The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Factors that Influence Cecal Intubation Rate in Unsedated Patients during Colonoscopy
No full textBackground: Successful cecal intubation is a primary quality indicator in colonoscopies and the mostimportant factor in detecting abnormal lesion in the colon. There are many factors that influence cecal intubationrate during colonoscopy procedure. The aim of this study is to evaluate the factors that influence cecal intubationrate in unsedated patients during colonoscopy. Method: A retrospective study of colonoscopy performed at Sardjito General Hospital, Jogjakarta, from January 2012 to August 2013. Age, sex, bowel preparation, indication for colonoscopy, colonoscopist, andreasons of incomplete colonoscopy from 564 colonoscopy reports were recorded and analysed. Results: Overall successful cecal intubation rate was 408 (72.34%). Causes of incomplete colonoscopywere patients discomfort or pain 41.66%, looping/redundant 28.85%, poor bowel preparation 18.59%, fixation/adhesion 6.41%, and bleeding risk 4.49%. Female was more unsuccessful in cecal intubation than male (31.50%vs. 24.05%; p = 0.048). The successful cecal intubation rates for gastroenterologists compared to gastroenterology(GI) fellows were 77.92% vs. 49.55%; p < 0.001, and poor bowel preparation was more difficult to reach cecalthan good preparation (57.58% vs. 23.69%; p < 0.001). Multivariate logistic regression analysis demonstratedthat female and poor bowel preparation were independently associated with lower cecal intubation rate, andgastroenterologists were independently associated less unsuccessful to reach cecal. Conclusion: The overall successful cecal intubation rate was still below the set standard. Several identifiedfactors that may predict lower of cecal intubation rate: the skill and experience of colonoscopists (GI fellows),poor bowel preparation and female.Keywords: cecal intubation rate, colonoscopy, unsedated colonoscop
Chronic Radiation Proctosigmoiditis in Patients with Cervical Cancer
No full textComplications in rectum and sigmoid due to radiation are usually called radiation proctosigmoiditis. It can be acute or chronic based on the onset of symptoms during radiation treatment. There are some treatment modalities aimed for reducing rectosigmoid bleeding and improving symptoms of chronic radiation proctosigmoiditis, which include medication, endoscopy and surgery. Most data about the effectiveness of those various modalities are provided by short-term studies with small sample size.A female patient, 59 years old, came with a chief complaint of passing persistent fresh bright red bloody stool since 1 year before admission. The patient was then diagnosed with stage IIIB cervical cancer and she received 25 times of external radiation, 3 times of internal radiation and 3 times of chemotherapy. She was diagnosed with chronic radiation proctosigmoiditis and treatment to stop the bleeding was carried out by performing argon plasma coagulation through colonoscopy. The problems in the patient were formulated as chronic radiation proctosigmoiditis with malnutrition and iron deficiency anemia due to chronic bleeding. Non-pharmacological and pharmacological medications were administered.Keywords: radiation proctosigmoiditis, argon plasma coagulation, medicatio
Helicobacter pylori Infection in Children with Recurrent Abdominal Pain and Positive Biopsy Findings
No full textRisk factors for Helicobacter pylori (H. pylori) infection include residence in a developing country, poor socio-economic status, overcrowding family, ethnic and genetic predisposition. The diagnosis and management H. pylori have not been satisfied yet; however, there is a problem of increasing H. pylori antibiotic resistance. We reported a case of 8 year-old girl who suffered from H. pylori infection. The diagnosis was made based on history, clinical findings, and laboratory work-up. Suspicion of H. pylori infection was started when she had recurrent abdominal pain. The result of serologic testing for H. pylori immunoglobulin G (IgG) was positive. Endoscopic biopsy revealed the presence of H. pylori. Patient received regimens for first line eradication of H. pylori, i.e. amoxicillin, clarithromycin and omeprazole for two weeks. Afterward, her condition improved markedly without any further complaint.Keywords: Helicobacter pylori, children, recurrent abdominal pai
Imaging Modalities Role inRecurrent Acute Pancreatitis Diagnosis
No full textRecurrent acute pancreatitis (RAP) is a potentially life-threatening pancreatic disorder. Itrequires a combination of medical and interventional skills to diagnose, determine the etiology, and treat the condition. Recurrencesoccur in 25-30% of all acute pancreatitis cases. The most common cause of RAP is gallstone (microlithiasis). Imaging modalities become an important aspect to evaluate multiple microlithiasis. In this case, we report a 52 years oldoverweight female with RAP and fatty liver ofunknown etiology.We suspected gallstone as the cause of RAP. Physical examination considered normal. Ultrasound and abdominal CT scan wasperformed in whichfatty liver were founded. Since the gallstone is not clearly found with radiologic imaging, we decide to undergoEndoscopic Retrograde Cholangiopancreatography(ERCP)procedure to evaluatea possibility of microlithiasis. ERCPresult showed a multiple microlithiasis, thus we evacuate the stones. Clinical outcome post ERCP and evacuationprocedure was good. We concluded that the best imaging modalities to evaluate microlithiasis in RAP with normal ultrasound and abdominal CT scan is ERCP. Keywords:recurrent acute pancreatitis (RAP), microlithiasis, endoscopic retrograde cholangiopancreatography (ERCP)
17 Year Old Female Patient with Systemic Lupus Erythematosus and Ulcerative Colitis
No full textGastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Although the relationshipbetween SLE with ulcerative colitis (UC) rarely obtained, SLE patients with gastrointestinal manifestations shouldpreferably be evaluated for the possibility of an inflammatory bowel disease (IBD). UC prognosis associatedwith SLE is usually good, whereas by proper diagnosis and management, the clinical output and a good life expectancy of patients will be obtainedA young female, 17 years old, who had previously been diagnosed with SLE for 5 years, came with complaintsof abdominal pain and chronic diarrhea. From the results of colonoscopy and biopsy of the intestinal mucosawas noted that in accordance with UC. After receiving treatment for 6 days, she no longer obtained complaintsof abdominal pain and diarrhea. Keywords: systemic lupus erythematosus, gastrointestinal, ulcerative colitis, inflammatory bowel disease ABSTRAKManifestasi gastrointestinal merupakan hal yang sering terjadi pada lupus eritematosus sistemik (LES).Meskipun hubungan antara LES dengan kolitis ulseratif (KU) jarang didapatkan, sebaiknya pada pasien LESdengan manifestasi gastrointestinal dilakukan evaluasi untuk kemungkinan adanya suatu penyakit inflamasiusus besar. Prognosis UC terkait LES biasanya baik, dimana dengan diagnosis dan penatalaksanaan yang tepatakan didapatkan keluaran klinis dan harapan hidup yang baik pada pasien.Seorang perempuan muda berusia 17 tahun yang sebelumnya telah terdiagnosa LES selama 5 tahun, datangdengan keluhan nyeri perut dan diare kronik. Dari hasil pemeriksaan kolonoskopi dan biopsi mukosa ususdidapatkan gambaran yang sesuai dengan KU. Setelah mendapat terapi selama 6 hari, tidak didapatkan lagi keluhan nyeri perut dan diare.Kata kunci: lupus eritematosus sistemik, gastrointestinal, colitis ulseratif, penyakit inflamasi usus besa
Natural Evolution of Regurgitation in Children Aged 12-24 Months: A 1-year Cohort Study
No full textBackground: There are very limited cohort studies regarding long term outcome of gastroesophageal reflux diseases (GERD), especially until 24 months old. The aim of this study is to see the natural history of GERD in12-24 months old children based on their clinical signs and symptoms.Method: Prospective one year population base cohort study involving 262 children. Their regurgitation history and GERD symptoms were recorded every two months.Results: Two hundred and fivety three children completed the study. Seventy three children (27.8%) were still having regurgitation when they were 6 months old, 44 (16.7%) until 9 months old, and 24 (9.2%) until 12months old. During 12 months follow-up the prevalence and frequency of regurgitation decreased to 2.4% and 1.2% in the age of 18 and 24 months respectively. Infant with regurgitation at 6 months old were 13.2 times more likely to have regurgitation at 12 months old (RR = 13.2; 95% CI = 4.8-36.6). Prevalence of regurgitation after 18 months old were 37 times higher risk compared to those not regurgitating at the age of 12 months (RR = 37; 95% CI = 2.2–613.9). GERD symptoms were higher in children that were still regurgitating until 9 months old 64.5% (RR = 2.3; 95% CI = 1.7-3.0) compared to those only experiencing until 6 months old 54.7% (RR = 1.3; 95% CI = 1.7-3.0).Conclusion: Regurgitation decrease during 12-24 months old period. The history of regurgitation in 6 and 9 months old is related to the probability to become GERD in 12-24 months old period. Keywords: gastroesophageal reflux, children 12-24 months, GERD symptom
Reactivation of Hepatitis B Infection During the Cause of Non Hodgkin's Lymphoma Chemotherapy
No full textHepatitis due to hepatitis B virus (HBV) reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. Frequently used combination regimens in Non-Hodgkin’s lymphoma are cyclophosphamide, hydroxydaunomycin (adriamycin), vincristine (oncovin), and prednison (CHOP). The use of rituximab, a monoclonal antibody targeting CD20 antigen present in benign and malignant B-cells, in combination with systemic chemotherapy has resulted in an improved duration of remission and survival for this patients. Rituximab is a HBV reactivation risk factor even greater than corticosteroids in a series of patients with lymphoma treated with combined-modality treatment (CMT).A 43 years old female patient who already diagnosed with Non-Hodgkin’s lymphoma, came with chief complain nausea and vomiting for three weeks. The patient recently got hospitalized with icteric and known have positive HBsAg. She received chemotherapy rituximab CHOP (R-CHOP) for four times and got rituximab in the last chemotherapy. Previously she had icteric and increased liver function test. After exclude other possibility causes this symptom and sign, it was concluded this is HBV reactivation. The chemotherapy was postponed until this reactivation of hepatitis B resolved and start giving lamivudine two weeks before reintroduce chemotherapy.Keywords: antiviral treatment, chemotherapy, hepatitis B virus, reactivatio
Portal Hypertensive Gastropathy: the Twilight Zone
No full textAs one of the major complication of liver cirrhosis, portal hypertensive gastropathy (PHG) should be an interesting topic to study. Until now the exact mechanism on how this phenomenon happened is yet, not clear.1 The occurrence of PHG is quite high in patient liver cirrhosis and some relationship occurred between PHG and portal hypertension. In liver cirrhosis patients, PHG may be closely associated with hepatic vein pressure gradient(HVPG).2 However, PHG may not be directly associated with portal pressure because the mucosal damage not linearly correlated with portal hypertension, hence other mechanism involved in the etiopathogenesis of PHG. In this regards, the most important factor related to PHG is the pressure in the splanchnic vasculature. Based on histopathology study in PHG, vascular congestion resulted from increased portal pressure reduced oxygen for gastric mucosa, hence exposed mucosal layer to irritants.2 Moreover, the congestion somehow increased the production of nitric oxide, either through the shearstress locally or as the result of increase production of splanchnic vasculature due to portal hypertension
Risk Factors of Chronic Atrophic Gastritis
No full textBackground: Chronic atrophic gastritis is a well-established precursor of gastric cancer. The development of atrophic chronic gastritis is multifactorial, involving the environment as well as host responses to the Helicobacter pylori (H. pylori) infection. The aim of this study is to determine prevalence and risk factors of chronic atrophic gastritis.Method: The study was a cross sectional study on gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, from May-October 2014. A simple random sampling was performed to obtain 50 patients. Data concerning sociodemographic factors and H. pylori status were collected. H. pylori were considered positive from the positive results of the campylobacter like organism (CLO) test. Univariate and bivariate analyses were performed using the SPSS 22 with 95% confidence interval. Bivariat analysis was performed using a Chi-square test. Results: Prevalence of chronic atrophic gastritis was 40%. There were associations between age and chronic atrophic gastritis (95% CI = 1.05-2.80; p = 0.021; OR = 1.73), body mass index and chronic atrophic gastritis (95% CI = 1.1-3.1; p = 0.011; OR = 1.85), and H.pylori infection and chronic atrophic gastritis (95% CI = 1.23-4.88; OR = 2.45; p = 0.001). There were no associations between gender, ethnicity, or rural-urban classification and chronic atrophic gastritis (p > 0.05).Conclusion: Elderly status, low BMI, and H. pylori infection are risk factors for the development of chronic atrophic gastritis. Keywords: chronic atrophic gastritis, Helicobacter pylori, gastric atrophy, body mass inde
Splanchnic Hypoperfusion and Enteral Feeding
No full textHypoperfusion or decrease in blood flow is may cause organ failure. When the body experiences hypoperfusion, body perfusion is prioritized to brain and heart, which may cause the hypoperfusion of splanchnic organ. Splanchnic hypoperfusion will cause ischemia of the mucosa, disturbance in the barrier, and increased splanchnic permeability, which in further level mayl cause bacterial and endotoxin translocation to systemic circulation.Enteral feeding in hypoperfusion is beneficial to prevent splanchnic hypoperfusion. However, method of enteral feeding needs to be considered, so that it does not cause harmful adverse effects. Early enteral feeding by slow continuous drip method can prevent splanchnic failure in critically ill patients with high risk of hypoperfusion. Keywords: splanchnic hypoperfusion, enteral feeding, continuous slow drip metho