The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Self Expanding Metallic Stent Placement as a Palliative Therapy for an Advanced Gastric Cancer Patient
No full textPatients with gastric cancer which infiltrates distal esophagus often complain of dysphagia. Stenting is currently the therapy of choice for malignant dysphagia. Self expanding metallic stent (SEMS) placement has become the standard stenting therapy.We reported a case of 63 year old male patient with an advanced gastric adenocarcinoma which infiltrated distal esophagus who complained of dysphagia. The diagnosis was made based on esophago gastro duodenoscopy (EGD), histopathology study and contrast enhanced abdominal computed tomography (CT) scan. Patient underwent esophageal stenting successfully. This case report demonstrates SEMS placement as an effectivepalliation therapy in patient with an advanced gastric cancer which infiltrated distal esophagus.Keywords: gastric cancer, self expanding metallic stents, malignant dysphagi
Detection of Hepatitis B Virus Pre-core Mutant by Allele Specific Polymerase Chain Reaction
No full textIntroduction: Mutation in pre-core region is characterized by negative HBeAg and positive anti-HBe despite active replications of the virus. The mutation has diagnostic and prognostic implications. Therefore, detectionof pre-core mutant is important. Standard diagnosis approach for detecting pre-core mutant is through DNA sequencing of hepatitis B virus (HBV) pre-core region. Unfortunately, DNA sequencing is not available in mostcenters. Hence, a simpler diagnostic approach is necessary.Method: An observational-analytic design study was performed. Detection of pre-core mutant was conducted in individuals with positive HBsAg and HBV DNA that had various patterns of HBeAg and anti HBe. HBsAg, HBeAg and anti-HBe was detected using immunochromatography technique. The HBV DNA was evaluated by using qualitative polymerase chain reaction (PCR) testing. PCR was done by three rounds of amplification with primers derived from wild type pre-core and mutant pre-core. Results: Of 25 sera with HBeAg negative, anti-HBe positive and HBV DNA positive, allele specific (AS) PCR pre-core mutant was detected in 20 (80%) sera. Two sera with HBeAg negative, anti HBe negative and HBV DNA positive were negative for pre-core mutant. Of 8 sera with HBeAg positive, anti HBe negative and HBV DNA positive, pre-core mutant was detected in 2 (25%) sera.Conclusion: Most of individuals with HBV DNA positive, HBeAg negative and anti-HBe positive have harbored pre-core mutant. The finding indicated that all patients with HBsAg positive, HBV DNA positive and HBeAg negative, but anti-HBe positive should be examined for the presence of pre-core mutant. Pre-core mutant is also found in HBeAg positive individual. Keywords: HBV, pre-core mutant, polymerase chain reactio
Prevention of Hepatitis B Virus Transmission in Pregnancy
No full textChronic hepatitis B virus infection is a serious health problem in many countries, particularly in developing countries. In Asia-Pacific region, vertical transmission from mother to child is the main endemicity factor of hepatitis B virus (HBV) infection. Almost 50% cases of hepatitis B virus infection happen during perinatal and neonatal period, including vertical transmission from mother to child during pregnancy.World Health Organization (WHO), World Gastroenterology Organization (WGO) and many countries have recommended immunoprophylaxis by the administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) to prevent transmission from mother to child. However, there are approximately 10-15% babies born from mother with hepatitis B infected by HBV through intrauterine transmission. Incidence of intrauterine transmission is accounted for around 43-50% if DNA of HBV in the mother is more than 107 copies/mL, although passive and active immunization to the baby has been administered. Therefore, administering antiviral drugs in pregnant women with chronic hepatitis B accompanied by immunoprophylaxis is effective in preventing hepatitis B infection transmission during pregnancy, particularly in decreasing the number of virus and administering active or even passive immunization to neonates. Keywords: hepatitis B, pregnancy, prevention, transmissio
Cranial Metastasis as Initial Manifestation of Hepatocellular Carcinoma
No full textCranial metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor withoutliver dysfunction is a very rare event. Cranial metastasis may be the sole initial presentation of HCC. Earlydiagnosis is essential in order to treat the primary disease. Cranial metastasis from HCC should be consideredin the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.A 55 year old female patient without known liver disease, presented with a palpable right occipital scalp mass. On head computed tomography (CT) scan, a tumor on right orbita wall, osteolytic skull and invasion to theright frontal lobe was observed. The histological diagnosis obtained from the biopsy was a poorly differentiatedcranial metastasis adenocarcinoma that was difficult to determine the origin. On positron emission tomography(PET) scan, there was a hypermetabolic mass around intra hepatal bile duct which suspicious primary cancer.The histological diagnosis obtained from the liver biopsy was appropriate with HCC grade II. The metastatictumor was removed via occipital craniectomy. She received a palliative course of external beam radiationtherapy to the right orbit. Then, she received symptomatic treatment and herbal medicine with cassava leavesfor the last three months. Evaluation of bone survey shows lytic lesion at calvaria and compression fractureat vertebrae thoracal 11-12 appropriate with metastasis process. According to Barcelona Clinic Liver Cancer(BCLC) criteria she suffered from HCC terminal stage D with average survival of about 4 months.Keywords: hepatocellular carcinoma, cranial metastasis, palliative treatment ABSTRAKMetastasis kranial dari karsinoma hepatoselular sebelum diagnosis tumor primer dengan hasil tanpa adanyagangguan fungsi hati adalah peristiwa sangat jarang ditemui. Metastasis pada tulang kranial dapat menjadi salah satu presentasi awal dari karsinoma hepatoseluler. Menegakkan diagnosis di awal sangat diperlukan untuk menentukan penatalaksanaan pada penyakit primer. Metastasis pada kranial dari karsinoma hepatoseluler harusdipertimbangkan pada kasus subkutan skalp tumor dan pada pasien dengan defek osteolitik pada gambaranradiologi.Seorang pasien perempuan usia 55 tahun, yang tidak didapatkan riwayat penyakit hati sebelumnya, datangdengan benjolan pada region oksipital kanan. Hasil computed tomography (CT) scan kepala didapatkantumor pada dinding orbita kanan. Dari pemeriksaan histologi menunjukkan metastasis dari adenokarsinomaberdiferensiasi buruk yang sulit ditentukan asalnya. Pada pemeriksaan positron emission tomography (PET)scan, terdapat massa hipermetabolik di sekitar duktus intrahepatik yang diduga sebagai tumor primer. Hasil biopsi menunjukkan karsinoma hepatoselular derajat 2. Dilakukan kraniektomi region oksipital pada penyebaran tumor dan dilanjutkan radioterapi paliatif pada region oksipital kanan. Selanjutnya pasien hanya mendapatkanterapi simtomatik dan daun singkong sebagai terapi herbal selama 3 bulan terakhir. Evaluasi survei tulangsetelah 3 bulan menunjukkan lesi litik pada kalvaria dan fraktur kompresi pada tulang vertebrae thorakal 11- 12. Menurut kriteria Barcelona Clinic Liver Cancer (BCLC) pasien tersebut masuk ke dalam stadium terminalD dengan rata-rata angka harapan hidup 4 bulan setelah terdiagnosis.Kata kunci: karsinoma hepatoseluler, metastasis kranial, terapi paliati
Correlation between Serum Albumin and Fasting Blood Glucose Level in Patients with Liver Cirrhosis
No full textBackground: Liver cirrhosis is a pathological condition describes the end-stage of liver fibrosis. On liver damage may occur impaired glucose metabolism such as insulin resistance and glucose intolerance. The correlation between chronic liver diseases with impaired glucose metabolism has been known as hepatogenous diabetes. Albumin levels were significantly affected by poorly controlled blood glucose seen from the high HbA1c. This study aims to determine correlation of serum albumin level and fasting blood glucose level in patients with liver cirrhosis.Method: This cross-sectional study was conducted in 52 patients with liver cirrhosis in Gastroentero-hepatology Clinic and Inpatients, Hasan Sadikin Hospital. The study was conducted from February to June 2013. History taking, physical examination and laboratory tests including liver function tests and fasting blood glucose were performed. Data were analyzed using Spearman rank test for the correlation.Results: There were 31 (59.6%) males and 21 (40.4%) females with mean age 53.4 ± 12.8 years. The mean serum albumin was 2.7 ± 0.5 g/dL and median fasting blood glucose was 100 (66-195) mg/dL. Etiology of liver cirrhosis was hepatitis B virus infection 28 (51.9%), hepatitis C virus infection 16 (30.8%) and non viral hepatitis B and C infection 9 (17.3%). Severity of cirrhosis scored using child turcotte pugh (CTP) which was 43 (82.7%) of CTP B and 9 (17.3%) of CTP C. There was statistically significant correlation between albumin level and fasting blood glucose with ρ = -0.630 and p < 0.01.Conclusion: In patients with liver cirrhosis have low serum albumin level correlates with high fasting blood glucose. Keywords: cirrhosis, albumin, fasting blood glucos
Role of Proton Pump Inhibitor in the Management of Acid-Related Disorders
No full textProton pump inhibitor (PPI) is the strongest inhibitor to gastric acid secretion. PPI is effective in all gastricacid disorders, such as: peptic ulcer, gastroesofageal reflux disease, non steroid anti inflammatory drugs (NSAIDs)gastropathy, and Zollinger-Ellison syndrome. Several studies comparing one PPI to another. Although somedifferences have been reported, there are small differences with unclear clinical importance.PPI has side effects that may be related to diarrhea due to Clostridium difficile, pneumonia, hip fracture, vitamin B12 deficiency, and IgE mediated allergic reaction. Several studies revealed strong association but havelimitation in design and sampel size. PPI therapy should be according to indication, dose, and appropriate period.Keywords: proton pump inhibitor, gastric acid disorder, indication, dose, period ABSTRAKPenghambat pompa proton (PPP) adalah inhibitor paling kuat terhadap sekresi asam lambung. PPPefektif untuk terapi semua gangguan asam lambung termasuk ulkus peptikum, penyakit gastroesofageal reflux,gastropati karena obat anti inflamasi non steroid (OAINS), dan sindrom Zollinger-Ellison. Beberapa penelitianmembandingkan beragam PPP satu dengan yang lainnya. Walaupun dilaporkan ada beberapa perbedaan,namun besaran perbedaannya kecil dan tidak jelas kepentingan klinisnya.PPP kemungkinan berkaitan dengan efek samping diare karena Clostridium difficile, pneumonia, frakturpanggul, defisiensi vitamin B12, dan reaksi alergi yang dimediasi IgE. Beberapa penelitian menunjukkanhubungan yang kuat namun memiliki keterbatasan desain dan besaran sampel. Terapi PPP harus sesuai denganindikasi, dosis, dan jangka waktu yang tepat.Kata kunci: penghambat pompa proton, gangguan asam lambung, indikasi, dosis, jangka wakt
Mirizzi Syndrome in Gallstone Complication
No full textMirizzi syndrome is a rare complication of gallstone which is characterized by the presence of gallstone impaction in cystic duct that leads to inflammatory stricture in the biliary duct and results in obstructive jaundice. In this report, we highlighted the diagnostic approach and management of Mirizzi syndrome in a 58 year-old male complaining of nausea, vomiting, and appearing jaundice. The role of imaging such as abdominal ultrasonography in depicting the characteristics of Mirizzi syndrome was also discussed and compared the findings with the classification of the disease in the literature. In this patient, Mirizzi syndrome was suspected by the appearance acoustic shadow in the gallbladder with dilated cystic duct suggesting the impaction of common bile duct (CBD). We performed endoscopic retrograde cholangiopancreatography (ERCP) as both diagnostic and therapeutic modalities by which we allowed sphingterectomy to evacuate the gallstone. However, due to the risk of further stone evacuation, the procedure was followed by elective cholecystectomy. Keywords: gallstone, Mirizzi syndrome, complicatio
The Effect of Zinc Supplementation in Adult Patients with Acute Diarrhea
No full textBackground: Acute diarrhea is a common problem in developing country such as Indonesia with quite high morbidity andmortality rate. It was revealed that the level of zinc deficiency in adult acute diarrhea patients in several hospitals in Jakarta was 69.3%. Although zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients, the effect of zinc supplementation is not fully understood. The objective of this study was to discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients.Method: A double blind randomized controlled trial was done to discover the effect of zinc supplementation to the duration, signs and symptoms on acute diarrhea in hospitalized adults patients in Pertamina Central Hospital, Jakarta from January to December 2013. The data was analyzed using Chi-square test to compare the duration of diarrhea and general linear model (GLM) to assess changes of the symptoms accompanying diarrhea.Results: Data analysis from 84 patients, 30 males (19 zinc, 11 placebo) and 54 females (23 zinc, 31 placebo) with p = 0.111 showed that zinc supplementation significantly reduced the duration of acute diarrhea (p = 0.027) and nausea (p = 0.032). In addition there is a tendency of improvement in several acute diarrhea associated symptoms.Conclusion: Zinc supplementation significantly reduces the duration of diarrhea, nausea, as well as improving some symptoms accompanying acute diarrhea. Keywords: zinc supplementation, acute diarrhea, adult patien
The Use of Immunochemical Fecal Occult Blood Test as Colorectal Cancer Screening Tool in Asymptomatic Population in Indonesia
No full textBackground: Colorectal cancer is the fourth leading cause of cancer-related mortality worldwide. Earlydetection of colorectal cancer is necessary in term of increasing survival. Immunochemical fecal occult bloodtest (I-FOBT) is one of the simple and inexpensive screening modality that can be used widely. No data has been available yet regarding the usage of I-FOBT in Indonesia. This study is a prevalence study of I-FOBT in asymptomatic population in Indonesia. Method: A cross sectional study was conducted in asymptomatic population visiting five public health service centers in Depok district, West Java, Indonesia. This study was performed from January to March 2012. Casereport form and I-FOBT kit were used to assess and screen the patients. Statistic analysis was performed usingChi-square test. Results: The prevalence of positive I-FOBT was almost equally distributed among age group. Femaledominated whole patients 202 (72.7%). Most of them had middle to low education level 116 (41.7%). As manyas 50.7% patients had normal body mass index. We had 11 (4%) patients with positive result of I-FOBT. Conclusion: Prevalence of positive result of I-FOBT in asymptomatic population in Indonesia was 4%.Further studies were needed to confirm sensitivity and specifity of I-FOBT in Indonesia.Keywords: colorectal cancer, immunochemical fecal occult blood test (I-FOBT), early detectio