
Naresh T GunaratnamSaint Joseph Mercy Health System · Gastroenterology
Naresh T Gunaratnam
MD
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97
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Publications (97)
Introduction : The increasing prevalence of obesity places a high burden on the economy with annual medical expenses approximating 150 billion dollars. Obesity-related gastrointestinal disorders, including non-alcoholic fatty liver disease (NAFLD), account for over 30% of patient visits to community GI practices. Total body weight loss (TBWL) of 10...
Introduction: The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Materials and Methods: Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and c...
Esophageal squamous cell carcinoma (ESCC) often presents with debilitating dysphagia, significantly affecting quality of life. In metastatic disease, standard therapy with radiation and chemotherapy is associated with high morbidity. Liquid nitrogen cryotherapy offers a minimally invasive intervention for palliation in metastatic esophageal cancers...
Background:
Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations.
Aims:
To characterize t...
Introduction
Obesity-related gastrointestinal disorders including nonalcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) are more frequent and usually present earlier than type 2 diabetes mellitus (T2DM) and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effe...
Objective
To develop a population-specific methodology for estimating glycaemic control that optimises resource allocation for patients with diabetes in rural Sri Lanka.
Design
Cross-sectional study.
Setting
Trincomalee, Sri Lanka.
Participants
Patients with non-insulin-treated type 2 diabetes (n=220) from three hospitals in Trincomalee, Sri Lan...
Adenomas or adenocarcinomas located within a colonic diverticulum are considered a rare phenomenon that has been described in the literature. These lesions are technically difficult to manage endoscopically and usually require surgical intervention for removal. There is also an increased risk of perforation upon endoscopic resection owing to the la...
Background and study aims Endoscopic resection is recommended as initial treatment for early-stage gastric and duodenal neuroendocrine tumors (G-NETs and D-NETs). However, it can cause serious adverse events. We aimed to evaluate the efficacy and safety of the band and slough (BAS) technique as a novel and less aggressive endoscopic therapy for man...
INTRODUCTION
Colonic polyps within a diverticulum are technically challenging to resect as the polyp might be difficult to access if it is buried within the diverticulum. There is also an increased risk of perforation upon endoscopic resection owing to the lack of muscularis propria in the wall of the diverticulum. We describe an endoscopic techniq...
INTRODUCTION
Esophageal cancer is the sixth most common cancer worldwide that is associated with a poor prognosis. Clinically, dysphagia and weight loss are the most common presentations. However, non-specific symptoms of distant metastatic disease might be the initial presentation which provides a diagnostic challenge and delay in management. We d...
INTRODUCTION
Obesity related gastrointestinal disorders including Non-Alcoholic Fatty Liver Disease (NAFLD) and Gastroesophageal Reflux Disease (GERD) are more frequent and usually present earlier than diabetes mellitus type 2 and cardiovascular disorders. This provides an opportunity for the gastroenterologist to intervene early with an effective...
Sri Lanka is experiencing a rapid increase in the number of people with diabetes mellitus (DM) due to population growth and aging. Physician shortages, outdated technology, and insufficient health education have contributed to the difficulties associated with managing the burden of disease. New models of chronic disease management are needed to add...
The civil war in 1983 and the 2004 tsunami in the island country of Sri Lanka both created a large number of health problems, particularly in coastal areas of the country. According to the Demographic Health Survey (DHS) for Sri Lanka, in the period 2006-2007 17.3% of children under five were found to be stunted, 14.7% were suffering from malnutrit...
Barrett's esophagus with high-grade dysplasia (BEHGD) and intramucosal esophageal adenocarcinoma (IMC) can be treated by radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR). Efficacy of RFA and EMR in academic medical centers has been demonstrated in previous studies. However, the clinical effectiveness of this approach in communit...
The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...
Endoscopic resection of nonampullary duodenal adenomas (NADAs) is effective but carries substantial procedural risks. Therapeutic banding for treatment of duodenal mucosal neoplasia has not been studied. We report a novel band and slough (BAS) technique for therapy of NADA without endoscopic resection.
Efficacy and safety of BAS.
Retrospective revi...
/st> Accidental swallowing or aspiration of dental instruments and prostheses is a complication of dental procedures. Failure to manage these complications appropriately can lead to significant morbidity and possibly death.
The authors present three cases of accidental swallowing of dental instruments during procedures and two cases of aspiration,...
Serrated colorectal lesions include hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs). Optical biopsy could misclassify SSAs as unimportant if they resemble HPs.
To explore the narrow-band imaging (NBI) features of SSAs. We hypothesized that SSAs resemble HPs under NBI.
Retrospective analysis of data from our prospective study of NBI i...
: Polyethylene glycol-3350 without electrolytes (MiraLAX; Schering-Plough Healthcare Products Inc.)+a carbohydrate-electrolyte solution (Gatorade; PepsiCo Inc.)+bisacodyl is frequently used for bowel cleansing, although limited data quantifies its efficacy and safety. No prior studies have assessed this in a community setting or with PM-only dosing...
Background & aims:
Accurate optical analysis of colorectal polyps (optical biopsy) could prevent unnecessary polypectomies or allow a "resect and discard" strategy with surveillance intervals determined based on the results of the optical biopsy; this could be less expensive than histopathologic analysis of polyps. We prospectively evaluated real-...
To evaluate the practice of otolaryngologists treating reflux-induced upper-respiratory disease in a nationwide survey.
Survey study using an anonymous questionnaire containing clinical vignettes.
The survey was mailed to all 6,899 board-certified fellow members in practice in the American Academy of Otolaryngology-Head and Neck Surgery residing in...
Proton pump inhibitors are the most potent drug treatment for gastro-oesophageal reflux disease. Pre-meal dosing maximizes efficacy while sub-optimal dose timing may limit efficacy.
To determine the prevalence of sub-optimal proton pump inhibitor dosing in a community-based gastro-oesophageal reflux disease population.
One hundred patients on proto...
Breast cancer can metastasize to the esophagus and the mediastinum. EUS-guided FNA (EUS-FNA) is being used increasingly as a less invasive alternative to mediastinoscopy for procuring a tissue diagnosis of mediastinal disease and may be useful for the diagnosis of breast cancer metastatic to the esophagus and the mediastinum.
Twelve women (age rang...
Duodenal lymphoma accounts for a small percentage of gastrointestinal tumors and has a very poor prognosis. The majority of patients have little or no cure with limited time of remission. Median survival is 5 to 10 years, and most patients die of lymphoma, its complications, or complications of therapy. We report a patient with lymphoma refractory...
Celiac plexus neurolysis, a chemical splanchnicectomy of the celiac plexus, is used to treat pain caused by pancreatic cancer. Most commonly, celiac plexus neurolysis is performed percutaneously under CT or fluoroscopic guidance, but can also be performed with EUS. The aim of this study was to prospectively assess the efficacy of EUS celiac plexus...
Immunosuppressed transplant recipients are at increased risk of developing several forms of malignancy. The aim of this study is to report the clinical presentation, treatment, and outcome of four liver transplant recipients with Helicobacter pylori-associated gastric mucosae-associated lymphoid tissue (MALT) lymphoma.
The medical records of four l...
Our study was a randomized, controlled trial to assess a novel strategy that provides comprehensive colorectal cancer screening in a single visit versus traditional sigmoidoscopy and, where appropriate, colonoscopy on a subsequent day.
Consecutive patients referred for screening were randomized to control or so-called "conversion" groups. Patients...
Bromfenac, a nonnarcotic analgesic nonsteroidal anti-inflammatory drug, was associated with reversible, minor elevations in serum aminotransferase levels during clinical trials. The aim of this study is to describe the clinical, laboratory, and histological features of 4 patients with severe bromfenac hepatotoxicity identified at 3 tertiary care ce...
Large-volume paracentesis is a safe and effective means of treating patients with refractory ascites. However, there is limited information regarding the need for ascitic fluid studies in asymptomatic outpatients presenting for therapeutic paracentesis. The aim of this prospective study was to define the incidence and natural history of peritoneal...
Bromfenac, a nonnarcotic analgesic nonsteroidal anti-inflammatory drug, was associated with reversible, minor elevations in serum aminotransferase levels during clinical trials. The aim of this study is to describe the clinical, laboratory, and histological features of 4 patients with severe bromfenac hepatotoxicity identified at 3 tertiary care ce...
Approximately 4 million Americans are infected with the hepatitis C virus (HCV). Most patients with hepatitis C have no symptoms until cirrhosis is established. Thus, initial diagnosis and management of hepatitis C rely on primary care physicians identifying and screening high-risk individuals. We administered a survey to 1,233 primary care physici...
Currently, the second- and third-generation enzyme immunoassays (EIA-2 and EIA-3) for hepatitis C virus antibody (anti-HCV) are the most practical screening tests for the diagnosis of HCV infection. The need for and the choice of supplementary or confirmatory tests depend on the clinical setting and the likelihood of a true-positive EIA result. Det...
Introduction: The finding of an adenomatous polyp during screening flexible sigmoidoscopy (FS) requires colonoscopy for ablation of the polyp seen during FS and inspection of the remainder of the colon for additional lesions. Since mid 1994 all patients undergoing screening FS at this institution have been prepped with oral Fleets® Phosphasoda whic...