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Gastrointestinal epidemiology – Jonas Ludvigsson's research group

We study causes and consequences of gastrointestinal diseases (including the liver, gallbladder and pancreas). We do so through linking histopathology data with the Swedish national healthcare registers.

Part of the:
Jonas Ludvigsson's research group

Our research

The gastrointestinal (GI) epidemiology group focus on research on GI organs and diseases. Most of that research is based on the ESPRESSO study, which you can read more about on a separate tab on this page. Through histopathology data we are able to examine a range conditions, including cancer precursors, the brain-gut axis, disease phenotypes, etc. Our research has been published in journals such as the New Engl J Medicine, Lancet, JAMA, the BMJ, Annals of Internal Medicine, Gastroenterology and Gut.

Publications

All publications from group members

  • Editorial comment: CLINICAL EPIDEMIOLOGY. 2025;17:193-196
    Ludvigsson JF; Lashkariani M
  • Journal article: LANCET REGIONAL HEALTH-EUROPE. 2025;52:101264
    Chen J; Sun Y; Dan L; Wellens J; Yuan S; Yang H; Tong TYN; Cross AJ; Papadimitriou N; Meyer A; Dahm CC; Larsson SC; Wolk A; Ludvigsson JF; Tsilidis K; Giovannucci E; Satsangi J; Wang X; Theodoratou E; Chan SSM; Li X; EPIC Investigators
  • Article: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. 2025;60(4):343-348
    Olsson N; Bergman D; Sun J; Carlson M; Uchida AM; Ludvigsson JF
  • Article: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. 2025;60(4):349-354
    Everhov AH; Eberhardson M; Soderling J; Nordenvall C; Halfvarson J; Ludvigsson JF; Olen O; Myrelid P; SWIBREG Study Grp H; Strid H; Hjortswang H; Olsson M; Bengtsson JL; Andersson MA; Karling P; Rejler M; Jaghult S; Fagerberg UL; Marild K; Hreinsson J; Hedin C
  • Journal article: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. 2025
    Forss A; Hansson MR; Holmberg D; Thuresson M; Ebrahimi F; Elbe P; Klevebro F; Håkanson B; Thorell A; Ludvigsson JF
  • Article: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. 2025;:S1542-3565(25)00250-2
    Forss A; Hansson MR; Holmberg D; Thuresson M; Ebrahimi F; Elbe P; Klevebro F; Håkanson B; Thorell A; Ludvigsson JF
  • Journal article: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. 2025;:1-10
    Bröms G; Forss A; Eriksson J; Askling J; Eriksson C; Halfvarson J; Linder M; Sun J; Westerlund E; Ludvigsson JF; Olén O
  • Article: CIRCULATION-GENOMIC AND PRECISION MEDICINE. 2025;18(2):e004933
    Gagnon E; Gill D; Chabot D; Cronje HT; Yuan S; Brennan S; Theriault S; Burgess S; Arsenault BJ; Dib M-J
  • Article: INFLAMMATORY BOWEL DISEASES. 2025;:izaf077
    Khalili H; Forss A; Söderling J; Bröms G; Eriksson C; Sun J; Ludvigsson JF; Olén O
  • Review: EUROPEAN JOURNAL OF EPIDEMIOLOGY. 2025;:1-11
    Everhov AH; Frisell T; Osooli M; Brooke HL; Carlsen HK; Modig K; Marild K; Lindstrom J; Skoldin K; Heurgren M; Ludvigsson JF; Olen O
  • Article: AMERICAN JOURNAL OF GASTROENTEROLOGY. 2025
    Forss A; Bröms G; Bergman D; Thuresson M; Sun J; Eriksson C; Eriksson C; Olén O; Zöller B; Ludvigsson JF
  • Article: ALIMENTARY PHARMACOLOGY & THERAPEUTICS. 2025;:1649-1661
    Hjaelte V; Myrelid P; Hjortswang H; Rejler M; Ludvigsson JF; Forss A; Bendtsen M; Olen O; Everhov AH; Eberhardson M
  • Editorial comment: EUROPEAN HEART JOURNAL. 2025;:ehaf113
    Titova OE; Yuan S; Byberg L; Baron JA; Lind L; Michaelsson K; Larsson SC
  • Article: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM. 2025;:dgaf140
    Bergman D; Kang X; Sun J; Ebrahimi F; Ludvigsson JF
  • Article: AMERICAN JOURNAL OF NEPHROLOGY. 2025;:1-21
    Rehnberg J; Ludvigsson JF; Emilsson L
  • Article: NATURE COMMUNICATIONS. 2025;16(1):2481
    Yuan S; Chen J; Geng J; Zhao SS; Yarmolinsky J; Arkema EV; Abramowitz S; Levin MG; Tsilidis KK; Burgess S; Damrauer SM; Larsson SC
  • Article: CLINICAL GASTROENTEROLOGY AND HEPATOLOGY. 2025;:S1542-3565(25)00160-0
    Bergman D; Ebrahim F; Sun J; Maret-Ouda J; Lindkvist B; Peery A; Ludvigsson JF
  • Preprint: MEDRXIV. 2025
    Yuan S; Khodursky S; Geng J; Sharma P; Spin JM; Tsao P; Levin MG; Damrauer SM
  • Article: LANCET REGIONAL HEALTH-EUROPE. 2025;50:101201
    Yao J; Sun J; Ebrahimi F; Bergman D; Green PHR; Hagström H; Lebwohl B; Leffler DA; Ludvigsson JF
  • Conference publication: GASTROENTEROLOGY. 2025;166(5):S134
    Bergman D; Peery AF; Ebrahimi F; Sun J; Lindkvist B; Ludvigsson JF
  • Show more

Funding

Grants

  • Inflammatory bowel disease, inflammation and risk of cardiovascular disease
    Swedish Heart-Lung Foundation
  • Autism in Preterm Birth
    NICHD
  • Consensus Statements for the Use of Routinely Collected Health Data in Inflammatory Bowel Disease Research
    Canadian Institutes of Health Research
  • Swedish Research Council
  • Swedish Cancer Society
  • Inflammatory bowel disease and cancer risk - a moving target in an era of new immunomodulatory therapies
    Swedish Research Council
  • Swedish Research Council for Health Working Life and Welfare
  • Swedish Research Council
  • Council for International Exchange of Scholars
  • Swedish Research Council for Health Working Life and Welfare
  • Swedish Research Council
  • Swedish Research Council
  • Swedish Research Council

Staff and contact

Group leader

All members of the group

Visiting address

̽ѡ, Department of Medical Epidemiology and Biostatistics, Nobels väg 12A, Stockholm, 171 77, Sweden

Postal address

̽ѡ, Department of Medical Epidemiology and Biostatistics, PO Box 281, Stockholm, 171 77, Sweden

ESPRESSO

A cup of smoking hot espresso
Photo: Pavel Koubek, Icon Photography

Between 2015-17, all pathology departments (n=28) in Sweden were contacted to obtain histopathology record data from the GI tract (pharynx to anus), liver, gallbladder and pancreas. For each individual, local histopathology IT personnel retrieved data on personal identity number, date of histopathology, topography (where the biopsy was taken), morphology (biopsy appearance), and where available free text. In total, histopathology record data were available in 2.1 million individuals between 1965 and 2017, but the number of data entries (since many individuals had been biopsied more than once) was 6.1 million. A subset of records also contain the free text from the histopathology report. Index individuals with histopathology data have since been matched with up to five controls from the general population, and all first-degree relatives and spouses have been identified. In total, the study population consists of 13.0 million individuals. In 2021-2023, we collected new histopathology data from Sweden’s 28 pathology department. An updated version of ESPRESSO is expected in early 2024. We expect the new cohort to be 25% bigger than the current one (covering the years up until 2017).

Data from all study participants have been linked to Swedish National Healthcare Registers allowing research on such aspects as fetal and perinatal conditions and risk of future GI disease, but also risk of comorbidity, complications (including cancer) and death in GI disease. Furthermore, the ESPRESSO study enables researchers to identify diagnoses and disease phenotypes that are not currently indexed in national registers (including disease precursors), but also to increase sensitivity and specificity of already recorded diseases in the National Health Registers.

Combining topography and morphology codes allows researchers to identify specific diseases. ESPRESSO can also be used to identify unspecific findings in a particular location (for instance 893,117 unique individuals have a colorectal histopathology report; 179,110 have a liver histopathology report, and the database contains 492,413 unique individuals with a normal small intestinal mucosa).

If you wish to donate to our research, you are welcome to send your contribution by Swish to 123 202 32 08. Mark your donation with ESPRESSO. For larger donations (over 10,000 SEK) please contact KI Development Office.

Study personnel

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Jonas Ludvigsson

Professor

David Bergman

Postdoctoral Researcher

Fahim Ebrahimi

Postdoctoral Studies
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Jiangwei Sun

Assistant Professor
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Jialu Yao

Phd Student
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Bjorn Roelstraete

Affiliated to Research
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Mariam Lashkariani

System Developer
+46852482316
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Linn Austin

Administrator
+46852482417

Collaborators

Hamed Khalili

Collaborator

Associate Professor at Harvard Medical School and Crohn’s and Colitis Center, Massachusetts General Hospital

Research interest: As a gastroenterologist, I am dedicated to clinical and translational investigations of inflammatory bowel diseases. To date, my research has focused on understanding and defining environmental predictors, such as diet, reproductive, and lifestyle factors, and their interplay with common genetic risk loci and the gut microbial environment, on risk and progression of inflammatory bowel disorders.

Benjamin Lebwohl

Collaborator

Departments of Medicine and Epidemiology, Celiac Disease Center, Columbia University

I am a gastroenterologist and clinical researcher with a primary focus on celiac disease and gluten-related disorders. I have investigated risk factors, long-term outcomes, and practice patterns in celiac disease. I am also investigating the changing mortality risk in this condition over time. My secondary focus is on colorectal cancer prevention, with an emphasis on colonoscopy quality.

Tracey Simon

Collaborator

Department of Epidemiology, Harvard T.H. Chan School of Public Health

I am examining the association between commonly-used medications (aspirin, statins) and clinical outcomes in patients with biopsy-proven nonalcoholic fatty liver disease.

Kyle Staller

Collaborator

Department of Epidemiology, Harvard T.H. Chan School of Public Health

I am examining the relationship between irritable bowel syndrome (IBS) and outcomes more traditionally associated with non-functional GI disorders such as mortality.

Yin Cao, ScD, MPH

Collaborator

Associate Professor of Surgery and Medicine, Washington University School of Medicine in St Louis

I am a molecular cancer epidemiologist. My lab incorporates high-throughput technologies (genomics, proteomics, microbiome, accelerometers) into large-scale collaborative epidemiologic and clinical studies to identify emerging risk factors and novel biomarkers for early-onset cancers. 

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Anders Forss

Affiliated to Research
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Louise Emilsson

Associate Professor University of Oslo & Docent MEB, KI
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Soran Rabin Bozorg

Affiliated to Research

Funding

The ESPRESSO study is supported by:

  • The Swedish Research Council
  • Mag-Tarmfonden (the Gastrointestinal fund)
  • European Crohn's and Colitis Organization
  • Stiftelsen Professor Nanna Svartz Fond
  • The Swedish Society for Medical Research
  • Ruth and Richard Julin Foundation
  • The Swedish Society of Medicine (in general, through the Gastroenterologisk fond and Ihre Fonden). 

Publications


Simon TG, Roelstraete B, Hagström H, Loomba R, Ludvigsson JF
J Hepatol 2023 Dec;79(6):1366-1373


Ebrahimi F, Hagström H, Sun J, Bergman D, Shang Y, Yang W, Roelstraete B, Ludvigsson JF
J Hepatol 2023 Dec;79(6):1374-1384


Mårild K, Söderling J, Stephansson O, Axelrad J, Halfvarson J, , Bröms G, Marsal J, Olén O, Ludvigsson JF
Gastroenterology 2024 May;166(5):802-814.e18


Yuan S, Leffler D, Lebwohl B, Green PHR, Sun J, Carlsson S, Larsson SC, Ludvigsson JF
Diabetologia 2024 Aug;67(8):1630-1641


Bergman D, Roelstraete B, Sun J, Ebrahimi F, Butwicka A, Pardi DS, Ludvigsson JF
Am J Gastroenterol 2024 Jul;():


Ebrahimi F, Yao J, Hagström H, Stephansson O, Sun J, Bergman D, Söderling J, Ludvigsson JF
JAMA Netw Open 2024 Sep;7(9):e2432420


Sun J, Yao J, Olén O, Halfvarsson J, Bergman D, Ebrahimi F, Carlsson S, Ludvigsson J, Ludvigsson JF
Lancet Reg Health Eur 2024 Nov;46():101056


Emilsson L, Song M, Ludvigsson JF
Eur J Epidemiol 2023 Oct;38(10):1105-1114


Ebrahimi F, Simon TG, Hagström H, Söderling J, Wester A, Roelstraete B, Ludvigsson JF
Clin Gastroenterol Hepatol 2023 Dec;21(13):3346-3355.e19


Cao Y, Zhao S, Bexelius TS, Söderling J, Shi M, Roelstraete B, Warner BB, Stephansson O, Ludvigsson JF
EClinicalMedicine 2023 May;59():101963


Sharma R, Simon TG, Stephansson O, Verna EC, Emond J, Söderling J, Roelstraete B, Hagström H, Ludvigsson JF
Clin Gastroenterol Hepatol 2023 Jan;21(1):103-114.e10


Forss A, Clements M, Bergman D, Roelstraete B, Kaplan GG, Myrelid P, Halfvarson J, Olén O, Ludvigsson JF
Aliment Pharmacol Ther 2022 Mar;55(6):691-699


Bozorg SR, Söderling J, Everhov ÅH, Lebwohl B, Green PHR, Neovius M, Ludvigsson JF, Mårild K
Clin Gastroenterol Hepatol 2022 May;20(5):1068-1076.e6


Hagström H, Simon TG, Roelstraete B, Stephansson O, Söderling J, Ludvigsson JF
J Hepatol 2021 11;75(5):1042-1048


Simon TG, Roelstraete B, Hartjes K, Shah U, Khalili H, Arnell H, Ludvigsson JF
J Hepatol 2021 11;75(5):1034-1041


Bergman D, King J, Lebwohl B, Clements MS, Roelstraete B, Kaplan GG, Green PH, Murray JA, Ludvigsson JF
Gut 2022 Jun;71(6):1088-1094


Khalili H, Axelrad JE, Roelstraete B, Olén O, D'Amato M, Ludvigsson JF
Gastroenterology 2021 04;160(5):1599-1607.e5


Song M, Emilsson L, Roelstraete B, Ludvigsson JF
BMJ 2021 05;373():n877


Ludvigsson JF, Lashkariani M
Clin Epidemiol 2019 ;11():101-114

Please go to "documents" for the pdf version of the publication.

Documents

IBD Alliance

Inflammatory bowel disease (IBD) affects about 1% of the Swedish population. It is generally divided into ulcerative colitis (UC), Crohn’s disease (CD), and unspecified IBD (IBD-U). IBD has undergone major changes over time. While the mortality in the 1950s was 30-40%, new treatment has meant that death is now rare in IBD. Initial treatment was restricted to bowel surgery (especially colectomy), until steroids were introduced and later 5-ASA and thiopurines. Today, IBD is one of the most exciting areas for new treatments. TNF-blockers and other biologics have shown great effect. Also the interplay between microbiota and dietary intake yields promises (the NOD2 mutation plays an important role in Crohn’s disease and recognises bacterial peptides). In children enteral nutrition often has a substantial effect on disease activity, and fecal transplantation is a potential treatment.

The increased survival in IBD means that physicians more and more will have to focus on long-term complications such as colorectal cancer, lymphoma and opportunistic infections. Patients are followed by regular visits to physicians, dieticians, dedicated IBD nurses etc, and IBD-specific diagnostics include fecal calprotectin and endoscopy and increasingly ultrasound and magnetic resonance.

The Karolinska IBD Alliance was founded in 2014 with the aim to promote IBD research collaboration between preclinical researchers, epidemiologists and clinicians in the Stockholm region. The Alliance has had regular meetings but has also served as a reference for the public and for companies willing to engage in IBD. The alliance also aims to increase knowledge about IBD at ̽ѡ. 

Contact person and coordinator for the IBD Alliance network

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Jonas Ludvigsson

Professor

Participants

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Jiangwei Sun

Assistant Professor
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Anders Forss

Affiliated to Research
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Ola Olén

Adjunct Professor
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Annika Bergquist

Professor/Senior Physician

Natalia Mouratidou

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Charlotte Hedin

Adjunct Lecturer
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Jenny Mjösberg

Professor
+46852482917
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Sven Almer

Affiliated to Research
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Petter Malmborg

Affiliated to Research
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Henrik Arnell

Affiliated to Research
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Helena Jonsson Rolandsdotter

Affiliated to Research

Selected publications


Selin KA, Andersson S, Bilén K, Strid H, Björk J, Soop M, Bresso F, Hedin CRH
Eur J Gastroenterol Hepatol 2025 Feb;37(2):167-175


Malmquist M, Voghera S, , Berg S, Saalman R, Olén O
J Crohns Colitis 2025 Feb;19(2):


Mårild K, Söderling J, Stephansson O, Axelrad J, Halfvarson J, Bröms G, Marsal J, Neovius M, Pasternak B, Olén O, Ludvigsson JF, 
Am J Gastroenterol 2025 Jan;():


Sun J, Arnell H, Ludvigsson JF, Olén O
Lancet Child Adolesc Health 2024 Sep;8(9):e8


Sun J, Yao J, Olén O, Halfvarson J, Bergman D, Ebrahimi F, Rosengren A, Sundström J, Ludvigsson JF
Eur Heart J 2024 Jul;45(28):2493-2504


Söderman J, Almer S
Gastro Hep Adv 2024 ;3(5):618-633


van Munster KN, Bergquist A, Ponsioen CY
J Hepatol 2024 Jan;80(1):155-168


Wang K, Olén O, Emilsson L, Khalili H, Halfvarson J, Song M, Ludvigsson JF
Int J Cancer 2023 Jun;152(11):2303-2313


Kokkinou E, Soini T, Pandey RV, van Acker A, Theorell J, Czarnewski P, Kvedaraite E, Vandamme N, Lourda M, Sorini C, Weigel W, Carrasco A, Tibbitt CA, Schlums H, Lindforss U, Nordenvall C, Ljunggren M, Ideström M, Svensson M, Henter JI, Villablanca EJ, Bryceson YT, Rolandsdotter H, Mjösberg J
Cell Rep Med 2023 May;4(5):101038


Olén O, Smedby KE, Erichsen R, Pedersen L, Halfvarson J, Hallqvist-Everhov Å, Bryder N, , Askling J, Ekbom A, Sachs MC, Sørensen HT, Ludvigsson JF
Clin Gastroenterol Hepatol 2023 Apr;():


Sun J, Fang F, Olén O, Song M, Halfvarson J, Roelstraete B, Khalili H, Ludvigsson JF
PLoS Med 2023 Feb;20(2):e1004185


Moraes Holst L, Halfvarson J, Carlson M, Hedin C, Kruse R, Lindqvist CM, Bergemalm D, Almér S, Bresso F, Ling Lundström M, Repsilber D, D'Amato M, Keita Å, Hjortswang H, Söderholm J, Sundin J, Törnblom H, Simrén M, Strid H, Magnusson MK, Öhman L
Clin Exp Gastroenterol 2022 ;15():129-144


Villablanca EJ, Selin K, Hedin CRH
Nat Rev Gastroenterol Hepatol 2022 Aug;19(8):493-507


Malmborg P, Everhov ÅH, Söderling J, Ludvigsson JF, Bruze G, Olén O
Aliment Pharmacol Ther 2022 Sep;56(6):1007-1017


Kochar B, Jylhävä J, Söderling J, Ritchie CS, , Ludvigsson JF, Khalili H, Olén O
Clin Gastroenterol Hepatol 2022 Oct;20(10):2358-2365.e11


Kokkinou E, Pandey RV, Mazzurana L, Gutierrez-Perez I, Tibbitt CA, Weigel W, Soini T, Carrasco A, Rao A, Nagasawa M, Bal SM, Jangard M, Friberg D, Lindforss U, Nordenvall C, Ljunggren M, Haapaniemi S, Keita ÅV, Söderholm J, Hedin C, Spits H, Bryceson YT, Mjösberg J
Sci Immunol 2022 Apr;7(70):eabj8301


Mazzurana L, Czarnewski P, Jonsson V, Wigge L, Ringnér M, Williams TC, Ravindran A, Björklund ÅK, Säfholm J, Nilsson G, Dahlén SE, Orre AC, Al-Ameri M, Höög C, Hedin C, Szczegielniak S, Almer S, Mjösberg J
Cell Res 2021 May;31(5):554-568

Keywords:
Celiac Disease Colitis, Microscopic Eosinophilia Epidemiology Epidemiology Show all
Content reviewer:
Jonas Ludvigsson
Gunilla Sonnebring
21-03-2025