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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Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms - a prospective study
(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; de Silva, A.P.; Hewavisenthi, S.J.; Jayathilake, T.M.A.H.; de Alwis, W.R.S.
INTRODUCTION: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.02-1%), and is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (about 6.5-40%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. AIMS: To study the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. Methods: The study was carried out in the University Medical Unit of the Colombo North Teaching Hospital, Ragama. Over a period of one year from March 2011, consecutive, consenting patients (aged 18-70) referred for gastroduodenoscopy (OGD), with persistent UGI symptoms despite standard therapy for at least two months, were included. All patients underwent OGD with two biopsies each from the distal and mid oesophagus. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to international guidelines. RESULTS: 106 patients (M: F= 42:64 mean age 48 yrs (SD 13.3) were recruited. Common symptoms were refractory dyspepsia, gastro-oesophageal reflux and dysphagia in74, 64, 27 patients respectively. Endoscopy was macroscopically normal in 97 patients, and suggestive of EoE in 7; concentric mucosal rings in 3 and white exudates in 4 patients. Only 2 (1.9%) patients had histological evidence of EoE, one of whom had compatible macroscopic endoscopic features. CONCLUSIONS: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in western series.
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.
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.
Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms: a prospective study
(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; de Silva, A.P.; de Alwis, R.; Waraketiya, P.R.; Jayathilake, T.M.A.H.; Niriella, M.A.; Dassanayake, A.S.; Hewavisenthi, S.J.de S.; de Silva, H.J.
BACKGROUND AND AIM: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.02–1%). It is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (8.8–48%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. Our aim of this study was to evaluate the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. METHODS: The study was carried out in the University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka. Over a period of one year from March 2011, consecutive, consenting patients (aged 18–70) referred for gastroduodenoscopy (OGD); with persistent UGI symptoms despite standard therapy for at least two months were recruited. Patients without significant abnormalities other than features of EoE on OGD underwent two biopsies each from the distal and mid oesophagus. Biopsies were obtained from duodenum and stomach at the same time to rule out possible eosonophilic gastroenteritis. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to the international guidelines. RESULTS AND DISCUSSION: Common refractory symptoms were dyspepsia, gastro-oesophageal refl ux and dysphagia in 74, 64, 27 respectively. Only 106 patients (M: F = 42:64 mean age 48 yrs (SD 13.3) who fulfill the criteria underwent oesophageal biopsies. Endoscopy was macroscopically normal in 98 patients and suggestive of EoE in 8; concentric mucosal rings in 2 and white exudates in 6 patients. Only 2 (1.9%) patients had histological evidence of EoE, both had symptoms of refractory dyphagia and one had compatible macroscopic endoscopic features of EoE (concentric mucosal rings). CONCLUSION: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in Western series
Gastric motility abnormalities in children suffering from cyclical vomiting syndrome
(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.
AJMS; Cyclical vomiting syndrome (CVS) is an uncommon, but bothersome upper gastrointestinal disorder seen in ap- roximately 0.5% of school aged children. Pathophysiology of this disorder is not fully understood. The aim of this study was to evaluate the gastric motility in children with CVS. METHODS : Consecutive 12 children [6 (50.0%) males, age 4-15years, mean 8.5 years, SD 3.2 years) referred to Gastro-nterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, from January 2008'to December2012, were screened and those fulfilling Rome HI criteria for CVS were recruited. None-had clinical or laboratory vidence of organic disorders or other gastrointestinal disorders. Twenty healthy children were recruited as controls [8 (40%) males, age 4-14 years, mean 8.4 years, SD 3.0 years]. Fasting antral area (FAA), liquid gastric emptying rate GER) and antral motility parameters were assessed using a well-established and validated ultrasound method, RESULTS: Average GER (38.2% vs. 66.2%, in controls), amplitude of antral contractions (51.1% vs. 89%) and antral -lotuty index (4.6 vs. 8.3) were lower and FAA (1.6cm2 vs. 0.6cm2) was higher in patients with CVS (p < 0.0001). Fre-uency of antral contractions (8.8 vs. 9.3) did not show a significant difference (p - 0.07). Scores obtained for severity )f abdominal pain had a negative correlation with GER (r = -0.25, p < 0,0001), amplitude of antral contractions (r = ;030,/5 < 0.0001) and motility index (r = -0.30,;p < 0,0001). A positive correlations were observed between FAA and severity(r= 0.18,p = 0.007). CONCLUSIONS : Gastric emptying rates and antral motility parameters are impaired in children with CVS. Furthermore, we 3served a significant correlation between symptom severity and gastric motility. These findings are suggestive of gastric lotility abnormalities in pathogenesis of CVS.
Quality of life in teenagers with abdominal pain related functional gastrointestinal disorders who have been exposed to child abuse
(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.
AIMS: Large number of previous studies conducted in children and adults have shown a significant association between abdominal pain predominant functional gastrointestinal disorders (AP-FGD) and exposure to child abuse. The main objective of this study was to assess the impact of child abuse on quality of life of Sri Lankan with AP-FGD. METHODS: A randomly selected group of 13-18 year olds were screened using the Rome iii questionnaires criteria for AP-FGD were recruited after obtaining consent from school administration, parents and teenagers themselves. Information regarding exposure to abuse and quality of life were assessed using previously translated and validated questionnaires. The questionnaires were administered in an examination setting to ensure confidentiality and privacy. Research assistants were present during filling the question¬naires and verifications were provided. They were collected on the same day. RESULTS: A total of 290 children with AP-FGD were recruited [males 128 (44.1%), mean age 14.6 years and SDI 1.5 years]. The number of children exposed to physical, emotional and sexual abuse, were respectively 90 (31.0%), 101 (34.8%) and 16 (5.5%). Average scores obtained for physical (85.3% vs.89.3% in nonabused), emotional (69.9% vs.79.7%), social (86.3% vs. 92.6%) and school (73.7% vs. 80.6%) functioning domains of quality of life in children exposed to emotional abuse were significantly lower (p < 0.05, unpaired t-test). Similar decrease was observed in children exposed physical abuse in social (86.4% vs. 92.2%) and school (74.6% vs. 79.9%) functioning domains (p < 0.05), but not in physical and emotional functioning domains (p > 0.05). Exposure to sexual abuse did not show a significant difference in in quality of life (p > 0.05). CONCLUSIONS : Even among teenagers with AP-FGD, those exposed to child abuse have a significantly lower quality of life than those not exposed to abuse.
Constipation and functional faecal retention in Sri Lankan school children and adolescents
(Wiley Blackwell Scientific Publications, 2008) Rajindrajith, S.; Adikari, C.; Pannala, W.; Devanarayana, N.M.
INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding it’s prevalence in Asia. AIMS : To assess prevalence of constipation and functional faecal retention among Sri Lankan school children and adolescents. MATERIALS: This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in 4 randomly selected schools, in 3 geographically and socioeconomically different Provinces in Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. RESULTS: A total of 2770 questionnaires were distributed and 2699 (97.4%) were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria and PACCT, 416 (15.4%) and 353 (13.1%) had constipation respectively [the agreement Cohen’s kappa (k) = 0.895, p < 0.0001]. Prevalence of constipation was higher in males than in females according to both PACCT (15.1% vs. 11%, p = 0.002) and Rome III criteria (16.8% vs. 14%, p = 0.047). The majority had family history of constipation (p < 0.0001). Straining, bleeding per rectum, abdominal pain, nausea, vomiting, anorexia and weight loss were significantly higher in the affected children (p < 0.001). Hundred and ten (4.1%) had functional faecal retention, of them 104 (94.5%) also fulfilled Rome III criteria for constipation (k = 0.402, p < 0.0001). CONCLUSIONS: Chronic constipation is a significant problem affecting 13–15% of Sri Lankan school children and adolescents. Constipation is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studies
Oro-caecal transit in Sri Lankan children and adolescents with functional recurrent abdominal pain
(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.
INTRODUCTION: Recurrent abdominal pain (RAP) is a common paediatric problem. The majority of the affected have no organic pathology. Gastrointestinal motility abnormalities are considered as a possible cause for their symptoms. This study evaluated oro-caecal transit in children and adolescents with functional RAP. METHODS: Thirty one children with functional RAP and 20 healthy children from the same geographical area underwent oro-caecal transit time measurement by lactulose (0.25 g/kg in 10% solution) breath hydrogen test. None had evidence of organic disease, except for one control who had a positive Helicobacter pylori stool antigen test. RESULTS: Oro-caecal transit times could be calculated in 30 patients [10 (33.3%) males, mean age 7.2 years, SD 2.4 years, 12 functional abdominal pain, 8 irritable bowel syndrome, 8 functional dyspepsia, 1 abdominal migraine, 1 non-specific abdominal pain according to Rome III criteria] and 19 controls [10 (52.6%) males, mean age 9 years, SD 2.7 years]. One patient (3%) and 1 control (5%) were non-responders. Oro-caecal transit time was significantly prolonged in patients (median 90 min, range 45–150 min) compared to controls (median 75 min, range 30–105 min) (p = 0.0045). Oro-caecal transit time did not correlate with scores obtained for severity of abdominal pain (r = 0.176, p = 0.354) and had no association with exposure to recent stressful life events (p > 0.05). CONCLUSIONS: Oro-caecal transit time was delayed in children and adolescents with functional RAP. The future studies are needed to confirm the role of delayed oro-caecal transit in generation of symptoms, and to evaluate the therapeutic value of drugs that normalize small intestinal transit.
Gastrointestinal disorders in children admitted to a tertiary care paediatric unit in Sri Lanka
(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; Adikari, A.M.D.B.; Sanjeewa, P.A.B.; Rajindrajith, S.
OBJECTIVES : Gastrointestinal diseases, including diarrhoea and abdominal pain, are common presenting complains in children admitted to hospitals. In those with abdominal pain, non-specific abdominal pain is the commonest diagnosis at discharge. This study evaluated the gastrointestinal disorders in children admitted to a tertiary care general paediatric unit in Sri Lanka. METHODS: Records of all neonates, infants and children admitted to University paediatric unit in North Colombo Teaching Hospital, Ragama, Sri Lanka, during 12 month period from 01/10/2006 to 30/09/2007, were evaluated. Demographic information, details regarding the symptoms, exam nation findings, investigations, treatments and diagnosis at discharge were analysed retrospectively. RESULTS: Of the 5202 patients admitted during the study period, 167 (3.2%) had gastrointestinal disorders [90 (54.9%) were males, mean age 6.3 years, SD 2.5 years, range 2–13 years]. Common presenting complains were diarrhoea [79 (47.3%)], abdominal pain [62 (37.1%)], constipation [10 (6%)] and vomiting [8 (4.8%)]. Most common discharge diagnosis was acute gastroenteritis (AGE) [57 (45.5%)]. Of 62 children presented with abdominal pain, only 23 (36.1%) had exact diagnosis at the discharge (AGE 13, gastritis 3, constipation 4, gastro-oesophageal reflux 1, typhoid fever 1, functional abdominal pain 1). CONCLUSIONS: Diarrhoea and abdominal pain accounted for more than 80% of hospital admissions due to gastrointestinal disorders. Nearly two third of patients admitted due to abdominal pain had no diagnosis at discharge. Even though, Rome III criteria are widely available, only one patient was diagnosed as having functional gastrointestinal disorder.

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