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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Irritable Bowel Syndrome in children: Current knowledge, challenges and opportunities(Baishideng Publishing Group, 2018) Devanarayana, N.M.; Rajindrajith, S.Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.Item Subtypes and some clinical aspects of irritable bowel Syndrome in children(Sri Lanka College of Paediatricians, 2011) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Irritable bowel syndrome (IBS) is a common paediatric functional gastrointestinal disorder affecting 6-13% of children and adolescents. In adults IBS is divided into four main subtypes: diarrhoea predominant IBS, constipation predominant IBS, mixed IBS and untypable IBS. The subtypes have not been characterised in children. OBJECTIVES: The objective of this study was to assess IBS subtypes in 10-16-year old children, their symptomatology and gender difference. DESIGN, SETTING AND METHOD: One hundred and seven children with IBS and 1610 healthy controls aged 10-16years were recruited from 8 randomly selected schools, in 4 randomly selected provinces (out of 9 provinces) in Sri Lanka. Data was collected using a previously validated, self administered questionnaire based on Rome III criteria, it was distributed in examination settings to ensure privacy and confidentiaiity and was filled under the guidance of research assistants. IBS was defined using Rome 111 criteria. RESULTS: Constipation predominant IBS (IBS-C), diarrhoea predominant IBS (IBS-D) and mixed IBS (1BS-M) were present in 27-28%. Untypable IBS (1BS-U) was seen in 17.8%. IBS was more common in girls (59.8% vs. 40.2% in boys, p=0.001; p<0.01). Straining, urgency and feeling of incomplete evacuation were seen in 74-78% children with IBS. Intestinal-related symptoms such as bloating, flatulence, nausea, vomiting and burping, and extraintestinal symptoms such as headache, sleeping difficulty, limb pain and photophobia were significantly higher in affected children (p<0.05). Burping was more commonly seen in boys with IBS (p<0.05). CONCLUSIONS: IBS-C, IBS-D and IBS-M had almost equal distribution while IBS-U had a relatively lower prevalence. Girls were significantly more commonly affected than boys (p<0.01). Intestinal-related and extra-intestinal symptoms were seen in a significantly higher percentage of children with IBS (pItem 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 The epidemiology of irritable bowel syndrome among children and adolescents in Asia: a systematic review(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Rajindrajith, S.; Gunawardena, N.K.; Abeygunasekara, C.; Devanarayana, N.M.Aims: Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and changing bowel habits including frequency and consistency. The aim of this study was to systematically review published literature on prevalence, risk factors and comorbid factors of IBS among children living in Asia. METHOD: A computer assisted search of PUB MED, CINHAL, and Index Medicus for South East Asia was carried out. Study selection criteria were; 1) Asian population based samples of children/adolescents; 2) Clear diagnostic criteria for IBS (Rome I, II or III); 3) Full manuscripts published in English. Selected articles were reviewed in depth; data were extracted and presented in descriptive form. RESULTS: Thirteen cross sectional studies which reported prevalence of IBS were included in the final analysis. Preva¬lence of IBS among Asian children and adolescents ranges from 2.8% to 25.7%. Nine studies have shown a higher prevalence of IBS in girls compared to boys. Studies from China have indicated untyped IBS as the commonest IBS subtype, while studies from Sri Lanka have shown approximately even distribution of all four subtypes. Clearly identi¬fied predisposing factors to develop IBS in Asian children included psychological stress, anxiety, depression, consump¬tion of alcohol and fatty food, smoking, and exposure to gastrointestinal infections. Comorbid factors of IBS reported among Asian children included an array of somatic symptoms, fatigue and psychological problems such as depression. CONCLUSIONS: According to published data, IBS is a significant problem among Asian children and adolescents. Female gender, exposure to stress, certain food habits, life styles and gastrointestinal infections predispose children to develop IBS in Asia.Item Gastric emptying and antral motility according to the subtypes of irritable bowel syndrome: a paediatric study(Lippincott Williams & Wilkins, 2011) Devanarayana, N.M.; Rajindrajith, S.; Bandara, C.; Shashiprabha, G.; Benninga, M.A.BACKGROUND: Irritable bowel syndrome (IBS) is a common paediatric functional gastrointestinal disorder. It is subtyped into diarrhoea predominant (IBS-D), constipation predominant (IBS-C), mixed (IBS-M) and untypable (IBS-U) IBS depending on stool consistency. Several studies have reported differences in colonic motility in children with different IBS subtypes. However, gastric motility has not been assessed according to subtypes yet. AIM: To assess gastric motility in children with different IBS subtypes using a non-invasive ultrasound method. METHODS: Seventy six children with IBS [33 (43%) males, age 4–14 years, mean 7.9 years, SD 3.0 years) referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, for gastric motility studies and 20 healthy controls [8 (40%) males, age 4–14 years, mean 8.4 years, SD 3.0 years] were recruited. Children with IBS were divided into IBS-D(n=21), IBS-C(n=31), IBS-M (n=19) and IBS-U (n=5) according to Rome III definitions. None of the patients recruited had clinical or laboratory evidence of organic disorders. Liquid gastric emptying rate (GER) and antral motility parameters were assessed using a previously reported ultrasound method. RESULTS: Compared to healthy controls, the mean GER (43.8% vs. 66.2% in controls), amplitude of antral contractions (A) (56.4% vs. 89%) and antral motility index (MI) (5.1 vs. 8.3) were significantly lower and fasting antral area (FA) (1.6 vs. 0.6) was higher in children with IBS ( p<0.0001). Frequency of antral contractions (F) (8.9 vs. 9.3) did not show a significant difference between the two groups. Patients exposed to recent stressful life events had a significantly lower mean GER (40.3%), compared to those who were not (45.7%) ( p=0.03). No significant relationship was observed between severity of symptoms and motility abnormalities. No significant differences were found between IBS-D, IBS-C and IBS-M with respect to GER (42.%, 46.3%, 39.6%), FA (1.4 cm2,1.8 cm2, 1.8 cm2), A (53%, 58.9%, 51.8%), F (8.7, 8.9, 9.2) and MI (4.7, 5.3, 4.8). CONCLUSIONS: GER and antral motility parameters were significantly impaired in children with IBS compared to controls. No significant difference observed in gastric motility parameters between different IBS subtypes. GER was lower in those exposed to recent stressful events