Browsing by Author "Amarasiri, D.L."

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Comparison of a composite symptom score assessing both symptom frequency and severity with a score that assesses frequency alone: a preliminary study to develop a practical symptom score to detect gastro-oesophageal reflux disease in a resource-poor setting
(Lippincott Williams And Wilkins, 2010) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, A.P.; Dassanayake, A.S.; Ranasinha, C.D.; de Silva, H.J.
BACKGROUND: There is a need for a practical instrument to screen for gastro-oesophageal reflux disease (GORD) in epidemiological studies. OBJECTIVES: To develop a practical score to detect GORD and compare assessment of both symptom frequency and severity with frequency alone. METHODS: One hundred patients with upper gastrointestinal symptoms and 150 volunteers with no such past history faced an interviewer-administered questionnaire assessing seven symptoms, graded for frequency and severity. Two scores were generated. Score 1, the sum of frequency of symptoms and score 2, the sum of products of frequency and severity of each. Internal consistency, test-retest reliability and criterion validity against 24-h pH monitoring were assessed. Cut-off scores were generated by receiver operating characteristic curves using scores of half the volunteers and patients selected randomly and validated on the other half. RESULTS: Cut-off scores and area under the curve for score 1 were >/=10.5 and 0.93, and score 2 were >/=12.5 and 0.93, respectively. The sensitivity and specificity of diagnosing the disease in the remaining participants using score 1 was 89.7 and 92.4% and score 2 was 93.8 and 94.0%, respectively. The instrument had good internal consistency (Cronbach alpha = 0.73) and reliability (intraclass correlation coefficient of scores 1 and 2 were 0.94 and 0.95, respectively). Score 2 showed better correlation with 24-h pH monitoring parameters (Spearman's rank correlation, P = 0.01). CONCLUSION: Our score is valid, reliable and can detect GORD with high sensitivity and specificity. A score assessing both frequency and severity of symptoms correlates better to an objective measure of GORD.
Esophageal motility, vagal function and gastroesophageal reflux in a cohort of adult asthmatics
(BioMed Central, 2012) Amarasiri, D.L.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Ranasinha, C.D.; de Silva, H.J.
BACKGROUND: Asthmatics are known to have esophageal hypomotility. Vagal hypofunction and prolonged intra-esophageal acidification cause esophageal hypomotility. The contribution of gastroesophageal reflux (GER) and vagal function to esophageal motility in asthmatics is unclear. We studied the relationship between esophageal motility, GER and vagal function in a cohort of adult asthmatics. METHODS: Thirty mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory esophageal monitoring, manometry, autonomic function testing and GER symptom assessment. 27 asthmatics underwent gastroscopy. A vagal function score calculated from 3 tests (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) was correlated with esophageal function parameters. RESULTS: Asthmatics (mean age 34.8 (SD 8.4), 60% female) had more frequent GERD symptoms than controls (mean age 30.9 (SD 7.7), 50% female). 10/27 asthmatics had esophageal mucosal damage, 22 showed hypervagal response, none had a hyperadrenergic response. 14 asthmatics had ineffective esophageal motility. Higher GERD-score asthmatics had significantly fewer peristaltic and more simultaneous contractions than controls, and higher esophageal acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls (p < 0.001, Mann-Whitney U test). There was no correlation between vagal function score and esophageal function parameters. CONCLUSIONS: A cohort of adult asthmatics was found to have peristaltic dysfunction and pathological GER, but otherwise normal esophageal motility. The peristaltic dysfunction seems to be associated with vagal hyperreactivity rather than vagal hypofunction
One-hour fast for water and six-hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort
(Wiley-Blackwell, 2009) de Silva, A.P.; Amarasiri, D.L.; Liyanage, M.N.; Kottahachchi, D.; Dassanayake, A.S.; de Silva, H.J.
BACKGROUND AND AIM: Current guidelines for upper gastrointestinal endoscopy (UGIE) advise at least 6-8 h fasting for solids and 4-h fasting for liquids. We aimed to determine whether a 6-h fast for solids and one-hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. METHODS: 128 patients referred for UGIE were given a standard meal 6 h before endoscopy, and then randomized to either nil by mouth for 6 h (group A, n = 65) or allowed to drink water for up to one hour prior to endoscopy (group B, n = 63). Before endoscopy patients were requested to indicate discomfort due to fasting on a visual analog scale. Fluid in the gastric fundus was aspirated, when present, for volume and pH measurements, and endoscopic vision was graded. RESULTS: 53 patients in group A and 43 patients in group B completed the study. Discomfort was significantly lower in group B than group A (P < 0.0001). Endoscopic vision was good in all 53 patients in group A and 40 in group B, and average in 3 patients in group B. Fluid in the gastric fundus was noted in 11 patients in group A and 16 in group B, but there were no significant differences in volume or pH between groups. There were no complications attributable to endoscopy in either group. CONCLUSIONS: A 6-h fast for solids and a 1-h fast for water prior to UGIE gives good endoscopic vision, and causes minimum patient discomfort.
The Prevalence of asthma in Sri Lankan adults
((Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Wickremasinghe, A.R.; Gunasekera, K.D.
BACKGROUND AND AIMS: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and related symptoms amongst adults in the general population. METHODS: A multi-centered, cross-sectional study was conducted using an interviewer-administered translated version of the screening questionnaire of the European Community Respiratory Health Survey from June to December 2013 in 7 provinces of Sri Lanka. Subjects were selected randomly from different regions by stratified sampling. The prevalence of asthma was defined as "wheezing in the past 12 months (current wheeze)", 'self-reported attack of asthma in the past 12 months' or 'current asthma medication use'. RESULTS: The study comprised 1872 subjects (45.1% males, 48.8% aged18-45 years) of which 12.2% were current smokers. In the total population, the prevalence of current wheeze was 23.9% (95% CI: 22.0%-25.9%), of self-reported asthma was 11.8% (95% CI: 10.3%- 13.2%) and of current asthma medication use was 11.1% (95% CI: 9.6%- 12.5%). The prevalence of asthma according to a positive response to either of the above questions was 31.4% (95% CI: 29.3%-33.4%) The prevalence of symptoms was higher in adults aged >45 years. Of those with current wheeze, 60.9% denied a diagnosis of asthma and only 38.2% admitted to use of asthma medication. In those with current wheeze, wheezing was the only symptom in 19.9% whereas 80.1% had at least one other respiratory symptom (tightness of chest, cough or shortness of breath) of which cough was the most common symptom. In those without current wheeze, self-reported asthma and current asthma medication use, 30%, 35.9% and 36.6% respectively had at least one other respiratory symptom. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is high in comparison with global data. A significant percentage of symptomatic individuals deny having asthma and are not on medication.
Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma
(BioMed Central, 2010) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, H.J.; Ranasinha, C.D.
BACKGROUND: Gastro-oesophageal reflux disease (GORD) symptoms are common in asthma and have been extensively studied, but less so in the Asian continent. Reflux-associated respiratory symptoms (RARS) have, in contrast, been little-studied globally. We report the prevalence of GORD symptoms and RARS in adult asthmatics, and their association with asthma severity and medication use. METHODS: A cross-sectional analytical study. A validated interviewer-administered GORD scale was used to assess frequency and severity of seven GORD symptoms. Subjects were consecutive asthmatics attending medical clinics. Controls were matched subjects without respiratory symptoms. RESULTS: The mean (SD) composite GORD symptom score of asthmatics was significantly higher than controls (21.8 (17.2) versus 12.0 (7.6); P < 0.001) as was frequency of each symptom and RARS. Prevalence of GORD symptoms in asthmatics was 59.4% (95% CI, 59.1%-59.6%) versus 28.5% in controls (95% CI, 29.0% - 29.4%). 36% of asthmatics experienced respiratory symptoms in association with both typical and atypical GORD symptoms, compared to 10% of controls (P < 0.001). An asthmatic had a 3.5 times higher risk of experiencing a GORD symptom after adjusting for confounders (OR 3.5; 95% CI 2.5-5.3). Severity of asthma had a strong dose-response relationship with GORD symptoms. Asthma medication use did not significantly influence the presence of GORD symptoms. CONCLUSIONS: GORD symptoms and RARS were more prevalent in a cohort of Sri Lankan adult asthmatics compared to non-asthmatics. Increased prevalence of RARS is associated with both typical and atypical symptoms of GORD. Asthma disease and its severity, but not asthma medication, appear to influence presence of GORD symptoms
The prevalence of upper respiratory symptoms in a cohort of adults presenting with symptoms of gastro-oesophageal reflux disease
(Sri Lanka Medical Association, 2016) Amarasiri, D.L.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Adikari, M.D.B.; Sanjeewa, P.A.B.; Jayaratne, A.; de Silva, H.J.
INTRODUCTION: Gastro-oesophageal reflux disease (GORD) is the pathological reflux of gastric contents into the oesophagus. The oesophagus and the upper respiratory tract have a common origin from the foregut. There is increasing evidence for multiple associations of GORD with the upper respiratory tract. OBJECTIVES: To study the presence of and association of upper respiratory symptoms (URS) with GORD. METHODS: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent GORD symptoms or no upper gastro-intestinal complaints completed a pre-tested URS questionnaire on the frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent upper gastro-intestinal endoscopy. The calculated URS score was correlated against the GORD symptom score and endoscopy findings. RESULTS: URS scores and individual symptom scores were higher in GORD patients compared to controls (mean ± SE, 4.7 ± 4.0; 1.9 ± 2.3). Individuals with higher GORD symptom scores reported more frequent URS. Pharyngeal symptoms had the highest correlation with the GORD symptom score (r=0.507, p<0.001). The presence of oeso-phagitis did not seem to influence the frequency of reporting URS. CONCLUSION: Upper respiratory symptoms are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damage.
Response of the airways and autonomic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study
(BioMed Central, 2013) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, H.J.; Ranasinha, C.D.
BACKGROUND: Gastro-esophageal reflux disease (GERD) predisposes to airway disease through a vagally-mediated esophago-bronchial reflex. This study investigates this vagal response to esophageal acid perfusion. METHODS: 40 asthmatics with mild stable asthma participated. Each subject underwent spirometry and autonomic function testing (valsalva maneuver, heart rate response to deep breathing and to standing from supine position) four times: a) before intubation, b) after intubation, and then immediately after perfusion with, in random order, c) concentrated lime juice solution (pH 2--3) and d) 0.9% saline. Subjects were blinded to the solution perfused. RESULTS: Asthmatics were of mean (SD) age 34.3 years (1.3), and 67.5% of them were females. pH monitoring demonstrated that 20 subjects had abnormal reflux and 20 did not. In each group 10 subjects had a positive GERD symptom score. Following perfusion with acidcompared to saline, all subjects showed significant decreases in FEV1 and PEFR and significant increases in the mean valsalva ratio and heart rate difference on deep breathing from baseline values, but no changes in FVC or heart rate ratio on standing. There were no significant differences in any of the parameters between subjects with and without reflux. CONCLUSIONS: Acid stimulation of the distal esophagus results in increased parasympathetic activity and concomitant broncho-constriction in asthmatics irrespective of their reflux state. This strengthens the hypothesis that GER triggers asthma-like symptoms through a vagally mediated esophago-bronchial reflex and encourages a possible role for anti-cholinergic drugs in the treatment of reflux-associated asthma
Rhinitis and asthma: it's one airway after all
(Medicine Today Pty Limited, 2006) Amarasiri, D.L.; Douglass, J.
The concept of `united airways disease - that allergic asthma and rhinitis are manifestations of a single inflammatory airways disease - is supported by laboratory and epidemiological studies and by treatment responses
Spirometry reference norms for 13-14 year old Sri Lankan children.
(Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Warnakulasuriya, D.T.; Wickremasinghe, A.R.; Gunasekera, K.D.;
BACKGROUND AND AIMS: Spirometry 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. METHODS: Spirometry was performed in 2078 healthy 13-14 year old Sri Lankan children (1023 boys (49.2%) and 1055 (50.8%) girls) according to American Thoracic Society guidelines. Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), 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 FEV1, PEF and FEF25-75% in females. The prediction equations in males for FVC: 0.047height + 0.0007age- 4.66; for FEV1: 0.041height + 0.016age - 4.22; for PEFR: 0.074height + 0.123age - 7.59 and FEF25- 75%: 0.042height + 0.066 age - 4.36. The equations in females for FVC: 0.028height + 0.031age - 2.36; for FEV1: 0.027height + 0.047age - 2.57; for PEFR: 0.038height + 0.159age - 2.93 and FEF25-75%: 0.02height + 0.136age - 3.18. CONCLUSIONS: Height and age influence ventilatory parameters and could be used to assess lung functions in Sri Lankan children.
Upper respiratory symptoms are common in a cohort of patients with symptomatic gastrooesophageal reflux disease (GORD) in Sri Lanka
(Wiley Blackwell Scientific Publications, 2011) Amarasiri, D.L.; Adikari, D.; Sanjeewa, B.; Jayaratne, A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: There is increasing evidence for multiple associations between gastro-oesophageal reflux disease (GORD) and the upper respiratory tract. This study evaluated the presence of upper respiratory symptoms (URS) in a cohort of patients with GORD symptoms from Sri Lanka. METHOD: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent or no GORD symptoms completed a pre-tested, valid URS questionnaire. They were questioned on frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent gastroscopy. An URS score was calculated and correlated against the GORD symptom score and gastroscopy fi ndings. RESULTS : The GORD patients (median age (range) 36 (15–65); 38% males) and controls (median age (range) 38 (15–68); 38% males) were comparable. URS scores were higher in GORD patients (mean ± SE, 4.7 ± 4.0) compared to controls (mean ± SE, 1.9 ± 2.3), as were individual symptom scores. Individuals with higher GORD symptoms scores reported more frequent URS. Nasal symptoms had the highest correlation with the GORD symptom score (r = 0.410; P = 0.001). of the GORD patients, 42 had no evidence of oesophageal or gastric mucosal damage. 28 had evidence of refl ux oesophagitis. In them, the presence of oesophagitis did not seem to influence the frequency of reporting URS. CONCLUSION : URS are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damage
Use of ambulatory oesophageal pH monitoring to diagnose gastrooesophageal reflux disease
(Sri Lanka Medical Association, 2007) Ferdinandis, T.G.H.C.; Amarasiri, D.L.; de Silva, H.J.
OBJECTIVES: To investigate the characteristics of patients referred for ambulatory oesophageal pHmetry, the referral pattern, and the role of oesophageal pHmetry as a diagnostic tool in a tertiary care hospital in Sri Lanka. DESIGN: Data obtained from patients referred to the Gastrointestinal Research Laboratory at Teaching Hospital Ragama for 24-hour ambulatory oesophageal pHmetry from 1998 to 2005 were reviewed. Patients' upper gastrointestinal endoscopy reports and stationary oesophageal manometry reports were also reviewed. RESULTS: 140 pHmetry studies were performed during the study period. The majority of patients (> 90%) were referred by specialists in gastroenterology practicing in hospitals in or around Colombo. There were 88 males and the median age was 37 years (range 0.5-74). The median duration of symptoms was 4.1 years (range 0.2 -25). Typical symptoms of gastro-oesophageal reflux disease (GORD) were present in 53 (38%) patients, atypical symptoms of GORD in 31 (22%), and nonspecific upper gastrointestinal symptoms in 56 (40%). Pathological acid reflux was found in 43 (31%) patients. Of them, 29 (67%) had typical GORD symptoms, 7 (16%) had atypical symptoms, and 7 (16%) had non-specific upper gastrointestinal symptoms. No significant association was found between endoscopy and pHmetry results. CONCLUSION: Oesophageal pH monitoring helped to establish a cause for the morbidity in a significant number of patients with GORD symptoms, but not in the majority of patients referred for the test. In our experience the investigation does not seem to be optimally used as a diagnostic tool.