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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Subtypes and some clinical aspects of irritable bowel Syndrome in children
(Sri Lanka College of Paediatricians, 2011) Rajindrajith, S.; Devanarayana, N.M.
INTRODUCTION: Irritable bowel syndrome (IBS) is a common paediatric functional gastrointestinal disorder affecting 6-13% of children and adolescents. In adults IBS is divided into four main subtypes: diarrhoea predominant IBS, constipation predominant IBS, mixed IBS and untypable IBS. The subtypes have not been characterised in children. OBJECTIVES: The objective of this study was to assess IBS subtypes in 10-16-year old children, their symptomatology and gender difference. DESIGN, SETTING AND METHOD: One hundred and seven children with IBS and 1610 healthy controls aged 10-16years were recruited from 8 randomly selected schools, in 4 randomly selected provinces (out of 9 provinces) in Sri Lanka. Data was collected using a previously validated, self administered questionnaire based on Rome III criteria, it was distributed in examination settings to ensure privacy and confidentiaiity and was filled under the guidance of research assistants. IBS was defined using Rome 111 criteria. RESULTS: Constipation predominant IBS (IBS-C), diarrhoea predominant IBS (IBS-D) and mixed IBS (1BS-M) were present in 27-28%. Untypable IBS (1BS-U) was seen in 17.8%. IBS was more common in girls (59.8% vs. 40.2% in boys, p=0.001; p<0.01). Straining, urgency and feeling of incomplete evacuation were seen in 74-78% children with IBS. Intestinal-related symptoms such as bloating, flatulence, nausea, vomiting and burping, and extraintestinal symptoms such as headache, sleeping difficulty, limb pain and photophobia were significantly higher in affected children (p<0.05). Burping was more commonly seen in boys with IBS (p<0.05). CONCLUSIONS: IBS-C, IBS-D and IBS-M had almost equal distribution while IBS-U had a relatively lower prevalence. Girls were significantly more commonly affected than boys (p<0.01). Intestinal-related and extra-intestinal symptoms were seen in a significantly higher percentage of children with IBS (p
Abdominal bloating in children: association with functional gastrointestinal diseases and adverse life events.
(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.
BACKGROUND/AIMS: Abdominal bloating is a common symptom among children with functional gastrointestinal diseases (FGDs). It can lead to significant distress among affected children. However, its epidemiology, risk factors and clinical characteristics have not been described in paediatric population. We aimed to study die epidemiology and risk factors of abdominal bloating, and associated FGDs in Sri Lankan children. METHODS: A cross-sectional, island-wide survey was conducted in Sri Lankan children aged 10-16 years. Four provinces (out of 9) of the country were randomly selected and 2 schools were randomly selected from each of the provinces. From each school, 12 classes from academic years (grades) 6 to 11 (2 from each academic year) were randomly selected and all children in these classes were included in the study. The Rome III questionnaire for paediatric FGDs (self-report form) was used for data collection. FGDs were diagnosed using Rome III criteria. Abdominal bloating was considered to be present if die child indicated as having abdominal bloating at least 25% of the time during the past 2 months. RESULTS: A total of 1972 children and adolescents (54.8% boys, mean age 13.4 years, SD 1.8 years) were included in the analysis. One hundred and ninety-four (9.8%) children had abdominal bloating. Of them, 52.6% had aerophagia, 15.4% had irritable bowel syndrome, 9.7% had constipation, 6-7% had rumination syndrome, and 5.6% had functional abdominal pain. Bloating was significantly common among children exposed to emotional stress and adverse life events (P < 0.0001). Intestinal related symptoms and extra intestinal symptoms that were significantly associated with bloating include abdominal pain, nausea, pallor, photophobia and headache (P < 0.05). CONCLUSIONS: Bloating is a common symptom of children and often associated with a range of FGDs. Children who faced adverse life events and stress, have a higher tendency to develop bloating. Bloating coexist with several other intestinal related and extra intestinal symptoms.
Association between faecal incontinence, child abuse, somatisation and health related quality of life
(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN), 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.
AIMS : Faecal incontinence (FI) is an important lower gastrointestinal disease. Bad aroma around children with FI leads to rejection by peers, psychosocial isolation and learning difficulties. Aim of this study was to evaluate the association between FI, child abuse and health related quality of life (HRQoL) in children and adolescents. METHODS : Children aged 13-18 years were selected from four semi-urban schools in Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection after obtaining consent from school authorities, parents and children themselves. Information regarding socio-demographic factors, gastrointestinal symptoms, child abuse, HRQoL and somatisation were collected. FI was defined as at least one episode of leaking of faeces in to the underwear per month. RESULTS: A total of 1807 children were included in the analysis [males/9.3 vs 53.8%), mean age 14.4years, SI.) 1.4 years]. Forty seven (2.6%) had FI. FT was significantly higher in boys (-74.49S vs. 25,6%% in girls, p < 0.0001)1. Prevalence of FI was significantly higher in those exposed to sexual abuse (17%.,. vs. 2.3% in non abused, p < 0.0.001)., emotional abuse i40.4% vs. 22.7%, p < 0.0001), and physical abuse (51% vs. 24:3.'%', p < 0.0001). Children with FI had higher mean somatisation score [mean 20.1, SD 14.5 vs. mean 9.3, SD 9.2 in those without FT (controls), p < 0.0001J. Children with FI had lower HRQoL scores for physical functioning (78.1 vs.'9:1:2.in controls, p < 0.0001), social functioning (78.4 vs. 92.6, p < 0.0001), emotional functioning (70.5 vs. 82.3, p < 0.0001) and school functioning (69.1 vs- 82.3, p < 0.0001) domains, and a lower overall HRQoL score (74.6 vs. 87.1, p < Q .0.001). CONCLUSIONS : FI in children shows a significant association with physical, sexual and emotional abuse. Children with FT have a range of somatic symptoms and a poor HRQoL score in physical, emotional, social and school functioning domains.
Epidemiology of cyclical vomiting syndrome in a cohort of Sri Lankan children
(The Korean Society of Neurogastroenterology and Motility, 2013) Devanarayana, N.M.; Rajindrajith, S.
BACKGROUND/AIMS: Cyclic vomiting syndrome (CVS) is characterised by recurrent episodes of intense nausea and vomiting or unremitting retelling lasting for hours to days. Very little is known of its epidemiology in paediatric age group. The aims of this study were to assess the prevalence, clinical profile and risk factors of CVS m Sri Lankan children and adolescents. METHODS: This is a school-based cross sectional survey conducted in 8 randomly selected schools in 4 randomly selected provinces of Sri Lanka. Data were collected using a validated, self-administered questionnaire, which consisted of 3 parts; part 1 - socio-demographic data, part 2 - data on stressful and adverse life events, part 3 - Rome III questionnaire (self report form for children above 10 years) which was translated and validated for Sri Lankan children. It was administered in an examination setting and collected on the same clay. Trained research assistants were present during filling the questionnaire to verify doubts. CVS was diagnosed using Rome III criteria. RESULTS: A total of 2,163 children were recruited for the study (male 1189 (54.9%), age range LO to 16 years, mean 13.4 years, SD 1.8 years). In this study, CVS was seen in 18 (0.8%). There was no gender difference in prevalence of CVS (boys 1.0% vs. girls 0.6%, P > 0-05). A significantly higher prevalence of CVS was observed in children exposed to recent stressful life events such as being bullied at school (3.4% vs. 0.7% in not exposed), major illness in a close family member (1.9% vs. 0.6%), hospital-ization of the child for other illness (2.2% vs. 0.7%), frequent punishment by parents (3.3% vs. 0.7%) and domestic violence (2.9% vs. 0.8%). No association observed between CVS, and age, socio-economic status, family size and birth order. CONCLUSIONS; The prevalence of cyclic vomiting syndrome among Sri Lankan children and adolescents is 0.8%. This condition is more common in those exposed to emotional stress.
Gastric motility in children with aerophagia.
(The Korean Society of Neurogastroenterology and Motility, 2013) Devanarayana, N.M.; Rajindrajith, S.
BACKGROUND/AIMS: Aerophagia is a functional gastrointestinal disease characterized by repetitive air swallowing, abdominal distension, belching and flatulence. When severe, it can lead to pneumoperitonium, volvulus and intestinal perforation. Gastric motility in children with aerophagia has never been studied, and our main objective was to assess it. METHODS: All children referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, from 1st January 2007 to 31, December 2011 were screened and those fulfilling Rome III criteria for aerophagia were recruited. None had clinical or laboratory evidence of organic diseases. An age and sex compatible group of healthy children were selected as controls. Liquid gastric emptying rate (LGER) and antral motility parameters were assessed using a previously reported ultrasound method. RESULTS: A total of 18 children with aerophagia (9 [50.0%] males, 4-14 years, mean 8.0 years, SD 2.9 years) and 20 controls (8 [40%] males, 4-14 years, mean 8.4 years, SD 3.0 years) were recruited. Average LGER (44.2% vs. 66.2% in controls), amplitude of antral contractions (49.2% vs. 89.0%), frequency of contractions per 3 mm (8.5 vs. 9.3) and antral motility index (4.2 vs. 8.3) were significantly lower in patients with aerophagia compared to controls (P < 0.05). GER in children with aerophagia exposed to stressful life events was 35.4% compared to 53.0% in those not exposed to such events (P = 0.01). CONCLUSIONS: LGER and antral motility parameters were significantly impaired in patients with aerophagia. However, no significant association observed between gastric motility and symptoms. Affected children exposed to emotional stress had a lower LGER than those not exposed to such events.
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.
Constipation and exposure to stressful Life events in 10 to 16 year olds: Sri Lankan experience
(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.
INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. OBJECTIVES: To assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. DESIGN, SETTING AND METHOD: A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, in 3 geographically and socio-economically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) which were returned were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria 416 (15.4%) had constipation and they were compared with 2278 children without constipation. Prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months [Odd's ratio (OR) 0.38,p<0.0001]. During univariate analysis the stressful life events associated with constipation were: change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step parent, hospitalization of the child himself/herself for other illness, frequent punishment by parents, father's alcoholism, domestic fights and living in an area affected by on-going separatist war (p<0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p<0.05), severe illness in a family member (adjusted OR 0.588, p<0.005); loss of job by a parent (adjusted OR 0.55 p<0.05), frequent punishment by parents (adjusted OR 0.581, p<0.01) and living in a war affected area (adjusted OR 0.666, p<0.001) remained to be significantly associated with constipation. CONCLUSIONS: Childhood constipation was significantly higher in those exposed to family and school related stressful life events and in those living in a war affected area.
Functional abdominal pain in children and adolescents: association with impaired gastric motility
(Sri Lanka College of Paediatricians, 2009) Devanarayana, N.M.; Dharmawansa, R.; Rajindrajith, S.
INTRODUCTION: Chronic abdominal pain is a common paediatric problem affecting nearly 10% of school aged children. The majority of them have functional gastrointestinal diseases including functional abdominal pain (FAP). In them, the exact mechanism of pain remains unclear. Periumbilical pain, characteristic of this condition, appears to be of visceral origin, probably originating in the gastrointestinal tract. Gastrointestinal motility disturbances are reported in children with irritable bowel syndrome and functional dyspepsia, but are not properly studied in those with FAP. OBJECTIVES: To evaluate gastric emptying and antral motility in children and adolescents with FAP, DESIGN, SETTING AND METHOD: Sixty six children with FAP [24 (36.4%) males, 4-14 years, mean 8.2 years, SD 2.7 years] referred to the Gastroenterology Research Laboratory for gastric motility studies and 20 healthy children without evidence of gastrointestinal diseases [8 (40%) males, 4-15 years, mean 8.9 years, SD 2.7 years] were evaluated. FAP was diagnosed using Rome III criteria. None had clinical or laboratory evidence of organic diseases except for one control who was positive for Helicobacter pylori stool antigen test. All subjects underwent ultrasonographic assessment of liquid gastric emptying rate (GE) and antral motility, using a previously reported method. RESULTS: Average gastric emptying rate (42.7% vs. 66.2%), amplitude of antral contractions (60.6% vs. 89%), frequency of contractions per 3 minutes (8.5 vs. 9.3) and antral motility index (5.2 vs. 8.3) were significantly lower in patients with FAP compared to controls (p<0.01). Fasting antral area was higher in patients (1.2 vs. 0.6, p<0.01). The gastric emptying rate had a significant negative correlation with the scores obtained for severity of abdominal pain (r=-0.42, p<0.005). CONCLUSIONS: Gastric emptying rate and antral motility parameters are significantly impaired in patients with functional abdominal pain. Gastric emptying rate had negative correlation with the severity of abdominal pain.
Prevalence of functional gastrointestinal diseases among a cohort of Sri Lankan school children aged 12 to 16 years
(Sri Lanka College of Paediatricians, 2009) Devanarayana, N.M.; Adikari, C.; Pannala, W.; Rajindrajith, S.
INTRODUCTION: Even though functional gastrointestinal disorders (FGID). such as irritable bowel syndrome and functional constipation, are common among children and adolescents around the world, little is known regarding their prevalence in developing countries including Sri Lanka. The current symptom based criteria (Rome III criteria) were released in 2006 and are still not widely used fay paediatricians for positive diagnosis of FGID. OBJECTIVES: To assess prevalence of FGID among a group of Sri Lankan adolescents using Rome III criteria. DESIGN, SETTING AND METHOD: This is a cross sectional survey conducted in a randomly selected group of 12-16 year olds in a semi-urban school in Gampaha district. A validated, self-administered questionnaire (developed on Rome III criteria for FGID in children) was distributed after obtaining consent from the school administration and the parents. It was administered in an examination setting, to ensure confidentiality and privacy. The questionnaire was in Sinhala, the first language of the cohort. The questions were simple and easy to understand. Research assistants were present during the whole time with students while they were filling the questionnaires and explanations were given whenever the need arose. FGID were diagnosed using Rome III criteria. RESULTS: A total of 464 questionnaires was distributed and 427 (92%) were included in the analysis [214 (50.1%) males, mean age 14.42 years, SD 1.27 years]. Thirty seven incompletely filled questionnaires were excluded from the analysis. According to Rome III criteria, 123 (28.8%) had at least one FGID. Of them, 58 (13.6%) had abdominal pain related FGID [irritable bowel syndrome 30 (7%), functional dyspepsia 14 (3.3%), functional abdominal pain 12 (2.8%) and abdominal migraine 2 (0.46%). Prevalence of functional constipation was 4.2% (18). Aerophagia was seen in 27 (6.3%), while adolescent rumination syndrome was seen in 17 (3.9%). Nonretentive faecal incontinence [1 (0.23%)] and cyclical vomiting syndrome [2 (0.46%)] were rare in our group of school children. There was no age or sex difference in the prevalence of any of the above FGID (p>0.05). CONCLUSIONS: Functional gastrointestinal disorders are a significant problem in our group of school children, affecting more than a quarter of them. Irritable bowel syndrome is the commonest FGID diagnosed.
Faecal incontinence in Sri Lankan children and adolescents: an epidemiological survey
(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.
INTRODUCTION: Faecal incontinence is seen in 1-4% of children and has a significant impact on their quality of life. Community based studies on this important problem are scare. There is no data regarding prevalence of faecal incontinence from developing countries. OBJECTIVES: To detect the prevalence of faecal incontinence in Sri Lankan school children 10-16 years and factors associated with this condition. DESIGN, SETTING AND METHOD: This was a school based, island-wide, cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, from 3 geographically and socio-economically different provinces in Sri Lanka. The questionnaire was filled under guidance of research assistants. Faecal incontinence was defined as defaecation into places inappropriate to the social context, at least once per month, for a minimum period of 2 months. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2686 (96%) were included in the analysis. Of them 55 (2%) had faecal incontinence [male 43 (78%), mean age 11.96 years, SD 1.59 years]. Forty five (82%) had constipation associated faecal incontinence and 10 (18%) had non-retentive faecal incontinence. The highest prevalence was seen in children aged 10 years (5.4%). A significant negative correlation was observed between age and the prevalence of faecal incontinence (r=-0.893, p<0.01). Faecal incontinence was significantly higher in males (male 3.2%, females 0.9%), those exposed to recent school and family related stressful life events and those from lower social classes (p<0.05). Other symptoms associated with this condition were abdominal pain, nausea and vomiting (p<0.05). CONCLUSIONS: Faecal incontinence was seen in 2% of Sri Lankan children and adolescents aged 10-16 years. The majority had constipation associated faecal incontinence. It was more commonly seen in males, younger age, those from a lower social background and children who were exposed to stressful events.

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