The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Diagnosis of Autoimmune Hepatitis using International Autoimmune Hepatitis Group Scoring
No full textAutoimmune hepatitis (AIH) is described as T lymphocyte suppressor disturbance, thus there is formation of autoantibody which attacks surface antigen of liver cells or hepatocytes. Diagnosis of AIH is done after other liver abnormalities have been ruled out. The diagnosis of AIH needs to be done with thorough and careful examination as there is no pathognomonic clinical appearance.Autoimmune hepatitis (AIH) is described as T lymphocyte suppressor disturbance, thus there is formation of autoantibody which attacks surface antigen of liver cells or hepatocytes. Diagnosis of AIH is done after other liver abnormalities have been ruled out. The diagnosis of AIH needs to be done with thorough and careful examination as there is no pathognomonic clinical appearance.Keywords: autoimmune hepatitis, asymptomatic, increased transaminas
Gastrointestinal Problems in HIV/AIDS Patients
No full textBackground: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital.Keywords: gastrointestinal, HIV/AIDS, oral candidiasis,CD
Ultrasound-Diagnosed Non-Alcoholic Fatty Liver Disease among Medical Check Up Patients
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is recognised as one of the most important causes of chronic liver disease and has become an important health issue in many countries. The aim of the study wasto evaluate the prevalence and risk factors of NAFLD patients based on ultrasound diagnosed in medical check up setting.Method: In this study, of 2,105 patients undergoing medical check up in Charitas Hospital, Palembang between January 2011 to August 2013, 115 NAFLD patients and 113 non-NAFLD patients as controls were included. Diagnosis of NAFLD was based on ultrasound appearance, patients did not consume alcohol, with negative HBsAg and hepatitis C virus antibodies.Results: The prevalence of NAFLD in medical check up patients was 7.9% whereas 39% patients had normal body mass index (BMI) (< 25 kg/m2). Patients with NAFLD compared with non-NAFLD patients had higher values of BMI (p < 0.001), triglycerides (p = 0.001), aspartate aminostransferase (AST) (p < 0.001), alanine aminotransferase (ALT) (p < 0.001), fasting glucose (p = 0.002), and lower HDL cholesterol (p = 0.001). Obesity was the strongest associated factor for NAFLD (95% CI = 1.87-7.85; OR = 3.83; p < 0.001), followed by high glucose levels (95% CI = 1.38 - 8.31; OR = 3.83; p = 0.008) and hypertriglyceridemia (95% CI = 1.38 - 4.11;OR = 2.38; p = 0.002).Conclusion: About 7.9% patients suffered from NAFLD. Approximately 39% medical check up patients had NAFLD with normal BMI. Obesity, hypertriglyceridemia and high glucose levels were the risk factors for NAFLD.Keywords: non-alcoholic liver disease, body mass index, prevalence, metabolic syndrom
Pharmacological and Non-Pharmacological Treatment in Non-Alcoholic Fatty Liver Disease
No full textNon-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease, from steatosis to liver cirrhosis in individual who does not consume alcohol in significant amount. The prevalence of NAFLD in Indonesia was estimated around 30%, this condition related to the increased incidence of metabolic disorders. Current understanding of NAFLD pathogenesis is the third-hit theory, in which insulin resistance resulting in free fatty acid accumulation that triggers inflammation causing fibrosis and hepatocyte death, and these conditions are not followed by adequate hepatocyte proliferation.Treatment of NAFLD requires both non-pharmacologic and pharmacologic interventions. Life style intervention includes restricting calories, low saturated fat and low sugar diet, and also physical activity. Bariatricsurgery remains controversial since in several study participants had experienced deterioration of disease. There are no definitive treatment for NAFLD currently. Treatment is aimed to improved insulin sensitivity, decreased oxidative stress and inflammation. Several agents use for treatment of NAFLD are insulin sensitizer (metformin and glitazones), statin, omega-3, vitamin E, ursodeoxycholic acid, orlistat, pentoxyphylline, and losartan.Keywords: NAFLD, treatment, pharmacologic, non-pharmacologi
A Deterioration of Anemia in Hemoglobin E Disease caused by Cholestatic Hepatitis A
No full textABSTRACTPatients with hemoglobin E disease usually have mild hemolytic anemia and mild splenomegaly. Acute infection including acute inflammatory disease of the liver caused by hepatitis A viral, which attacks patients with previous hemolytic anemia, may result in deterioration of anemia.A 17-year-old female patient was admitted with chief complaint of having jaundiced body and non-specific prodromal symptoms within one week prior to admission. Physical examination revealed jaundiced skin and sclera as well as tenderness in right upper quadrant of the abdomen. Laboratory tests revealed microcytic hypochromic anemia with hemoglobin (Hb) level of 6.3 g/dL, increased reticulocyte count and abnormal morphology of erythrocyteson blood smear. Hemoglobin electrophoresis indicated hemoglobin E disease and serologic tests suggested a positive anti-HAV immunoglobulin M (IgM) with increased level of liver enzymes and functions. Abdominal ultrasound showed hepatosplenomegaly without extra-hepatic cholestasis. The working diagnosis was hepatitis A with intrahepatic cholestasis and hemoglobin E disease. The patient was treated with hepatoprotector and ursodeoxycholic acid. Anemia was not treated specifically. It was assumed that hemolytic anemia was worsened by acute infection of hepatitis A viral. The assumption had been proven to be right since there was improvement of anemia after the acute infection had recovered. Patients with hemoglobin E disease usually have mild anemia; however, in this case, the hemoglobin level decreased significantly due to the acute co-infection. Keywords: hemoglobin E disease, anemia, acute infection, acute hepatitis A infectio
Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain
No full textBackground: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicit
Detection of HBV-DNA and Its Correlation with the HBeAg/Anti-HBe Serological Status in HBsAg-positive Patients
No full textBackground: In the past years, HBeAg and anti-HBe status in individuals with positive HBsAg were often correlated to viral replication. This study was aimed to find correlation between the HBV viremia and HBeAg/anti-HBe serological status in HBsAg-positive individuals. Method: An observational-analytic design was performed in this study. The sera of all positive HBsAg patients at Biomedika Hospital Laboratory were collected and examined for HBeAg and anti-HBe using immunochromatography technique between January and April 2012. The sampling method was purposive sampling. Afterwards, the sera were examined for HBV-DNA by polymerase chain reaction (PCR). Results: Sufficient amount of sera were collected from 44 patients consisting of 33 males and 11 females. The mean age was 15-68 years. Positive HBeAg and negative anti-HBe status was found in 11 (42%) patients. Negative HBeAg and positive anti-HBe was found in 26 (59.1%) patients. Both HBeAg and anti-HBe were negative in 7 (16.3%) patients. HBV-DNA was detected in all 11 (100%) patients with positive HBeAg and negative anti-HBe. HBV-DNA was also detected in 11 (42%) patients with negative HBeAg and positive anti-HBe. However, there was only one patient (14.3%) with both negative HBeAg and anti-HBe status, who had detectable HBV-DNA. Conclusion: Positive HBeAg can be used as an indicator of viremia, but negative HBeAg cannot be used as an indicator of the absence of viremia without further HBV-DNA testing. Patients with negative HBeAg and positive HBV-DNA were suspected for having pre-core mutant. Keywords: HBV-DNA, positive HBsAg, HBeAg, anti-HBe, pre-core mutan
Management of Nutrition in Gastric Emptying Preparation before Medical Procedures
No full textPatient preparation before medical procedures, for example in elective surgery, abdominal ultrasonograhy (USG), endoscopy, intubation, etc., is by emptying the stomach. Attempt in emptying stomach is by fasting since the night before medical procedure with the intention to decrease the risk of aspiration. Management of nutrition guidelines in preparation of medical procedures currently refers to pre- surgery fasting which is recommended by American Society of Anaesthesiologist (ASA) and the Canadian Anaesthetists Society (CAS). In Indonesia, pre-surgery fasting guideline is suggested by Indonesia Society of Anesthesiology and Intensive Care. However, in various unit of service, fasting the patient since the night before is still performed. Development of nutrition management in medical procedures has experienced many changes, such as surgery which is aimed to restore organ normal function and to accelerate the healing of patients. Various studies on nutrition are developed in conjunction with the programs development to optimize pre-surgery preparation. Keywords: nutrition management, pre-surgery nutrition, aspiratio
Helicobacter pylori Infection in Superficial Gastritis, Erosive Gastritis and Gastric Ulcer
No full textBackground: Helicobacter pylori (H. pylori) infection leads to inflammation of the gastric mucosa. It damages the gastric epithelium and related to the risk of developing gastric cancer. Over time, it may develop into the development of glandular atrophy and intestinal metaplasia. This study was aimed to evaluate the histological features of gastric mucosa, including H. pylori infection in patients with endoscopically found superficial gastritis, erosive gastritis and gastric ulcer. Method: Subjects with abdominal complaints who underwent consecutive upper gastrointestinal endoscopy were prospectively selected at Tugurejo Hospital between November 2004 and December 2010. Eligible subjects were those with endoscopic diagnosis of superficial gastritis, erosive gastritis or gastric ulcer. The biopsy specimens were taken from the corpus, angulus and antrum of all the patients. Giemsa and hematoxylin-eosin staining were used for the histological diagnosis H. pylori and gastric mucosa inflammation. Results: The overall prevalence of H. pylori infection in superficial gastritis, erosive gastritis and gastric ulcer were 24.3%. There was significant difference between H. pylori infection rate in antrum of patients with superficial gastritis 19.4%, erosive gastritis 26.3%, and gastric ulcer 34.7%. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H. pylori- positivity was 12.5%, 14.0%; erosive gastritis 26.3%, 16.6%; and of gastric ulcer 38.9%, 29.3%; respectively. However, there was no significant difference. Conclusion: Patients with gastric ulcer have H. pylori infection, atrophic gastritis and metaplasia intestinal more than superficial gastritis and erosive gastritis. Progression of the gastric ulcer to atrophic gastritis and intestinal metaplasia is related to H. pylori infection. Keywords: Helicobacter pylori infection, superficial gastritis, erosion and ulce
Acupuncture in the Management of Functional Dyspepsia
No full textDyspepsia is an uncomfortable sensation or pain in the upper abdomen which is persisting or recurring. Dyspepsia can be classified into functional and organic dyspepsia. Functional dyspepsia is more commonly found compared to the organic type, approximately 60%. Pharmacologic therapy in the management of functional dyspepsia has not shown optimal results, with the multifactorial etiology of functional dyspepsia as the main challenge. Therefore, the management of functional dyspepsia is widened and involves variety treatment modalities, acupuncture being one of them. Acupuncture is a way of treatment by puncturing needles to particular area on the skin to eliminate pain and treat particular diseases. Acupuncture affects stomach motility and gastric acid secretion in functional dyspepsia patients. Two acupuncture points commonly used in functional dyspepsia are ST 36 and PC 6. Acupuncture can restore gastric motility in patients with functional dyspepsia, who have gastric emptying disturbance. Besides, functional dyspepsia complaints, such as epigastric pain, nausea, vomiting, anorexia, burning sensation, and bloating were found to improve after acupuncture therapy. Side effects of acupuncture are not life threatening with low incidence rate. The effectiveness of acupuncture therapy compared to standard medication shows varies results. Further studies are needed to determine the characteristics of functional dyspepsia patients which could have optimal results through acupuncture therapy. Keywords: epigastric pain, gastric motility, ST 36, PC