Browsing by Author "Wijesinghe, N.T."

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Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka
(Sri Lanka Medical Association, 2012) Waraketiya, P.R.; de Silva, A.P.; Wijesinghe, N.T.; Waraketiya, P.R.; Wijewantha, H.S.; Chandrasena, L.G.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Over the last decade an increase in Clostridium difficile associated diarrhoea (CDAD) has been observed among Caucasians (1%). The frequency of CDAD is very high in Caucasian IBD patients; 8.7% in one study of IBD patients in remission. This has led to guidelines recommending routine screening for CDAD in IBD. Clinical impressions are that CDAD is rare among Sri Lankans. AIMS: This study was conducted to determine the frequency of CDAD in a cohort of Sri Lankan IBD patients and healthy controls. METHODS: Cases [n=154] were histologically confirmed IBD patients, in clinical remission. The controls [n=100) were non-IBD patients who presented to medical clinics without diarrhoea and with no exposure to antibiotics for up to 8 weeks prior to recruitment. Immunoassays for Clostridium difficile toxins A and B were performed on stool samples obtained from both groups. RESULTS: The frequency of CDAD was 0.7% (n=l) and 0% (n=0) in IBD patients and controls respectively. CONCLUSIONS: Compared to Caucasians, CDAD was very rare in this cohort of Sri Lankans, including those with IBD. Routine screening for CDAD does not seem necessary in our setting.
The long term outcome of a cohort of Sri Lankan patients with ulcerative colitis at two tertiary care hospitals: preliminary results
(Sri Lanka Medical Association, 2011) Senanayaka, S.M.; Fernandopulle, A.N.R.; Wijesinghe, N.T.; Ranaweera, A.G.R.M.A.; Kasturiratne, A.; Pathmeswaran, A.; Nawaratne, N.M.M.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Inflammatory bowel disease, especially ulcerative colitis (UC), is increasing in many 'non-western' populations. Although clinical impressions are that UC has a mild clinical course in these populations, long term outcomes have been poorly studied. Methods: In this ongoing retrospective cohort study conducted at the Gastroenterology clinics of the Colombo North Teaching hospital and the National Hospital of Sri Lanka, patients diagnosed with ulcerative colitis (UC) were assessed for 3 outcomes: colectomy, development of colorectal carcinoma and death. Registered patients not attending the clinic during the past 4 weeks or their families were contacted by telephone to obtain clinical details and survival status. The cause of death was confirmed from clinical records and death certificates. RESULTS: Of 414 registered patients with UC, to date, details of 274 (66%) (mean age 44.9 (SD 13.6) years, M:F =1:1.13) were available for analysis. The mean duration of follow up was 6.8 (SD 6.5) years. Cumulative rates for colectomy, colorectal carcinoma and death were 3.3%, 1.1% and 1.1% respectively. At 1, 5, 10 and 15 years, cumulative cancer free survival proportions were 0.99, 0.99, 0.99 and 0.98, cumulative colectomy free survival proportions were 0.99 0.96, 0.96 and 0.96, and cumulative survival proportions were 0.99, 0.99, 0.98 and 0.98 respectively. The proportions of patients who had none of these three outcomes were 0.98, 0.95, 0.93 and 0.92. CONCLUSIONS: In this cohort of Sri Lankan patients with UC, rates of colectomy, colorectal carcinoma and death were rare, indicating a benign disease course.
The Long-term outcomes of a cohort of Sri Lankan patients with ulcerative colitis: a retrospective study at two national referral centers and review of literature
(Dove Medical Press, 2013) Senanayake, S.M.; Fernandopulle, A.N.; Niriella, M.A.; Wijesinghe, N.T.; Ranaweera, A.; Mufeena, M.N.; Pathmeswaran, A.; Navarathne, N.M.; de Silva, A.P.; de Silva, H.J.
BACKGROUND: Inflammatory bowel disease, especially ulcerative colitis, is increasing in many "non-Western" countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population. METHODS: A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates. RESULTS: Details of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001). CONCLUSION: In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis.
Usefulness of ileoscopy during Colonoscopy
(Sri Lanka Medical Association, 2011) Wijewantha, H.S.; de Silva, A.P.; Wijesinghe, N.T.; Kumarasena, R.S.; Hewavisenthi, J.; Dassanayake, A.S.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: To investigate utility of ileoscopy during colonoscopy in a cohort of Sri Lankan patients. METHODS: We performed a retrospective analysis of all patients who underwent colonoscopy from January 2007 to September 2010. We compared diagnostic utility of ileoscopy in patients who were considered to have specific clinical indications for ileoscopy (group A) with those who did not (group B). RESULTS: 789 colonoscopies were performed and the terminal ileum was successfully intubated in 638 (80.9%). Overall, 108/638 (16.9%) patients had macroscopic or microscopic abnormalities of the ileum. 51/638 (8%) of these were considered to be significant ileal pathology: Crohn's disease (34), tuberculosis (5), ileitis - resolving infection (8) or drug induced (4). The others of doubtful clinical importance were backwash ileitis in ulcerative colitis (12) and non-specific ileitis (37). 35 patients with ileal abnormalities (Crohn's disease 6, non-specific ileitis 29) had no abnormalities in the colon. 66 patients with a macroscopicalfy normal terminal ileum had abnormal microscopy: Crohn's desease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis (4), non-specific ileitis (36). In group A [n=511; mean (SD) age 47.7 (16) years; 53.4% males] 47/511 (9.2%) had significant ileal pathology compared to 4/127 (3.15%) in group B [n=127; mean (SD) age 53.2 (16) years; 50.4% males] (x2 = 4.270, df=l , p=0.03S). CONCLUSIONS: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, even in situations where the rest of the colon is normal and the ileum appears macroscopically normal. The procedure should be recommended.
Usefulness of Ileoscopy during Colonoscopy
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2011) Wijewantha, H.; de Silva, A.P.; Wijesinghe, N.T.; Kumarasena, R.S.; Dassanayake, A.S.; Hewavisenthi, S.J.; de Silva, H.J.
INTRODUCTION: Ileoscopy during colonoscopy adds only three minutes to total procedure time and has no added complications. However, available evidence for recommending the procedure is contradictory. There are few studies adressing this issue in South Asian populations. Aims: To investigate the usefulness of terminal ileoscopy during colonoscopy in a cohort of Sri Lankan patients attending a tertiary care centre. METHODOLOGY: From January 2007, our unit policy was to perform ileoscopy in all patients undergoing colonoscopy. A retrospective analysis of all patients who underwent colonoscopy in the unit from January 2007 to September 2010 was performed. Data were obtained from endoscopy unit and patient records. We compared usefulness of ileoscopy in patients considered to have specific clinical indications for ileoscopy - right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers (group A) with those that did not (group B). RESULTS: 789 colonoscopies were performed during the study period, and the terminal ileum was successfully intubated in 638 (80.9%). Reasons for not intubating the ileum were technical difficulty and/or severe patient discomfort. Overall, 108/ 638 (16.9%) patients had macroscopic or microscopic abnormalities of the ileum. 51/638 (8%) of these were considered to be significant ileal pathology: Crohn’s disease (34), tuberculosis (5), ileitis-resolving infection (8) or drug induced (4). The other abnormalities, of doubtful clinical importance and which did not alter management, were backwash ileitis in ulcerative colitis (12), and non-specific ileitis (37). 35 patients with ileal abnormalities (Crohn’s disease 6, non-specific ileitis 29) had no abnormalities in the colon. 66 patients with a macroscopically normal terminal ileum had abnormal microscopy: Crohn’s disease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis in ulcerative colitis (4), non-specific ileitis (36). In group A [n=511; mean (SD) age 47.7 (16) years; 53.4% males] 47/511 (9.2%) had significant ileal pathology compared to 4/ 127 (3.15%) in group B [n=127; mean (SD) age 53.2 (16) years; 50.4% males] (x2 4.270, df=1, p=0.038). CONCLUSION: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, in some instances where the rest of the colon is normal and sometimes even when the ileum appears macroscopically normal. The procedure should be recommended, especially for patients with right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers.