Browsing by Author "de Silva, A.P."

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Acute Dermato-Lymphangio-Adenitis Following Administration of Infliximab for Crohn's Disease.
(American College of Gastroenterology, 2019) Liyanage, I.K.; Niriella, M.A.; de Silva, A.P.; de Silva, N.; de Silva, H.J.
Tumor necrosis factor-α inhibitor (TNF-α) is frequently used for Crohn's disease and other autoimmune conditions. Increased risk of infection is an accepted adverse effect of TNF-α, and routine screening for potential infections are carried out before initiation of therapy. We report the case of a patient who developed a localized painful swelling near the injection site, which was diagnosed as acute dermato-lymphangio-adenitis due to filarial infection. This adds to the limited number of case reports on parasitic complications following TNF-α therapy
Acute systemic paraquat intoxication: survival without long-term complications
(Sri Lanka Medical Association, 2008) Mettananda, K.C.D.; de Silva, A.P.; de Silva, H.J.
No Abstract Available
Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)
(Ceylon College of Physicians, 2010) Satarasinghe, R.L.; de Silva, A.P.; Arulnithy, K.; Abeyratne, P.D.; Jayawardana, M.A.R.
OBJECTIVES: To ascertain major causes of UGIB and other related clinical features of adult Sri Lankan using open access endoscopy facilities. DESIGN AND SETTING: 1500 upper gastrointestinal endoscopies performed by Ward-06, Sri Jayewardenepura General Hospital, Kotte from 01/03/2002 to 01/03/2004 for whatever reason was retrospectively reviewed. Those who had endoscopy for UGIB were selected for the study, and their endoscopy findings and other clinical features analysed. RESULTS: There were 342 (24%) upper GI bleeders. The mean age of presentation was 55.5 years +/-14.4 SD. A high proportion was seen between 50-70 years of age. Sex distribution was, male:female = 229:114 (2:1). 45% have presented with haematemesis, 31% with malaena, and 24% with both. Endoscopy showed the presence of severe antral gastritis and duodenitis, oesophageal varices, oesaphagitis, erosive gastropathy, portal hypertensive gastropathy, pangastritis and peptic ulcer disease in 38%, 35%, 28%, 28%, 20%, 17% and 15% of the instances respectively. Hiatus herniae were seen in 43% although its role was unclear. Often combined pathologies were seen. Only 52% of the varices showed endoscopic evidence of bleeding. Excess alcohol consumption was seen in 36% while 5% were on NSAIDs. 5% had endoscopic negatives. CONCLUSIONS: UGIB is a major problem to the endoscopist, constituting about 25% of the work load, in this part of the continent. Although approximately 50% of the varices found had bled, portal hypertension related pathologies are a cause for concern. Alcohol was a contributory factor in 1/3 of the endoscoped population. Bleeding from PUD was not a dominant feature compared to the west.
The aetiology of chronic clinical or biochemical hepatic dysfunction in a group of adult Sri Lankans: experience in a tertiary referral centre
(Sri Lanka Medical Association, 2005) Satarasinghe, R.L.; de Silva, A.P.; Arulnity, K.
OBJECTIVES: To evaluate the histological outcome and clinical implications of such a finding in a group of adults who were admitted for investigation of either clinical or biochemical hepatic dysfunction lasting over 3 months. DESIGN AND SETTING: 100 consecutive liver biopsies performed from 15.2.2002 to 30.9.2004 in patients with abnormal hepatic function for at least three months prior to biopsy were reviewed. The clinicopathological features of patients who showed histological evidence of chronic liver disease were analysed retrospectively by examining their case notes. RESULTS: The age range was 15 - 80 years. Male to Female ratio 2.5:1. The peek incidence (37%) of chronic liver damage was seen in 40-49 year group, while 57% was within 50-59 year group. Histology showed cirrhosis, non-alcoholic steatohepatitis (NASH), steatosis, hepatoma, and chronic active hepatitis in 54%, 14%, 8%, 5%, and 4% respectively. There was a high male preponderance for NASH (M: F=8: l) and cirrhosis (M: F=6: l). 57% of cirrhotics were alcoholics. Hepatitis C serology was negative in all, and only one was positive for hepatitis B serology. 33% of patients with NASH had Diabetes mellitus and another 33% of patients with NASH had dyslipidaemias. Diet, social class and obesity were not associated with NASH. CONCLUSIONS: NASH and hepatic steatosis are emerging as significant causes for chronic hepatic dysfunction. The aetiology of non-alcoholic cirrhosis merit in depth study.
Aetiology of cirrhosis in a tertiary referral centre in Sri Lanka
(Sri Lanka Medical Association, 2007) Dassanayake, A.S.; Munasinghe, C.S.; Mettananda, K.C.D.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Alcoholic liver disease is believed to be the commonest cause of cirrhosis in Sri Lanka. However, with the rising prevalence of obesity and diabetes, non-alcoholic steatohepatitis (NASH) is increasingly being diagnosed. The prevalence of both Hepatitis B (<2%) and C (<1 %) is low in our population. OBJECTIVE: To study the aetiology of cirrhosis in a tertiary referral centre in Sri Lanka. DESIGN, SETTING AND METHODS: We analysed the database of outpatients with cirrhosis maintained since 2001, reviewing records with regard to aetiology. Diagnosis of cirrhosis was established on clinical, biochemical and radiological evidence, and confirmed histologically when required. A detailed alcohol and drug history was obtained. Hepatitis B and C serology, iron and copper studies, and an autoimmune screen were also performed. RESULTS: Records of 204 patients were analysed [male: female =160:44, mean age 51.2y (SD 12.2)]. The aetiology of cirrhosis was: alcohol in 116 (57.1%, male: female= 110:6); cryptogenic in 63 (31%, male:female 38:25), chronic Hepatitis B in 7 (male: female = 4:3), Wilson disease in 6 (male: female= 4:2), confirmed NASH in 6 (male: female= 2:4), autoimmune hepatitis in 4 (ai! females), chronic Hepatitis C in 1 (male) and haemochromatosis in 1 (male). Prevalence of diabetes was 44% among patients with cryptogenic cirrhosis and 24% among others. CONCLUSIONS: Alcohol remains the commonest cause of cirrhosis. Cryptogenic cirrhosis was the second commonest cause, and the leading cattse among females. The high prevalence of diabetes in cryptogenic cirrhosis suggests an aetiology of burned out NASH. Chronic viral hepatitis remains an uncommon cause for cirrhosis.
Aetiology of cirrhosis in a tertiary referral centre in Sri Lanka
(Wiley Blackwell Scientific Publications, 2005) Dassanayake, A.S.; Mettananda, K.C.D.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Alcoholic liver disease is widely believed to be the commonest cause of cirrhosis in Sri Lanka. However, with the rising prevalence of obesity and diabetes, non-alcoholic steatohepatitis (NASH) is increasingly being diagnosed. Despite being situated in an intermediate to high transmission region, the prevalence of both hepatitis B (o2%) and C ( 1%) is low in our population. AIMS: To study the aetiology of cirrhosis in a tertiary referral centre in Sri Lanka. METHODS: We analysed the database of outpatients with cirrhosis maintained since 2001, reviewing records with regard to aetiology. A diagnosis of cirrhosis was established on clinical, biochemical and radiological evidence, and confirmed histologically when required. A detailed alcohol and drug history was obtained from all cirrhotic patients. Hepatitis B and C serology, iron and copper studies, and an autoimmune screen were also performed. RESULTS: Records of 101 patients were analysed (male:female 5 78:23, mean age 38.3 years (SD 17.5)). The aetiology of cirrhosis was as follows: alcohol 64 patients (63.4%, male:female 5 60:4), cryptogenic 24 (23.8%, male:female 5 12:12), chronic hepatitis B four (all males), autoimmune hepatitis four (all females), Wilson’s disease two (both females), previously diagnosed NASH two (one male, one female), and chronic hepatitis C one (male). The prevalence of diabetes was 45% among patients with cryptogenic cirrhosis compared to 27% among patients with other causes. CONCLUSIONS: Alcohol remains the commonest cause of cirrhosis in our patients. Cryptogenic cirrhosis was the second commonest cause overall, and the commonest among females. The high prevalence of diabetes among patients with cryptogenic cirrhosis suggests an aetiology of previously undetected NASH.
Alanine Transaminase (ALT) levels in normal adult Sri Lankans
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.; Kalubowila, U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND : Alanine transaminase (ALT) levels are widely used in screening for liver disease.The upper limit of normal (ULN) of ALT (males 30 IU/l, females 19 IU/l) have been definedfor western populations. Normal levels have not been established for Asian populations. OBJECTIVES: To establish levels of ALT for a normal, adult Sri Lankan population METHODS: This study was part of a community based investigation - Ragama Health Study (RHS). The study population consisted of 35-64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, liver ultrasound and collection of 10 ml venous blood. The “normal” population was defined as those not using potentially hepatotoxic drugs, safe alcohol consumption (14 units/week for males, 7 units/week for females), absence of fatty liver, and being HBsAg and anti-HCVab negative. ALT levels were estimated by a kit using the Bergmeyer method. The 95th percentile of the ALT levels was taken as the ULN. RESULTS: 3012 subjects participated in the study. The ALT level (U/l) among 831 normal males (mean 36, median 30, SD 20, ULN 68) was significantly higher than that of the 885 normal females (mean 29, median 25, SD 13, ULN 53) (p<0.001,Student's t-test ). CONCLUSION: The ULN for ALT levels of a “normal” Sri Lankan population was higher than observed in western populations. The levels were higher in males. ULN for ALT may need to be redefined for different population groups.
Anthropometric correlates of total body fat, visceral adiposity and cardio-metabolic health risk: a community cohort study of urban, adult Sri Lankans
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranawaka, U.K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Anthropometric measurements (AM) are used as proxies for more direct measurements of body fat (BF) and its distribution. Several studies have examined the association between AM, BF and health outcomes such as cardiovascular risk (CVR). However, correlation of such simple AM and advanced measures of BF and the ability of these to predict CVR has not been studied in community follow up studies. OBJECTIVES: To examine the relationship between simple and advanced anthropometric measurements and their ability to predict cardiovascular risk factors in an urban adult Sri Lankan population. METHOD: The data was collected from a community cohort of adults (aged 42-71 years) selected by age-stratified random sampling from electoral lists of the Medical Officer of Health area, Ragama. Individual simple measurements [body weight, height, waist circumference (WC), hip circumference (HC)], advanced measurements [total body fat (TBF), visceral fat percentage (VFP) by Omron® body fat monitor] and cardiovascular risk factors [blood pressure, HbA1c, triglycerides, low-density (LDL-C), high-density-lipoprotein cholesterol (HDL-C) level, cardio-metabloic risk (CMR) (2 or more risk factors)] were assessed and their relationships were examined. RESULTS: 2155 individuals [1244 (57.7%) women, mean age 59.2 years (SD, 7.7)] participated. Complete data were available for 2000 (92.8%) [1147 (57.4%) women, mean age 59.2 years (SD, 7.7)]. Mean (SD) for anthropometric measurements were: males WC-85.9 (10.8) cm, HC-93.4 (8.0) cm, WHpR (waist-to-hip ratio) -0.92 (0.06), WhtR (waist-to-height ratio) -0.52 (0.06), BMI (body mass index) -23.5 (3.8) kg/m2, TBF -27.0 (5.7)%, VFP -10.7 (5.2)%; females WC -84.8 (10.7) cm, HC-97.2 (9.5) cm, WHpR-0.87(0.08), WhtR-0.52 (0.07), BMI -25.4 (4.4) kg/m2, TBF -38.2 (4.2)%, VFP-9.6 (4.9)%. BMI and WC correlated well with VFP (Pearson’s r for males: 0.94 and 0.85, females: 0.96 and 0.78, respectively). In both sexes, increasing BMI, WC, WHtR, TBF and VFP, were significantly associated with higher risks of hypertension, diabetes, dyslipidemia and combined CMR (ROC area under the curve>0.6). CONCLUSIONS: In this cohort of urban, adult Sri Lanka, simple anthropometric measurements correlated strongly with VFP, and were equally good in predicting cardiovascular risk factors.
Are alanine transaminase (ALT) levels useful to screen for Non-alcoholic Fatty Liver Disease (NAFLD) in the community?
(Sri Lanka Medical Association, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; Rajindrajith, S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND: The value of ALT in screening for NAFLD is controversial. Furthermore, the upper limit of normal (ULN) ALT is defined for western populations but not Asian populations. Objectives: To establish ULN ALT for an urban adult Sri Lankan population, and assess its value in screening for NAFLD in that community. METHODS: This was part of a community based study on non-communicable diseases - the Ragama Health Study. 35-64y adults were selected using stratified random sampling. They were screened by structured interview and liver ultrasound, and 10ml venous blood .was obtained. "Normal" adults were defined as those not using potentially hepatotoxic drugs, drinking alcohol within safe limits, HBsAg and anti-HCV negative, and no fatty liver on ultrasound. NAFLD was diagnosed on established ultrasound criteria, .safe alcohol consumption and being HBsAg and anti-HCV negative. The 95th percentile of ALT was taken as the ULN for this population. RESULTS: 3012 subjects participated in the study. Those with NAFLD (n=930) and "normals" (n=1716) were matched for age and sex. ULN ALT (U/l) was significantly higher in normal males than females (68 vs. 53; p<0.001, Student's t-test). ALT was significantly higher in NAFLD than normals (p<0.001). However, ALT>ULN had a sensitivity [positive predictive value (PPV)] of only 14.5% (58%) for males and 11.5% (60%) for females with NAFLD. When ULN ALT cut offs for western populations (males 30 IU/1, females 19 IU/1) were used, although sensitivity considerably increased, the PPV to detect NAFLD decreased.further [sensitivity (PPV): males 79.4% (42%); females 94.6% (41%)]. CONCLUSIONS: Although ALT was significantly higher in NAFLD than in normal adults, it does not seem a useful test to screen for NAFLD in the community.
Association between road accidents and low-grade hepatic encephalopathy among Sri Lankan drivers with cirrhosis: a prospective case control study
(Biomed Central, 2016) Subasinghe, S.K.C.E.; Nandimuni, Y.; Ranasinghe, S.; Niriella, M.A.; Miththinda, J.K.N.D.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
BACKGROUND: Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA. STUDY DESIGN AND METHODS: A prospective, case–control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1 month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1 month were recorded: categorized as ‘major’ when resulted in hospitalization of the involved, ‘minor’ when there were injuries, but not serious enough for hospitalization of the involved and ‘other’ when limited to damages to vehicle or environment without injuries. RESULTS: Among 55 drivers with cirrhosis and LGHE [males, median age 53 years (range 30–60)], 7 (12.7 %) reported RA compared to 6 (10.9 %) among 55 controls [males; median age 51 years (range 30–60)]. There were no ‘major’ accidents in either group. 2/55 (3.6 %) cases and 2/55 (3.6 %) controls reported ‘minor’ accidents. CONCLUSION: There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.
Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan cirrhotic drivers
(Wiley Blackwell Scientific Publications, 2014) Subasinghe, S.K.C.E.; Nandamuni, Y.; Ranasinghe, S.; Kodisinghe, K.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.
OBJECTIVE: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephalopathy (HE) but has mild cognitive and psychomotor deficits which can interfere with executive decision making and psychomotor speed. It affects driving ability and previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan cirrhotic drivers. METHODS: A prospective, case controlled study ongoing study has been conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests used to detect MHE. Road accidents were recorded for both cirrhotic drivers with MHE and controls. Accidents were categorized as major when they resulted in hospitalization of the involved person/s, and minor when there were no serious injuries. RESULTS: Among 55 cirrhotic drivers with MHE [males, median age 53 years (range 30-60)], 7 (12.7%) reported any type of accident compared to 6 (10.9%) among 55 controls [males; median age 51 years (range 30-60)]. 2/55 (3.6%) cases and 2/55 (3.6%) controls reported minor accidents. There were no major accidents in either group. CONCLUSION: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan cirrhotic drivers with MHE
Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan drivers with cirrhosis
(Sri Lanka Medical Association, 2014) Subasinghe, S.K.C.E.; de Silva, A.P.; Niriella, M.A.; Kodisinghe, S.K.; Nandamuni, Y.; Sameera, R.A.C.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephaiopathy (HE) but has mild cognitive and psychomotor deficits. Previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan drivers with cirrhosis. Study design; Prospective, case controlled study. Study setting; Ongoing study conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. METHODS: Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests to detect MHE. An abnormality in 3 or more tests was considered diagnostic of MHE. Road accidents were recorded among drivers with cirrhosis with MHE. Age and sex matched healthy drivers (controls) who also underwent the 5 psychometric tests. RESULTS: Among 54 drivers with cirrhosis with MHE [males, median age 53 years (range 30-60}], 7 (13%) reported any type of accident compared to 6 (11%) among 54 controls [males; median age 51 years (range 30-60)]. 2 (3.7%) cases and 2 (3.7%) controls reported minor accidents involving another person. There were no major accidents in either group. CONCLUSIONS: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan drivers with cirrhosis with MHE.
The association between steatosis and liver damage in transfusion-dependent beta thalassaemia patients
(Wiley-Blackwell, 2023) Padeniya, P.; Ediriweera, D.; de Silva, A.P.; Niriella, M.; Premawardhena, A.
Non-alcoholic fatty liver disease (NAFLD) is a global health problem. Iron is the leading cause of liver damage in patients with transfusion-dependent thalassaemia (TDT), and data on the contribution of NAFLD to liver damage in TDT is lacking. Forty-five heavily transfused TDT patients who did not have biochemical or ultrasonic evidence of liver cirrhosis were evaluated for effects of iron overload, including the presence of diabetes mellitus, hypogonadism, serum ferritin, R2-MRI-liver, and liver enzymes alanine aminotransferase and aspartate aminotransferase. Liver fibrosis and steatosis were estimated using transient elastography (TE). Nine (20%) patients had significant steatosis (S1), and their body mass index (BMI) and liver fibrosis scores were higher than in patients without significant steatosis (S0) (p = 0.03 and p = 0.004, respectively). On regression analysis, the controlled attenuation parameter (CAP) score (i.e., degree of liver steatosis) was associated only with increasing BMI. The TE score (i.e., degree of liver fibrosis) was associated with increasing age, CAP score, male gender, and presence of diabetes. Neither liver steatosis nor fibrosis showed significant association with the liver iron concentration or iron-related organ damage (hypogonadism). In this cohort of TDT patients, steatosis of the liver, which is associated with increasing BMI, appeared to increase the risk of liver fibrosis.
Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community
(Wiley-Blackwell, 2015) Kasturiratne, A.; Akiyama, K.; Niriella, M.A.; Takeuchi, F.; Isono, M.; Dassanayake, A.S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Bleeding from oesophageal ulceration induced by endoscopic variceal ligation for primary prophylaxis
(British Medical Assosiation, 2010) Kumarasena, R.S.; Niriella, M.A.; Kalubowila, U.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
Comment on : García-Pagán JC et al Spanish Variceal Bleeding Study Group.(Gut. 2009; 58(8):1144-50.) No Abstract Available
Changing phenotype of IBD in Sri Lanka
(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kodisinghe, S.K.; Dinamithra, N.P.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; Dassanayake, A.S.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
INTRODUCTION: Inflammatory bowel disease (IBD) is increasing in Asia Pacific, with recent changes in phenotype reported from some countries. METHOD: Patients with histologically proven IBD [ulcerative colitis(UC), Crohn’s disease(CD), unclassified(U)], diagnosed between January 2006-December 2010 (Group 1) and January 2011-December 2015 (Group 2), who had regular follow up, were included from Colombo North Teaching Hospital and National Hospital of Sri Lanka (two main referral centers). The two groups were compared with regard to phenotype of IBD (subgroups, severity, age at diagnosis, duration of symptoms, extra-intestinal manifestations (EIM) at diagnosis, cigarette smoking, family history, and highest therapy during follow up). RESULTS: 304 patients were included [Group 1: UC-72(74.2%), CD-25(25.8%); Group 2: UC-113(54.6%), CD-90(43.5%), U-4(1.9%)]. There were more females in Group 2 for UC and CD. Median age at diagnosis was similar for UC but higher for CD in Group 2 compared to Group 1.The median duration of symptoms to diagnosis was not different for UC and CD in the two groups. In both groups, left sided colitis (E2) predominated for UC and Ileo-colonic disease (L3) and non-stricturing, non-penetrating (B1) disease predominated for CD. There was no difference in degree of severity, rate of complications, pattern of EIM, smoking history at presentation, family history or highest therapy during follow up for either disease in the two groups (Table 1). CONCLUSIONS: During the 10 years, there seems to be a recent increase in the proportion of CD among IBD patients. However, there were no major changes in disease phenotype for UC or CD.
Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study
(BioMed Central, 2021) Niriella, M.A.; Liyanage, I.K.; Kodisinghe, S.K.; de Silva, A.P.; Jayatissa, A.V.G.A.M.; Navarathne, N.M.M.; Peiris, R.K.; Kalubovila, U.P.; Kumarasena, S.R.; Jayasekara, R.W.; de Silva, H.J.
BACKGROUND: Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients. METHODS: We included patients [diagnosed between June/2003-December/2009-Group-1(G1), January/2010-June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use). RESULTS: 375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23-45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes. CONCLUSION: There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes. KEYWORDS: Clinical course; Clinical predictors; Crohn disease; Inflammatory bowel disease; Phenotype; Sri Lanka; Ulcerative colitis.
Changing phenotype, early clinical course and clinical predictors of irritable bowel syndrome in Sri Lanka: a prospective, multi-centre descriptive study
(Sri Lanka Medical Association, 2017) Niriella, M.A.; Kodisinghe, S.K.; Nanayakkara, S.D.; Silva, K.T.M.; Rajapakshe, N.; Luke, D.; de Silva, A.P.; Navarathne, N.M.M.; Dissanayake, V.H.W.; Jayasekara, R.W.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Incidence of inflammatory bowel disease (IBD) is increasing in the Asia Pacific, with changes in phenotype and disease course been reported. METHODS: Ulcerative colitis (UC) and Crohn disease (CD) cases from four national referral centres were included. Phenotype was compared for cases [Group-1/G1-diagnosed between June/2003-December/2009, Group-2/G2-January/2010-June/2016]. Early clinical course (ECC) [complicated disease (Comp D-stricturing/penetrating CD, extensive-UC/pancolitis), treatment refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory, biologics), disease complications (DC-perforation/bleeding/colectomy/malignancy)] among disease duration <3 years, and clinical predictors (CP) of CompD/TRD/DC among disease duration >1 year were also assessed. RESULTS: A total of 452-cases [G1: UC-89 (78.8%), CD-24 (21.2%); G2: UC-197 (58.1%), CD-142 (41.9%)] were included. G2 had a higher proportion of CD (p<0.001). In both groups, leftsided colitis (E2) for UC, ileo-colonic (L3)/non-stricturing, non-penetrating (B1) for CD predominated. More penetrating-CD (B3) in G2 (p<0.01) and more stricturing-CD (B2) in G1 (p<0.05) were noted. ECC was assessed in 293 patients [UC-168 (57.3%), CD-125 (42.7%)]. Among UC: extensive/pan-colitis (E3)-40 (24.5%), severe (S3)-38 (42.2%); among CD:severe episodes-15 (25.9%), stricturing (B2)/penetrating(B3)-18 (14.7%), perianal-disease (P)-29 (23.4%). TRD was seen in 19 (11.3%)-UC and 17 (10.1%)-CD. Immunomodulator use was-70 (41.7%)/93 (74.4%), and anti-TNF use was 3 (1.8%)/12 (9.6%) respectively for UC and CD. Complications for UC: bleeding-6 (3.6%), malignancy-1 (0.6%), surgery-3 (1.8%); for CD: stricture-6 (4.9%), perforation-3 (2.4%), malignancy-1 (0.8%), surgery-2 (1.6%). CP were assessed in 373 [UC-266 (71.3%), CD 107 (28.7%)]. EIM of joints predicted CompD in UC/CD (OR-1.94/OR-2.28). Family history (OR=8.64) and EIM of joints (OR=10.07) predicted DC in UC. CONCLUSION: There was an increase in CD during the study period, but no changes in disease phenotype for UC or CD. Although admissions with CompD were common for UC (but not CD), few patients had TRD or DCs indicating a relatively benign early disease course. Family history, EIM of joints predicted poor outcomes in UC, EIM of joints predicted a poor outcome in CD.
The characteristics of people with diabetes mellitus in Kalutara District
(Sri Lanka Medical Association, 2010) de Silva, A.P.; de Silva, S.H.P.; Rajapakse, L.C.; Jayasinghe, S.; Katulanda, P.; Wijeratne, C.N.; Wijeratne, S.
INTRODUCTION AND OBJECTIVES: Diabetes mellitus is on the rise. Although recent studies are available data on ethnic minorities and estate sector are scarce. Aim of this study was to describe selected socio demographic aspects of people with diabetes mellitus in Kalutara District. METHODS: A cross sectional descriptive study was done. One person randomly selected from 20 randomly selected households in each gramasevaka (GS) division. There were 65 random (GS) divisions from all divisional secretariat areas. The data were collected using a pre-tested standard questionnaire. Fasting blood sugar was done to detect diabetes mellitus. RESULTS: Among 1225 screened there were 205 (16.7%) diabetics. Approximately one third was newly detected. There were 107 (52.2%) females in the diabetic group. The highest proportion was observed in the 50-54 and 55-59 age groups (44, 21.5%) and the middle income group (93, 48.9%). Those who were educated from Grade 6 to 0/L contained most of the diabetic patients (75, 39.7%). The prevalence in the urban, rural and estate sectors were 25.5%, 15.5 and 9.2% respectively. The prevalence among Sinhalese, Tamils and Muslims were 19.0%, 9.0% and 22.4% respectively. A gradient can be observed when prevalence was graphed according to the unsatisfactory basic needs index of the GS divisions. The highest proportion (23%) was observed in the richest GS Division. CONCLUSION: The prevalence of diabetes mellitus is high in the Kautara District. A higher prevalence was observed in urban areas, among Muslims and in rich GS divisions.
Chronic nausea and vomiting: a diagnostic approach
(Future Drugs Ltd., 2022) Niriella, M.A.; Jayasena, H.; Withanage, M.; Devanarayana, N.M.; de Silva, A.P.
INTRODUCTION: Chronic nausea and vomiting (CNV) are commonly encountered symptoms in medical practice. CNV is the presenting symptom in a variety of gastrointestinal and non-gastrointestinal disorders. However, in a significant percentage of patients without an obvious underlying cause, CNV poses a significant diagnostic challenge to the evaluating physician. AREAS COVERED: A comprehensive clinical history and physical examination form the foundation for further diagnostic work-up. In the present review, we discuss the diagnostic approach to CNV, highlighting the epidemiology, pathophysiology, causes, and modes of evaluation of this condition. Specific investigations, carefully guided by clinical assessment and tailored for each patient, would be more beneficial in diagnosing CNV than empirically performing a blanket of investigations. EXPERT OPINION: Whilst CNV remains a historically challenging diagnostic and therapeutic dilemma, research into this topic is limited. Hence, there is a growing call for more research into diagnostic modalities for CNV. With scientific advancement and further research, it is hoped that easy-to-use, cheap, noninvasive novel diagnostic modalities for CNV will be available soon.