International Journal of Human Capital Management (IJHCM)
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Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children
No full textBackground: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitorin
Upper Gastrointestinal Abnormalities in Esophagogastroduodenoscopy Examination: Descriptive Study in PSUPAU Endoscopic Unit
No full textBackground: The Endoscopy Unit of Indonesian Air Force Central Hospital Dr. Esnawan Antariksa, Jakarta, Indonesia, has just been established in late 2004 and it is still in developing process. This study was aim to depict the profile of patients who underwent esophagogastroduodenoscopy procedure in the unit. Method: This study was a retrospective study that analyzed data in endoscopic registry of patients who underwent esophagogastroduodenoscopy (EGD) examination from September 2004 to December 2007. Result: Total of 108 patients underwent EGD examination, comprised of 66 (61%) males and 42 (39%) females, with average age of 45.4 years old (range 16-77 years old). The most frequent indication for EGD was dyspepsia 63%, followed by hematemesis-melena 26% and dysphagia 5.5%. Among patients with dyspepsia, EGD revealed organic abnormalities in 71% patients, with descriptions of erosive gastritis 35%, gastritis 18%, bile reflux 7%, esophagitis 5% and gastric ulcer 3%. Among patients with hematemesis-melena, EGD revealed abnormalities, which were described as erosive gastritis 48%, esophageal varices bleeding 22%, gastric ulcer 18%, caustic injury 4%, and esophagitis 4%. Conclusions: EGD is an important procedure to ascertain the occurence of organic abnormalities in patient with gastrointestinal symptoms and signs e.g. dyspepsia and gastrointestinal bleeding. More than half of patients with dyspepsia showed organic abnormalities. Among patients with hematemesis-melena, erosive gastritis is more common than variceal bleeding. Keywords: esophagogastroduodenoscopy, dyspepsia, upper gastrointestinal bleeding, hematemesis melen
Colorectal Polyp Evaluation Management and Its Role in Gastrointestinal Tract Malignancy
No full textColorectal polyp is one of important factors that have roles in developing malignancy of lower gastrointestinal tract. Adenomatous polyp is the most common colorectal polyps and it has been known as a lesion precursor for transformation process in developing gastrointestinal malignancy. Such transformation is known as adenocarcinoma sequence, a long-term process which usually does not elaborate any symptoms and remains asymptomatic. Since most colorectal polyps are asymptomatic, they are usually undiscovered at the time of diagnosis and results to the increasing case of malignancy especially the colorectal cancer. Considering that colorectal cancer still becomes one of the most common causes of death and morbidity worldwide, early detection and elimination of colorectal polyp may have a significant role in preventing lower gastrointestinal tract malignancy. Keywords: polyp, colorectal polyp, adenomatous poly
The Role of Esophageal pH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis
No full textGastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal endoscopic result but still having refractory reflux symptoms against proton pump inhibitor medication; detecting refractory reflux in patients chest pain following the heart evaluation; evaluating patients with otolaryngologic manifestations (laryngitis, pharyngitis, chronic cough) of the esophageal reflux disease after therapeutic failure of 4-weeks proton pump inhibitor treatment; and looking for correlation between adult onset gastro-esophageal reflux disease and non-allergic asthma. Keywords: gastro-esophageal reflux disease, esophagus pH-metry, symptoms-reflux correlatio
Intractable Diarrhea due to Secondary Gastrointestinal Amyloidosis in a Patient with History of Leprosy
No full textAmyloidosis is not a single disease but a term for diseases that share a common feature: the extracellular deposition of pathologic insoluble fibrillar proteins in organs and tissues. In both primary and secondary amyloidosis, the most commonly involved organ system is the gastrointestinal system, with the colon being the most frequently involved organ. A 30 years-old male, complained of diarrhea since 4 months prior to admission. The colonoscopy examination revealed pancolitis, ileitis, and the result from histopathological examination showed chronic destructive ileocolitis with 40-70% amyloidosis of mucosa. The abdominal ultrasonography showed chronic cholecystitis, multiple cholelithiasis and minimally ascites. The esophagogastroduodenoscopy revealed candida esophagitis, erosive pangastritis grade V, pyloring gapping, erosive duodenitis, bile reflux gastritis and esophagitis, and the result from histo-pathological examination showed amyloidosis on gastric mucosa.The immunofixation electrophoresis was negative for monoclonal light chains, and the serum protein electrophoresis showed normal pattern. Enteral and parenteral nutritional therapy were given. Secondary infection was treated by antibiotics. Complication and organ failure occured lately. This chalenging case demonstrated complicated management of gastestinal amyloidosis. Keywords: gastrointestinal amyloidosis, intractable diarrhea, lepros
Gastroesophageal Reflux Disease in Obesity
No full textIncidence of gastroesophageal reflux disease (GERD) has been significantly increased, and nearly 25% of the population has experienced GERD. It appears to be correlated to an increasing number of obesity in the population (BMI >30 kg/m2). Mechanism of the GERD is affected by multifactor. Increased intra-abdominal pressure is considered as one of risk factors for GERD. The development of GERD is virtually associated with a down turning of lower esophageal sphincter tonus, increased transient lower esophagus sphincter relaxation (TLESR), and decreased capacity of esophageal clearance. Management of GERD in obesity includes weight loss treatment, pharmacotherapy by using prokinetics, H2 -receptor antagonists, proton pump inhibitor and surgical approach including fundoplication, gastric banding and vertical banded gastroplasty. Keywords: GERD, obesity, BMI, TLESR, weight loss, abdominal pressur
The Role of Insulin Resistance in Diabetic Patients with Chronic Liver Disease
No full textBackground: The association between diabetes and chronic liver disease has been well documented. However, the mechanism remains unknown. The aim of this study was to investigate the insulin resistance in chronic liver disease and normal liver in diabetic patient. Method: A total of 31 diabetic, non-alcoholic patients with multiple oral hypoglycemic drugs, either with or without lipid abnormalities were enrolled in this study. Subjects were recruited from outpatient clinic of Department of Endocrine at Dr. Sardjito Hospital, Jogjakarta, Indonesia from May-June 2004. This was a cross sectional study. Fasting insulin and glucose level, liver function test, body mass index, and the presence of fatty liver by ultrasound were examined. Insulin resistance was estimated by calculating fasting insulin and glucose plasma level as the homeostasis model assessment (HOMA) index ratio. Data was described with mean ± SD and analyzed by independent sample t-test. Results: Thirty one patients were enrolled to the study, i.e. 8 patients with normal liver and 23 patients with fatty liver. Only 14 patients agreed to continue the study including 10 patients with fatty liver and 4 patients with normal liver. Mean of age was 59.1 ± 8.7 and mean value of BMI was 24.62 ± 3.05. The liver function test revealed normal Results. Triglyceride, cholesterol, fasting glucose level, and HOMA index (2.77 ± 1.95 vs. 1.66 ± 1.02) in patients with fatty liver were higher than patients with normal liver. No correlation was found between fasting insulin level as well as HOMA index and mean value of BMI (obese and non-obese) as well as hypertension. There was significant correlation between triglyceride level and fasting insulin among fatty liver patients (p = 0.048; CI 95% -7.404; -0.032). Conclusion: The non-alcoholic fatty liver disease in diabetic patients with normal liver enzymes and multiple oral hypoglycemic drugs appear to be related with insulin resistance and hypertriglyceridemia. Keywords: fatty liver, diabetic, insulin resistanc
Endoscopic Findings and Histopathological Pattern in Patients with Chronic Dyspepsia at Panti Rapih Hospital Jogjakarta
No full textBackground: To determine the relationship between clinical manifestation of chronic dyspepsia and endoscopic findings along with histopathological pattern by descriptive analysis. Methods: This study was a retrospective study. Subjects were patients with chronic dyspepsia who underwent endoscopic examination and gastric biopsy between June 2005 and July 2006. Result: There are 10.17% normal endoscopic results of 79 patients with chronic dyspepsia and almost 90% show abnormal result in endoscopic examination. The histopathological pattern is normal in 2.53% and 97.47% demonstrate abnormal result. The prevalence of Helicobacter pylori due to gastric ulcer is 1.26% and chronic atrophic gastritis is 3.80%. Conclusion: Most of chronic dyspepsia patients have abnormal endoscopic and histopathologic result. Keywords: chronic dyspepsia, endoscopic findings, histopathological pattern, Helicobacter pylor
Approach to the Patient with Accidentally Swallowing a Needle
No full textPeople are capable of ingesting, inserting, or injecting themselves or others with all manner of foreign objects. Ingested or inserted foreign bodies may cause bowel obstruction or perforation; which lead to severe hemorrhage, abscess formation, or septicemia; or distant embolization. Fortunately, once a foreign body has reached the stomach, it has an 80-90% chance of passage. All sharp foreign bodies should be removed before they pass from the stomach because 15-35% of these will cause intestinal perforation, usually in the area of the ileocecal valve. The abdominal radiograph should be made and repeated to confirm the location of foreign bodies. If a sharp foreign body does not progress for three consecutive days, surgical intervention should be considered and, if the patient becomes symptomatic, surgical intervention will be necessary. In this case, the patient had accidentally swallowed needle 2 days prior to admission, with no complaint any symptoms of abdominal discomfort, and no bloody stools. Observation is the treatment of choice for this case, since needle had passed stomach and reached colon, and it is hoped that the needle pass through without any complication. Keywords: sharp foreign bodies, needle, swallowin
The Pathophysiology Gastroesophageal Reflux Disease
No full textABSTRACT The incidence of Gastroesophageal Reflux Disease (GERD), especially in Indonesia, is increasing with the change of community life-style. Also, the doctors’ perception in understanding clinical manifestation of GERD is alike in addition to the development of diagnostic facilities such as endoscopy in Indonesia. The GERD incidence in Indonesia is as high as the incidence in developed countries. Esophageal reflux develops in physiological condition, which may be found in normal individual. GERD development is caused by anatomical and physiological disorders such as hereditary or acquired factor; and other factors that may be categorized into offensive factors such as gastric acid, pepsin, bile acid, trypsin and disturbance in defensive factors such as hypotensive Lower Esophageal Sphincter (LES), Transient Lower Esophageal Sphincter Relaxations (TLESR), hiatal hernia, disrupted saliva production, esophageal peristaltic disorder; as well as other factors such as genetic, diet, or certain drugs. Imbalance of such factors may cause pathological repeated esophageal reflux which may damage esophageal mucosa and lead to GERD development including all of complications. Keywords: esophageal reflux, GERD, LE