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 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.
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.
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
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.
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.
Available
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.

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