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 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 Association between faecal incontinence, child abuse, somatisation and health related quality of life(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN), 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.AIMS : Faecal incontinence (FI) is an important lower gastrointestinal disease. Bad aroma around children with FI leads to rejection by peers, psychosocial isolation and learning difficulties. Aim of this study was to evaluate the association between FI, child abuse and health related quality of life (HRQoL) in children and adolescents. METHODS : Children aged 13-18 years were selected from four semi-urban schools in Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection after obtaining consent from school authorities, parents and children themselves. Information regarding socio-demographic factors, gastrointestinal symptoms, child abuse, HRQoL and somatisation were collected. FI was defined as at least one episode of leaking of faeces in to the underwear per month. RESULTS: A total of 1807 children were included in the analysis [males/9.3 vs 53.8%), mean age 14.4years, SI.) 1.4 years]. Forty seven (2.6%) had FI. FT was significantly higher in boys (-74.49S vs. 25,6%% in girls, p < 0.0001)1. Prevalence of FI was significantly higher in those exposed to sexual abuse (17%.,. vs. 2.3% in non abused, p < 0.0.001)., emotional abuse i40.4% vs. 22.7%, p < 0.0001), and physical abuse (51% vs. 24:3.'%', p < 0.0001). Children with FI had higher mean somatisation score [mean 20.1, SD 14.5 vs. mean 9.3, SD 9.2 in those without FT (controls), p < 0.0001J. Children with FI had lower HRQoL scores for physical functioning (78.1 vs.'9:1:2.in controls, p < 0.0001), social functioning (78.4 vs. 92.6, p < 0.0001), emotional functioning (70.5 vs. 82.3, p < 0.0001) and school functioning (69.1 vs- 82.3, p < 0.0001) domains, and a lower overall HRQoL score (74.6 vs. 87.1, p < Q .0.001). CONCLUSIONS : FI in children shows a significant association with physical, sexual and emotional abuse. Children with FT have a range of somatic symptoms and a poor HRQoL score in physical, emotional, social and school functioning domains.Item Quality of life and somatic symptoms in children with constipation(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND/AIMS: Chronic constipation is a common problem among Sri Lankan school children. We assessed the Health Related Quality of Life (HRQOL) and somatisation in school children with constipation. METHODS: This cross sectional survey was conducted in children aged 13-18 years, in 4 randomly selected schools in Gampaha district of Sri Lanka. From each school, 4 classes each were randomly selected from academic years 9-12. All children in the selected classes were included in the study. Data were collected using a set of validated, self administered questionnaires. They include Rome III questionnaire for paediatric functional gastrointestinal diseases, the somatisation inventory and PedsQL generic quality of life inventory. Constipation was diagnosed using Rome III criteria. Results: A total of 1,792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years and SD 1.3 years]. Hundred and thirty-eight (7.7%) fulfilled Rome criteria for constipation. Children with constipation had lower HRQOL scores for physical (83.6 vs. 91.4 in controls, P < 0.0001), social (85.0 vs. 92.7, P = 0.0001), emotional (73.6 vs. 82.7, P -0,0001), school functioning (75.0 vs. 82.5, P < 0.0001) domains, and lower overall scores (79.6 vs. 88-0, P = 0.0001). HRQOL scores were lower in those with faecal incontinence (70.0 vs. 81.1, P = 0,004), Total somatisation score for children with constipation was significantly higher than that of controls (16vs. 8.3, P < 0.0001). Patient perceived severity of abdominal pain (r = -0.22, P = 0.01), severity of bowel symptoms (r = -0.22, P = 0.01) and total somatisation score (r = -0.47, P < 0.0001) showed significant negative correlation with total HRQOL scores. CONCLUSIONS: Children with constipation have a lower quality of life in all 4 domains; physical, emotional, social and school functioning. They also have a higher somatic symptom score than controls. HRQOL has an inverse relationship with severity of symptoms.Item Quality of life in teenagers with abdominal pain related functional gastrointestinal disorders who have been exposed to child abuse(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.AIMS: Large number of previous studies conducted in children and adults have shown a significant association between abdominal pain predominant functional gastrointestinal disorders (AP-FGD) and exposure to child abuse. The main objective of this study was to assess the impact of child abuse on quality of life of Sri Lankan with AP-FGD. METHODS: A randomly selected group of 13-18 year olds were screened using the Rome iii questionnaires criteria for AP-FGD were recruited after obtaining consent from school administration, parents and teenagers themselves. Information regarding exposure to abuse and quality of life were assessed using previously translated and validated questionnaires. The questionnaires were administered in an examination setting to ensure confidentiality and privacy. Research assistants were present during filling the question¬naires and verifications were provided. They were collected on the same day. RESULTS: A total of 290 children with AP-FGD were recruited [males 128 (44.1%), mean age 14.6 years and SDI 1.5 years]. The number of children exposed to physical, emotional and sexual abuse, were respectively 90 (31.0%), 101 (34.8%) and 16 (5.5%). Average scores obtained for physical (85.3% vs.89.3% in nonabused), emotional (69.9% vs.79.7%), social (86.3% vs. 92.6%) and school (73.7% vs. 80.6%) functioning domains of quality of life in children exposed to emotional abuse were significantly lower (p < 0.05, unpaired t-test). Similar decrease was observed in children exposed physical abuse in social (86.4% vs. 92.2%) and school (74.6% vs. 79.9%) functioning domains (p < 0.05), but not in physical and emotional functioning domains (p > 0.05). Exposure to sexual abuse did not show a significant difference in in quality of life (p > 0.05). CONCLUSIONS : Even among teenagers with AP-FGD, those exposed to child abuse have a significantly lower quality of life than those not exposed to abuse.Item Functional gastrointestinal diseases in children: facing the rising tide(Wiley-Blackwell, 2013) Rajindrajith, S.; Devanarayana, N.M.No Abstract available