Browsing by Author "Satarasinghe, R.L."

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Aetiology and other features of a cohort of adult Sri Lankans presenting with upper gastrointestinal bleeding (UGIB)
(Ceylon College of Physicians, 2010) Satarasinghe, R.L.; de Silva, A.P.; Arulnithy, K.; Abeyratne, P.D.; Jayawardana, M.A.R.
OBJECTIVES: To ascertain major causes of UGIB and other related clinical features of adult Sri Lankan using open access endoscopy facilities. DESIGN AND SETTING: 1500 upper gastrointestinal endoscopies performed by Ward-06, Sri Jayewardenepura General Hospital, Kotte from 01/03/2002 to 01/03/2004 for whatever reason was retrospectively reviewed. Those who had endoscopy for UGIB were selected for the study, and their endoscopy findings and other clinical features analysed. RESULTS: There were 342 (24%) upper GI bleeders. The mean age of presentation was 55.5 years +/-14.4 SD. A high proportion was seen between 50-70 years of age. Sex distribution was, male:female = 229:114 (2:1). 45% have presented with haematemesis, 31% with malaena, and 24% with both. Endoscopy showed the presence of severe antral gastritis and duodenitis, oesophageal varices, oesaphagitis, erosive gastropathy, portal hypertensive gastropathy, pangastritis and peptic ulcer disease in 38%, 35%, 28%, 28%, 20%, 17% and 15% of the instances respectively. Hiatus herniae were seen in 43% although its role was unclear. Often combined pathologies were seen. Only 52% of the varices showed endoscopic evidence of bleeding. Excess alcohol consumption was seen in 36% while 5% were on NSAIDs. 5% had endoscopic negatives. CONCLUSIONS: UGIB is a major problem to the endoscopist, constituting about 25% of the work load, in this part of the continent. Although approximately 50% of the varices found had bled, portal hypertension related pathologies are a cause for concern. Alcohol was a contributory factor in 1/3 of the endoscoped population. Bleeding from PUD was not a dominant feature compared to the west.
The aetiology of chronic clinical or biochemical hepatic dysfunction in a group of adult Sri Lankans: experience in a tertiary referral centre
(Sri Lanka Medical Association, 2005) Satarasinghe, R.L.; de Silva, A.P.; Arulnity, K.
OBJECTIVES: To evaluate the histological outcome and clinical implications of such a finding in a group of adults who were admitted for investigation of either clinical or biochemical hepatic dysfunction lasting over 3 months. DESIGN AND SETTING: 100 consecutive liver biopsies performed from 15.2.2002 to 30.9.2004 in patients with abnormal hepatic function for at least three months prior to biopsy were reviewed. The clinicopathological features of patients who showed histological evidence of chronic liver disease were analysed retrospectively by examining their case notes. RESULTS: The age range was 15 - 80 years. Male to Female ratio 2.5:1. The peek incidence (37%) of chronic liver damage was seen in 40-49 year group, while 57% was within 50-59 year group. Histology showed cirrhosis, non-alcoholic steatohepatitis (NASH), steatosis, hepatoma, and chronic active hepatitis in 54%, 14%, 8%, 5%, and 4% respectively. There was a high male preponderance for NASH (M: F=8: l) and cirrhosis (M: F=6: l). 57% of cirrhotics were alcoholics. Hepatitis C serology was negative in all, and only one was positive for hepatitis B serology. 33% of patients with NASH had Diabetes mellitus and another 33% of patients with NASH had dyslipidaemias. Diet, social class and obesity were not associated with NASH. CONCLUSIONS: NASH and hepatic steatosis are emerging as significant causes for chronic hepatic dysfunction. The aetiology of non-alcoholic cirrhosis merit in depth study.
The contribution of alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), and low dose aspirin (LDA) to upper gastrointestinal (GI) morbidity in a group of symptomatic patients who underwent upper GI endoscopy
(Sri Lanka Medical Association, 2005) Satarasinghe, R.L.; de Silva, A.P.
OBJECTIVE: To evaluate the contribution of alcohol, NSAIDs and LDA to GI morbidity in symptomatic patients undergoing upper GI endoscopy in a tertiary referral centre. Methods: Case notes of 1492 symptomatic patients who underwent oesophago-gastro-duodenoscopies from 1/3/2002 to 1/3/2004 were retrospectively analysed. RESULTS: Prior to endoscopy 220 had been on significant quantities of alcohol for at least 6 months, 95. had been on NSAIDS for at least 1 month, and 42 had been on LDA for at least 1 month. Alcoholics presented with haematernesis, malaena, and both in 43%, 33% and 20% respectively. 33% had proven alcoholic liver disease. Endoscopy showed oesophageal varices, portal hypertensive-gastropathy, antral gastritis and duodenitis, gastric erosions, oesophagitis, pangastritis, peptic ulcer disease (PUD) in 45%, 36%, 33%, 29%, 27%, 17% and 12% respectively. CLO test had been done in 64. It was positive in 18%. NSAIDs users also presented with dyspepsia, abdominal pain, upper GI bleeding, anaemia, and reflux symptoms in 25%, 18%, 17%, 15% and 9% respectively. Aspirin users had the -above in 40%, 17%, 36%, 11% and 9% respectively. Endoscopy revealed severe antral gastritis, duodenitis, gastric erosions, oesophagitis, PUD and pan-gastritis in 55%, 46%, 32%, 8%, respectively in NSAIDs users while same was observed in 68%, 36%, 36%, 30%, and 15% respectively in aspirin users. Overlapping pathologies were noted. CONCLUSIONS: Alcohol, NSAIDs, low dose aspirin cause significant upper GI morbidity. A third of alcoholic bleeders had proven alcoholic liver disease.
A descriptive study of gastro-intestinal (GI) malignancies of adult Sri Lankans: data from a 2 year survey in a medical unit of a tertiary referral centre
(Sri Lanka Medical Association, 2005) Satarasinghe, R.L.; de Silva, A.P.; Abeyratne, P.D.
OBJECTIVES: To describe demographics and clinico-endoscpoic features of GI malignancies of adult Sri Lankans, seeking medical advice. DESIGN AND SETTING: Data of 1491 consecutive upper GI and 327 consecutive lower GI endoscopies performed by Ward 6, SJGH Kotte, from 01/03/2002 to 01/03/2004 were retrospectively analysed. Those who had endoscopic and histological proof of GI malignancies were included in the study. RESULTS: There were 51 total GI malignancies, showing oesophageal, gastric, colo-rectal and duodenal involvement in 13, 18, 19 an 1 respectively, which was 2.8 % of the whole study population.2.1% and 5.8% revealed upper GI and lower GI malignancies in respective populations. Mean age of presentation in oesophageal, stomach, and colo-rectal carcinomas were 63.8, 70.1 and 58.3 respectively. All malignancies showed a male preponderance of 2.4:1 while in carcinoma of stomach this was 8:1 .The mean haemoglobin at presentation was 10.7, 9.0 and 9.7 g/dl for oesophageal, gastric and colo-rectal malignancies respectively. There were no other significant haernatological or bio¬chemical abnormalities at presentation. CONCLUSIONS: The study population showed three times preponderance of colo-rectal malignancies compared to those of upper GIT in respective groups. Mean age of presentation was early in carcinoma of the colon compared to other three GI malignancies (p<0.05). Anaemia was the single most significant abnormal laboratory parameter in this study.
Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey
(BioMed Central, 2010) Niriella, M.A.; de Silva, A.P.; Dayaratne, A.H.G.K.; Ariyasinghe, M.H.A.D.P.; Navarathne, M.M.N.; Peiris, R.S.K.; Samarasekara, D.; Satarasinghe, R.L.; Rajindrajith, S.; Dassanayake, A.S.; Wickremasinghe, A.R.; de Silva, H.J.
BACKGROUND: Inflammatory bowel disease (IBD) is being increasingly diagnosed in Asia. However there are few epidemiological data from the region. METHODS: To determine prevalence and clinical characteristics of IBD, a hospital-based survey was performed in the Colombo and Gampaha districts (combined population 4.5 million) in Sri Lanka. Patients with established ulcerative colitis (UC) and Crohn's disease (CD), who were permanent residents of these adjoining districts, were recruited from hospital registries and out-patient clinics. Clinical information was obtained from medical records and patient interviews. RESULTS: There were 295 cases of IBD (UC = 240, CD = 55), of which 34 (UC = 30, CD = 4) were newly diagnosed during the study year. The prevalence rate for UC was 5.3/100,000 (95% CI 5.0-5.6/100,000), and CD was 1.2/100,000 (95% CI 1.0-1.4/100,000). The incidence rates were 0.69/100,000 (95% CI 0.44-0.94/100,000) for UC and 0.09/100,000 (95% CI 0.002-0.18/100,000) for CD. Female:male ratios were 1.5 for UC and 1.0 for CD. Mean age at diagnosis was (males and females) 36.6 and 38.1y for UC and 33.4 and 36.2y for CD. Among UC patients, 51.1% had proctitis and at presentation 58.4% had mild disease. 80% of CD patients had only large bowel involvement. Few patients had undergone surgery. CONCLUSIONS: The prevalence of IBD in this population was low compared to Western populations, but similar to some in Asia. There was a female preponderance for UC. UC was mainly mild, distal or left-sided, while CD mainly involved the large bowel.
Spectrum of liver disease in a cohort of adult Sri Lankans admitted to a medical unit in a tertiary referral center- a ten month survey based on histology
(Sri Lanka Medical Association, 2007) Satarasinghe, R.L.; de Silva, G.V.T.S.K.; Abeyrathne, V.; de Silva, A.P.; Duminda, K.D.; Riyaaz, A.A.A.
OBJECTIVE: To study the pattern of chronic liver cell disease in adult Sri Lankans seeking medical advise in a tertiary referral centre. Data of such diseases remain largely unevaluated in Sri Lanka with scanty data from South East Asia for comparison. DESIGN, SETTING AND METHODS: Case notes of sixty consecutive patients having clinical and investigative abnormalities suggestive of liver disease over a six month period, subjected to consented liver biopsy (selection-biased sample) from 01.12.2004 to 01.10.2005 were retrospectively analyzed. RESULTS: The study group had an age range of 20 to 80 years with a male: female sex ratio of 53:7 (8:1). 41.7% were in the 51-60 years age group, males constituting 92%. Histology revealed cirrhosis, fatty liver, non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma in 35(59%), 12 (20%), 11(18%) and 2(3%) respectively. At presentation, 71% had evidence of hepatomegaly clinically or ultrasonic ally. Non-alcoholic group constituted 66.6% with male:female ratio of 35:5(7:1), while in alcoholics it was 24:1. NASH group had an age range of 25-55 years with a mean age of 3S+/-2 SD years. Male: female ratio is 10:8. BM1, AST, ALT, ALP showed mean values of 25.2 kg/nr, 86.7+7-15.2 IU/L, 93.21+/-16.3 IU/L and 251.0+/-18.1 IU/L respectively. Hepatitis B and C serology were negative in all. CONCLUSIONS: Amongst current chronic liver cell diseases, non-alcoholic group constitutes the greatest challenge for the future, which merit multi center in-depth studies. Hepatitis B and hepatitis C infections seem to be unimportant aetiological factors.