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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Association between faecal incontinence, child abuse, somatisation and health related quality of life(Belgian Society of Paediatric Gastroenterology, Hepatology and Nutrition (BeSPGHAN), 2013) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.AIMS : Faecal incontinence (FI) is an important lower gastrointestinal disease. Bad aroma around children with FI leads to rejection by peers, psychosocial isolation and learning difficulties. Aim of this study was to evaluate the association between FI, child abuse and health related quality of life (HRQoL) in children and adolescents. METHODS : Children aged 13-18 years were selected from four semi-urban schools in Gampaha district, Sri Lanka. A validated, self-administered questionnaire was used for data collection after obtaining consent from school authorities, parents and children themselves. Information regarding socio-demographic factors, gastrointestinal symptoms, child abuse, HRQoL and somatisation were collected. FI was defined as at least one episode of leaking of faeces in to the underwear per month. RESULTS: A total of 1807 children were included in the analysis [males/9.3 vs 53.8%), mean age 14.4years, SI.) 1.4 years]. Forty seven (2.6%) had FI. FT was significantly higher in boys (-74.49S vs. 25,6%% in girls, p < 0.0001)1. Prevalence of FI was significantly higher in those exposed to sexual abuse (17%.,. vs. 2.3% in non abused, p < 0.0.001)., emotional abuse i40.4% vs. 22.7%, p < 0.0001), and physical abuse (51% vs. 24:3.'%', p < 0.0001). Children with FI had higher mean somatisation score [mean 20.1, SD 14.5 vs. mean 9.3, SD 9.2 in those without FT (controls), p < 0.0001J. Children with FI had lower HRQoL scores for physical functioning (78.1 vs.'9:1:2.in controls, p < 0.0001), social functioning (78.4 vs. 92.6, p < 0.0001), emotional functioning (70.5 vs. 82.3, p < 0.0001) and school functioning (69.1 vs- 82.3, p < 0.0001) domains, and a lower overall HRQoL score (74.6 vs. 87.1, p < Q .0.001). CONCLUSIONS : FI in children shows a significant association with physical, sexual and emotional abuse. Children with FT have a range of somatic symptoms and a poor HRQoL score in physical, emotional, social and school functioning domains.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 Gastric motility in children with abdominal migraine(Wiley Blackwell Scientific Publications, 2012) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.BACKGROUND/AIMS: Abdominal migraine (AM) is an uncommon disease in children. Approximately 0.2 to 1% of children suffer from this distressing problem. Pathophysiology of this disorder has not been studied in children. The aim of this study was to evaluate the gastric motility in children with AM. METHODS: Consecutive 17 children [6 (46.3%) males, age 4–15 years, mean 9.5 years, SD 3.1 years) referred to Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, January 2007 to December 2011, were screened and those fulfilling Rome III criteria for AM were recruited. None had clinical or laboratory evidence of organic disorders. Twenty healthy children were recruited as controls [8 (40%) males, age 4–14 years, mean 8.4 years, SD 3.0 years]. Liquid gastric emptying rate (GER) and antral motility parameters were assessed using a well-established and validated ultrasound method. RESULTS AND DISCUSSION: Average GER (41.6 vs. 66.2%, in controls), amplitude of antral contractions (57.9 vs. 89%) and antral motility index (5.04 vs. 8.3) were lower and fasting antral area (1.8 cm2 vs. 0.6 cm2) was higher in patients with AM (p < 0.01). Frequency of antral contractions (8.8 vs.9.3) did not show a significant difference (p = 0.08). Scores obtained for severity of abdominal pain had a negative correlation with amplitude of antral contractions (r = −0.55, p = 0.03). Negative correlations were observed between duration of the disease and amplitude of antral contractions (r = –0.55, p = 0.03), frequency of antral contractions (r = –0.52, p = 0.03), and motility index (r = −0.57, p = 0.03). A similar correlation was observed between average duration of an abdominal pain episodes and GER (r = –0.58, p = 0.02). CONCLUSIONS: Gastric emptying rates and antral motility parameters are signifi cantly lower in children with AM. Furthermore, we observed a signifi cant correlation between symptoms and gastric motility. These fi ndings indicate the possible role of abnormal gastric motility in pathogenesis of AMItem Abdominal pain predominant functional gastrointestinal diseases: association with child abuse, traumatic life events and quality of life(Wiley Blackwell Scientific Publications, 2012) Devanarayana, N.M.; Rajindrajith, S.; Karunanayake, A.; Nishanthini, S.; Perera, M.S.; Benninga, M.A.BACKGROUND/AIMS: Abdominal pain predominant functional gastrointestinal diseases (AP-FGD) have significant repercussions on affected individuals. Aims of this study were to assess its association with traumatic life events and child abuse, and its impact on quality of life. METHODS: Children aged 13–18 years were randomly selected from 3 schools in Western province of Sri Lanka. A previously validated, self administered questionnaire was used to collect information on gastrointestinal symptoms, traumatic life events, exposure to abuse, healthcare consultation and quality of life (QOL). AP-FGD were diagnosed using Rome III criteria. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years and SD 1.22 years]. AP-FGD were found in 243 (17.8%) children [Irritable bowel syndrome in 70 (5.1%), functional dyspepsia in 11 (0.8%), abdominal migraine in 26 (1.9%) and functional abdominal pain in 146 (10.7%)]. Prevalence of AP-FGDs were significantly higher in those exposed to traumatic life events (37.9% vs. 3.1%, p = 0.03), sexual abuse (35.3% vs. 17.3%, p = 0.01), physical abuse (19.7% vs. 12.6%, p = 0.0003), and emotional abuse (27.4% vs. 16.9%, p < 0.0001). Health care consultation was significantly higher in children exposed to physical abuse (26.4% vs. 0.0%, p = 0.03). QOL scores for physical (85.7 vs. 89.6), emotional (71.7 vs. 79.4), social (85.9 vs. 92.3) and school (74.3 vs. 81.1) function domains were significantly lower in children with AP-FGD who were exposed to emotional abuse (p < 0.05). QOL scores for school function domain was lower in children exposed to physical abuse (77.8 vs. 83.6, p = 0.03). CONCLUSIONS: Traumatic life events and child abuse in any form are significantly associated with higher prevalence of AP-FGD. Children exposed to physical abuse are more likely to seek healthcare for abdominal pain. Children with AP-FGD, exposed to emotional abuse, have significantly poor quality of life in all four domains.Item Determinants of healthcare consultation behavior in children with chronic constipation: a school based survey(Lippincott Williams & Wilkins, 2011) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.BACKGROUND: Constipation is a common pediatric disorder associated with poor quality of life and high healthcare expenditure. Healthcare consultation patterns in childhood functional gastrointestinal diseases are poorly understood. To date there are no community-based studies to identify factors determining healthcare consultation in children with functional constipation. AIMS: To assess the healthcare consultation patterns in Sri Lankan children with constipation and identifying socio-demographic and clinical factors that predict consultation behavior. METHODS: Island-wide cross-sectional survey was conducted among 10–16 years old children. Five schools were randomly selected from 3 randomly selected provinces of Sri Lanka. From each school, children were randomly selected from academic years (grades) 6–11. Previously pretested questionnaire based on Rome III criteria was used in the survey and questions were included regarding healthcare seeking for symptoms of constipation. RESULTS: Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice for their symptoms during previous 12 months. Children < 0.05). Healthcare consultation in children with stool frequency less than 3 per week, hard stools, painful defecation, large volume stool, fecal incontinence, with-holding posture and blood stained stools were respectively 7.5%, 2.7%, 6.6%, 11.6%, 11.1%, 7.7% and 14.3%. Exposure to stressful life events show no association with healthcare consultation (p=0.82). CONCLUSIONS: Healthcare consultation for chronic constipation in Sri Lankan school children and adolescents is quite low, despite the majority of them having features suggestive of significant constipation. Socio-demographic factors such as younger age and family history of constipation were significantly associated with healthcare seeking. It is essential to educate general public regarding features of chronic constipation and bring their children to medical attention early to avoid complications.Item Gastric emptying and antral motility according to the subtypes of irritable bowel syndrome: a paediatric study(Lippincott Williams & Wilkins, 2011) Devanarayana, N.M.; Rajindrajith, S.; Bandara, C.; Shashiprabha, G.; Benninga, M.A.BACKGROUND: Irritable bowel syndrome (IBS) is a common paediatric functional gastrointestinal disorder. It is subtyped into diarrhoea predominant (IBS-D), constipation predominant (IBS-C), mixed (IBS-M) and untypable (IBS-U) IBS depending on stool consistency. Several studies have reported differences in colonic motility in children with different IBS subtypes. However, gastric motility has not been assessed according to subtypes yet. AIM: To assess gastric motility in children with different IBS subtypes using a non-invasive ultrasound method. METHODS: Seventy six children with IBS [33 (43%) males, age 4–14 years, mean 7.9 years, SD 3.0 years) referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, Sri Lanka, for gastric motility studies and 20 healthy controls [8 (40%) males, age 4–14 years, mean 8.4 years, SD 3.0 years] were recruited. Children with IBS were divided into IBS-D(n=21), IBS-C(n=31), IBS-M (n=19) and IBS-U (n=5) according to Rome III definitions. None of the patients recruited had clinical or laboratory evidence of organic disorders. Liquid gastric emptying rate (GER) and antral motility parameters were assessed using a previously reported ultrasound method. RESULTS: Compared to healthy controls, the mean GER (43.8% vs. 66.2% in controls), amplitude of antral contractions (A) (56.4% vs. 89%) and antral motility index (MI) (5.1 vs. 8.3) were significantly lower and fasting antral area (FA) (1.6 vs. 0.6) was higher in children with IBS ( p<0.0001). Frequency of antral contractions (F) (8.9 vs. 9.3) did not show a significant difference between the two groups. Patients exposed to recent stressful life events had a significantly lower mean GER (40.3%), compared to those who were not (45.7%) ( p=0.03). No significant relationship was observed between severity of symptoms and motility abnormalities. No significant differences were found between IBS-D, IBS-C and IBS-M with respect to GER (42.%, 46.3%, 39.6%), FA (1.4 cm2,1.8 cm2, 1.8 cm2), A (53%, 58.9%, 51.8%), F (8.7, 8.9, 9.2) and MI (4.7, 5.3, 4.8). CONCLUSIONS: GER and antral motility parameters were significantly impaired in children with IBS compared to controls. No significant difference observed in gastric motility parameters between different IBS subtypes. GER was lower in those exposed to recent stressful eventsItem 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 The Association between adverse life events and abdominal pain-predominant functional gastrointestinal disorders.(Lippincott Williams & Wilkins, 2015) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.BACKGROUND: Abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are a common public health problem in children. The precise aetiology of AP-FGIDs is far from clear. Psychological stress and all forms of child abuse are known predisposing factors to develop AP-FGIDs. The main objective of this study is to study the association between adverse life events (ALEs) and development of AP-FGIDs. METHODS: A cross sectional, school based study was conducted in Gampaha district of Sri Lanka. All children aged 13-18 years were recruited from four randomly selected semi-urban schools in the district after obtaining consent from parents, school administration and children themselves. A translated and validated, self-administered questionnaire consisting of four parts was used for data collection. Part I was the Rome III questionnaire for functional gastrointestinal disorders, self-report form for children above 10 years. Part II was a questionnaire on exposure to adverse life events. Part III was the Sinhala (the native language) version of the PedsQL, Pediatric Quality of Life Inventory 4.0 (Generic Core Scales). Part IV was the Child Somatization Inventory. The questionnaire was administered under examination setting to ensure confidentiality and privacy. Research assistant were present during filling the questionnaire for provide assistance and verifications. AP-FGIDs were defined using the Rome III criteria. RESULTS: A total of 1792 children were included in the analysis (males 975 [54.4%], mean age 14.4 years, SD 1.3 years years). Out of them, 305 (17.0%) had AP-FGIDs. ALEs that showed a significant association with AP-FGIDs include, parental substance abuse (25.1% vs. 16.0% in controls, p = 0.015) and domestic violence (28.5% vs. 16.1%, p = 0.02). Children with AP-FGIDs exposed to ALEs have a higher somatization index compared to children not exposed to ALEs (16.9 vs. 13.4, p = 0.003), and a lower overall health-related quality of life (HRQoL) score (81.8 vs. 85.1, p = 0.02). The scores they obtained for psycho-social (86.4 vs. 92.4, p < 0.0001) and emotional (72.5 vs. 77.7, p = 0.03) domains of the HRQoL were also lower than that of children with no such experiences. CONCLUSIONS: Exposure to ALEs predispose children to develop AP-FGIDs. Experience of childhood ALEs deleteriously affects the HRQoL and somatization of children with AP-FGIDs.Item Infant dyschezia in Sri lankan children: epidemiology and risk factors(Lippincott Williams & Wilkins, 2015) Hovenkamp, A.; Walter, H. A.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.OBJECTIVES: Little is known regarding functional gastrointestinal diseases in infants, especially in developing countries. Our aim was to assess the prevalence of infant dyschezia in relation to bowel habits and sociodemographic factors in a representative community sample in Sri Lanka. METHODS: A multicenter cross-sectional study was conducted among mothers of 0 -7-month-old infants, attending 14 growth monitoring and immunization clinics in Gampaha District, Sri Lanka. A self-administered questionnaire was used to determine gastrointestinal symptoms, the infant's bowel habits and sociodemographic characteristics for a total of 1004 infants. The questionnaire was translated to the native language (Sinhala) and pretested. Infant colic and infant dyschezia were diagnosed according to the Rome III criteria. RESULTS: The prevalence of infant dyschezia in Sri Lanka was 4.3%. An infant was more likely to suffer from infant dyschezia if he or she was formula-fed (9.6% vs. 7.8% in breast fed and 4.2% in those on additional foods, P = 0.025) or had a highly educated father (mean years of education 13.5 [SD 4.0] vs. 12.3 [SD 2.6] in unaffected children, P = 0.005). No significant association was found between infant dyschezia and age, sex, gestational age, birth order, birth weight, current weight, and presence of domestic violence (P > 0.05). CONCLUSIONS: Infant dyschezia is a significant health problem in Sri Lanka affecting approximately 4.3% of healthy infants. Infants with infant dyschezia are more likely to be formula-fed and have a highly educated father.Item Bowel habits in Sri Lankan infants and toddlers, a population based study.(Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.OBJECTIVE: To obtain knowledge about bowel habits in healthy population of infants and toddlers in Sri Lanka. METHODS: We selected healthy children between 7 months and 5 years of age who visited vaccination and weighing clinics. To achieve data we used a self-administered questionnaire about the child's bowel habits during the previous two months. All subjects were selected in Gampaha district, Sri Lanka. Only those without defecation disorders were used for analysis. RESULTS: A total of 879 toddlers were eligible for analysis, (female n = 442 [50,3%], mean age 21,7 months, standard deviation [SD] 12,5 months). Of them, 595 (69,6%) defecated once a day, 20 (2,3%) had defecation >3/week and 6 (0,7%) <3/week. Stool consistency was hard or very hard in 30 (3,4%), 665 (78,9%) had smooth and soft stool and 107 (12,2%) had varying consistency. Straining and painful stool were reported in 560 (64,7%) respectively 194 (23%) of the sample, stool holding was present in 93 (10,8%) and 44 (4,9%) passed blood with the stool. No children reported fecal incontinence. CONCLUSIONS: This study provides data on normal bowel habits of Sri Lankan toddlers and infants. Bowel habits and disorders related to defecation in Sri Lankan toddlers and children differ from those living in the West probably due to dietary, genetic and environmental variations