Medicine

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    Upper respiratory symptoms are common in a cohort of patients with symptomatic gastrooesophageal reflux disease (GORD) in Sri Lanka
    (Wiley Blackwell Scientific Publications, 2011) Amarasiri, D.L.; Adikari, D.; Sanjeewa, B.; Jayaratne, A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
    INTRODUCTION: There is increasing evidence for multiple associations between gastro-oesophageal reflux disease (GORD) and the upper respiratory tract. This study evaluated the presence of upper respiratory symptoms (URS) in a cohort of patients with GORD symptoms from Sri Lanka. METHOD: Seventy adults scoring ≥12.5 on a previously validated GORD symptom score (GORD patients) and 70 healthy controls who had infrequent or no GORD symptoms completed a pre-tested, valid URS questionnaire. They were questioned on frequency of 14 URS in 5 categories (laryngeal, nasal, pharyngeal, sinusal and aural). All GORD patients underwent gastroscopy. An URS score was calculated and correlated against the GORD symptom score and gastroscopy fi ndings. RESULTS : The GORD patients (median age (range) 36 (15–65); 38% males) and controls (median age (range) 38 (15–68); 38% males) were comparable. URS scores were higher in GORD patients (mean ± SE, 4.7 ± 4.0) compared to controls (mean ± SE, 1.9 ± 2.3), as were individual symptom scores. Individuals with higher GORD symptoms scores reported more frequent URS. Nasal symptoms had the highest correlation with the GORD symptom score (r = 0.410; P = 0.001). of the GORD patients, 42 had no evidence of oesophageal or gastric mucosal damage. 28 had evidence of refl ux oesophagitis. In them, the presence of oesophagitis did not seem to influence the frequency of reporting URS. CONCLUSION : URS are common in individuals with GORD symptoms though there appears to be no association with oesophageal mucosal damage
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    Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma
    (BioMed Central, 2010) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, H.J.; Ranasinha, C.D.
    BACKGROUND: Gastro-oesophageal reflux disease (GORD) symptoms are common in asthma and have been extensively studied, but less so in the Asian continent. Reflux-associated respiratory symptoms (RARS) have, in contrast, been little-studied globally. We report the prevalence of GORD symptoms and RARS in adult asthmatics, and their association with asthma severity and medication use. METHODS: A cross-sectional analytical study. A validated interviewer-administered GORD scale was used to assess frequency and severity of seven GORD symptoms. Subjects were consecutive asthmatics attending medical clinics. Controls were matched subjects without respiratory symptoms. RESULTS: The mean (SD) composite GORD symptom score of asthmatics was significantly higher than controls (21.8 (17.2) versus 12.0 (7.6); P < 0.001) as was frequency of each symptom and RARS. Prevalence of GORD symptoms in asthmatics was 59.4% (95% CI, 59.1%-59.6%) versus 28.5% in controls (95% CI, 29.0% - 29.4%). 36% of asthmatics experienced respiratory symptoms in association with both typical and atypical GORD symptoms, compared to 10% of controls (P < 0.001). An asthmatic had a 3.5 times higher risk of experiencing a GORD symptom after adjusting for confounders (OR 3.5; 95% CI 2.5-5.3). Severity of asthma had a strong dose-response relationship with GORD symptoms. Asthma medication use did not significantly influence the presence of GORD symptoms. CONCLUSIONS: GORD symptoms and RARS were more prevalent in a cohort of Sri Lankan adult asthmatics compared to non-asthmatics. Increased prevalence of RARS is associated with both typical and atypical symptoms of GORD. Asthma disease and its severity, but not asthma medication, appear to influence presence of GORD symptoms
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    Comparison of a composite symptom score assessing both symptom frequency and severity with a score that assesses frequency alone: a preliminary study to develop a practical symptom score to detect gastro-oesophageal reflux disease in a resource-poor setting
    (Lippincott Williams And Wilkins, 2010) Amarasiri, D.L.; Pathmeswaran, A.; de Silva, A.P.; Dassanayake, A.S.; Ranasinha, C.D.; de Silva, H.J.
    BACKGROUND: There is a need for a practical instrument to screen for gastro-oesophageal reflux disease (GORD) in epidemiological studies. OBJECTIVES: To develop a practical score to detect GORD and compare assessment of both symptom frequency and severity with frequency alone. METHODS: One hundred patients with upper gastrointestinal symptoms and 150 volunteers with no such past history faced an interviewer-administered questionnaire assessing seven symptoms, graded for frequency and severity. Two scores were generated. Score 1, the sum of frequency of symptoms and score 2, the sum of products of frequency and severity of each. Internal consistency, test-retest reliability and criterion validity against 24-h pH monitoring were assessed. Cut-off scores were generated by receiver operating characteristic curves using scores of half the volunteers and patients selected randomly and validated on the other half. RESULTS: Cut-off scores and area under the curve for score 1 were >/=10.5 and 0.93, and score 2 were >/=12.5 and 0.93, respectively. The sensitivity and specificity of diagnosing the disease in the remaining participants using score 1 was 89.7 and 92.4% and score 2 was 93.8 and 94.0%, respectively. The instrument had good internal consistency (Cronbach alpha = 0.73) and reliability (intraclass correlation coefficient of scores 1 and 2 were 0.94 and 0.95, respectively). Score 2 showed better correlation with 24-h pH monitoring parameters (Spearman's rank correlation, P = 0.01). CONCLUSION: Our score is valid, reliable and can detect GORD with high sensitivity and specificity. A score assessing both frequency and severity of symptoms correlates better to an objective measure of GORD.
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    One-hour fast for water and six-hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort
    (Wiley-Blackwell, 2009) de Silva, A.P.; Amarasiri, D.L.; Liyanage, M.N.; Kottahachchi, D.; Dassanayake, A.S.; de Silva, H.J.
    BACKGROUND AND AIM: Current guidelines for upper gastrointestinal endoscopy (UGIE) advise at least 6-8 h fasting for solids and 4-h fasting for liquids. We aimed to determine whether a 6-h fast for solids and one-hour fast for water prior to UGIE gives good endoscopic vision and less patient discomfort. METHODS: 128 patients referred for UGIE were given a standard meal 6 h before endoscopy, and then randomized to either nil by mouth for 6 h (group A, n = 65) or allowed to drink water for up to one hour prior to endoscopy (group B, n = 63). Before endoscopy patients were requested to indicate discomfort due to fasting on a visual analog scale. Fluid in the gastric fundus was aspirated, when present, for volume and pH measurements, and endoscopic vision was graded. RESULTS: 53 patients in group A and 43 patients in group B completed the study. Discomfort was significantly lower in group B than group A (P < 0.0001). Endoscopic vision was good in all 53 patients in group A and 40 in group B, and average in 3 patients in group B. Fluid in the gastric fundus was noted in 11 patients in group A and 16 in group B, but there were no significant differences in volume or pH between groups. There were no complications attributable to endoscopy in either group. CONCLUSIONS: A 6-h fast for solids and a 1-h fast for water prior to UGIE gives good endoscopic vision, and causes minimum patient discomfort.
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    Use of ambulatory oesophageal pH monitoring to diagnose gastrooesophageal reflux disease
    (Sri Lanka Medical Association, 2007) Ferdinandis, T.G.H.C.; Amarasiri, D.L.; de Silva, H.J.
    OBJECTIVES: To investigate the characteristics of patients referred for ambulatory oesophageal pHmetry, the referral pattern, and the role of oesophageal pHmetry as a diagnostic tool in a tertiary care hospital in Sri Lanka. DESIGN: Data obtained from patients referred to the Gastrointestinal Research Laboratory at Teaching Hospital Ragama for 24-hour ambulatory oesophageal pHmetry from 1998 to 2005 were reviewed. Patients' upper gastrointestinal endoscopy reports and stationary oesophageal manometry reports were also reviewed. RESULTS: 140 pHmetry studies were performed during the study period. The majority of patients (> 90%) were referred by specialists in gastroenterology practicing in hospitals in or around Colombo. There were 88 males and the median age was 37 years (range 0.5-74). The median duration of symptoms was 4.1 years (range 0.2 -25). Typical symptoms of gastro-oesophageal reflux disease (GORD) were present in 53 (38%) patients, atypical symptoms of GORD in 31 (22%), and nonspecific upper gastrointestinal symptoms in 56 (40%). Pathological acid reflux was found in 43 (31%) patients. Of them, 29 (67%) had typical GORD symptoms, 7 (16%) had atypical symptoms, and 7 (16%) had non-specific upper gastrointestinal symptoms. No significant association was found between endoscopy and pHmetry results. CONCLUSION: Oesophageal pH monitoring helped to establish a cause for the morbidity in a significant number of patients with GORD symptoms, but not in the majority of patients referred for the test. In our experience the investigation does not seem to be optimally used as a diagnostic tool.
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    Rhinitis and asthma: it's one airway after all
    (Medicine Today Pty Limited, 2006) Amarasiri, D.L.; Douglass, J.
    The concept of `united airways disease - that allergic asthma and rhinitis are manifestations of a single inflammatory airways disease - is supported by laboratory and epidemiological studies and by treatment responses
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