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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Navigating through 65 years of insights: lessons learned on functional abdominal pain in children(Springer Verlag, 2024) Rajindrajith, S.; Boey, C.C.M.; Devanarayana, N.M.; Niriella, M.A.; Thapar, N.; Benninga, M.A.In 1958, Apley and Naish authored a groundbreaking paper in Archives of Disease in Childhood, elucidating the epidemiology and risk factors of recurrent abdominal pain in children-a subject that had confounded clinicians of their time. Surprisingly, even after 65 years, there are several unanswered questions regarding the etiology, pathophysiology, and management of pediatric abdominal pain. Contrary to the prevailing notion that children naturally outgrow functional abdominal pain, compelling evidence suggests it's possible these children develop a number of clinically significant psychological issues that could profoundly impact their quality of life and, consequently, future health and educational outcomes. In this light, we aimed to comprehensively review the current literature to update the knowledge of practicing clinicians on functional abdominal pain, summarizing the evidence from the last 65 years.Conclusion: The enduring unanswered questions surrounding childhood abdominal pain continue to challenge clinicians, resulting in unnecessary investigations, thereby contributing to substantial healthcare expenditures. It is also evident that children with long-standing symptoms would progress to adulthood with the potential to develop irritable bowel syndrome and many psychological disturbances. Several key interventions using pharmacological agents, such as amitriptyline, showed that some of these drugs are no more effective than the placebo in clinical trials. Several research during the recent past suggest that psychological interventions such as gut-directed hypnotherapy alleviate symptoms and ensure better prognosis in the long run. Therefore, clinicians and researchers must join hands to explore the pathophysiological mechanisms underpinning functional abdominal pain and novel therapeutic strategies to ensure the well-being of these children. What is Known: • Functional abdominal pain disorders are common among children, with a worldwide prevalence of 13.5% of children suffering from at least one of these disorders • These disorders contribute to a significant reduction in the quality of life of affected children and their families and lead to an array of psychological problems What is New: • The biological basis of functional abdominal pain is becoming more explicit, including complex interactions between altered microbiome, deranged motility, and psychological dysfunction with gut-brain interactions • Novel approaches giving minimal emphasis on pharmacological interventions and exploring psychological interventions are showing promising results.Item Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country(Wiley Blackwell Scientific Publications, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Navarathne, N.M.M; Peiris, R.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.Item Helicobacter pylori infection in children(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.; de Silva, H.J.No Abstract AvailableItem Helicobacter pylori infection in children(Medknow Publications, 2009) Rajindrajith, S.; Devanarayana, N.M.; de Silva, H.J.Helicobacter pylori infection is a common problem in pediatric practice, and its acquisition is related with poor socioeconomic conditions. Although the organism is thought to be responsible for many diseases, only a handful of them have a direct causal relationship. At present, only a small number of children with well-defined clinical syndromes are benefited from testing and treatment. The treatment should include at least two antibiotics with a proton pump inhibitor.Item Histological evaluation and H. pylori status of dyspeptic patients without gastrooesophageal reflux(College of Surgeons of Sri Lanka, 2004) Hewavisenthi, S.J.de S.; Suranimala, H.D.C.; Alwis, W.H.E.; Senevirathne, K.A.D.C.OBJECTIVE: To identify different types of gastric pathology in patients with dyspeptic symptoms without gastro oesophageal reflux, to assess the prevalence of H, pylori in their biopsies and to correlate the histological changes with the presence of these organisms. METHOD: 788 dyspeptic patients were included in the study during the period April 2000 - August 2002. Their gastric biopsies were reviewed and diagnoses were classified as normal, chronic gastritis, reactive gastritis, portal gastropathy, peptic ulcer, neoplastic and others. 22 non diagnostic biopsies were excluded. The biopsies in which H. pylori was identified were graded histologically as mild, moderate and severe for organism density, chronic inflammation, activity, intestinal metaplasia and glandular atrophy in accordance with the updated Sydney classification. RESULTS: Gastric pathology identified in the dyspeptic patients studied included normal (187), chronic gastritis (373), reactive gastritis (50), portal gastropathy (9), peptic ulcers including both gastric and duodenal ulcers (128), neoplastic (15) and others (4). H pylori was identified in 210 patients. 189 (90%) of these were associated with chronic gastritis. Chronic inflammation in gastric biopsies was graded as mild in 75, moderate in 104, severe in 31 and activity was graded as absent in 45, mild in 115, moderate in 3 8 and severe in 12. Associated intestinal metaplasia was present in 32/210 > ymild (26), moderate (6)?y and glandular atrophy was present in 42/210 (mild (36), moderate (8)). H .pylori density was mild in 165, moderate in 39 and severe in 6. The H. pylori density showed a significant correlation with inflammation and activity. CONCLUSION: Chronic gastritis was the single most common condition diagnosed in dyspeptic patients without gastro oesophageal reflux. Overall, H. pylori was identified in 27.4% of dyspeptic patients. In most biopsies chronic inflammation was moderate and activity was mild or absent, and this was associated with a low H. pylori density. The incidence of metaplasia and glandular atrophy was low.Item Helicobacter pylori:after ten years, still an enigma(Sri Lanka Medical Association, 1994) de Silva, H.J.