Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Myths and misconceptions about childhood constipation(Springer-Verlag., 2023) Rajindrajith, S.; Devanarayana, N.M.; Thapar, N.; Benninga, M.A.Many widely held beliefs and assumptions concerning childhood constipation continue to interfere with rational management of childhood constipation. Although many still believe that constipation is not a common disease, about 9.5% of the world's children suffer from chronic constipation. Most of these children live in non-Western countries. There are major misconceptions about the etiology of constipation as a significant proportion of clinicians still believe that constipation is caused by some form an organic pathology, whereas in reality, the majority have functional constipation. Contrary to a commonly held belief that children outgrow constipation without long-term problems, there is evidence that constipation leads to significant bowel and psychological consequences and has a major impact on the quality of life which detrimentally affects future health and education. Finally, ineffective management strategies such as increasing fiber and water in the diet, and short duration of treatment owing to the fear that long-term laxative treatment leads to colonic dysfunction, interfere with effective therapeutic strategies. Conclusions: It is apparent that myths and misconception often lead to wrong assumptions regarding the distribution of the disease, its etiology, pathophysiology, and management leading to ordering incorrect investigations and ineffective therapeutic strategies while spending large sums of public funds unnecessarily. Poorly treated constipation leads to deleterious psychological consequences predisposing children to develop significant psychological damage and bowel dysfunctions. This review aims to challenge these myths about various elements of constipation by exploring the existing literature and encouraging clinicians to have a fresh look at old concepts that could interfere with the well-being of children with constipation. What is Known: • Childhood constipation is a growing problem in the world leading to significant suffering and high healthcare expenditure • Myths and misconceptions lead to poor management strategies causing psychological and bowel damage What is New: • Organic, systemic, and bowel disorders leading to constipation are uncommon, and in the majority, it arises due to deliberate fecal withholding and most investigations ordered by clinicians are not very helpful in the management • Most non-pharmacological interventions are not effective in the day-to-day management of childhood constipation. The use of laxatives is considered to be the first-line management strategy.Item Association between childhood constipation and exposure to stressful life events: a systematic review(Blackwell Scientific Publications, 2022) Liyanarachchi, H.; Rajindrajith, S.; Kuruppu, C.; Chathurangana, P.; Ranawaka, R.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND: Several cross-sectional studies have reported an association between childhood constipation and exposure to stressful events. We planned to systematically review the literature on constipation and its associated stressful events. METHODS: PubMed, Embase, and PsycINFO databases were searched (until February 2021) using standard search terms related to "constipation" and "stress" from 0 to 18 years that describe the association between psychological stressors and constipation. Studies were screened using pre-designed eligibility criteria. Studies that fulfilled the criteria were reviewed in a full-text format. The quality assessment of selected articles was conducted using standard methods. KEY RESULTS: Of 2296 titles and abstracts screened, 38 were included in the full-text review. Out of that, 15 articles were included in this systematic review. There were 2954 children with constipation, and the age range was from 6 months to 16 years. Exposure to home-related stressors (divorce or separation of parents, severe illness in family, and parental job loss) school-related stressors (including being bullied at school, change in school, separation from the best friend at school, and failure in an examination), exposure to child maltreatments and exposure to war/civil unrest were associated with childhood constipation. CONCLUSIONS AND INFERENCES: Exposure to day-to-day home- and school-related stressors, to child maltreatment, and to civil unrest is associated with constipation in children and adolescents. These factors need to be explored during clinical evaluation of children with constipation. KEYWORDS: adolescents; child maltreatment; children; civil unrest; constipation; stress.Item Quality of Life in children with functional constipation: A systematic review and meta-analysis(Elsevier-Mosby, 2019) Vriesman, M.H.; Rajindrajith, S.; Koppen, I.J.N.; van Etten-Jamaludin, F.S.; van Dijk, M.; Devanarayana, N.M.; Tabbers, M.M.; Benninga, M.A.OBJECTIVE:To systematically review the literature on health-related quality of life (HRQoL) in children with functional constipation and to identify disease-related factors associated with HRQoL.STUDY DESIGN:The Pubmed, Embase, and PsycINFO database were searched. Studies were included if they prospectively assessed HRQoL in children with functional constipation according to the Rome criteria. Articles were excluded if patients had organic causes of constipation and if HRQoL was only assessed after successful therapeutic interventions. A meta-analysis was performed calculating sample size-weighted pooled mean and SD of HRQoL scores. The quality of the studies was also assessed.RESULTS:A total of 20 of 2658 studies were included, providing HRQoL data for 2344 children. Quality of evidence was considered to be poor in 9 of the 20 studies (45%); 13 of the 20 studies reported sufficient data to be included in the meta-analysis. Pooled total HRQoL scores of children with functional constipation were found to be lower compared with healthy reference samples (65.6 vs 86.1; P < .01). Similar HRQoL scores were found according to self-report and parent proxy report. Hospital-based studies reported lower HRQoL scores as compared with community-based studies. Two studies reported on HRQoL scores of children with and without fecal incontinence, but no significant difference was found.CONCLUSIONS:HRQoL is compromised in children with functional constipationItem Delayed or not delayed? That is the question in Indian children with constipation(Springer, 2018) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Item Prevalence and risk factors for functional constipation in adolescent Nigerians(BMJ Pub. Group, 2017) Udoh, E.E.; Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.OBJECTIVES: To determine the prevalence and risk factors for functional constipation (FC) in adolescent Nigerians. METHOD: A cross-sectional study was conducted in rural and urban areas of two states in the southern part of Nigeria. Adolescents aged 10-18 years were recruited from 11 secondary schools, using a stratified random sampling technique. A validated self-administered questionnaire on Rome III criteria for diagnosing FC and its predisposing factors was filled by each participant in a classroom setting. RESULTS: A total of 874 questionnaires was distributed and 818 (93%) properly filled questionnaires were included in the analysis. The mean age of the participants was 14.6±2.0 years with 409 (50%) being boys. FC was present in 223 (27%) with no difference in prevalence between sexes. Prevalence of FC was 29% in urban areas and 26% in rural areas (p>0.05). The condition was significantly associated with low social class (p=0.013). Exposure to stressful life events at home and school did not predispose the participants to develop FC. CONCLUSIONS: FC is a significant health problem among adolescent Nigerians. The condition is associated with low social class.Item Constipation and constipation predominant Irritable Bowel Syndrome: a comparative study using Rome III Criteria(Lippincott Williams and Wilkins, 2017) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.OBJECTIVE: The aim of this study is to compare functional constipation (FC) and constipation predominant irritable bowel syndrome (IBS-C) in adolescents. METHOD: A school based survey was conducted involving adolescents aged 13-18 years. A set of validated questionnaires including Rome IIIquestionnaire for functional gastrointestinal disorders in children/adolescents, somatization inventory, quality of life inventory, and childhood traumatic events inventory were used for data collection. FC, and IBS-C were defined using Rome III criteria. RESULTS: A total of 1792 adolescents [975 males (45.4%)] were included in the analysis. Prevalence of FC and IBS-C were 7.7% and 1.6%, respectively. Bowel habits such as stool frequency less than 3 per week (10% vs 44.9%, p < 0.0001), hard stools (20% vs 40.5% p < 0.05) painful defecation (33.3% vs 56.5% p < 0.05), large diameter stools (23.3% vs 50.7% p < 0.01), stool withholding behaviour (20% vs 44.2% p < 0.05), were more commonly associated with FC than IBS-C. Occurrence of faecal incontinence (0% vs 8% p = 0.21), urgency (56.7% vs 66.7% p = 0.65) and straining (56.7% vs 36.9% p = 0.47) were not significantly different between IBS-C and FC. Exposure to physical abuse, emotional abuse, and sexual abuse were equally prevalent among adolescents with FC and IBS-C. There was no difference between somatization scores, and health related quality of life between the two groups. CONCLUSION: Although bowel habits related to stool withholding is more prevalent in FC, than in IBS-C, they are more likely to be a spectrum of a disorder rather than two separate entitiesItem Item Rectal prolapse: impact on pelvic floor physiology and current management(Elsevier-W.B. Saunders, 1996) Deen, K.I.; Madoff, R.D.Rectal prolapse may be associated with fecal incontinence or constipation. Incontinence results from reduced internal sphincter tone and may be worsened by direct or neurogenic damage to the external sphincter and puborectalis muscles. Impaired anal sensation and previous anal sphincter injury may also contribute to incontinence. Constipation results from either difficulty in evacuation, delayed transit, or both. Management should aim to identify the extent of prolapse and degree of functional impairment. Almost all patients with occult prolapse should be treated conservatively. However, rare, markedly symptomatic patients with convincing evidence of occult prolapse may benefit from surgery. Abdominal fixation techniques are the abdominal operations of choice for fit patients with complete rectal prolapse. There is no evidence that addition of foreign material slings enhance the outcome of surgery. Considerable recent data support the use of a sigmoid resection in conjunction with rectal fixation, although this remains a contentious issue. Resection is not advised for patients with poor sphincter function associated with significant neuropathy. Patients with severe preoperative constipation require complete evaluation before surgery; those with documented slow-transit constipation may benefit from subtotal, rather than sigmoid colectomy, performed in conjunction with rectopexy. The Delorme operation and perineal rectosigmoidectomy are both acceptable choices for high-risk patients and patients who wish to avoid abdominopelvic dissection. Our preference is for the perineal rectosigmoidectomy, and we advocate associated levator plication at the time of surgery, particularly in incontinent patients. The Thiersch operation is associated with a high complication rate and should be avoided. The chief advantages of perineal over abdominal repair are avoidance of laparotomy and related complications, preservation of autonomic nerve function, avoidance of ureteric injury, and the ability to perform a concomitant sphincter or pelvic floor repair through the same incision. Laparoscopic prolapse repair is in its infancy with no data on long-term follow-up, making it impossible to evaluate its impact on the treatment of rectal prolapse.Item Scintigraphic defecography: quantitative and dynamic assessment of anorectal function(Lippincott Williams and Wilkins, 1993) Hutchinson, R.; Mostafa, A.B.; Grant, E.A.; Smith, N.B.; Deen, K.I.; Harding, L.K.; Kumar, D.PURPOSE: Conventional assessment of anorectal function with defecating videoproctography is semiquantitative and the high radiation exposure precludes prolonged or repeated testing. The aim of this study was to develop a dynamic scintigraphic method of assessing anorectal function. METHODS: Fourteen patients with fecal incontinence, 18 patients with chronic constipation, and 8 control subjects were assessed by scintigraphicdefecography. This involves introduction of a technetium-99m-radiolabeled artificial stool into the rectum of the subject and acquisition of gamma camera images during evacuation. RESULTS: Mean evacuation rate was 2.8 percent/second in incontinent patients and 0.9 percent/second in constipated patients (P < 0.001). The mean anorectal angles were 136 degrees and 133 degrees, respectively. There were 18 cases of pelvic floor descent and 6 rectoceles. Scintigraphicdefecography provides quantitative information on rectal evacuation. Anorectal angle and pelvic floor movement can be examined. The radiation dose to pelvic organs is significantly less than with videoproctography. CONCLUSION: We believe that scintigraphic defecography is the investigation of choice for objective and dynamic assessment of anorectal function