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I have ‘GASTRITIS’, Doctor!

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Most, if not all, practitioners of Medicine in Sri Lanka, I believe, would surely have come across patients presenting with the above complaint.

I find this rather strange, since, for over two decades of practicing medicine outside Sri Lanka, I have never, (that’s right, never) not once, had a patient complaining of “Gastritis”. Thus, this complaint, endemic in our country, appears to be a uniquely Sri Lankan phenomenon and merits reflection and thought.

I find that the manner in which this complaint is made to some extent reflects the individual’s educational and socioeconomic standard. Thus, white collar worker types, present with the standard “I have gastritis, doctor” (mata hariata gastritis, doctor). Blue collar workers come, saying, ” I have gastric, doctor” (mata hondatama gastric thiyenawa, sir).

Then finally there is the classic lady in her late sixties or early seventies,(she runs the corner grocery shop- “podi sillara kadayak dala thiyanawa, sir,) dressed in white blouse with lace trimmings and a printed cloth,(admittedly a fast disappearing dress code!), generally overweight, with betel stained teeth, who waddles into the consultation room and plonks herself on a chair like a beached whale and comes out with, “Sir, mata Gas -Trick thiyanawa!” Now, this is said with a triumphant, almost challenging smirk on her face as if to say “There, now, sort that trick if you’re so clever”. I find myself cringing, reduced to a nail biting, quivering mass of flesh, not knowing how to respond!!

Seriously, folks, “Gastritis” is not a SYMPTOM; it’s a condition where the lining of your stomach is abnormal, and can accurately be diagnosed only by looking into your stomach with an endoscope. Not even then sometimes, the endoscopist may have to take bits of tissue and look at it under the microscope to diagnose “Gastritis”.

Thus, if I were to draw an analogy, when you have a headache, for example, you don’t tell your doctor, “I have migraine, or a tension headache, or meningitis, or Benign Intracranial Hypertension or Brain tumour”, do you? Of course, you don’t. You just say I have a headache! Your doctor will then try to ascertain what the headache is due to. Another example, if you have chest pain, you’re not going to tell the doctor “I have Pericarditis, or Pleurisy, or Costochondritis, or I’m having a Myocardial Infarct, or Intercostal neuralgia”? No, you don’t, you just tell him your SYMPTOM, which is chest pain. (I have deliberately used some medical terms readers may not be familiar with, to drive home my point.).

In fact, if you do have Gastritis, it can produce symptoms like, discomfort or pain in the tummy, nausea, bloating, early satiety and so on, but the point is that these symptoms can be due to a whole variety of other conditions, and to conclude that Gastritis is the underlying cause is often quite misleading. There are a few occasions where one might correctly self-diagnose “gastritis”. Thus if you have had a bout of heavy alcohol drinking, you may have alcoholic gastritis, or if you have accidentally swallowed dishwashing liquid or other household cleaning agent, you may have a chemical gastritis, or if you have been taking pills like anti-inflammatory drugs for a while you may have a drug induced gastritis ,

Some patients who have presented with the infamous ‘i have gastritis” complaint have in fact turned out to have a completely different diagnosis, Reflux Oesophagitis, Biliary Colic, Irritable Bowel Syndrome, Acute Pancreatitis, Gastroenteritis, Acute appendicitis ,Diverticulitis, are some examples that come to mind, and some of these are quite serious illnesses unlike the much-maligned “Gastritis”.

Well researched studies have shown that over fifty percent of patients attending gastroenterology clinics, in fact have what are medically called “functional disorders” .This means that there is no demonstrable structural abnormality in the organ under study, (in this case the stomach and intestinal tract mainly),but that its functioning is not normal. Many of the symptoms attributed to “Gastritis” mentioned earlier are due to these types of “functional disorders.”

There are nerve impulses travelling to and fro, from parts of the brain to the intestinal tract, the ‘’Brain Gut Axis”. This Brain Gut Axis and its functioning is still not fully understood, but to put it simply, it’s when this is out of sync that a number of functional disorders of the bowel arise. It’s a common experience when under intense stress you feel your “stomach knotted up” or you feel like “throwing up”, due to these nerve connections between the brain and intestinal tract. ‘Visceral Hypersensitivity’ is another concept which explains many functional disorders of the intestinal tract. Here, in some individuals, normal impulses that arise – for example when the bowel is filled with gas – is perceived as a painful sensation in those with visceral hypersensitivity (perhaps an oversimplified explanation).

When you tell your doctor, I have gastritis (particularly if he’s very busy and hasn’t much time to listen ) you’ll invariably be prescribed two types of drugs, an acid suppressant also called a Proton Pump Inhibitor, which reduces acid secretion in the stomach and a “pro kinetic ” drug, which helps emptying of the stomach, and you’ll end up popping these pills in your mouth for months! A small percentage of patients may actually need these medications, but the majority have “Functional disorders”, incorrectly attributed to “Gastritis”, and what is needed is an explanation of the harmless nature of the symptom, and perhaps a few lifestyle changes. The true beneficiary of these medications are of course the drug companies, who’ll be laughing all the way to the bank!

How did the term ‘Gastritis’ come to be so widely used/misused? In the late eighties, this was a complaint we hardly heard of. At the time Endoscopy services were not widely available in Sri Lanka, unlike the present time. With the increasing use of endoscopy, it’s quite common to find some degree of “gastritis”, which is an endoscopic diagnosis and does not result in clinical symptoms. Secondly, patients may feel they don’t want to waste time of a busy doctor, and instead of describing their symptoms, just say that they have “gastritis”.

The major culprits responsible for misuse of the term “gastritis” is of course the medical profession itself! Particularly practitioners, who have what I call the “Next Patient Syndrome”! In so much of a hurry to see the next patient, it’s much easier to say “you have gastritis” for any tummy problem, and prescribe a few drugs; than to give a long-winded explanation on the lines mentioned earlier.

I must end with this classic example illustrating the misuse of “gastritis”. A patient rang me recently saying “Doctor, my friend’s mother has high blood pressure and has got a sudden headache and is now vomiting” and before I could say, OMG, she could be having a Sub Arachnoid bleed, (type of bleeding inside the skull) she goes, ‘Doctor, can you give something for her gastritis, because she’s vomiting!” That telephone conversation ended sharply. Need I say more?

So, folks, let’s do the “In thing” and have a “system change”, and use the term Gastritis, as it should be!

N. J.

Consultant Physician, Internal Medicine and Gastroenterology



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Opinion

Sri Lanka Cricket needs a bitter pill

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A systemic diagnosis of a fading legacy

The outcome of the 2026 T20 World Cup, coupled with the trajectory of the sport in recent years, provides harrowing evidence that Sri Lankan cricket is suffering from a terminal malignancy.The Doomsday clock for Sri Lankan cricket has not just started ticking—it has reached its final hour.

Therefore this note is written to call the attention of the cricketing elite who love the sport.

The current state of affairs suggests a pathology so deep-seated that conventional remedies—be it revolving-door coaching changes or fleeting, opportunistic victories—can no longer arrest its spread.

What we are witnessing is not a mere slump in form or a temporary lapse in rhythm; it is a profound systemic collapse that threatens the very foundation of our national pastime.

The Illusion of Recovery: The “Sanath Factor” as Palliative Care:

Since late 2024, the appointment of Sanath Jayasuriya as Head Coach injected a much-needed surge of adrenaline into the national side.

Statistically, the highlights were historic: a first ODI series win against India in 27 years, a Test victory at The Oval after a decade, and a clinical 2-0 whitewash of New Zealand.

However, a data-driven autopsy reveals that these will be “palliative” successes rather than a cure.

Under Jayasuriya’s tenure, the team maintained a win rate of approximately 50 percent (29 wins in 60 matches).

While analysts optimistically labeled this a “transitional phase,” the recent T20 series against England and Pakistan exposed the raw truth: in high-pressure “crunch” moments, the team’s performance metrics—specifically Strike Rate (SR) and Fielding Efficiency—regress to amateur levels.

We are not transitioning; we are stagnating in a professional abyss.

The Scientific Gap:

Why India and Australia Lead

The disparity between Sri Lanka and global giants such as the BCCI and Cricket Australia (CA) is now rooted in High-Performance Science and Algorithmic Management.

Predictive Analytics & Biometrics

In Australia, fast bowlers utilise wearable sensors to monitor workload and biomechanical stress.

AI models analyse this data to predict stress fractures before they occur.

Sri Lanka, conversely, continues to cycle through injured pacemen with no predictive oversight.

Virtual Reality (VR) Training

While Australian batters use VR to simulate the trajectories of elite global bowlers, Sri Lankan players remain tethered to traditional net sessions on deteriorating domestic tracks.

Data-Driven Talent Identification:

India’s “transmission system” utilises automated data analysis across thousands of domestic matches to identify players who thrive under specific pressure indices.

In Sri Lanka, 85 percent of national talent still originates from just four districts—a statistical failure in talent scouting and geographic expansion.

Infrastructure vs. Intellect:

A Misallocation of Capital

Sri Lanka Cricket (SLC) boasts massive reserves, yet its investment strategy is fundamentally flawed.

Capital is funneled into “bricks and mortar”—grand stadiums and administrative buildings—rather than the human capital of the sport.

We build colosseums but fail to train the gladiators.

The domestic structure remains a “spin trap.”

By producing “rank turners” to suit club politics, we have effectively de-skilled our batters against elite pace and rendered our spinners ineffective on the flat, true wickets required for international success.

The Leadership Deficit:

A Failure of Succession Planning

The crisis of leadership post-Sangakkara and Mahela is a byproduct of poor “Succession Science.”

Australia maintains a “Culture of Continuity,” backing leadership even through lean periods to ensure stability.

India employs a rigid “Succession Roadmap,” ensuring the next generation is integrated into the system long before the veterans depart.

In contrast, SLC operates on a “carousel of convenience,” changing captains and coaches to distract from administrative failures.

This lack of imaginative management stems from a low literacy in modern Sports Governance.

From a philosophical perspective, our established cricketing traditions have failed to absorb the antithesis of the modern, hyper-professionalized global game.

As a result, a truly modern Sri Lankan brand of cricket has failed to materialise.

Instead, we are trapped in what is called a “Static Synthesis,” where the administration clings to the glories of 1996 and 2014 as a shield against the necessity of change.

This is not a transition; it is a refusal to evolve

We are witnessing the alienation of the sport from its people, where the “Master” (the administration) has become detached from the “Slave” (the grassroots talent and the fans).

The Verdict:

A National Emergency

The “cancer” in Sri Lankan cricket is a trifecta of political interference, irrational management, and a refusal to embrace the Fourth Industrial Revolution (AI, VR, and Big Data).

As someone who contributed to the formation of the Sri Lankan Professional Cricketers’ Association, I see the current trajectory as a betrayal of the players’ potential and the nation’s heritage.

Sri Lanka Cricket does not need another “review committee” or a new coach to act as a human shield for the board.

It needs a “Bitter Pill”—an aggressive, independent restructuring that prioritises scientific professionalisation over cronyism.

Without this, our cricket will remain at the bottom of the well, looking up at a world that has moved light-years ahead.

Shiral Lakthilaka

LLB, LLM/MA
Attorney-at-Law
Former Advisor to H.E. the President of Sri Lanka
Former Member of the Western Provincial Council
Executive Committee member of the Asian Social Democratic Political Parities

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Opinion

Unable to forget the dead

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A church damaged by the Easter Sunday terror attacks

The present government was elected on a commitment to prioritise truth, justice, and accountability to which it is being held by the Catholic Church in particular. This may account for the renewed momentum in investigations into the 2019 Easter Sunday bombings which was one of the gravest acts of violence in Sri Lanka’s recent history. A story on the recent developments in the Easter Sunday bombing investigation refers to a father whose six year old daughter died in the explosions that killed 279 people. The news report quotes him saying, “If she were alive today, she would be 13. You cannot suppress the truth for long. Now it’s starting to come out. We want the full truth and justice. Our children did not die in vain.” https://www.ucanews.com/news/sri-lanka-arrests-ex-intelligence-chief-over-2019-easter-bombings/112031  His words capture the ache of continuing grief and the stubborn refusal to let memory fade into oblivion.

The desire for justice, especially for loved ones killed by the actions or omissions of others, is universal. It is seen in the mothers of the North, in Jaffna and other towns, who have sat by the roadside year after year asking what happened to their children who disappeared in 2009 when the war ended or even earlier as when 158 people were taken from the temporary refugee camp in Eastern University in Vantharumoolai, Batticaloa, on September 5, 1990 never to be seen again. The reality, however, is that the suffering of individuals is easily submerged in the larger schemes of power. Governments are concerned about retaining political power, security forces close ranks, and societies are encouraged to forget in the name of stability, economic recovery, or national pride.

In Sri Lanka that forgetting has not taken place. Due to the sustained efforts of the Catholic Church and the families of the victims, the demand for truth and justice regarding the Easter Sunday attacks has not gone away. It has persisted through indifference, hostility, and at times intimidation. It is perhaps this persistence that has made the arrest of retired Major General Suresh Sallay a significant moment for those who have not forgotten. The arrest of General Sallay, who once headed military intelligence and later the State Intelligence Service, has been controversial. He is widely credited with playing a significant role in dismantling the LTTE’s networks and is regarded by some as one of the country’s most capable intelligence officers.

Persisting Doubts

From the very day of the Easter bombings in April 2019, there has been a doubt that the attacks were too meticulously planned to have been carried out solely by a ragtag group of youth or radicalised men acting on their own. The suspicion of a “grand conspiracy” has existed from the beginning and was voiced even by senior legal officials involved in the investigations. The attacks were claimed to be staged by ISIS, whose leader issued a statement claiming credit for them as part of a global ideological struggle. But this did not answer the central question about why known Muslim extremists were not apprehended when the war with the LTTE had ended many years before and they were no longer needed as a counterforce and why repeated intelligence warnings from India were ignored.

For seven years successive governments failed to move beyond the finding of negligence on the part of those who were in charge of national security. Investigations stalled and key questions remained unanswered. A parliamentary committee questioned whether sections within the intelligence community, supported by some politicians, sought to undermine investigations.

The Supreme Court held several government leaders and senior officials guilty of negligence and dereliction of duty, imposing heavy fines. That judgment established that the state failed its citizens. But negligence is one thing. Deliberate connivance is another. The present government was elected in 2024 on a promise that the truth behind the Easter attacks would be uncovered. President Anura Kumara Dissanayake committed himself publicly to accountability.

As several foreigners including US and UK citizens also lost their lives in the bombings, foreign intelligence agencies from the United States, the United Kingdom and other countries came to Sri Lanka soon after the attacks to conduct their own inquiries. The US has filed charges against three Sri Lankans. So far, international findings have not identified an external mastermind directing the plot from abroad. The focus remains on possible failures or complicity within.

Indeed, by arresting a former intelligence head who was widely credited with playing a significant role in dismantling the LTTE, the government has taken a considerable political risk. Opposition politicians and nationalist voices have framed the arrest as a betrayal of the security forces and an attempt to appease external actors. Others have suggested that it is a diversion from present economic or political challenges.

Beyond Easter

The Catholic Church, which most directly represents the victims of the Easter attacks, has expressed support for the renewed investigations. The involvement of the Church has helped to take the issue beyond the realm of partisan party politics and to one of the search for truth and justice. But this search for the truth cannot be limited to the Easter bombings. It needs to extend beyond this particular bombing, heinous though it was. A state that investigates only one atrocity while ignoring others signals that some lives matter more than others. That is a dangerous message in a country that has been divided along ethnic and religious lines. Truth seeking is not a betrayal of those who fought in difficult circumstances. It is an affirmation that the rule of law applies to all. It strengthens institutions by cleansing them of suspicion. It restores trust between citizens and the state.

Sri Lanka’s modern history is marked by many unresolved crimes. Large scale killings, enforced disappearances, and extrajudicial actions during the period of the ethnic war remain unaccounted for. There were churches and orphanages bombed during the war. There were hundreds taken from camps or who surrendered only to disappear forever. Thousands of families continue to live without answers. The mothers of the disappeared have not gone away.

They sit in the heat and rain because they cannot forget their children and want to know what happened to them. Their persistence mirrors that of the Easter victims’ families. Both ask the same question. Who was responsible and why. For too long Sri Lanka has avoided these questions, arguing that reopening the past would endanger stability and that the path to success is to focus on the future.

But memory and the desire for truth and justice does not die. By prioritising truth and justice as governing principles, the government can begin to restore faith in public institutions. This requires investigating what happened and why accountability was denied. Healing the wounds for Sri Lanka does not lie in forgetting the dead. Justice is not only punitive. It is also restorative. It allows societies to move forward without carrying unspoken burdens.

The Easter Sunday victims, the disappeared of the war years, and all those lost to political violence belong to the same community of Sri Lankan citizens that the government has pledged to treat equally. This calls for a consistent standard of truth. By pursuing the Easter investigation wherever it leads and by reopening and resolving the unresolved crimes of the war years, the government can set the country on a path of redemption.

by Jehan Perera

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Opinion

Sri Lanka – world’s worst facilities for cricket fans

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A file photo of a packed cricket stadium in Sri Lanka

Having watched Sri Lanka play in multiple World Cups (both formats) in six countries over the past 15 years, I regret that the worst facilities for fans are in the ongoing edition in Sri Lanka. I’m in my mid 60s and over many decades have watched our team play in every international cricket venue in Sri Lanka and several abroad. Even in developing countries such as in the Caribbean and Bangladesh, where I saw us triumph in 2014, there seems to be more concern for ordinary spectators and their basic expectations.

On this occasion, I travelled from the other side of the world and had to plan ahead. In the past editions, I recall tickets going on sale well ahead, but on this occasion, only a couple of months for some games and a couple of weeks for others. Even then, only low priced categories were released initially and I snapped them up, only to find better seats released a few days later. When I tried to buy those, I was told by the system that the maximum ticket quota is exceeded. I had to ask a friend to buy the tickets for me and transfer, hence paying multiple times for the same game. Why can’t all tickets be made available transparently to all fans at one time and sold to the 1st comers? Is there some racket in sending tickets “underground” initially to be resold at higher prices or given away free to cronies? I am tempted to believe this as in smaller grounds like P Sara and Galle, I have found in past bilateral tours such as vs England, where tickets are in high demand, the better tickets are never offered for public sale. But at the venue, I find many empty good seats. I understand that hundreds of tickets are given away as compliments to past cricketers families and friends and families of SLC big wigs, who routinely never turn up, depriving the opportunity to fans who are ready to pay for those same seats.

The most agonising part is entering and leaving the grounds which at both Premadasa and Pallekele this year was an absolute nightmare, with high possibilities of stampedes causing serious injuries or worse. Is the ICC not concerned – at least for the sake of avoiding legal liabilities? In past decades I remember long metal barricaded pathways set up a little away from the gates to force fans to queue up for body search, etc. This ensures more orderly entry as Sri Lankans are notorious for queue-jumping. Instead this time round it was a free-for-all for. The next shock is upon entry; there are clearly more people in each stand than the available seats. If you don’t arrive early and grab a seat, you end up standing in the aisles or stairs with an obstructed view and crushed on all sides. I saw some elderly foreign fans walk off half way in disgust. There was a time when in most stands at the R. Premadasa Stadium, a ticket guaranteed a seat. Now, it is not so even in the highest priced Grandstand. Seat numbers have been obliterated. With all the financial stability of the SLC that they claim in media, can’t they afford to repaint the seat numbers and set up some physical queuing pathways? Or is it that they are simply unconcerned about the suffering of ordinary fans? Or do they prefer free seating so that it’s easier to admit favoured individuals free of charge? At a world cup in New Zealand, I observed they had engaged many volunteers, young and old to act as guides/ ushers in and around the stadium. This is a common practice even in Olympics. Apart from trips for multiple board members, their families and other companions, can’t SLC spend a little to send some operational level staff to study and apply the best practices of other member countries to improve things at our local facilities? Moving onto toilets, without exaggeration, Pallekelle had 3 inches of filthy water (maybe urine) on the men’s toilet floor to wade through. In Sri Lanka, it is essential to have the constant presence of several janitors to ensure clean toilets. There wasn’t even one in sight. At the previous edition of this tournament in St. Lucia, West Indies, a small island where Sri Lanka played, I found impeccably clean toilets at the Gros Islet grounds.

Food and beverages is the next bone of contention. Quality and range offered was pathetic compared to the past in Sri Lanka and certainly compared to world cup venues elsewhere. Only plain instant noodle, hot dogs and some Chinese Rolls were generally available and some of the vendor stalls were unbranded, causing doubt in the minds of about the origin and quality of the offerings. Beer was the next scam, at Premadasa only Corona R. 2000 per cup and Budweiser Rs, 1500 were on offer, both unknown brands to most Sri Lankans. Budweiser also ran out early in the match, leaving a Hobson’s choice for fans. Apparently, this was a global sponsorship deal, but strangely at Pallekele, there was a small, unbranded shed in a corner selling Beer (presumably local) at Rs. 500. Was this something underhand? SLC Office bearers boast of their good relationships and having influence at the top levels within ICC. They also sit on their Boards and committees. Can’t they influence better deals on offerings and prices appropriate to local crowds? Finally, at the end of many hours of suffering, we come to the chaotic exit with everybody pouring out into narrow highly populated streets around the Premadasa stadium. With all the millions they are reportedly raking in, can’t SLC attempt to collaborate with the local authorities and acquire some of the surrounding lands, offering the residents attractive deals. Sri Lanka already has a very high number of stadia per capita. Building more and more may be lucrative for some, but investing in improving say three select existing venues to international standards in different parts of the country is the need of the hour. Once I took a flight via Mattala to watch Sri Lanka play at the Sooriyawewa stadium. Built in the middle of nowhere, with no surrounding infrastructure, it fell into total neglect just a few years after it was opened. When thousands of spectators attempt to find their way home at once, it can be anticipated that all modes of public transport including Uber and Pickme get overwhelmed. I had to walk about three kilometres and try repeatedly for almost one hour to secure a ride. After watching Sri Lanka play a world cup match at Sydney Cricket Ground, (capacity 50,000) we were able to calmly walk about 15 minutes to a long line of parked busses which took us painlessly to different points of the city. At the Oval, London, three underground tube stations are within 15 m walking distance and extra trains are deployed to handle the load after matches. Are SLC officers too busy to engage in some discussion with Public and Private sector transportation providers to make some special arrangement for the weary cricket fans?

I bought tickets to watch Sri Lanka play Pakistan in their final game in this tournament, but decided that the hardship and risks of bodily injury to be endured to support our team was not worthwhile at my age. Since that triumphant day in Dhaka in 2014, not only the standard of our Cricket but the facilities and basic comforts expected by ordinary fans have sadly declined drastically.

Sujiva Dewaraja
sujiva.dewaraja@gmail.com

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