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 Early clinical course 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: There is very limited data on the early clinical course of IBD from Sri Lanka. METHOD: Patients with histologically proven IBD [ulcerative colitis(UC), Crohn disease(CD)] of less than 3 years duration, were included from Colombo North Teaching Hospital and National Hospital of Sri Lanka (two main referral centers). Complicated disease behaviour (stricturing or penetrating CD, extensive or pancolitis for UC), treatment refractory disease (frequently relapsing, steroid dependent, steroid refractory, need for biologics) and complications (perforation, bleeding, colectomy and malignancy) were analysed. RESULTS: 177 patients were eligible for inclusion [UC-97(54.8%), 46(47.4%) males, median follow up (IQR) 17.0(5.5-28) months; CD 80(45.2%), 39(48.8%) males, median follow up (IQR) 7(2-21.5) months]. Admissions with severe episodes of extensive or pancolitis for UC were 26(26.8%) and 20(21.1%) respectively. Admissions with severe episodes, stricturing(B2), penetrating(B3) or perianal disease(P) for CD were 7(8.8%), 9(11.5%) and 16(20%) respectively. Treatment refractoriness (steroid dependency, steroid refractory or frequently relapsing) was 6(9.6%) for UC and 6(8.4%) for CD. Immunomodulator use was 35 (37.2%) and 56(72.7%), and Anti-TNF agent use 2(2.1%) and 2(2.6%) respectively for UC and CD. Few had complications [UC-bleeding 5(5.2%), malignancy 1(1%), surgery 2(2.1%); CD-stricture 3(3.8%), perforation 3(3.8%), malignancy 1(1.3%), surgery 3(3.8%)]. CONCLUSIONS: In the early clinical course of this cohort of IBD patients, admissions with complicated disease were common for UC but not CD. Few patients were treatment refractory. Immunomodulator use was more common for CD, but need for biologics was rare for both. Few IBD patients developed complications. This indicates a relatively benign early disease course.Item 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.Item Incidence and phenotype of Inflammatory Bowel Disease from 2012-2013 across 9 countries in Asia: results from the 2012 access inception cohort(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) Ng, S.C.; Zeng, Z.; Chen, M.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Yang, hong; Qian, J.M.; Yu, H.H.; Li, M.F.; Zhang, J.; Ng, K.K.; Ong, D.E.; Ling, K-L; Goh, K.L.; Hilmi, I.; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Manatsathit, S.; Abdullah, M.; Simadibrata, M.; Gunawan, J.A.; Chong, V.H.; Tsang, S.; Chan, K.H.; Lo, F.H.; Hui, A.J.; Chow, C.M.; Kamm, M.A.; Hu, P.; Ching, J.; Chan, F.K.L.; Sung, J.J.Y.BACKGROUND: The incidence of inflammatory bowel disease (IBD) in Asia was first reported in the 2011 ACCESS inception cohort. This study aims to validate the incidence reported in 2011 by including a second independent cohort from 8 of the participating countries in 2011 and Brunei to investigate the incidence of IBD in Asia in 2012. METHODS: Incident IBD cases diagnosed between April 1, 2012 and March 31, 2013 from 18 centres, 11 cities and 9 countries in Asia were enrolled. Data including demographics and disease phenotype were entered into a Web-based database (http://www.access-apibd.com/access/index.html). Disease location and behavior were classified according to the Montreal classification. RESULTS: A total of 325 IBD patients were identified including 189 (58%) ulcerative colitis (UC), 119 (37%) Crohn’s disease (CD), and 17 (5%) indeterminate colitis (IC). The crude overall annual incidence per 100,000 of IBD was 1.61 (95% confidence interval, CI, 1.44-1.79) in 2012 compared with 1.15 (95% CI, 1.25-1.51) in 2011. The highest incidence in Asia was in Guangzhou (3.86 per 100,000), Hong Kong (2.91 per 100,000) followed by Macau (2.60 per 100,000). Overall ratio of UC to CD in 2012 was similar to that of 2011 (1.57 vs. 1.69; p=0.211). There were more male than female patients in both years (59% vs 60%; p=0.773). Mean age of diagnosis was 40 years (±15.96) in 2011 and 42 years (±16.30; p=0.084) in 2012. Median time from symptom onset to diagnosis was 6 months (IQR 3-24) and 7 months (IQR 2-16), respectively, in 2011 and 2012 (p=0.958). Disease behavior (B1: 72.0%, B2: 9.9%, B3: 4.4%, perianal: 13.2%), location for CD (L1: 25.3%, L2: 25.3%, L3: 49.5%) and UC (E1: 30.9%, E2: 40.1%, E3: 28.9%) did not differ from previous year. Most CD patients were non-smokers (80.3%) whereas 9.9% were current smokers and 9.9% were ex-smokers. CONCLUSION: The incidence of IBD, UC to CD ratio and age of disease onset in the ACCESS 2012 cohort was not significantly different from that reported in the 2011 cohort. Disease phenotype was also similar over 2 years. The ACCESS inception cohort reflects the true incidence of IBD in Asia.