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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Causes for recurrent abdominal pain in children and adolescents: a classification according to rome ii criteria(Sri Lanka College of Paediatricians, 2007) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.BACKGROUND: Recurrent abdominal pain (RAP) among children and adolescents is defined as "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than 3 months". RAP has multifactorial aetiology with many affected children having no evidence of organic pathology. The ROME II criteria for 'childhood functional gastrointestinal disorders' classify non-organic RAP into five main categories: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, aerophagia and functional abdominal pain. OBJECTIVES: To identify the causes of RAP in Sri Lankan children. To classify non-organic RAP using ROME II criteria. DESIGN, SETTING AND METHOD: The children identified as having RAP during a school survey were recruited and screened for organic diseases using history, examination, stool microscopy and culture, full blood count, erythrocyte sedimentation rate and abdominal radiograph. Other investigations, performed based on clinical evidence, included serum amylase, renal and liver function tests, abdominal ultrasound and gastrointestinal endoscopy. RAP was defined according to Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified using ROME II criteria. RESULTS: Fifty five children with RAP were investigated [25(45.5%) males, aged 5-15 years {mean 8.1 years, SD3.1 years)]. Thirteen (23.6%) had organic RAP (constipation 7, urinary tract infection 2, urinary calculi 1, gastro-oesophageal reflux I, antral gastritis and duodenitis I, and intestinal amoebiasis 1) and 42 (76.4%) had no organic disease. Thirty three (60%) could be classified according to ROME II criteria [functional abdominal pain 13, IBS 9, FD 9, abdominal migraine l,aerophagia I]. Nine (16.4%) did not fall into any of the above categories. CONCLUSIONS: The majority (60%) of children with RAP had functional bowel disease, which can be classified using ROME II criteria. • Organic pathology accounted for symptoms in less than 25% of patients.Item Oro-caecal transit in Sri Lankan children and adolescents with functional recurrent abdominal pain(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.INTRODUCTION: Recurrent abdominal pain (RAP) is a common paediatric problem. The majority of the affected have no organic pathology. Gastrointestinal motility abnormalities are considered as a possible cause for their symptoms. This study evaluated oro-caecal transit in children and adolescents with functional RAP. METHODS: Thirty one children with functional RAP and 20 healthy children from the same geographical area underwent oro-caecal transit time measurement by lactulose (0.25 g/kg in 10% solution) breath hydrogen test. None had evidence of organic disease, except for one control who had a positive Helicobacter pylori stool antigen test. RESULTS: Oro-caecal transit times could be calculated in 30 patients [10 (33.3%) males, mean age 7.2 years, SD 2.4 years, 12 functional abdominal pain, 8 irritable bowel syndrome, 8 functional dyspepsia, 1 abdominal migraine, 1 non-specific abdominal pain according to Rome III criteria] and 19 controls [10 (52.6%) males, mean age 9 years, SD 2.7 years]. One patient (3%) and 1 control (5%) were non-responders. Oro-caecal transit time was significantly prolonged in patients (median 90 min, range 45–150 min) compared to controls (median 75 min, range 30–105 min) (p = 0.0045). Oro-caecal transit time did not correlate with scores obtained for severity of abdominal pain (r = 0.176, p = 0.354) and had no association with exposure to recent stressful life events (p > 0.05). CONCLUSIONS: Oro-caecal transit time was delayed in children and adolescents with functional RAP. The future studies are needed to confirm the role of delayed oro-caecal transit in generation of symptoms, and to evaluate the therapeutic value of drugs that normalize small intestinal transit.Item Recurrent abdominal pain among children: its role in school performance(Sri Lanka Medical Association, 2006) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.OBJECTIVES: Recurrent abdominal pain (RAP) is a common problem among school children. The majority of affected children do not attend school regularly. It is believed to be common among high academic achievers but available data has failed to show such an association. Our main objective was to detect the association between RAP and school performance in Sri Lankan children. METHOD: This was a cross sectional survey. Questionnaires were distributed to a randomly selected group of school children attending year 1 to 9. Questionnaires were filled by parents and returned by post. Details regarding the child's academic performance were obtained from school records. RAP was defined according to Apley's criteria. RESULTS: Eight hundred and ten questionnaires were distributed, 734 (90.6%) were returned. Seventy seven (10.5%) had RAP. RAP was significantly higher in children who had changed their school (p=0.0026) and were being bullied at school (p=0.00098). School absenteeism was 80.5% in the RAP group compared to 45% among controls (p<0.0001). Twenty five (32.2%) and 16 (20.8%) children with RAP had disturbances in participation in sports and extracurricular activities respectively. Prevalence of RAP in good, average and poor academic performers was 11.2%, 11.5% and 10.4% respectively (p>0.05). Performance in the year-5-scholarship examination (12.6% in scholarship holders vs. 10.2% in failures) and child's participation in sports showed no association with RAP (p>0.05). CONCLUSIONS: RAP was associated with exposure to stressful events at school. School absenteeism was significantly higher among affected children. RAP was not associated with high academic achievement and participation in sports.Item Recurrent abdominal pain syndrome among school children in the Gampaha district in Sri Lanka(Sri Lanka Medical Association, 2005) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.OBJECTIVES: Recurrent abdominal pain (RAP) syndrome is defined as "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than three months". The prevalence of RAP syndrome among Sri Lankan children was unknown and the main objective of this study was to detect it. Methods: Questionnaires were distributed to a randomly selected sample of school children, aged between 5 to 15 years, from 4 randomly selected schools in the Gampaha district. RAP was defined according to Apley's criteria, a percentage of children fulfilling these criteria were interviewed and prevalence was adjusted accordingly. RESULTS: A total of 810 questionnaires were distributed and 734 (90.6%) were returned. There were 432 (46.6%) males and 392 (53.4%) females. The prevalence of RAP was 10.5% (9.6% in males and 11.2% in females). The highest prevalence was seen in children aged between 10 and 11 years and the mean age was 10.6years (SD 2.6years). RAP was significantly higher among children who were exposed to at least one stressful life event during past 6 months (p<0.0001) and who had a family history of RAP (p<0.000l). There were no associations between RAP and total family income, family size, father's alcohol consumption and having a working mother. CONCLUSIONS: Recurrent abdominal pain syndrome of childhood is a common problem in Sri Lanka affecting 10.5% of school children. RAP was higher in children who were exposed to emotional stress and who had a family history suggestive of the condition.