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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2016 - 20172

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Author: search.filters.author.Luke, H.P.D.P.Subject: search.filters.subject.inflammatory bowel disease

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    Influence of urban/rural and coastal/inland environment on the phenotype and clinical course of inflammatory bowel disease patients from Sri Lanka: a cross-sectional study
    (Sri Lanka Medical Association, 2017) Niriella, M.A.; Kodisinghe, S.K.; Dinamithra, N.P.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
    INTRODUCTION & OBJECTIVES: Rural/urban and coastal/inland environmental influences on inflammatory bowel disease (IBD) is poorly studied. We investigated such environmental influences on IBD. METHODS: Patients with histologically proven IBD [ulcerative colitis (UC), Crohn disease (CD)] with a permanent residence and regular follow up, were included. Urban areas (UA) were defined as those administered by Municipal and Urban councils. Coastal areas (CA) were defined as areas with elevation <30 meters above sea level. Patients in different groups were compared with regard to phenotype of IBD [sex, age at diagnosis, Montreal subgroups, severity, extraintestinal manifestation (EIM) at diagnosis, and highest therapy during follow-up]. Fisher’s exact test was used to compare categorical variables. RESULTS: A total of 387 patients were included [UC-251 (64.8%), males-122 (48.6%), median followup (IQR)-22.5 (2-59) months; CD-136 (35.2%), males-65 (47.8%), median follow-up (IQR)- 63.0 (23-115) months; urban/rural distribution: UC-1.7:1, CD-1.5:1; coastal/inland distribution: both UC and CD-0.7:1]. Urban/rural or coastal/inland location did not affect the distribution of type of IBD, gender, age at diagnosis or presence of EIM. UC patients from rural areas had extensive disease (E3) (42.4% vs 24.5%, p=0.029) and used long term immunomodulator drugs more frequently (60.2% vs 47.3%; P=0.006) than UA patients. CD patients living in CA had more frequent ileo-colonic disease (L3) compared to inland patients (53.2% vs 38.0%, p=0.016). Patients with both UC and CD from inland areas needed immunomodulators or anti-TNF more frequently than coastal patients (56.7% vs 44.9%, p=0.026 and 82.1% vs 69.9%, p=0.023). CONCLUSION: IBD was more common among patients from inland, UA. Urban/rural or coastal/inland location did not affect gender, age at diagnosis or presence of EIM. However, UC patients from rural areas and CD patients from inland areas had more severe disease.
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    Clinical predictors of poor disease outcome for inflammatory bowel disease in Sri Lanka
    (Sri Lanka Medical Association, 2016) Niriella, M.A.; Kodisinghe, S.K.; Dassanayake, S.U.B.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
    INTRODUCTION: There is limited data on clinical predictors of poor outcomes of inflammatory bowel disease from Sri Lanka. OBJECTIVES: To study clinical predictors of poor outcomes of inflammatory bowel disease among patients attending National Hospital of Sri Lanka and Colombo North Teaching Hospital. METHOD: Patients with ulcerative colitis (UC) and crohn disease(CD) of at least one year duration were included from Colombo North Teaching Hospital and National Hospital of Sri Lanka. Predictors of complicated disease (CompD) (structuring/penetrating-CD, extensive/pancolitis-UC), treatment refractoriness (TR) (frequently relapsing, steroid dependent, steroid refractory, need for biologics) and disease complications (DC) (perforation, bleeding, colectomy, malignancy) were assessed. Gender, age, duration at diagnosis, extra-intestinal manifestations (EIM), cigarette smoking and family history were assessed as independent risk factors using binary logistic regression. RESULTS: 287 patients were included [UC-208 (72.5%%), 100 (48.1%) males, median follow up (IQR) 74.5 (35.0–127.5) months; CD 79(27.5%), 37(46.8%) males, median follow up (IQR) 50.0 (29.0-84.0) months]. CompD was observed among 65(31.25%) UC and 20(25.31%) CD patients; family history (OR 4.103, adjusted p=0.029) was predictive of CompD in UC. TR was observed among 13(6.31%) UC and 9(11.39%) CD patients; non-smoking was predictive of TR in UC (OR=0.000, adjusted p=0.027). DC was seen in 8(3.86%) of UC and 11(13.92%) of CD. Family history (OR=16.457, adjusted p=0.001), EIM of skin (OR=14.071, adjusted p=0.039) and joints (OR=8.940, adjusted p=0.002) were predictive of DC in UC; eye EIM (OR=4.286, adjusted p=0.047) was predictive of DC in CD. CONCLUSIONS: CompD was not uncommon in UC and CD. TR and DC were uncommon. Family history, being a non-smoker, EIM of skin and joints independently predicted worse outcomes in UC, while EIM of eyes predicted a poor outcome in CD.