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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Prevalence of irritable bowel syndrome in an urban adult Sri Lankan population(Sri Lanka Medical Association, 2016) Rishikesavan, V.; de Silva, A.P.; Niriella, M.A.; Mendis, W.A.S.; Ruston, S.M.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: The community prevalence of irritable bowel syndrome (IBS) globally varies from 10 to 25%. Telephone interviews have been widely used to collect data. There is limited data on community prevalence of IBS in South Asia. Objective of the study was to determine the community prevalence of IBS and its subtypes in an urban adult Sri Lankan population. METHOD: The study was conducted in the Ragama medical officer of health (MOH) area. Householders lists of 22 Grama Niladari divisions were used for balanced random sampling. Individuals aged between 18-65 years (stratified into three groups: 18-33, 34-49, 50-65) were included. A random sample of households was selected and the person who had the closest birthday was selected from each household. A telephone interview was conducted. IBS and its subtypes [constipation predominant (IBS-C), diarrhea predominant (IBS-D), mixed (IBS-M)] were defined according to Rome III criteria. RESULTS: 504/1407(35.8%) of selected households were contactable. Of 504 persons invited to participate 500(99.2%) responded [277-females, mean (SD) age: 42.37 (13.2) years]. The overall prevalence of IBS was 18/500 (3.6%) [13-males(5.83%), 5-females(1.81%); p=0.017]. There was significant difference in prevalence among age groups for males (least among 34-49 years; p=0.024) but not for females (p=0.665). Of the males with IBS, 2(15.38%), 5(38.46%) and 6(46.15%) had IBS-D, IBS-C and IBS-M, respectively. Of the females with IBS, 2 (40%), 1(20%) and 2(40%) had IBS-D, IBS-C and IBS-M, respectively. CONCLUSIONS: Using accepted criteria, the overall community prevalence of IBS was low in this population, with a significant male predominance, and IBS-M being the commonest subtype.Item Natural history of inflammatory bowel disease in Asia: A follow-up population-based cohort study(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2014) Ng, S.C.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Ooi, C.J.; Ling, K-L; Ong, D.E.; Goh, K.L.; Hilmi, I.; Ouyang, Q.; Wang, Y-F.; Hu, P.; Chen, M.; Zeng, Z.; Zhu, Z.; Wu, K.; Wang, X.; Pisespongsa, P.; Manatsathit, S.; Aniwan, S.; Simadibrata, M.; Abdullah, M.; Tsang, S.; Wong, T.; Leung, V.; Lo, F.H.; Hui, A.R.; Chow, C.M.; Yu, H.H.; Li, M.F.; Ng, K.K.; Ching, J.; Sung, J.J.Y.; Chan, F.K.L.BACKGROUND AND AIM: Data on the natural history of inflammatory bowel disease (IBD) in population-based setting in Asia are scarce. It is not clear if IBD disease course differs between Asian and Western cohorts. METHODS: In a population-based incident cohort from eight countries in Asia, we identified 259 IBD patients diagnosed between 2011 and 2013, including 158 ulcerative colitis (UC) and 101 Crohn's disease (CD) with a median follow up of 15 months (range, 12-31 months). The risk of disease extent and behaviour change according to the Montreal classification, and probability of medical or surgical therapy were prospectively assessed. RESULTS: Median age at diagnosis was 29 years (Interquartile range, IQR, 20-44) for CD, and 41 years (IQR, 30-54) for UC. At diagnosis, in CD, ileo-colonic disease (51%) and inflammatory behaviour (67%) were the most frequent phenotype. At one year, cumulative probability of behavior change from inflammatory to stricturing or penetrating disease was 18%, and cumulative rate of colectomy was 8%. In CD cumulative probabilities of receiving 5-aminosalicylic acid (5-ASA), corticosteroids, immune-suppressants and anti-tumor necrosis factor therapy were 61%, 43%, 66% and 10%, respectively, at one year. In UC, disease extent at diagnosis was evenly distributed including 31% with proctitis, 37% with left sided disease and 32% with extensive colitis. Disease extension occurred during follow-up in 19% of patients. Cumulative rate of colectomy at one year was 1%. In UC cumulative probabilities of receiving 5-ASA, corticosteroids and immunesuppressants were 91%, 28% and 13%, respectively at one year. There were two mortalities at maximal follow-up from lung carcinoma and severe sepsis. CONCLUSION: In this populationbased follow-up study, clinical presentation and early disease course in Asian IBD patients appear comparable to that of Western patients. Progression to complicated behavior and accelerated use of immunesuppressants is common in CD. Early surgical rate for UC in Asia remains low. Understanding the natural history of IBD in our population can help optimize therapeutic interventions. Reference: SC Ng, et al. Incidence and Phenotype of Inflammatory Bowel Disease, Based on Results from the Asia-Pacific Crohn's and Colitis Epidemiologic Study. Gastroenterology 2013; 145(1):158-165Item Sub clinical intestinal mucosal inflammation in diarrhea predominant Irritable Bowel Syndrome (IBS) in a tropical setting(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) de Silva, A.P.; Manamperi, A.; Hewavisenthi, S.J.de S.; Ariyasinghe, M.P.; Dassanayake, A.S.; Jewell, D.P.; de Silva, H.J.BACKGROUND: There is evidence for potential roles for gut flora and the host immune response in the pathophysiology of IBS, and especially, for low grade colonic mucosal inflammation in the pathophysiology of post-infectious IBS. AIM: To investigate for evidence of sub-clinical intestinal mucosal inflammation in diarrhea- predominant IBS (IBS-D) in a tropical setting. METHODS: In a prospective study over one year, we investigated 49 patients with IBS-D [median age 34 years (range 18-59; M:F 36:13], based on Rome III criteria. None had alarm symptoms: unintentional significant loss of weight, bleeding per rectum or malaena. None were on NSAIDS or proton pump inhibitors. All patients had normal ESR, CRP, TSH and stools reports. 14 individuals with a family history of colon cancer [median age 46.5 years (range 23-56); median 46.5, M:F 6:8] were selected as controls. Stools of patients and controls were tested for calprotectin. During colonoscopy, serial biopsies were obtained from the ileum, caecum, ascending, transverse and descending colon, and rectum. In addition to histology, tissue expression of IL-8 and IL-10 were assessed in biopsy specimens using semi-quantitative RT-PCR. RESULTS: Colono-ileoscopy was macroscopically normal and faecal calprotectin was undetectable in cases and controls. Microscopic colitis not otherwise specified(MNOS) was seen in 10/49 cases and 1/14 controls (p=0.43, Fisher's Exact test). Histology was normal in others. A history suggestive of an episode of infectious diarrhea (ID) was seen in 16/49 cases and 0/14 controls (p=0.013). There was no significant association between ID and the presence of MNOS. Tissue expression of IL-8 was significantly higher and IL-10 significantly lower in cases compared to controls (target/standard cDNA ratio, median (range) IL-8: 1.25 (0.75-2) Vs 0.85 (0.63-1.3), p<0.0001, Mann-Whitney U test; IL-10: 0.33 (0-0.63) Vs 0.55 (0.5-0.7), p<0.0001). There was a significant inverse correlation between IL-8 and IL-10 expression (Pearson Correlation, (-) 0.509; p<0.01). In patients with IBS-D, cytokine abnormalities were not significantly different in those with or without a history of ID or the presence or absence of MNOS. CONCLUSION: There is evidence for subclinical intestinal mucosal inflammation in patients with IBS-D in a tropical setting, whether or not a history of ID or MNOS was present or absent.Item Quality of life of inflammatory bowel disease at diagnosis in 8 countries in Asia: The ACCESS study(Wiley Blackwell Scientific Publications, 2013) Ng, S.C.; Tang, W.; de Silva, H.J.; Mettananda, K.C.D.; Weerasinghe, S.K.; Ling, K.L.; Ho, L.; Ong, D.; Ooi, C.J.; Hilmi, I.; Goh, K.L.; Manatsathit, S.; Aniwan, S.; Pisespongsa, P.; Abdullah, M.; Zeng, Z.; Hu, P.; Chen, M.; Ouyang, Q.; Wang, Y.F.; WU, K.; Ng, K.K.; Yu, H.H.; Ching, J.; Sung, J.; Chan, F.K.OBJECTIVE: Health-related quality of life (QOL) is an important outcome measure in inflammatory bowel disease (IBD). QOL of Asian patients with IBD at presentation has not been studied. AIM: This study evaluates the QOL of IBD patients at diagnosis from an inception cohort across eight countries in Asia. METHODS: Health-related QOL was measured by the validated IBD Questionnaire (IBDQ) in patients with newly diagnosed IBD between 2011 and 2012. Disease activity was assessed by the Simple Clinical Colitis Activity Index and Harvey-Bradshaw index for ulcerative colitis (UC) and Crohn’s disease (CD), respectively. Demographic and disease characteristics were recorded. RESULTS: 284 incident IBD cases (CD 93; UC 147; IC 14) were included. Median age was 37 (IQR: 26–49). Median duration from symptom onset to diagnosis was 6 months (IQR:2– 24). Overall mean IBDQ score was 159 ± SEM 2.2 (Remission: IBQ≥170). The median IBDQ Score of South Asians (Thailand, Malaysia, Indonesia, Sri Lanka) (150; IQR:117–181) was significantly lower than the Han Chinese (Mainland China, Hong Kong, Singapore, Macau) (167; IQR:139–190; p = 0.003). IBD patients with active disease had significantly lower scores for all 4 dimensions of IBDQ (bowel, systemic, emotional and social functions) compared with those in remission (p < 0.001). Multiple regression analyses identified only disease activity index to be associated with variations in QOL (p < 0.001). There was no significant difference in QOL between patients with CD, UC or IC (p = 0.403). QOLwas not significantly affected by disease behavior for CD (B1, B2, B3, or perianal) but worsened with increasing mucosal involvement in UC (extensive > distal > proctitis; p = 0.014). QOL score was not affected by employment status, education level or smoking history. CONCLUSION: QOL is impaired in newly diagnosed IBD patients, and varies across ethnic groups in Asia. Active disease and more extensive disease are associated with worse QOL in IBD.Item Irritable bowel syndrome(State Pharmaceuticals Corporation, 1996) de Silva, H.J.; Samarasekera, D.N.