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Childhood constipation:Current status,challenges,and future perspectives

World Journal of Clinical Pediatrics 2022年第5期11卷 385-404页

作者： Shaman Rajindrajith niranga manjuri devanarayana Marc A Benninga Department of Paediatrics Faculty of MedicineUniversity of ColomboColombo 00800Sri Lanka University Paediatric Unit Lady Ridgeway Hospital for ChildrenColombo 00800Sri Lanka Department of Physiology Faculty of MedicineUniversity of KelaniyaRagama 11010Sri Lanka Department of Pediatric Gastroenterology and Nutrition Emma Children HospitalAmsterdam University Medical CenterAmsterdam 1105AZThe Netherlands

Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.

关键词： Constipation Children Functional gastrointestinal disorders Psychological stress Treatment Surgical interventions

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Irritable bowel syndrome in children:Current knowledge, challenges and opportunities

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World Journal of Gastroenterology 2018年第21期24卷 2211-2235页

作者： niranga manjuri devanarayana Shaman Rajindrajith Department of Physiology Faculty of MedicineUniversity of Kelaniya Department of Paediatrics Faculty of MedicineUniversity of Kelaniya

Irritable bowel syndrome(IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.

关键词： abdominal pain functional gastrointestinal disorder Irritable bowel syndrome management microbiota patho-physiology post-infectious

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Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study

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World Journal of Clinical Cases 2018年第15期6卷 944-951页

作者： Manori Vijaya Kumari niranga manjuri devanarayana Lakmali Amarasiri Shaman Rajindrajith Department of Physiology Faculty of Medicine and Allied Sciences Rajarata University of Sri Lanka Department of Physiology Faculty of Medicine University of Kelaniya Clinical Physiologist and Senior Lecturer in Physiology Faculty of Medicine University of Colombo Department of Pediatrics Faculty of Medicine University of Kelaniya

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 selfadministered 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 nonasthmatics), 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.

关键词： Health related quality of life Functional gastrointestinal disorders Abdominal pain Asthma Children

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Autonomic functions and gastric motility in children with functional abdominal pain disorders

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World Journal of Gastroenterology 2019年第1期25卷 95-106页

作者： Amaranath Karunanayake Shaman Rajindrajith Hitanadura Asita de Silva Sampath Gunawardena niranga manjuri devanarayana Department of Physiology Faculty of Medicine University of Ruhuna Department of Paediatrics Faculty of Medicine University of Kelaniya Department of Pharmacology Faculty of Medicine University of Kelaniya Department of Physiology Faculty of Medicine University of Kelaniya

BACKGROUND Abdominal pain-predominant functional gastrointestinal disorders(AP-FGIDs)are the most common cause of recurrent abdominal pain in children. Despite its high prevalence, the underlying pathophysiology of this condition is poorly understood.AIM To assess the role of gastric dysmotility and autonomic nervous system dysfunction in the pathophysiology of AP-FGIDs.METHODS One hundred children, fulfilling Rome III criteria for AP-FGIDs, and 50 healthy controls, aged 5 to 12 years, were recruited after obtaining parental consent. All patients were investigated for underlying organic disorders. Gastric motility and cardiovascular autonomic functions were assessed using validated non-invasive techniques.RESULTS The main gastric motility parameters assessed(gastric emptying rate [45.7 vs 59.6 in controls], amplitude [48.7 vs 58.2], frequency of antral contractions [8.3 vs 9.4],and antral motility index [4.1 vs 6.4]) were significantly lower in children with AP-FGIDs(P 0.05). The duration of pain episodes negatively correlated with the parasympathetic tone(maladaptive parasympathetic tone)(P< 0.05).CONCLUSION Children with AP-FGIDs have abnormal gastric motility but normal cardiovascular autonomic functions. There is no relationship between abnormal gastric motility and autonomic functions. The pathogenesis of AP-FGIDs is not related to cardiovascular autonomic dysfunction.

关键词： Abdominal pain Functional gastrointestinal disorders Autonomic function Gastric motility

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Childhood constipation as an emerging public health problem

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World Journal of Gastroenterology 2016年第30期22卷 6864-6875页

作者： Shaman Rajindrajith niranga manjuri devanarayana Bonaventure Jayasiri Crispus Perera Marc Alexander Benninga Department of Paediatrics Faculty of Medicine University of Kelaniya Department of Physiology Faculty of Medicine University of Kelaniya Consultant Paediatrician Asiri Hospital Department of Paediatric Gastroenterology and Nutrition Emma Children’s Hospital Academic Medical Centre

Functional constipation(FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence(0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities.

关键词： Constipation Public health Risk factors Prevention

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