The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Not a member yet
381 research outputs found
Sort by
Comparison of Endoscopic Ultrasound (EUS) and Magnetic Resonance Cholangiopancreatography (MRCP) in Diagnosing Cholelithiasis in Acute Biliary Pancreatitis Patients
No full textAim: To determine how endoscopic ultrasound (EUS) is compared to magnetic resonance cholangiopancreatography (MRCP) in diagnosing cholelithiasis in acute biliary pancreatitis.Method: Five steps of evidence based medicine is conducted, they are: (1) Formulate the clinical question; (2) Search the evidence; (3) Appraise the study; (4) Apply the answer; (5) Assess the outcome. The search term in general is: (“cholelithiasis”) and (“EUS”) and (“MRCP”) and diagnosis.Results: We searched in Pubmed and Cochrane library. We excluded articles that do not focus on answering our clinical question. There is one systematic review that is capable of answering our clinical question.Conclusion: It can generally be concluded from this study that EUS and MRCP are useful techniques in the etiological diagnosis of acute pancreatitis of non-established cause. Endoscopic ultrasonography should be preferred for establishing a possible biliary etiology in patients who have not had a cholecystectomy
Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer
No full textDespite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology
CD38+ Liver Stellate Cells in Chronic Hepatitis C Patients with Fibrosis
Get PDFBackground: Approximately 3% of the world population is infected with hepatitis C virus (HCV). Protein of hepatitis C virus modulates apoptosis and steatosis, liver cell injury, activates liver stellate cells and liver fibrosis. Hepatitis C virus infection will cause injury to the hepatocytes. This injury to the hepatocyte will activate liver stellate cells. Stellate cells have a huge role in the development of liver fibrosis. The objective of this study is to evaluate the difference of active CD38+ liver stellate cells in various degree of fibrosis as well as its relation with aspartate transaminase (AST), alanine transaminase (ALT), and quantitative amount of hepatitis c virus ribonucleic acid (HCV RNA) in chronic hepatitis C.Method: This study was a cross-sectional study performed in 32 patients with chronic hepatitis C who had undergone liver USG, did not suffer from hepatoma, had undergone liver biopsy. Paraffin block of patients’ liver tissue was further stained using Haematoxylin and Eosin technique to identify the Metavir degree which is categorized into mild-moderate or severe degree. Special staining is performed to evaluate liver stellate cells that were then counted in averagely in five fields of view.Results: In this study, we found significant difference in the amount of CD38+ stellate liver cells between severe and mild-moderate fibrosis (p < 0.001), there was no association between CD38+ stellate liver cells with AST (p = 0.2) or ALT (p = 0.7), and there was association between CD38+ stellate liver cells with quantitative HCV RNA (r = -0.372).Conclusion: Total amount of CD38+ stellate liver cells in severe fibrosis was higher compared to the total amount of CD38+ liver stellate cells in mild-moderate fibrosis. There was no association between the value of AST, ALT, and quantitative HCV RNA with the number of CD38+ stellate liver cells
Effect of Steamed Broccoli Juice (Brassica oleraceae L. var. italica) to the Serum Interleukin 8 Level in Colitis Murine Model
Get PDFBackground: Ulcerative colitis (UC) is a bowel inflammation that happens in the colon and rectum. In UC there is an increased level of inflammatory mediators, one of which is interleukin-8 (IL-8), the main chemoattractant for polymorphonuclear (PMN) inflammatory cells causing inflammation to worsen. Broccoli (Brassica oleraceae L. var. italica) contains sulforaphane which can inhibit nuclear factor kappa B (NF-ĸB), resulting in the decrease of IL-8. This study was performed to identify the effect of steamed broccoli juice to the serum interleukin-8 level in murine model of colitis.Method: This study was a true experimental laboratory study using complete randomized design. Experimental animals being used were 28 murines with Balb/c strain and were divided into 4 intervention groups. Serum IL-8 level was measured by using enzyme-linked immunosorbent assay (ELISA) method. Data analysis was performed using analysis of variance (ANOVA) test, followed by multiple comparisons Tukey honest significant difference (HSD) test (a = 0.05) and p 0.05.Results: The highest mean of IL-8 level was found in the positive control group. This study also showed highly significant difference (p < 0.001) of IL-8 level between positive control group and treatment group.Conclusion: Steamed broccoli juice could decrease serum interleukin-8 level in murine model of colitis
Chronic Inflammation in Colorectal Carcinogenesis: Role of Inflammatory Mediators, Intestinal Microbes, and Chemoprevention Potency
No full textColorectal carcinogenesis is a multi-factorial process which involves accumulation of genetic defect, protein modification, and cell interaction with matrix in colonic epithelial cells. Chronic inflammation is suspected to play role in carcinogenesis by inhibiting apoptosis, impairing DNA, and chronically stimulating mucosal proliferation. Alteration in intestinal microbes’ population, either in one particular species or in overall composition, may also cause chronic inflammation which increase the risk of developing adenoma or carcinoma.Inflammatory mediators and intestinal microbes have diverse effect in colorectal carcinogenesis. Several may increase host anti-tumor immunity, while the others may increase tumor growth. Various ways of interactionshave just started to be partially understood. In addition, colorectal cancer chemoprevention is a promising and important knowledge due to limited success of current available therapy. Chemopreventive agents are currentlybeing studied and have different success rate.Keywords: inflammation, microbes, chemoprevention, carcinogenesis, colorectal cance
Role of Double Balloon Enteroscopy in the Diagnosis of Obscure Gastrointestinal Bleeding
No full textObscure gastrointestinal bleeding (OGIB) is bleeding in the digestive tract which persist or recur and with unclear aetiology. OGIB is one of the important problems in the gastrointestinal field due to difficulty in diagnosing the aetiology and determining the source of digestive tract bleeding in patients. In diagnosing the cause of OGIB, clinical approach through history taking and physical examination still have important roles. Most of the sources of bleeding in OGIB is from the small intestine, which cannot be reached by esophagogastroduodenoscopy (EGD) or colonoscopy. Therefore, role of diagnostic tool which is able to perform total enteroscopy becomes important in diagnosing the cause of OGIB.Double balloon enteroscopy (DBE) technique is a safe endoscopy procedure which may use oral or even rectal approach. In finding the cause of OGIB, where most of the lesions is found in the proximal region of the small intestine, oral approach is more beneficial. When bleeding is not found after conventional endoscopy is performed, it needs to be suspected that the source might come from the small intestine. Currently, the two main modalities which can be used in the evaluation are video capsule endoscopy (VCE) and DBE. However, based on cost effectiveness DBE without prior VCE has benefit because it can also administer therapy in the abnormalities being found. Keywords: obscure gastrointestinal bleeding, endoscopy, diagnosis, double balloon enteroscop
Alpha-1 Acid Glycoprotein Cut-off Value as Diagnostic Biomarker in Hepatocelular Carcinoma with Liver Cirrhosis
No full textBackground: Hepatocellular carcinoma (HCC) remains a major problem throughout the world, especially in diagnostic and therapeutic management. Previous studies stated that alpha-1 acid glycoprotein (AAG) was a potensial biomarker in diagnostic of HCC. This study assessed the best cut-off value of AAG as a diagnostic biomarker of HCC with liver cirrhosis.Method: This was a cross-sectional, diagnostic study, conducted from January to October 2013 in Cipto Mangunkusumo Hospital. The subjects were HCC with liver cirrhosis patients and as control were liver cirrhosis patients. Abdominal ultrasonography (USG), abdominal 3 phase contrast computerized tomography (CT) scan, and liver biopsy, if necessary, were done. All patients were having AAG examination, then the result was analyzed using receiver operating characteristic (ROC) curve and assessment of some cut-off values was done.Results: There were 25 HCC with liver cirrhosis patients and 37 liver cirrhosis patients as control included in this study. HCC with liver cirrhosis patients were 92% male and 8% were female, over 50 years old (72%). HBV infection was the most common etiology and most of the patients had multiple nodules in the liver (80%). ROC curve showed the area under the curve (AUC) was 81.44%.Conclusion: The best cut-off value of AAG to be aware of HCC with liver cirrhosis was 61 mg/dL and as a diagnostic was 136 mg/dL. Keywords: hepatocelullar carcinoma, alpha-1 acid glycoprotein, cut-off
Correlation between Quantitative HBsAg and HBV-DNA in Chronic Hepatitis B Infection
No full textBackground: Methods used to diagnose and monitor chronic hepatitis B (CHB) by quantitation of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) levels is expensive. Cheaper laboratory test as an additional markeris needed, thus we studied serum quantitative HBsAg to be used as surrogate marker in CHB patients. This study was aimed to investigate correlation between serum quantitative HBsAg and HBV-DNA in CHB patients.Method: In this cross-sectional study, we enrolled 62 CHB patients between January 2010 and December 2012 who had quantitative HBsAg and HBV-DNA assays in a private laboratory at Denpasar. HBV-DNA was measured by real-time polymerase chain reaction and quantitative serum HBsAg was measured by chemiluminescent microparticle immunoassay (CMIA). Stastistical analysis was performed by Mann-Whitney and Spearman’s correlation.Results: Of 62 patients, most subjects were males (82.26%). Mean HBsAg titer of CHB in HBeAg positive and negative patients were 281,000 and 4,900 IU/mL, respectively; while mean HBV-DNA in HBeAg positiveand negative patients were 59,000,000 and 7,530,000 IU/mL, respectively. We found that quantitative HBsAg and HBV-DNA in HBeAg positive and HBeAg negative patients were statistically signi cant (p = 0.0001, p = 0.0001, respectively). Signi cant correlation was found between serum quantitative HBsAg and HBV-DNA (r = 0.737; p= 0.000). Quantitative HBsAg was signi cantly correlated with HBV-DNA in HBeAg-positive subgroup (r = 0.717; p = 0.0001); and signi cant correlation was also found in HBeAg-negative subgroup (r = 0.443; p = 0.006) although the correlation was weak. Conclusion: Quantitative HBsAg has signi cant correlation with HBV-DNA in CHB patients. Keywords: quantitative HBsAg Assay, HBV-DNA, HBeAg, chronic hepatitis B infectio
The Use of Balanced Scorecard to Support Achievement of Business Plan in Digestive Endoscopy Center, 2013
No full textBackground: Digestive Endoscopy Center, Cipto Mangunkusumo Hospital was established in 2011 in which the concept was developed as center of excellence (CoE). The business plan was created based on safety and patient satisfaction, fast, accurate, quality and one stop services. 2013 is the 2nd year in Digestive Endoscopy Center business plan development and it is expected to increase in many aspects. The aim of this study is to measure the performance of business plan in Digestive Endoscopy Center.Method: This study was conducted from April-December 2013 with quantitative method and cross sectional studies on 76 subjects and also used secondary data from endoscopy’s reports. The balanced scorecard contains 4 measurements, such as financial approach, customer approach, internal process approach, and learning and growth approach. Results: The financial approach resulted that income from 2 types of patients (cash and insurance) were increased in 2013. The customer approach resulted a high satisfaction rate with mean 4.69 of 5 for patient satisfaction and the employee satisfaction increased in 2013 (mean: 3.88 of 5) and in 2010 (mean: 3.64 of 5). Internal process approach was measured using facilities and infrastructure discovered is increased too. Learning and growth approach resulted that accumulation of trainings, achievement of target of the trainings was increased.Conclusion: The achievement of bussiness plan has been evaluated using balanced scored card and showed that there is a balance on the financial approach, customer approach, internal process approach, and learning and growth approach.Keywords: business plan, digestive endoscopy center, balance scorecard
Gastric pH Comparison Between Mild and Severe Cirrhotic Portal Hypertensive Gastropathy
No full textBackground: One of the causes of upper gastrointestinal bleeding in patients with liver cirrhosis is thepresence of portal hypertensive gastropathy (PHG). The prevalence of PHG in patients with liver cirrhosis isquite high but there is still inconsistency regarding the studies about gastric pH in cirrhosis patient. The aim of this study is to compare the gastric pH in mild and severe PHG due to liver cirrhosis.Method: Cross sectional method with consecutive sampling was done to all liver cirrhotic patients who came to Clinic of Gastroenterology and Hepatology in Cipto Mangunkusumo hospital from March to May 2014. Sixtytwo patients with portal hypertensive gastropathy underwent endoscopy to measure the degree of gastropathy based on Mc Cormack classification ad the mean basal gastric pH using pH-metric.Results: There are 50 (80.6%) male patients and 12 (19.4%) female patients participated in this study. Portal hypertensive gastropathy is mostly caused by hepatitis C (56.5%), hepatitis B (32.3%), non-hepatitis (8.1%) and alcohol (3.2%). The mean of gastric pH in all liver cirrhosis patients with portal hypertensive gastropathy was 2.13.The mean gastric pH in liver cirrhosis patient with mild portal hypertensive gastropathy (2.00 mEq/L) was lower than the gastric pH in severe portal hypertensive gastropathy (2.25 mEq/L) with significant differences (p<0.05)Conclusion: The gastric pH in liver cirrhosis patient between mild and severe portal hypertensive gastropathy are significantly different Keywords: gastric pH, liver cirrhosis, portal hypertensive gastropathy, pH-metri