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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Gastrointestinal disorders in children admitted to a tertiary care paediatric unit in Sri Lanka(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; Adikari, A.M.D.B.; Sanjeewa, P.A.B.; Rajindrajith, S.OBJECTIVES : Gastrointestinal diseases, including diarrhoea and abdominal pain, are common presenting complains in children admitted to hospitals. In those with abdominal pain, non-specific abdominal pain is the commonest diagnosis at discharge. This study evaluated the gastrointestinal disorders in children admitted to a tertiary care general paediatric unit in Sri Lanka. METHODS: Records of all neonates, infants and children admitted to University paediatric unit in North Colombo Teaching Hospital, Ragama, Sri Lanka, during 12 month period from 01/10/2006 to 30/09/2007, were evaluated. Demographic information, details regarding the symptoms, exam nation findings, investigations, treatments and diagnosis at discharge were analysed retrospectively. RESULTS: Of the 5202 patients admitted during the study period, 167 (3.2%) had gastrointestinal disorders [90 (54.9%) were males, mean age 6.3 years, SD 2.5 years, range 2–13 years]. Common presenting complains were diarrhoea [79 (47.3%)], abdominal pain [62 (37.1%)], constipation [10 (6%)] and vomiting [8 (4.8%)]. Most common discharge diagnosis was acute gastroenteritis (AGE) [57 (45.5%)]. Of 62 children presented with abdominal pain, only 23 (36.1%) had exact diagnosis at the discharge (AGE 13, gastritis 3, constipation 4, gastro-oesophageal reflux 1, typhoid fever 1, functional abdominal pain 1). CONCLUSIONS: Diarrhoea and abdominal pain accounted for more than 80% of hospital admissions due to gastrointestinal disorders. Nearly two third of patients admitted due to abdominal pain had no diagnosis at discharge. Even though, Rome III criteria are widely available, only one patient was diagnosed as having functional gastrointestinal disorder.Item Personality assessment in children with abdominal pain predominant functional gastrointestinal diseases(Wiley Blackwell Scientific Publications, 2012) Ranasinghe, N.; Rajindrajith, S.; Devanarayana, N.M.; Warnakulasuriya, T.; Nishanthini, S.; Perera, M.S.BACKGROUND AND AIMS: Chronic abdominal pain is a commonly associated with psychological problems. This study aimed to evaluate the personality traits in teenagers with abdominal pain predominant functional gastrointestinal diseases (AP-FGD). METHODS: Data regarding gastrointestinal symptoms, and personality assessment were collected from teenagers aged 13–18 years from 5 randomly selected schools in Ampare district of Sri Lanka. AP-FGD were diagnosed using Rome III criteria. Translated and validated personality assessment questionnaire (PAQ) was used to assess the total personality maladjustment score and personality domains; namely hostility and aggression, dependency, lack of self esteem, lack of self adequacy, emotional instability, emotional unresponsiveness, and negative world view. RESULTS AND DISCUSSION: A total of 1697 children were recruited [males 778 (45.9%), mean age 15.1 years and SD 1.66 years]. AP-FGD were seen in 202 (11.9%) teenagers. They were compared with 1051 normal children. When the cutoff value for Sri Lankan children (89) was used, 66.3% of with AP-FGD and 42.5% controls had PAQ scores within that of psychological maladjustment (p < 0.001). When the international normative value of 105 was used, these percentages were 27.2% and 11.2% respectively (p < 0.0001). Subgroup analysis revealed similar differences in all 4 subtypes of AP-FGD compared to controls (p < 0.05). Children with AP-FGD had significant higher mean scores for all personality domains compared to controls except for dependence (p < 0.05). Children with irritable bowel syndrome and abdominal migraine also showed similar results (p < 0.05). Apart from dependency and emotional instability children with functional dyspepsia were noted to have higher mean scores for all other personality domains (p < 0.05). In addition, children with functional abdominal pain had signifi cantly higher mean scores for all personality domains except dependency and negative world view (p < 0.05). CONCLUSIONS: Psychological maladjustment is significantly more common in all four subtypes of AP-FGD.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 Therapeutic effects of domperidone on abdominal pain-predominant functional gastrointestinal disorders: randomized, double-blind, placebo- controlled trial.(Lippincott Williams & Wilkins, 2015) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.; de Silva, A.INTRODUCTION: The therapeutic effect of domperidone on abdominal pain-predominant functional gastrointestinal diseases (AP-FGIDs) was assessed on children in 5-12 year age group at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka. METHODS: Children fulfilling Rome III criteria for AP-FGIDs were recruited from the out-patient clinic of the University Paediatric Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka, after obtaining parental consent. They were randomized in to 8 weeks of placebo or Domperidone (Motillium 10 mg, 3 times per day, before meals) groups, using computer generated random numbers. Placebo was a specially prepared dummy tablet without any active ingredients, had the same colour, size, shape and taste of domperidone tablet and were packaged similarly. Primary outcomes defined were cure (abdominal pain less than 25 mm on the visual analogue scale and no impact on daily activities) and improvement (pain relief and sense of improvement recorded on global assessment scale). Secondary outcomes were significant improvement in symptoms, gastric motility, quality of life (QoL) and family impact. Both patients and investigators who assessed primary and secondary outcomes before and after intervention were blind to inventions administered. Symptom severity was recorded on a validated 100 mm visual analogue scale. Translated and validated PedQL Generic Score Scale version 4.0 and Family Impact Module were used. Gastric motility was assessed using a validated ultrasound method. RESULTS: One hundred children were enrolled and 89 completed the trial [Placebo 42 (22 girls), Domperidone 47(33 girls)]. While comparing primary outcomes, domperidone group had significant improvement [37 (78.7%) vs. 25 (59.5%) in placebo group, p = 0.04], while no such difference was observed in cure. When assessing secondary outcomes, domperidone group reported significant reduction in abdominal pain severity (70.84% vs. 48.18% p = 0.03) and improvement in motility index (29.3% vs. 8.6% p = 0.04) after intervention. No such difference was seen in improvement of QoL and family impact (p > 0.05). CONCLUSIONS: Domperidone has a favorable therapeutic effect on improvement AP-FGIDs in children aged 5-12 years. It causes significant reduction in abdominal pain and improvement in motility of the gastric antrum. However, it has no significant effect on improvement of QoL and family impact.Item 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.