The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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The Effect of Pediococcus pentosaceus on Stool Frequency, TNF-α Level, Gut Microflora Balance in Diarrhea-induced Mice
No full textBackground: Enteropathogenic Escherichia coli (EPEC) are pathogenic microorganisms causing inflammation and imbalanced gut microflora that may result in diarrhea. Pediococcus pentosaceus (P. pentosaceus) isolated from “dadih” (milk curd) are used as probiotics containing lactic acid bacteria (LAB), which are useful to improve the balance of intestinal microflora and inhibit the growth of pathogenic microorganisms. This study was aimed to recognize the effect of P. pentosaceus supplementation on stool frequency, tumor necrosis factor-α (TNF-α) and gut microflora balance in experimental mice with EPEC-induced diarrhea. Method: The study was conducted in 60 white mice (Mus muscullus) at Biomedical Laboratory, Biotechnology/Production and Animal Husbandry Technology Institute, University of Andalas, Padang in April 2012. The frequency of stool, TNF-α level and microflora balance of the mice were measured before and after the EPEC-induced diarrhea and following the administration of antibiotics. Statistical analysis was performed using ANOVA and Duncan test. Results: The highest mean stool frequency was found in positive control group, i.e. 55 times, which was reduced significantly after 12-hour P. pentosaceus supplementation in a dose of 2 x 108 cfu/g into 18 times. The mean TNF-α level in positive control group was 128.17 pg/mL that lowered significantly to 48.0 pg/mL. The highest mean total number of LAB was 97.0 x 107 cfu/g, which was significantly different from positive control group of 7 x 107 cfu/g. Conclusion: P. pentosaceus supplementation in a dose of 2 x 108 cfu/g may reduce the stool frequency, lower TNF-α and improve the gut microflora balance following 12-hour supplementation in diarrhea-induced mice. Keywords: Pediococcus pentosaceus, TNF-α, diarrhea, EPEC, gut microflor
The Difference Expressions of EBNA-1 in Epstein-Barr Virus Infection in Low and High Grade Colorectal Carcinoma
No full textBackground: Colorectal carcinoma is a common malignancy with the highest mortality rate. Epstein- Barr virus (EBV) as the virus that most commonly infect humans, also can infect the body in a latent and induce the occurrence of malignancy. This study aimed to prove an association between EBV virus infection with degree of colorectal carcinoma by examining the main EBV oncogene expression, namely Epstein-Barr nuclear antigen-1 (EBNA-1), in low grade and high grade colorectal carcinoma. Method: Cross-sectional study was performed in 14 colorectal cancer patients in Moewardi Hospital, Surakarta between July 2011 and January 2012. The biopsy specimens were stained for EBNA-1 expression using immunohistochemical technique. Statistical analysis was performed using T-test and Mann-Whitney by SPSS software version 19.0 for windows. Results: Of the 14 patients, there were 7 patients with low grade colorectal carcinoma and 7 patients with high grade colorectal carcinoma. EBNA-1 expression was found in epithelium of low grade and high grade colorectal carcinoma with p = 0.01; CI = -5.24-0.88. We also assessed the expression of EBNA-1 on lymphocytes B of low grade colorectal carcinoma and high grade colorectal carcinoma with p = 0.043. Conclusion: Significant differences in the expression of EBNA-1 was found in association with EBV infection either in low grade and high grade colorectal carcinoma. The role of EBNA-1 as tumor initiator needs to be elucidated further. Keywords: carcinoma colorectal, Epstein-Barr virus, EBNA-
Approach for Diagnostic and Treatment of Chronic Diarrhea Caused by Hookworm Infection
No full textChronic diarrhea has various etiologies. One of the causes includes parasitic infection, such as hookworm. Human hookworm infections are caused by the blood-feeding intestinal nematodes (Ancylostoma duodenale and Necator americanus). A 54-year-old male was admitted to Cipto Mangunkusumo Hospital with a chief complaint of diarrhea since one month before hospital admission. He experienced diarrhea more than five times a day, without blood and mucus. The stool appearance was yellow without bubbles. He also noted decreased appetite and weight loss. The remarkable physical finding was pain in whole abdomen. Laboratory results showed leukocytosis; while the feces analysis showed bacteria, leukocytes and Gram-negative bacilli. Colonoscopy examination revealed a lot of worms in the colon with multiple ulcers. Histopathological findings indicated colitis with plasma and eosinophils cells in the lamina propia. Parasitology analysis confirmed the hookworms (Necator americanus). The patient was given intravenous fluid, albendazole 400 mg in three consecutive days. The patient’s clinical condition was improved and he was subsequently discharged after seven days of hospitalization. During the follow up at outpatient clinic, the patient was in healthy condition. This is a demonstrative case of human hookworm infection that cause chronic diarrhea. Colonoscopy plays important role for evaluating and finding the etiology of chronic diarrhea. Proper treatment with albendazole has been proven to be effective in eradicating hookworm infection. Keywords: diarrhea, parasite, hookwor
Correlation between Aspartate Aminotransferase to Platelet Ratio Index Score and the Degree of Esophageal Varices with Liver Cirrhosis
No full textABSTRACTBackground: Esophageal varices is the most common complication in liver cirrhosis. Bleeding varices is a serious complication causing increased mortality rate. In anticipation of those complications, the role of screening test is essential. Endoscopy is the standard method for assessing esophageal varices, but it carries certain risks for patients if it is contraindicated. Moreover, it is an invasive, expensive and uncomfortable procedure. Accordingly, a non-invasive method, aspartat aminotransferase to platelet ratio index (APRI) score, has been developed for evaluating esophageal varices. Method: An analytic cross-sectional observational study was conducted in patients with liver cirrhosis who underwent endoscopy between March 2011 and August 2012. Data were obtained from medical records of hospitalized patients in Mohammad Hoesin General Hospital. The degree of esophageal varices was assessed based on endoscopic findings and APRI score. Spearman test was performed to analyze the correlation between APRI score and the degree of esophageal varices.Results: There were 55 patients, 30 (54.5%) male and 25 (45.5%) female patients, with a range of age between 15-70 years and a mean value of age of 47.09 ± 12.8. APRI score < 0.5 was found in 21.81% subjects, APRI score of 0.5-1.5 was obtained in 41.81% subjects and APRI score > 1.5 was noted in 36.36% subjects with a mean value of 2.32 ± 3.92. There was a correlation between APRI score and degree of esophageal varices with p = 0.011 Conclusion: APRI score can indirectly predict esophageal varices in patients with liver cirrhosis. Keywords: APRI score, the degree of esophageal varices, liver cirrhosi
Histopathology of Helicobacter pylori in Chronic Dyspepsia Patients
No full textABSTRACTBackground: Helicobacter pylori (H. pylori) are the most common infection found in dyspepsia cases. This infection is almost always found in digestive tract inflammation and commonly develops into chronic gastritis. Meanwhile, chronic gastritis is a condition assumed as the early event in pathological abnormalities of the stomach which finally may develop into carcinoma of the gaster. In Indonesia, data describing the incidence of H. pylori infection based on the histopathological appearance, location of specimen collection, inflammatory degree, and age of chronic dyspepsia patients is not yet available. The aim of this study is to determine the incidence of H. pylori based on histopathology appearance in chronic dyspepsia patients in Moewardi Hospital Surakarta.Method: This study is a cross sectional descriptive study by performing endoscopy-biopsy and histopathology examination to chronic dyspepsia patients who came to Gastroenterohepatology Clinic, Department of Internal Medicine, Moewardi Hospital, Surakarta on 1 January 2009 - 31 December 2010.Results: More than 90% subjects were > 40 year old with the distribution of majority patients were 46-55 year old (32.43%). The most commonly found endoscopic appearance in subjects with positive H. pylori was superficial chronic gastritis (81.08%) with mild inflammatory degree (64.86%) and majority located in the antrum 97.3%.Conclusion: The proporsion of H. pylori infection in male and female was almost equal and was mostly found in the age group of 46-55 year old. This infection frequently happens in chronic dyspepsia who has histopathologic appearance of superficial chronic gastritis with mild inflammatory degree in the antrum area. Keywords: Helicobacter pylori, superficial chronic gastritis, ag
The Prevalence and Factors Associated with Drug-induced Hepatitis in HIV-positive Tuberculosis Patients
No full textIntroduction: Tuberculosis (TB) have demonstrated a global increase since 1990 along with the increase of world’s population and the transmission of human immunodeficiency virus (HIV). Anti- tuberculosis drugs are very effective, but it may cause drug-induced hepatitis (DIH). The aim of this study was to assess the prevalence and association of several risk factos with the occurence of drug-induced hepatitis in HIV-positive tuberculosis patients. Method: We conducted a retrospective case-control study based on medical records of HIV-positive TB patients who seek medical attention to HIV Referral Center at Cipto Mangunkusumo Hospital between July 2008 and December 2010. Overall, we enrolled 168 medical records with 42 cases and 126 controls. Chi-square and logistic regression test analysis were conducted for analyzing risk factors of drug-induced hepatitis in HIV-positive tuberculosis patients. Results: Drug-induced hepatitis were found in 42 (8.04%) patients.The prevalence of DIH was highest among 35 (25.2%) male patients, aged < 35 years old in 32 (26.0%) patients, with albumin level < 3.5 g% in 10 (11.2%) patients, body mass index (BMI) < 18.5 kg/m2 in 14 (18.4%) patients, CD4+ count < 100 cells/mm3 in 29 (24.4%) patients, and those who received rifampicin (R), isoniazid (H), and pirazinamid (Z) regiments for their anti-tuberculosis drugs 24 (31.2%) patients. No risk factors were found to have statistically significant association with DIH. Conclusion: The prevalence of DIH is quite high. Although no risk factor was found statistically significant, but evaluation and liver biochemical examination should be carried out regularly in patients with DIH risk factors. Keywords: drug-induced hepatitis, tuberculosis, human immunodeficiency viru
Non-alcoholic Fatty Liver Disease Related to Metabolic Syndrome: a Case-control Study
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is a benign condition, but it can go for years and progress to liver cirrhosis or eventually to liver cancer. Metabolic syndrome (MS) is a condition associated with NAFLD. This study was aimed to know the risk factors of NAFLD related to metabolic syndrome. Method: A case-control study was performed in NAFLD patients with or without MS and healthy individuals. All subjects were recruited from population that underwent routine medical check-up at Sardjito Hospital, Jogjakarta, during March 2007–August 2008. Diagnosis of NAFLD is defined based on clinical and liver ultrasound findings. Diagnosis of MS is defined by International Diabetes Federation on criteria for the diagnosis of MS. Data were analyzed by using T-test, ANOVA and linear regression. Odds ratio (OR) (95% CI and p < 0.05) was calculated by cross-tab analysis. Results: There were 84 patients enrolled in the study (group I = 30 NAFLD + MS subjects; group II = 26 NAFLD patients; group III = 28 healthy). The data showed statistically significant Results in waist circumference, systole blood pressure, fasting glucose, triglyceride, high density lipoprotein (HDL) cholesterol level, homeostasis models assessment index ratio (HOMA-IR), free fatty acid (FFA), and adiponectin. The ANOVA and linear regression test among NAFLD groups showed significant difference only on HDL-cholesterol and FFA level. The lowest OR was 1.674 for HDL-cholesterol and highest OR was 13.571 for triglyceride. Conclusion: The independent factors of NAFLD related to metabolic syndrome are FFA and HDL- cholesterol level, even though a decreasing of HDL-cholesterol level has a lowest risk of NAFLD. Keywords: NAFLD, metabolic syndrome, FFA, adiponectin, HDL-cholestero
Zinc Supplementation in Children with Acute Diarrhea of Invasive Bacterial and Non-bacterial Infection
No full textBackground: Diarrhea is one of the manifestations of gastrointestinal disorder. In Indonesia, diarrhea is still one of the leading causes of death in infants and children. Diarrhea requires a rational and comprehensive management to deliver an optimal result. This study was aimed to assess the effectiveness of zinc supplementation in children with acute diarrhea of invasive bacterial infection. Method: A cross-sectional study was performed in 74 children aged 2-14 years with acute diarrhea, who visited the Outpatient Clinic, Pasar Rebo Hospital Jakarta, between January and June 2011. The inclusion criteria were patients had suffered diarrhea for 1-7 days. Based on fecal analysis Results, subjects were divided into group A (non-infectious) and group B (infectious). All children received zinc supplementation. Results: The mean value of subject age was 46.6 months in group A and 81.3 months in group B. The mean frequency of diarrhea prior to zinc supplementation was 7.5 times/day in group A and 7.8 times/day in group B. Duration of diarrhea before zinc supplementation was 52.6 hours in group A and 45.4 hours in group B. On the seventh day, there was no subject of both groups who still suffered from diarrhea. Although the duration of diarrhea in group A was shorter than group B, no significant difference was found (62.4 hours vs 66.8 hours, p = 0.07). Conclusion: Zinc supplementation shows similar efficacy in children with acute diarrhea caused by invasive bacterial infection and those without bacterial infection as well. Keywords: acute diarrhea, invasive diarrhea, zinc supplementatio
Acute Pancreatitis as a Complication of Choledochal Cyst
No full textCholedochal cysts (CCs) are rare congenital disorders of the biliary tree which are associated with biliary tract and pancreatic complications. Its etiology is still unknown, but some evidences suggest that CCs are caused by infection during embryogenesis. The laboratory evaluation reveals abnormalities due to pancreatobiliary complications, such as ascending cholangitis, cholecystitis, and pancreatitis. Radiologic examination may delineate the structural abnormalities occured in CCs and confirm the diagnosis. The major mortality is caused by cholangiocarcinoma. This case discussed the diagnosis and treatment of a 20-year-old male with choledochal cyst and its complications. Management consists of therapy on complication and definitive therapy. Keywords: choledochal cyst, acute pancreatitis, cholecystiti