Browsing by Author "Ferdinandis, H.C."

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Assessment of colorectal transit by radiopaque marker excretion -A Sri Lankan study
(Wiley Blackwell Scientific Publications, 2007) Ferdinandis, H.C.; de Silva, H.J.
INTRODUCTION: Information about colorectal transit is obtained by counting ingested radiopaque markers on plain abdominal x-ray films. A person who expels at least 80% of the ingested markers by day 5 is considered to have a normal colonic transit time. Diet and lifestyle have a significant influence on colonic transit time. Therefore the diagnosis of normal or delayed transit based on values obtained in the West may not be appropriate for the Asian population METHOD: Thirty four healthy male volunteers were recruited to the study. Informed consent was obtained from all the volunteers prior to the study. They were on a normal Sri Lankan diet (rice with vegetable curry and fish/meat curry) prior to and during the study without any fibre supplements. They carried out their routine daily activities during the study. Each subject swallowed a radiopaque marker capsule (SITZMARK, USA) containing 24 radiopaque rings at 9.00am with a glass of water. The day of marker ingestion was taken as day 0. Starting from day 1, plain abdominal x-rays were taken daily, at 9.00am, till all the markers were excreted. RESULTS: Thirty three (33) subjects completed the study. The mean age of the subjects was 38 (range 27-46) yrs. None of the subjects reported any alteration in their bowel habits during the study. The number of markers remained in the abdomen each day after ingestion: day 1 - mean 3.10 (SD 6.3), day 2 - mean 0.88 (SD 2.5), day 3 - mean 0.28 (SD 0.7), day 4 - mean 0.00 (SD 0.0). By day 3 all the subjects excreted more than 21 (87.5%) ingested markers. CONCLUSION: Colonic transit is unlikely to be delayed If a Sri Lankan male expels more than 85% of the ingested markers by day 3.
Diagnosis of achalasia, A Sri Lankan study
(Wiley Blackwell Scientific Publications, 2007) Ferdinandis, H.C.; de Silva, H.J.
BACKGROUND :A definitive diagnosis of achalasia is usually provided by oesophageal manometry. Though stationary oesophageal manometry is available in Sri Lanka as a diagnostic tool since 1998, the diagnosis of achalasia continues to be based on barium swallow studies. METHOD: Clinic records of all patients who had features of achalasia on stationary oesophageal manometry (from 1998-2006) were reviewed and analyzed. RESULTS: A total of thirty six (36) patients with achalasia were identified. There were 34 adults [median age 40 (range 24-72 years)] and two paediatric patients (5 yrs & 10 yrs.). Dysphagia for solids (with or without regurgitation) was the main presenting symptom in 28(78%) patients. Six patients (17%) had retrosternal chest pain or heartburn as the main presenting symptom and were treated as having GERD. Vomiting after meals was the main presenting complaint in the two pediatric patients. Upper GI endoscopy showed oesophageal dilatation (± retained food particles) in 13(41%) subjects while in the rest (59%) the findings were inconclusive. Achalasia was stated as a diagnostic possibility in radiologists' reports in only 17(47%) patients (sensitivity of the test 47%). The duration between the onset of symptoms and the manometric confirmation of the diagnosis was 3 years (range 0.25 - 7). CONCLUSION: Though barium swallow continues to be used to diagnose achalasia, neither this nor upper GI endoscopy has high sensitivity and leads to a significant delay in the diagnosis. In patients with symptoms of upper GI obstruction, a normal endoscopy should be followed by early oesophageal manometry