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 Causes for recurrent abdominal pain in children and adolescents: a classification according to rome ii criteria(Sri Lanka College of Paediatricians, 2007) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.BACKGROUND: Recurrent abdominal pain (RAP) among children and adolescents is defined as "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than 3 months". RAP has multifactorial aetiology with many affected children having no evidence of organic pathology. The ROME II criteria for 'childhood functional gastrointestinal disorders' classify non-organic RAP into five main categories: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, aerophagia and functional abdominal pain. OBJECTIVES: To identify the causes of RAP in Sri Lankan children. To classify non-organic RAP using ROME II criteria. DESIGN, SETTING AND METHOD: The children identified as having RAP during a school survey were recruited and screened for organic diseases using history, examination, stool microscopy and culture, full blood count, erythrocyte sedimentation rate and abdominal radiograph. Other investigations, performed based on clinical evidence, included serum amylase, renal and liver function tests, abdominal ultrasound and gastrointestinal endoscopy. RAP was defined according to Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified using ROME II criteria. RESULTS: Fifty five children with RAP were investigated [25(45.5%) males, aged 5-15 years {mean 8.1 years, SD3.1 years)]. Thirteen (23.6%) had organic RAP (constipation 7, urinary tract infection 2, urinary calculi 1, gastro-oesophageal reflux I, antral gastritis and duodenitis I, and intestinal amoebiasis 1) and 42 (76.4%) had no organic disease. Thirty three (60%) could be classified according to ROME II criteria [functional abdominal pain 13, IBS 9, FD 9, abdominal migraine l,aerophagia I]. Nine (16.4%) did not fall into any of the above categories. CONCLUSIONS: The majority (60%) of children with RAP had functional bowel disease, which can be classified using ROME II criteria. • Organic pathology accounted for symptoms in less than 25% of patients.Item 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.Item Effects of body mass index on gastric motility in children with abdominal pain-predominant functional gastrointestinal disorders(The Physiological Society of Sri Lanka, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.INTRODUCTION: Objective of this study was to assess the effects of body mass index (BM1) on gastric motility abnormalities in children with abdominal pain-predominant FGIDs (AP- FGIDs). METHODS: Gastric motility parameters of 100 children with AP-FGIDs (39.0% boys, mean age 8.0 years [SD +or -2.1years] and 50 healthy controls (30% boys, mean age 8.6 years [SD +or -1.9 years]) were assessed by previously validated ultrasound method. AP-FGIDs were diagnosed using Rome III criteria. Fifty four had functional abdominal pain, 23 had irritable bowel syndromes, 9 had functional dyspepsia, 8 had abdominal migraine and 6 had more than one AP-FGID. RESULTS: Patients with AP-FGIDs had significantly lower gastric emptying rate (44.9% vs. 59.5% in controls, p<0.0001), frequency of antral contractions (8-3 vs. 9.4, p<0.000l), amplitude of antral contraction (48.6% vs. 58.1%, p<0.000l) and antral motility index (MI) (4.0 vs. 6.4, p=0.001). Fasting antral size (FA) and antral area at Iminute (AA1) and antral area at I5 minutes (AA15) after ingestion of the liquid test meal were not significantly different. BMI of children with AP-FGIDs and controls were respectively 15.2 and 15.6 (p=0.42). The correlations between BMI and AA1 (r=0.29, p=0.007), AA15 (r=0.32, p=0.003) and MI (r=0.22, p=0.038) in children with AP-FGIDs were significant. Patients with BMI <15Kg/m2 had a lower FA (1.5cm2 vs. 2.1cm2, p=0.03), AA1 (8.9 cm2 vs. 10.7 cm2, p=0.003) and AA15 (4.6 cm2 vs. 5.8 cm2, p= 0.01) than patients with BMI >15Kg/m2. CONCLUSION: BMI has an impact on certain gastric motility parameters in children with AP-FGIDs.Item Therapeutic effects of domperidone on abdominal pain-predominant functional gastrointestinal disorders in children: randomized, double-blind, placebo-controlled trial(The Physiological Society of Sri Lanka, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.AvailableItem Assessment of gastric emptying and antral motility in different types of abdominal pain related functional gastrointestinal diseases: a paediatric study(BMJ Publishing, 2010) Devanarayana, N.M.; Rajindrajith, S.INTRODUCTION: Functional gastrointestinal disorders (FGD) are common among paediatric population. Abdominal pain related FGD are the most common subgroup found, of which irritable bowel syndrome is the most common. The exact mechanism of pain remains unclear in FGD. Visceral hypersensitivity and altered gastrointestinal motility are considered possible causes for abdominal pain and discomfort found in these children. METHODS: The main aim of this study was to evaluate the gastric emptying and antral motility in children and adolescents with abdominal pain related FGD. Hundred and fifty-five children referred to the Gastroenterology Research Laboratory who fulfilled Rome III criteria for abdominal pain related FGD (60 (38.5%) males, 4–14 years, mean 8.1 years, SD 2.6 years) and 20 healthy children without gastrointestinal symptoms (8 (40%) males, 4–15 years, mean 8.9 years, SD 2.7 years) were recruited. None had clinical or laboratory evidence of organic diseases. All subjects underwent ultrasonographic assessment of liquid gastric emptying rate (GE) and antral motility, using a previously reported method. RESULTS: Gastric motility parameters of children with FGD and controls are presented in the table. GE negatively correlated with the scores obtained for severity of symptoms in functional dyspepsia (FD) (r=−0.67, p<0.001) and functional abdominal pain (FAP) (r=−0.38, p<0.001), but not in irritable bowel syndrome (IBS) (r=−0.16, p=0.29). CONCLUSIONS: GE and antral mortality parameters were significantly impaired in children with all types of abdominal pain related FGD. GE negatively correlated with symptoms in FD and FAP. Mortality parameters were not significantly different between subtypes of IBS.Item Effects of body mass index on gastric motility in children with abdominal pain-predominant functional gastrointestinal disorders.(Lippincott Williams & Wilkins, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.INTRODUCTION: There is evidence that overweight children have a higher prevalence of functional gastrointestinal disorders (FGIDs) than normal-weight children. Objective of this study was to assess the effects of body mass index (BMI) on gastric motility abnormalities in children with abdominal pain-predominant FGIDs (AP-FGIDs). METHODS: Gastric motility parameters of 100 children with AP-FGIDs (61(61%) girls, mean age 8.0 years [SD 2.1years] and 50 healthy controls (30 (30%) boys, mean age 8.6 years [SD 1.9 years]) were assessed at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka, using a previously validated ultrasound method. AP-FGIDs were diagnosed using Rome III criteria. Fifty-four had functional abdominal pain, 23 had irritable bowel syndromes, 9 had functional dyspepsia, 8 had abdominal migraine and 6 had more than one AP-FGID. RESULTS: Patients with AP-FGIDs had significantly lower gastric emptying rate (44.9% vs. 59.5% in controls, p < 0.0001), frequency of antral contractions (8.29 vs. 9.44, p < 0.0001), amplitude of antral contraction (48.6% vs. 58.1%, p < 0.0001) and antral motility index (4.0 vs. 6.4, p = 0.001). Fasting antral size (FA) and antral area at 1minute (AA1) and antral area at 15 minutes (AA15) after ingestion of the liquid test meal were not significantly different. BMI of children with AP-FGIDs and controls were respectively 15.2 and 15.6 (p = 0.42). The correlations between BMI and AA1 (r = 0.29, p = 0.007), AA15 (r = 0.32, p = 0.003) and MI (r = 0.22, p = 0.038) in children with AP-FGIDs were significant. Patients with BMI <15Kg/m2 had a lower FA (1.5cm2 vs. 2.1cm2, p = 0.03), AA1 (8.9 cm2 vs. 10.7 cm2, p = 0.003) and AA15 (4.6 cm2 vs. 5.8 cm2, p = 0.01) than patients with BMI >15Kg/m2. CONCLUSIONS: BMI has an impact on certain gastric motility parameters in children with AP-FGIDs. However, it does not contribute to abnormalities seen in main gastric motility parameters such as gastric emptying.Item Recurrent abdominal pain among children: its role in school performance(Sri Lanka Medical Association, 2006) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.OBJECTIVES: Recurrent abdominal pain (RAP) is a common problem among school children. The majority of affected children do not attend school regularly. It is believed to be common among high academic achievers but available data has failed to show such an association. Our main objective was to detect the association between RAP and school performance in Sri Lankan children. METHOD: This was a cross sectional survey. Questionnaires were distributed to a randomly selected group of school children attending year 1 to 9. Questionnaires were filled by parents and returned by post. Details regarding the child's academic performance were obtained from school records. RAP was defined according to Apley's criteria. RESULTS: Eight hundred and ten questionnaires were distributed, 734 (90.6%) were returned. Seventy seven (10.5%) had RAP. RAP was significantly higher in children who had changed their school (p=0.0026) and were being bullied at school (p=0.00098). School absenteeism was 80.5% in the RAP group compared to 45% among controls (p<0.0001). Twenty five (32.2%) and 16 (20.8%) children with RAP had disturbances in participation in sports and extracurricular activities respectively. Prevalence of RAP in good, average and poor academic performers was 11.2%, 11.5% and 10.4% respectively (p>0.05). Performance in the year-5-scholarship examination (12.6% in scholarship holders vs. 10.2% in failures) and child's participation in sports showed no association with RAP (p>0.05). CONCLUSIONS: RAP was associated with exposure to stressful events at school. School absenteeism was significantly higher among affected children. RAP was not associated with high academic achievement and participation in sports.