mie Dilling Kjaer 1 , Stig Borbjerg Laursen 2 , Peiman Hossein Poornoroozy 1
1 Department of surgical gastroenterology, 2 Department of medical gastroenterology, Odense
University Hospital, Odense, Denmark
Introduction
Colectomy and construction of an IPAA may be indicated in patients with ulcerative colitis (UC) not
responding to medical treatment and in patients with familial adenomatous polyposis (FAP). It is
important to evaluate the postoperative sexual function associated with construction of IPAA, as
the majority of these patients are sexually active and in their fertile age.
18

In general, performance of laparoscopic colorectal surgery seems to be associated with lower
morbidity compared to open colorectal surgery. Studies comparing the sexual function after
laparoscopic assisted IPAA and open IPAA are needed in order to investigate if the laparoscopic
assisted approach is associated with better postoperative sexual function.
Aim & Methods
The main objective of this study was to examine whether laparoscopic assisted ileal pouch-anal
anastomosis (IPAA) is associated with better postoperative sexual function, body image and
quality of life compared to open IPAA.
The study was conducted as a retrospective survey study. Patients treated with laparoscopic
assisted or open IPAA in the period October 2008 to March 2012 were included. Evaluation of
sexual function, body image and quality of life was performed using the female sexual function
index (FSFI), the international index of erectile function (IIEF), the body image questionnaire (BIQ)
and the short inflammatory bowel disease questionnaire (SIBDQ).
Results
A total of 37 patients were treated with laparoscopic assisted IPAA and 33 patients with open
IPAA. The surveys were returned in 67% of cases. Data from 27 laparoscopic assisted cases and
20 cases treated with open surgery were included in the final analyses. There were no differences
in median age (42 versus 38 yrs), functional outcome and health related quality of life as evaluated
by SIBDQ (median score 52.5 versus 53), or median time of follow-up (684 versus 827 days)
between the laparoscopic and open group. Diagnoses were UC (n=41), FAP (n=4) and other
(n=2). Among women treated with open surgery there was a tendency towards a lower degree of
sexual satisfaction (P=0.10) compared to the women in the laparoscopic group. There were,
however, no differences in lubrication, ability to achieve orgasm or pain related to intercourse.
Among men there was no difference in erectile function or ability to achieve orgasm. There were
no significantly differences in body image or quality of life.
Conclusions
Although there was a tendency towards better sexual satisfaction among women treated with
laparoscopic assisted IPAA the two surgical techniques in general seem equal regarding
postoperative sexual function.
13. Extracorporeal Shock Wave Lithotripsy and ERCP in patients with chronic
pancreatitis
Kristina Fruerlund
Department of medical gastroenterology, Odense University Hospital, Odense, Denmark
Introduction:
Chronic pancreatitis might be complicated by pain caused by stones in the main pancreatic duct. In
some patients endoscopic removal is unsuccessful. Extracorporeal Shock Wave Lithotripsy
(ESWL) is a possible option for these patients.
Material and Methods:
A retrospective single center survey was performed to evaluate the efficacy of ESWL in
combination with Endoscopic Retrograde Cholangiopancreatography (ERCP) as a treatment of
pancreatic stones in the pancreatic duct. Medical records of 28 patients were evaluated. ESWL
and ERCP were undertaken in all patients. Data collected included patient characteristics, number
and complications of ERCP and ESWL and number and location of pancreatic stones. The use of
analgesics was registered before and after treatment.
Results:
19

71.4 % patients became completely or partially free of stones after the treatment. A median of one
ESWL and three ERCP sessions were necessary. 40.0 % experienced a significant improvement
of pain. 68.8 % of the opioid users had a significant decline in the use of opioids. Three patients
were lost to follow up.
Conclusion:
ESWL combined with ERCP is, in selected patients with chronic calcified pancreatitis and stones in
the main pancreatic duct, associated with a significant improvement in symptoms in most of the
patients and with a high technical success. The ESWL procedure is well tolerated and associated
with few complications.
14. Nutritional factors and bone metabolism in patients with alcohol dependency
Anne Wilkens Knudsen, MSC 1 , Jens-Erik Beck Jensen, MD, PhD 2 , Aleksander Krag 1 , Thomas
Almdal, MD, DMSc 2,3 , Inge Nordgaard-Lassen, MD, DMSc 1 , Ulrik Becker, MD, DMSc 1,4 .
1 Department of medical gastroenterology, Hvidovre University Hospital, Capital Region, Hvidovre,
Denmark. 2 Department of Endocrinology, Hvidovre University Hospital, Capital Region, Hvidovre,
Denmark. 3 Steno Diabetes Center, Niels Stensensvej 1, Gentofte, Denmark. 4 National Institute of
Public Health, University of Southern Denmark.
Rationale
Individuals with an excessive intake of alcohol have increased fracture-risk. The relationship
between variables related to nutritional status and bone mineral density (BMD) of the hip was
studied as well as clinical and nutritional variables that predict risk of osteoporosis among people
with alcohol dependency.
Methods
Outpatients with alcohol dependency were DXA-scanned. Handgrip strength (HGS), weight, height
and circumference of the waist and hip were measured. The questionnaire EQ-5D and ASI as well
as biochemical markers were obtained. Multiple linear regression analysis was used to determine
the association between BMD and markers of nutritional status. General linear model was used to
determine the relation between number of risk factors and Z-score for hip.
Results
Body Mass Index (BMI) and BMD were positively associated (n= 61, p=

15. Markers of inflammation and cardiac dysfunction are associated with the
hemodynamic derangement and prognosis in patients with cirrhosis
Signe Wiese, Christian Mortensen, Jens Peter Gøtze, Ove Andersen, Erik Christensen, Flemming
Bendtsen, Søren Møller
Background and aims:
Inflammation and cardiac dysfunction seem to play an important role in the development of
extrahepatic complications leading to increased mortality in patients with cirrhosis. A number of
novel proinflammatory biomarkers such as soluble urokinase-type plasminogen receptor (suPAR),
lipopolysaccharide binding protein (LBP), high-sensitivity C-reactive protein (hs-CRP) and
cardiovascular markers such as copeptin, proBNP, and high-sensitivity troponin T (hs-tnT) have
been shown to be related to these conditions, but their impact on prognosis have only been partly
assessed. We aimed to investigate if proinflammatory and cardiac markers are related to markers
of severity of liver disease, cardiac and hemodynamic changes, and survival.
Methods:
193 cirrhotic patients (Child group: A=46; B=97; C=50) had a full hemodynamic investigation
performed with measurement of splanchnic and systemic hemodynamics and measurement of
circulating levels of suPAR, LBP, hs-CRP, copeptin, proBNP, and hs-tnT.
Results:
SuPAR, hs-CRP and hs-tnT were significantly different throughout the Child classes (Table,
p

16. Soluble CD163, a macrophage activation marker, is an independent predictor of
severe fibrosis in patients with chronic viral hepatitis B and C.
Konstantin Kazankov 1 , Francisco Barrera 2 , Holger Jon Møller 3 , Hendrik Vilstrup 1 , Jacob George 2 ,
Henning Grønbæk 1
1) Department of Medicine V, Aarhus University Hospital, Aarhus, Denmark, 2) The Storr Liver
Unit, Westmead Hospital, Westmead, Australia 3) Department of Clinical Biochemistry, Aarhus
University Hospital, Aarhus, Denmark
Introduction:
CD163 is a haemoglobin-haptoglobin scavenger receptor expressed exclusively on monocytes and
macrophages, and is shed into the circulation as soluble CD163 (sCD163) upon macrophage
activation. sCD163 is elevated in cirrhosis and portal hypertension, and predicts mortality in acute
liver failure.
We aimed to assess macrophage activation by sCD163, relate it to biochemical and histological
parameters of disease and investigate sCD163 as a prognostic marker in chronic viral hepatitis.
Methods:
We studied 208 patients with chronic HBV and 556 patients with chronic HCV. All patients were
untreated. Histological scores of activity and fibrosis (Metavir and Scheuer), and steatosis were
obtained, as well as clinical, biochemical and metabolic parameters. Soluble CD163 was
measured by ELISA.
Results:
Soluble CD163 was higher in patients with HCV compared to HBV (3.7 (2.5 - 5.5) mg/L vs. 2.4 (1.8
- 3.6) mg/L, p

The study population consisted of all patients with AIH confirmed with a biopsy between 2006 and
2011 and afterwards followed at the department. The cohort was divided in to 4 subgroups
according to initial medical treatment (prednisolone, prednisolone and azathioprine, budesonide,
budesonide and azathioprine). The primary outcome was clinical and biochemical remission and
recorded side effects.
Results
We found 35 patients with incident AIH based on the pathology registry (incidence 1.2 per 100.000
per year). Only 25 were followed at the Dept. of Gastroenterology in Aalborg. Median age 47 years
(range 14-83), 17 (68%) were females).
Prednisolone was used as first line single drug in 12 patients. Half of these obtained lasting
remission on prednisolone, while the other half due to lack of effect were supplemented with
tacrolimus. Two patients with initial combination of prednisolone and azathioprine likewise ended
with tacrolimus. Budesonide was first line single drug in eight cases giving lasting remission in five
patients. One was supplemented with azathioprine, one with tacrolimus and the third was
supplemented with both drugs. Two patients were initially treated with both budesonide and
azathioprine, one of these had tacrolimus added later. Only few changes in treatment were due to
side effects.
Conclusion
The incidence of AIH in North Jutland was comparable to reports from the literature. Initial
treatment was distributed evenly between prednisolone and budesonide. The number of patients
was too small to draw conclusions about treatment effects. Recorded side effects were rare.
18. Vitamin B 12 related proteins in patients with hepatocellular carcinoma and other
liver diseases.
Kira Simonsen 1,2 , Anthony Rode 3 , Amanda Nicoll 3 , Gerda Villadsen 1 , Lucy Lim 4 , Ian Kronborg 5 ,
Alexandria Gorelik 6 , Hendrik Vilstrup 1 , Ebba Nexo 2 , Henning Grønbæk 1
1. Department of Hepato- and Gastroenterology, 2. Department of Clinical Biochemistry,
Aarhus University Hospital, Aarhus, Denmark, 3. Department of Gastroenterology & Hepatology,
Royal Melbourne Hospital, Melbourne, Australia 4.Victorian Liver Transplant Unit & Department of
Gastroenterology, Austin Hospital, Melbourne, Australia, 5. Department of Gastroenterology,
Western Hospital, Melbourne, Australia. 6. Epicentre, Royal Melbourne Hospital, Melbourne,
Australia.
Introduction:
Serum Vitamin B 12 (cobalamin(Cbl)) is often elevated in patients with liver diseases including
hepatocellular carcinoma (HCC). Studies on small groups of patients have suggested this to be
caused by alterations in the Cbl binding protein haptocorrin (a protein of unkown function) and
transcobalamin. Transcobalamin is partly saturated with Cbl (holoTC) and ensures cellular uptake
of Cbl through binding to a receptor that in its soluble form is named sCD320. Haptocorrin has
been suggested as a tumour marker for HCC, mainly based on promising findings in HCC of the
fibrolammelar variant (FLHCC). Here we explored the level of haptocorrin, transcobalamin, holoTC
and sCD320 in patients with various liver diseases as compared to patients with HCC.
Methods:
We investigated two cohorts: A cross-sectional cohort of HCC patients (n=95), patients with
chronic liver diseases (CLD, n=105) and 39 healthy controls from Melbourne, Australia. And a
follow up study of HCC patients (n=39) from Aarhus University Hospital followed prospectively with
blood samples at baseline and 1,4, and 12 weeks following ablative treatment. Patients were
evaluated by standard biochemistry, Child-Pugh-score and TNM classification for tumour status.
23

We analyzed haptocorrin, transcobalamin, holoTC and sCD320, employing in house ELISA based
assays.
Results:
Haptocorrin showed slightly higher levels for both HCC and CLD patients, compared to controls.
There was no relation to tumour status. The follow-up study showed no systematic change
following tumour ablation. One patient with verified FLHCC was included and showed normal
values of HC and no change according to tumour response.
HoloTC showed elevated levels in both HCC and CLD compared to controls and was significantly
elevated one week after ablative treatment. Transcobalamin and sCD320 showed elevated levels
for HCC and CLD compared to controls, but no significant change following ablative treatment.
Conclusion:
Haptocorrin did not prove to be a useful tumour marker for HCC and was not increased in our
patient with FLHCC. The Cbl related proteins all showed alterations in both HCC and patients with
liver diseases, but did not show a HCC specific pattern.
19. Bariatrisk kirurgi hos IBD patienter – et retrospektivt studie
Karen Raben Kudsk, Anna Johnsson, Lisbet Ambrosius Christensen.
Medicinsk afdeling V, Århus Universitetshospital.
Introduktion:
Blandt IBD patienter kan fedme forekomme, og dermed også et ønske om at få foretaget
fedmekirurgi. Denne type kirurgi kan efterfølgende vanskeliggøre såvel endoskopiske som
radiologiske procedurer ligesom abdominalsmerter og diarre kan skyldes dels postoperative
komplikationer (intern herniering eller dumping) men også recidiv af tarmsygdommen. Formålet
med undersøgelsen er at beskrive operationskomplikationer og det postoperative kliniske forløb af
tarmsygdommen.
Metode:
Retrospektivt studie af 6 patienter baseret på journalgennemgang.
Resultater:
Vi identificerede i alt seks patienter, som i perioden 2005-11 fik foretaget bariatrisk kirurgi, heraf
havde fem Crohns sygdom og en colitis ulcerosa. Den mediane sygdomsvarighed var 7 år (4-20
år). Tre var forud opereret for tarmsygdommen: kolektomi, iliocoecalresektion samt aflastende
kolostomi. Tre var i medicinsk behandling: 5-ASA, imurel og remicade. De seks patienter fik
foretaget i alt syv bariatriske operationer: Fire patienter fik gastric banding, heraf fik 1 patient
fjernet båndet efter 5 år og fik efterfølgende lavet gastric bypass. Yderligere 2 fik gastric bypass.
Der var ingen postoperative komplikationer. Vægttab for patienterne, der fik lavet bypass var
generelt større end efter banding: 77kg/3år og 38 kg/2 år over for 5kg/6 mdr, 58 kg/5 år og 22kg/7
år. To af de tre patienter, som fik foretaget gastric bypass, fik opblussen i deres tarmsygdom inden
for 1 år og blev behandlet med henholdsvis systemisk steroid, sandimmun og remicade. Den tredje
har fået diare et år efter operationen og er aktuelt under udredning. De fire patienter, som fik
foretaget gastric banding, er alle forblevet i remission efter operationen.
Konklusion:
Resultaterne kunne tyde på, at gastric banding proceduren bør foretrækkes frem for gastric bypass
hos disse patienter, om end vægttabet ikke er så stort.
24

20. Coloskopi – En sag for ligestillingsrådet
Lars M. L. Lehrskov-Schmidt 1 , Anders Bak-Christensen 1 , Elisabeth Knudsen 1 , Jakob Hendel 3 , Inge
Bøtker-Rasmussen Ifaoui 2 , Lene Hendel 3 .
Gastroenheden, Hvidovre Hospital 1 , Kirurgisk Klinik, Allerød 2 , Speciallægerne Rolighedsvej,
Birkerød 3
Baggrund
Kvinder er mere smertereagerende end mænd under coloskopi! Fordom eller faktum
Det ønskede vi at opklare.
Patienter
962 patienter blev undersøgt med coloskopi i sammenfaldende 16 mdr i en kirurgisk og en
medicinsk gastroenterologisk speciallægepraksis. Patienterne var jævnt fordelt på de to praksis.
Der indgik 541 kvinder og 421 mænd.
Metode
Patienterne blev, efter der var opnået informeret samtykke, bedt om at vurdere ubehaget ved
undersøgelsen på en visuel analog skala (VAS) umiddelbart efter undersøgelsen, VAS1. En score
på 0 var intet ubehag overhovedet, mens en score på 10 var smertefuldt. De blev desuden bedt
om at VAS-score ubehaget ved coloskopien dagen derpå, VAS2, og sende svaret på en frankeret
svarformular. Herudover blev en del af patienterne VAS-scoret af assistenten ved undersøgelsen,
VAS3.
Til vurdering af forskellen på mænd og kvinders gennemsnits VAS-score er der benyttet ordinal
logistisk regressionsanalyse af data.
Resultater
Forskellen på mænd og kvinders gennemsnits VAS-score viser en signifikant lavere score hos
mændene på 3,2 ± 2,53SD kontra 4,6 ± 2,98SD hos kvinderne, p

cultured from 56 % of patients with ulcerative colitis, from 42 % patients with Crohn’s disease
compared to 11 % of healthy controls (p < 0.05). Furthermore, when comparing B2 E. coli strains
with at least one positive ExPEC gene among different groups, 79 % were found positive among
active UC, 86 % among active CD patients, significantly more than 25 % among inactive IBD
patients (p < p < 0.05), and 6 % among healthy controls (p < 0.05). When comparing B2 isolates
with IBD patients with active disease with positive ExPEC genes the distribution was not different
from uropathogenic isolates, in both groups the most frequently detected ExPEC genes were
PapC and KPSMII
CONCLUSION: In conclusion, E. coli of the phylogenetic group B2 with ExPEC genes were found
more frequently among IBD patients with active disease compared to patients with inactive
disease, and no difference in ExPEC gene distribution could be determined compared to
uropathogenic isolates.
22. RIFAXIMIN MAY IMPROVE SERUM AMMONIA AND OVERT HEPATIC
ENCEPHALOPATHY IN CHRONIC LIVER DISEASE
Nina Kimer 1 , Lise Lotte Gluud 2, Søren Møller 1 , Flemming Bendtsen 3 , Aleksander Krag 2/3
From the 1 Department of Clinical Physiology and Nuclear Medicine, Copenhagen University
Hospital Hvidovre, 2 Department of Internal Medicine, Copenhagen University Hospital Gentofte,
3 Department of Gastroenterology, Copenhagen University Hospital Hvidovre.
Background:
Hepatic encephalopathy (HE) is a severe complication to liver cirrhosis that is associated with a
high mortality. The exact mechanism behind HE is still unsettled but ammonia from bacterial
fermentation in the gut may be important. Rifaximin, a non-absorbable antibiotic exhibit
antimicrobial activity against both aerobic and anaerobic gram-positive and gram-negative
microorganisms and may thereby reduce ammonia production and improve overt HE.
Aim:
To evaluate the clinical effect of rifaximin versus lactulose and lactitol in the treatment of overt HE.
Methods:
A systematic review including randomised clinical trials comparing rifaximin to lactulose, lactitol or
placebo was conducted. Eligible trials were identified through electronic and manual searches (last
update July 2012). Our primary outcome measures were mortality, remission of HE, and ammonia
levels. Random effects meta-analyses were performed with results expressed as risk differences,
weighted mean differences and I 2 as a marker of heterogeneity. Here we present the preliminary
data of these analyses.
Results:
In total, 343 patients with overt HE in seven randomised controlled trials on rifaximin versus
lactulose or lactitol were included. None of the studies reported any deaths. In total 65 of 104
patients randomised to rifaximin and 49 of 106 patients randomised to lactulose or lactitol in 4
studies completely remitted from HE. The risk difference was 0.17 (0.04;0.29), P =0.009, I 2 0%.
Six studies reported s-ammonium after treatment. The mean difference was –7.62 g/100 ml (-
13.16;-2.03) P= 0.007, I 2 44% in favour of rifaximin. Six studies reported HE grade (coma grade 0-
4) after treatment. The mean difference was –0.26 (-0.54;0.03) P=0.08, I 2 61%.
Conclusion:
Treatment with rifaximin may improve overt HE and lower s-ammonium levels. None of the studies
reported data on duration of hospitalisation or complications to HE. Additional studies are still
needed to validate the benefits of rifaximin in the treatment of overt HE.
26

23. Eosinofil øsofagit hos voksne
Stud. med. Christian Schjang Bladt og Troels Havelund
Medicinsk Gastroenterologisk afd. S, OUH
Formål:
Eosinofil øsofagit (EoE) i voksenpopulationen er en sparsomt rapporteret tilstand i Danmark.
Formålet med dette arbejde var ved retrospektiv journalgennemgang at beskrive en dansk
population med særligt fokus på de allergologiske aspekter.
Materiale og metoder:
Patienter diagnosticeret i perioden 1.1.2009 – 31.12.2011 på OUH blev fundet retrospektivt. De
blev fundet i patologidatabasen og i det patientadministrative system ved anvendelse af
henholdsvis SNOMED- og SKS-koder. I alt 106 patienter var registreret med relevante koder, og
de blev inkluderet i en primær database, hvorfra studiepopulationen blev udtrukket efter følgende
inklusionskriterier: relevante symptomer (dysfagi, fastsiddende fødebolus, reflukslignende
symptomer, retrosternale smerter) og mindst 15 eosinofile celler pr. high power field i minimum en
øsofagusbiopsi samt alder over 18 år. Blandt de frasorterede var den hyppigste årsag mindre end
15 eosinofile celler pr. high power field (37%). Ved journalgennemgang blev data registreret
vedrørende klinisk billede, endoskopifund, histologi, allergologisk udredning og behandling.
Resultater
Studiepopulationen bestod af 30 mænd og 16 kvinder med en gennemsnitsalder på 48 år.
Gennemsnitsalderen ved symptomdebut var 32 år. Næsten alle (96%) havde dysfagi og 80%
havde haft fastsiddende fødebolus. Anden allergisk sygdom var kendt hos 43%, og 32% havde
astma. Endoskopiske fund var hyppigst lineære furer (28%) og fibrøse strikturer (20%).
Gennemsnittet af eosinofile celler pr. high power field var 28 (15 – 50+), og øvrige histologiske
fund var basalzone hyperplasi (26%) og forlængede papiller (15%). Der blev ikke beskrevet
superficielle eosinofile ansamlinger eller mikroabscesser.
Hyppigste behandling var lokalt virkende kortikosteroid (76%), og ballondilatation var foretaget hos
22%. Allergologisk udredning var foretaget hos 22 (48%), og allergi påvist hos 19, de fleste med
en positiv priktest. Færre havde forhøjet specifik-IgE for mindst et fødevareallergen (8) eller positiv
epikutanprøve (4) var. Fødevareallergenerne var oftest æg, soja og hvede, og luftvejsallergenerne
var gråbynke, græs og husstøvmider. Kun 2 blev anbefalet eliminationsdiæt.
Diskussion
De registrerede specifikke endoskopiske fund er formentligt for få, men ofte var der blot noteret
fund forenelige med EoE. De makroskopiske fund er diskrete og kan let overses, hvis man ikke er
bekendt med dem. Biopsier og symptomer er afgørende for diagnosen. Antallet af eosinofile celler
pr. HPF er et relativt upræcist diagnostisk kriterium, fordi det afhænger af forstørrelsen på
mikroskopet, kvaliteten af objektivet, samt patologens delvist subjektive og semikvantitative skøn.
Indtil videre er der dog ikke noget bedre diagnostisk kriterium. Kun ca. halvdelen af kohorten var
udredt for allergi, men trods positive fund var resultaterne kun i få tilfælde anvendt til
eliminationsdiæt. Ved behandlingen med lokalt virkende kortikosteroid blev der i alle tilfælde
konstateret bedring af symptomerne. Symptomerne recidiverede efter kortere eller længere tids
ophør, og der er derfor behov for fastlæggelse af langtidsbehandlingsstrategier.
Konklusion
EoE er en relativt ny diagnose med delvist ukendte allergiske sygdomsmekanismer, og der er
behov for klinisk forskning i behandlingsstrategier. De anvendte allergologiske udredningsmetoder
har ringe klinisk anvendelsespotentiale, med kun få specifikke anbefalinger om eliminationsdiæt.
27

Lokalt virkende kortikosteroid har en vis symptomatisk effekt. Prævalensen synes højere end hidtil
antaget.
24. Increased levels of circulating Th17 cells in quiescent versus active Crohn’s
disease
Anders Dige 1 , Sidsel Støy 1 , Tue Kruse Rasmussen 2 , Jens Kelsen 1,3 , Christian L. Hvas 1 , Thomas
Damgaard Sandah 1 , Jens F. Dahlerup 1 , Bent Deleuran 2 , Jørgen Agnholt 1
1 Gastro-Immuno Research Laboratory (GIRL), Department of Medicine V (Hepatology and
Gastroenterology), Aarhus University Hospital, DK-8000 Aarhus C, Denmark 2 Department of
Medical Microbiology and Immunology, University of Aarhus, DK-8000 Aarhus C,
Denmark 3 Department of Medicine, Randers Regional Hospital, DK-8930 Randers, Denmark
Background and Aims:
Th17 cells, a subset of CD4+ T cells that produce interleukin (IL)-17A, IL-17F, IL-21, IL-22, IL-26,
and the chemokine CCL20 are critically involved in the mucosal inflammation observed in Crohn’s
disease (CD). However, their role as mediators of inflammation in CD has been questioned by a
recent clinical trial in which anti-IL-17A (secukinumab) treatment was ineffective. Besides being
pro-inflammatory, Th17-related cytokines mediate mucosal protective functions. We aimed to
investigate the role of Th17 cells in CD inflammation.
Methods:
Blood samples from 26 patients with active CD and 10 healthy controls (HC) were analyzed for
levels of IL-17A-, IL-21- and IL-22-producing CD45RO+CD4+ T cells using multicolor flow
cytometry. Samples were analyzed before and during adalimumab treatment to compare intraindividual
changes during active and quiescent disease.
Results:
CD patients had statistically significantly higher levels of IL-17-A-, IL-21- and IL-22-producing
CD45RO+CD4+ T cells in both active and quiescent disease compared with HC. Baseline levels of
IL-21 and IL-22 producing CD45RO+CD4+ T cells correlated inversely with mucosal inflammation
estimated by fecal calprotectin. Patients who responded to adalimumab treatment demonstrated a
2-to 3-fold increase in levels of IL-17A and IL-21 CD45RO+CD4+ T cells in quiescent disease
compared with active disease.
Conclusion:
Our data support the involvement of Th17 cells and IL-21- and IL-22-producing CD45RO+CD4+ T
cells in CD. Because patients had higher levels in quiescent disease compared with active CD, we
question whether Th17 cells are promoters of inflammation. Instead, Th17 cells may
counterbalance inflammation and maintain gut homeostasis.
25. Different injection techniques in assessment of central haemodynamics in
patients with cirrhosis
Tine Nøhr Christensen 1 , Christian Mortensen 2 , Jens H. Henriksen 1 , Søren Møller 1
1 Centre of Functional Imaging and Research, Department of Clinical Physiology and 2 Department of
Medical Gastroenterology, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen,
Copenhagen, Denmark
Objective.
Patients with cirrhosis often present with an abnormal distribution of the blood volume with a
reduced central blood volume (CBV) and central circulation time (CCT). In this group of patients it
is important to determine the central haemodynamics as accurate as possible. The purpose of the
28

present study is to compare an alternative injection technique by injecting technetium-labelled
human serum albumin ( 99m Tc-HSA) from a deposit within the catheter lumen with the conventional
injection technique by injecting iodine-labelled human serum albumin ( 125 I-HSA) directly from a
syringe.
Materials and methods.
In 192 patients with cirrhosis, CCT, CBV, and cardiac output (CO) were determined according to
the kinetic principles. Injection of the two radiolabelled HSA were performed simultaneously and
followed by arterial blood sampling every second the first minute.
Results. CCT was significantly shorter, and CO and CBV were significantly lower when
determined by the alternative catheter deposit injection technique compared to determination by
the traditional syringe deposit injection technique. The mean difference (bias) between CCT
measured with the two methods was 0.38 s with limits of agreement ranging from -0.83 s to 1.59 s.
Conclusion.
This study demonstrates that different injection techniques result in a minor but significant
difference of the measured haemodynamics. When highly accurate measurements of the central
haemodynamics are needed, we recommend using the alternative injection technique by injection
of the indicator from a deposit within the catheter in order to reduce overestimation of CCT.
26. Complications associated with the use of peripherally inserted central catheter
(PICCline) for home parenteral nutrition.
Line Dahlstrøm-Christensen, Lone Larsen, Helle Bendtsen, Henrik Højgaard Rasmussen, Lars
Vinter-Jensen.
Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg
Hospital, Aarhus University Hospital.
Background:
Peripherally inserted central catheter (PICCline) is a relatively new device for the use in home
parenteral nutrition. Usually classic tunneled central catheters (e.g. Hickmann) are used for this
purpose, however insertion of these are, as apposed to PICCline, associated with risk of major
complications, e.g. pneumothorax. Additionally, PICCline insertion can be delegated to specially
trained nurses. There are multiple studies on short-term use of PICCline in hospital settings, but
only a few focusing on the use of parenteral nutrition in home care settings. We addressed the
issue in our center for home parenteral nutrition.
Method: A retrospective study was performed in our Center for Nutrition and Bowel Diseases in the
years 2008-2012. Patients receiving parenteral nutrition were identified, their medical files
reviewed and dwell time, complications and the cause of removal were recorded. Complications
were calculated per 1000 catheter days.
Results:
56 patients (aged 28-81) were included, and they had a total of 94 PICClines. Total catheter days
were 9859. Each patient had catheter for 179,1 sd ± 187,02 days, and the mean dwell time of
each line was 104,9 sd ± 112,5 days. The longest dwell time was 572 days. There were no major
complications registered in relation to catheter insertions. The catheters were removed due to
catheter related sepsis, mechanical reasons and thrombotic complications in 1,72, 2,13 and 0,2 in
1000 catheter days, respectively.
Conclusion:
Our retrospective study demonstrates that PICCline is well suitable for use in home parenteral
nutrition for at least 3-4 months (mean dwell time in study) and in single patients for more than a
year. The causes for removal equals those reported on tunneled central catheters in literature. We
29

therefore conclude that PICCline is a relevant alternative for patients receiving home parenteral
nutrition. However, at present no studies define which catheter is most relevant to different
subgroups of patients and this must therefore be determined on individual basis.
27. Analysis of risk factors for ulcer bleeding in patients who after PCI start lowdose
aspirin and ADP-receptor inhibitor combination treatment.
Berit Elin Søltoft Jensen 1 , Jane Møller Hansen 1 , Anders Junker 2 , Jens Flensted Lassen 3 , Svend
Eggert Jensen 4, , Ove B. Schaffalitzky de Muckadell 1
1
Department of Medical Gastroenterology Odense University Hospital, 2 Department of Cardiology
Odense University Hospital, 3 Department of Cardiology Aarhus University Hospital, 4 Department
of Cardiology Aarhus University Hospital Aalborg.
Introduction
Antithrombotic combination treatment with ADP-receptor inhibitor and low-dose aspirin reduces the
risk of ischemic complications after acute coronary syndrome (ACS) and is standard treatment
following percutaneous coronary intervention (PCI) and stenting. Antithrombotic treatment however
increases the risk of bleeding, including gastrointestinal bleeding. Other risk factors for upper
gastrointestinal complications (UGIC) are well documented; Increasing age, non-steroidal antiinflammatory
drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), anticoagulant and
corticosteroids. Prophylactic proton pump inhibitor (PPI) treatment reduces the risk of UGIC, but it
is debated if PPI at the same time reduces the effect of clopidogrel.
The aim of the present study is to describe risk factors for UGIC in patients who after PCI start lowdose
aspirin and ADP-receptor inhibitor combination treatment.
Methods
The data were collected from a prospective randomised study in the period from April 26. 2011 to
April 25. 2012. Patients eligible for inclusion were first time PCI patients from Odense University
Hospital, Aarhus University Hospital and Aarhus University Hospital Aalborg. All patients studied
were prescribed a combination treatment of low dose ASA and ADP-receptor inhibitor. Patients
with a prior history of ADP-receptor inhibitor treatment (treatment start one month before the
current PCI were accepted) were excluded. A questionnaire was used to assess the different risk
factors for UGIC.
Results
One thousand patients were included in the study. The median age was 65.1 [range: 33.4-92.7].
39.7% had previously experienced dyspepsia and 11.7% had a prior history of peptic ulcer (2.9%
UGIC). A total of 16.0% used NSAIDs weekly (8.7%) or daily (7.3%). Use of corticosteroids, SSRIs
and anticoagulants were less prevalent (3.0%, 5.6% and 6.8%, respectively). Nearly half of the
patients (46.7%) were already treated with cardioprotective aspirin prior to PCI. 70.1% of the
patients had a moderate to high risk for UGIC, but only 18.8% were treated with PPI prior to PCI.
Conclusion
Data demonstrate a high frequency of risk factors among PCI patients treated with dual
antiplatelet therapy. To prevent UGIC it is suggested to implement a gastrointestinal risk
stratification and to consider prophylactic PPI in moderate to high-risk patients at start of
antithrombotic treatment.
30

28. Small intestinal transit in patients with liver cirrhosis and portal hypertension: a
descriptive study
Stine Karlsen, Lotte Fynne, Henning Grønbæk, Klaus Krogh
Department of Medicine V (Hepatology & Gastroenterology), Aarhus University Hospital, Aarhus,
Denmark
BACKGROUND AND AIMS:
Gastrointestinal dysmotility may be involved in the development of bacterial translocation and
infection in patients with liver cirrhosis. The aim of the present study was to describe gastric, small
intestinal and colorectal motility and transit in patients with liver cirrhosis and portal hypertension
using a novel magnet based Motility Tracking System (MTS-1) and standard radiopaque markers.
METHODS:
We included 15 patients with liver cirrhosis (8 Child-Pugh A (CP-A), 6 CP-B, and 1 CP-C) and
portal hypertension (11 males, median age 54 years (range 38-73), median portal pressure 18
mmHg (range 12-37), and 18 healthy controls (8 males, median age 58 years (range 34-64).
Gastric emptying time and small intestinal motility were evaluated by MTS-1 and total
gastrointestinal transit time was assessed by radiopaque markers and abdominal radiograph.
RESULTS:
The velocity through the proximal small intestine was significantly faster in cirrhotic patients
(median 1.27 meters (m)/hour, range 0.82-2.68) than in the healthy controls (median 1.00 m/hour,
range 0.46-1.88) (p = 0.03). Likewise, the magnet travelled significantly longer by both fast
(p=0.04) and slow movements (p=0.05) in the patient group. There was no significant difference in
either gastric emptying time: 23 minutes (range 5-131) in patients and 29 minutes (range 10.5-182)
in healthy controls (p = 0.43) or total gastrointestinal transit time: 1.6 days (range 0.5-2.9) in
patients and 2.0 days (range 1.0-3.9) in healthy controls (p=0.33). No correlation was observed
between hepatic venous pressure gradient and velocity of the magnet through the small intestine.
CONCLUSIONS:
Patients with liver cirrhosis and portal hypertension have faster than normal transit through the
proximal small intestine. This may be due to an overactive bowel as suggested by previous
studies.
29. Nutritional therapy in cirrhosis and alcoholic hepatitis: A systematic review and
meta-analyses of randomized trials.
Fialla AD 1 , Israelsen M 2 , Hamberg O 3 , Gluud LL 2 , Krag A 2 .
1) Department of Medical Gastroenterology, Odense University Hospital, Denmark, 2) Department
of Internal Medicine, Copenhagen University Hospital Gentofte, Denmark, 3) Department of
Hepatology, Rigshospitalet, Denmark
Background:
Among patients with cirrhosis and alcoholic hepatitis there is a superimposed stress metabolism
that increases nutritional demands. Nutritional therapy in these patients may therefore improve
clinical outcomes. Individual trials are equivocal.
Aim: To assess the beneficial and harmful effects of nutritional therapy in patients with cirrhosis or
alcoholic hepatitis.
Methods:
Electronic and manual searches were combined. The last search update was May 2012. Included
trials assessed nutrition versus no intervention. Patients with cirrhosis or alcoholic hepatitis were
eligible for inclusion. Two authors extracted data in an independent manner. Random effects meta-
31

analyses were performed and the results expressed as risk ratio and I 2 as a marker of intertrial
heterogeneity.
Results:
Eleven randomized controlled trials with 463 patients were included. Included patients had
alcoholic hepatitis (N=206) and/or cirrhosis (N=257). Included trials assessed enteral (7 trials) or
parenteral (4 trials) nutrition containing protein (34-106 g/day). All the studies had a high risk of
bias. Nutritional therapy had no effect on overall mortality (RR 0.77; 95% CI, 0.50-1.20, I 2 =15 %).
In subgroup analyses, nutrition had a beneficial effect in patient with cirrhosis (0.55; 0.32-0.94, I 2
=0%), but not in patients with alcoholic hepatitis. Nutrition was associated with lower bilirubin levels
(WMD -2.73 g/dL; 95% CI -4.69- to-0.77 g/dL, I 2 =37 %). No differences between the intervention
and control groups were seen on hepatic encephalopathy (1.45;0.87-2.40, I 2 =0%), ascites
(1.36;0.89-2.08, I 2 =0%), infections (0.61;0.23-1.64, I 2 =51%), or gastrointestinal bleeding
(1.43;0.47-4.39, I 2 =60%) .
Conclusion:
Nutritional therapy may reduce mortality in cirrhosis. Additional evidence from high quality trials is
needed to evaluate the clinical effects of nutrition in cirrhosis as well as alcoholic hepatitis.
30. The lectin pathway of the complement system is down regulated in patients who
respond to biological therapy in Crohn’s disease
1 Sandahl TD, 1 Hvas CL, 2 Kelsen J, 1 Dige AK, 1 Dahlerup JF, 1 Agnholt J, and 3 Thiel S
1 Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital,
Aarhus, Denmark,
2 Department of Medicine, Randers Regional Hospital, Randers, Denmark, 3 Department of Medical
Microbiology and Immunology, University of Aarhus, Aarhus, Denmark
Background
The lectin pathway of the complement system is activated through the recognition of pathogens or
altered self-structures by mannan-binding lectin (MBL) or one of three ficolins in collaboration with
MBL-associated serine proteases (MASPs). Previous studies suggest that altered ficolin levels
may contribute to a dysregulated immune response in Crohn’s disease (CD), but the role of the
lectin pathway in active CD remains unexplored.
Methods
Blood samples from 43 patients with active CD were obtained before and during standard
induction treatment with infliximab or adalimumab. Serum levels of M-ficolin, L-ficolin, H-ficolin,
MBL, MASP-2 and MASP-3 were assessed. Clinical, biochemical, and fecal markers of
inflammation were obtained and the patients were monitored for 8 weeks.
Results
Of 43 patients 32 (74%) were classified as responders. The baseline disease severity (as
estimated by HBI) as well as markers of inflammation was similar responders and non-responders.
We observed a 50% decrease in median M-ficolin levels between day 0 and week 1 and week 8 in
responders (1150 to 571 pg/ml, p

in non-responders.
Conclusion
Our findings indicate that M-ficolin, MASP-2, and MASP-3 act in concert to reduce complement
activation in CD patients who respond to biological therapy.
31. Predictors for Treatment Response to Budesonide and for Clinical Relapse in
Collagenous Colitis
Miehlke, Stephan; Hansen, Jesper B.; Schwarz, Franca; Kuhlisch, Eberhard; Morgner, Andrea;
Madisch, Ahmed; Teglbjaerg, Peter S.; Vieth, Michael; Baretton, Gustavo; Bonderup, Ole K.
1. Center for Digestive Diseases, Cooperation of Internal Medicine, Hamburg, Germany. 2.
Department of Gastroenterology, Aalborg Hospital, Aalborg, Denmark. 3.Strategic Management,
University Hospital, Dresden, Germany. 4. Institute for Medical Biometry and Statistics, Technical
University, Dresden, Germany.5. Medical Department I, Siloah Hospital, Hannover, Germany.
6. Institute of Pathology, Aalborg Hospital, Aalborg, Denmark. 7. Institute for Pathology, Klinikum
Bayreuth, Bayreuth, Germany. 8. Institute for Pathology, University Hospital, Dresden, Germany.
9. Department of Internal Medicine, Silkeborg Hospital, Silkeborg, Denmark.
Background:
Oral budesonide has been proven effective for inducing and maintaining clinical and histological
response in patients with collagenous colitis. However, there is a high risk of relapse after
discontinuation of treatment. Risk factors for treatment failure and for clinical relapse are unknown.
Aims:
To identify predictors for response to induction treatment and for clinical relapse with and without
maintenance treatment with budesonide.
Methods:
Metaanalysis of 4 randomized controlled trials on budesonide in collagenous colitis.
Available for analysis were 135 patients with induction treatment (budesonide 9 mg/day), 40
patients with maintenance treatment (budesonide 6 mg/day for 6 months) and 89 patients without
active maintenance treatment. Variables available for analysis were age, gender, stool frequency,
duration of diarrhea, collagenous band thickness, and lamina propria inflammation.
Results: The overall response rate to acute treatment with budesonide was 96% with a median
time to response of 6 days. A stool frequency of > 5/day significantly delayed the time to response
(9 versus 4 days, p=0.011). By univariate analysis, the risk for relapse was increased for age < 60
years (2.29 (1.04-5.03), p=0.039), stool frequency >5/day (2.51, 1.14-5.54, p=0.022) and duration
of diarrhea > 12 months (2.85 (1.18-6.88), p=0.02). By multivariate analysis, stool frequency (2.52
(1.03-6.17), p=0.04) and duration of diarrhea 2.63 (1.05-6.64), p=0.044) remained significant risk
factors for relapse. The thickness of the collagen band and the inflammation score did not
influence the treatment response or the risk for relapse.
Conclusions:
A long history of diarrhea and a high stool frequency significantly increases the risk for clinical
relapse in collagenous colitis. Patient younger than 60 years may also carry a higher risk for
relapse.
32. Endotoxin causes high mortality and reduced hepatic synthesis of acute phase
proteins in rats with experimental non-alcoholic fatty liver disease
KL Thomsen¹, E Glavind¹, J George², H Vilstrup¹, A Clouston 3 , L Hebbard², H Grønbæk¹
¹ Department of Medicine V (Hepatology & Gastroenterology), Aarhus University Hospital, Aarhus,
Denmark, ² Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, University of
33

Sydney, Westmead, Australia, 3 Centre for Liver Disease Research, School of Medicine, University
of Queensland, Brisbane, Australia
Background:
Non-alcoholic fatty liver disease (NAFLD) affects up to 30% of the general population. The
prognosis of patients with NAFLD is unimpaired, whereas non-alcoholic steatohepatitis (NASH)
often has a progressive course with increased liver morbidity including mortality from infections. It
remains unclear whether fatty liver disease affects the inflammatory systemic component of innate
immunity, the so-called ‘acute phase response'. We hypothesized that NAFLD and NASH may be
a risk factor for systemic inflammation with a reduced acute phase response induced by
lipopolysaccharide (LPS), leading to increased mortality.
Methods:
We induced NAFLD and NASH in Wistar rats using a high-fat, high-cholesterol (HFD) diet for 4
(NAFLD) and 16 (NASH) weeks, respectively. We examined the acute phase response induced by
a low dose of LPS (0.5 mg/kg i.p.) and measured the serum concentrations of tumor necrosis
factor- (TNF-), interleukin 6 (IL-6), and -2-macroglobulin (2MG), and registered the mortality.
Results:
Two hours after injection, LPS induced an increased TNF- response in rats with NAFLD and
NASH (64.3 ± 8.9 and 72.2 ± 34.2 pg/l, respectively) compared to controls (16.5 ± 6.4 pg/l)
(P

symptoms at admission, medication, disease activity at time of debut and at birth, smoking,
gestational age at delivery, mode of delivery and birth outcome were obtained from medical
records.
Results
7 patients had their first symptoms of UC during pregnancy. Time from debut of symptoms to
initiation of treatment varied from 2 to 30 weeks. Patients most often presented with bloody stools
and weight loss. Six were diagnosed with severe UC and treated with intravenous
methylprednisolone. One patient required infliximab infusion to obtain remission. Two patients
presented with dyspnea and high fever after treatment with mesalazine and were both diagnosed
with severe allergic reactions to the drug and improved promptly after institution of prednisolone.
One patient developed Clostridium difficile infection.
Two children were born preterm, one after induction of labor, another after elective cesarean
section. All children had normal birth weight for gestational age. One patient had active disease at
time of birth.
Conclusion
This study indicates that patients presenting with UC in pregnancy may have a more severe
course of disease. In our subset of patients we experienced numerous complications and a
diagnostic barrier and delay became apparent in some of the patients. Our results emphasize the
importance of a multidisciplinary approach and early referral of these patients. Further prospective
studies are warranted.
*These authors have contributed equally to the study
34. Inflammatory bowel disease and allocation of health-related benefits.
Kirsten Fonager, Department of Social Medicine, Aalborg Hospital, Aarhus University, Jeanette
Barnewitz Leth, University College North Jutland, Aalborg, Thomas Mulvad, Department of Health
Planning and Quality, North Jutland Region, Bent Ascanius Jacobsen, Department of Medical
Gastroenterology, Aalborg Hospital, Aarhus University.
Background:
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are
chronic diseases that impact patients’ lives at many different levels. The incidence is highest in
young adults and the disease course unpredictable. The aim was to study whether patients with
inflammatory bowel disease had a higher risk of leaving the regular work force.
Method:
We included all patients in North Jutland, Denmark, diagnosed with CD or UC from 1993 to 2002.
31 patients had left the regular work force at the time of diagnosis and 11 died during follow up
leaving 317 patients with CD and 558 patients with UC for the analyses. Data were linked to the
DREAM database which holds information on public social benefits. Risks of leaving the regular
work force (allocated to permanent health related benefit) after five years were estimated in logistic
regression models. The number of days having received social support/sickness benefit the five
years following diagnosis was assessed by linear regression analysis. Sub-analysis was performed
using a Poisson regression model to calculate the incidence rate ratios (IRRs) for disability pension
among CD and UC patients compared with the background population.
Results:
A total of 8.2% with CD and 4.3% with UC had left the regular work force within five years after
diagnosis. CD women had a higher risk than UC women (OR 2.5 (95% CI=1.0-6.0)), whereas no
difference was found for men (OR 1.0 (95% CI=0.4-2.8). Receiving social benefits one year before
diagnosis seemed to have impact on both the number of days receiving social support/sickness
35

enefit and the risk of leaving the regular work force during the five year time period. Both CD and
UC patients had a higher risk than the background population of receiving disability pension (CD:
IRR 2.82 (95% CI=1.08-3.08); UC: IRR 1.82 (95% CI=1.57-5.14)).
Conclusions:
The study showed that patients with inflammatory bowel disease, especially women with CD, had
an increased risk of leaving the regular work force five year after diagnosis. The study indicates
that factors unrelated to the disease might be important.
35. Effects of alpha- and beta-adrenergic-blockade on circulatory regulation and
oxygenation in cirrhosis
Lise Hobolth 1,2 , Flemming Bendtsen 2 , Erik F. Hansen 2 , Søren Møller 1
1 Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Faculty of Health
Sciences, University of Copenhagen, DK-2650 Hvidovre, Denmark.
2 Department of
Gastroenterology, Hvidovre University Hospital, Faculty of Health Sciences, Copenhagen
University, DK-2650 Hvidovre, Denmark.
Background and aims.
Patients with cirrhosis often develop serious complications in relation to portal hypertension such
as bleeding from oesophageal varices and a hyper dynamic syndrome with complications from the
circulation and the kidneys. Beta-blockers have been used for many years in patients with portal
hypertension and oesophageal varices, but newer studies have shown that Carvedilol, a combined
alpha-beta-receptor blocker may seem superior to Propranolol in reducing the portal pressure.
Recently it was hypothesized that Propranolol may adversely affect systemic haemodynamics and
survival in decompensated patients. Therefore, the aims of the present study were to assess
potential differential effects of beta-blockers and combined alfa-beta-blockers on selected
haemodynamic, humoral, cardiac, and respiratory characteristics in cirrhosis.
Methods.
Twenty-nine patients with cirrhosis and portal hypertension (HVPG 12mmHg) were included.
They were randomised to treatment with Carvedilol (n=16) or Propranolol (n=13) with a daily mean
dose of 14 mg and 122 mg, respectively. All patients underwent a full haemodynamic investigation
at inclusion and after 3 months of treatment. We measured splanchnic and systemic
haemodynamics including cardiac output (CO), heart rate (HR), arterial blood pressure (MAP),
systemic vascular resistance (SVR), arterial compliance (AC) central blood volume (CBV), central
circulation time (CCT), plasma volume (PV), arterial oxygen tension (PaO2), the alveolar arterial
oxygen gradient (AaPO2), QTc interval, and circulating renin concentrations.
Results. The two groups were comparable with respect to severity of the liver disease and portal
hypertension. After three months of treatment HVPG decreased equally in the Carvedilol and
Propranolol groups (-17 % and – 20%, NS). Arterial blood pressure, HR, and CO output decreased
equally in the two groups, CCT and SVR increased significantly but similarly in both groups. CBV,
plasma volume and arterial compliance were unaltered. The QTc interval and the renin levels
decreased similarly in the two groups whereas PaO2 and AaPO2 remained constant in both
groups during the study period.
Conclusions.
The results of the present study show that the effects of Carvedilol and Propranolol on splanchnic,
systemic and circulatory characteristics and oxygenation are largely comparable. The study does
not support differential pharmacological actions of the two drugs with respect to haemodynamics.
36

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