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 Abdominal suture rectopexy without large bowel resection for rectal prolapse does not result in constipation: data from prospective bowel function evaluation, anorectal physiology and transit studies(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Rathnayake, G.; Deen, K.I.INTRODUCTION: Traditionally, suture rectopexy has been combined with sigmoid resection for rectal prolapse to prevent postoperative constipation. Furthermore, preservation of lateral ligaments will not result in constipation. Suture rectopexy alone without resection, is being popularised. OBJECTIVE: To study the influence of suture rectopexy without resection on colonic transit and postoperative constipation. PATIENTS AND METHODS: Forty-six patients (median (range) age 32(19-82) years) with rectal prolapse underwent suture rectopexy alone without division of lateral ligaments from March 1999. Prospectively, bowel function and anorectal physiology (ARP) were evaluated before and after surgery in a subset of 15 patients. Follow up (median, range) has been 12 (1-42) months. RESULTS: Follow up was complete in 36 patients. Recurrent prolapse was seen in 5 (full thickness 3 (8.3%); mucosa! prolapse 2 (5.5%)). Physiological data in a subset of 15 patients revealed no significant difference in anorectal physiology before and 3 months after the operation (table). Similarly there was no significant difference in the rate of evacuation of transit markers on day 3 and 5. Maximum resting pressure (median and range) was 25(7-50) mmHg and 33.2(7- 80, P value 0.026) before and after surgery. The median (range) maximum squeeze pressure were 67.5(19-i30) and 90(28 - 157, P 0.!64) before and after surgery. The maximum tolerable volume (ml) was 230 ( ! 80 -340) before surgery and 200 (50-290) after surgery (P. 0.139). Transit (as an excretion percentage) was 100% before and after surgery (P = 0. 197). CONCLUSION: Abdominal suture rectopexy without resection for rectal prolapse improves constipation and does not result in significant change in colonic transit. We recommend this procedure either by open operation or by laparoscopy.Item Quality of life and somatic symptoms in children with constipation(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND/AIMS: Chronic constipation is a common problem among Sri Lankan school children. We assessed the Health Related Quality of Life (HRQOL) and somatisation in school children with constipation. METHODS: This cross sectional survey was conducted in children aged 13-18 years, in 4 randomly selected schools in Gampaha district of Sri Lanka. From each school, 4 classes each were randomly selected from academic years 9-12. All children in the selected classes were included in the study. Data were collected using a set of validated, self administered questionnaires. They include Rome III questionnaire for paediatric functional gastrointestinal diseases, the somatisation inventory and PedsQL generic quality of life inventory. Constipation was diagnosed using Rome III criteria. Results: A total of 1,792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years and SD 1.3 years]. Hundred and thirty-eight (7.7%) fulfilled Rome criteria for constipation. Children with constipation had lower HRQOL scores for physical (83.6 vs. 91.4 in controls, P < 0.0001), social (85.0 vs. 92.7, P = 0.0001), emotional (73.6 vs. 82.7, P -0,0001), school functioning (75.0 vs. 82.5, P < 0.0001) domains, and lower overall scores (79.6 vs. 88-0, P = 0.0001). HRQOL scores were lower in those with faecal incontinence (70.0 vs. 81.1, P = 0,004), Total somatisation score for children with constipation was significantly higher than that of controls (16vs. 8.3, P < 0.0001). Patient perceived severity of abdominal pain (r = -0.22, P = 0.01), severity of bowel symptoms (r = -0.22, P = 0.01) and total somatisation score (r = -0.47, P < 0.0001) showed significant negative correlation with total HRQOL scores. CONCLUSIONS: Children with constipation have a lower quality of life in all 4 domains; physical, emotional, social and school functioning. They also have a higher somatic symptom score than controls. HRQOL has an inverse relationship with severity of symptoms.Item Constipation and exposure to stressful Life events in 10 to 16 year olds: Sri Lankan experience(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. OBJECTIVES: To assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. DESIGN, SETTING AND METHOD: A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, in 3 geographically and socio-economically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) which were returned were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria 416 (15.4%) had constipation and they were compared with 2278 children without constipation. Prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months [Odd's ratio (OR) 0.38,p<0.0001]. During univariate analysis the stressful life events associated with constipation were: change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step parent, hospitalization of the child himself/herself for other illness, frequent punishment by parents, father's alcoholism, domestic fights and living in an area affected by on-going separatist war (p<0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p<0.05), severe illness in a family member (adjusted OR 0.588, p<0.005); loss of job by a parent (adjusted OR 0.55 p<0.05), frequent punishment by parents (adjusted OR 0.581, p<0.01) and living in a war affected area (adjusted OR 0.666, p<0.001) remained to be significantly associated with constipation. CONCLUSIONS: Childhood constipation was significantly higher in those exposed to family and school related stressful life events and in those living in a war affected area.Item Constipation and exposure to stressful life events in 10–16 year olds: a Sri Lankan experience(BMJ Publishing, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. The majority have functional constipation. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. AIMS AND METHODS: The aim of this study was to assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in five randomly selected schools, in three geographically and socioeconomically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was 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 416 (15.4%) had constipation and they were compared with 2278 children without defaecation disorders (eg, constipation, diarrhoea, functional faecal retention, non-retentive faecal soiling, etc). The prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months (odds ratio (OR) 0.38, p,0.0001). During univariate analysis the stressful life events associated with constipation were change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step-parent, hospitalisation of the child himself/herself for other illness, frequent punishment by parents, father’s alcoholism, domestic fights and living in an area affected by ongoing separatist war (p,0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p = 0.016), severe illness in a family member (adjusted OR 0.588, p = 0.001), loss of job by a parent (adjusted OR 0.55, p = 0.017), frequent punishment by parents (adjusted OR 0.581, p = 0.005) and living in a war-affected area (adjusted OR 0.666, p = 0.0001) remained to be significantly associated with constipation. CONCLUSION: Childhood constipation was significantly higher in those exposed to stressful life events. Modulation of gut motility through the brain–gut axis probably delays colonic transit causing constipationItem 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 studiesItem Children and adolescents with constipation: Do they have different personalities?(Wiley Blackwell Scientific Publications, 2012) Ranasinghe, N.; Rajindrajith, S.; Devanarayana, N.M.; Warnakulasuriya, T.; Nishanthini, S.; Perera, M.S.BACKGROUND AND AIMS: Children with constipation are known to have behavioral and psychological problems. This may partly be due to difference in their personality. Aim of this study is to assess the different personality traits in children having functional constipation. METHOD: We conducted a cross sectional survey in 5 schools in the Eastern province of Sri Lanka. Children and adolescents between 13–18 years were included in the study. Previously validated questionnaires were used to collect bowel habits and demographic data. Translated and validated personality assessment questionnaire (PAQ) was used to assess the personality. Rome III criteria were used to diagnose constipation. RESULTS AND DISCUSSION: A total of 1697 children were recruited [males 778 (45.9%), mean age 15.1 years and SD 1.66 years]. Prevalence of constipation was 6% (102 children). They were compared with 1018 normal children (controls). Seventy eight (76.5%) children with constipation and 426 (41.8%) of controls had PAQ scores above the normative value for Sri Lankan children (89) (p <0.0001). When the international normative value of 105 was used, 33 (32.4%) children with constipation and 111 (10.8%) of controls had psychological maladjustment (p < 0.001). Furthermore Children with constipation scored significant higher scores for different personality traits than controls. They include hostility and aggression (14.1 vs. 12.1 in controls p < 0.001), negative self esteem (11.7 vs. 10.2 in controls p < 0.001), negative self adequacy (11.7 vs. 9.5 controls p < 0.001), emotional unresponsiveness (12.7 vs. 11.1 controls p < 0.001), emotional instability (17.3 vs. 15.0 p < 0.001), and negative world view (12.1 vs. 9.9 controls p < 0.001). CONCLUSIONS: Children with constipation have significant psychological maladjustment than healthy controls. This maladjustment was prominent in hostility and aggression, negative self esteem, negative self adequacy, emotional unresponsiveness, emotional instability and negative world view domains. Addressing these issues is important in the management of children with constipation.Item Constipation in Sri Lankan children: association with physical, sexual, emotional abuse(Wiley Blackwell Scientific Publications, 2012) Rajindrajith, S.; Devanarayana, N.M.; Lakmini, C.; Subasinghe, V; Benninga, M.A.BACKGROUND/AIMS: Child abuse in any form leads to multiple psychosomatic sequel. It is commonly associated with gastrointestinal manifestations. The main aim of this study was to evaluate the association between child abuse and constipation among school children. METHODS: Children aged 13–18 years were randomly selected from three semi-urban schools in Gampaha district, Sri Lanka. A previously validated, questionnaire was administered in an examination setting. Information regarding sociodemographic factors and gastrointestinal symptoms, child abuse and somatisation were collected. Constipation was diagnosed using Rome III criteria for paediatric functional gastrointestinal diseases. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years, SD 1.22 years]. Hundred and ten (8.1%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional and sexual abuse, were respectively 1001 (73.3%), 299 (21.9%) and 34 (2.4%). Prevalence of functional constipation was significantly higher in those exposed to sexual (17.6% vs. 7.8%, p =0.038), emotional (14.7% vs. 6.2%, p = 0.0001) abuse, and physical abuse (9.1% vs. 5.2%, p = 0.02). Mean somatization score in children with constipation and controls were 15.9 and 8.3, respectively (p < 0.0001). Among children with constipation, somatisation index was higher in those who have experienced emotional abuse (20.1 vs. 13.1 p = 0.003). CONCLUSIONS: Childhood constipation shows a significant association with physical, sexual and emotional abuse. Children with constipation complain of more somatic symptoms, especially those exposed to emotional abuse.Item Determinants of healthcare consultation behavior in children with chronic constipation: a school based survey(Lippincott Williams & Wilkins, 2011) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND: Constipation is a common pediatric disorder associated with poor quality of life and high healthcare expenditure. Healthcare consultation patterns in childhood functional gastrointestinal diseases are poorly understood. To date there are no community-based studies to identify factors determining healthcare consultation in children with functional constipation. AIMS: To assess the healthcare consultation patterns in Sri Lankan children with constipation and identifying socio-demographic and clinical factors that predict consultation behavior. METHODS: Island-wide cross-sectional survey was conducted among 10–16 years old children. Five schools were randomly selected from 3 randomly selected provinces of Sri Lanka. From each school, children were randomly selected from academic years (grades) 6–11. Previously pretested questionnaire based on Rome III criteria was used in the survey and questions were included regarding healthcare seeking for symptoms of constipation. RESULTS: Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice for their symptoms during previous 12 months. Children < 0.05). Healthcare consultation in children with stool frequency less than 3 per week, hard stools, painful defecation, large volume stool, fecal incontinence, with-holding posture and blood stained stools were respectively 7.5%, 2.7%, 6.6%, 11.6%, 11.1%, 7.7% and 14.3%. Exposure to stressful life events show no association with healthcare consultation (p=0.82). CONCLUSIONS: Healthcare consultation for chronic constipation in Sri Lankan school children and adolescents is quite low, despite the majority of them having features suggestive of significant constipation. Socio-demographic factors such as younger age and family history of constipation were significantly associated with healthcare seeking. It is essential to educate general public regarding features of chronic constipation and bring their children to medical attention early to avoid complications.Item Do traumatic life events predispose children to develop constipation?(Lippincott Williams & Wilkins, 2015) Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.BACKGROUND: The aetiology of functional constipation (FC) in children is not been fully understood. Exposure to physical, emotional and sexual abuse are known to predispose children to develop FC. No paediatric study has evaluated traumatic life events other than abuse as a potential predisposing factor for FC in children. We aimed to assess the association between traumatic life events and development of FC in children. METHODS: We conducted a cross sectional, school based study. Children aged 13-18 years were selected from four semi-urban schools in the Gampaha district, Sri Lanka. A validated, self-administered questionnaires were used for collect data on functional gastrointestinal disease and traumatic life events. FC was defined using the Rome III criteria. RESULTS: A total of1792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years, SD 1.3 years years]. Out of them, 138(7.7%) had FC. Prevalence of FC was significantly higher in those exposed to traumatic life events compared to controls (53.6% vs.32.9%,p < 0.0001). Traumatic life events such as parents living separately (13.4% vs. 7.12%,p = 0.038), living in a boarding house (10.1% vs. 1.6%, p = 0.049), liquor abuse by parents (14,8% vs. 6,3%, p < 0.0001), witnessing a murder (16.7% vs. 3.9%, p = 0.002), child labour (13.9%vs. 7.3%, p = 0.02) and ill-treated by parents (27.5% vs. 7.3%, p < 0.0001) were shown to predispose children to develop FC. Parental substance abuse (12.8% vs. 7.4%), domestic violence (14.8 vs. 7.5%) were not associated with FC (p > 0.05). CONCLUSIONS: FC is associated with childhood traumatic experiences. This provides further insight into how traumatic childhood events are associated with development and perpetuation of FC in children.Item Prevalence of functional constipation in infants and toddlers in Sri Lanka.(Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.