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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 functional abdominal pain disorders and asthma in adolescents: A cross-sectional study(Baishideng Publishing Group, 2018) Kumari, M.V.; Devanarayana, N.M.; Amarasiri, L.; Rajindrajith, S.AIM: To find the association between asthma and different types of functional abdominal pain disorders (FAPDs) among teenagers. METHOD : A cross-sectional study was conducted among 13 to 15-year-old children from six randomly selected schools in Anuradhapura district of Sri Lanka. Data were collected using translated and validated self-administered questionnaires (Rome III questionnaire, International Study on Asthma and Allergies in Childhood questionnaire, and Pediatric Quality of Life Inventory 4.0) and administered under an examination setting after obtaining parental consent and assent. RESULTS: Of the 1101 children included in the analysis, 157 (14.3%) had asthma and 101 (9.2%) had at least one FAPDs. Of children with asthma, 19.1% had at least one type of FAPDs. Prevalence rates of functional abdominal pain (FAP)(8.9% vs 3.3% in non-asthmatics), functional dyspepsia (FD) (2.5% vs 0.7%), and abdominal migraine (AM) (3.2% vs 0.4%) were higher in those with asthma (P < 0.05, multiple logistic regression analysis), but not in those with irritable bowel syndrome (4.5% vs 3.1%, P = 0.2). Severe abdominal pain (10.8% vs 4.6%), bloating (16.6% vs 9.6%), nausea (6.4% vs 2.9%), and anorexia (24.2% vs 16.2%) were more prevalent among asthmatics (P < 0.05). Lower gastrointestinal symptoms did not show a significant difference. Scores obtained for health related quality of life (HRQoL) were lower in those with asthma and FAPDs (P < 0.05, unpaired t-test). CONCLUSION: Asthma is associated with three different types of FAPDs, namely, FD, AM, and FAP. HRQoL is significantly impaired in teenagers with asthma and FAPDs.Item Abdominal bloating in children: association with functional gastrointestinal diseases and adverse life events.(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.BACKGROUND/AIMS: Abdominal bloating is a common symptom among children with functional gastrointestinal diseases (FGDs). It can lead to significant distress among affected children. However, its epidemiology, risk factors and clinical characteristics have not been described in paediatric population. We aimed to study die epidemiology and risk factors of abdominal bloating, and associated FGDs in Sri Lankan children. METHODS: A cross-sectional, island-wide survey was conducted in Sri Lankan children aged 10-16 years. Four provinces (out of 9) of the country were randomly selected and 2 schools were randomly selected from each of the provinces. From each school, 12 classes from academic years (grades) 6 to 11 (2 from each academic year) were randomly selected and all children in these classes were included in the study. The Rome III questionnaire for paediatric FGDs (self-report form) was used for data collection. FGDs were diagnosed using Rome III criteria. Abdominal bloating was considered to be present if die child indicated as having abdominal bloating at least 25% of the time during the past 2 months. RESULTS: A total of 1972 children and adolescents (54.8% boys, mean age 13.4 years, SD 1.8 years) were included in the analysis. One hundred and ninety-four (9.8%) children had abdominal bloating. Of them, 52.6% had aerophagia, 15.4% had irritable bowel syndrome, 9.7% had constipation, 6-7% had rumination syndrome, and 5.6% had functional abdominal pain. Bloating was significantly common among children exposed to emotional stress and adverse life events (P < 0.0001). Intestinal related symptoms and extra intestinal symptoms that were significantly associated with bloating include abdominal pain, nausea, pallor, photophobia and headache (P < 0.05). CONCLUSIONS: Bloating is a common symptom of children and often associated with a range of FGDs. Children who faced adverse life events and stress, have a higher tendency to develop bloating. Bloating coexist with several other intestinal related and extra intestinal symptoms.Item Aerophagia among school children: epidemiological patterns and symptom characteristics(Lippincott Williams & Wilkins, 2011) Devanarayana, N.M.; Rajindrajith, S.BACKGROUND: Aerophagia is a functional gastrointestinal disease characterized by repetitive air swallowing, abdominal distension, belching and flatulence. In severe cases, it can lead to pneumoperitonium, volvulus and intestinal perforation. Little is known about the epidemiology and clinical profile of affected children. The main objective of this study was to assess the epidemiology of aerophagia in Sri Lankan children and adolescents. METHODS: This cross sectional survey was conducted in 10–16 years old children in 8 randomly selected schools of 4 randomly selected provinces in Sri Lanka. Data were collected using a self-administered questionnaire Questionnaire on Pediatric Gastrointestinal Symptoms - Rome III version, which is translated into native language and pretested for Sri Lankan children). It was distributed in an examination setting and collected on the same day. Trained research assistants were present during the answering of the questionnaire, for any required clarification. Aerophagia was diagnosed using Rome III criteria. RESULTS: In this study, aerophagia was seen in 163 (7.5%), of the 2163 children evaluated. The prevalence was higher in older children (10.5% in 15-year-olds). No gender difference was observed (boys 8.2% vs. girls 6.8%, p>0.05). Other intestinal-related (abdominal pain, nausea and anorexia) and extraintestinal symptoms (headache, limb pain, sleeping difficulty, photophobia and lightheadedness) were more prevalent among affected children ( p<0.05). Out of 163 children with aerophagia, 18 (11%) had difficulty in sleeping and 31 (19.0%) had missed school because of symptoms. Both entities were significantly commoner among children with aerophagia than in controls ( p<0.05). A higher percentage of affected children were found to be exposed to recent stressful life events when compared to controls ( p=0.01). CONCLUSIONS: This study highlights the high prevalence of aerophagia among Sri Lankan children and adolescents. Other intestinal-related and extraintestinal somatic symptoms are frequently seen in affected children. Furthermore, aerophagia has a significant impact on daily activities, such as sleep and schooling, of 10–20% of affected children. This condition is more commonly seen in children exposed to emotional stressItem 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 Do traumatic life events predispose children to develop constipation?(Lippincott Williams & Wilkins, 2015) Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.BACKGROUND: The aetiology of functional constipation (FC) in children is not been fully understood. Exposure to physical, emotional and sexual abuse are known to predispose children to develop FC. No paediatric study has evaluated traumatic life events other than abuse as a potential predisposing factor for FC in children. We aimed to assess the association between traumatic life events and development of FC in children. METHODS: We conducted a cross sectional, school based study. Children aged 13-18 years were selected from four semi-urban schools in the Gampaha district, Sri Lanka. A validated, self-administered questionnaires were used for collect data on functional gastrointestinal disease and traumatic life events. FC was defined using the Rome III criteria. RESULTS: A total of1792 children were included in the analysis [males 975 (54.4%), mean age 14.4 years, SD 1.3 years years]. Out of them, 138(7.7%) had FC. Prevalence of FC was significantly higher in those exposed to traumatic life events compared to controls (53.6% vs.32.9%,p < 0.0001). Traumatic life events such as parents living separately (13.4% vs. 7.12%,p = 0.038), living in a boarding house (10.1% vs. 1.6%, p = 0.049), liquor abuse by parents (14,8% vs. 6,3%, p < 0.0001), witnessing a murder (16.7% vs. 3.9%, p = 0.002), child labour (13.9%vs. 7.3%, p = 0.02) and ill-treated by parents (27.5% vs. 7.3%, p < 0.0001) were shown to predispose children to develop FC. Parental substance abuse (12.8% vs. 7.4%), domestic violence (14.8 vs. 7.5%) were not associated with FC (p > 0.05). CONCLUSIONS: FC is associated with childhood traumatic experiences. This provides further insight into how traumatic childhood events are associated with development and perpetuation of FC in children.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 Abnormal personality traits in children with aerophagia(Lippincott Williams & Wilkins, 2015) Devanarayana, N.M.; Jayawickrama, N.; Gulegoda, I.C.; Rajindrajith, S.OBJECTIVE: The main objective of this study is to study the personality types in children with aerophagia. METHODS: A cross sectional survey was conducted in 8 randomly selected schools in 4 randomly selected provinces Sri Lanka. From each school, all children aged 13-18 years were selected after obtaining written consent from parents, school administration and provincial education office. Assent was obtained from all children recruited. Date were collected using a self-administered questionnaire administered under examination setting to ensure confidentiality and privacy. Questionnaire contained previously translated and validated Rome III questionnaire for functional gastrointestinal diseases (self-administered form for children above 10 years) and childhood personality assessment questionnaire. Trained research assistants were present during filling the questionnaire to provide assistance and to verify doubts. Aerophagia was defined using the Rome III criteria. Severities of individual symptoms were recorded in 100 mm visual analogue scale. RESULTS: A total of 1069 questionnaires were distributed and all of them were returned and included in analysis [males 508 (47.5%), mean age 15.3 years, SD 1.8 years years]. One hundred and thirty six (12.7%) fulfilled Rome III criteria for aerophagia and 933 children without aerophagia were considered as controls. Nineteen (13.8%) children with aerophagia and 71 (7.6%) controls had personality scores above the international cut-off value (105) for abnormal personality (p = 0.01). Children with aerophagia had significantly higher scores for different personality traits than controls; including hostility and aggression (13.2 vs. 12.2 in controls, p = 0.006), negative self-esteem (11.0 vs. 9.9, p < 0.0001), negative self-adequacy (10.6 vs. 9.6, p = 0.001), emotional unresponsiveness (10.5 vs. 9.6, p < 0.0001), emotional instability (16.9 vs. 15.7, p < 0.001), negative world view (10.9 vs. 10.1, p = 0.02) and total personality score (92.1 vs. 87.7, p = 001). In children with aerophagia, scores obtained for severity of bloating correlated with scores obtained for hostility and aggression (r = 0.22, p = 0.02). CONCLUSIONS: Children with aerophagia has abnormal personality traits and this fact may at least partly responsible for development and perpetuation of symptoms in them.Item Aerophagia in children is associated with emotional ill-treatment.(Lippincott Williams & Wilkins, 2015) Rajindrajith, S.; Silva, R. L.; Devanarayana, N.M.BACKGROUND: Aerophagia is a functional gastrointestinal disease characterized by air swallowing, abdominal distension, excessive flatus and belching. The aetiology of this disorder is not clear. Previous studies have suggested an association between aerophagia and psychological stress. We aimed to assess the association between emotional ill-treatment and aerophagia. METHODS: A cross sectional survey was conducted in 4 provinces of Sri Lanka. Children aged 13-18 years were selected from schools in these provinces. A validated, self-administered questionnaires were used for collect data on functional gastrointestinal disease including aerophagia and emotional ill-treatment. Aerophagia was defined using the Rome III criteria. RESULTS: A total of 1069 questionnaires were included in the final analysis (males 508 [47.5%], mean age 15.3 years, SD 1.8 years). One hundred and thirty six (136) children had aerophagia. Prevalence of aerophagia was significantly higher in children who experienced emotional ill-treatments (43 (23.2%) vs. 160 (17.1%), p < 0.0001). Emotional ill-treatments that were significantly associated with aerophagia include, teasing by others (54.1% vs. 45.0%, p < 0.0001), humiliation (38.2% vs. 20.3%, p < 0.0001), treating inferiorly by others (22.8% vs. 11.1%, p < 0.0001), threatening to abandon (8.8% vs. 2.6%, p < 0.0001), threatening destroy belongings (14.0 vs. 4.5%, p < 0.0001), and forcing to do unwanted deeds (9.6% vs. 3.9, p = 0.003). Parenting factors such as refusal of attending to emotional needs (8.8% vs. 3.0%, p < 0.001), refusal to look at (6.6% vs. 0.7%, p < 0.0001), refusal of hugging (10.5% vs. 5.6%, p = 0.03), and not appreciating achievements (5.9% vs. 2.1%, p < 0.0001) were significantly common among children with aerophagia. CONCLUSIONS: Aerophagia in children is associated with emotional ill-treatments. Attending to child's emotional needs likely reduce the prevalence of aerophagia and its consequences.