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Mettananda C, Egodage T, Dantanarayana C, Fernando R, Ranaweera L, Luke N, Ranawaka C, Kottahachchi D, Pathmeswaran A, de Silva HJ, Dassanayake AS. Identification of patients with type 2 diabetes with non-alcoholic fatty liver disease who are at increased risk of progressing to advanced fibrosis: a cross-sectional study. BMJ Open 2023; 13:e063959. [PMID: 36639212 PMCID: PMC9843224 DOI: 10.1136/bmjopen-2022-063959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Identification of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) is important as this may progress to cirrhosis and hepatocellular carcinoma. The risk of hepatic fibrosis is especially high among patients with diabetes with NAFLD. Annual screening of patients with diabetes for fatty liver and calculation of Fibrosis-4 (FIB-4) score and exclusion of significant fibrosis with vibration-controlled transient elastography (VCTE) have been recommended. However, VCTE is expensive and may not be freely available in resource-limited settings. We aim to identify predictors of significant liver fibrosis who are at increased risk of progression to advanced liver fibrosis and to develop a prediction model to prioritise referral of patients with diabetes and NAFLD for VCTE. METHODS AND ANALYSIS This cross-sectional study is conducted among all consenting adults with type 2 diabetes mellitus with NAFLD at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All patients get the FIB-4 score calculated. Those with FIB-4 ≥1.3 undergo VCTE (with FibroScan by Echosens). Risk associations for progression to advanced liver fibrosis/cirrhosis will be identified by comparing patients with significant fibrosis (liver stiffness measure (LSM) ≥8 kPa) and without significant fibrosis (LSM <8 kPa). A model to predict significant liver fibrosis will be developed using logistic regression. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (P/66/07/2021). Results of the study will be disseminated as scientific publications in reputable journals.
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Affiliation(s)
- Chamila Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Thimira Egodage
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Channaka Dantanarayana
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Rumal Fernando
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Lakmali Ranaweera
- Gastroenterology unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Nathasha Luke
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Chamila Ranawaka
- Gastroenterology unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Dulani Kottahachchi
- Department of Physiology, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
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Singh SP, Khandelwal R, Dassanayake AS. Nonalcoholic Fatty Liver Disease in Diabetics: The Role of Hepatologist. Euroasian J Hepatogastroenterol 2022; 12:S37-S40. [DOI: 10.5005/jp-journals-10018-1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Singh SP, Anirvan P, Reddy KR, Conjeevaram HS, Marchesini G, Rinella ME, Madan K, Petroni ML, Al-Mahtab M, Caldwell SH, Aithal GP, Hamid SS, Farrell GC, Satapathy SK, Duseja A, Acharya SK, Dassanayake AS, Goh KL. Non-alcoholic fatty liver disease: Not time for an obituary just yet! J Hepatol 2021; 74:972-974. [PMID: 33340575 DOI: 10.1016/j.jhep.2020.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Shivaram Prasad Singh
- Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India.
| | - Prajna Anirvan
- Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, Odisha, India
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hari S Conjeevaram
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Giulio Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, Sant'Orsola-Malpighi Hospital, "Alma Mater" University, via G. Massarenti 9, 40138 Bologna, Italy
| | - Mary E Rinella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kaushal Madan
- Department of Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, 110017, India
| | - Maria Letizia Petroni
- Unit of Metabolic Diseases and Clinical Dietetics, Sant'Orsola-Malpighi Hospital, "Alma Mater" University, via G. Massarenti 9, 40138 Bologna, Italy
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Stephen H Caldwell
- Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, VA, USA
| | - Guruprasad P Aithal
- National Institute for Health Research (NIHR), Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK
| | - Saeed S Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Geoffrey C Farrell
- Department of Hepatic Medicine, ANU College of Health and Medicine, Senior Staff Hepatologist, Canberra Hospital, Australian Capital Territory, Australia
| | - Sanjaya K Satapathy
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Department of Medicine, North Shore University Hospital/Northwell Health, 400 Community Drive, Manhasset, NY 11030, USA
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Subrat Kumar Acharya
- Department of Gastroenterology and Hepatology,KIIT University, Patia, Bhubaneshwar 751024, Odisha, India
| | | | - Khean-Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kasturiratne A, Ediriweera DS, De Silva ST, Niriella MA, Thulani UB, Pathmeswaran A, Dassanayake AS, De Silva AP, Chackrewarthy S, Ranawaka U, Kato N, Wickremasinghe AR, de Silva HJ. Patterns and predictors of mortality in a semi-urban population-based cohort in Sri Lanka: findings from the Ragama Health Study. BMJ Open 2020; 10:e038772. [PMID: 32994253 PMCID: PMC7526314 DOI: 10.1136/bmjopen-2020-038772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe patterns and predictors of mortality in a semi-urban population in Sri Lanka. DESIGN A prospective population-based cohort study. SETTING Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. PARTICIPANTS Adults between 35 and 64 years of age were recruited using an age stratified random sampling technique in 2007. MEASURES At baseline, we recorded socio-demographic, lifestyle, anthropometric, biochemical and clinical data of the participants. Over 10 years, we obtained the cause and date of death from the death registration documents of deceased participants. We determined the survival probability of the cohort over 10 years and estimated Hazard ratios (HRs) for all-cause mortality (ACM), cardiovascular mortality (CVM) and cancer-related mortality (CRM) using Cox's proportional hazards model. We also estimated the survival probabilities for men and women in each 10-year age group and standardised mortality ratio relative to the source population. RESULTS There were 169 deaths over 10 years with standardised mortality rates of 5.3 and 2.4 per 1000 years of follow-up for men and women, respectively. Independent predictors of: ACM were older age, lower income, smoking and diabetes mellitus while gender, education, occupation, harmful alcohol use, waist circumference and hypertension were not; CVM were older age, lower income, smoking, diabetes and hypertension while gender and harmful alcohol use were not; CRM was older age while gender, smoking and diabetes were not. Those engaged in clerical and technical occupations or unemployed had a lower risk of CRM as compared with those engaged in elementary occupations. CONCLUSIONS Older age, lower income, smoking, diabetes and hypertension strongly predict mortality in this cohort. Addressing the identified modifiable predictors through behavioural modification will improve longevity in similar populations.
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Affiliation(s)
| | - Dileepa Senajith Ediriweera
- Centre for Health Informatics, Biostatistics and Epidemiology, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | | | - Madunil Anuk Niriella
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Uthuru Beddage Thulani
- Department of Public Health, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | | | | | | | - Sureka Chackrewarthy
- Department of Biochemistry and Clinical Chemistry, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, National Center for Global Health and Medicine Research Institute, Shinjuku-ku, Tokyo, Japan
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Niriella MA, Kobbegala VJ, Karalliyadda HN, Ranawaka CK, de Silva AP, Dassanayake AS, de Silva HJ. Sero-prevalence and vaccination status of hepatitis A and hepatitis B among adults with cirrhosis in Sri Lanka: a hospital based cohort study. BMC Res Notes 2017; 10:303. [PMID: 28732527 PMCID: PMC5521068 DOI: 10.1186/s13104-017-2634-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 07/17/2017] [Indexed: 11/27/2022] Open
Abstract
Background As acute viral hepatitis can be fatal in patients with cirrhosis, vaccination against hepatitis A (HAV) and hepatitis B (HBV) is recommended for non-immune patients. With increasing affluence the incidence of hepatitis A in childhood has decreased leading to a significant proportion of non-immune adults. As part of their routine investigation, hepatitis A IgG antibodies (anti-HAV IgG), hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was checked and immunization status was assessed among consenting newly diagnosed cirrhotic patients presenting to a tertiary referral center. Findings Out of 135 patients, 107 [79.3%; males 91; mean age (SD) at presentation: 55.5 (11.6) years] with complete data were included for analysis. Most patients had either cryptogenic cirrhosis (62.6%) or alcoholic cirrhosis (29.9%); 2 (1.9%) had HBV cirrhosis, none had hepatitis C (HCV) cirrhosis. None of the patients had received vaccination against hepatitis A, while 71 (67.6%) had been vaccinated against HBV. The majority [62 (58%)] were negative for anti-HAV IgG. Conclusion Most cirrhotic patients in this cohort were not immune to hepatitis A. None had been vaccinated against HAV, while a third of patients had not been vaccinated against HBV. Cirrhotic patients should be routinely investigated for immunity against HAV and HBV, and vaccination offered to those found to be non-immune.
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Affiliation(s)
- Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Vipuli Jayendra Kobbegala
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Hasnatha Nuwan Karalliyadda
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | | | - Arjuna Priyadarshin de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Anuradha Supun Dassanayake
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Hithanadura Janaka de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
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Niriella MA, Kumarasena RS, Dassanayake AS, Pathirana A, de Silva Hewavisenthi J, de Silva HJ. Worsening cholestasis and possible cefuroxime-induced liver injury following "successful" therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report. J Med Case Rep 2016; 10:371. [PMID: 28003028 PMCID: PMC5178075 DOI: 10.1186/s13256-016-1123-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023] Open
Abstract
Background Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone. Case presentation A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive treatment and withdrawal of the offending drug. Conclusions This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
| | | | | | - Aloka Pathirana
- Faculty of Medical Sciences, University of Sri Jayawardenapura, Colombo, Sri Lanka
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Siriwardana RC, Niriella MA, Dassanayake AS, Liyanage CAH, Gunetilleke B, de Silva HJ. Recurrence of graft steatosis after liver transplantation for cryptogenic cirrhosis in recently commenced liver transplant program. Indian J Gastroenterol 2016; 35:222-4. [PMID: 27142096 DOI: 10.1007/s12664-016-0653-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 03/27/2016] [Indexed: 02/04/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) seems to recur in at least one third of patients transplanted for non-alcoholic steatohepatitis (NASH)-related cirrhosis. While, NASH recurrence does not seem to affect overall graft and patient survival up to 10 years, cardiovascular and infection-related morbidity and mortality seem to be increased in these patients. This report looks at the graft histology in patients who were transplanted for NASH-related cirrhosis after short-term follow up. We report a high prevalence of recurrent NAFLD in liver grafts post-transplant among five patients. The degree of steatosis noted among the recipients is alarming.
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Affiliation(s)
- Rohan C Siriwardana
- Hepato-Pancreatico-Biliary and Liver Transplant Unit Ragama, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
| | - Madunil Anuk Niriella
- Hepato-Pancreatico-Biliary and Liver Transplant Unit Ragama, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradha Supun Dassanayake
- Hepato-Pancreatico-Biliary and Liver Transplant Unit Ragama, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Bhagya Gunetilleke
- Hepato-Pancreatico-Biliary and Liver Transplant Unit Ragama, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Hithanadura Janaka de Silva
- Hepato-Pancreatico-Biliary and Liver Transplant Unit Ragama, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Siriwardana RC, Niriella MA, Dassanayake AS, Liyanage CAH, Upasena A, Sirigampala C, de Silva HJ. Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis. BMC Gastroenterol 2015; 15:96. [PMID: 26239844 PMCID: PMC4524364 DOI: 10.1186/s12876-015-0329-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/29/2015] [Indexed: 02/07/2023] Open
Abstract
Background Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. Methods Of 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI). Results 84 patients [90.5 % males, 89.2 % cirrhotics, 89.2 % nodular HCC, median age 63 (34–84) years] underwent 111 TACE sessions. All were Child class A [69.4 % sessions (n = 77)] or B; ascites and portal vein invasion was present in 18 (16.2 %) and 15 (13.6 %), respectively. 42 (38.2 %) TACE procedures resulted in complications [PEF 28 (25.2 %), NV 4 (3.6 %), abdominal pain 9 (8.1 %), infection 7 (6.3 %), AHD 13 (11.7 %), AKI 3 (2.7 %)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p = 0.046) and low serum albumin (p = 0.035) predicted PEF while low serum albumin (p = 0.021) and low platelet counts (p = 0.041) predicted AHD. In the multivariate model, factors with p < 0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p = 0.029, OR = 1.412), ascites (p = 0.030, OR = 1.212), elevated serum bilirubin (p = 0.007, OR = 4.357) and large tumour size (p = 0.036, OR = 3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p = 0.049, OR = 2.410) and elevated serum bilirubin (p = 0.036, OR = 1.517) predicted AHD. Conclusion In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.
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Affiliation(s)
| | | | | | | | - Angappulige Upasena
- Department of Radiology, North Colombo Teaching Hospital, Ragama, Sri Lanka.
| | - Chandra Sirigampala
- Department of Radiology, North Colombo Teaching Hospital, Ragama, Sri Lanka.
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Amarasiri WADL, Pathmeswaran A, de Silva AP, Dassanayake AS, Ranasinha CD, de Silva HJ. Gastric motility following ingestion of a solid meal in a cohort of adult asthmatics. J Neurogastroenterol Motil 2013; 19:355-65. [PMID: 23875103 PMCID: PMC3714414 DOI: 10.5056/jnm.2013.19.3.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 04/26/2013] [Accepted: 04/30/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Asthmatics have abnormal esophageal motility and increased prevalence of gastroesophageal reflux disease (GERD). The contribution of gastric motility is less studied. We studied gastric myoelectrical activity, gastric emptying (GE) and their association with GERD symptoms and vagal function in adult asthmatics. METHODS Thirty mild, stable asthmatics and 30 healthy controls underwent real-time ultrasonography and 1 hour pre- and post-prandial cutaneous electrogastrography, following a test meal (480 kcal, 60% carbohydrate, 20% protein, 20% fat and 200 mL water). The percentage of normal slow waves and arrhythmias, dominant frequency and power, frequency of antral contractions, gastric emptying rate (GER) and antral motility index (MI) was calculated. Twenty-seven asthmatics underwent gastroscopy and in all subjects GERD symptoms were assessed by a validated questionnaire. Vagal function parameters were correlated with gastric motility parameters. RESULTS The asthmatics (37% male; 34.8 ± 8.4 years) and controls (50% male; 30.9 ± 7.7 years) were comparable. None had endoscopic gastric pathological changes. Twenty asthmatics described GERD symptoms. Twenty-two (73.3%) asthmatics showed a hypervagal response. Compared to controls, asthmatics had delayed GER and lower MI, lower percentage of normal gastric slow waves, more gastric dysrythmias and failed to increase the post-prandial dominant power. There was no correlation of GE and cutaneous electrogastrography parameters with presence of GERD symptoms or with vagal function. CONCLUSIONS Asthmatics showed abnormal gastric myoelectrical activity, delayed GE and antral hypomotility in response to a solid meal compared to controls. There was no association with vagal function or GERD symptom status.
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Senanayake SM, Niriella MA, Weerasinghe SK, Kasturiratne A, de Alwis JP, de Silva AP, Dassanayake AS, de Silva HJ. Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study. BMC Res Notes 2012. [PMID: 23198995 PMCID: PMC3543705 DOI: 10.1186/1756-0500-5-663] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves. Results Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child’s class predicted overall survival among all groups. The median survival in Child’s class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status. Conclusions The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.
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De Silva AP, Nandasiri SD, Hewavisenthi J, Manamperi A, Ariyasinghe MP, Dassanayake AS, Jewell DP, de Silva HJ. Subclinical mucosal inflammation in diarrhea-predominant irritable bowel syndrome (IBS) in a tropical setting. Scand J Gastroenterol 2012; 47:619-24. [PMID: 22486731 DOI: 10.3109/00365521.2012.666672] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS There is evidence for low-grade inflammation in the pathophysiology of post-infectious irritable bowel syndrome (IBS). We assessed the degree of subclinical intestinal mucosal inflammation in diarrhea-predominant IBS (IBS-D) in a tropical setting. MATERIAL AND METHODS In a prospective study over 1 year, we investigated 49 patients with IBS-D (cases; median age 34 years (range 18-59); M:F 36:13), diagnosed on Rome III criteria. 14 individuals with a family history of colon cancer (median age 46.5 years (range 23-56); M:F 6:8) were selected as controls. Stools of cases and controls were tested for calprotectin. During colonoileoscopy, serial biopsies were obtained. Mucosal mast cells, neutrophils, eosinophils and lymphocytes/plasma cell infiltrate were quantified. Tissue expression of IL-8 and IL-10 was assessed in biopsies by semi-quantitative RT-PCR. RESULTS A history suggestive of an episode of infectious diarrhea (ID) was present in 16/49 cases and 0/14 controls (p = 0.013). In cases, there were significantly more mucosal mast cells in the ileum and all segments of colon and significantly more eosinophils in the cecum. Tissue expression of IL-8 was significantly higher and IL-10 significantly lower in cases compared with controls (target/standard cDNA ratio, median (range) IL-8: 1.25 (0.75-2) vs. 0.85 (0.63-1.3), p < 0.0001, Mann-Whitney U test; IL-10: 0.33 (0-0.63) vs. 0.55 (0.5-0.7), p < 0.0001). There was a significant inverse correlation between IL-8 and IL-10 expression (Pearson correlation, (-) 0.509; p < 0.01). CONCLUSION There was evidence of subclinical intestinal mucosal inflammation in patients with IBS-D. The finding of increased eosinophils is novel, and may be of special relevance to IBS-D in the tropics.
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Silva APD, Karunanayake AL, Dissanayaka TGI, Dassanayake AS, Duminda HKKT, Pathmeswaran A, Wickramasinghe AR, Silva HJD. Osteoporosis in adult Sri Lankan inflammatory bowel disease patients. World J Gastroenterol 2009; 15:3528-31. [PMID: 19630109 PMCID: PMC2715980 DOI: 10.3748/wjg.15.3528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine if inflammatory bowel disease (IBD) is a risk factor for osteoporosis in adult Sri Lankans.
METHODS: We identified eligible subjects from among consecutive patients diagnosed with IBD who attended our outpatient clinic. We included only patients aged between 20 and 70 years. Patients who were pregnant, had significant comorbidity, or were on calcium supplements or treatment for osteoporosis within the past 6 mo, were excluded. Healthy, age- and sex-matched controls were also recruited, in a control to patient ratio of 3:1. Both groups were screened for osteoporosis using peripheral dual energy X-ray absorptiometry scanning.
RESULTS: The study population consisted of 111 IBD patients (male:female = 43:68; mean age 42.5 years) and 333 controls (male:female = 129:204; mean age 43.8 years). The occurrence of osteoporosis among IBD patients (13.5%) was significantly higher than among controls (4.5%) (P = 0.001). The frequency of osteoporosis was not significantly different between ulcerative colitis (14.45%) and Crohn’s disease (10.7%). However, on multivariate analysis, only age (P = 0.001), menopause (P = 0.024) and use of systemic steroids (P < 0.001) were found to be associated independently with the occurrence of osteoporosis, while IBD, severity of disease, number of relapses, duration of illness or treatment other than systemic steroids were not.
CONCLUSION: IBD does not appear to be an independent risk factor for the occurrence of osteoporosis in this population. However, the use of systemic steroids was a risk factor.
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de Silva AP, Kasturiratne A, Liyanage DLMN, Karunanayaka TKMP, de S Hewavisenthi SJ, Dassanayake AS, Farrell GC, de Silva HJ. Is past exposure to hepatitis A protective against progressive fibrosis in non-alcoholic fatty liver disease? Liver Int 2008; 28:147-9. [PMID: 18173565 DOI: 10.1111/j.1478-3231.2007.01605.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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de Silva HJ, Dassanayake AS, Manamperi A, de Silva AP. Treatment of lamivudine-resistant hepatitis B infection in post-renal transplant patients with adefovir dipivoxil: preliminary results. Transplant Proc 2007; 38:3118-20. [PMID: 17112914 DOI: 10.1016/j.transproceed.2006.08.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Indexed: 12/22/2022]
Abstract
We report the treatment outcome in six post-renal transplant patients with lamivudine-resistant hepatitis B virus (LR-HBV) infection using adefovir dipivoxil and followed for 6 to 18 months. Posttransplant immunosuppressive therapy was not altered. Adefovir dipivoxil effectively suppressed hepatitis B virus DNA and improved alanine transferase, although DNA suppression seemed dependent on continued therapy. Nephrotoxicity led to withdrawal of the drug in three patients. This may limit therapeutic usefulness in a significant proportion of post-renal transplant patients with LR-HBV infection.
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Affiliation(s)
- H J de Silva
- Faculty of Medicine, University of Kelaniya, Ragama, Western Province, Sri Lanka.
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de Silva HA, Hewavisenthi J, Pathmeswaran A, Dassanayake AS, Navaratne NMM, Peiris R, de Silva HJ. Comparison of one week and two weeks of triple therapy for the eradication of Helicobacter pylori in a Sri Lankan population: a randomised, controlled study. ACTA ACUST UNITED AC 2005; 49:118-22. [PMID: 15693450 DOI: 10.4038/cmj.v49i4.1921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Resistance of Helicobacter pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing the duration of treatment (triple therapy) from 1 week to 2 or 3 weeks. AIM To assess the efficacy and tolerability of 1 week versus 2 weeks of triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS Eighty two patients aged 18-70 years with gastritis or peptic ulcer and testing positive for H. pylori infection were randomly allocated to two treatment groups. Both groups received omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg. Group A (n = 42) received the trial medication twice daily for 1 week and the Group B (n = 40) twice daily for 2 weeks. H. pylori eradication was defined as a negative 14C labelled urea breath test at 2 weeks after completion of the therapy. RESULTS H. pylori infection was eradicated in 36 (85.7%) patients in Group A and 36 (90%) patients in Group B (p = 0.9). Twenty three (55%) patients in Group A and 17 (43%) in Group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. Three (7.5%) patients in Group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION Twice daily treatment with clarithromycin, tinidazole, and omeprazole for 1 week is well tolerated and provides as good a rate of H. pylori eradication as 2-week therapy in Sri Lankan patients.
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Affiliation(s)
- H A de Silva
- Faculty of Medicine, University of Kelaniya, University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
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Dassanayake AS, Karunanayake P, Kasturiratne KTAA, Fonseka MMD, Wijesiriwardena B, Gunatilake SB, de Silva HJ. Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite. Ceylon Med J 2002; 47:48-9. [PMID: 12140877 DOI: 10.4038/cmj.v47i2.3451] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the safety of low dose subcutaneous adrenaline given as prophylaxis against acute adverse reactions to anti-venom serum (AVS) in patients bitten by snakes. METHODS Patients admitted with snakebite envenoming who satisfied inclusion criteria were given 0.25 ml of 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were monitored. RESULTS 51 patients [35 males, mean age 34.8 years (SD 14)] were included in the study. Adverse reactions to AVS occurred in 15 (29.4%) patients. There was one death from suspected cerebral haemorrhage, and 3 (5.9%) patients developed small haematomas at the subcutaneous injection site. There were no significant changes in mean pulse or BP following administration of subcutaneous adrenaline. CONCLUSIONS Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. Although the death was unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before its routine use.
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Affiliation(s)
- A S Dassanayake
- Faculty of Medicine, University of Kelaniya, P O Box 6, Ragama
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