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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Epidemiology of functional abdominal pain disorders and functional defecation disorders in adolescents in Curacao. [Letter to the editor](Raven Press., 2020) Zeevenhooven, J.; van der Heijden, S.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.This is response to the article (J. Pediatr. Gastroenterol. Nutr. . 2020;70(4):e71-e76.) by same authors.Item Epidemiology of functional abdominal pain disorders and functional defecation disorders in adolescents in Curacao.(Raven Press., 2020) Zeevenhooven, J.; van der Heijden, S.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.OBJECTIVES: Functional abdominal pain disorders (FAPDs) and functional defecation disorders (FDDs) are common in children and adolescents, but prevalence rates from the Caribbean are lacking. Therefore, our aim was to determine the prevalence of FAPDs and FDDs in adolescents in Curacao and to assess the influence of psychosocial factors on the prevalence of FAPDs and FDDs. METHODS: The prevalence of FAPDs and FDDs in children and adolescents living in Curacao, ages 11 to 18 years, was assessed using the Rome IV Questionnaire on Pediatric Gastrointestinal Disorders (RIV-QPGD). FAPDs and FDDs were diagnosed according to the Rome IV criteria. Sociodemographic characteristics, somatic symptoms, early adverse life events, stressful life events, and physical and emotional abuse were evaluated as associated factors. RESULTS: Out of 946 questionnaires distributed, 783 were included for further analysis. The mean age of adolescents was 14.7 years (±1.6) with 61.7% being girls. A total of 266 adolescents (34%, 95% confidence interval [CI] 30.7-37.5) met Rome IV criteria for at least 1 FAPD or FDD. Twenty-nine adolescents (3.7%) qualified for 2 functional gastrointestinal disorders. Functional constipation (18.6%) and irritable bowel syndrome (12.3%) were the most prevalent disorders. After multivariate logistic regression analyses, dizziness (odds ratio [OR] 1.84, 95% CI 1.28-2.64) was significantly associated with having a FAPD or FDD. CONCLUSIONS: FAPDs and FDDs are common in adolescents in Curacao. Dizziness is associated with the presence of a FAPD or FDD.Item A Core outcome set for clinical trials in pediatric functional abdominal pain disorders.(Mosby, 2020) Zeevenhooven, J.; Rexwinkel, R.; Van Berge Henegouwen, V.W.A.; Krishnan, U.; Vandenplas, Y.; Strisciuglio, C.; Staiano, A.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.; Tabbers, M.M.; Consensus Group on Outcome Measures Made in Pediatric Enteral Nutrition Clinical Trials Working GroupOBJECTIVE: To ensure consistency and reduce outcome measure reporting heterogeneity in clinical trials on pediatric functional abdominal pain disorders (FAPDs), a core outcome set (COS) was developed for pediatric FAPD trials. STUDY DESIGN: A mixed-method 2-round Delphi technique was used and key stakeholders, including healthcare professionals (HCPs), patients with FAPD, and their parents were invited to participate. In the first round, key stakeholders identified outcomes of importance through an open-ended questionnaire. Outcomes mentioned by ≥10% of the participants were included in a shortlist. In the second round, this shortlist was rated and prioritized. During a consensus meeting with an expert panel, the final COS was defined. RESULTS: The first round was completed by 152 of 210 (72%) HCPs, 103 (100%) parents, and 50 of 54 (93%) patients. A total of 104 from 167 (62%) HCPs, 102 (100%) parents, and 53 (100%) patients completed round 2. Pain intensity, pain frequency, quality of life, school attendance, anxiety/depression, adequate relief, defecation pattern (disease specific, irritable bowel syndrome), and adverse events were included in the final COS for FAPDs. CONCLUSION: A set of 8 core outcomes has been identified that should minimally be measured in pediatric FAPD trials. Implementation of the use of this COS will increase comparison between studies and, therefore, improve management of children with FAPDs.Item Quality of life in teenagers with abdominal pain related functional gastrointestinal disorders who have been exposed to child abuse(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN),, 2013) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.AIMS: Large number of previous studies conducted in children and adults have shown a significant association between abdominal pain predominant functional gastrointestinal disorders (AP-FGD) and exposure to child abuse. The main objective of this study was to assess the impact of child abuse on quality of life of Sri Lankan with AP-FGD. METHODS: A randomly selected group of 13-18 year olds were screened using the Rome iii questionnaires criteria for AP-FGD were recruited after obtaining consent from school administration, parents and teenagers themselves. Information regarding exposure to abuse and quality of life were assessed using previously translated and validated questionnaires. The questionnaires were administered in an examination setting to ensure confidentiality and privacy. Research assistants were present during filling the question¬naires and verifications were provided. They were collected on the same day. RESULTS: A total of 290 children with AP-FGD were recruited [males 128 (44.1%), mean age 14.6 years and SDI 1.5 years]. The number of children exposed to physical, emotional and sexual abuse, were respectively 90 (31.0%), 101 (34.8%) and 16 (5.5%). Average scores obtained for physical (85.3% vs.89.3% in nonabused), emotional (69.9% vs.79.7%), social (86.3% vs. 92.6%) and school (73.7% vs. 80.6%) functioning domains of quality of life in children exposed to emotional abuse were significantly lower (p < 0.05, unpaired t-test). Similar decrease was observed in children exposed physical abuse in social (86.4% vs. 92.2%) and school (74.6% vs. 79.9%) functioning domains (p < 0.05), but not in physical and emotional functioning domains (p > 0.05). Exposure to sexual abuse did not show a significant difference in in quality of life (p > 0.05). CONCLUSIONS : Even among teenagers with AP-FGD, those exposed to child abuse have a significantly lower quality of life than those not exposed to abuse.Item Delayed gastric emptying rates and impaired antral motility in children fulfilling ROME III criteria for functional abdominal pain(Lippincott Williams & Wilkins, 2011) Devanarayana, N.M.; Rajindrajith, S.; Rathnamalala, N.; Samaraweera, S.; Benninga, M.A.BACKGROUND: Abdominal pain is a common paediatric disorder affecting approximately 10% of children worldwide. The majority of affected children has no identifiable organic cause for their symptoms and considered to have functional gastrointestinal disorders (FGD). Gastric sensory motor dysfunctions have been implicated in the pathophysiology of FGD such as functional dyspepsia and irritable bowel syndrome. However, very little is known regarding gastric motility in children with functional abdominal pain (FAP), whose predominant symptom is abdominal pain. AIM: We hypothesized that abnormal gastric emptying and impaired antral motility are possible underlying mechanisms of symptoms in children with FAP. METHODS: All children referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya from 1st January 2006 to 31st December 2010 were screened and those fulfilling Rome III criteria for FAP were recruited. All patients were screened for organic disorders using history, examination and basic investigations (urine microscopy and culture, stool microscopy, C-reactive protein, full blood count and liver and renal function tests). An age and sex compatible group of healthy children were selected as controls. Liquid gastric emptying rate (GER) and antral motility (frequency of antral contractions, amplitude of antral contractions and antral motility index) were assessed using a previously reported ultrasound method. Results: A total of 102 children with FAP [37 (36.3%) males, 4–14 years, mean 7.8 years, SD 2.7 years] and 20 healthy controls [8 (40%) males, 4–14 years, mean 8.4 years, SD 3.0 years] were recruited. Average GER (42.1% vs. 66.2% in controls), amplitude of antral contractions (56.5% vs. 89%), frequency of contractions per 3 min (8.5 vs. 9.3) and antral motility index (4.9 vs. 8.3) were significantly lower in patients with FAP compared to controls ( p<0.01). Fasting antral area was higher in patients (1.4 vs. 0.6, p<0.0001). GER negatively correlated with the scores obtained for severity of abdominal pain (r= -0.29, p=0.004). CONCLUSIONS: Gastric emptying and antral motility parameters were significantly impaired in patients with FAP and GER negatively correlated with symptom severity. These findings highlight the possible role of gastrointestinal motility abnormalities in the pathophysiology of childhood FAPItem Abdominal pain predominant functional gastrointestinal disorders in adolescent Nigerians(Lippincott Williams and Wilkins, 2016) Udoh, E.; Devanarayana, N.M.; Rajindrajith, S.; Meremikwu, M.; Benninga, M.A.AIMS: To determine the prevalence, pattern and predisposing factors of abdominal painpredominant functional gastrointestinal disorders (AP-FGIDs) in adolescent Nigerians. METHODS: A cross sectional study was conducted in two states in the southern part of Nigeria in June 2014. Adolescents aged 10 - 18 years were recruited from 11 secondary schools using a stratified random sampling technique. A validated self-administered questionnaire on Rome III criteria for diagnosing AP-FGIDs and its determinants were filled by the participants in a class room setting. RESULTS: A total of 874 participants filled the questionnaire. Of this, 818 (93.4%) filled it properly and were included in the final analysis. The mean age of participants was 14.6 ± 2.0 years with 409 (50.0%) being males. AP-FGIDs were present in 81 (9.9%) participants. Among them, 46 (5.6%) had irritable bowel syndrome (IBS), 21 (2.6%) functional abdominal pain, 15 (1.8%) abdominalmigraine while 3 (0.4%) had functional dyspepsia. The difference in AP-FGIDs between adolescents residing in rural and urban areas was not statistically significant (P = 0.22). AP-FGDs was significantly associated with frequent punishment at school (P = 0.03), Intestinal and extra-intestinal symptoms occurred more frequently in those with AP-FGIDs. loss of appetite (56.8% vs. 38.4% in controls), nausea (51.6% vs. 30.0%), headache (76.5% vs. 65.0%), photophobia (56.8% vs. 34.6%) and light-headedness (50.6% vs. 32.6%). Nausea was the only symptom independently associated with AP-FGIDs (p = 0.015). Multiple regression analysis showed no significant association between stressful life events and FGIDs. (P < 0.05). CONCLUSIONS: AP-FGIDs are a significant health problem in Nigerian adolescents. In addition to the intestinal symptoms, most of the affected children had other them also had extra-intestinal symptoms. None of the stressful life events evaluated was significantly associated with FGIDs. Frequent punishment in schools was significantly associated with the condition.Item Childhood functional abdominal pain: mechanisms and management(Nature Pub. Group, 2015) Korterink, J.; Devanarayana, N.M.; Rajindrajith, S.; Vlieger, A.; Benninga, M.A.Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.