The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Clinical Characteristics and Microbiological Profiles of Community-Acquired Intra-Abdominal Infections
No full textBackground: Intra-abdominal infections (IAIs) have different aspects to consider. One important aspectis the microbiological analyses, especially in the era of broad spread of resistant microorganisms. The studywas designed to describe the clinical characteristics and microbiological profiles of community acquired IAIs. Method: An observational study was performed on medical records of 12 months period (January toDecember 2013) in a General Hospital, Karawaci, Tangerang. Adult patients undergoing surgery for IAIs with positive microbiological culture and identification of microorganisms were included. Data collected were clinical characteristics and microbiological profiles and wereanalyzed statisticallyusing the SPSS version 17. Results: In 12 months period of study, 17 patients of IAIs with a total of 17 intra peritoneal specimens were collected. A total of six microorganisms were cultured. All the IAIs were monomicrobial, with aerobicmicroorganism dominantly Gram-negative bacilli. The dominant microorganism was Escherichia coli (E.coli), found in 58.8% of IAIs. The most common site was appendix (41.2%), and none from small intestine. Thesusceptibility test found that piperacillin tazobactam, tigecycline, meropenem and amikacin were the most activeantimicrobial against E. coli. Multi-drug resistant (MDR) E. coli in this study was 40%. The MDR E. coli had66.6% resistance to levofloxacin and ciprofloxacin, 66.6% susceptibility to ceftriaxone and ceftazidime, and100.0% susceptibility to amikacin. Conclusion: The most common site of community-acquired IAIs was appendix (41.2%). E. coli is still adominant microorganism with the MDR E. coli proportion of 40%.Keywords: intra-abdominal infections, clinical characteristics, microbiological profile
Current Prevention and Management of Non Steroid Anti Inflammatory Drugs Associated Gastroenteropathy
No full textNon-steroid anti-inflammatory drugs (NSAIDs) are the most frequently used drugs to treat inflammation and are used almost in the whole world. However, NSAID is one of the important causes of gastroenteropathy development. NSAIDs enteropathy is frequently undetected because most of them are asymptomatic and required sophisticated examinations to diagnose. Not only non-selective cyclo-oxygenases (COX) inhibitor that can cause NSAID gastropathy, but selective COX-2 inhibitors may also cause gastrointestinal complications. NSAID gastroenteropathy require further evaluation and it may differ between patients.Currently, there is no effective treatment available to treat gastrointestinal damage associated with NSAIDs administration. Identification of protective factors in gastrointestinal complication due to NSAIDs use is still a serious challenge. In this review, we will discuss the effect of NSAID administration towards gastrointestinal system, also the prevention and management strategies.Keywords: non-steroid anti-inflammatory drugs, gastroenteropathy, COX inhibitor, prevention, treatmen
Chemotherapy for Advanced Colorectal Cancer among Indonesians in a Private Hospital in Jakarta: Survival when Best Treatment is Given
No full textBackground: Survival of colorectal cancer in Indonesia is thought to be shorter due to to several factors, among these: ethnic, nutritional, and the low affordability factors. Aim of this study to assess and evaluate survival in advanced colorectal cancer when given the best drugs available as recommended by international guidelines.Method: A historical cohort study was done in patients with advanced colon or rectal cancer between 2008 and 2010 at Medistra Hospital. Cases were retrieved from medical record data. Subjects were included if they were diagnosed or had a relapse of their disease during the study period and were followed until they died or lost to follow-up. Staging procedure was done using the tumor node metastasis (TNM) system. All patients received the combination of 5-uorouracil (5-FU)/leucovorin (LV), oxaliplatin for 6 cycles (FOLFOX4) as the standard rst-line regimen for metastatic colorectal cancer (mCRC) in Indonesia. Oral capecitabine and targeted therapy such as bevacizumab and cetuximab might were also given, whenever indicated.Results: Nineteen patients (48.7%) died during the study period, while the rest were alive or lost to follow-up. The median overall survival of patients was 18 months (95% CI = 6.98 – 29.02 months). The longest survival was76 months (the patient is still alive when this manuscript was being prepared). Patients with colon cancer tended to live longer than rectal cancer, i.e. 21 vs. 15 months; log-rank p = 0.147. There was no signi cant difference of survival between patients with stage IV disease and relapse cases, i.e. 18 vs. 12 months, log-rank p = 0.807. Conclusion: With proper treatment and access to cytostatics and biologicals, advanced colorectal cancer among Indonesian patients have the same survival rates as patients in more developed countries as reported in the literature. Keywords: advanced colorectal cancer, chemotherapy, surviva
Role of Digestive Tract Hormone in Functional Dyspepsia
No full textDyspepsia is a complaint commonly found in daily practice. Functional dyspepsia is considered if the organic cause of dyspepsia is not found. The pathophysiology of functional dyspepsia has not been fully understood.However there are three main pathophysiology, which are: motility disturbance, non-motility disturbance, and psychosocial factor. Several digestive tract hormones are ghrelin, motilin, cholecystokinin (CCK), peptide YY (PYY), somatostatin, glucagon-like-peptide 1 (GLP), are thought to play role in the pathophysiology of functional dyspepsia, particularly in the regulation of digestive tract motility. Currently, a new paradigm in digestive tract disturbance treatment is developing, such as motilin receptor agonist therapy (for example mitemcinal) and ghrelin receptor agonist therapy, which is used as one of the new modalities in treatment of dyspepsia.Keywords: dyspepsia, functional dyspepsia, motilin, ghrelin, cholecystokinin, motilin receptor agonist, ghrelin receptor agonis
Current Diagnostic Approach of Inflammmatory Bowel Disease
No full textInflammatory bowel disease (IBD) has begun to emerge in Indonesia. The disease is further classifiedinto two types, ulcerative colitis (UC) and Crohn's disease (CD). Diagnosis of IBD is initiated from symptomfindings such as diarrhea, abdominal pain, bleeding diarrhea, and weight loss, and supported by physicalexamination and additional tests. The options for additional examinations of IBD are mainly endoscopy (esophagogastroduodenoscopy, colonoscopy, and also intestinal endoscopy), imaging techniques, and laboratory examinations either from blood or feces. The application of these modalities should be prompted by sufficientclinical suspicion to promote their efficiency as well as prevent underdiagnosis or overdiagnosis. In primaryhealth care settings, patients with IBD are expected to be recognized for therapy or to use appropriate referralsystem to warrant a proper treatment.Keywords: inflammatory bowel disease, diagnosis terkini, kolitis ulseratif, penyakit Crohn ABSTRAKInflammatory bowel disease (IBD) mulai banyak ditemukan di Indonesia. Penyakit ini terbagi atas dua jenisyaitu kolitis ulseratif (KU) dan penyakit Crohn (PC). Diagnosis IBD dimulai dari gejala yang ditemukan sepertidiare, nyeri perut, buang air besar berdarah dan penurunan berat badan, serta didukung oleh pemeriksaan fisikdan pemeriksaan penunjang. Pilihan pemeriksaan penunjang untuk IBD secara garis besar adalah endoskopi(esofagogastroduodenoskopi, kolonoskopi maupun endoskopi usus halus), pencitraan, dan pemeriksaanlaboratorium, baik dari darah atau feses. Penggunaan berbagai modalitas ini harus didahului adanya kecurigaanyang cukup secara klinis agar tepat guna, mencegah under- atau overdiagnosed. Pada tingkat layanan primer,pasien IBD juga diharapkan dapat ditemukan untuk diterapi atau menggunakan sistem rujukan yang tepat agar ditatalaksana dengan baik.Kata kunci: inflammatory bowel disease, diagnosis terkini, kolitis ulseratif, penyakit Croh
Quantification Hepatitis B Surface Antigen: Does It Really Matter in Clinical Practice?
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Management of Inflammatory Bowel Disease
No full textInflammatory bowel disease (IBD) is an inflammatory disease, which involves the digestive tract with still unknown definite etiology. IBD cases are frequently underdiagnosed or even overdiagnosed. Delay in diagnosis often happen due to the unspecific intermittent symptoms. Principally, treatment of IBD is targeted to acute episodes and maintenance of therapy during remission phase. First line therapy drugs include 5-acetil salicylic acid (5-ASA) and corticosteroids are systemic and topical. If failed, then second line therapy, which has immunosuppressive characteristic, is given such as: 6-mercaptopurine, azathioprine, cyclosporine, methotrexate, and anti-TNF (infliximab). Efforts to prevent recurrent inflammation in IBD are to maintain the remission phase as long as possible. Surgery management may be considered if conservative of pharmacological treatment fails or complication happens. Keywords: inflammatory bowel disease, management, treatmen
How to Negotiate Difficult Colonoscopy to Optimize Cecal Intubation Rate
No full textColonoscopy is the current standard method for evaluating colon. Cecal intubation rate is an important indicator of colonoscopy quality. In up to 10–20% colonoscopies, cecal intubation may be considered difficult.There are several consequences of low cecal intubation rate: it limits the efficacy of colonoscopy, increasing risk of complications and cost, and missing in detecting adenoma colorectal or other abnormal mucosa lesion.Failure to intubate the cecal can be a result of: (1) patients factors (female, older, diverticular disease, history of abdominal surgery, low body mass index, history of constipation, laxative use); (2) endoscopist factors (prior experience, the specific techniques and instrument used; (3) or some combination thereof. In an effort to solve these problems endoscopist should increase their technical manoeuvres (minimizing inflation and looping, using water–aided method, appropriate use of positional changes and abdominal pressure) and use various accessories methods (inserting a biopsy forceps through the biopsy channel, pediatric colonoscopy, variable stiffness colonoscopy).Keywords: cecal intubation rate, difficult colonoscopy, colonoscopy quality, water–aided colonoscop
Proton Pump Inhibitors Therapy in Children with Gastroesophageal Reflux
No full textProton pump inhibitors (PPI) has been widely used by clinicians to treat diseases that require suppression of gastric acid. PPI work by inhibiting the proton pump in gastric parietal cells.In adult patients, PPI hasbeen widely studied and showed effective results and safe. This result make PPI positioning as the first choice medicine in the treatment of diseases that require suppression of gastric acid. As the primary choice therapy, PPI administration has been increased not only in adults but also in children.PPI is often administered to children with a diagnosis of gastroesophageal reflux disease (GERD) which defined as symptoms or complications caused by gastroesophageal reflux (GER). GERD diagnosis in children is quite difficult, so it is common to find that diagnosis is established only by the basis of clinical symptoms, resulting in overdiagnosis and over-treatment of GERD. The use of PPI in children still needs further study andcan not be inferred based on adult studies. Inappropropriate PPI prescription without indication will increase side effect, risk and also harm the children. Thus, it is important to know the indications, side effects and safety of PPI therapy in children.Keywords: proton pump inhibitor, children, gastroesophageal reflux diseas
Liver Disorders in Type 2 Diabetes Mellitus
No full textBackground: Patients with type 2 diabetes mellitus (T2DM) are frequently diagnosed with some abnormal liver features. These liver abnormalities are suggested to be correlated with insulin resistance. The aim of thisstudy was to evaluate liver abnormalities and fasting insulin levels in patients with T2DM.Method: This study was conducted in Koja Hospital from February to July 2013. Study design was analytical study. Data for sex, age, complication, body mass index (BMI), liver function, liver enzyme, and fasting insulinlevel were collected. Univariate and bivariate statistical analyses were done using SPSS 20.Results: Twenty eight patients were included in this study, 71.43% of them were female. The age group of 40-60 years was the highest among the patients (64.28%). Highest complication was neuropathy, BMI of mostpatients were obese. Liver abnormalities were documented in 35.8% patients, liver enzyme increased in 21.4% patients. Non alcoholic fatty liver disease (NAFLD) were noted in 46.6% patients, and one patient was positive for hepatitis B. Mean fasting insulin in T2DM with NAFLD were higher than in T2DM without NAFLD. However, it was not statistically significant (40.08 ± 36.8 μU/mL vs. 54.3 ± 37.1 μU/mL; p = 0.27).Conclusion: Liver abnormalities found in T2DM patients were elevated liver enzyme, decreased albumin and increased of bilirubin. Through ultrasound, NAFLD and liver cirrhosis were found. Fasting insulin levelwas higher in T2DM with NAFLD but it was not statistically significant.Keywords: type 2 diabetes mellitus, non alcoholic steato-hepatitis, fasting insuli