Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Quality of life and somatic symptoms in children with constipation(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND/AIMS: Chronic constipation is a common problem among Sri Lankan school children. We assessed the Health Related Quality of Life (HRQOL) and somatisation in school children with constipation. METHODS: This cross sectional survey was conducted in children aged 13-18 years, in 4 randomly selected schools in Gampaha district of Sri Lanka. From each school, 4 classes each were randomly selected from academic years 9-12. All children in the selected classes were included in the study. Data were collected using a set of validated, self administered questionnaires. They include Rome III questionnaire for paediatric functional gastrointestinal diseases, the somatisation inventory and PedsQL generic quality of life inventory. Constipation was diagnosed using Rome III criteria. Results: A total of 1,792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years and SD 1.3 years]. Hundred and thirty-eight (7.7%) fulfilled Rome criteria for constipation. Children with constipation had lower HRQOL scores for physical (83.6 vs. 91.4 in controls, P < 0.0001), social (85.0 vs. 92.7, P = 0.0001), emotional (73.6 vs. 82.7, P -0,0001), school functioning (75.0 vs. 82.5, P < 0.0001) domains, and lower overall scores (79.6 vs. 88-0, P = 0.0001). HRQOL scores were lower in those with faecal incontinence (70.0 vs. 81.1, P = 0,004), Total somatisation score for children with constipation was significantly higher than that of controls (16vs. 8.3, P < 0.0001). Patient perceived severity of abdominal pain (r = -0.22, P = 0.01), severity of bowel symptoms (r = -0.22, P = 0.01) and total somatisation score (r = -0.47, P < 0.0001) showed significant negative correlation with total HRQOL scores. CONCLUSIONS: Children with constipation have a lower quality of life in all 4 domains; physical, emotional, social and school functioning. They also have a higher somatic symptom score than controls. HRQOL has an inverse relationship with severity of symptoms.Item Constipation in Sri Lankan children: association with physical, sexual, emotional abuse(Wiley Blackwell Scientific Publications, 2012) Rajindrajith, S.; Devanarayana, N.M.; Lakmini, C.; Subasinghe, V; Benninga, M.A.BACKGROUND/AIMS: Child abuse in any form leads to multiple psychosomatic sequel. It is commonly associated with gastrointestinal manifestations. The main aim of this study was to evaluate the association between child abuse and constipation among school children. METHODS: Children aged 13–18 years were randomly selected from three semi-urban schools in Gampaha district, Sri Lanka. A previously validated, questionnaire was administered in an examination setting. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse and somatisation were collected. Constipation was diagnosed using Rome III criteria for paediatric functional gastrointestinal diseases. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years, SD 1.22 years]. Hundred and ten (8.1%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional and sexual abuse, were respectively 1001 (73.3%), 299 (21.9%) and 34 (2.4%). Prevalence of functional constipation was significantly higher in those exposed to sexual (17.6% vs. 7.8%, p =0.038), emotional (14.7% vs. 6.2%, p = 0.0001) abuse, and physical abuse (9.1% vs. 5.2%, p = 0.02). Mean somatization score in children with constipation and controls were 15.9 and 8.3, respectively (p < 0.0001). Among children with constipation, somatisation index was higher in those who have experienced emotional abuse (20.1 vs. 13.1 p = 0.003). CONCLUSIONS: Childhood constipation shows a significant association with physical, sexual and emotional abuse. Children with constipation complain of more somatic symptoms, especially those exposed to emotional abuse.Item Determinants of healthcare consultation behavior in children with chronic constipation: a school based survey(Lippincott Williams & Wilkins, 2011) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND: Constipation is a common pediatric disorder associated with poor quality of life and high healthcare expenditure. Healthcare consultation patterns in childhood functional gastrointestinal diseases are poorly understood. To date there are no community-based studies to identify factors determining healthcare consultation in children with functional constipation. AIMS: To assess the healthcare consultation patterns in Sri Lankan children with constipation and identifying socio-demographic and clinical factors that predict consultation behavior. METHODS: Island-wide cross-sectional survey was conducted among 10–16 years old children. Five schools were randomly selected from 3 randomly selected provinces of Sri Lanka. From each school, children were randomly selected from academic years (grades) 6–11. Previously pretested questionnaire based on Rome III criteria was used in the survey and questions were included regarding healthcare seeking for symptoms of constipation. RESULTS: Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice for their symptoms during previous 12 months. Children < 0.05). Healthcare consultation in children with stool frequency less than 3 per week, hard stools, painful defecation, large volume stool, fecal incontinence, with-holding posture and blood stained stools were respectively 7.5%, 2.7%, 6.6%, 11.6%, 11.1%, 7.7% and 14.3%. Exposure to stressful life events show no association with healthcare consultation (p=0.82). CONCLUSIONS: Healthcare consultation for chronic constipation in Sri Lankan school children and adolescents is quite low, despite the majority of them having features suggestive of significant constipation. Socio-demographic factors such as younger age and family history of constipation were significantly associated with healthcare seeking. It is essential to educate general public regarding features of chronic constipation and bring their children to medical attention early to avoid complications.Item Do traumatic life events predispose children to develop constipation?(Lippincott Williams & Wilkins, 2015) Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.BACKGROUND: The aetiology of functional constipation (FC) in children is not been fully understood. Exposure to physical, emotional and sexual abuse are known to predispose children to develop FC. No paediatric study has evaluated traumatic life events other than abuse as a potential predisposing factor for FC in children. We aimed to assess the association between traumatic life events and development of FC in children. METHODS: We conducted a cross sectional, school based study. Children aged 13-18 years were selected from four semi-urban schools in the Gampaha district, Sri Lanka. A validated, self-administered questionnaires were used for collect data on functional gastrointestinal disease and traumatic life events. FC was defined using the Rome III criteria. RESULTS: A total of1792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years, SD 1.3 years years]. Out of them, 138(7.7%) had FC. Prevalence of FC was significantly higher in those exposed to traumatic life events compared to controls (53.6% vs.32.9%,p < 0.0001). Traumatic life events such as parents living separately (13.4% vs. 7.12%,p = 0.038), living in a boarding house (10.1% vs. 1.6%, p = 0.049), liquor abuse by parents (14,8% vs. 6,3%, p < 0.0001), witnessing a murder (16.7% vs. 3.9%, p = 0.002), child labour (13.9%vs. 7.3%, p = 0.02) and ill-treated by parents (27.5% vs. 7.3%, p < 0.0001) were shown to predispose children to develop FC. Parental substance abuse (12.8% vs. 7.4%), domestic violence (14.8 vs. 7.5%) were not associated with FC (p > 0.05). CONCLUSIONS: FC is associated with childhood traumatic experiences. This provides further insight into how traumatic childhood events are associated with development and perpetuation of FC in children.Item Prevalence of functional constipation in infants and toddlers in Sri Lanka.(Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.Item Infant dyschezia in Sri lankan children: epidemiology and risk factors(Lippincott Williams & Wilkins, 2015) Hovenkamp, A.; Walter, H. A.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.OBJECTIVES: Little is known regarding functional gastrointestinal diseases in infants, especially in developing countries. Our aim was to assess the prevalence of infant dyschezia in relation to bowel habits and sociodemographic factors in a representative community sample in Sri Lanka. METHODS: A multicenter cross-sectional study was conducted among mothers of 0 -7-month-old infants, attending 14 growth monitoring and immunization clinics in Gampaha District, Sri Lanka. A self-administered questionnaire was used to determine gastrointestinal symptoms, the infant's bowel habits and sociodemographic characteristics for a total of 1004 infants. The questionnaire was translated to the native language (Sinhala) and pretested. Infant colic and infant dyschezia were diagnosed according to the Rome III criteria. RESULTS: The prevalence of infant dyschezia in Sri Lanka was 4.3%. An infant was more likely to suffer from infant dyschezia if he or she was formula-fed (9.6% vs. 7.8% in breast fed and 4.2% in those on additional foods, P = 0.025) or had a highly educated father (mean years of education 13.5 [SD 4.0] vs. 12.3 [SD 2.6] in unaffected children, P = 0.005). No significant association was found between infant dyschezia and age, sex, gestational age, birth order, birth weight, current weight, and presence of domestic violence (P > 0.05). CONCLUSIONS: Infant dyschezia is a significant health problem in Sri Lanka affecting approximately 4.3% of healthy infants. Infants with infant dyschezia are more likely to be formula-fed and have a highly educated father.