Browsing by Author "Amarasiri, W.A.D.L."

Now showing 1 - 13 of 13

The association between respiratory symptoms and gastro-oesophageal reflux events
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Amarasiri, W.A.D.L.; de Silva, H.J.; Ranasinha, C.
Introduction: The oesophagus and the airways have a common origin. Abnormal gastroooesophageal reflux (GOR) may predispose to genesis of respiratory symptoms. This association has not been reported previously in Sri Lanka. Aims: To describe the association between reflux events and respiratory symptoms in a cohort of adult asthmatics in Sri Lanka. Methods: 30 stable, mild asthmatics (American Thoracic Society criteria) underwent dual-sensor oesophageal pH monitoring. Respiratory symptoms (cough, wheeze, difficulty in breathing, chest tightness) experienced during monitoring were recorded. Respiratory symptoms were correlated with reflux events by reviewing diary events and oesophageal pH tracings. A reflux episode was defined as a drop in pH to values <4 lasting> 4 seconds. A respiratory symptom was considered as associated with a reflux episode if it occurred 2 minutes prior to or after a reflux episode. Results: 50% of the asthmatics complained of one or more respiratory symptoms during the 24- hour recording period. Of 102 respiratory symptoms recorded, 73 were cough, 23 were wheezing and 5 were episodes of chest tightness. None experienced difficulty in breathing. 93% of coughs, 81 % of wheezes and all episodes of chest tightness were reflux-associated. In most cases reflux episodes preceded respiratory symptoms. There was no statistically significant difference in any oesophageal monitoring parameter between asthmatics with and without respiratory symptoms. Conclusion: Asthmatics experience respira~ory symptoms during reflux events. The deve:lopment of respiratory symptoms during an episode of acid reflux or within 2 minutes thereafter suggests that it is probably GOR that triggers asthma.
Coconut fats
(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Dissanayake, A.S.
In many areas of Sri Lanka the coconut tree and its products have for centuries been an integral part of life, and it has come to be called the "Tree of life". However, in the last few decades, the relationship between coconut fats and health has been the subject of much debate and misinformation. Coconut fats account for 80% of the fat intake among Sri Lankans. Around 92% of these fats are saturated fats. This has lead to the belief that coconut fats are 'bad for health', particularly in relation to ischaemic heart disease. Yet most of the saturated fats in coconut are medium chain fatty acids whose properties and metabolism are different to those of animal origin. Medium chain fatty acids do not undergo degradation and re-esterification processes and are directly used in the body to produce energy. They are not as 'bad for health' as saturated fats. There is the need to clarify issues relating to intake of coconut fats and health, more particularly for populations that still depend on coconut fats for much of their fat intake. This paper describes the metabolism of coconut fats and its potential benefits, and attempts to highlight its benefits to remove certain misconceptions regarding its use.
Gastric motility following ingestion of a solid meal in a cohort of adult asthmatics
(The Korean Society of Neurogastroenterology and Motility, 2013) Amarasiri, W.A.D.L.; Pathmeswaran, A.; de Silva, A.P.; Dassanayake, A.S.; Ranasinha, C.D.; de Silva, H.J.
BACKGROUND/AIMS: Asthmatics have abnormal esophageal motility and increased prevalence of gastroesophageal reflux disease (GERD). The contribution of gastric motility is less studied. We studied gastric myoelectrical activity, gastric emptying (GE) and their association with GERD symptoms and vagal function in adult asthmatics. METHODS: Thirty mild, stable asthmatics and 30 healthy controls underwent real-time ultrasonography and 1 hour pre- and post-prandial cutaneous electrogastrography, following a test meal (480 kcal, 60% carbohydrate, 20% protein, 20% fat and 200 mL water). The percentage of normal slow waves and arrhythmias, dominant frequency and power, frequency of antral contractions, gastric emptying rate (GER) and antralmotility index (MI) was calculated. Twenty-seven asthmatics underwent gastroscopy and in all subjects GERD symptoms were assessed by a validated questionnaire. Vagal function parameters were correlated with gastric motility parameters. RESULTS: The asthmatics (37% male; 34.8 ± 8.4 years) and controls (50% male; 30.9 ± 7.7 years) were comparable. None had endoscopicgastric pathological changes. Twenty asthmatics described GERD symptoms. Twenty-two (73.3%) asthmatics showed a hypervagal response. Compared to controls, asthmatics had delayed GER and lower MI, lower percentage of normal gastric slow waves, more gastric dysrythmias and failed to increase the post-prandial dominant power. There was no correlation of GE and cutaneous electrogastrography parameters with presence of GERD symptoms or with vagal function. CONCLUSIONS: Asthmatics showed abnormal gastric myoelectrical activity, delayed GE and antral hypomotility in response to a solid mealcompared to controls. There was no association with vagal function or GERD symptom status
Hypersensitivity pneumonitis associated with Red-Vented Bulbul: a new encounter of bird related hypersensitivity pneumonitis.
(Hindawi Pub. Corp., 2019) Amarasinghe, W.D.N.L.; Jayasekara, R.; Jayamanne, B.D.W.; Nalaka, T.D.K.; Amarasiri, W.A.D.L.; Punchihewa, R.; Fernando, A.
Bird related hypersensitivity pneumonitis (HP) is becoming more common than other forms of HP around the world. We present two cases of HP, associated with exposure to visiting birds which had nested within their homes in semi urban areas of Colombo, Sri Lanka. A 65-year-old female (case 1) and a 61-year-old male (case 2) presented to the chest clinic complaining of gradually progressive and persistent chronic dry cough and dyspnoea during the year 2018. Both were found to have close contact with red-vented bulbuls (Konda kurulla) in their homes for more than 6 months prior to onset of symptoms and denied any other risk exposures in detail history taking. In both patients, high-resolution computed tomography chest (HRCT) showed centrilobular nodules of ground glass density with significant lobular air trapping. Video-assisted thoracoscopic (VATs) lung biopsy of case 1 showed patchy and focal interstitial thickening with lymphocytic infiltrate, minimal fibrosis, and few noncaseating granulomata within the interstitium. Transbronchial lung biopsy of case 2 showed thickened alveolar septae with lympho-histiocytic infiltrate and occasional neutrophils and eosinopils. Both showed severe reduction in forced vital capacity (FVC) at presentation. Multidisciplinary diagnosis of HP associated with red-vented bulbuls was made. Both achieved good improvement in clinical, lung function, and radiological assessment following removal of offending antigen exposure and treatment with oral corticosteroids.
Liquid gastric emptying and antral motility in adult asthmatics
(University of Kelaniya, 2008) Amarasiri, W.A.D.L.; de Silva, H.J.; Ranasinghe, C.P.
Introduction: Asthmatics have increased prevalence of gastro-oesophageal reflux disease (GERD). Gastric antral hypomotility may contribute to this. Gastric motility has been little studied in asthma. Objective: To study gastric emptying (GE) of a liquid meal in adult asthmatics and investigate association with GERD symptoms and autonomic functions. Method: GE response to 200mL of chicken soup (54kJ, 15% protein, 30% fat and 65% carbohydrate) was assessed by real time ultrasonography in 30 stable, mild asthmatics (diagnosed according to American Thoracic Society Criteria) and 30 healthy controls. Percentage emptying at 15 minutes (GER%) and antral motility index were measured. Symptomatic GERD was assessed by a validated questionnaire, and autonomic nervous function by blood pressure and heart rate response to standing and deep breathing and the Valsalva maneuver. Results: The asthmatics (15 males, age (mean ± SD) 34.7 ± 8.4) and controls were comparable in age, gender and body mass index. On autonomic function assessment, 3 asthmatics showed hypervagal response, 2 showed reduced vagal response but none showed a hyperadrenergic response. They were only on inhaled ��-agonists as required. Although, 20 asthmatics had symptomatic GERD, none had endoscopic gastric pathology. Compared to controls, asthmatics had significantly delayed GER% (mean ± SD 55.4±14.4 versus 64.0±13.5, p=0.036) and lower antral motility index (mean ± SD 4.9±1.5 versus 6.4±1.4, p=
Lung Functions and Airway Inflammatory Markers during Different Phases of Menstrual Cycle in Asthmatic and Healthy Females of Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Atukorala, K.R.; Fernando, D.M.S.; Silva, W.A.N.Y.; Amarasiri, W.A.D.L.
Background & objectives: Sex hormones affect lung functions by different mechanisms. Thus the status of asthma is known to vary during menstrual cycle but conclusions drawn are divergent. We aimed to assess lung function and airway inflammatory markers; Fractional exhaled breath Nitric oxide (FeNO) and blood eosinophil count (EC) during different phases of menstrual cycle in healthy females and stable asthmatics. Methods: Healthy females (n=39) and asthmatics (n=26) with regular menstrual cycles were recruited after informed consent. Lung function variables FEV1, FVC, PEF and FeNO, EC were measured during menstruation, follicular and luteal phases. Results: Mean age of asthmatics and healthy women were 22.38(±1.44) years and 22.36(± 1.33) years respectively. The mean PEF, FEV1, FEV1% were lower in asthmatics (p< 0.05). FEV1, FVC positively correlated with height in both asthmatics (r=.43, p=0.028), (r=0.519, p=0.007) and in healthy females (r=0.458, p=0.003), (r=0.501 p= 0.001). In asthmatics BMI correlated positively with FEV1 (in menstrual and follicular phases), FVC, PEF, EC (in all phases). BMI correlated negatively with FEV1%. In normal girls BMI correlated positively with FEV1, FVC, (r =0.317, p=0.049 at follicular phase), PEF of all phases. BMI correlated negatively with FEV1% (r= -0.411, p=0.009 at follicular phase). In healthy females highest mean FEV1 (2.467±.41) L and FVC (2.73±.4390) L were during luteal phase while lowest FEV1 (2.462±.38) L and FVC (2.71L±.438) were obtained during follicular phase. In asthmatics the highest mean FEV1 was recorded in follicular phase (2.305L±.3018) while lowest was recorded in luteal phase (2.2904±0.308) L. Asthmatics had higher FeNO level compared to controls (p<0.001). In both groups, mean FeNO level was highest in luteal phase (42.19±36.8) ppb vs (21.15 ± 17.362) ppb; In asthmatics, highest mean EC was in luteal phase (0.40x109/Liter±.258) while lowest was seen in menstrual phase (0.33±.15). FeNO level correlated positively with EC on all phases in both groups. In asthmatics EC correlated positively with PEF at menstrual and follicular phases but negatively at luteal phase. FeNO correlated negatively with PEF at follicular and luteal phases and with FEV1 during all three phases. In normal females, FeNO correlated negatively with PEF in all three phases. FeNO correlated negatively with FEV1 at follicular phases and positively at other phases. However, no statistically significant variation in lung function variables, FeNO nor EC was observed in either group in the course of menstruation. Conclusions: FeNO and EC changes parallel through the phases of menstrual cycle in both asthmatics and in healthy individuals. Changes in PEF, FEV1, FEV1% appear to follow a distinct pattern innormal women and asthmatics. Future prospects: Role of reproductive hormones in mediating inflammatory changes in the lungs needs to be elucidated.
Oesophageal dysfunction in asthmatics
(Sri Lanka Medical Association, 2010) Amarasiri, W.A.D.L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, H.J.
INTRODUCTION: Gastro-oesophageal reflux (GOR) predisposes to respiratory symptoms through reflex vagal activity. Asthmatics have oesophageal hypomotility and vagal hyperactivity. Whether this oesophageal hypomotility is primary or secondary to damage from GOR is unclear. METHODS: 30 mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory oesophageal pH monitoring, manometry, autonomic function testing and GORD symptom assessment and gastroscopy. A vagal score using 3 tests (valsalva manouvre, heart rate response to deep breathing and to standing from supine position) was correlated with oesophageal function parameters. Respiratory symptoms during pH monitoring were correlated with reflux events. RESULTS: Asthmatics (mean age 34,8y; 60% female) had more frequent GORD symptoms than controls (mean age 30.9y; 50% female). 10/27 asthmatics had oesophageal mucosal damage, 22/30 showed hypervagal response, none had a hyperadrenergic response. 14/30 asthmatics had ineffective oesophageal motility. Higher GOR-score asthmatics had significantly fewer peristaltic contractions and more simultaneous contractions than controls, and higher oesophageal.acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls. There was no correlation of vagal function with oesophageal function parameters. 50% of the asthmatics complained of respiratory symptoms during pH monitoring, and reflux episodes usually preceded respiratory symptoms. CONCLUSION: Asthmatics have abnormal oesophageal motility and pathological GOR which usually precede respiratory symptoms. There was no vagal dysfunction, and the vagal function score did not correlate with oesophageal motility parameters. Peristaltic dysfunction may be secondary to damage due to gastro-oesophageal reflux.
Prevalence of asthma and its symptoms in Sri Lankan adults.
(BioMed Central, London, 2022) Gunasekera, K.D.; Amarasiri, W.A.D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Perera, B.P.R.; Wickremasinghe, A.R.
BACKGROUND: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and its symptoms in adult Sri Lankans. METHODS: A cross-sectional study using a translated version of the European Community Respiratory Health Survey screening questionnaire on subjects ≥ 18 years from 7 provinces in Sri Lanka was conducted. The asthma was defined as "wheezing in the past 12 months (current wheeze)", self-reported asthma attack in the past 12 months or on current asthma medication use. RESULTS: Among 1872 subjects (45.1% males, 48.8% between 18-44 years of age), the prevalence of current wheeze was 23.9% (95%CI: 22.0%-25.9%), self-reported asthma was 11.8% (95%CI: 10.3%-13.2%) and current asthma medication use was 11.1% (95% CI: 9.6%-12.5%). The prevalences were higher in adults > 44 years, 31.4% positively responded to any of the above questions (95%CI: 29.3%-33.4%) and 60.9% of current wheezers did not report having asthma whilst 38.2% used asthma medication. Among current wheezers, 80.1% had at least one other symptom, cough being the commonest. Those with no current wheeze, self-reported asthma and on current asthma medication use, 30%, 35.9% and 36.6%, respectively, reported at least one other symptom. Smokers comprises 22% current wheezers, 20.6% of self-reported asthmatics and 18.7% of current asthma medication users. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is higher than the other South Asian countries and higher in the older age group. A significant percentage of symptomatic individuals did not report having asthma or being on medication.
The relationship between asthma and gastro-oesophageal reflux disease(GORD) in a Sri Lankan population
(University of Kelaniya, 2009) Amarasiri, W.A.D.L.
Gastro-oesophageal Reflux Disease (GORD) predisposes to asthma-like respiratory disease through several mechanisms all of which are thought to be vagally mediated. This study attempted to extend the current understanding of the relationship between GORD and asthma by investigating the prevalence of GORD symptoms, prevalence of upper gastrointestinal motility abnormalities and possible mechanisms of GORD-induced asthma in a group of adults with mild clinically stable asthma in Sri Lanka. The prevalence of GOR symptoms using an interviewer administered GORD questionnaire was 59.4 % in Sri Lankan adult asthmatics. The frequency and severity of GOR symptoms were higher and reflux associated respiratory symptoms were more prevalent in asthmatics when compared to non asthmatics. The severity of asthma showed a strong dose-response effect on the presence of GORD symptoms in asthmatics, though the use of asthma medication did not significantly influence the presence of GORD symptoms. This study reports the development and validation of the first interviewer administered GORD-specific questionnaire in Sri Lanka. This could be used as a case-finding tool in epidemiological studies and be used to assess the response of individuals to treatment. A GORD symptom score using both symptom frequency and severity was found to correlate better with an objective measure of GORD. Using stationary oesophageal manometry and twenty four hour ambulatory pH monitoring, this study demonstrated that asthmatics have abnormal oesophageal motility and increased gastro-oesophageal reflux compared to non-asthmatic healthy volunteers. Asthmatic were seen to have more proximal oesophageal reflux and experience reflux-associated respiratory symptoms, and in most instances, reflux episodes preceded the respiratory symptoms. The presence or severity of GORD symptoms or oesophagitis did not influence the abnormal oesophageal function parameters. Using cutaneous electrogastrography and real-time ultrasonography, this study gives the first report on gastric myoelectrical activity and gastric emptying in asthmatics. Asthmatics have more gastric myoelectrical abnormalities, a significantly lower percentage of gastric emptying and impaired antral mortility in response to both solid and liquid meals compared to non-asthmic healthy volunteers. The antral mortility index and gastric emptying rate of a liquid meal was positively correlated with lower oesophageal sphincter tone in asmatics supporting the theory that delayed gastric emptying and impaired antral mortility induces reflux. Asthmatics with higher GORD symptom scores had lower gastric emptying rates and more abnormal mortility in response to the solid meal. Finally, this study reports the first demonstration of vagal function following intra-oesophageal acid infusion in asthmatics. Asthmatics demonstrated a higher vagal response and a concomitant bronchoconstrictive response to artificially infused oesophageal acid when compared to infusion of normal saline, irrespestive of reflux state.
The relationship betweena asthma and gastro-oesophageal reflux disease (GORD) in Sri Lankan population
(2009) Amarasiri, W.A.D.L.
Spirometry reference norms for 13-14 year old Sri Lankan children
(Sri lanka Medical Association, 2015) Gunasekera, K.D.; Amarasiri, W.A.D.L.; Fernando, E.A.C.; Warnakulesuriya, D.T.D.; Undugodage, U.C.M.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: Reference norms have only been reported for Peak Expiratory Flow Rate (PEFR) in Sri Lankan children. The aim of this study was to construct prediction equations for spirometry in Sri Lankan children aged 13-14 years. METHOD: Spirometry was performed in 2078 Sri Lankan healthy children (1023 boys (49.2%) and 1055 (50.8%) girls) of 13-14 years of age according to American Thoracic Society guidelines. Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEVi), PEFR and Forced Mid-Expiratory Flow Rates (FEF25-75%) were measured. Correlation coefficients were established between each parameter and standing height, weight, and age. The functions were regressed over all possible combinations of variables separately for boys and girls. RESULTS: There were significant correlations between spirometry parameters and height and weight in both genders. There were significant correlations between age and PEFR, FEF25 and FEF50 in males and age and FEVi, PEF and FEF25-75% in females. The prediction equations in males for FVC: 0.047 height + 0.0007 age - 4.66; for FEVi: 0.041 height + 0.016 age - 4.22; for PEFR: 0.074 height + 0.123 age - 7.59 and FEF25-75%: 0.042 height -i-0.066 age-4.36. The equations in females for FVC: 0.028 height + 0.031 age - 2.36; for FEVi: 0.027 height + 0.047 age - 2.57; for PEFR: 0.038 height + 0.159 age - 2.93 and FEF25-75%: 0.029 height + 0.136 age-3.18. CONCLUSION: Height, weight and age influence ventilatory parameters and could be used to formulate prediction equations for spirometry in Sri Lankan children.
Validation of a Gastro-oesophageal Reflux Disease (GERD) Specific Screening Instrument for Epidemiological Purposes
(University of Kelaniya, 2007) Amarasiri, W.A.D.L.; Pathmeswaran, A.; Ranasinha, C.; de Silva, H.J.
Introduction: The prevalence of GERD is increasing worldwide: the community prevalence in Sri Lanka is not known. Objectives : To develop a practical clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. Methodology : 100 patients (endoscopy positive - which included patients with all grades of oesophagitis) and 150 controls (comparable in age and gender) faced a GERDspecific interviewer-administered questionnaire assessing seven upper gastro-intestinal symptoms. Each symptom was graded using Likert scales for frequency (4-items) and severity (5-items) and two scores were generated. Score 1 being the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each. All patients then underwent 24-h ambulatory pHmetry. Both symptom scores were compared against 24-h pHmetry parameters as it is considered the gold standard to diagnose GERD. Cut-off values were determined by receiver-operating characteristic curves. Results : For both scores, mean scores of cases were significantly higher than controls (p=O.OOO). The cut-off score for score 1 was 2': 10.50 (sensitivity 92.0 %; specificity 78.7 %; area under the curve- 0.937). The cut-off score for score 2 was 2': 12.50 (sensitivity 90.0%; specificity 78.0%; area under the curve - 0.929). Both showed high reproducibility (Intra class correlation coefficient score1: 0.94 and score2: 0.82). There was good correlation between both symptom scores and 24-h pHmetry parameters (Spearman rank correlation, p=0.01), but score 2 showed a significantly better correlation. Conclusion: Our GERD questionnaire is valid, reproducible and showed better correlation with an objective test when both severity and frequency of symptoms were scored than frequency alone.
Validation of a gastro-oesophageal reflux disease (GERD) specific screening instrument for epidemiological purposes
(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Ranasinghe, C.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: The prevalence of GERD is increasing worldwide; its community prevalence in Sri Lanka is unknown. AIMS: To develop a clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. METHODOLOGY: 58 GERD patients (endoscopy positive) and 60 controls (matched for age and gender) were given a GERD-specific interviewer-administered questionnaire assessing seven upper gastrointestinal symptoms. Each symptom was graded using Likert scales for frequency (4-items) and severity (5-items), and two scores were generated. Score 1 was the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each symptom. The patients then underwent oesophageal manometry and 24h pHmetry. Cut-off values were determined by constructing receiver-operating characteristic curves. RESULTS: For both scoring systems, mean scores of cases were significantly higher than controls (p=0.000). The cut-off for score 1 was > 11.50 (sensitivity 91.4%, specificity 85%, positive and negative predictive values 83.29% and 92.34%). The cut-off for score 2 was > 12.50 (sensitivity 96.6%, specificity 80%, positive and negative predictive values 81.06% and 92.32%). Both scores showed high reproducibility (intra class correlation coefficient scorel=0.94 and score 2=0.82). There was good correlation between both scores and 24-h pH parameters (Spearman rank correlation, p=0.01), but score 2 was significantly better. CONCLUSION: Our GERD questionnaire is valid, reproducible and showed better correlation with an objective test when both severity and frequency of symptoms were scored rather than frequency alone.