Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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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 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 Assessment of gastric emptying and antral motility in different types of abdominal pain related functional gastrointestinal diseases: a paediatric study(BMJ Publishing, 2010) Devanarayana, N.M.; Rajindrajith, S.INTRODUCTION: Functional gastrointestinal disorders (FGD) are common among paediatric population. Abdominal pain related FGD are the most common subgroup found, of which irritable bowel syndrome is the most common. The exact mechanism of pain remains unclear in FGD. Visceral hypersensitivity and altered gastrointestinal motility are considered possible causes for abdominal pain and discomfort found in these children. METHODS: The main aim of this study was to evaluate the gastric emptying and antral motility in children and adolescents with abdominal pain related FGD. Hundred and fifty-five children referred to the Gastroenterology Research Laboratory who fulfilled Rome III criteria for abdominal pain related FGD (60 (38.5%) males, 4–14 years, mean 8.1 years, SD 2.6 years) and 20 healthy children without gastrointestinal symptoms (8 (40%) males, 4–15 years, mean 8.9 years, SD 2.7 years) were recruited. None had clinical or laboratory evidence of organic diseases. All subjects underwent ultrasonographic assessment of liquid gastric emptying rate (GE) and antral motility, using a previously reported method. RESULTS: Gastric motility parameters of children with FGD and controls are presented in the table. GE negatively correlated with the scores obtained for severity of symptoms in functional dyspepsia (FD) (r=−0.67, p<0.001) and functional abdominal pain (FAP) (r=−0.38, p<0.001), but not in irritable bowel syndrome (IBS) (r=−0.16, p=0.29). CONCLUSIONS: GE and antral mortality parameters were significantly impaired in children with all types of abdominal pain related FGD. GE negatively correlated with symptoms in FD and FAP. Mortality parameters were not significantly different between subtypes of IBS.Item 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 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.