Abdominal pain-predominant functional gastrointestinal diseases (AP-FGD) are common in children and commonly attributed to exposure to child abuse. However, this relationship has not been studied in teenagers, and the main objective of the current study was to assess it. Teenagers were recruited from four randomly selected schools in Western province of Sri Lanka. Data were collected using a validated self-administered questionnaire. AP-FGD were diagnosed using Rome III criteria. A total of 1850 teenagers aged 13-18 years were included. Three hundred and five (16.5%) had AP-FGD. AP-FGD were significantly higher in those exposed to sexual (34.0%), emotional (25.0%) and physical (20.2%) abuse, than in those not abused (13.0%, p < 0.001). Those with AP-FGD exposed to abuse had a higher severity score for bowel symptoms (30.8% vs. 24.7% in not abused, p < 0.05). This study highlights the importance of identifying exposure to abuse in management of teenagers with AP-FGD.

Domperidone may be a safe and effective therapeutic modality to achieve a lasting remission of symptoms in children with AP-FGIDs.

Introduction Prevalence of coronary artery disease (CAD) is on the rise in Sri Lanka resulting in high hospital mortality rates. Because of paucity of community based data on CAD we carried out this study to assess prevalence of CAD and associated factors in a suburban population in Southern Sri Lanka.Methods A cross sectional descriptive study was carried out among community living adults aged 30 years or more in Bope-Poddala Medical Officer of Health (MOH) area. Total of 1000 eligible individuals were recruited using cluster sampling. Cardiovascular Questionnaire of London School of Hygiene was administered to each participant by trained data collectors. CAD was diagnosed using criteria by Epstein and colleagues and electrocardiograms were classified according to the Minnesota code by a Cardiologist blinded to participant details [9,10].Results Total of 579 (57.9%) females and 421 (42.1%) males were studied. Mean age of the group was 53 years. Among the participants 32% had cardiovascular risk related non communicable diseases (NCDs) and 22.2% had a family history of the same. Prevalence of CAD was 6.9% (95% CI: 5.33 -0.47) and silent ischaemia was 2.2% (95% CI: 1.29 -3.11). Only gender and past history of cardiovascular risk related NCDs emerged as predictors of CAD.Conclusion CAD was more prevalent among males and those with past history of cardiovascular risk related NCDs. Community based preventive programmes should be implemented to minimize the adverse impact of CAD.

BACKGROUNDAbdominal 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.AIMTo assess the role of gastric dysmotility and autonomic nervous system dysfunction in the pathophysiology of AP-FGIDs.METHODSOne 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.RESULTSThe 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 post-prandial antral dilatation at 1 min after the test meal significantly correlated with the severity of abdominal pain (P < 0.05). Assessment of autonomic functions in AP-FGID patients showed neither a significant difference compared to the control group, nor a correlation with gastric motility abnormalities (P > 0.05). The duration of pain episodes negatively correlated with the parasympathetic tone (maladaptive parasympathetic tone) (P < 0.05).CONCLUSIONChildren 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.

Background: Impaired gut barrier function has been reported in some functional gastrointestinal (GI) disorders. Evidences suggest that gut microbiota affects GI motility in particular Lactobacillus species elicits anti-inflammatory activity and exerts protective effects on damage induced by pathogen Gram negative-derived lipopolysaccharide (LPS). LPS produced an oxidative imbalance in human colonic smooth muscle cells (SMC) that persists after LPS-washout and contributes to SMC morphofunctional alterations. The aim was to evaluate if supernatants harvested from LGG cultures protect SMC from LPS-induced myogenic damage. Methods: L. rhamnosus GG (ATCC 53103 strain) was grown in MRS medium and samples were collected from bacterial cultures in middle exponential phase, in early, in middle and late stationary phase (overnight). Supernatants were recovered, filtered and stored at -20 8C. Highly pure human SMC culture was then exposed for 24 h to highly purified LPS (1 mg/ml) of E. coli (O111:B4) in the absence and presence of the supernatants. Their effects were evaluated on LPS-induced SMC morphofunctional alterations and pro-inflammatory IL-6 production. Data are expressed as mean AE SE (P < 0.05 significant). Results: LPS induced persistent significant 20.7% AE 1.2 cell shortening and 35.2% AE 2.6 decrease in contraction of human colonic SMC. These alterations were paralleled to a 238.5% AE 82.5% increase in IL-6 production. These effects disappeared in the presence of LGG-supernatants, following a progression related to LGG growth curve phases. Supernatants collected in the middle exponential phase already significantly partially restored LPS-induced cell shortening by 43.4% AE 10.2% and IL-6 increase by 47.6% AE 13.1%, but had no effect on LPS-induced inhibition of contraction. Supernatants collected later, in the early and middle stationary phase, further counteract LPS-induced damage, including inhibition of contraction. Maximal protective effects were observed with supernatants of the late stationary phase where LPS-induced cell shortening was reversed by 86% AE 4.7%, inhibition of contraction by 98.2% AE 1.8%, and IL-6 basal production by 91.3% AE 0.6%. Conclusions: LGG-secreted products are substances/byproducts able to directly protect human SMC from LPS-induced myogenic damage. Novel insights are then provided about the possibility that LGG-derived products could reduce the risk of progression to a post-infective motor disorder.