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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Author: search.filters.author.Karunanayake, A.Has files: No

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    Impact of early life events (ELE) and family dynamics for developments of abdominal pain predominate functional gastrointestinal disorders (AP-FGIDs) in 5-12 age group
    (Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Karunanayake, A.; Rajindrajith, S.; Devanarayana, N.M.
    INTRODUCTION The pathophysiology of AP-FGIDs in children are poorly understood. Animal and human studies have suggested that adverse ELE such as pain or stress can induce long-term changes in the neurons. Apart from the abuse other aspects in early life have not been well investigated. METHODS ELE were evaluated in 182 school children with AP-FGIDs (62.1% girls, mean age 8.5, SD 2.1) and 571 children without AP-FGIDs recruited as controls (51.1% girls, mean age 8.8 SD 1.9 ) using a translated and pretested parental questionnaire. AP- FGIDs were diagnosed by Rome III criteria. RESULTS Compared to controls AP-FGIDs patients were low in birth order (1.7 vs. 1.9 p=0.01). Birth order of the parents, maternal and paternal age of marriage and number of members in the house were not associated with AP-FGIDs (p >0.05, Independent sample T test.). Prenatal complications (14.8% vs. 7.4% p= 0.002) and post-natal complications and receiving PBU care (7.7% vs. 3.1% p=0.008) were significantly higher in AP-FGIDs. Gestational period, mode of delivery, duration of hospital stay, period of exclusive breast feeding and duration of breast feeding were not significantly different (p>0.05). Presence of a family member with abdominal pain lasting more than 2 months and the presence of a family member with chronic pain (other than abdominal pain) in the family is also significantly higher in AP-FGIDs families (p<0.0001, Chi-square test). CONCLUSION ELEs occurring during pre and post-natal periods, which is a vulnerable period for developing neurons may be an important contributory factor for the development of AP-FGIDs. Familial predisposition for development of AP-FGIDs highlight the possible genetic basis for pathogenesis of AP-FGIDs. Breast feeding does not protective against the development of AP-FGIDs.
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    Health related quality of life (HRQOL), family impact and disturbances to child activity in children with abdominal pain predominate functional gastrointestinal disorders(AP-FGIDs); School based, cross sectional study
    (Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.
    INTRODUCTION This study assessed the impact of AP-FGIDs on life of 5-12-year olds and their families. METHODS A cross sectional survey was conducted in four randomly selected schools in Gampaha District of Sri Lanka. Data was collected using a translated and validated parental PedsQL TM4.0 Generic Core Scales and PedsQL TM2.0 family impact module. AP-FGIDs were diagnosed using Rome III criteria. RESULTS Eighty two AP-FGIDs children (63.4% girls, mean 9.2years, SD 1.9years) and 571 healthy controls (51.1% girls, mean 8.8years, SD1.9 years) were included in the analysis. Scores obtained for HRQOL were lower in those with AP-FGIDs in all domains (total 81.8 vs. 87.3 in controls, physical 85.3 vs. 91.8, emotional 72.5 vs. 81.8, school 73.7 vs. 80.7, p<0.01), except social functioning (89.7 vs. 92.8, p=0.83). The severity of pain negatively correlated with emotional (r=-0.31) and school (r=-0.359) functioning (p<0.01). The total HRQOL score negatively correlated with the number of healthcare consultations (r=-0.25, p=0.008). Scores obtained for family impact were lower in children with AP-FGIDs in all domains (total 79.0 vs. 86.9, physical 76.6 vs. 86.0, emotional 74.7 vs. 83.7, cognitive 81.6 vs. 88.2, communication 87.9 vs. 92.8, worry 83.1 vs. 90.7, family relationship 76.6 vs. 86.0) (p<0.01), except social (86.6 vs. 89.3) and daily activity (74.6 vs. 75.7) domains (p>0.05). The total score in family impact negatively correlated with scores obtained for pain frequency (r = -0.21) and severity (r = -0.267), anorexia (r= -0.20), school interruption (r = -0.19) and disturbances to daily activities (r= -0.32) and child's hobbies (r = -0.27) (p<0.05). CONCLUSION AP-FGIDs are severe enough to reduce HRQOL in affected children and has a significant impact on the families.
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    Abdominal pain predominant functional gastrointestinal diseases: association with child abuse, traumatic life events and quality of life
    (Wiley Blackwell Scientific Publications, 2012) Devanarayana, N.M.; Rajindrajith, S.; Karunanayake, A.; Nishanthini, S.; Perera, M.S.; Benninga, M.A.
    BACKGROUND/AIMS: Abdominal pain predominant functional gastrointestinal diseases (AP-FGD) have significant repercussions on affected individuals. Aims of this study were to assess its association with traumatic life events and child abuse, and its impact on quality of life. METHODS: Children aged 13–18 years were randomly selected from 3 schools in Western province of Sri Lanka. A previously validated, self administered questionnaire was used to collect information on gastrointestinal symptoms, traumatic life events, exposure to abuse, healthcare consultation and quality of life (QOL). AP-FGD were diagnosed using Rome III criteria. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years and SD 1.22 years]. AP-FGD were found in 243 (17.8%) children [Irritable bowel syndrome in 70 (5.1%), functional dyspepsia in 11 (0.8%), abdominal migraine in 26 (1.9%) and functional abdominal pain in 146 (10.7%)]. Prevalence of AP-FGDs were significantly higher in those exposed to traumatic life events (37.9% vs. 3.1%, p = 0.03), sexual abuse (35.3% vs. 17.3%, p = 0.01), physical abuse (19.7% vs. 12.6%, p = 0.0003), and emotional abuse (27.4% vs. 16.9%, p < 0.0001). Health care consultation was significantly higher in children exposed to physical abuse (26.4% vs. 0.0%, p = 0.03). QOL scores for physical (85.7 vs. 89.6), emotional (71.7 vs. 79.4), social (85.9 vs. 92.3) and school (74.3 vs. 81.1) function domains were significantly lower in children with AP-FGD who were exposed to emotional abuse (p < 0.05). QOL scores for school function domain was lower in children exposed to physical abuse (77.8 vs. 83.6, p = 0.03). CONCLUSIONS: Traumatic life events and child abuse in any form are significantly associated with higher prevalence of AP-FGD. Children exposed to physical abuse are more likely to seek healthcare for abdominal pain. Children with AP-FGD, exposed to emotional abuse, have significantly poor quality of life in all four domains.
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    Therapeutic effects of domperidone on abdominal pain-predominant functional gastrointestinal disorders: randomized, double-blind, placebo- controlled trial.
    (Lippincott Williams & Wilkins, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.; de Silva, A.
    INTRODUCTION: The therapeutic effect of domperidone on abdominal pain-predominant functional gastrointestinal diseases (AP-FGIDs) was assessed on children in 5-12 year age group at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka. METHODS: Children fulfilling Rome III criteria for AP-FGIDs were recruited from the out-patient clinic of the University Paediatric Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka, after obtaining parental consent. They were randomized in to 8 weeks of placebo or Domperidone (Motillium 10 mg, 3 times per day, before meals) groups, using computer generated random numbers. Placebo was a specially prepared dummy tablet without any active ingredients, had the same colour, size, shape and taste of domperidone tablet and were packaged similarly. Primary outcomes defined were cure (abdominal pain less than 25 mm on the visual analogue scale and no impact on daily activities) and improvement (pain relief and sense of improvement recorded on global assessment scale). Secondary outcomes were significant improvement in symptoms, gastric motility, quality of life (QoL) and family impact. Both patients and investigators who assessed primary and secondary outcomes before and after intervention were blind to inventions administered. Symptom severity was recorded on a validated 100 mm visual analogue scale. Translated and validated PedQL Generic Score Scale version 4.0 and Family Impact Module were used. Gastric motility was assessed using a validated ultrasound method. RESULTS: One hundred children were enrolled and 89 completed the trial [Placebo 42 (22 girls), Domperidone 47(33 girls)]. While comparing primary outcomes, domperidone group had significant improvement [37 (78.7%) vs. 25 (59.5%) in placebo group, p = 0.04], while no such difference was observed in cure. When assessing secondary outcomes, domperidone group reported significant reduction in abdominal pain severity (70.84% vs. 48.18% p = 0.03) and improvement in motility index (29.3% vs. 8.6% p = 0.04) after intervention. No such difference was seen in improvement of QoL and family impact (p > 0.05). CONCLUSIONS: Domperidone has a favorable therapeutic effect on improvement AP-FGIDs in children aged 5-12 years. It causes significant reduction in abdominal pain and improvement in motility of the gastric antrum. However, it has no significant effect on improvement of QoL and family impact.