Medicine

Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12

This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

Browse

Filters

2016 - 20173

Settings

Has files: NoSubject: search.filters.subject.inflammatory bowel disease

Search Results

Now showing 1 - 3 of 3
  • No Thumbnail Available
    Item
    Changing phenotype, early clinical course and clinical predictors of irritable bowel syndrome in Sri Lanka: a prospective, multi-centre descriptive study
    (Sri Lanka Medical Association, 2017) Niriella, M.A.; Kodisinghe, S.K.; Nanayakkara, S.D.; Silva, K.T.M.; Rajapakshe, N.; Luke, D.; de Silva, A.P.; Navarathne, N.M.M.; Dissanayake, V.H.W.; Jayasekara, R.W.; de Silva, H.J.
    INTRODUCTION & OBJECTIVES: Incidence of inflammatory bowel disease (IBD) is increasing in the Asia Pacific, with changes in phenotype and disease course been reported. METHODS: Ulcerative colitis (UC) and Crohn disease (CD) cases from four national referral centres were included. Phenotype was compared for cases [Group-1/G1-diagnosed between June/2003-December/2009, Group-2/G2-January/2010-June/2016]. Early clinical course (ECC) [complicated disease (Comp D-stricturing/penetrating CD, extensive-UC/pancolitis), treatment refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory, biologics), disease complications (DC-perforation/bleeding/colectomy/malignancy)] among disease duration <3 years, and clinical predictors (CP) of CompD/TRD/DC among disease duration >1 year were also assessed. RESULTS: A total of 452-cases [G1: UC-89 (78.8%), CD-24 (21.2%); G2: UC-197 (58.1%), CD-142 (41.9%)] were included. G2 had a higher proportion of CD (p<0.001). In both groups, leftsided colitis (E2) for UC, ileo-colonic (L3)/non-stricturing, non-penetrating (B1) for CD predominated. More penetrating-CD (B3) in G2 (p<0.01) and more stricturing-CD (B2) in G1 (p<0.05) were noted. ECC was assessed in 293 patients [UC-168 (57.3%), CD-125 (42.7%)]. Among UC: extensive/pan-colitis (E3)-40 (24.5%), severe (S3)-38 (42.2%); among CD:severe episodes-15 (25.9%), stricturing (B2)/penetrating(B3)-18 (14.7%), perianal-disease (P)-29 (23.4%). TRD was seen in 19 (11.3%)-UC and 17 (10.1%)-CD. Immunomodulator use was-70 (41.7%)/93 (74.4%), and anti-TNF use was 3 (1.8%)/12 (9.6%) respectively for UC and CD. Complications for UC: bleeding-6 (3.6%), malignancy-1 (0.6%), surgery-3 (1.8%); for CD: stricture-6 (4.9%), perforation-3 (2.4%), malignancy-1 (0.8%), surgery-2 (1.6%). CP were assessed in 373 [UC-266 (71.3%), CD 107 (28.7%)]. EIM of joints predicted CompD in UC/CD (OR-1.94/OR-2.28). Family history (OR=8.64) and EIM of joints (OR=10.07) predicted DC in UC. CONCLUSION: There was an increase in CD during the study period, but no changes in disease phenotype for UC or CD. Although admissions with CompD were common for UC (but not CD), few patients had TRD or DCs indicating a relatively benign early disease course. Family history, EIM of joints predicted poor outcomes in UC, EIM of joints predicted a poor outcome in CD.
  • No Thumbnail Available
    Item
    Influence of urban/rural and coastal/inland environment on the phenotype and clinical course of inflammatory bowel disease patients from Sri Lanka: a cross-sectional study
    (Sri Lanka Medical Association, 2017) Niriella, M.A.; Kodisinghe, S.K.; Dinamithra, N.P.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
    INTRODUCTION & OBJECTIVES: Rural/urban and coastal/inland environmental influences on inflammatory bowel disease (IBD) is poorly studied. We investigated such environmental influences on IBD. METHODS: Patients with histologically proven IBD [ulcerative colitis (UC), Crohn disease (CD)] with a permanent residence and regular follow up, were included. Urban areas (UA) were defined as those administered by Municipal and Urban councils. Coastal areas (CA) were defined as areas with elevation <30 meters above sea level. Patients in different groups were compared with regard to phenotype of IBD [sex, age at diagnosis, Montreal subgroups, severity, extraintestinal manifestation (EIM) at diagnosis, and highest therapy during follow-up]. Fisher’s exact test was used to compare categorical variables. RESULTS: A total of 387 patients were included [UC-251 (64.8%), males-122 (48.6%), median followup (IQR)-22.5 (2-59) months; CD-136 (35.2%), males-65 (47.8%), median follow-up (IQR)- 63.0 (23-115) months; urban/rural distribution: UC-1.7:1, CD-1.5:1; coastal/inland distribution: both UC and CD-0.7:1]. Urban/rural or coastal/inland location did not affect the distribution of type of IBD, gender, age at diagnosis or presence of EIM. UC patients from rural areas had extensive disease (E3) (42.4% vs 24.5%, p=0.029) and used long term immunomodulator drugs more frequently (60.2% vs 47.3%; P=0.006) than UA patients. CD patients living in CA had more frequent ileo-colonic disease (L3) compared to inland patients (53.2% vs 38.0%, p=0.016). Patients with both UC and CD from inland areas needed immunomodulators or anti-TNF more frequently than coastal patients (56.7% vs 44.9%, p=0.026 and 82.1% vs 69.9%, p=0.023). CONCLUSION: IBD was more common among patients from inland, UA. Urban/rural or coastal/inland location did not affect gender, age at diagnosis or presence of EIM. However, UC patients from rural areas and CD patients from inland areas had more severe disease.
  • No Thumbnail Available
    Item
    Clinical predictors of poor disease outcome for inflammatory bowel disease in Sri Lanka
    (Sri Lanka Medical Association, 2016) Niriella, M.A.; Kodisinghe, S.K.; Dassanayake, S.U.B.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
    INTRODUCTION: There is limited data on clinical predictors of poor outcomes of inflammatory bowel disease from Sri Lanka. OBJECTIVES: To study clinical predictors of poor outcomes of inflammatory bowel disease among patients attending National Hospital of Sri Lanka and Colombo North Teaching Hospital. METHOD: Patients with ulcerative colitis (UC) and crohn disease(CD) of at least one year duration were included from Colombo North Teaching Hospital and National Hospital of Sri Lanka. Predictors of complicated disease (CompD) (structuring/penetrating-CD, extensive/pancolitis-UC), treatment refractoriness (TR) (frequently relapsing, steroid dependent, steroid refractory, need for biologics) and disease complications (DC) (perforation, bleeding, colectomy, malignancy) were assessed. Gender, age, duration at diagnosis, extra-intestinal manifestations (EIM), cigarette smoking and family history were assessed as independent risk factors using binary logistic regression. RESULTS: 287 patients were included [UC-208 (72.5%%), 100 (48.1%) males, median follow up (IQR) 74.5 (35.0–127.5) months; CD 79(27.5%), 37(46.8%) males, median follow up (IQR) 50.0 (29.0-84.0) months]. CompD was observed among 65(31.25%) UC and 20(25.31%) CD patients; family history (OR 4.103, adjusted p=0.029) was predictive of CompD in UC. TR was observed among 13(6.31%) UC and 9(11.39%) CD patients; non-smoking was predictive of TR in UC (OR=0.000, adjusted p=0.027). DC was seen in 8(3.86%) of UC and 11(13.92%) of CD. Family history (OR=16.457, adjusted p=0.001), EIM of skin (OR=14.071, adjusted p=0.039) and joints (OR=8.940, adjusted p=0.002) were predictive of DC in UC; eye EIM (OR=4.286, adjusted p=0.047) was predictive of DC in CD. CONCLUSIONS: CompD was not uncommon in UC and CD. TR and DC were uncommon. Family history, being a non-smoker, EIM of skin and joints independently predicted worse outcomes in UC, while EIM of eyes predicted a poor outcome in CD.
All items in this Institutional Repository are protected by copyright, with all rights reserved, unless otherwise indicated. No item in the repository may be reproduced for commercial or resale purposes.