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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Imaging in pediatric disorders of the gut-brain interactions: current best practice and future directions(Taylor and Francis Group, 2023) Rajindrajith, S.; Hathagoda, W.; Ganewatte, E.; Devanarayana, N.M.; Thapar, N.; Benninga, M.INTRODUCTION: Disorders of Gut-Brain Interactions (DGBI) are a common clinical problem in children and pose significant challenges to the attending pediatrician. Radiological investigations are commonly ordered to evaluate these children. AREA COVERED: This review focuses on the current best practice of using radiological investigations in DGBIs and how novel radiological investigations could revolutionize the assessment and therapeutic approach of DGBI in children. EXPERT OPINION: We believe imaging in DGBI is still in its early stages, but it has the potential to revolutionize how we diagnose and treat children with DGBI. As the understanding of the gut-brain axis continues to grow, we can expect to see the disappearance of conventional imaging techniques and the emergence of more sophisticated imaging techniques with less radiation exposure in the future which provide more clinically meaningful information regarding the gut-brain axis and its influence on intestinal function. Some of the novel imaging modalities will be able to broaden our horizon of understanding DGBI in children providing more useful therapeutic options to minimize their suffering.Item Childhood constipation as an emerging public health problem(Baishideng Publishing Group, 2016) Rajindrajith, S.; Devanarayana, N.M.; Perera, B.J.C.; Benninga, M.A.Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. Thisarticle highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.Item Evidence-based recommendations for functional constipation in infants and children(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Benninga, M.Chronic constipation is a common problem in childhood with an estimated prevalence of 3% in the Western world and is probably the most common gastrointestinal complaint in children. According to the ROME-III criteria, functional constipation is defined as a child experiencing 2 or more of the following symptoms: 1) two or fewer defecations in the toilet per week, 2) at least one episode of fecal incontinence per week, 3) stool retentive posturing, 4) painful or hard bowel movements, 5) presence of a large fecal mass in the rectum or 6) large diameter stools that may obstruct the toilet without objective evidence of a pathological condition. Infants up to 4 years of age have to fulfill two or more criteria for at least 1 month while children older than 4 years need at least 2 months of symptoms. Only less than 5% of children with constipation have an underlying disease. In the majority of patients, constipation is difficult to treat and often a long-lasting problem. Up to 50% of children followed for 6-12 mo continue to have symptoms and need ongoing laxative use. Two evidence-based guidelines (the Netherlands and Great Britain) have been developed concerning the diagnostic and therapeutic approach for childhood constipation. To assist healthcare workers worldwide in the management of children with functional constipation, only recently the North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) decided to develop an evidence-based guideline as a joined effort. At present, a thorough medical history and complete physical exam are usually sufficient to confirm the diagnosis of functional constipation. Further laboratory or radiological investigations should only be performed in case of doubt, to exclude an underlying disease. Treatment of childhood constipation consists of four steps: (1) education, (2) disimpaction, (3) prevention of re-accumulation of faeces and (4) follow-up. Surprisingly, there is only limited evidence that laxative treatment is better than placebo in children with constipation. According to the available evidence, lactulose is recommended for children <1 year as first-choice treatment. For children older than 1 year, both lactulose and polyethylene glycol (PEG) with or without electrolytes can be used as first-choice treatment.