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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Clinical epidemiology of inflammatory bowel disease among adults in the South Asian region: A systematic review and meta-analysis(Elsevier Ltd, 2025-01) Niriella, M.A.; Martinus, C.K.; Withanage, M.Y.; Darshika, S.; Illangasinghe, M.; Perera, H.R.; Ediriweera, D.S.; De Silva, H.J.OBJECTIVES Inflammatory bowel disease (IBD) is an emerging disease in the South Asia. We conducted a systematic review to determine the characteristics and overall prevalence of IBD among South Asian adults.DESIGN We searched the PubMed database and included descriptive, epidemiological studies with satisfactory methodological quality, reporting the epidemiology of IBD with histological confirmation. The quality of the studies was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Two authors screened and extracted data independently. A random-effects meta-analysis of characteristics and overall prevalence of IBD was performed.RESULTS This review analysed data from over 9000 IBD patients from 21 studies across multiple South Asian countries. It found a higher prevalence of ulcerative colitis (UC) compared to Crohn's disease (CD) (2:1). There was a male predominance and modest familial aggregation of IBD cases. Left-sided colitis was the most common disease extent for UC. Colonic involvement was more frequent than ileal involvement for CD. The non-stricturing, non-penetrating behaviour was dominant in CD cases. Joint manifestations were commonly reported in both UC and CD. Immunomodulators, such as azathioprine, were used in a significant proportion of patients, particularly for CD. The use of biological agents like infliximab was relatively low. Surgical intervention rates were lower than in Western cohorts but higher in CD compared to UC.CONCLUSIONS This study provides an epidemiological overview of adult IBD characteristics, phenotypes, and treatment patterns in the South Asian region. There were epidemiological, clinical, phenotypic and treatment differences compared to western IBD.Item Emerging IBD demographics, phenotype and treatment in South Asia, South-East Asia and Middle East: preliminary findings from the IBD-Emerging Nations' Consortium(Blackwell Scientific Publications, 2022) Banerjee, R.; Pal, P.; Hilmi, I.; Ghoshal, U.C.; Desai, D.C.; Rahman, M.M.; Dutta, U.; Mohiuddin, S.A.; Al Mohannadi, M.; Philip, M.; Ramesh, G.N.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.; Pisespongsa, P.; Limsrivilai, J.; Aniwan, S.; Nawarathne, M.; Fernandopulle, N.; Aye, T.T.; Ni, N.; Al Awadhi, S.; Joshi, N.; Ngoc, P.T.V.; Kieu, T.V.; Nguyen, A.D.; Abdullah, M.; Ali, E.; Zeid, A.; Sollano, J.D.; Saberi, B.; Omar, M.; Mohsin, M.N.; Aftab, H.; Wai, T.M.; Shastri, Y.M.; Chaudhuri, S.; Ahmed, F.; Bhatia, S.J.; Travis, S.P.L.Abstract Background and aims Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South East Asia and the Middle East, yet epidemiological data are scarce. Methods: We performed a cross-sectional study of IBD demographics, disease phenotype and treatment across 38 centers in 15 countries of South Asia, South-East Asia and Middle East. Intergroup comparisons included gross national income (GNI) per capita. Results: Among 10,400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD-Unclassified 227, 58% male). Peak age of onset was in the third decade, with a low proportion of elderly onset IBD (5% age >60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; IQR 5-30). Treatment of CD included mesalamine, steroids and immunomodulator (61%, 51% and 56% respectively), but a fifth received empirical anti-tubercular therapy. Treatment with biologics was uncommon (4% UC,13% CD) which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD)/100 patient/years. Conclusions: The IBD-ENC cohort provides insight into IBD in South-East Asia and the Middle East, but is not yet population-based. UC is twice as common as CD, familial disease uncommon and rates of surgery are low. Biologic use correlates with per capita GNI.Item Inflammatory bowel disease (IBB) in a tertiary referral centre in Sri Lanka(Sri Lanka Medical Association, 2005) de Silva, A.P.; Mettananda, K.C.D.; Dassanayake, A.; Ariyaratne, S.; Deen, K.I.; de Silva, H.J.AIMS: To study disease patterns of IBD in a tertiary referral centre in Sri Lanka, METHODS: We analysed the database of outpatients with IBD maintained since 1995, reviewing records with regard to history, clinical findings, colonoscopy, histology, medical treatment, surgery, and outcome. RESULTS: Records of 108 patients with IBD were analysed [Male: Female = 68:40, mean age 38.3 years (SD 17.5), 96.5% Sinhalese]. 78 (72.2%) had ulcerative colitis (UC), 23 (20.3%) Crohn's disease (CD) and 7 (6.5%) had indeterminate colitis. The main clinical features for UC were bloody diarrhoea (95 %), tenesmus (84%), and left sided abdominal pain (74%), and for CD were watery diarrhoea (59%), tenesmus (53%) and right sided abdominal pain (47%). The main extra-intestinal manifestations were: polyarthritis - UC (18%), CD (12%), and iritis - UC (4%), CD (6%). Among UC patients 44.8% had multiple relapses and 43.5% had moderate to severe disease; in CD cases 43.5% had multiple relapses and 56.5% had moderate to severe disease, A family history was recorded in 3% of UC cases and 6% of CD. There were no intestinal complications among UC patients. Two with CD developed strictures. Proctocolectomy was performed in 13 (16.6%) patients with UC (12 had ileal pouch procedures). Five patients with CD underwent surgery; 2 right hemicolectomy, 2 fistulectomy, and 1 colectomy with ileo-rectal anastomosis. CONCLUSION: The pattern of IBD among our patients was comparable to what is described in the western literature, with the exceptions of a low frequency of family history, extra-intestinal manifestations and intestinal complications.