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 How do we define normal bowel frequency from newborn to teens?:A Bayesian meta-analysis(Wiley, 2024-12) Munasinghe, S.; Manathunga, S.; Hathagoda, W.; Kuruppu, C.; Ranasinghe, P.; Devanarayana, N. M.; Baaleman, D. F.; Benninga, M. A.; Rajindrajith, S.OBJECTIVES Defecation disorders are a common pediatric problem and bowel frequency is crucial in identifying them. The aim of this analysis is to define normal bowel frequencies in healthy children ranging from newborns to adolescents. METHODS A literature search was conducted using MEDLINE, SCOPUS, EMBASE, Cochrane Library, and Web of Science from their inception to February 2024, aiming to identify studies reporting bowel habits of healthy children (0–18 years). A Bayesian distribution modeling approach was adopted to pool the mean frequency of bowel opening using inverse-variance weighing. A subgroup analysis and a meta-regression were performed with Bayesian generalized additive mixed distributional models. The methodological quality of the articles was evaluated using the Newcastle–Ottawa Scale modified for cross-sectional studies. RESULTS Seventeen studies were included in the analysis, including 22,698 children aged from 0 to 18 years. The subgroup meta-analysis showed mean bowel frequencies for newborns, 1–6 months, 6–12 months, 1–2 years, 2–5 years, and over 5 years are 3.24 (95% credible interval [CrI]: 2.83–3.63), 1.99 (95% CrI: 1.77-2.19), 1.66 (95% CrI: 1.45–1.88), 1.53 (95% CrI: 1.37–1.7), 1.15 (95% CrI: 0.99–1.31), and 1.02 (95% CrI 0.88–1.18), respectively. Between studies, heterogeneity demonstrated a near-normal distribution with a mean of 0.16 and a 95% CrI of 0.04–0.28. The variance of the distribution of mean bowel frequency reduced with age. DISCUSSION In this Bayesian meta-analysis, we found that younger children have a higher bowel frequency. The reported bowel frequencies for each age group could serve as normal values in clinical practice to differentiate health and disease.Item Childhood constipation: Current status, challenges, and future perspectives(Baishideng Publishing Group, 2022) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.Item Constipation in children: the bird’s eye view(Galle Medical Association, 2020) Rajindrajith, S.; Devanarayana, N.M.No Abstract availableItem Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation(BioMed Central, 2019) Walter, A.W.; Hovenkamp, A.; Devanarayana, N.M.; Solanga, R.; Rajindrajith, S.; Benninga, M.A.BACKGROUND:Functional constipation (FC) is a pediatric problem that is seen frequently. However, its prevalence in Asia remains undetermined. In this study we attempted to determine the prevalence, risk factors and therapeutic modalities of FC in infants and toddlers in Sri Lanka.METHODS:Children aged 6.5 months to 4 years were selected from 14 well-baby and vaccination clinics in the Gampaha District of Sri Lanka. A questionnaire with questions regarding the socio-demographic characteristics, child's bowel habits, psycho-social risk factors and treatment modalities were filled by the mothers. FC was diagnosed according to ROME III criteria.RESULTS:A total of 1113 children were analyzed [(female n = 560 (50.3%) with a mean age of 20.7 months, standard deviation [SD] 11.2 months. FC was found in 89 (8.0%). FC was significantly and independently associated with underweight (14.3% vs 7.2%, p = 0.008. [OR and 95% CI: 2,3 (CI; 1.3-4.2)] and residence in an urban area (9.6% vs 5.6%, p = 0.013). [OR and 95% CI: 0.592 (CI; 0.396-0.95)]. Children subjected to violence showed a significantly higher prevalence of FC (20.0 vs 7.8%, p = 0.046). Children being overweight and children living with mothers subjected to violence showed a higher, though not statistically significant, tendency to develop FC. Children with FC visited healthcare clinics more frequently when compared to controls (19.6% vs 6.0%, p < 0.0001). However, only 24% of infants and toddlers with FC were treated specifically for the condition by a doctor. CONCLUSIONS:FC occurred in 8% of this cohort of Sri Lankan infants and toddlers. It is significantly associated with underweight and living in an urban area. Only a quarter of them received medical attention for their constipation.TRIAL REGISTRATION:SLCP/ERC/2014/12 , December 2014Item Epidemiology of paediatric constipation in Indonesia and its association with exposure to stressful life events(Biomed Central, 2018) Oswari, H.; Alatas, F.S.; Hegar, B.; Cheng, W.; Pramadyani, A.; Benninga, M.A.; Rajindrajith, S.BACKGROUND: We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group. METHODS: A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria. RESULTS: Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P < 0.001), being bullied at school (adjusted OR 1.67, 95% CI 1.01–2.76, P = 0.047) and loss of a parent’s job (adjusted OR 1.39, 95% CI 1.03–1.88, P = 0.034). CONCLUSIONS: Constipation in children and adolescent is a significant health problem, affecting almost 20% of Indonesian school-age children and adolescents. Common school and home related stressful life events appear to have predisposed these children to develop constipation.Item Constipation in children: New developments(Sri Lanka College of Paediatricians, 2016) Rajindrajith, S.; Devanarayana, N.M.