Gastroenterology and hepatology

Gastroenterology

In gastroenterology and hepatology, researchers are studying diseases of the gastrointestinal tract, liver, biliary tract and pancreas. Although great progress has been made against these diseases in the past few decades, much is still unknown about how and why they arise, how they cause symptoms and what can be done to treat them.

In Sweden, one in ten adults has irritable bowel syndrome(IBS), which causes pain, flatulence (gas or wind), abdominal swelling, and diarrhoea and/or constipation. Disorders of the upper gastrointestinal tract due to diseases such as functional dyspepsia (“gastric ulcer”) and gastroparesis (slow emptying of food from the stomach) are as common as IBS. Approximately 1% of the population suffer from inflammatory bowel diseases , such as ulcerative colitis and Crohn’s disease. World-leading research on all these pathological conditions is taking place at our Institute.

Hepatology

Reduced bile flow is typical of what are known as “cholestatic”liver diseases. The most common of these is pregnancy cholestasis (intrahepatic cholestasis of pregnancy, ICP), which affects more than one in 100 pregnant women in Sweden and is characterised by increased bile acids in the blood, often pruritus (severe, chronic itching) in the mother and risk of complications for the foetus. For 20 years, world-leading ICP research, focusing on mechanisms and treatment options for mother and baby alike, has been conducted at Sahlgrenska Academy. In addition, advanced translational research* on other cholestatic diseases, but also various metabolic liver diseases, is carried out. This research highlights the central role of the liver in a variety of pathological conditions in the human body.

Research areas

Brain–gut interaction in people with IBS, other intestinal disorders and functional dyspepsia.

Developing new treatments for patients with IBS, functional dyspepsia and gastroparesis.

• Clinical care of large patient groups with various gastrointestinal disorders and how to improve their work capacity.
• Gastroparesis and the importance of slow stomach emptying.
• Interaction between diet and various intestinal factors, such as bacteria, and how they can lead to gastrointestinal symptoms.
• Developing and evaluating new treatments for patients with inflammatory bowel diseases, and understanding why certain patients respond better than others to specific treatments.
• Genetics, hormones and the influence of gastric bacteria on ICP.
• Treatment of ICP focused on relieving the mother’s symptoms and reducing the risk of complications in the foetus.
• How drugs that affect acid metabolism change glucose and fat metabolism in patients with various pathological conditions, such as cholestatic liver disease, gallstones and fatty liver disease.
• Translational research on bile-acid metabolism and bile formation to gain a better understanding of normal and deviant functioning in these processes, and thus certain pathological conditions.

Important findings

• Various treatment options with local effects in the gut, and also cognitive behavioural therapy, hypnosis and anti depressants that affect our central nervous system, may be beneficial inpatients with IBS. Work in gastrointestinal clinics should therefore being multi-professional teams.
• Factors in both gut and brain interact, and there appears to be mutual potentiation between them in patients with IBS and functional dyspepsia.
• Diet and intestinal bacteria have a major bearing on IBS symptoms.
• Symptoms of gastroparesis can be successfully treated with gastric electro-stimulation.
• Factors in the immune system and gut flora composition affect clinical response to anti-inflammatory treatment in ulcerative colitis and Crohn’s disease.
• ICP with high levels of bile acids in the blood boosts the risk of foetal complications, but also the mother’s risk of liver disease.
• Specific hormone metabolites can be used for early and improved ICP diagnostics.
• Molecular mechanisms of gallstone formation, and those underlying other side effects of new drugs that stimulate bile acid receptors, and are being used or tested for cholestatic liver disease and fatty liver disease, have been clarified.
• The crucial importance of gut bacteria in chronic biliary tract disease has been surveyed at molecular level in various animal models.