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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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
2 results
Search Results
Item Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study(BioMed Central, 2021) Niriella, M.A.; Liyanage, I.K.; Kodisinghe, S.K.; de Silva, A.P.; Jayatissa, A.V.G.A.M.; Navarathne, N.M.M.; Peiris, R.K.; Kalubovila, U.P.; Kumarasena, S.R.; Jayasekara, R.W.; de Silva, H.J.BACKGROUND: Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients. METHODS: We included patients [diagnosed between June/2003-December/2009-Group-1(G1), January/2010-June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use). RESULTS: 375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23-45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes. CONCLUSION: There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes. KEYWORDS: Clinical course; Clinical predictors; Crohn disease; Inflammatory bowel disease; Phenotype; Sri Lanka; Ulcerative colitis.Item Is osteoporosis more common among adult Sri Lankans with inflammatory bowel disease (IBD)?(Sri Lanka Medical Association, 2008) de Silva, A.P.; Karunanayake, A.L.; Dissanayaka, T.G.I.; Dassanayake, A.S.; Duminda, H.K.K.T.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND: IBD is a recognized risk factor for osteoporosis among Caucasians. Although the incidence of IBD seems to be increasing in Asians, there are no data on osteoporosis in Asian patients. Objective: To determine whether osteoporosis is more common among adult Sri Lankans with IBD. DESIGN, SETTING AND METHODS: Consecutive patients with previously diagnosed IBD who were older than 30 years and age and sex matched controls from the general population (3 controls for I patient) were screened for osteoporosis using a previously validated peripheral DEXA scan. Patients who were pregnant, had other significant co-morbidities, were on caicium supplements or on treatment for osteoporosis within the past 6 months were excluded. RESULTS: There were 86 IBD patients (55 females, mean age 46.4 years) and 258 controls (165 females, mean age 47.3 years). Osteoporosis was significantly more common among IBD patients (14.7%) than controls (6.5%) (P=0.048). Increasing age (P=0.019), female gender (P=O.OOS), menopause (P=0.022) and use of systemic steroids (P= 0.008) were found to be significantly associated with osteoporosis among JBD patients, while severity of disease (PKK470), number of relapses (P=0.391), duration of illness (P=0.540) and treatments other than systemic steroids (P=0.434) were not. Osteoporosis did not differ significantly between patients with ulcerative colitis (14.28%) and Crohn's disease (15.79%) (P=0.891). CONCLUSION: Osteoporosis is more common among adult Sri Lankans with IBD than community controls. The use of systemic steroids is a disease related independent risk factor for development of osteoporosis in these patients.