The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Survival of Pancreatic Cancer Patients in Dr Cipto Mangunkusumo National Referral Hospital Jakarta from November 2018 To December 2018
Full text linkBackground: Pancreatic cancer is a leading cause for cancer deaths worldwide and its survival rate remains low. The one year- and five year-survival rate remain as low as 21% and 6-8% consecutively. Little is known about the survival rate of pancreatic cancer in Indonesia. This study aims to evaluate the survival rate of pancreatic cancer patients at Gastrointestinal Endoscopy Center, National Referral Hospital Dr. Cipto Mangunkusumo, Jakarta, during November 2018 to December 2018.Method: This retrospective cohort study extracted the registry data of newly diagnosed pancreatic cancer patients between November 2018 to December 2018 from the Gastrointestinal Endoscopy Center, Cipto Mangunkusumo Hospital, Jakarta. All patients were followed since they were diagnosed to two months after diagnosis or 31st December 2018 or to their date of death, whichever came first. Results: We found 12 newly diagnosed pancreatic cancer cases between November 2018 to December 2018. The mean age at diagnosis was 55 years old, with 58% male, 50% sundanese, and 75% patient come from low educated level. About 58% cases presented with cholangitis, and the mean bilirubin concentration at diagnosis was 26 mg/dL. All patient came with an obstructive jaundice symptoms, and 91% had endoscopic biliary drainage procedure. After 2 months of observation, we found 16% patient died due to unresolved infection.Conclusion: There were 12 cases of pancreatic cancer, of which 16% pancreatic cancer patients died within 2 months of follow up. Infection is the main cause of morbidity and mortatlity in pancreatic cancer patients.
Gut Microbiota in Human Immunodeficiency Virus Infection
Full text linkHuman microbiota, majority presents in human gastrointestinal tract, plays crucial role in body physiological functions, such as immune system. Human immunodeficiency virus (HIV) infection impairs gut barrier and alter the microbiota ecosystem, called dysbiosis. Several studies showed different composition of gut microbiota between healthy individual and HIV patient. Moreover, different phase of HIV infections had their own characteristic of gut microbiota. Antiretroviral treatment might improve the CD4 level, however, it inconsistently restore the gut ecosystem. Some studies in prebiotic and probiotic revealed the potential beneficial effect in gut microbiota. Probiotic might inhibit mucosal invasion, improve intestinal mechanical barrier integrity, reduce microbial translocation, restore mucosal immune function, counteract local inflammation and lower systemic inflammation
Association Between Patient Characteristics and Diet Profile with Kirsten rat sarcoma (KRAS) and Neuroblastoma rat sarcoma (NRAS) Gene Mutation in Colorectal Cancer
Full text linkBackground: Colorectal cancer is the third most common cancer according to American Cancer Society. It is also the third most common cause of death in men and women in US. Colorectal cancer encompasses 5% of all cancer and 29% of gastrointestinal cancer with men and women ratio is about 3:1. More than 1/3 of colorectal cancer occur below the age of 45 years. Mutation in Kirsten rat sarcoma (KRAS) gene was found in 30-50% of colorectal cancer in which it was suggested to associated with increase proliferation and decrease apoptosis. This study aimed to analyze the association between diet profile and KRAS gene mutation.Method: This study was a cross sectional study. Data was collected from medical records of colorectal cancer patient in Dr. Saiful Anwar General Hospital, which included KRAS gene mutation analysis.Results: There were 12 subjetcs included in this study. Four subjects (33.3%) had gene mutation with 3 subjects (75%) had positive KRAS mutation and 1 subjects (25%) had positive Neuroblastoma rat sarcoma (NRAS) mutation. In non-mutation group, it had been found a higher frequency of green leaf vegetables diet, in comparison with mutation group (p = 0.023). There was positive correlation between green leaf vegetables diet with gene mutation.Conclusion: Mutation of KRAS and NRAS mutation in colorectal carcinoma were found in 33.3% of subjects. Data analysis showed positive association between low green leaf vegetables diet with KRAS and NRAS mutation
Decreased Liver Fibrosis in Patients with Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) Coinfection After Treatment with Sofosbuvir/Daclatasvir
Full text linkBackground: Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) co-infection increases the progression of liver fibrosis to advanced liver disease and death. The aim of this study is to determine whether the changes of liver fibrosis occur in HCV/HIV coinfection patients after therapy with Sofosbuvir/daclatasvir.Method: This study used a quasi-experimental study design without a control group. The study subjects were HCV / HIV coinfection patients who received Sofosbuvir / daclatasvir therapy in the Gastroentero-Hepatology Clinic of Dr. Hasan Sadikin Hospital. In this study measurement of liver fibrosis was carried out by using AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) before therapy and when SVR-24 was achieved.Results: The study involved 29 subjects. Most of the research subjects were men, with an average age of 40.38 years (SD 3.48). From the results of this study, we found a decrease in APRI scores and FIB-4 index when HCV / HIV coinfection patients, that were treated with Sofosbuvir / Daclatasvir, achieved SVR 24. The median of APRI scores before therapy and after SVR-24 was decreased from 0.41 to 0.28 (95% CI: 0.01 - 0.23, p-value 0,01) and the median of FIB-4 Index before therapy and after the SVR 24 was decreased from 0.94 to 0.81 (95% CI: -0, 04 - 0.35, p-value 0.28).Conclusion: This study concluded that therapy using Sofosbuvir / Daclatasvir in HCV / HIV coinfected patients has very good effectiveness and can reduce liver fibrosis
Endoscopic Variceal Ligation and ß-Blocker Combination Versus Ligation Monotherapy as Variceal Esophagus Bleeding Secondary Prevention
Full text linkBackground: Variceal esophagus' risk of re-bleeding in the first year is 60-70%. Mortality rate of acute bleeding is 20-35%. Latest guidelines of esophageal rupture suggest endoscopic ligation and Non-selective b-Blocker combination for re-bleeding prevention. However, monotherapy still can be chosen, depends on the clinical judgement and patient preference. The previous meta-analysis still gave inconclusive results on therapy combination effectivity. Moreover, there is no side effect discussion between both treatment choices. Hence, this evidence-based case report analyses the effectivity of combination treatment for esophageal bleeding secondary prevention.Method: Literature searching in Scopus, ProQuest, PubMed, ScienceDirect, and EBSCOhost used keywords and their synonyms. Three articles selected included two meta-analyses and one RCT. Critical appraisal on validity, importance, and applicability based on Oxford Center of EBM 2011 was conducted.Results: Two meta-analysis prove treatment combination is significantly effective decreasing variceal re-bleeding. Ravipati et al. results in RR 0.601 (95% CI 0.44 - 0.82). However, Kumar et al. shows non-significant result. On the other hand, three articles show that therapy combination failed to significantly lower the mortality rates RR 0,786 (95% IK 0,45 - 1,39). This is due to the limitation of treatment combination to prevent cirrhotic progression and other complications. Moreover, this also is due to contraindications and non-suitability of the patients toward non-selective b-Blocker in 30-40% cases.Conclusion: Endoscopic ligation and non-selective b-Blocker combination is recommended for variceal esophagus bleeding secondary prevention, but other treatments are needed to lower the mortality rate1
Helicobacter pylori Antral Density More Valuable than Corporal Density in Chronic Gastritis Patients
Full text linkBackground: Helicobacter pylori has the capacity to colonize in stomach. In countries with a high prevalence of H. pylori, biopsy specimens must be obtained from corpus and antrum to elevate the accuracy. However, in a country with low prevalence of H. pylori such as Indonesia, the sensitivity of antrum specimen only is still questionable. We compared the density of H. pylori in the antrum and corpus of Indonesian gastric biopsy.Method: We conducted a prospective, cross-sectional, and observational study in thirty-two samples of corpus and antrum biopsy tissues from Pathology Anatomy Laboratory. The samples were stained by Modified Giemsa or Diff Quik. Updated Sydney System is utilized to classify the density of H. pylori.Results: Among 32 biopsy specimens from corpus and antrum, it has been statistically proven that H. pylori density in antrum and in corpus has a significant difference (65.5% vs. 15.6%, p < 0.001). The density of H. pylori in antrum is mild predominant (43.8%), while the density in corpus is normal predominant (87.5%). Thus, the antral H. pylori infection was the predominant site. In 53.12% case, H. pylori was found in antrum but was not found in the corpus. In 6.24% case, H. pylori was found in both sites, but the density was higher in antrum. Importantly, no case with H. pylori infection in corpus only was found.Conclusion: H. pylori density in antrum is higher than in corpus. Only a small advantage to use additional biopsy from corpus to detect H. pylori in Indonesia
The Diagnosis and Management of Acute Fatty Liver of Pregnancy
Full text linkAcute fatty liver of pregnancy (AFLP) is a rare catastrophic illness constituting an obstetric emergency in third trimester of pregnancy and may have complications for both mother and fetus, including death. Yet it is still unclear, the pathogenesis of AFLP has been identified related to defects in fatty acid metabolism during pregnancy, especially in the setting of fetal genetic defects in fatty oxidation. Establishing the diagnosis of AFLP is challenging, further it may overlap with other liver diseases of pregnancy, such as preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. The management of AFLP is a multidisciplinary progress providing the prompt intervention more than the termination of the pregnancy. The awareness of AFLP is highly needed to provide early diagnosis and management so that it can reduce the morbidity and mortality
Correlation Between Fibrosis-4 (FIB-4) Score and Metavir Score of Chronic Hepatitis C (CHC) Patients in Saiful Anwar Hospital Malang
Full text linkBackground: Hepatitis C still remain a serious problem in Indonesia lead to increasing prevalence , major morbidity and mortality. Liver biopsy is gold standar, invasive procedure for liver fibrosis staging for treatment monitoring and fibrosis regression. Fibrosis-4 (FIB-4) score has been proposed as a non-invasive, easy, inexpensive as alternative indirect marker for the assessment of liver fibrosis in chronic hepatitis C (CHC).Method: Analytical cross sectional study was conducted among 54 patients with CHC from 2012 -2017 in Saiful Anwar Hospital Malang. Subjects were examined for complete blood count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), anti hepatitis C virus (anti HCV), hepatitis C virus ribonucleic acid (HCV RNA), genotype, and performed liver biopsy. Statistical analysis was performed using Spearman test and statistical significant was assumed when p < 0,05.Results: Fifty four (54) patients were fulfilled the selection criteria from total 67 patients. 29 (53%) males, and 25 (47%) were females. The characteristic were 33 (61%) genotype 1, 12 (22%) genotype 2, 5 (9%) genotype 3, and undetermined 3 (6%); with means of HCV RNA titer 2,57 x 106, AST 79 ± 44 IU/L, ALT 77 ± 48 IU/L platelet 160.000/mm3. Distribution of Metavir F1 10 (19%) , Metavir F2 31(57%), Metavir F3 6(11%), and Metavir F4 7 (13%). Median of FIB-4 score as Metavir F1 1,88;Metavir F2 3,24; Metavir F3 5,36; Metavir F4 4,36. There was positive correlation between FIB-4 score and Metavir score (r = 0.38; p = 0,01).Conclusion: This study indicate that there was significant correlation between FIB-4 score and Metavir score in CHC patients
Acute Pancreatitis – Etiology, Pathogenesis, Pathophysiology and The Current Trend in Its Management and Prevention
No full textAcute pancreatitis is an episode of cellular injury and inflammation of the pancreas parenchyma triggered by autodigestion of pancreatic parenchyma by abnormally activated pancreatic enzymes, its manifestations ranges from mild, moderate-severe and severe pancreatitis. Most episode of acute pancreatitis resolved completely while some develop recurrent acute pancreatitis and in turn progressing to chronic pancreatitis and its sequelae. While many etiologies known may cause acute pancreatitis, current theories propose three mechanism that may be involved in the pathogenesis of acute pancreatitis i.e. duct obstruction, direct acinar injury and defective intracellular transport. Recommendations from current guidelines are very useful to treat acute pancreatitis, few groundbreaking changes from the previously dated guidelines on treating acute pancreatitis are also made, providing us dated evidence-based approach to treat acute pancreatitis. Judicious and aggressive treatment are needed to minimize the damaged area of involved pancreatic parenchyma. Holistic prevention is needed to minimize the incidence of acute pancreatitis, pushing down the numbers of recurrent acute pancreatitis and ultimately may decrease the incidence of chronic pancreatitis and its sequelae
Clinicomorphological Profile of Gastric Polyps in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (CMH): A Retrospective Study in Correlation of Long-Term Use of Proton-Pump Inhibitors
No full textBackground: Gastric polyps are mucosal elevation into the lumen, found incidentally during endoscopic examination and generally brings no specific symptoms. Long-term use of proton-pump inhibitors (PPIs) is related to the development of the fundic gland polyp (FGP). This retrospective study was conducted to determine the distribution of gastric polyps in CiptoMangunkusumo Hospital along with histomorphological features and their relation with long-term PPI use.Method: This retrospective review is a descriptive analytic study. Gastric polyp cases were taken consecutively from the archive of the Anatomical Pathology Department, Faculty of Medicine Universitas Indonesia/CiptoMangunkusumo Hospital the period of 2016-2017. Clinical data obtained from patient’s medical records. Statistical analysis was carried out with the IBM ® SPSS version 23 program.Results: Among 83 cases of gastric polyps, there were 66 cases of FGP, 11 cases of inflammatory polyps, 5 cases of hyperplastic polyps, and 1 case of Peutz-Jegher polyp. Long term PPI was used in 40 cases and was related with parietal cell hyperplasia.Conclusion: FGP is the most common type of gastric polyp in the Department of Anatomical Pathology CMH. Long term PPI use was found in half of gastric polyps and was related to parietal cell hyperplasia morphology