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 Prevalence of functional gastrointestinal diseases among a cohort of Sri Lankan school children aged 12 to 16 years(Sri Lanka College of Paediatricians, 2009) Devanarayana, N.M.; Adikari, C.; Pannala, W.; Rajindrajith, S.INTRODUCTION: Even though functional gastrointestinal disorders (FGID). such as irritable bowel syndrome and functional constipation, are common among children and adolescents around the world, little is known regarding their prevalence in developing countries including Sri Lanka. The current symptom based criteria (Rome III criteria) were released in 2006 and are still not widely used fay paediatricians for positive diagnosis of FGID. OBJECTIVES: To assess prevalence of FGID among a group of Sri Lankan adolescents using Rome III criteria. DESIGN, SETTING AND METHOD: This is a cross sectional survey conducted in a randomly selected group of 12-16 year olds in a semi-urban school in Gampaha district. A validated, self-administered questionnaire (developed on Rome III criteria for FGID in children) was distributed after obtaining consent from the school administration and the parents. It was administered in an examination setting, to ensure confidentiality and privacy. The questionnaire was in Sinhala, the first language of the cohort. The questions were simple and easy to understand. Research assistants were present during the whole time with students while they were filling the questionnaires and explanations were given whenever the need arose. FGID were diagnosed using Rome III criteria. RESULTS: A total of 464 questionnaires was distributed and 427 (92%) were included in the analysis [214 (50.1%) males, mean age 14.42 years, SD 1.27 years]. Thirty seven incompletely filled questionnaires were excluded from the analysis. According to Rome III criteria, 123 (28.8%) had at least one FGID. Of them, 58 (13.6%) had abdominal pain related FGID [irritable bowel syndrome 30 (7%), functional dyspepsia 14 (3.3%), functional abdominal pain 12 (2.8%) and abdominal migraine 2 (0.46%). Prevalence of functional constipation was 4.2% (18). Aerophagia was seen in 27 (6.3%), while adolescent rumination syndrome was seen in 17 (3.9%). Nonretentive faecal incontinence [1 (0.23%)] and cyclical vomiting syndrome [2 (0.46%)] were rare in our group of school children. There was no age or sex difference in the prevalence of any of the above FGID (p>0.05). CONCLUSIONS: Functional gastrointestinal disorders are a significant problem in our group of school children, affecting more than a quarter of them. Irritable bowel syndrome is the commonest FGID diagnosed.Item Faecal incontinence in Sri Lankan children and adolescents: an epidemiological survey(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Faecal incontinence is seen in 1-4% of children and has a significant impact on their quality of life. Community based studies on this important problem are scare. There is no data regarding prevalence of faecal incontinence from developing countries. OBJECTIVES: To detect the prevalence of faecal incontinence in Sri Lankan school children 10-16 years and factors associated with this condition. DESIGN, SETTING AND METHOD: This was a school based, island-wide, cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, from 3 geographically and socio-economically different provinces in Sri Lanka. The questionnaire was filled under guidance of research assistants. Faecal incontinence was defined as defaecation into places inappropriate to the social context, at least once per month, for a minimum period of 2 months. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2686 (96%) were included in the analysis. Of them 55 (2%) had faecal incontinence [male 43 (78%), mean age 11.96 years, SD 1.59 years]. Forty five (82%) had constipation associated faecal incontinence and 10 (18%) had non-retentive faecal incontinence. The highest prevalence was seen in children aged 10 years (5.4%). A significant negative correlation was observed between age and the prevalence of faecal incontinence (r=-0.893, p<0.01). Faecal incontinence was significantly higher in males (male 3.2%, females 0.9%), those exposed to recent school and family related stressful life events and those from lower social classes (p<0.05). Other symptoms associated with this condition were abdominal pain, nausea and vomiting (p<0.05). CONCLUSIONS: Faecal incontinence was seen in 2% of Sri Lankan children and adolescents aged 10-16 years. The majority had constipation associated faecal incontinence. It was more commonly seen in males, younger age, those from a lower social background and children who were exposed to stressful events.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.