The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Colonoscopic Findings in Patients with Chronic Diarrhea at Mohammad Hoesin Hospital Palembang
No full textBackground: Chronic diarrhea is a common problem encountered by clinicians. Colonoscopy is a tool with high accuracy and sensitivity to depict abnormalities and has the advantage in distinguishing the abnormalities that cause chronic diarrhea. Nevertheless, the colonoscopic findings in patients with chronic diarrhea vary by age. The objective of this study is to observe abnormalities found in lower gastrointestinal tract in patients withchronic diarrhea who underwent colonoscopy and its relationship with age.Method: An observational analytic study, data retrieved from medical record of outpatient and inpatient with chronic diarrhea at Mohammad Hoesin Hospital Palembang from January 2011 until December 2012. Chronic diarrhea diagnosis was based on clinical findings, laboratory result, and colonoscopy procedure. Patients were then divided into groups based on age (< 40 and > 40). Data were analyzed with SPSS 12.0.Results: There were 92 patients consisted of 56 (60.9%) male and 36 (39.1%) female. Mean age was 47.67 ± 16.83 with age interval 15-85 years. Group I of 35 (38%) patients, whereas group II of 57 (62%) patients. The colonoscopic findings were ulcerative colitis 33 (35.9%), normal 27 (29.3%), colon tumor 20 (21.7%), colitis tuberculosis 5 (5.4%), Crohn’s disease 3 (3.3%) and polyp 4 (4.3%). Based on age, the incidence of ulcerative colitis was most frequently encountered in both groups, whereas normal colon and colon tumors were encountered most in group II. No correlation was found between age and colon abnormality (p = 0.87).Conclusion: The most common finding was ulcerative colitis followed by normal colon and colon tumor. There was no correlation between age and colon abnormalities.Keywords: chronic diarrhea, colonoscopy, ag
Approach for Diagnostic and Treatment of Achalasia
No full textAchalasia is a rare motor disorder of the esophagus and lower esophageal sphincter. The incidence is approximately 1/100,000 per year and the prevalence rate is 10/100,000. Achalasia is quite difficult to establishbecause the symptoms might be insidious and therefore not many people come to seek medical attention until it deteriorates to final stage of the disease. There are several modalities that can be used as diagnostic toolssuch as manometry, barium esophagogram, esophagoduodenoscopy, esophageal CT-scan, until the recent one, high-resolution manometry that can classify achalasia into three different types. The treatment options are the pharmacologic intervention, endoscopic treatment, minimal invasive surgery, and radical surgery.We reported a case of 20 year old female with achalasia who came with dysphagia symptom since three years before. The diagnosis was made by historytaking, physical examination and barium meal and esophagogastroduodenoscopy. The patient underwent pneumatic dilatation and since then the symptom was relieved.Keywords: achalasia, diagnostic, treatmen
Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management
No full textHepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.Keywords: hepatitis A, prolonged cholestasis, steroid therap
Role of Lamivudine as Preemptive Therapy in Cancer Patients with Hepatitis B undergoing Chemotherapy
No full textPatients diagnosed with hematology malignancy and solid tumor who underwent chemotherapy, frequently encountered hepatitis B reactivation. Patients with blood cancer, including lymphoma, had higher risk of reactivation compared to those with solid tumor. Steroid and immunosuppressant drugs contained in chemotherapy regimens were responsible for those events. Hepatitis B reactivation during chemotherapy treatment could contribute to acute liver failure and increase mortality. Administration of analog nucleoside therapy in this group of patient prior to the initiation of chemotherapy could prevent reactivation of hepatitis B.A 43 year-old male patient were diagnosed with diffuse large B cell non-Hodgkin lymphoma stadium II BE (oropharynx) under chemotherapy and had hepatitis B. In this evidence based case report, we reported a critical appraisal of the role of lamivudine as preemptive therapy in blood cancer and solid tumor.Keywords: chemotherapy, hepatitis B reactivation, malignanc
Effect of Omeprazole to Dyspeptic Symptom on Ramadan Fasting Patient based on Dyspepsia Symptoms Severity Index Scores
No full textBackground: Dyspepsia is a symptoms collection of discomfort at the upper abdomen. Ramadan Fasting is a worship that must be run by all Moslems that do not eat and drink for ± 12 hours. Proton pump inhibitors are drugs commonly given to patients with dyspepsia with mechanism controlling gastric acid secretion. The aim of this study is to find the effect of omeprazole to the patient with dyspepsia and undergo Ramadan fasting.Method: Using analytic study design, conducted in outpatient in Koja Hospital Jakarta from June - July 2013, for patients with dyspepsia who will undergo Ramadan fasting. Subjects are divided into 2 groups; one group was given omeprazole while others were given a placebo. Before and after 2 weeks of fasting, dyspepsia symptoms severity index scores (DSSI) was taken which assessed changes in both groups and compared using student T-test.Results: DSSI scores on average before the intervention of both groups (n = 30) was not significant (p = 0.9). In the placebo group obtained increasing of DSSI score from 27.7 ± 14 to 36 ± 14.8 (p = 0.001), whereas in the omeprazole group obtained increasing of score only from 27.2 ± 9.4 to 30 ± 9.9 (p = 0.08). In the placebo group score worsened by 8.3 ± 7.2 but in the omeprazole group with only 2.7 ± 5.7 (p = 0.02).Conclusion: There was a significant decrease of DSSI scores in fasting patient with omeprazole. Therapy with omeprazole 20 mg twice daily during the month of fasting can reduce the abdominal complain in patient with dyspepsia.Keywords: dyspepsia, DSSI, fasting, Ramada
Combination Therapy of Sorafenib and Transarterial Chemoembolization in Management of Hepatoma
No full textIncidence of hepatocellular carcinoma (HCC) continues to increase in developing countries and rank 5th in male and 7th in female. Main cause being reported is chronic hepatitis B in Asian region. Treatment of choice for HCC is liver resection, however it is oftenly not possible to be performed as the disease has entered advanced stage. Due to the less choice of treatment in HCC, one of the several other alternatives has been considered is transarterial chemoembolization (TACE) which is applied in patients who cannot undergo resection or ablation therapy, failure of therapy. However limitation of TACE is very high recurrence rate of HCC. Sorafenib is ananti-angiogenic medicine approved as first systemic drug in HCC therapy. Several studies stated the benefits of combination therapy of TACE and Sorafenib administration to prevent HCC recurrence. Success rate of thiscombination therapy reaches control disease rate of 100% based on response evaluation criteria in solid tumors (RECIST) from European Association for the Study of the Liver (EASL).Keywords: TACE, sorafenib, liver cancer, HC
S-Index and APRI Score to Predict Liver Fibrosis Chronic in Hepatitis B and C Patients
No full textBackground: A great interest has been dedicated to the development of non invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. The aim of this study was to comparethe accuracy between S-index and aspartate aminotransferase to platelet ratio index (APRI) to FibroScan for predicting liver fibrosis in chronic hepatitis B and C patients.Method: A cross-sectional study was conducted in 40 patients with chronic hepatitis B and C between January 2010 - May 2011 at Division of Gastroentero-hepatology, Department of Internal Medicine, Adam Malik Hospital, Medan. Patients underwent laboratory examination and FibroScan, then used predictive values to assess the accuracy of S-index scores and APRI compared to FibroScan. The analysis was performed using SPSS 15.0.Results: S-index identified significant fibrosis in 87.5% patients with sensitivity (Se) 87.5% and specificity (Sp) 100%. About 67.5% of 40 patients could be identified correctly. S-index also could accurately predict the absence or presence of cirrhosis in 87.5% of the total 40 patients, with NPV 91.7% and PPV 81.25%, respectively. APRI for significant fibrosis has Se 85.7%, Sp 88%, PPV 88.8%, NPV 69.2%; while Se 53%, Sp 88%, PPV 72.7%, NPV 75.8% for liver cirrhosis. AUROC value for S-index was higher than APRI in predicting significant fibrosis and cirrhosis, i.e. 0.938 vs. 0.917 and 0.873 and 0.707, respectively.Conclusion: The S-index has a higher accuracy than APRI in predicting significant fibrosis and cirrhosis in patients with chronic hepatitis B virus and hepatitis C virus infection.Keywords: S-index, APRI score, FibroScan, chronic hepatitis B and
Aspartate Aminotransferase to Platelet Ratio Index and FibroScan for Predicting Liver Fibrosis with Chronic Hepatitis B
No full textBackground: Non-invasive test have been constructed and evaluated mainly for binary diagnoses. The accuracy of non-invasive tests such as aspartate aminotransferase to platelet ratio index (APRI) and transientelastography/FibroScan should be evaluated especially in clinical practice. The aim of the study was to evaluate the accuracy of detailed fibrosis classification available for APRI and FibroScan to liver biopsy in chronichepatitis B patients.Method: A cross sectional study was conducted in 51 patients with chronic hepatitis B. The patients underwent laboratory test, FibroScan and liver biopsy between April 2011 and July 2013 at Adam Malik Hospital, Medan.Liver biopsy was assessed based on the METAVIR score. Area under receiver operating characteristic curve (AUROC) predictive value was used to evaluate the accuracy of APRI and FibroScan. All data were analyzedusing SPSS 20.0.Results: APRI versus METAVIR diagnosed severe fibrosis and cirrhosis with sensitivity 40% and specificity 83.9%, positive predictive value (PPV) 61.5%, negative predictive value (NPV) 68.4%, positive likelihood ratio(LR) 2.48 and negative LR 0.72 with diagnostic accuracy 66.7%. The AUROC value was 0.619 (95% CI = 0.446 – 0.715); kappa = 0.255; p > 0.05. FibroScan versus METAVIR predictive value with sensitivity 75% andspecificity 67.6% were PPV 60%, NPV 67.7%, positive LR 2.31 and negative LR 0.36 with diagnostic accuracy 70.6%. The AUROC value was 0.714 (95% CI = 0.567–0.861); kappa 0.409; p < 0.05.Conclusion: FibroScan has better accuracy than APRI for predicting severe fibrosis and cirrhosis in patientswith chronic hepatitis B.Keywords: APRI, FibroScan, liver biopsy, chronic hepatitis