The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Pancreatic Cancer: Review of Etiology, Clinical Features, Diagnostic Procedures, Treatment and Mesothelin Role
No full textPancreatic cancer is one with high mortality cancer in the world. Ninety percent of pancreatic cancer is pancreatic adenocarcinoma. Various factors is associated with an increased risk of pancreatic cancer including age, sex, race, genetic, history of chronic pancreatitis, diabetes mellitus, gallstone, obesity, Helicobacter pylori infection, smoking, diet, and polution exposure. A lot of cases were diagnosed in late stadium due to non-specific early clinical symptoms, and also, until now, there is no examination tool that may screen pancreatic cancer in the earliest stage. Total surgery resection is the therapy of choice in the early stadium of pancreatic cancer, and other therapy modalities are chemotherapy, radiotherapy. Combination of these modalities is frequently used in order to increase the effectiveness of therapy. Mesothelin, a surface glycoprotein on normal mesothelial cells, is overexpressed in pancreatic cancer; therefore, although it is not a cancer specific antigen, it can be used in diagnostic and treatment of pancreatic cancer. Several studies about mesothelin application in pancreatic cancer have been performed; however, more studies are needed to improve the application of mesothelin on pancreatic cancer. Keywords: pancreatic cancer, risk factor, therapy, mesotheli
Non-invasive Markers for Diagnosis of Liver Cirrhosis in Chronic Hepatitis B
No full textBackground: Indonesia is an endemic country for hepatitis B viral infection. Thus, early diagnosis of cirrhosis is important to be established with regard to prompt treatment and to determine the patients’ prognosis. Liver biopsy which is a gold standard in diagnosing liver cirrhosis has several limitations, such as expensive and invasive. The objective of this study was to identify the accuracy of non-invasive markers: aspartate/alanine transaminase ratio (AAR), age-platelet index (API), aspartate transaminase to platelet ratio index (APRI), spleen to platelet ratio index (SPRI), and age-spleen-platelet ratio index (ASPRI) in predicting cirrhosis in chronic hepatitis B patients. Methods: A diagnostic study was performed in Division of Hepatology and Hepatology Outpatient Clinic, Depatment of Internal Medicine, Cipto Mangunkusumo Hospital between January 2009 and July 2010, with the participation of 71 chronic hepatitis B patients who had undergone liver biopsy consecutively. Stage of fibrosis was determined based on the METAVIR scoring system. Five non-invasive markers: AAR, API, APRI, SPRI, and ASPRI were compared with liver biopsy Results. Statistical analysis was performed by using T-test and Spearman correlation test using SPSS version 13. Results: API, APRI, SPRI, and ASPRI had significant correlation with the incidence of liver cirrhosis in hepatitis B infection (p < 0.05). However, AAR had no correlation with the incidence of cirrhosis. Using the cut-off point of 1.19, APRI was the best marker with area under curve (AUC) 0.91, sensitivity 83.3%, and specificity 89.2%. Conclusion: Non-invasive markers were suitable in predicting cirrhosis and have the potential to decrease the number of liver biopsy in chronic hepatitis B patients. Keywords: non-invasive markers, chronic hepatitis B, liver cirrhosi
Evaluation of Increased Serum Aminotransferase Level in Asymptomatic Patient
No full textLiver test abnormalities are commonly found in ambulatory patients. The liver function tests are routinely included in chemistry panels. According to the American Gastroenterological Association (AGA), 1-4% of the asymptomatic population may have elevated serum liver chemistry. The majority of asymptomatic patients with liver test abnormalities have no evidence of liver disease. Unfortunately, abnormal Results for liver function are often not adequately investigated, missing an important chance of identifying treatable chronic liver disease. Potential causes of liver aminotransferase elevation are originated from hepatic causes (viral hepatitis, alcohol use, medication use, steatosis and non-alcoholic steatosis hepatitis, autoimmune hepatitis, hemochromatosis, Wilson’s disease, α-antitrypsin deficiency) and non hepatic causes. In the majority patients (92%) with chronically elevated aminotransferase tests, etiologies of the liver disease could be diagnosed through close clinical approach, which includes: history taking, physical examination, and blood tests. If elevation persists after an appropriate period of observation, further testing may include ultrasonography and other serum studies. In about 8% of patients with chronic abnormal alanine aminotransferase levels no cause is found. So, if liver test abnormalities cannot be explained by other findings, liver biopsy examination can help to exclude serious liver disease or disclose the nature and severity of liver disease. Keywords: elevated liver transaminase, asymptomatic patients, chronic liver diseas
Preventing NSAID-induced Gastropathy: The Role of Mucus Cells to Prevent Aspirin-Induced Acute Gastric Mucosal Damage
No full textBackground: Mucus is pre-epithelial gastric layer that may prevent damages due to direct contact between aspirin and gastric epithelial cells. The integrity of gastric mucosa and mucous cellular reaction may serve as primary and secondary prevention of extended aspirin-induced gastric mucosal damage. The aim of this study was to prove the function of mucus as defensive factor in rats. Method: The study was conducted in twenty white rats of the Sprague-Dawley strain at Department of Pathology and Clinical Reproduction, Bogor Agricultural University, between January and December 2008. The rat in the treatment group were given 400 mg aspirin diluted in aqua bidest through intra- gatric canules; while the control group received aqua bidest only once daily for 3 days. Necropsies, macroscopic and microscopic observation were performed by counting the number of Alcian blue- periodic acid Schiff-stained mucous cells at fundus/corpus and antrum/pylorus regions. Data analysis was performed using ANOVA and Duncan test. Results: The number of mucous cells with positive lesions in the treatment group was significantly different from the control group at both regions. There was no significant difference of negative lesions between treatment and control group at both regions. At antrum/pylorus region, there was no difference of negative lesions between treatment and control groups; however, both groups demonstrated significant difference of positive lesions in treatment group. Conclusion: In primary prevention for gastric mucosal lesions, there is no increasing number of mucous cells in normal mucosa. Increasing number of mucous cells is a secondary prevention against extended aspirin-induced gastric mucosal damage. Keywords: NSAIDs/ASA, mucus cells, gastric mucosal lesion, ra
Cytokeratin 7 and Cytokeratin 19 Expressions in Oval Cells and Mature Cholangiocytes as Diagnostic and Prognostic Factors of Cholestasis
No full textBackground: The activity of liver progenitor cells as bipotent liver stem cells, such as the oval cells, has been observed. The presence of oval cells and mature cholangiocytes forming hepatobiliary ductules may be applied to distinguish extrahepatic and intrahepatic cholestasis of the infants. Method: This cross sectional study was performed on 40 paraffin-embedded sections consisting of 2 groups of 20 cases with extrahepatic and intrahepatic cholestasis of the infants from histophatological examination in Cipto Mangunkusumo hospital Jakarta between January 2000 and September 2011. The liver fibrosis grading was reevaluated by hematoxylin and eosin and also trichrome staining. The specimens were tested by immunohistochemical staining for cytokeratin (CK) 7 and CK 19 expressions in oval cells and mature cholangiocytes. The correlation between CK7/CK19 expressions in oval cells and liver fibrosis were analyzed by Spearman’s correlation test. Results: Expressions of CK7 and CK 19 on oval cells and mature cholangiocytes performed in hepatobiliary ductules, were significantly higher in extrahepatic than intrahepatic cholestasis with p < 0.05. CK7 and CK19 expressions in oval cells showed strong correlation with the degree of liver fibrosis with r = 0.793; p < 0.05 for CK 7 and r = 0.827; p < 0.05 for CK 19. Conclusion: Expressions of CK7 and CK19, in oval cells and mature cholangiocytes, were higher at extrahepatic than intrahepatic cholestasis. Expressions of CK7 and CK19 in oval cells were directly proportional to the degree of liver fibrosis in cholestasis of the infants. Keywords: cholestasis, oval cell, cholangiocytes, fibrosis, CK7, CK1
The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital
No full textBackground: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study. Keywords: upper gastrointestinal endoscopy, profile, indications, endoscopic diagnosi
Dyspepsia in Nonsteroidal Anti-inflammatory Drugs Gastropathy
No full textBackground: Nonsteroidal anti-inflammatory drugs (NSAIDs) gastropathy is a common complication, which has characteristic symptoms of dyspepsia syndrome. Mostly, it includes epigastric discomfort with bloating and nausea. The aim of this study was to provide evidences that clinical symptoms of dyspepsia are related to macroscopic changes of gastric form in rats, which are expected to be applied in human. Method: The study was conducted in 20 white rats (Rattus norvegicus, Sprague-Dawley strain) at the Department of Pathology and Clinical Reproduction, Bogor Agricultural University between January and December 2008. The rats were divided to treatment group and control group and each group consisted of 10 rats. Acetyl salicylic acid (ASA/aspirin) was administered at 400 mg dose, diluted in distilled water and was given to the treatment group using gastric cannula, once daily for three days period; while the control group had received aquabidest only. Subsequently, necropsies were conducted for both groups, followed by macroscopic observation and measurement of sagittal and transversal diameter. Gastric incisions along the minor curvature were performed in both groups to recognize any macroscopic changes of gastric mucosa. ANOVA test was utilized for data analysis, which was followed by Duncan test when the results were significant. Results: Gastric diameters in treatment group with positive lesion were significantly different from the control group and the treatment group with negative lesion on anthrum/pylorus region, with p < 0.05. Conclusion: Prominent gastric dilatation at anthrum/pylorus region found in the treatment group may become the initial cause and signs of dyspepsia in human. Keywords: NSAID gastropathy, dyspepsia, NSAIDs/aspirin, gastric dilatatio
Characteristic Profiles of Parasitic and Fungal Infections in Acute Diarrhea
No full textBackground: Diarrhea has been widely encountered in developing countries, including Indonesia. This study aimed to investigate the incidence of parasites and fungal infections, which also constitutes the etiologies of acute diarrhea. Method: A cross-sectional study was performed involving 93 patients. Patients with chief complaint of acute diarrhea were recruited at five hospitals in Jakarta, Indonesia during the period of November 2008 until May 2009. Acute diarrhea was defined as passing watery or soft stools with frequency of more than three times per day, weighted more 200 g per day, and occurred in less than 15 days duration. They were asked to collect their stool to the laboratory for further parasites and fungal detection. Results: This study showed that 41 out of 93 patients (44.09%) were found to be infected with parasites or fungi. The most common microorganism found was Candida albicans in 18 (19.35%) patients. Other parasites encountered in the stool samples were Blastocystis hominis, Entamoeba histolytica, Entamoeba coli, Giardia lamblia. The presenting clinical symptoms of the patients were fever (44.87%), bloating (41.03%), nausea (39.74%), oliguria (39.74%), cephalgia (35.90%), vomiting (24.36%), and tenesmus (19.23%). Conclusion: The incidence of parasitic and fungal infections in patients with acute diarrhea constitutes nearly half of all cases of infection-caused diarrhea. The most commonly encountered microorganism is Candida albicans. Keywords: parasites, fungi, acute diarrhe
