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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Childhood constipation: Current status, challenges, and future perspectives(Baishideng Publishing Group, 2022) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.Item Behavioral and emotional problems in adolescents with constipation and their association with quality of life(Public Library of Science, 2020) Rajindrajith, S.; Ranathunga, N.; Jayawickrama, N.; van Dijk, M.; Benninga, M.A.; Devanarayana, N.M.Objectives: To assess behavioral and emotional problems in children and adolescents with functional constipation and their relationship with psychological maladjustment and health-related quality of life (HRQoL). Design: A school-based cross-sectional survey conducted in 8 randomly selected schools from 4 randomly selected districts in Sri Lanka. A previously validated questionnaire was used for data collection. Behavioral and emotional problems were assessed using the Sinhala version of the Child Behavior Check List (CBCL-S/4-18). Constipation was diagnosed by applying the Rome III criteria. Results: A total of 1000 questionnaires were distributed, and 913 completed questionnaires were included in the analysis. Sixty adolescents (6.5%) had functional constipation. Scores obtained for isolated psychological problems such as withdrawal (3.1 [3.1] vs. 1.9 [2.4], p<0.001), somatic complaints (3.2 [2.8] vs. 2.3 [2.5], p<0.05) anxiety/depression (5.8 [2.5] vs. 3.9 [3.6], p<0.001), social problems (3.0 [2.7] vs. 2.2 [1.9] p<0.001) and attention problems (5.4 [4.1] vs. 3.9 [3.4], p<0.001), and broadband scale of internalization (12.1 [8.4] vs. 8.3 [7.2], p<0.05) and mean total CBCL-S/4-18 score (29.4 [19.5] vs. 23.2 [17.0], p<0.001) were higher in adolescents with functional constipation. Clinical characteristics, socio-demographic and family factors and psychological maladjustment had no relationship with externalization, internalization and total CBCL-S/4-18 score. Internalization (-0.49, p<0.0001), externalization (-0.30, p<0.05), and total CBCL-S/4-18 (-0.44, p<0.001) scores had a negative impact on HRQoL of adolescents with functional constipation. Conclusions: Adolescents with functional constipation are suffering from significant behavioral and emotional problems. These problems negatively affect their HRQoL.Item Functional abdominal pain disorders in adolescents in Indonesia and their association with family related stress.(BioMed Central,London, 2019) Oswari, H.; Alatas, F.S.; Hegar, B.; Cheng, W.; Pramadyani, A.; Benninga, M.A.; Rajindrajith, S.BACKGROUND: Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents. METHODS: This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire.RESULTS: A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p < 0.05) and those exposed to family-related stressful life events (p < 0.05). They include divorce or separation of parents (adjusted OR 2.55, 95% CI 1.75-3.7, p = < 0.001), death of a close family member (adjusted OR 2.24, 95% CI 1.39-3.59, P = 0.001), and father's alcoholism (adjusted OR 1.94, 95% CI 1.22-3.1, P = 0.005). CONCLUSIONS: FAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.Item Functional constipation in infancy and early childhood: epidemiology, risk factors, and healthcare consultation(BioMed Central, 2019) Walter, A.W.; Hovenkamp, A.; Devanarayana, N.M.; Solanga, R.; Rajindrajith, S.; Benninga, M.A.BACKGROUND:Functional constipation (FC) is a pediatric problem that is seen frequently. However, its prevalence in Asia remains undetermined. In this study we attempted to determine the prevalence, risk factors and therapeutic modalities of FC in infants and toddlers in Sri Lanka.METHODS:Children aged 6.5 months to 4 years were selected from 14 well-baby and vaccination clinics in the Gampaha District of Sri Lanka. A questionnaire with questions regarding the socio-demographic characteristics, child's bowel habits, psycho-social risk factors and treatment modalities were filled by the mothers. FC was diagnosed according to ROME III criteria.RESULTS:A total of 1113 children were analyzed [(female n = 560 (50.3%) with a mean age of 20.7 months, standard deviation [SD] 11.2 months. FC was found in 89 (8.0%). FC was significantly and independently associated with underweight (14.3% vs 7.2%, p = 0.008. [OR and 95% CI: 2,3 (CI; 1.3-4.2)] and residence in an urban area (9.6% vs 5.6%, p = 0.013). [OR and 95% CI: 0.592 (CI; 0.396-0.95)]. Children subjected to violence showed a significantly higher prevalence of FC (20.0 vs 7.8%, p = 0.046). Children being overweight and children living with mothers subjected to violence showed a higher, though not statistically significant, tendency to develop FC. Children with FC visited healthcare clinics more frequently when compared to controls (19.6% vs 6.0%, p < 0.0001). However, only 24% of infants and toddlers with FC were treated specifically for the condition by a doctor. CONCLUSIONS:FC occurred in 8% of this cohort of Sri Lankan infants and toddlers. It is significantly associated with underweight and living in an urban area. Only a quarter of them received medical attention for their constipation.TRIAL REGISTRATION:SLCP/ERC/2014/12 , December 2014Item Global prevalence and international perspective of pediatric gastrointestinal disorders(London: Radcliffe Publishing,, 2014) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.This chapter discusses the epidemiological trends and international perspectives of Functional gastrointestinal disorders (FGIDs) in children. FGIDs consist of a group of chronic gastrointestinal problems characterised by recurrent symptoms that cannot be explained by structural and biochemical abnormalities. The chronic and disabling nature of symptoms and their remarkably high prevalence across the globe has identified them as a concern for paediatric public health. Several studies have shown a significant percentage of children with non-organic recurrent abdominal pain to have functional gastrointestinal diseases. Aerophagia is a functional gastrointestinal disease characterised by repetitive swallowing of air that leads to abdominal distension, excessive belching and/or flatus. Cyclical vomiting syndrome is a clinical entity associated with recurrent episodes of severe nausea and vomiting that may last for hours to days with well-demarcated symptom-free intervals. Functional constipation is a cosmopolitan problem and with prevalence rates varying by geographical location and environmental cons.Item Epidemiology of paediatric constipation in Indonesia and its association with exposure to stressful life events(Biomed Central, 2018) Oswari, H.; Alatas, F.S.; Hegar, B.; Cheng, W.; Pramadyani, A.; Benninga, M.A.; Rajindrajith, S.BACKGROUND: We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group. METHODS: A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria. RESULTS: Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P < 0.001), being bullied at school (adjusted OR 1.67, 95% CI 1.01–2.76, P = 0.047) and loss of a parent’s job (adjusted OR 1.39, 95% CI 1.03–1.88, P = 0.034). CONCLUSIONS: Constipation in children and adolescent is a significant health problem, affecting almost 20% of Indonesian school-age children and adolescents. Common school and home related stressful life events appear to have predisposed these children to develop constipation.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 Clinical evaluation of children with constipation: history and physical examination(Nova Science Publishers Inc, 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Item Abdominal migraine in children: association between gastric motility parameters and clinical characteristics(BioMed Central, 2016) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.BACKGROUND: Approximately 0.2-1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM. METHODS: Seventeen children (6 boys), within an age range of 4-15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4-14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method. RESULTS: Average GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm(2) vs. 0.6 cm(2)) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = -0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = -0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = -0.55), F (r = -0.52), and MI (r = -0.57) (p < 0.05). CONCLUSIONS: GE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.Item Defecation disorders in children: constipation and functional fecal incontinence(Springer International Publishing, 2016) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Defecation disorders denote a state of altered defecation dynamics leading to an array of clinical presentations. With the currently available epidemiological studies, it is evident that these disorders have become a set of rapidly spreading global health problems. Due to the broadening of the understanding of escalating health-care costs and poor quality of life, these diseases demand attention of clinicians and researchers, more than at any other time in history. However, it is regrettable that only a little guidance is available for health-care professionals to manage these disorders. Most of the therapeutic trials and investigation plans are archaic from the viewpoint of a twenty-first-century clinician and are not evidence based. However, new research ventures are being carried out, and the horizon of the knowledge base is expanding, perhaps indicating a brighter future. In this chapter, we discuss emerging concepts of definitions, epidemiology, pathophysiology, clinical evaluation, and management of defecation disorders in children and adolescents.