Crohn's disease is a chronic inflammatory bowel disease which may affect any part of the gastrointestinal tract with a preference for the terminal ileum and ileocaecal region. The disease was first described in 1932 and has increased during the last decades. The clinical manifestations could be referred to as inflammation, malabsorption and obstruction. The annual incidence of Crohn's disease in the county of Västerbotten, North Sweden, was found to be 4.9/105 inhabitants. In a study of 87 patients in a medical gastrointestinal unit, 23% of non-operated patients and 66% of resected patients had increased fecal fat excretion. D-xylose test and lactose tolerance test were abnormal 1n 19% and 24% respectively of the non-operated patients. No clear relation could be found between the outcome of these malabsorption tests and localization, extension or activity of the disease. This suggests the cause of malabsorption 1n Crohn's disease to be complex and multi- factorial . The morphology of jejunal biopsies from 18 patients with Crohn's disease elsewhere 1n the gastrointestinal tract demonstrated an abnormal picture 1n 13 patients when assessed by light microscopy and scanning electron microscopy. A high proportion of these patients had abnormal Intestinal absorptive tests. Skeletal muscle biopsies were performed 1n 13 patients showing a depletion of muscle potassium content and more Infrequently low skeletal muscle magnesium content. This depletion 1s not reflected by subnormal plasma concentration. In the Initial clinical assessment of a new gamma labelled synthetic bile ac1d-SeHCAT, 45 patients, 19 of whom had Crohn's disease, were studied. The outcome of the test correlated well with the excretion of fecal bile acids. It was possible to discriminate patients with terminal Ileal disease from other patient groups. In a follow-up study, the SeHCAT test was modified as to make it simpler and to shorten the test period. Nine patients with Crohn's disease were tested, showing a suffi cent accuracy of the outcome of the test within 48 hours, using simple equipment available in many hospitals. The elimination of radioactivity was calculated as WBR50*» the time for 50% of the administered dose to be excreted. This gives information as to the rate of excretion, reflecting the degree of terminal ileal malfunction. / <p>S. 1-41: sammanfattning, s. 43-115: 5 uppsatser</p> / digitalisering@umu

SeHCAT-test utgör “golden standard” vid diagnostisering av gallsyramalabsorption. På Skånes universitetssjukhus utförs retentionsmätningarna av 75SeHCAT i en helkroppsräknare som är placerad i ett rum som är kraftigt skärmad mot bakgrundsstrålning. Nackdelen är att patienten måste ligga stilla på en hård brits i ett varmt och ett isolerat rum under 17 minuter samt att det är tidskrävande för undersökaren att göra retentionsmätningar på en patient. Av dessa skäl pågår ett kliniskt utvecklingsarbete för SeHCAT-test på Skånes universitetssjukhus. Syftet med studien var att studera om samma resultat skulle erhållas utifrån stationär mätning och helkroppsmätning samt i hur stor utsträckning eventuella avvikelser i retentionsvärdena mellan mätmetoderna hade påverkat diagnostiseringen av gallsyramalabsorption utifrån resultat från föregående SeHCAT-tester som genomförts på Skånes universitetssjukhus.  I denna studie genomfördes 5 minuters stationär mätning efter helkroppsmätningarna på 11 patienter som remitterades till Klinisk fysiologi och nuklearmedicinmottagningen i Malmö för att utföra SeHCAT-test. Resultaten påvisade signifikant skillnad mellan mätmetoderna (p &lt; 0,05) och lägre erhållna retentionsvärden från de stationära mätningarna än helkroppsmätningarna för samtliga deltagaren. Dessutom erhöll en stor del av tidigare patienter resultat som hade kunnat ge en annan diagnos om den nya mätmetoden skulle användas i retentionsmätningarna. Slutsatsen som kan dras är att den nya mätmetoden inte kommer att implementeras på kliniken förrän ytterligare studier med flera deltagaren har genomförts. Vidare ligger denna studie grund till att en modifierad variant av den nya mätmetoden kommer att testas på verksamheten. / The SeHCAT test is the “golden standard” method in terms of diagnosing bile acid malabsorption. At Skåne University Hospital, the retention measurements of 75SeHCAT are performed in a whole-body-counter located in a room that is heavily shielded from background radiation. However, the disadvantage is that the patient must lie still on a hard bunk bed in a warm and an isolated room for 17 minutes as well it is time-consuming for the examiner to conduct the retention measurements on a patient. Thus, a clinical development work for SeHCAT test is ongoing at Skåne University Hospital. The aim of the study was to study if same results would be obtained from the stationary measurement and the whole body measurement and to study the extent to which any deviations in the retention values between the two measurement methods would have affected the diagnosis of bile acid malabsorption based on results from previous SeHCAT tests that were performed at Skåne University Hospital. In the study, a 5-minute stationary measurement was executed after the whole-body measurements on 11 patients who were all referred to Clinical Physiology and Nuclear Medicine Clinic in Malmö to perform the SeHCAT-test. The results showed a significant difference between the measurement methods (p &lt; 0,05) and lower retention values obtained from the stationary measurements compared to whole-body measurements for all participants. Additionally, a large proportion of the previous patients obtained results that could have given a different diagnosis if the new measurement method were to be used in the retention measurements. To conclude, the new measurement method for the SeHCAT test will not be implemented at the clinic until further studies with more participants have been carried out. Moreover, this study is the basis for a modified variant of the new measurement method that will be tested at the clinic.