Asle Wilhelm Medhus

• Myhre, Anders Eivind; Meyer-Myklestad, Malin Holm; Gullaksen, Hanne Hestdal; Søgaard, Ole S.; Tolstrup, Martin & Salgado, Maria [Show all 51 contributors for this article] (2026). Long-term HIV-1 remission achieved through allogeneic haematopoietic stem cell transplant from a CCR5Δ32/Δ32 sibling donor. Nature Microbiology. 11, p. 1374–1386. doi: 10.1038/s41564-026-02304-8. Full text in Research Archive Show summary

  Only few cases of human immunodeficiency virus (HIV) remission have been reported after allogeneic haematopoietic stem cell transplantation (HSCT), mostly involving stem cell donors with the homozygous CCR5Δ32 (CCR5Δ32/Δ32) mutation, which confers resistance to CCR5-tropic HIV-1. Here we report the case of a 63-year-old man in off-treatment HIV remission, 5 years after HSCT with a CCR5Δ32/Δ32 sibling donor for myelodysplastic syndrome. In-depth clinical characterization including virological and immunological analyses of peripheral blood, gut and bone marrow samples revealed that full donor chimerism was achieved. Antiretroviral therapy was discontinued after 24 months, and 48 months after HSCT, no intact HIV DNA was detected in blood or gut biopsies. Replication-competent virus and HIV-specific T cell responses were absent, and HIV antibody responses showed a gradual decline. Full donor chimerism in the gut, which is the primary viral reservoir, underscores the likelihood of a cure.

• Johansen, Ingunn; Hagen, Milada; Løkkeberg, Stine Eileen Torp; Aabrekk, Tone Bergene; Asak, Øyvind & Bengtson, May-Bente [Show all 22 contributors for this article] (2026). Anxiety and depression in newly diagnosed patients with inflammatory bowel disease (the IBSEN III study) compared with the general population in Norway. Journal of Crohn's and Colitis. ISSN 1873-9946. 20(3). doi: 10.1093/ecco-jcc/jjag021. Full text in Research Archive Show summary

  Background and Aims: Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD); the aim of this study was to assess the proportion of anxiety and depression in patients newly diagnosed with IBD, compare the rates with the Norwegian general population (NGP), and examine associations with selected sociodemographic, psychological, and disease-related factors. Methods: This prospective cohort study included newly diagnosed patients with IBD, and data from the HUNT4 survey of the NGP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Crude statistical comparisons were performed using t-tests, Mann–Whitney U test, chi-square tests, or Fisher’s exact tests. Adjusted associations were modeled using multiple robust linear regression and multiple logistic regression. Results: In total, 938/1562 (62.1%) patients with IBD completed the Hospital Anxiety and Depression Scale (Crohn’s disease [CD]: n = 297, ulcerative colitis [UC]: n = 641). The proportion of anxiety was 37.4% in CD and 32.1% in UC, while depression was reported by 21.9% and 16.8%, respectively. Both rates were significantly higher than those observed in the NGP (17.5% for anxiety and 9.4% for depression). Compared with the NGP, males with CD had significantly higher levels of anxiety and depression, males with UC had elevated anxiety only, while females with CD and UC showed increased anxiety and depression. Both substantial fatigue and general self-efficacy were significantly associated with anxiety and depression in IBD. Conclusions: Newly diagnosed patients with IBD experienced significant psychological challenges compared with the NGP. Early identification of anxiety and depression may enable targeted interventions.

• Bajer, Lukas; Polakovicova, Petra; Heczkova, Marie; Holm, Kristian; Hole, Mikal Jacob & Hlavaty, Mojmir [Show all 19 contributors for this article] (2025). Geography-independent mucosal microbiota alterations in primary sclerosing cholangitis persist after liver transplantation. JHEP Reports. 8(4). doi: 10.1016/j.jhepr.2025.101716. Full text in Research Archive Show summary

  Background & Aims Primary sclerosing cholangitis (PSC)-associated alterations of fecal gut microbiota have already been described, but data on the mucosal microbiota are still limited. We aimed to further define disease-specific mucosal microbial patterns independent of geography and assess the relationship to liver transplantation (LTx), gut inflammation (inflammatory bowel disease), and PSC recurrence (rPSC). Methods We performed 16S ribosomal RNA gene (V3–V4) sequencing of ileocolonic biopsies from 115 patients with PSC (pre-LTx), 159 liver-transplanted patients (post_LTx, recurrence occurred in 38), and 96 healthy controls (HC) from Norway and the Czech Republic. Results Alpha diversity was lower in all PSC groups compared with HC. Elastic net models discriminated pre_LTx (AUC ileum 0.97; colon 0.93; p <0.001) and post_LTx PSC patients (AUC ileum 0.97; colon 0.97; p <0.001) from HC, and distinguished pre_LTx from post_LTx (AUC ileum 0.83; colon 0.83; p <0.001). The shared, cohort-independent PSC microbiota was dominated by Enterococcus, Pseudomonas, Veillonella, Klebsiella, and Streptococcus, while several common commensals were underrepresented. A microbial dysbiosis index calculated from PSC-associated genera correlated negatively with alpha diversity and serum albumin, while a positive correlation was observed with markers of cholestatic disease (ALP, GGT) and liver fibrosis (APRI). There were no associations with the presence of inflammatory bowel disease or fecal calprotectin. Differences between post-LTx patients with and without recurrence were limited, but several genera deregulated in pre-LTx PSC (Klebsiella, Bilophila, Coprococcus, Odoribacter) showed similar trends in rPSC. Conclusions Our findings in two European countries revealed a distinct mucosal microbiota composition associated with PSC that persists after LTx. These microbial patterns correlate with the severity of liver injury in PSC but not with markers of intestinal inflammation. Impact and implications This study provides an extensive evaluation of mucosa-associated microbiota in primary sclerosing cholangitis (PSC) before and after liver transplantation across two European cohorts. The persistence of PSC-related dysbiosis after transplantation highlights the importance of the gut–liver axis in PSC and supports further investigation into microbiota-driven mechanisms. Together with the strong association between microbiota composition and markers of cholestasis and fibrosis, this suggests potential clinical utility as an indicator of disease activity or even as a target for prevention or therapy.

• Kaarbø, Mari; Yang, Mingyi; Meyer-Myklestad, Malin Holm; Sundaram, Arvind; Sousa, Mirta & Sharma, Animesh [Show all 13 contributors for this article] (2025). Transcriptomic and proteomic profiling reveal immune and metabolic dysregulation in the colonic mucosa of people living with HIV with incomplete immune recovery. Frontiers in Immunology. 16. doi: 10.3389/fimmu.2025.1635523. Full text in Research Archive Show summary

  Background People living with HIV are called immunological non-responders (INR) when their CD4+ T cell count is not restored to immunocompetent levels, despite successful viral suppression. INR have increased risk of progression to AIDS, non-AIDS related morbidity, and death. Impaired mucosal barrier function is a prevailing hypothesis for why INR among people with HIV (PWH) have persistently low CD4+ T cell counts. Objective To understand the molecular mechanisms behind incomplete immune recovery in INR, we analyzed gene regulation and protein expression in gut tissues from INR, immunological responders (IR) and healthy controls (HC). Methods The transcriptome was assessed by RNA-sequencing (RNA-seq) and the proteome was examined using shotgun proteomic mass spectrometry in mucosal biopsies from the sigmoid colon and terminal ileum. Results In INR compared to IR, we identified 3326 differentially expressed genes (DEGs) in the colon while no DEGs were observed in the ileum. Gene ontology (GO) analyses revealed that the DEGs in colon of INR, compared to IR, predominantly involved pathways related to immune response, metabolism, and cellular processes. Notably, GO analysis highlighted downregulation of genes associated with B cell-mediated immunity and adaptive responses in INR. Deconvolution analysis indicated that these transcriptomic changes were not solely due to shifts in immune cell composition. Proteomic analysis supported these findings, showing more differential protein composition between INR and IR in colon than ileum. These proteins are associated with the regulation of adaptive immune signaling and essential cellular processes, including cell signaling, tissue repair, and growth, all of which are characteristic features of inflammatory bowel disease (IBD). Conclusion Our findings suggest that incomplete immune recovery during anti-retroviral therapy in PWH is associated with specific dysregulations in the molecular environment of the sigmoid colon, which may share mechanisms with IBD. The identified macromolecules may serve as potential targets for adjuvant treatment to improve the prognosis for INR.

• Olsen, Bjørn Christian Elias Grova; Opheim, Randi; Kristensen, Vendel Ailin; Høivik, Marte Lie; Lund, Charlotte & Aabrekk, Tone Bergene [Show all 22 contributors for this article] (2025). Prevalence of Irritable Bowel Syndrome Based on Rome IV Criteria in Patients in Biochemical and Endoscopic Remission From Newly Diagnosed Inflammatory Bowel Disease: One- and Three-Year Results (the IBSEN III Cohort). Inflammatory Bowel Diseases. ISSN 1078-0998. 31(10), p. 2704–2713. doi: 10.1093/ibd/izaf047. Full text in Research Archive Show summary

  Background: Distinguishing irritable bowel syndrome (IBS) from inflammatory bowel disease (IBD) flare-ups is challenging. This study used objective remission markers to accurately determine IBS prevalence in a population-based cohort of patients with IBD. Methods: Adults with ulcerative colitis and Crohn’s disease were recruited from the IBD in South-Eastern Norway III cohort study. Irritable bowel-like symptoms were assessed using the Rome IV criteria for patients in remission from IBD at 1- and 3-year follow-ups. Remission was defined objectively using the biochemical marker fecal calprotectin (FC) ≤ 250 μg/g, and comparisons to remission based on endoscopic indices were made at 1-year follow-up. Results: Among patients with FC ≤ 250 μg/g, IBS prevalences were 21.9% (n = 62/283) and 16.1% (n = 49/304) at the 1- and 3-year follow-ups, respectively, which were higher than that in the Norwegian population (9.5%; P < .005). Of patients in endoscopic remission at 1-year follow-up, 19.2% (n = 43/224) reported IBS-like symptoms, which was not significantly different from IBS prevalence for patients with FC ≤ 250 μg/g. Irritable bowel syndrome was independently associated with substantial fatigue (odds ratio: 3.05 [95% CI, 1.48-6.27]) and female sex (odds ratio: 2.67 [95% CI, 1.34-5.32]) at the 1-year follow-up. Patients with IBS reported significantly reduced health-related quality of life (HRQoL) scores. Conclusions: The prevalence of IBS among patients in remission from IBD was approximately twice as common as that in the Norwegian population. Irritable bowel syndrome was independently associated with substantial fatigue, female sex, and reduced HRQoL.

• Strande, Vibeke; Hagen, Milada; Lund, Charlotte; Asak, Øivind Wessel; Bengtson, May-Bente & Cetinkaya, Raziye Boyar [Show all 26 contributors for this article] (2025). Predicting severe inflammatory bowel disease: a risk matrix model based on the IBSEN III inception cohort. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 60(7), p. 716–727. doi: 10.1080/00365521.2025.2512591. Full text in Research Archive Show summary

  Background and aims: Identifying patients at risk of developing severe inflammatory bowel disease (IBD) can aid treatment decisions. However, predicting disease course remains challenging. We aimed to identify predictive factors associated with severe disease course in the first year after IBD diagnosis. Methods: Newly diagnosed adult (≥18 years) patients with IBD were recruited from a population-based inception cohort (IBSEN III study). Preselected baseline factors were tested for associations with severe disease course, defined as IBD-related hospitalisation, surgery, treatment with ≥2 steroid courses, >2 biologics and/or new event of complication (stricture, fistula, abscess only applicable Crohn's disease (CD)). From a best fitted multivariable logistic regression model stratified by diagnosis and age (18-40/>40 years), probability of severe disease for given combinations of predictive factors was summarised in prediction matrices. Results: At one-year follow-up, 90/559 (16%) patients with ulcerative colitis (UC) and 74/312 (24%) with CD had severe disease. Treatment with systemic steroids, vitamin D deficiency, Simple Clinical Colitis Activity Index >2, and hypoalbuminemia at diagnosis were all significantly associated with severe disease in UC patients. CD patients with stricturing or penetrating disease behaviour, systemic steroids and hypoalbuminemia at diagnosis were associated with severe disease course. The least favourable combination of these factors increased the probability of severe disease from 3% (95%CI[0-5%]) to 72% (95%CI[66-79%]) for UC and from 8% (95%CI[3-13%]) to 88% (95%CI[84-93%]) for CD. Conclusions: Our study identified predictive factors associated with severe disease the first year after diagnosis. The probability of severe disease summarised in matrices enables easy risk stratification.

• Lundekvam, Jonas Andre; Høivik, Marte Lie; Anisdahl, Karoline; Hagen, Milada; Warren, David & Bolstad, Nils [Show all 7 contributors for this article] (2025). Tumour necrosis factor inhibitors in Ulcerative colitis: real-world data on Therapeutic drug monitoring and evaluation of current treatment targets (STRIDE II). Annals of Medicine. ISSN 0785-3890. 57(1). doi: 10.1080/07853890.2024.2424447. Full text in Research Archive Show summary

  Background The benefit of therapeutic drug monitoring (TDM) and implementation of recommendations from the Selection of Therapeutic Targets in Inflammatory Bowel Disease (IBD, STRIDE) are discussed in the IBD community. We report real-world data in ulcerative colitis patients receiving first-line tumour necrosis factor inhibitor (TNFi) treatment followed by TDM, and assess how implementation of the STRIDE II recommendations might affect clinical practice. Methods Adult, biologically naïve UC patients starting TNFi between 2014 and 2021 at Oslo University Hospital were included in a medical chart review study, and data were collected at three and twelve months after the start of treatment. Target serum drug levels were defined as ≥7.5 mg/L for adalimumab and ≥5 mg/L for infliximab. Results Of 141 included patients, 36% were in clinical and biochemical (combined) remission after twelve months. Among 102 treatment persistent patients, 54% were in combined remission after twelve months. Target drug level at three months was associated with clinical remission at twelve months (OR = 2.97, 95% CI [1.24–7.12]) and biochemical remission at twelve months (OR = 2.64, 95% CI [1.03–6.77]). In total, 56% of recorded dosage adjustments were related only to serum drug levels. Conclusions Combined remission rates at twelve months for treatment persistent patients suggest that 46% should have been considered for a change of treatment according to the STRIDE II recommendations. A majority of dosage adjustments were made proactively. Target drug level at three months was associated with remission at twelve months and supports the use of proactive TDM.

• Helm, Thea Elisabeth; Høivik, Marte Lie; Anisdahl, Karoline; Buer, Lydia Celine Tansem; Warren, David & Bolstad, Nils [Show all 9 contributors for this article] (2024). Subcutaneous Vedolizumab Treatment in a Real-World Inflammatory Bowel Disease Cohort Switched From Intravenous Vedolizumab: Eighteen-Month Prospective Follow-up Study. Crohn's & Colitis 360. 6(1). doi: 10.1093/crocol/otae013. Full text in Research Archive Show summary

  Background: Vedolizumab has since 2021 been available as a subcutaneous formulation. We aimed to assess 18-month drug persistence and possible predictive factors associated with discontinuation, safety, serum drug profile, drug dosing, and disease activity in a real-world cohort of patients with inflammatory bowel disease switched from intravenous to subcutaneous vedolizumab maintenance treatment. Methods: Eligible patients were switched to subcutaneous vedolizumab and followed for 18 months or until discontinuation of subcutaneous treatment. Data on preferred route of administration, adverse events, drug dosing, serum-vedolizumab, disease activity, fecal calprotectin, and C-reactive protein were collected. Persistence was described using Kaplan–Meier analysis. The impact of clinical and biochemical variables on persistence was analyzed with Cox proportional hazard models. Results: We included 108 patients, and the estimated 18-month drug persistence was 73.6% (95% CI [64.2–80.1]). Patients in clinical remission at switch were less likely to discontinue SC treatment (HR = 0.34, 95% CI [0.16–0.73], P = .006), and patients favoring intravenous treatment at switch were almost 3 times more likely to discontinue (HR = 2.78, 95% CI [1.31–5.90], P = .008). Four patients discontinued subcutaneous vedolizumab due to injection site reactions. At 18 months, 88% of patients administered subcutaneous vedolizumab with an interval of ≥ 14 days, and serum-vedolizumab was 39.1 mg/L. Disease activity was stable during follow-up. Conclusions: Three of the four patients remained on subcutaneous vedolizumab after 18 months, a large proportion received treatment at standard dosing intervals, and disease activity remained stable. This indicates that switching from intravenous to subcutaneous vedolizumab treatment is convenient and safe.

• Strande, Vibeke; Lund, Charlotte; Hagen, Milada; Bengtson, May-Bente; Cetinkaya, Raziye Boyar & Detlie, Trond Espen [Show all 23 contributors for this article] (2024). Clinical course of ulcerative colitis: Frequent use of biologics and low colectomy rate first year after diagnosis—results from the IBSEN III inception cohort. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 60(3), p. 357–368. doi: 10.1111/apt.18097. Full text in Research Archive Show summary

  Background: The introduction of biologic therapies and the 'treat-to-target' treatment strategy may have changed the disease course of ulcerative colitis (UC). Aims: To describe the early disease course and disease outcome at 1-year follow-up in a population-based inception cohort of adult patients with newly diagnosed UC. Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study with prospective follow-up. Patients newly diagnosed with inflammatory bowel disease during 2017-2019 were included. Patients ≥18 years at diagnosis of UC who attended the 1-year follow-up were investigated. We registered clinical, endoscopic and demographic data at diagnosis and 1-year follow-up. Results: We included 877 patients with UC (median age 36 years (range: 18-84), 45.8% female). At diagnosis, 39.2% presented with proctitis, 24.7% left-sided colitis and 36.0% extensive colitis. At the 1-year follow-up, 13.9% experienced disease progression, and 14.5% ha

• Lund, Charlotte; Strande, Vibeke; Hagen, Milada; Bengtson, May-Bente; Cetinkaya, Raziye Boyar & Detlie, Trond Espen [Show all 26 contributors for this article] (2024). Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort—The Inflammatory Bowel Disease in South-Eastern Norway III Study. Inflammatory Bowel Diseases. ISSN 1078-0998. doi: 10.1093/ibd/izae297. Full text in Research Archive Show summary

  Background and aims: The emergence of biologic therapy has coincided with a decline in surgery rates for Crohn's disease (CD). This study aims to describe the disease course, including intra-abdominal surgery rates, biologic therapy use, and variables associated with biologic therapy initiation in a cohort of newly diagnosed CD patients. Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study. From 2017 to 2019, newly diagnosed inflammatory bowel disease patients were included for prospective follow-up. The present study included CD patients ≥ 18 years. Clinical, endoscopic, and demographic data were collected at diagnosis and 1-year follow-up. Data were analyzed by using the Kaplan-Meier method and regression analyses. Results: In total, 424 CD patients (median age 37.0 years (range 18-80), female 55.0%) were included. At diagnosis, 50.5% presented with ileal disease and 80.7% with inflammatory behavior. Within a 1-year follow-up, 39.6%

• Zerouga, Insaf; Valeur, Jørgen; Sommer, Christine; Småstuen, Milada Cvancarova; Medhus, Asle Wilhelm & Lund, Charlotte [Show all 22 contributors for this article] (2024). Dietary intake and nutritional status in patients with newly diagnosed inflammatory bowel disease: insights from the IBSEN III study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 59(6), p. 1–9. doi: 10.1080/00365521.2024.2313056. Full text in Research Archive Show summary

  Background: Dietary recommendations in inflammatory bowel disease (IBD) are inconclusive, and patients may follow restrictive diets with increased risk of malnutrition. The aim of this study was to compare dietary intakes and nutritional status in men and women with newly diagnosed IBD with a general population sample, and to investigate whether intakes were in line with the Nordic Nutrition Recommendations. Methods: This was a cross-sectional study including adults≥ 40 years with IBD from the Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III cohort study. A validated food frequency questionnaire (FFQ) was used in dietary data collection, and a sample from the seventh survey of the Tromsø Study was included as a comparison group. Results: A total of 227 men and women with IBD were included. IBD patients had higher intake of grain products, sweetened beverages, energy, fat and polyunsaturated fat (PUFA), but lower intake of dairy products, alcohol and iodine compared to adults from the comparison sample (p < 0.01). Intakes of saturated fat and carbohydrates in both genders, and vitamin D in women were not within recommended levels. Anemia and hypoalbuminemia were more prevalent in IBD patients than in the comparison sample. Conclusions: Dietary intakes in newly diagnosed IBD patients were mostly in line with Nordic Nutrition Recommendations. Higher proportion of IBD patients exceeded recommended allowances of fat and added sugar than the comparison sample. Insufficient micronutrient intake, anemia and hypoalbuminemia are present challenges in IBD patients that require monitoring.

• Anisdahl, Karoline; Lirhus, Sandre Svatun; Medhus, Asle Wilhelm; Moum, Bjørn Allan; Melberg, Hans Olav & Høivik, Marte Lie (2024). Frailty risk and treatment strategy in elderly-onset inflammatory bowel disease. A Norwegian nationwide population-based registry study. Digestive and Liver Disease. ISSN 1590-8658. doi: 10.1016/j.dld.2024.02.002. Full text in Research Archive Show summary

  Background/Aims: To determine real-world medical and surgical treatment patterns in elderly-onset inflammatory bowel disease in a nationwide cohort, and to investigate associations between frailty and treatment choices.<p> <p>Methods: Norwegian health registries were used to identify adult-onset (born 1950–1989) and elderlyonset (born 1910–1949) patients with Crohn’s disease (CD) and ulcerative colitis (UC) diagnosed 2010– 2017 (n = 13,006). Patients were classified as no, low and intermediate/high frailty risk after the Hospital Frailty Risk Score. Outcomes included use of medical and surgical treatment. <p>Results: Within five years, elderly-onset patients received less biologics (13% [CD], 7% [UC]) and immunomodulators (24% [CD], 11% [UC]), and major surgery was more frequent (22% [CD], 9% [UC]) than in adult-onset. Respective log rank tests were significant (p < 0.01). Compared to no frailty risk groups, elderly-onset UC with intermediate/high frailty risk had lower probability of starting biologics (4% versus 9%), immunomodulators (7% versus 13%) and 5-aminosalisylic acids (66% versus 84%), and elderly-onset CD with intermediate/high frailty risk had higher probability of starting prednisolone (67% versus 49%). Respective log rank tests were significant (p < 0.05). <p>Conclusions: Elderly-onset patients received less biologics and immunomodulators and a larger proportion underwent major surgery. Frailty risk in elderly-onset patients was associated with increased use of prednisolone, and less use of 5-aminosalisylic acids, immunomodulators and biologics.

• Holten, Kristina Ingeborg; Bernklev, Tomm; Opheim, Randi; Johansen, Ingunn; Olsen, Bjørn Christian Elias Grova & Lund, Charlotte [Show all 22 contributors for this article] (2023). Fatigue in Patients with Newly Diagnosed Inflammatory Bowel Disease: Results from a Prospective Inception Cohort, the IBSEN III Study. Journal of Crohn's and Colitis. ISSN 1873-9946. 17(11), p. 1781–1790. doi: 10.1093/ecco-jcc/jjad094. Full text in Research Archive Show summary

  Background and aims: Although fatigue is common in inflammatory bowel disease (IBD), its pathogenesis remains unclear. This study aimed to determine the prevalence of fatigue and its associated factors in a cohort of patients newly diagnosed with IBD. Methods: Patients ≥18 years were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Fatigue was assessed using the Fatigue Questionnaire and compared with data from a Norwegian general population. Univariate and multivariate linear and logistic regression analyses were performed to evaluate the associations of total fatigue (TF) (continuous score) and substantial fatigue (SF) (dichotomized score ≥4) with sociodemographic, clinical, endoscopic, laboratory, and other relevant patient data. Results: In total, 983/1509 (65.1%) patients with complete fatigue data were included (ulcerative colitis (UC), 68.2%; Crohn's disease (CD), 31.8%). The prevalence of SF was higher in CD (69.6%) compared with UC (60.2%) (p<0.01), and in both diagnoses when compared to the general population (p<0.001).In the multivariate analyses, depressive symptoms, pain intensity, and sleep disturbances were associated with increased TF for both diagnoses. In addition, increased clinical disease activity and Mayo endoscopic score were significantly associated with TF in UC, whereas all disease-related variables were insignificant in CD. Similar findings were observed for SF, except regarding the Mayo endoscopic score. Conclusions: SF affects approximately two-thirds of patients newly diagnosed with IBD. Fatigue was associated with depressive symptoms, sleep disturbances, and increased pain intensity in both diagnoses, while clinical and endoscopic activity were associated factors only in UC.

• Mikalsen, Ina; Breder, Sigurd; Medhus, Asle Wilhelm; Folseraas, Trine; Aabakken, Lars & Ånonsen, Kim Vidar (2023). ERCP for the initial management of malignant biliary obstruction–real world data on 596 procedures. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2023.2282375. Full text in Research Archive Show summary

  Aims To evaluate outcomes of ERCP as first-line management in patients with malignant biliary obstruction (MBO) of all causes and stages, reflecting a real-life setting. Methods Retrospective observational study of patients with ERCP as the first-line management of MBO at Oslo University Hospital between 2015 and 2021. Primary outcome measure was a ≥ 50% decrease from the pre-procedural bilirubin within 30 days after ERCP. Secondary outcome measures were technical success of ERCP, complications and overall mortality. Results A total of 596 patients were included, median age 70 years. ASA score was ≥ III in 67% of patients. The most common cancers causing MBO were pancreatic cancer (52%), metastatic lesions (20%) and cholangiocarcinoma (16%). The primary outcome measure was achieved in 62% of patients. With endoscopic access, overall technical success was 80% with 85% for the distal extrahepatic group, 71% for the perihilar, 40% for the intrahepatic and 53% for multiple level MBOs. Reinterventions were performed in 27% of the patients. Complications occurred in 15% of the patients, including post-ERCP pancreatitis in 9%. Most complications were of minor/moderate severity (81%). Overall mortality was 33% within the first 90 days. Patients deceased by the end of the study period (83%) had median survival of 146 days (range 1–2,582 days). Conclusions ERCP has a high rate of clinical effect and technical success in the management of both distal extrahepatic and perihilar MBO. Our data indicate that ERCP is a valid option in the first-line management of MBO.

• Helm, Thea Elisabeth; Høivik, Marte Lie; Buer, Lydia Celine Tansem; Warren, David; Bolstad, Nils & Moum, Bjørn Allan [Show all 9 contributors for this article] (2023). Switching from intravenous to subcutaneous vedolizumab maintenance treatment in patients with inflammatory bowel disease followed by therapeutic drug monitoring. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(8), p. 863–873. doi: 10.1080/00365521.2023.2176252. Full text in Research Archive Show summary

  Objective: Vedolizumab (VDZ) for subcutaneous (SC) administration has recently become available. We aimed to assess feasibility, safety and clinical outcome when switching from intravenous (IV) to SC VDZ maintenance treatment in a real world cohort of patients with inflammatory bowel disease (IBD) followed by therapeutic drug monitoring (TDM). Methods: Eligible IBD patients were switched from IV to SC treatment and assessed six months prior to switch, at baseline and six, twelve and twenty-six weeks after switch. Primary outcome was propor- tion of patients on SC treatment after 26 weeks. Secondary outcomes included adverse events (AEs), clinical disease activity, biochemical markers, treatment interval, serum-VDZ (s-VDZ), preferred route of administration and health-related quality of life. Results: In total, 108 patients were switched. After 26 weeks, 100 patients (92.6%) were still on SC treatment and median s-VDZ was 47.6 mg/L (IQR 41.3 54.6). The most frequent AE was injection site reaction (ISR), reported by 20 patients (18.5%). There were no clinically significant changes in disease activity, biochemical markers and quality of life. The proportion of patients preferring SC administra- tion increased from 28.0% before switch to 59.4% after 26 weeks (p < 0.001). Conclusions: Nine out of ten patients still received SC treatment after 26 weeks. No change in disease activity occurred, and levels of serum VDZ increased. Although almost one fifth of patients experi- enced ISRs, a higher proportion favored SC administration at 26 weeks. This study demonstrates that SC maintenance treatment is a safe and feasible alternative to IV treatment.

• Jørgensen, Kristin Kaasen; Høivik, Marte Lie; Chopra, Adity; Benth, Jurate Saltyte; Ricanek, Petr & Moum, Bjørn Allan [Show all 18 contributors for this article] (2023). Humoral immune response to SARS-CoV-2 vaccination in patients with inflammatory bowel disease on immunosuppressive medication: association to serum drug levels and disease type. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(8), p. 874–882. doi: 10.1080/00365521.2023.2177884. Full text in Research Archive Show summary

  Objectives Immune responses following SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD) are not well characterized. The aims of this study were to explore the serological response associated with IBD, and immunosuppressive medications including serum concentrations of biologics and thiopurine metabolites. Materials and methods This prospective, observational study included adult patients with ulcerative colitis (UC) and Crohn’s disease (CD), and healthy controls. Antibodies to the receptor-binding domain of SARS-CoV-2 spike proteins, and serum concentrations of ongoing biologic and immunomodulatory medications were assessed prior to, and 2-5 weeks after the second vaccine dose. Serologic response was defined as anti-Spike antibodies ≥70 AU/ml. Results In 958 IBD patients (380 UC, 578 CD) and 323 healthy controls, the median (Q1; Q3) anti-Spike antibody level (AU/ml) was lower in patients (618 (192; 4370)) compared to controls (3355 (896; 7849)) (p < 0.001). The antibody levels were lower in CD (439 (174; 3304)) compared to UC (1088 (251; 5975)) (p < 0.001). No associations were demonstrated between antibody levels and serum drug concentrations for TNF inhibitor (TNFi), vedolizumab and ustekinumab. Patients receiving TNFi + thiopurines with a subtherapeutic 6-thioguanine nucleotide (6-TGN) level had higher response rate (93%) compared to patients with 6-TGN within the therapeutic range (53%) (p = 0.003). A diagnosis of UC, mRNA-1273 vaccine, and other treatments than TNFi + thiopurines were associated with humoral response. Conclusions Patients with CD had an attenuated humoral response to SARS-COV-2 vaccination as compared to patients with UC. The lack of association between serum levels of biologics and serologic response indicates vaccination regardless of proximity to drug administration.

• Svanevik, Marius; Lorentzen, Jolanta Halabowska; Borgeraas, Heidi; Sandbu, Rune; Seip, Birgitte Karen Berggreen & Medhus, Asle Wilhelm [Show all 11 contributors for this article] (2023). Patient-reported outcomes, weight loss, and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre, randomised controlled trial. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 11(8), p. 555–566. doi: 10.1016/S2213-8587(23)00127-4. Full text in Research Archive Show summary

  Little is known about the comparative effects of various bariatric procedures on patient-reported outcomes. We aimed to compare 3-year effects of gastric bypass and sleeve gastrectomy on patient-reported outcome measures in patients with obesity and type 2 diabetes. Methods The Oseberg trial was a single-centre, parallel-group, randomised trial at Vestfold Hospital Trust, a public tertiary obesity centre in Tønsberg, Norway. Eligible patients were aged 18 years or older with previously verified BMI 35·0 kg/m 2 or greater. Diabetes was diagnosed if glycated haemoglobin was at least 6·5% (48 mmol/mol) or by their use of anti-diabetic medications with glycated haemoglobin at least 6·1% (43 mmol/mol). Eligible patients were randomly assigned (1:1) to gastric bypass or sleeve gastrectomy. All patients received identical preoperative and postoperative treatment. Randomisation was done with a computerised random number generator and a block size of ten. Study personnel, patients, and the primary outcome assessor were blinded to allocations for 1 year. The prespecified secondary outcomes reported here were 3-year changes in several clinically important patient-reported outcomes, weight loss, and diabetes remission. Analyses were done in the intention to treat population. This trial is ongoing, closed to recruitment and is registered with ClinicalTrials.gov , NCT01778738 . Findings Between Oct 15, 2012 and Sept 1, 2017, 319 consecutive patients with type 2 diabetes scheduled for bariatric surgery were assessed for eligibility. 101 patients were not eligible (29 did not have type 2 diabetes according to inclusion criteria and 72 other exclusion criteria) and 93 declined to participate. 109 patients were enrolled and randomly assigned to sleeve gastrectomy (n=55) or gastric bypass (n=54). 72 (66%) of 109 patients were female and 37 (34%) were male. 104 (95%) of patients were White. 16 patients were lost to follow up and 93 (85%) patients completed the 3-year follow-up. Three additional patients were contacted by phone for registration of comorbidities Compared with sleeve gastrectomy, gastric bypass was associated with a greater improvement in weight-related quality of life (between group difference 9·4, 95% CI 3·3 to 15·5), less reflux symptoms (0·54, 0·17 to –0·90), greater total bodyweight loss (8% difference, 25% vs 17%), and a higher probability of diabetes remission (67% vs 33%, risk ratio 2·00; 95% CI 1·27 to 3·14). Five patients reported postprandial hypoglycaemia in the third year after gastric bypass versus none after sleeve-gastrectomy (p=0·059). Symptoms of abdominal pain, indigestion, diarrhoea, dumping syndrome, depression, binge eating, and appetitive drive did not differ between groups. Interpretation At 3 years, gastric bypass was superior to sleeve gastrectomy in patients with type 2 diabetes and obesity regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about similarities and differences between expected outcomes after the two surgical procedures.

• Evensen, Helge; Sandstad, Olav; Larssen, Lene; Hagen, Milada; Kristensen, Vendel Ailin & Søvik, Torgeir Thorson [Show all 9 contributors for this article] (2023). Intraoperative distensibility measurement in POEM for achalasia: impact on patient outcome and associations with other outcome variables at 1-year follow-up. Surgical Endoscopy. ISSN 0930-2794. 37, p. 9283–9290. doi: 10.1007/s00464-023-10494-z. Full text in Research Archive Show summary

  Background and aims The functional luminal imaging probe (FLIP) can provide measurements of lower esophageal sphincter (LES) distensibility. Studies report that use of intraoperative FLIP examination during peroral endoscopic myotomy (POEM) for achalasia is associated with treatment success, but evidence is limited and inconsistent. The main aim of the present study was to assess associations between intraoperative FLIP values and 1-year outcomes. Additionally, associations between 1-year FLIP measurements and other 1-year outcome variables were studied. Methods We performed a single-center prospective study of consecutive achalasia patients treated with POEM with a standardized 1-year follow-up. The inclusion period was from June 2017 to January 2020. We compared 1-year outcomes (FLIP measurement values, Eckardt score (ES), reflux esophagitis, timed barium esophagogram (TBE), and lower esopha- geal sphincter resting pressure (LES-rp)) in patients with and without intraoperative FLIP examination. We also assessed associations between intraoperative FLIP values, 1-year FLIP values, and other 1-year outcomes. Results are given as median (IQR), and non-parametrical statistical analyses were applied. Results Sixty-two patients (27 females) with median age 45 years (35–54) were included. Baseline characteristics were similar in patients with (n = 32) and without (n = 30) intraoperative FLIP examination. In patients with intraoperative FLIP, ES was 2 (1–3) and LES distensibility index (DI) 3.7 (2.6–5.4) after 1 year, compared with ES 2 (1–3) and DI 4.0 (3.1–6.8)) in patients without intraoperative FLIP (ns). Intraoperative DI was not correlated with 1-year ES or DI. One-year DI cor- related significantly with 1-year ES (rs − 0.42), TBE (rs − 0.34), and LES-rp (rs − 0.29). Conclusions Use of intraoperative FLIP measurements in POEM for achalasia is not associated with improved 1-year out- come, and the clinical value of intraoperative FLIP in POEM for achalasia is questioned. Follow-up FLIP measurements are moderately associated with symptomatic outcome, and may serve as an additional diagnostic modality in post-treatment evaluation.

• Tran, Trung; Vaage, Eline Benno; Mehta, Adi; Chopra, Adity; Tietze, Lisa & Kolderup, Heidi Anette [Show all 40 contributors for this article] (2022). Titers of antibodies against ancestral SARS-CoV-2 correlate with levels of neutralizing antibodies to multiple variants. npj Vaccines. 7(1). doi: 10.1038/s41541-022-00586-7. Full text in Research Archive Show summary

  Diagnostic assays currently used to monitor the efficacy of COVID-19 vaccines measure levels of antibodies to the receptor-binding domain of ancestral SARS-CoV-2 (RBDwt). However, the predictive value for protection against new variants of concern (VOCs) has not been firmly established. Here, we used bead-based arrays and flow cytometry to measure binding of antibodies to spike proteins and receptor-binding domains (RBDs) from VOCs in 12,000 serum samples. Effects of sera on RBD-ACE2 interactions were measured as a proxy for neutralizing antibodies. The samples were obtained from healthy individuals or patients on immunosuppressive therapy who had received two to four doses of COVID-19 vaccines and from COVID-19 convalescents. The results show that anti-RBDwt titers correlate with the levels of binding- and neutralizing antibodies against the Alpha, Beta, Gamma, Delta, Epsilon and Omicron variants. The benefit of multiplexed analysis lies in the ability to measure a wide range of anti-RBD titers using a single dilution of serum for each assay. The reactivity patterns also yield an internal reference for neutralizing activity and binding antibody units per milliliter (BAU/ml). Results obtained with sera from vaccinated healthy individuals and patients confirmed and extended results from previous studies on time-dependent waning of antibody levels and effects of immunosuppressive agents. We conclude that anti-RBDwt titers correlate with levels of neutralizing antibodies against VOCs and propose that our method may be implemented to enhance the precision and throughput of immunomonitoring.

• Evensen, Helge; Hjermstad, Marianne Jensen; Småstuen, Milada Cvancarova; Kristensen, Vendel Ailin; Larssen, Lene & Skattum, Jorunn Pettersen [Show all 9 contributors for this article] (2022). Quality of life in patients with achalasia: Associations with Eckardt score and objective treatment outcomes after peroral endoscopic myotomy. Endoscopy International Open. 10(12). doi: 10.1055/a-1968-7682. Full text in Research Archive Show summary

  Background and study aims Knowledge on self-reported quality of life (QoL) in achalasia and QoL improvements after peroral endoscopic myotomy (POEM) is limited. Furthermore, the clinical role of QoL in achalasia follow-up has not been evaluated. The present study aimed to examine QoL in achalasia patients before and after POEM and assess associations between QoL, Eckardt score (ES) and objective results. Patients and methods This was a single-center prospective study of treatment-naïve achalasia patients with 12-month follow-up after POEM including manometry, upper endoscopy, 24-hour pH registration, and timed barium esophagogram. QoL data were registered using European Organisation for Research and Treatment of Cancer core questionnaire (QLQ-C30) and esophageal module (QLQ-OES18). Comparison with a reference population was performed to assess impact of achalasia on QoL and effect of therapy. Mixed models for repeated measures were applied. Results Fifty patients (26 females) with a median age of 47 years (18-76) were included. Before treatment, all QoL domains were significantly impaired compared with an age- and gender-adjusted reference population ( P < 0.05). No significant QoL-differences were found after POEM, except for fatigue and nausea/vomiting. Clinically relevant QoL improvement was observed in ≥ 50 % of the patients in all QoL domains, except for physical and role functioning. QoL was significantly associated with ES ( P < 0.05) but not with objective results. Conclusions Achalasia is associated with severe QoL impairment. Following POEM, a significant and clinically relevant QoL improvement is observed. QoL is associated with ES, but not with objective results after POEM. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

• Hole, Mikal Jacob; Jørgensen, Kristin Kaasen; Holm, Kristian; Braadland, Peder Rustøen; Meyer-Myklestad, Malin Holm & Medhus, Asle Wilhelm [Show all 13 contributors for this article] (2022). A shared mucosal gut microbiota signature in primary sclerosing cholangitis before and after liver transplantation. Hepatology. ISSN 0270-9139. doi: 10.1002/hep.32773. Full text in Research Archive Show summary

  Background and Aims Several characteristic features of the fecal microbiota have been described in primary sclerosing cholangitis (PSC), whereas data on mucosal microbiota are less consistent. We aimed to use a large colonoscopy cohort to investigate key knowledge gaps, including the role of gut microbiota in PSC with inflammatory bowel disease (IBD), the effect of liver transplantation (LT), and whether recurrent PSC (rPSC) may be used to define consistent microbiota features in PSC irrespective of LT. Approach and Results We included 84 PSC and 51 liver transplanted PSC patients (PSC-LT) and 40 healthy controls (HCs) and performed sequencing of the 16S ribosomal RNA gene (V3–V4) from ileocolonic biopsies. Intraindividual microbial diversity was reduced in both PSC and PSC-LT versus HCs. An expansion of Proteobacteria was more pronounced in PSC-LT (up to 19% relative abundance) than in PSC (up to 11%) and HCs (up to 8%; QFDR < 0.05). When investigating PSC before (PSC vs. HC) and after LT (rPSC vs. no-rPSC), increased variability (dispersion) in the PSC group was found. Five genera were associated with PSC before and after LT. A dysbiosis index calculated from the five genera, and the presence of the potential pathobiont, Klebsiella, were associated with reduced LT-free survival. Concomitant IBD was associated with reduced Akkermansia. Conclusions Consistent mucosal microbiota features associated with PSC, PSC-IBD, and disease severity, irrespective of LT status, highlight the usefulness of investigating PSC and rPSC in parallel, and suggest that the impact of gut microbiota on posttransplant liver health should be investigated further.

• Kazmi, Syed Sajid Hussain; Safi, Natkai; Berge, Simen Tveten; Kazmi, Marryam; Sundhagen, Jon Otto & Julien, Kari [Show all 10 contributors for this article] (2022). Plasma α-Glutathione S-Transferase in Patients with Chronic Mesenteric Ischemia and Median Arcuate Ligament Syndrome. Vascular Health and Risk Management. ISSN 1176-6344. 18, p. 567–574. doi: 10.2147/VHRM.S365625. Full text in Research Archive Show summary

  Background: Chronic mesenteric ischemia (CMI) due to either atherosclerosis of the mesenteric arteries or median arcuate ligament syndrome (MALS) is an underdiagnosed entity. The etiology of MALS and its existence have been debated and questioned. We aimed to identify plasma biomarkers indicating mesenteric ischemia in patients with CMI and MALS. Methods: Plasma α-glutathione S-transferase (α-GST), intestinal fatty acid-binding protein (I-FABP), citrulline, and ischemia modified albumin (IMA) were analyzed in fifty-eight patients with CMI (Group A, n=44) and MALS (Group B, n=14) before and after revascularization. The plasma levels of these potential biomarkers were compared with those of healthy individuals (Group C, n=16). Group comparison was performed with the Mann–Whitney U-test. Cross-tabulation and its derivatives were obtained. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were calculated. Results: Plasma levels of α-GST were significantly raised in the patients with CMI (7.8 ng/mL, p< 0.001) and MALS (8.4 ng/mL, p< 0.001), as compared with the control Group C (3.3 ng/mL). The threshold for normal median plasma α-GST levels of 4 ng/mL yielded a sensitivity of 93% and 86%, specificity of 86% and 88%, respectively, for the diagnosis of CMI due to atherosclerosis and MALS. AUC of ROC curves was 0.96 (p< 0.0001) for CMI and 0.85 (p< 0.002) for MALS. The patient groups did not differ from the healthy controls in any other biomarkers. Conclusion: Plasma α-GST levels are elevated in CMI and MALS patients. Elevated plasma levels of α-GST suggest ischemia as the etiology of MALS.

• Safi, Natkai; Ånonsen, Kim Vidar; Berge, Simen Tveten; Medhus, Asle Wilhelm; Sundhagen, Jon Otto & Hisdal, Jonny [Show all 7 contributors for this article] (2022). Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound. Vascular Health and Risk Management. ISSN 1176-6344. p. 233–243. doi: 10.2147/VHRM.S358570. Full text in Research Archive Show summary

  Introduction: Due to diagnostic delay, chronic mesenteric ischemia (CMI) is underdiagnosed. We assumed that the patients suspected of CMI of the atherosclerotic origin or median arcuate ligament syndrome (MALS) could be identified earlier with endoscopic duplex ultrasound (E-DUS). Patients and Methods: Fifty CMI patients with CTA-verified stenosis of either ≥ 50% and ≥ 70% of celiac artery (CA) and superior mesenteric artery (SMA) were examined with E-DUS and transabdominal duplex ultrasound (TA-DUS). Peak systolic velocities (PSV) of ≥ 200cm/s and ≥ 275cm/s for CA and SMA, respectively, were compared with CTA. Subgroup analysis was performed for the patients with (n=21) and without (n=29) prior revascularization treatment of CMI. The diagnostic ability of E-DUS and TA-DUS was tested with crosstabulation analysis. Receiver operating characteristics (ROC) curve analysis was performed, and the area under the curve (AUC) was calculated to investigate the test accuracy. Results: In the patients with ≥ 70% stenosis, E-DUS had higher sensitivity than TA-DUS (91% vs 81% for CA and 100% vs 92% for SMA). AUC for SMA ≥ 70% in E-DUS was 0.75 and with TA-DUS 0.68. The sensitivity of E-DUS for CTA-verified stenosis ≥ 70% for CA was 100% in the patients without prior treatment. E-DUS demonstrated higher sensitivity than TA-DUS for both arteries with stenosis ≥ 50% and ≥ 70% in the treatment-naive patients. Conclusion: E-DUS is equally valid as TA-DUS for the investigation of CMI patients and should be used as an initial diagnostic tool for patients suspected of CMI.

• Meyer-Myklestad, Malin Holm; Medhus, Asle Wilhelm; Stiksrud, Birgitte; Lorvik, Kristina Berg; Seljeflot, Ingebjørg & Hansen, Simen Hyll [Show all 13 contributors for this article] (2022). Probiotics to HIV-infected immunological nonresponders: Altered mucosal immunity and microbial diversity restricted to ileum. Journal of Acquired Immune Deficiency Syndromes. ISSN 1525-4135. 89(1), p. 77–86. doi: 10.1097/QAI.0000000000002817. Full text in Research Archive
• Pedersen, Ina Borgenheim; Rawa-Goleblewska, Anna; Calderwood, Audrey H.; Brix, Lone D.; Grode, Louise B. & Botteri, Edoardo [Show all 17 contributors for this article] (2022). Complete Polyp Resection with Cold versus Hot snare Polypectomy for Polyps sized 4-9 mm: A randomized controlled trial. Endoscopy. ISSN 0013-726X. 54(10), p. 961–969. doi: 10.1055/a-1734-7952. Full text in Research Archive Show summary

  Background: Endoscopic screening with polypectomy reduces the incidence of colorectal cancer (CRC). Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) in terms of complete polyp resection. Methods: We included patients ≥ 40 years of age at eight hospitals in four countries who had at least one non-pedunculated polyp of 4-9 mm detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP, with a non-inferiority margin of 5 %. Logistic regression models were fitted to identify the factors explaining incomplete resection. Results: 425 patients, with 601 polyps, randomized to either CSP or HSP were included in the analysis. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7 %) and 21 (7.4 %) were incompletely resected, respectively, with an adjusted risk difference of 3.2 % (95 %CI -1.4 % to 7.8 %). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated histology (odds ratio [OR] 3.96; 95 %CI 1.63 to 9.66) and hyperplastic histology (OR 2.52; 95 %CI 1.30 to 4.86) in adjusted analyses. Conclusion: In this randomized trial, non-inferiority for CSP could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared with adenomas. CSP can be used safely for small polyps in routine colonoscopy practice.

• Lorvik, Kristina Berg; Meyer-Myklestad, Malin Holm; Kushekhar, Kushi; Handeland, Charlotte Andrea; Medhus, Asle Wilhelm & Lund-Iversen, Marius [Show all 11 contributors for this article] (2021). Enhanced Gut-Homing Dynamics and Pronounced Exhaustion of Mucosal and Blood CD4⁺ T Cells in HIV-Infected Immunological Non-Responders. Frontiers in Immunology. 12, p. 1–12. doi: 10.3389/fimmu.2021.744155. Full text in Research Archive Show summary

  Immunological non-responders (INR), a subgroup of people living with HIV (PLHIV) who fail to restore CD4 + T cell numbers upon effective antiretroviral treatment, have impaired gut mucosal barrier function and an inferior clinical prognosis compared with immunological responders (IR). The contribution of gut-homing and exhaustion of mucosal T cells to the INR phenotype was previously unknown. Flow cytometry analysis of mononuclear cells from peripheral blood and ileal and colonic lamina propria showed that INR had higher fractions of gut-homing CD4 + T cells in blood compared with IR. In addition, gut-homing cells were more likely to display signs of exhaustion in INR. The increased CD4 + T cell exhaustion in INR was ubiquitous and not restricted to subpopulations defined by activation, differentiation or regulatory T cell markers. In INR, colon CD4 + T cell exhaustion correlated negatively with the fraction of CD4 + T cells in the same compartment, this was not apparent in the ileum. The fraction of exhausted mucosal CD4 + T cells correlated with I-FABP and REG3α, markers of enterocyte damage. We conclude that alterations of gut-homing and exhaustion of T cells may contribute to impaired gut immune and barrier functions associated with immunological non-response in PLHIV.

• Anisdahl, Karoline; Lirhus, Sandre Svatun; Medhus, Asle Wilhelm; Moum, Bjørn; Melberg, Hans Olav & Høivik, Marte Lie (2021). First-line biologic treatment of inflammatory bowel disease during the first 12 months after diagnosis from 2010 to 2016: a Norwegian nationwide registry study. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–7. doi: 10.1080/00365521.2021.1955147. Full text in Research Archive Show summary

  Objectives The use of biologic therapy in inflammatory bowel disease (IBD) is likely to increase with lower costs and more biologics and biosimilars becoming available. Our aim was to estimate the trends in use of first-line biologics during the first year after diagnosis in a Norwegian IBD population from 2010 to 2016. Methods Data were collected from the Norwegian National Patient Registry and Norwegian Prescription Database. Patients defined as incident IBD cases between 2010 and 2016 were included and followed for 12 months. Patients were stratified by year of diagnosis to examine change over time. Chi-square test was used for calculations on proportions. Time from diagnosis to first biologic was calculated by Kaplan-Meier failure estimates. Results 14,645 patients were included, 5283 (36%) with Crohn’s disease (CD) and 9362 (64%) with ulcerative colitis (UC). In the 2010 and 2016 cohort, the proportion initiating biologics increased from 17% to 33% (p < .001) for CD and 7% to 13% (p < .001) for UC. The most frequently used first-line biologics were infliximab (CD: 64% and UC: 82%) and adalimumab (CD: 36% and UC: 15%). The highest registered use of adalimumab was in the 2012 cohort (CD: 56% and UC: 39%). In the 2014–2016 cohorts, infliximab was the most used first-line biologic for both CD and UC. Conclusions The proportion of IBD patients initiating biologics within 12 months after diagnosis increased between 2010 and 2016. The use of infliximab as first-line biologic increased after the approval of biosimilar infliximab in 2013.

• Evensen, Helge; Småstuen, Milada Cvancarova; Schulz, Anselm; Kristensen, Vendel Ailin; Larssen, Lene & Skattum, Jorunn Pettersen [Show all 9 contributors for this article] (2021). One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy. Annals of Medicine. ISSN 0785-3890. 53(1), p. 2227–2235. doi: 10.1080/07853890.2021.2005253. Full text in Research Archive Show summary

  Peroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM. Methods: This single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome. Results: Fifty patients were included with a drop-out rate of < .001), and 28% (13/47) of the patients had a positive 24-h pH registration. An oesophageal diameter >3 cm after POEM was associated with treatment failure assessed by ES (p ¼ .04) and TBE (p ¼ .03). Advanced achalasia stage (p ¼ .02) and long symptom duration (p ¼ .04) were identified as independent predictive factors for poor outcome assessed by TBE. Conclusions: The present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure.

• Tønnesen, Christer Julseth; Hjelmesæth, Jøran; Hofsø, Dag; Tonstad, Serena; Hertel, Jens Kristoffer & Heggen, Eli [Show all 14 contributors for this article] (2021). A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 57(2), p. 232–238. doi: 10.1080/00365521.2021.1994641. Full text in Research Archive Show summary

  Background and aims: Obesity with type-2 diabetes is a global challenge. Lifestyle interventions have limited effect for most patients. Bariatric surgery is highly effective, but resource-demanding, invasive and associated with serious complications. Recently, a new intragastric balloon was introduced, not requiring endoscopy for placement or removal (Elipse™, Allurion Inc., Natick, MA). The balloon is swallowed in a capsule and filled with water once in the stomach. The balloon self-deflates after 4 months and is naturally excreted. The present trial investigated balloon feasibility, safety and efficacy in patients with obesity and type-2 diabetes. <p> <p>Patients and methods: We treated 19 patients, with type-2 diabetes and body mass index (BMI) of 30.0-39.9 kg/m2 at two Norwegian centers with the Elipse balloon. Patient follow-up during balloon treatment mimicked real-world clinical practice, including dietary plan and outpatient visits. The primary efficacy endpoints were total body weight loss (TBWL) and HbA1c at weeks 16 and 52. <p> <p>Results: All patients underwent balloon insertion uneventfully as out-patients. Mean TBWL and HbA1c reduction after 16 and 52 weeks of balloon insertion was 3.9% (95%CI 2.1-5.7) and 0.8% (95%CI 1.9-3.5); and 7 (95%CI 4-10), and 1 (95%CI -6 to 9) mmol/mol, respectively. Adverse events occurred in two patients (10.5%): one developed gastric outlet obstruction, managed by endoscopic balloon removal; the other excessive vomiting and dehydration, managed conservatively. <p> <p>Conclusions: This first Scandinavian real-world clinical trial with a new minimally invasive intragastric balloon system demonstrated good feasibility, but did not confirm expected efficacy for weight loss and diabetes control.

• Hoff, Geir; Botteri, Edoardo; Huppertz-Hauss, Gert; Kvamme, Jan-Magnus; Holme, Øyvind & Aabakken, Lars [Show all 13 contributors for this article] (2021). The effect of train-the-colonoscopy-trainer course on colonoscopy quality indicators. Endoscopy. ISSN 0013-726X. 53(12), p. 1229–1234. doi: 10.1055/a-1352-4583. Full text in Research Archive Show summary

  Background: Systematic training in colonoscopy is highly recommended; however, we have limited knowledge of the effects of "training-the-colonoscopy-trainer" (TCT) courses. Using a national quality register on colonoscopy performance, we aimed to evaluate the effects of TCT participation on defined quality indicators. Methods: This observational study compared quality indicators (pain, cecal intubation, and polyp detection) between centers participating versus not participating in a TCT course. Nonparticipating centers were assigned a pseudoparticipating year to match their participating counterparts. Results were compared between first year after and the year before TCT (pseudo)participation. Time trends up to 5 years after TCT (pseudo)participation were also compared. Generalized estimating equation models, adjusted for age, sex, and bowel cleansing, were used. Results: 11 participating and 11 nonparticipating centers contributed 18 555 and 10 730 colonoscopies, respectively. In participating centers, there was a significant increase in detection of polyps ≥ 5 mm, from 26.4 % to 29.2 % (P = 0.035), and reduction in moderate/severe pain experienced by women, from 38.2 % to 33.6 % (P = 0.043); no significant changes were found in nonparticipating centers. Over 5 years, 20 participating and 18 nonparticipating centers contributed 85 691 and 41 569 colonoscopies, respectively. In participating centers, polyp detection rate increased linearly (P = 0.003), and pain decreased linearly in women (P = 0.004). Nonparticipating centers did not show any significant time trend during the study period. Conclusions: Participation in a TCT course improved polyp detection rates and reduced pain experienced by women. These effects were maintained during a 5-year follow-up.

• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hofsø, Dag; Svanevik, Marius; Seip, Birgitte Karen Berggreen & Hjelmesæth, Jøran (2021). Sleeve gastrectomy confers higher risk of gastroesophageal reflux disease than gastric bypass. A Randomized Controlled Trial From the Oseberg Reflux Working Group. Gastroenterology. ISSN 0016-5085. 161(6), p. 2044–2046. doi: 10.1053/j.gastro.2021.08.021. Full text in Research Archive
• Kristensen, Vendel Ailin; Opheim, Randi; Perminow, Gøri Margrete; Huppertz-Hauss, Gert; Detlie, Trond Espen & Lund, Charlotte [Show all 39 contributors for this article] (2021). Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 56(8), p. 899–905. doi: 10.1080/00365521.2021.1922746. Full text in Research Archive Show summary

  Background and aim: Modern treatment strategies for inflammatory bowel disease (IBD) are postulated to change the natural disease course. Inception cohort studies are the gold standard for investigating such changes. We have initiated a new population-based inception cohort study; Inflammatory bowel disease in South Eastern Norway III (IBSEN III). In this article, we describe the study protocol and baseline characteristics of the cohort. Methods: IBSEN III is an ongoing, population-based observational inception cohort study with prospective follow-up. Adult and pediatric patients with suspected IBD in the South-Eastern Health Region of Norway (catchment area of 2.95 million inhabitants in 2017), during the 3-year period from 2017 to 2019, were eligible for inclusion. Comprehensive clinical, biochemical, endoscopic, demographic, and patient-reported data were collected at the time of diagnosis and throughout standardized follow-up. For a portion of the patients, extensive biological material was biobanked. Results: The study included 2168 patients, of whom 1779 were diagnosed with IBD (Crohn's disease: 626, ulcerative colitis: 1082, IBD unclassified: 71). In 124 patients, there were subtle findings indicative of, but not diagnostic for, IBD. The remaining 265 patients were classified as symptomatic non-IBD controls. Conclusion: We have included patients in a comprehensive population-based IBD cohort from a catchment population of 2.95 million, and a unique biobank with materials from newly diagnosed and treatment-naïve IBD patients and symptomatic non-IBD controls. We believe this cohort will add important knowledge about IBD in the years to come.

• Safi, Nathkai; Johannessen, Hans Olaf; Medhus, Asle Wilhelm; Mala, Tom & Kazmi, Syed Sajid Hussain (2020). Laser doppler flowmetry and visible light spectroscopy of the gastric tube during minimally invasive esophagectomy. Vascular Health and Risk Management. ISSN 1176-6344. 16, p. 497–505. doi: 10.2147/VHRM.S269138. Full text in Research Archive Show summary

  Introduction: Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube’s tissue perfusion and circulation. Patients and Methods: Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test. Results: A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%– 28%) and 42% (range, 35%– 52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks. Conclusion: Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.

• Meyer-Myklestad, Malin Holm; Medhus, Asle Wilhelm; Lorvik, Kristina Berg; Seljeflot, Ingebjørg; Hansen, Simen Hyll & Holm, Kristian [Show all 13 contributors for this article] (2020). HIV-infected immunological non-responders have colon-restricted gut mucosal immune dysfunction. Journal of Infectious Diseases. ISSN 0022-1899. doi: 10.1093/infdis/jiaa714. Full text in Research Archive Show summary

  Abstract Background Human immunodeficiency virus (HIV)–infected immunological nonresponders (INRs) fail to reconstitute their CD4+ T-cell pool after initiation of antiretroviral therapy, and their prognosis is inferior to that of immunological responders (IRs). A prevailing hypothesis is that the INR phenotype is caused by a persistently disrupted mucosal barrier, but assessments of gut mucosal immunology in different anatomical compartments are scarce. Methods We investigated circulating markers of mucosal dysfunction, immune activation, mucosal Th17 and Th22 cells, and mucosa-adherent microbiota signatures in gut mucosal specimens from sigmoid colon and terminal ileum of 19 INRs and 20 IRs in addition to 20 HIV-negative individuals. Results INRs had higher blood levels of the enterocyte damage marker intestinal fatty acid–binding protein than IRs. In gut mucosal biopsies, INRs had lower fractions of CD4+ T cells, higher fractions of interleukin 22, and a tendency to higher fractions of interleukin 17–producing CD4+ T cells. These findings were all restricted to the colon and correlated to circulating markers of enterocyte damage. There were no observed differences in gut microbial composition between INRs and IRs. Conclusions Restricted to the colon, enterocyte damage and mucosal immune dysfunction play a role for insufficient immune reconstitution in HIV infection independent of the gut microbiota.

• Berge, Simen Tveten; Safi, Nathkai; Medhus, Asle Wilhelm; Sundhagen, Jon Otto; Hisdal, Jonny & Kazmi, Syed Sajid Hussain (2020). Perioperative microcirculatory changes detected with gastroscopy assisted laser doppler flowmetry and visible light spectroscopy in patients with median arcuate ligament syndrome. Vascular Health and Risk Management. ISSN 1176-6344. 16, p. 331–341. doi: 10.2147/VHRM.S252192. Full text in Research Archive Show summary

  Purpose: Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients. Patients and Methods: In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively. Results: Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO2 76± 6), as compared to healthy individuals (SO2 81± 4), p=0.02. An overall significant improvement in SO2 after surgical decompression of the celiac artery was found (SO2 81± 3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4– 24 months). Four of the five dimensions investigated with EQ-5D-5L improved. Conclusion: VLS detected a significantly lower baseline transmucosal SO2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.

• Kazmi, Syed Sajid Hussain; Berge, Simen Tveten; Sahba, Mehdi; Medhus, Asle Wilhelm & Sundhagen, Jon Otto (2020). A Short Series of Laparoscopic Mesenteric Bypasses for Chronic Mesenteric Ischemia. Vascular Health and Risk Management. ISSN 1176-6344. 16, p. 87–97. doi: 10.2147/VHRM.S243264. Full text in Research Archive Show summary

  Background: Laparoscopic aortomesenteric bypass may be performed to treat the chronic mesenteric ischemia patients who are not suitable for endovascular treatment. This study presents an initial experience with a limited series of laparoscopic mesenteric artery revascularization for the treatment of mesenteric ischemia. Methods: Chronic mesenteric ischemia (CMI) patients with previous unsuccessful endovascular treatment or with arterial occlusion and extensive calcification precluding safe endovascular treatment were offered laparoscopic mesenteric revascularization. From October 2015 until November 2018, nine patients with CMI underwent laparoscopic revascularization. In addition to demographic data and perioperative results of the treatment, graft patency was assessed with Duplex ultrasound at 1, 3, 6 and 12 months, and annually thereafter. A descriptive analysis of the data was performed. Results: All bypasses were constructed with an 8 mm ring enforced expanded polytetrafluoroethylene graft in a retrograde fashion (from infrarenal aorta or iliac artery) to either superior mesenteric artery or splenic artery (2 cases). Median operation time was 356 mins (range 247– 492 mins). Five patients had a history of unsuccessful endovascular treatment. Laparoscopic technical success was 78%, and the primary open conversion rate was 22%. All laparoscopic revascularization procedures remained patent after discharge during a median follow-up time of 26 months (range 18– 49 months). The primary graft patency at 30 days was 78%. Primary assisted, and secondary graft patency was 78% and 100%, respectively. Median weight gain was 2 kg (range 2– 18 kg), and all patients achieved relief from postprandial pain and nausea. No mortality was observed during the follow-up period. Conclusion: Laparoscopic aortomesenteric revascularization procedures for chronic mesenteric ischemia are feasible but require careful patient selection. These procedures should only be performed at referral centers by vascular surgeons with prior experience in laparoscopic vascular surgery.

• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hertel, Jens Kristoffer; Borgeraas, Heidi; Karlsen, Tor-Ivar & Kolotkin, Ronette Loganzo [Show all 12 contributors for this article] (2020). Erosive Esophagitis and Symptoms of Gastroesophageal Reflux Disease in Patients with Morbid Obesity with and without Type 2 Diabetes: a Cross-sectional Study. Obesity Surgery. ISSN 0960-8923. 30, p. 2667–2675. doi: 10.1007/s11695-020-04545-w. Full text in Research Archive Show summary

  Background Type 2 diabetes (T2DM) is associated with gastroesophageal reflux disease (GERD) in the general population, but the relationship between these conditions in candidates for bariatric surgery is uncertain. We compared the prevalence of GERD and the association between GERD symptoms and esophagitis among bariatric candidates with and without T2DM. Methods Cross-sectional study of baseline data from the Oseberg study in Norway. Both groups underwent gastroduodenoscopy and completed validated questionnaires: Gastrointestinal Symptom Rating Scale and Gastroesophageal Reflux Disease Questionnaire. Participants with T2DM underwent 24-h pH-metry. Results A total of 124 patients with T2DM, 81 women, mean (SD) age 48.6 (9.4) years and BMI 42.3 (5.5) kg/m2, and 64 patients without T2DM, 46 women, age 43.0 (11.0) years and BMI 43.0 (5.0) kg/m2, were included. The proportions of patients reporting GERD-symptoms were low (< 29%) and did not differ significantly between groups, while the proportions of patients with esophagitis were high both in the T2DM and non-T2DM group, 58% versus 47%, p = 0.16. The majority of patients with esophagitis did not have GERD-symptoms (68–80%). Further, 55% of the patients with T2DM had pathologic acid reflux. Among these, 71% also had erosive esophagitis, whereof 67% were asymptomatic. Conclusions The prevalence of GERD was similar in bariatric patients with or without T2DM, and the proportion of patients with asymptomatic GERD was high independent of the presence or absence of T2DM. Accordingly, GERD may be underdiagnosed in patients not undergoing a preoperative endoscopy or acid reflux assessment

• Berge, Simen Tveten; Safi, Nathkai; Medhus, Asle Wilhelm; Ånonsen, Kim Vidar; Sundhagen, Jon Otto & Hisdal, Jonny [Show all 7 contributors for this article] (2019). Gastroscopy assisted laser Doppler flowmetry and visible light spectroscopy in patients with chronic mesenteric ischemia. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 79(7), p. 541–549. doi: 10.1080/00365513.2019.1672084. Full text in Research Archive Show summary

  Mucosal pathology due to chronic mesenteric ischemia (CMI) is rarely seen during upper endoscopy. Combining Laser Doppler Flowmetry (LDF) and Visible Light Spectroscopy (VLS) may aid in detection of CMI at an early stage. We aimed to investigate the utility of LDF and VLS in detecting microcirculatory changes in patients with CMI during upper endoscopy. In a single center, prospective study, 104 patients were evaluated for mesenteric ischemia during a 24 months period. Patients with a consensus diagnosis of CMI (n = 40) were examined with LDF and VLS. Thirty-two were successfully treated and had a definitive diagnosis of CMI. Results were compared with controls (n = 38) with normal intestinal circulation evaluated with duplex ultrasonography (DUS). Treatment response was evaluated clinically and with DUS at 1 month and with VLS and LDF at 3 months. A significant reduction in mucosal capillary hemoglobin oxygen saturation (SO2) was found in CMI patients compared to controls before treatment: mean ± SD: 67 ± 9%, 81 ± 4%, respectively (p < .001). A significant reduction was also seen for the relative hemoglobin (rHb) amount, flow and velocity (p < .001). The sensitivity of SO2 measured by VLS for diagnosing CMI was 94% and the specificity 72% (cut-off 78%), calculated with ROC curve analysis. A combination of SO2 and rHb increased the test sensitivity and specificity to 97% and 79%, respectively. Conclusion: CMI patients have significantly reduced microcirculation in the stomach and duodenum compared to controls. The results suggest that VLS should be included when performing an upper endoscopy in patients with suspected CMI.

• Bjørkhaug, Steinar Traae; Neupane, Sudan Prasad; Bramness, Jørgen Gustav; Aanes, Håvard; Skar, Viggo Øystein & Medhus, Asle Wilhelm [Show all 7 contributors for this article] (2019). Plasma cytokine levels in patients with chronic alcohol overconsumption: relations to gut microbiota markers and clinical correlates. Alcohol. ISSN 0741-8329. 85, p. 35–40. doi: 10.1016/j.alcohol.2019.10.002. Full text in Research Archive Show summary

  BACKGROUND: Alcohol-related morbidity may involve changes in the gut microbiota and immune dysregulation. We have previously demonstrated alterations in gut microbiota composition and functions in patients with alcohol overconsumption, and now aimed to investigate possible associations between cytokine levels, gut microbiota and clinical symptoms. METHODS: We included hospital inpatients with a history of chronic alcohol overconsumption. For comparison, we included control patients with a low alcohol intake. Cytokine levels (TGF-β1, TNF-α, IL-10, IL-8, IL-6, IFN-γ, MCP-1, IL-1RA, IL-1β and IL-17) were determined using a customized V-plex assay. We then examined associations of cytokine levels with the abundance of Proteobacteria and Faecalibacterium, percentage of the short-chain fatty acid butyrate, psychiatric symptoms (Hospital Anxiety and Depression Scale) and biochemical liver variables. RESULTS: We included 28 patients with alcohol overconsumption (79% men), and 25 control patients (72% men). Patients with alcohol overconsumption had higher levels of IL-6 (p = 0.002), IFN-γ (p = 0.018) and MCP-1 (p = 0.006), and lower levels of TGF-β1 (p = 0.017) compared with control patients. Inverse correlations were found between Proteobacteria abundance and TNF-α (Rs = -0.55, p = 0.02) and IL-8 (Rs = -0.58, p = 0.014), and between Faecalibacterium and MCP-1 levels (Rs = -0.56, p = 0.02) in the control patients, but not in patients with alcohol overconsumption. Patients with alcohol overconsumption reported more psychiatric symptoms, and these symptoms were inversely correlated with IL-10 levels. There were positive correlations between several of the assessed cytokines and biochemical liver variables, and negative correlations between cytokine levels and albumin. CONCLUSION: Patients with alcohol overconsumption had a cytokine profile suggestive of increased systemic inflammatory activity, with higher levels of pro-inflammatory cytokines (IL-6, IFN-γ and MCP-1) and lower levels of anti-inflammatory cytokines (TGF-β1). The findings may represent a link between alcohol use and alcohol-related morbidity. Copyright © 2019 Elsevier Inc. All rights reserved. KEYWORDS: HADS; alcoholism; immune system; inflammation

• Bjørkhaug, Steinar Traae; Aanes, Håvard; Neupane, Sudan Prasad; Bramness, Jørgen Gustav; Malvik, Stine & Henriksen, Christine [Show all 9 contributors for this article] (2019). Characterization of gut microbiota composition and functions in patients with chronic alcohol overconsumption. Gut microbes. ISSN 1949-0976. 10(6), p. 663–675. doi: 10.1080/19490976.2019.1580097. Full text in Research Archive Show summary

  Excessive alcohol intake can alter the gut microbiota, which may underlie the pathophysiology of alcohol-related diseases. We examined gut microbiota composition and functions in patients with alcohol overconsumption for >10 years, compared to a control group of patients with a history of no or low alcohol intake. Faecal microbiota composition was assessed by 16S rRNA sequencing. Gut microbiota functions were evaluated by quantification of short-chain fatty acids (SCFAs) and predictive metagenome profiling (PICRUSt). Twenty-four patients, mean age 64.8 years (19 males), with alcohol overconsumption, and 18 control patients, mean age 58.2 years (14 males) were included. The two groups were comparable regarding basic clinical variables. Nutritional assessment revealed lower total score on the screening tool Mini Nutritional Assessment, lower muscle mass as assessed by handgrip strength, and lower plasma vitamin C levels in the alcohol overconsumption group. Bacteria from phylum Proteobacteria were found in higher relative abundance, while bacteria from genus Faecalibacterium were found in lower relative abundance in the group of alcohol overconsumers. The group also had higher levels of the genera Sutterella, Holdemania and Clostridium, and lower concentration and percentage of butyric acid. When applying PICRUSt to predict the metagenomic composition, we found that genes related to invasion of epithelial cells were more common in the group of alcohol overconsumers. We conclude that gut microbiota composition and functions in patients with alcohol overconsumption differ from patients with low consumption of alcohol, and seem to be skewed into a putative pro-inflammatory direction.

• Evensen, Helge; Kristensen, Vendel Ailin; Larssen, Lene; Sandstad, Olav; Hauge, Truls & Medhus, Asle Wilhelm (2019). Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 54(1), p. 1–7. doi: 10.1080/00365521.2018.1549271. Full text in Research Archive Show summary

  Objectives: Achalasia is a primary motility disorder of the esophagus characterized by aperistalsis and failure of lower esophageal sphincter (LES) relaxation. Treatment of achalasia aims at reducing LES pressure. The common treatment modalities are laparoscopic Heller myotomy and pneumatic dilatation, but during the last decade, a promising treatment, per oral endoscopic myotomy (POEM), has been introduced. The aim of the present study was to perform a systematic review of the literature to assess the outcome of POEM in treatment-naive patients. Materials and methods: A systematic literature search in PubMed, Embase and Cochrane databases was performed using the terms ‘Achalasia AND (POEM OR peroral endoscopic myotomy OR per-oral endoscopic myotomy)’. Inclusion criteria were: original article; English language; n ≥ 20 with ≥90% treatment-naive patients; follow-up ≥3 months; and outcome evaluation of POEM including symptom score and objective tests. Exclusion criteria were: reviews and meta-analyses; pediatric data; duplicates; and articles with overlapping data material. Results: Of the 1641 articles identified, seven were included. The included studies all reported a short-term clinical success of >90%. Clinical success including post-POEM reflux was mainly estimated by symptom scorings. There were few procedure-related complications. Conclusions: The studies of treatment-naive patients indicate a high rate of clinical success. Nevertheless, a more systematic and standardized evaluation is recommended to improve the reports on outcome of POEM. The follow-up rate should be high and the evaluation protocol should include both symptom scoring and objective testing with predefined treatment goals.

• Buer, Lydia Celine Tansem; Moum, Bjørn; Småstuen, Milada Cvancarova; Warren, David; Bolstad, Nils & Medhus, Asle Wilhelm [Show all 7 contributors for this article] (2018). Real world data on effectiveness, safety and therapeutic drug monitoring of vedolizumab in patients with inflammatory bowel disease. A single center cohort. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–9. doi: 10.1080/00365521.2018.1548646. Full text in Research Archive
• Holme, Øyvind; Pedersen, Ina Borgenheim; Medhus, Asle Wilhelm; Aabakken, Lars; Glomsaker, Tom Birger & Kvamme, Jan-Magnus [Show all 14 contributors for this article] (2018). Endoscopy assistants influence the quality of colonoscopy. Endoscopy. ISSN 0013-726X. 50(9), p. 871–877. doi: 10.1055/s-0044-101706. Full text in Research Archive Show summary

  Background: Colonoscopy performance varies between endoscopists, but little is known about the impact of endoscopy assistants on key performance indicators. We used a large prospective colonoscopy quality database to perform an exploratory study to evaluate differences in selected quality indicators between endoscopy assistants. Methods: All colonoscopies reported to the Norwegian colonoscopy quality assurance register Gastronet can be used to trace individual endoscopy assistants. We analyzed key quality indicators (cecum intubation rate, polyp detection rate, colonoscopies rated as severely painful, colonoscopies with sedation or analgesia, and satisfaction with information) for colonoscopies performed between 1 January 2013 and 31 December 2014. Differences between individual assistants were analyzed by fitting multivariable logistic regression models, with the best performing assistant at each participating hospital as reference. All models were adjusted for the endoscopist. Results: 63 endoscopy assistants from 12 hospitals assisted in 15 365 colonoscopies. Compared with their top performing peers from the same hospital, one assistant was associated with cecum intubation failure, four with poor polyp detection, nine with painful colonoscopy, 16 with administration of sedation or analgesics during colonoscopy, and three with patient dissatisfaction about information given relating to the colonoscopy. The number of procedures during the study period or lifetime experience as an endoscopy assistant were not associated with any quality indicator. Conclusion: In this exploratory study, there was little variation on important colonoscopy quality indicators between endoscopy assistants. However, there were differences among assistants that may be clinically important. Endoscopy assistants should be subject to quality surveillance similarly to endoscopists. © 2018 Georg Thieme Verlag KG Stuttgart

• Høivik, Marte Lie; Buer, Lydia Celine Tansem; Småstuen, Milada Cvancarova; Warren, David; Bolstad, Nils & Moum, Bjørn [Show all 7 contributors for this article] (2018). Switching from originator to biosimilar infliximab?real world data of a prospective 18 months follow-up of a single-centre IBD population. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 53(6), p. 692–699. doi: 10.1080/00365521.2018.1463391. Full text in Research Archive
• Buer, Lydia Celine Tansem; Høivik, Marte Lie; Warren, David; Medhus, Asle Wilhelm & Moum, Bjørn (2018). Combining Anti-TNF-? and Vedolizumab in the Treatment of Inflammatory Bowel Disease: A Case Series. Inflammatory Bowel Diseases. ISSN 1078-0998. 24(5), p. 997–1004. doi: 10.1093/ibd/izx110. Full text in Research Archive Show summary

  Background Anti-tumor necrosis factor α (anti-TNF-α) is important in the treatment of inflammatory bowel disease, but some patients experience only a partial response. In these patients, a combination of anti-TNF-α and vedolizumab (VDZ) may act as a bridge until the full VDZ effect occurs. At present, clinical data on combination treatment with anti-TNF-α and VDZ are not available. The aim of this case series was to evaluate the safety and clinical response of combination therapy with anti-TNF-α and VDZ in clinical practice. Methods All patients started on combination treatment with anti-TNF-α and VDZ from November 2015 to July 2016 were prospectively followed for at least 12 months. Results Six patients with ulcerative colitis and four patients with Crohn’s disease received combination treatment. These patients were followed for a median of 1712–20 months. No more adverse events than expected with anti-TNF-α alone were observed during combination treatment. At the end of follow-up, all patients were in clinical remission, and 8 patients could discontinue anti-TNF-α treatment and receive VDZ monotherapy. Two of the patients with Crohn’s disease required combination treatment throughout follow-up to obtain sustained remission. Conclusion Our findings suggest that combination treatment with anti TNF-α and VDZ is safe and might represent a long-term treatment option in selected patients.

• Knatten, Charlotte Kristensen; Fjeld, Jan Gunnar; Medhus, Asle Wilhelm; Pripp, Are Hugo; Fyhn, Thomas Johan & Aabakken, Lars [Show all 10 contributors for this article] (2017). Preoperative liquid gastric emptying rate does not predict outcome after fundoplication. Journal of Pediatric Surgery. ISSN 0022-3468. 52(4), p. 540–543. doi: 10.1016/j.jpedsurg.2016.09.068. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Skar, Viggo Øystein; Medhus, Asle Wilhelm; Tollisen, Anita; Bramness, Jørgen Gustav & Valeur, Jørgen (2017). Chronic alcohol overconsumption may alter gut microbial metabolism: a retrospective study of 719 13C-D-xylose breath test results. Microbial Ecology in Health and Disease. ISSN 0891-060X. 28(1). doi: 10.1080/16512235.2017.1301725. Full text in Research Archive Show summary

  Objective: Alterations of gut microbiota composition or function may participate in the pathophysiology of several diseases. We aimed to explore the effect of chronic alcohol overconsumption on gut microbial metabolism, as assessed by evaluating 13C-D-xylose breath test results. Materials and methods: We investigated all 13C-D-xylose breath tests performed at Lovisenberg Diaconal Hospital during the years 2005 to 2011, using patient files for diagnosing the patients into one of three patient categories: alcohol overconsumption, coeliac disease and functional bowel disorder. In addition, a group of healthy controls was included. The time curves of 13CO2 excretion in breath samples were divided into two phases, evaluating small intestinal absorption (0–60 min) and colonic microbial metabolism (90–240 min), respectively. Results: A total of 719 patients underwent 13C-D-xylose breath testing during the inclusion period. Thirty-five had a history of alcohol overconsumption, 66 had coeliac disease, and 216 had a functional bowel disorder, while 44 healthy controls were included for comparison. The alcohol overconsumption group had similar small intestinal phase results as the group of patients with untreated coeliac disease. During the colonic phase, the group of patients with alcohol overconsumption differed from all the other groups in terms of 13C-xylose recovery, with significantly less 13CO2 excretion compared to the other groups. Conclusion: The results suggest that patients with a history of alcohol overconsumption suffer from both small intestinal malabsorption and impaired colonic microbial metabolism. The role of gut microbiota in chronic alcohol overconsumption should be investigated further.

• Buer, Lydia Celine Tansem; Høivik, Marte Lie; Medhus, Asle Wilhelm & Moum, Bjørn (2017). Does the Introduction of Biosimilars Change Our Understanding about Treatment Modalities for Inflammatory Bowel Disease? Digestive Diseases. ISSN 0257-2753. 35(1-2), p. 74–82. doi: 10.1159/000449087. Full text in Research Archive
• Buer, Lydia Celine Tansem; Moum, Bjørn; Småstuen, Milada Cvancarova; Warren, David; Medhus, Asle Wilhelm & Høivik, Marte Lie (2016). Switching from Remicade® to Remsima® is well tolerated and feasible: a prospective, open-label study. Journal - Crohn's and Colitis Foundation of Canada. ISSN 1197-4982. doi: 10.1093/ecco-jcc/jjw166. Full text in Research Archive
• Brun, Anne Charlotte; Olafsdottir, Edda Jonina; Bentsen, Beint Sigmund; Størdal, Ketil; Johannesdottir, Groa B & Medhus, Asle Wilhelm (2014). Electrogastrography in children with cerebral palsy: Abnormal postprandial response to both fast- and slow-emptying meals. e - SPEN: the European e-journal of clinical nutrition and metabolism. 9(6), p. e215–e219. doi: 10.1016/j.clnme.2014.09.003. Full text in Research Archive
• Knatten, Charlotte Kristensen; Åvitsland, Tone Lise; Medhus, Asle Wilhelm; Fjeld, Jan Gunnar; Pripp, Are Hugo & Emblem, Ragnhild [Show all 7 contributors for this article] (2013). Gastric emptying in children with gastroesophageal reflux and in healthy children. Journal of Pediatric Surgery. ISSN 0022-3468. 48(9), p. 1856–1861. doi: 10.1016/j.jpedsurg.2013.03.076. Full text in Research Archive
• Brun, Anne Charlotte; Størdal, Ketil; JOHANNESDOTTIR, GROA; Fossum, Vibeke; Bentsen, Beint Sigmund & Medhus, Asle Wilhelm (2013). Nissen fundoplication in children with cerebral palsy: Influence on rate of gastric emptying and postprandial symptoms in relation to protein source in caloric liquid meals. Clinical Nutrition. ISSN 0261-5614. 32(4), p. 619–623. doi: 10.1016/j.clnu.2012.11.010. Full text in Research Archive
• Finnes, Trine Elisabeth; Meyer, Haakon E; Falch, Jan Arvid; Medhus, Asle Wilhelm; Wentzel-Larsen, Tore & Lofthus, Cathrine Marie (2013). Secular reduction of excess mortality in hip fracture patients > 85 years. BMC Geriatrics. 13. doi: 10.1186/1471-2318-13-25. Full text in Research Archive Show summary

  Background More than 20% of the hip fracture patients die within the first year after the incident. Few data are available on the trends in mortality following a hip fracture. The present aim was to study changes in excess mortality after hip fracture from 1978/79 up to 1996/97. Methods Data on 5180 hip fracture patients aged ≥ 50 years, identified in three earlier, well validated, incidence studies from Oslo were used. The studies took place in the two years periods 1978–79 and 1989–89 and in a one year period from 1st of May 1996 to 30th of April 1997. The study was designed as a historic cohort study. Exposure was sustaining a hip fracture in the registration periods. Outcome was death of all causes. Age- and sex-specific one year-mortality rates were provided by Statistics Norway. Standardized mortality ratios (SMR) were calculated for the three cohorts for each sex and age-group, for the 0–6 months, 6–12 months, 0–1 year, 1–5 years and 5–10 years intervals after fracture. To assess the duration of the excess mortality in hip fracture patients, time-framed Kaplan-Meier curves for consecutive 5-years intervals were conducted for the hip fracture patients and the corresponding background population. Only patients still alive at the start of the time interval were included. One sample log rank tests were used to test for statistical significance. Results The one-year SMR ranged from 3.64 (2.82 – 4.61) to 4.53 (3.67 – 5.54) in men and from 2.78 (2.39 – 3.19) to 3.60 (3.19 – 4.05) in women. In the 0–6 months interval a reduction in SMR from 1978/79 to 1996/97 was observed in women aged ≥85 years. The duration of excess mortality ranged from two years in men ≥85 years to more than ten years in men and women aged 65–84 years. Conclusion Excess mortality among hip fracture patients remains high. Over the decades, a reduced excess mortality was mainly seen in the oldest patients, suggesting that specific efforts intending to improve prevention and treatment of osteoporosis and osteoporotic fractures in the youngest elderly are required.

• Larssen, Lene; Hauge, Truls & Medhus, Asle Wilhelm (2012). Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surgical Endoscopy. ISSN 0930-2794. 26(10), p. 2955–2960. doi: 10.1007/s00464-012-2291-7. Full text in Research Archive
• Larssen, Lene; Medhus, Asle Wilhelm; Kørner, Hartwig; Glomsaker, Tom Birger; Søberg, Taran & Gleditsch, Dagfinn [Show all 11 contributors for this article] (2012). Long-term outcome of palliative treatment with self-expanding metal stents for malignant obstructions of the GI tract. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 47(12), p. 1505–1514. doi: 10.3109/00365521.2012.711854. Full text in Research Archive
• Hope, Håvar Blich; Skar, Viggo Øystein; Sandstad, Olav; Husebye, Einar & Medhus, Asle Wilhelm (2012). Small intestinal malabsorption in chronic alcoholism: a retrospective study of alcoholic patients by the C-14-D-xylose breath test. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 47(4), p. 428–434. doi: 10.3109/00365521.2011.648951. Full text in Research Archive
• Brun, Anne Charlotte; Størdal, Ketil; Johannesdottir, Groa B; Bentsen, Beint Sigmund & Medhus, Asle Wilhelm (2012). The effect of protein composition in liquid meals on gastric emptying rate in children with cerebral palsy. Clinical Nutrition. ISSN 0261-5614. 31(1), p. 108–112. doi: 10.1016/j.clnu.2011.07.009. Full text in Research Archive
• Larssen, Lene; Medhus, Asle Wilhelm; Hjermstad, Marianne Jensen; Kørner, Hartwig; Glomsaker, Tom & Søberg, Taran [Show all 12 contributors for this article] (2011). Patient-reported outcomes in palliative gastrointestinal stenting: a Norwegian multicenter study. Surgical Endoscopy. ISSN 0930-2794. 25(10), p. 3162–3169. doi: 10.1007/s00464-011-1680-7. Full text in Research Archive Show summary

  Background The clinical effect of stent treatment has been evaluated by mainly physicians; only a limited number of prospective studies have used patient-reported outcomes for this purpose. The aim of this work was to study the clinical effect of self-expanding metal stents in treatment of malignant gastrointestinal obstructions, as evaluated by patient-reported outcomes, and compare the rating of the treatment effect by patients and physicians. Methods Between November 2006 and April 2008, 273 patients treated with SEMS for malignant GI and biliary obstructions were recruited from nine Norwegian hospitals. Patients and physicians assessed symptoms independently at the time of treatment and after 2 weeks using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire supplemented with specific questions related to obstruction. Results A total of 162 patients (99 males; median age = 72 years) completed both assessments and were included in the study. A significant improvement in the mean global health score was observed after 2 weeks (from 9 to 18 on a 0–100 scale, P\0.03) for all stent locations. Both patients and physicians reported a significant reduction in all obstruction-related symptoms ([20 on the 0–100 scale, P\0.006) after SEMS treatment. The physicians reported a larger mean improvement in symptoms than did the patients, mainly because they reported more severe symptoms before treatment. Conclusion SEMS treatment is effective in relieving symptoms of malignant GI and biliary obstruction, as reported by patients and physicians. The physicians, however, reported a larger reduction in obstructive symptoms than did the patients. A prospective assessment of patientreported outcomes is important in evaluating SEMS treatment.

• Hope, Håvar Blich; Medhus, Asle Wilhelm; Sandstad, Olav; Borge, Christine Råheim & Skar, Viggo Øystein (2011). Reduced C-13-D-xylose absorption in alcoholics is more likely caused by alterations in small intestinal mucosa than delayed gastric emptying. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 46(4), p. 414–419. doi: 10.3109/00365521.2010.536252. Full text in Research Archive
• Medhus, Asle Wilhelm; Bjørnland, Kristin; Emblem, Ragnhild & Husebye, Einar (2010). Motility of the oesophagus and small bowel in adults treated for Hirschsprung's disease during early childhood. Neurogastroenterology and Motility. ISSN 1350-1925. 22(2). doi: 10.1111/j.1365-2982.2009.01397.x. Full text in Research Archive
• Larssen, Lene; Medhus, Asle Wilhelm & Hauge, Truls (2009). Treatment of malignant gastric outlet obstruction with stents: An evaluation of the reported variables for clinical outcome. BMC Gastroenterology. 9. doi: 10.1186/1471-230X-9-45. Full text in Research Archive Show summary

  Background Malignant gastric outlet obstruction (GOO) is commonly seen in patients with advanced gastric-, pancreatic-, duodenal, hepatobiliary or metastatic malignancies. Ten to 25% of patients with pancreatic cancer will develop duodenal obstruction during the course of the disease. Duodenal stenting with self-expandable metal stents is an alternative treatment to surgical bypass procedures. Our aim was to review the published literature regarding treatment of malignant GOO with stents to reveal whether the information provided is sufficient to evaluate the clinical effects of this treatment Methods A literature search from 2000 – 2007 was conducted in Pub Med, Embase, and Cochrane library, combining the following search terms: duodenal stent, malignant duodenal obstruction, gastric outlet obstruction, SEMS, and gastroenteroanastomosis. All publications presenting data with ≥ 15 patients and only articles written in English were included and a review focusing on the following parameters were conducted: 1) The use of graded scoring systems evaluating clinical success; 2) Assessment of Quality of life (QoL) before and after treatment; 3) Information on stent-patency; 4) The use of objective criteria to evaluate the stent effect. Results 41 original papers in English were found; no RCT's. 16 out of 41 studies used some sort of graded scoring system. No studies had objectively evaluated QoL before or after stent treatment, using standardized QoL-questionnaires, 32/41 studies reported on stent patency and 9/41 performed an oral contrast examination after stent placement. Objective quantitative tests of gastric emptying had not been performed. Conclusion Available reports do not provide sufficient relevant information of the clinical outcome of duodenal stenting. In future studies, these relevant issues should be addressed to allow improved evaluation of the effect of stent treatment.

• Lofthus, Cathrine Marie; Cappelen, Inger; Osnes, Eivind Kaare; Falch, Jan Arvid; Kristiansen, Ivar Sønbø & Medhus, Asle Wilhelm [Show all 8 contributors for this article] (2005). Local and national electronic databases in Norway demonstrate a varying degree of validity. Journal of Clinical Epidemiology. ISSN 0895-4356. 58, p. 280–285. Full text in Research Archive

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• Haug, Helene Marie; Hagen, Rolf Eikeland; Kristinsson, Jon Adalsteinn; Svanevik, Marius; Sandbu, Rune & Medhus, Asle Wilhelm [Show all 10 contributors for this article] (2026). A two-center randomized clinical superiority trial of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy for severe obesity: SASSY study protocol. doi: 10.1177/14574969261470903. Full text in Research Archive Show summary

  Background: Single-anastomosis sleeve ileal bypass is a novel metabolic bariatric surgery intended to enhance metabolic outcomes and reduce the risk of postoperative complications. Although preliminary outcome data for single-anastomosis sleeve ileal bypass are promising, evidence from adequately powered, randomized head-to-head comparisons is scarce. This trial compares the efficacy and safety of single-anastomosis sleeve ileal bypass versus sleeve gastrectomy in patients with class II obesity (body mass index = 35.0–39.9 kg/m²) with at least one obesity‑related comorbidity or class III obesity (body mass index ⩾40.0 kg/m²). Methods: This two-center randomized clinical superiority trial enrolls patients eligible for metabolic bariatric surgery at two specialized Norwegian centers. Included patients are randomly assigned (1:1) to either single-anastomosis sleeve ileal bypass or sleeve gastrectomy with standardized perioperative treatment and care. The primary endpoint is the between-group difference in change in body mass index from baseline to 2 years after single-anastomosis sleeve ileal bypass versus sleeve gastrectomy. Secondary endpoints include additional weight loss outcomes, the prevalence of gastroesophageal reflux disease, surgical and postoperative complications, obesity-related comorbidities, nutritional status, bone mineral density, gastrointestinal symptoms, quality of life, and rates of revisional and conversion surgery. All endpoints will be evaluated at 2 and 5 years after surgery. Statistical analyses utilize linear mixed models and analysis of covariance within an intention-to-treat framework. Discussion: This trial will provide high-level evidence with robust and comparative outcome data on single-anastomosis sleeve ileal bypass and sleeve gastrectomy, aiming to clarify the clinical utility of single-anastomosis sleeve ileal bypass and inform surgical practice. Findings will address gaps in medium- and long-term evidence regarding weight loss, safety, comorbidity resolution, and quality of life following single-anastomosis sleeve ileal bypass.

• Valeur, Jørgen; Tveito, Kari; Røseth, Arne; Strøm, Finn; Kristensen, Vendel Ailin & Sandstad, Olav [Show all 9 contributors for this article] (2024). Minneord: Viggo Øystein Skar (1945-2024). Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(14), p. 1155–1155. Full text in Research Archive
• Johansen, Ingunn; Hagen, Milada; Løkkeberg, Stine Eileen Torp; Kristensen, Vendel; Høivik, Marte Lie & Lund, Charlotte [Show all 24 contributors for this article] (2024). P247 Anxiety and depression in newly diagnosed patients with Inflammatory Bowel Disease – Results from the IBSEN III study. Full text in Research Archive
• Bazov, I.; Kruse, R.; Bergemalm, D.; Eriksson, C.; Hedin, C.R. & Nieuwenhoven, M. van [Show all 28 contributors for this article] (2023). A novel serum protein signature as biomarker for Inflammatory Bowel Disease: A diagnostic performance and prediction modelling study using data from two independent inception cohorts. Journal of Crohn's and Colitis. ISSN 1873-9946. 17, p. i314–i315. doi: 10.1093/ecco-jcc/jjac190.0284. Full text in Research Archive
• Hansen, Simen Hyll; Maseng, M Gjerstad; Bjørkqvist, O; Halfvarsson, J; Bang, C & Detlie, Trond Espen [Show all 23 contributors for this article] (2023). Gut microbiota at diagnosis is associated with clinical features and future disease course in Inflammatory Bowel Disease: Data from IBSEN III, a new large Norwegian population-based inception cohort. Journal of Crohn's and Colitis. ISSN 1873-9946. 17, p. i1028–I2029. doi: 10.1093/ecco-jcc/jjac190.1050. Full text in Research Archive
• Hole, Mikal Jacob; Jørgensen, Kristin Kaasen; Holm, Kristian; Braadland, Peder Rustøen; Meyer-Myklestad, Malin Holm & Medhus, Asle Wilhelm [Show all 13 contributors for this article] (2023). Reply: The mucosal gut signature in primary sclerosing cholangitis before and after liver transplantation. Is the dysbiosis index really predictive for the recurrence of PSC? Hepatology. ISSN 0270-9139. 77(6), p. E188–E189. doi: 10.1097/HEP.0000000000000340. Full text in Research Archive
• Tran, Trung; Vaage, Eline Benno; Mehta, Adi; Chopra, Adity; Tietze, Lisa & Kolderup, Heidi Anette [Show all 40 contributors for this article] (2023). Author Correction: Titers of antibodies against ancestral SARS-CoV-2 correlate with levels of neutralizing antibodies to multiple variants (npj Vaccines, (2022), 7, 1, (174), 10.1038/s41541-022-00586-7). npj Vaccines. 8(1). doi: 10.1038/s41541-023-00600-6. Full text in Research Archive
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hofsø, Dag; Svanevik, Marius; Seip, Birgitte Karen Berggreen & Hjelmesæth, Jøran Sture (2022). Letter to the Editor regarding the article «Gerd symptoms after laparoscopic Roux-en-Y gastric bypass: an emerging scenario» by Antonella Santonicola, Luigi Ruggiero, Rossella Palma, Luigi Angrisani and Paola Iovino. International Journal of Obesity (2022) 46:1076–1078. International Journal of Obesity. ISSN 0307-0565. 46(10), p. 1936–1937. doi: 10.1038/s41366-022-01200-5. Full text in Research Archive
• Evensen, Helge & Medhus, Asle Wilhelm (2019). Response to letter to the editor: ‘Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review’. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 54(4), p. 520–520. doi: 10.1080/00365521.2019.1599416. Full text in Research Archive
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hertel, Jens Kristoffer; Karlsen, Tor-Ivar; Borgeraas, Heidi & Sandbu, Rune [Show all 10 contributors for this article] (2019). Gastroesophageal reflux disease in patients With severe obesity and type 2 diabetes one year after sleeve gastrectomy or roux-en-y gastric bypass. A Randomized controlled trial. Surgery for Obesity and Related Diseases. ISSN 1550-7289. 15, p. S3–S3. doi: 10.1016/j.soard.2019.08.052. Full text in Research Archive
• Meyer-Myklestad, Malin Holm; Kummen, Martin; Stiksrud, Birgitte; Holm, Kristian; Dyrhol-Riise, Anne Ma & Kvale, Dag [Show all 11 contributors for this article] (2019). ALTERED GUT IMMUNITY IN IMMUNOLOGICAL NONRESPONDERS PARTLY RESTORED BY PROBIOTICS. Full text in Research Archive
• Lorvik, Kristina Berg; Meyer-Myklestad, Malin Holm; Medhus, Asle Wilhelm; Kvale, Dag; Dyrhol-Riise, Anne Ma & Reikvam, Dag Henrik [Show all 7 contributors for this article] (2019). Increased expression of gut and blood CD4+ T cells in people living with HIV and insufficient response to antiviral therapy. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Aanes, Håvard; Medhus, Asle Wilhelm; Skar, Viggo Øystein; Malvik, Stine & Henriksen, Christine [Show all 9 contributors for this article] (2018). Tarmfloraendringer hos pasienter med forhøyet alkoholkonsum. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Aanes, Håvard; Skar, Viggo Øystein; Medhus, Asle Wilhelm; Bramness, Jørgen Gustav & Valeur, Jørgen (2017). Alterations of gut microbiota composition in patients with chronic alcohol overconsumption. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Aanes, Håvard; Skar, Viggo Øystein; Medhus, Asle Wilhelm; Bramness, Jørgen Gustav & Valeur, Jørgen (2017). Alterations of gut microbiota composition in patients with chronic alcohol overconsumption. Neurogastroenterology and Motility. ISSN 1350-1925. 29, p. 84–85. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Aanes, Håvard; Skar, Viggo Øystein; Medhus, Asle Wilhelm; Bramness, Jørgen Gustav & Valeur, Jørgen (2017). Chronic alcohol overconsumption may alter composition of gut microbiota. Full text in Research Archive
• Bjørkhaug, Steinar Traae; Skar, Viggo Øystein; Bramness, Jørgen Gustav; Medhus, Asle Wilhelm; Tollisen, Anita & Valeur, Jørgen (2016). Påvirker alkohol tarmens mikroflora? En retrospektiv studie av 719 13C-D-Xylose pusteprøver. Full text in Research Archive
• Lorentzen, Jolanta Halabowska; Medhus, Asle Wilhelm; Hjelmesæth, Jøran; Hofsø, Dag; Karlsen, Tor-Ivar & Sandbu, Rune [Show all 8 contributors for this article] (2016). GERDQ- og GSRS-skjemaer kan være utilstrekkelig til å diagnostisere gastroøsofageal reflukssykdom (GØRS). Oseberg Refluksstudie, Tønsberg. Full text in Research Archive
• Lorentzen, Jolanta; Medhus, Asle Wilhelm; Hjelmesæth, Jøran; Hofsø, Dag; Karlsen, Tor-Ivar & Sandbu, Rune [Show all 7 contributors for this article] (2015). Esophageal motility in morbidly obese patients with type 2 diabetes. Full text in Research Archive
• Lorentzen, Jolanta; Hjelmesæth, Jøran; Medhus, Asle Wilhelm; Hofsø, Dag; Karlsen, Tor-Ivar & Sandbu, Rune [Show all 7 contributors for this article] (2015). Questionnaires may be insufficient to diagnose gastroesophageal reflux disease (GERD) in morbidly obese patients with type 2 diabetes. Full text in Research Archive
• Lorentzen, Jolanta Halabowska; Hjelmesæth, Jøran; Medhus, Asle Wilhelm; Hofsø, Dag; Karlsen, Tor-Ivar & Sandbu, Rune [Show all 7 contributors for this article] (2015). Questionnaires may be insufficient to diagnose gastroesophageal reflux disease (GERD) in morbidly obese patients with type 2 diabetes. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. Full text in Research Archive
• Sandbu, Rune; Seip, Birgitte Karen Berggreen; Medhus, Asle Wilhelm; Lorentzen, Jolanta Halabowska; Hjelmesæth, Jøran & Hofsø, Dag [Show all 7 contributors for this article] (2015). Esophageal motility in morbidly obese patients with type 2 diabetes. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. Full text in Research Archive
• Finnes, Trine Elisabeth; Meyer, Haakon E; Falch, Jan Arvid; Medhus, Asle Wilhelm; Wentzel-Larsen, Tore & Lofthus, Cathrine Marie (2012). DURATION OF EXCESS MORTALITY AFTER HIP FRACTURES IN OSLO, NORWAY: A LONG TERM FOLLOW UP. Osteoporosis International. ISSN 0937-941X. 23, p. S123–S124. Full text in Research Archive
• Larssen, Lene; Medhus, Asle Wilhelm; Wayessa, Seoum; Tholfsen, Jan K.; Nesbakken, Arild & Hauge, Truls (2007). Register over stentbehandling ved GI-cancer. Full text in Research Archive
• Medhus, Asle Wilhelm & Meling, Torstein Ragnar (1993). Sammensatte ord og apostrof som genitivsmerke på norsk og engelsk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 25, p. 3180–3180. Full text in Research Archive
• Meling, Torstein Ragnar & Medhus, Asle Wilhelm (1993). Nobelprisvinnerdagene 1993. 23, p. 2944–2947. Full text in Research Archive

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