Roshini Rajapaksa, M.D.

Ask Health. Straight talk about sweating down there, whiteheads, earwax, and more
Rajapaksa R
2008 ;22(6):90,92- Jul-Aug, HEALTH (San Francisco, California)
— id: 80317, year: 2008, vol: 22, page: 90,92, stat: Journal Article,

Straight talk about body odor, reusing towels, and more
Rajapaksa R
2008 ;22(4):80- May, HEALTH (San Francisco, California)
— id: 79162, year: 2008, vol: 22, page: 80, stat: Journal Article,

Straight talk about hair loss, urinary trouble, and yoga during your period
Rajapaksa R
2008 ;22(3):102-3 Apr, HEALTH (San Francisco, California)
— id: 79164, year: 2008, vol: 22, page: 102, stat: Journal Article,

Post 9/11 GERD: a new entity
Rajapaksa, R; Cheng, Q; Liu, M; Fernandez-Beros, ME; Reibman, J
2008 SEP ;103(9):S33-S34, American journal of gastroenterology
— id: 86595, year: 2008, vol: 103, page: S33, stat: Journal Article,

Racial/ethnic differences in patient experiences with and preferences for computed tomography colonography and optical colonoscopy
Rajapaksa, Roshini C; Macari, Michael; Bini, Edmund J
2007 Nov;5(11):1306-1312, Clinical Gastroenterology & Hepatology
BACKGROUND & AIMS: Racial/ethnic minorities are less likely than whites to undergo colorectal cancer (CRC) screening. Although computed tomography colonography (CTC) is a less invasive alternative to optical colonoscopy (OC), it is not known whether CTC will increase acceptance of CRC screening in minorities. METHODS: Patients undergoing OC for clinically indicated reasons had CTC followed by same-day OC. After the sedation from the OC had worn off, a questionnaire was administered to assess pain, discomfort, bloating, embarrassment, anxiety, and patient satisfaction using a 10-point scale (1 = least, 10 = greatest). RESULTS: Of the 272 patients enrolled, there were 134 whites, 71 blacks, 53 Hispanics, and 14 who self-identified their race/ethnicity as other. Although the proportion of subjects who preferred CTC over OC was not significantly different (52.9% vs 47.1%, P = .36), racial/ethnic minorities were significantly less likely than whites to prefer CTC over OC (whites, 65.7%; blacks, 45.1%; Hispanics, 35.8%; and other, 35.7%; P < .001). Racial/ethnic minorities were less satisfied with CTC (whites, 8.4 +/- 1.7; blacks, 7.8 +/- 1.7; Hispanics, 7.4 +/- 1.8; and other, 7.5 +/- 2.1; P = .001) and were significantly less willing to undergo CTC again in the future (whites, 95.5%; blacks, 80.3%; Hispanics, 84.9%; and other, 85.7%; P = .006). CONCLUSIONS: Compared with white patients, OC is better tolerated and is preferred over CTC for evaluation of the colon among racial/ethnic minorities. Although CTC is less invasive than OC, our findings suggest that CTC is unlikely to overcome racial/ethnic disparities in CRC screening
— id: 75365, year: 2007, vol: 5, page: 1306, stat: Journal Article,

Marked racial and ethnic differences in patient satisfaction with and preferences for CT colonography and optical colonoscopy
Rajapaksa, RC; Macari, M; Bini, EJ
2006 SEP ;101(9):S557-S557, American journal of gastroenterology
— id: 69316, year: 2006, vol: 101, page: S557, stat: Journal Article,

Positive predictive value of fecal occult blood testing in persons taking warfarin
Bini, Edmund J; Rajapaksa, Roshini C; Weinshel, Elizabeth H
2005 Jul;100(7):1586-1592, American journal of gastroenterology
BACKGROUND: In clinical practice, some physicians discontinue warfarin prior to fecal occult blood testing (FOBT). Although anticoagulant use is associated with an increased risk of overt gastrointestinal bleeding, the impact of warfarin on the positive predictive value of FOBT is unknown. METHODS: During a 5-yr period, we prospectively studied all patients taking warfarin who were referred for the evaluation of a positive FOBT. For each patient taking warfarin, we enrolled one age- and gender-matched control subject with a positive FOBT who was not taking anticoagulants. A detailed clinical history was obtained, and all subjects underwent colonoscopy and esophagogastroduodenoscopy. RESULTS: Lesions consistent with occult bleeding were identified in 59.0% of the 210 patients in the warfarin group and 53.8% of the 210 control subjects (p= 0.27). Although more lesions were identified by colonoscopy in the warfarin group than in control subjects (36.2%vs 25.7%, p= 0.02), there was no difference in the frequency of lesions identified by esophagogastroduodenoscopy (35.2%vs 39.5%, p= 0.43). Overall, adenomas > or =1 cm in diameter (16.2%) and colorectal carcinoma (9.5%) were the most common lesions identified by colonoscopy, while erosive gastritis (15.5%) and erosive duodenitis (11.0%) were the most frequent lesions found by esophagogastroduodenoscopy. Among individuals with colorectal cancer, 83.3% of patients in the warfarin group had early cancers (Dukes' stage A or B) compared with 50.0% of control subjects (p= 0.046). CONCLUSIONS: Warfarin use did not decrease the positive predictive value of FOBT. These findings suggest that warfarin should not be discontinued prior to FOBT
— id: 57718, year: 2005, vol: 100, page: 1586, stat: Journal Article,

Colorectal polyps and cancers in asymptomatic average-risk patients: evaluation with CT colonography
Macari, Michael; Bini, Edmund J; Jacobs, Stacy L; Naik, Sanjay; Lui, Yvonne W; Milano, Andrew; Rajapaksa, Roshini; Megibow, Alec J; Babb, James
2004 Mar;230(3):629-636, Radiology
PURPOSE: To compare thin-section multi-detector row computed tomographic (CT) colonography with conventional colonoscopy in the evaluation of colorectal polyps and cancer in asymptomatic average-risk patients. MATERIALS AND METHODS: Sixty-eight asymptomatic men (age > 50 years) scheduled to undergo screening colonoscopy were enrolled in this study. CT colonography was followed by conventional colonoscopy, performed on the same day. Supine and prone CT colonography were performed after colonic insufflation with room air. A gastroenterologist measured all polyps, which were categorized as 1-5, 6-9, or over 10 mm. Biopsy and histologic evaluation were performed of all polyps. CT colonography and colonoscopy results were compared for location, size, and morphology of detected lesions. Point estimates and 95% CIs were provided for specificity and sensitivity of CT by using results at conventional colonoscopy as the reference standard. RESULTS: At colonoscopy, 98 polyps were identified in 39 patients; 21 (21.4%) of 98 were detected at CT colonography. Sensitivity was 11.5% (nine of 78) for polyps 1-5 mm, 52.9% (nine of 17) for polyps 6-9 mm, and 100% (three of three) for polyps over 10 mm. Results at colonoscopy were normal in 29 (42.6%) of 68 patients; at CT colonography, results were correctly identified as normal in 26 of these 29 patients. In one of these patients, a lesion larger than 10 mm was detected at CT colonography. The per-patient specificity of CT was 89.7% (26 of 29; 95% CI: 72.7%, 97.8%). The mean time for CT image interpretation was 9 minutes. CONCLUSION: In patients at average risk for colorectal cancer, CT colonography is a sensitive and specific screening test for detecting polyps 10 mm or larger; the sensitivity for detecting smaller polyps is decreased. Examination findings can be interpreted in a clinically feasible amount of time
— id: 42610, year: 2004, vol: 230, page: 629, stat: Journal Article,

Prevalence and impact of extracolonic findings in patients undergoing CT colonography
Rajapaksa, Roshini C; Macari, Michael; Bini, Edmund J
2004 Oct;38(9):767-771, Journal of clinical gastroenterology
BACKGROUND: CT colonography (virtual colonoscopy) is a new technique being offered to patients as a noninvasive method of imaging the colon. The aims of this study were to prospectively determine the prevalence of extracolonic findings in patients undergoing CT colonography, as well as to determine the clinical significance and consequences of these findings. METHODS: Two-hundred and fifty patients who were referred for colonoscopy for clinically indicated reasons underwent CT colonography using low-dose radiation (50 mAs) immediately prior to conventional colonoscopy. A single radiologist reviewed the CT images for extracolonic pathology, and findings were classified as having high, moderate, or low clinical significance. Electronic medical records were reviewed to assess what follow up diagnostic tests, if any, were performed. RESULTS: A total of 136 extracolonic findings were detected in 83 (33.2%) of the 250 patients. Of these 136 findings, 17 (12.5%) were highly significant, 53 (38.9%) were moderately significant, and 66 (48.5%) were of low significance. The most common highly significant lesions were solitary lung nodules in 3 patients, mesenteric lymphadenopathy in 3, adrenal masses in 2, low attenuation liver lesions consistent with metastases in 2, and bone metastases in 2 patients. Fourteen of the 17 (82.4%) highly significant findings were new findings, and in 11 the extracolonic abnormalities resulted in further diagnostic testing. None of the patients with moderate or low significance lesions underwent further testing. CONCLUSIONS: Low-dose CT colonography can detect highly significant extracolonic findings. Although extracolonic lesions were common, only a small proportion of patients required further diagnostic testing. Additional studies to determine the optimal radiation dose, cost-effectiveness, and legal implications of detecting extracolonic findings are warranted
— id: 49341, year: 2004, vol: 38, page: 767, stat: Journal Article,

Fractured colon: an endoscopically distinctive lesion associated with colonic perforation following colonoscopy in patients with collagenous colitis
Sherman, Alex; Ackert, John J; Rajapaksa, Roshini; West, A Brian; Oweity, Thaira
2004 Apr;38(4):341-345, Journal of clinical gastroenterology
BACKGROUND: Collagenous colitis is characterized by collagen deposition in the superficial colonic mucosa, beneath the surface epithelium, resulting in chronic nonbloody diarrhea of variable severity. The mucosa generally appears endoscopically normal. METHODS: We report the occurrence of distinctive linear mucosal tears, unassociated with trauma, in 4 patients during diagnostic colonoscopy. The patients' tissue specimens were examined histologically, and clinical courses were recorded. OBSERVATIONS: Recognition of linear 'fractures' was followed in 3 patients by colonic perforation. One patient required colectomy. Severe collagenous colitis was present in all. The resection specimen contained shallow linear ulcers overlying fibrotic submucosa, with pneumatosis and acute peritonitis. CONCLUSIONS: We theorize that the stiffness of the colon in areas of collagenous colitis with submucosal fibrosis makes it susceptible to linear 'fractures' during colonoscopic air insufflation with subsequent transmural air dissection. We urge extreme caution if this lesion is recognized at colonoscopy and recommend aborting the examination and obtaining plain radiographs to detect free intraperitoneal air
— id: 56129, year: 2004, vol: 38, page: 341, stat: Journal Article,

Prevalence and impact of extracolonic findings in patients undergoing CT colonography
Rajapaksa, R; Macari, M; Bini, EJ
2002 SEP abstract #339;97(9):S111-S112, American journal of gastroenterology
— id: 32558, year: 2002, vol: 97, page: S111, stat: Journal Article,

Patient preferences and satisfaction with virtual vs. conventional colonoscopy
Rajapaksa, R; Macari, M; Weinshel, E; Bini, EJ
2002 ;55(5):468-468, Gastrointestinal endoscopy
— id: 108250, year: 2002, vol: 55, page: 468, stat: Journal Article,

Does warfarin increase the rate of false positive fecal occult blood tests? A prospective endoscopic study
Bini, EJ; Rajapaksa, RC; Weinshel, EH
2001 APR ;53(5):AB58-AB58, Gastrointestinal endoscopy
— id: 55074, year: 2001, vol: 53, page: AB58, stat: Journal Article,

Is upper gastrointestinal endoscopy indicated in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy?
Bini EJ; Rajapaksa RC; Valdes MT; Weinshel EH
1999 Jun;106(6):613-618, American journal of medicine
PURPOSE: There are no recommendations as to whether endoscopic evaluation of the upper gastrointestinal tract is indicated in asymptomatic patients who have a positive fecal occult blood test and a negative colonoscopy. SUBJECTS AND METHODS: All asymptomatic patients with a positive fecal occult blood test who were referred for diagnostic endoscopy were identified. Patient charts, endoscopy records, and pathology reports were reviewed. RESULTS: During the 5-year study period, 498 asymptomatic patients with a positive fecal occult blood test and negative colonoscopy were evaluated. An upper gastrointestinal source of occult bleeding was detected in 67 patients (13%), with peptic ulcer disease being the most common lesion identified (8%). Four patients were diagnosed with gastric cancer and 1 had esophageal carcinoma. In addition, 74 patients (15%) had lesions that were not considered a source of occult bleeding; these findings prompted a change in management in 56 patients (11%). Anemia was the only variable significantly associated with having a clinically important lesion identified (multivariate odds ratio = 5.0; 95% confidence interval 2.9 to 8.5; P <0.001). CONCLUSIONS: Upper gastrointestinal endoscopy yields important findings in asymptomatic patients with a positive fecal occult blood test and negative colonoscopy. Our data suggest that endoscopic evaluation of the upper gastrointestinal tract should be considered, especially in patients with anemia
— id: 6142, year: 1999, vol: 106, page: 613, stat: Journal Article,

The findings and impact of nonrehydrated guaiac examination of the rectum (FINGER) study: a comparison of 2 methods of screening for colorectal cancer in asymptomatic average-risk patients
Bini EJ; Rajapaksa RC; Weinshel EH
1999 Sep 27;159(17):2022-2026, Archives of internal medicine
BACKGROUND: Testing stool for occult blood at the time of digital rectal examination (DRE) has been discouraged because it is thought to increase the number of false-positive test results. OBJECTIVE: To compare the diagnostic yield of colonoscopy and the cost per cancer detected in asymptomatic patients with a positive fecal occult blood test result obtained by DRE with that obtained from spontaneously passed stool (SPS) samples. METHODS: We reviewed the medical records of consecutive asymptomatic patients at average risk for colorectal cancer who were referred for colonoscopy to evaluate a positive fecal occult blood test result obtained by DRE (n = 282) or SPS samples (n = 390). The cost of colonoscopy was estimated by adding the physician fee under Medicaid reimbursement, the facility fee for endoscopy, and the pathology fee for the biopsy specimens. RESULTS: During the 5-year study period, 672 patients were evaluated and a colonic source of occult bleeding was identified in 145 patients (21.6%). The predictive value of a positive fecal occult blood test result (22.0% vs 21.3%, P = .85) and the cost per cancer detected ($7604.80 vs $7814.54) were no different in the DRE and SPS groups, with carcinomas being detected in 11.7% and 11.3% of patients, respectively. CONCLUSIONS: Testing stool for occult blood at the time of DRE does not increase the number of false-positive test results or the cost per cancer detected in asymptomatic patients at average risk for colorectal cancer. In this patient population, all individuals should be evaluated by full colonoscopy regardless of the method of stool collection
— id: 6216, year: 1999, vol: 159, page: 2022, stat: Journal Article,

Activity of combination therapy with interferon alfa-2b plus ribavirin in chronic hepatitis C patients co-infected with HIV
Dieterich DT; Purow JM; Rajapaksa R
1999 ;19 Suppl 1:87-94, Seminars in liver disease
The hepatitis C virus (HCV) and the human immunodeficiency virus (HIV) often co-infect the same individuals because they share comparable routes of transmission. Co-infection with HIV in those patients infected with HCV influences the accuracy of HCV diagnostic testing, levels of HCV viremia, severity of liver histopathology, and rate of progression to cirrhosis. By contrast, the effect of HCV co-infection on HIV disease is unclear. Nevertheless, the combination therapy containing recombinant interferon alfa-2b (rIFN-alpha 2b) plus ribavirin has been shown to be efficacious in the treatment of chronic hepatitis C, whereas alpha interferon monotherapy has been shown to be efficacious in patients co-infected with HCV and HIV. It is therefore logical to propose and test the hypothesis that combination rIFN-alpha 2b/ribavirin therapy will also benefit patients who are co-infected with HCV and HIV. A double-blind, placebo-controlled study is presently under way to investigate this hypothesis
— id: 14720, year: 1999, vol: 19 Suppl 1, page: 87, stat: Journal Article,