The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Association between HBV DNA Level and Intrahepatic HBcAg Protein Expression of Hepatocytes in Patients with Chronic Hepatitis B
No full textBackground: Correlation between serum Hepatitis B viral deoxyribonucleic acid (HBV DNA) and hepatitis B core antigen (HBcAg) protein expression in the liver regarding hepatitis B e-antigen (HBeAg) status have not been well studied. This study was aimed to demonstrate association between serum HBV DNA and HBeAg levels with HBcAg expressions in the liver. Method: A total of 55 naive chronic hepatitis B (CHB) patients were enrolled. All samples were tested for HBeAg serum by serological test enzyme-linked immunosorbent assay (ELISA) and HBV DNA was determined by polymerase chain reaction (PCR) HBsAg and HBcAg were evaluated immunohistochemically in the liver tissue Results: Of 55 patients, 44 (80%) were HBeAg positive and 11 (20%) were HBeAg negative. There was a positive correlation between serum HBV DNA and HBcAg expression in the nuclei (r: 0.383; p = 0.004). There was association between HBcAg expression in the nucleus and qualitative HBeAg (p = 0.017). Conclusion: In the patient with chronic HBV, there is a very significant positive correlation between the level of viral replication and HBcAg expression in the nucleus of hepatocytes. Moreover, there is association between HBcAg expression in the hepatocytes nucleus and HBeAg serum level. These finding lead to the proposition that nucleus localization of HBcAg protein function to amplify the pool of cccDNA in the replication cycle of HBV.. Keywords: HBV DNA, Imunohistochemistry, HBcA
The Efficacy of L-Ornithine L-Aspartate Granules and Normal Protein Diet in Minimal Hepatic Encephalopathy with Malnutrition
No full textBackground: The dietary protein restriction that was commonly recommended to hepatic encephalopathy (HE) patients, often leads to malnutrition, whereas malnutrition can deteriorate cirrhosis prognosis. The aims of this study were to find out encephalopathy improvement that was measured by critical flicker frequency (CFF) test and nutritional status by measuring prealbumin level after L-Ornithine L-Aspartate (LOLA) treatment with adequate calories and protein intake in patients with HE. Method: Patients with liver cirrosis who visited Cipto Mangunkusumo hospital on June-October 2009 was evaluated by CFF test using HEPAtonormTM device. Encephalopathy was defined when CFF < 39 Hz. Nutritional status was measured by the mid-arm muscle circumference (MAMC) and was stated as malnutrition when the MAMC was below the 15th percentile. Patients had been treated by 3 x 6 mg LOLA granules for 2 weeks, and adequate calories and protein intake with branched-chain amino acid (BCAAs) substitution. The change of encephalopaty was evaluated by the CFF test and the nutritional status by measuring prealbumin blood level. Results: There were 17 patients with liver cirrhosis who fulfilled the inclusion criteria. The mean CFF Result increased from 34.1 ± 2.5 Hz to 36.5 ± 2.9 Hz after LOLA treatment with the adequate calories and protein intake including BCAAs substitution, which was statistically significant (p < 0.001) compared to before treatment. The prealbumin level also increased significantly compared before treatment, i.e. from 5.4 ± 2.1 mg/dL to 6.4 ± 2.6 mg/dL, p = 0.008. Conclusion: HE patients with malnutrition could be given adequate calorie and protein with BCAAs substitution to improve their nutritional status, and LOLA granules for the improvement of HE. Keywords: minimal hepatic encephalopathy, malnutrition, CFF, LOLA, prealbumin, BCAA
Imaging of the Biliary Tract
No full textImaging is central to the investigation and diagnoses of biliary tract disease. Upper abdominal pain, jaundice and abnormal liver function test are common symptoms and signs and imaging of the biliary tract should be performed to make an exact diagnosis of the disease. There are many options in the field of imaging from simple to more sophisticated examinations. Several imaging techniques are obsolete namely oral cholecystography, Intravenous cholangiography and biliary scintigraphy, and should therefore be omitted. These imaging techniques are expensive and we should choose one or two options. Abdominal ultrasound is less expensive and can be performed rapidly without special preparation or contrast agent. It is the imaging of choice in the initial evaluation to evaluate patients with hepatopacreaticobiliary diseases. From the Result of abdominal ultrasound examination we can choose further the right imaging technique that can disclose the diagnoses of the disease.Keywords: biliary tract, diseases, imagin
Clinical Scoring of Positive Histophatology Findings for Inflammatory Bowel Disease at Four Hospital in Jakarta
No full textBackground: Inflammatory bowel disease (IBD) in the form of Crohn’s disease (CD) or ulcerative colitis (UC) is chronic IBD which still difficult to diagnose and clinically characterized by exacerbation and spontaneous remission. A precise diagnosis is needed and essential for appropriate treatment. Most of internists in Indonesia have to cope with a condition of poorly equipped endoscopic facilities - especially colonoscopy and subsequently refer their patients to endoscopic centers with colonoscopy facilities as well as sending biopsy specimens for histopathology examination. They also should be concerned that it would be expensive, time- consuming, and patients may suffer from considerable distress while waiting for the results of diagnostic confirmation. Therefore, we were interested in studying the clinical scoring for IBD to determine the diagnosis of possible IBD by assessing the combination of clinical reporting aspects, identification of probable IBD and histopathology examination Method: The study design was cross-sectional. We collected data pertinent to this study from medical records of patients with IBD clinical features at the endoscopic units of four hospitals in Jakarta between 1999 and 2009. Student t-test and logistic regression analysis were used for the statistic examination. Results: Based on colonoscopy examination, there were 213 patients with positive IBD and 173 patients with negative results. Histopathology results were considered as the gold standard in diagnosis of IBD. The mean clinical score was 9 (nine) points. Subjects with positive histopathology findings were significantly had higher average score than those with negative histopathology findings. Using ROC curves, we found cut-off score of 10 points with a sensitivity and specificity of 73% and 88% consecutively; while by applying logistic regression analysis, we found odds ratio (OR) of 20 (9.9-40.0 Conclusion: The clinical scoring for IBD is a valuable diagnostic tool in determining definitive diagnostic of IBD based on histopathology findings Keywords: clinical scoring, histopathology findings, definitive IB
Diagnosis and Management Pancolitis in Patient with Ulcerative Colitis
No full textABSTRACT Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that usually affects the rectum and part of the colon, which spreads continuously with no skip area. Pancolitis occurs in 20% of patients with UC. Patients with chronic UC, especially pancolitis, have a higher risk of colon cancer. In patients with pancolitis, the risk of cancer increases by 0.5-1% per year after having 8-10 years of disease. A 72-year-old man came with complaint of bloody-mucus diarrhea associated with abdominal cramps. The colonoscopic appearance of colitis was observed in whole lumen throughout colon. Histopathological analysis demonstrated dense infiltrates of granulocytes and macrophages formed by severe inflammation. Normal appearances were observed in the remaining epithelial cells. No parasites, specific process, or malignancy were found. Moreover, no acid-resistant bacteria were found. However, atypical cells were found in one of the biopsy specimens. The patient was diagnosed with extensive type of severe UC. The initial management of treatment included improvement of his general condition along with antibacterial therapy of metronidazole and ciprofloxacin. Specific treatment of sulphasalazine and prednisone were given after pancolitis appearance was revealed, which has similar clinical manifestations in accordance with UC. Keywords: pancolitis, ulcerative colitis, chronic diarrhea, inflammatory bowel diseas
The Cyclooxygenase-2 and Nuclear Factor-kappa B Expressions in Colorectal Polyps
No full textBackground: Cyclooxygenase-2 (COX-2) is the rate-limiting enzyme in prostaglandin synthesis, while nuclear factor kappa B (NF-kB) is a family of transcription factors. Both play an important role in tumorigenesis. In the present study, we examined NF-kB and COX-2 expressions pattern, and their association in neoplastic and non-neoplastic colorectal polyps (CP). Method: Formalin-fixed and paraffin embedded tissue blocks from 77 patients with CP were immunostained with anti-NF-kB (p 65) and anti-COX-2. Expressions of NF-kB, and COX-2 were detected immunohistochemically. The relationship between these expressions and the two types of CP, and other clinicopathological findings were evaluated Results: The expressions of NF-kB and COX-2 in patients with neoplastic and non-neoplastic CP were high. The results of this study indicated that generally in CP, NF-kB was associated with COX-2 and the association was also seen in neoplastic and non-neoplastic polyps. There was no significant difference of NF-kB and COX-2 expressions in terms of patient’s age, sex, histologic type, and location of the CP. Neoplastic CPs were more common in the distal colon, female patients and older patients (> 60 years) compared with non-neoplastic CPs. Neoplastic CP were located more at the distal colon, more in female, and more in older (> 60 years) patients as compared with the non-neoplastic CP. Further studies are needed to elaborate the role of inflammation in sporadic colorectal carcinogenesis. Conclusion: The expressions of NF-kB and COX-2 in patients with CP were high, and strong correlated each other. There were no significant differences between expression of NF-kB and COX-2 in neoplastic and non-neoplastic polyps. Keywords: colorectal polyps (CP), NF- B, COX-2, inflammatio
In Searching of Colorectal Cancer Screening Tools Suitable for Resource-limited Countries
No full textAlteration of Subcellular Beta Catenin Expression in Normal Mucosa Adenoma and Carcinoma in Relation to Colorectal Carcinogenesis
No full textBackground: Adenomatous polyposis coli (APC) gene mutation was found in up to 80% of cases of sporadic colorectal cancers and adenomas. Loss of APC protein function has been known as one of the early process in colorectal carcinogenesis. This event leads to the accumulation of beta catenin in the cytoplasm and nucleus and subsequently activates target genes that regulate cell proliferation and apoptosis. The aim of this study was to investigate the alteration of subcellular beta catenin expression in the progression of colorectal cancer. Method: This cross-sectional study was conducted with 30 paraffin-embedded tissue sections each of normal colorectal mucosa, adenomas and carcinomas. Alteration of beta catenin expression in membranous, cytoplasmic, and nuclear compartments were evaluated by immunohistochemical staining. Results: Beta catenin immunoreactivity was detected in all cases, of which 87 (96.7%) cases showed membranous expression, 78 (86.7%) cases had cytoplasmic and 51 cases (56.7%) had nuclear expression. Such results were statistically significant (p < 0.000). All normal colorectal epithelium showed membranous beta catenin expression with 18 (60.0%) cases showed cytoplasmic and no nuclear beta catenin expression was found. Strong cytoplasmic expression was found in 17 (56.7%) adenomas and 25 (83.3%) carcinomas; while strong nuclear expression was found in 12 (40.0%) adenomas and 17 (56.7%) carcinomas. There was no statistical significant association between beta catenin expression in the membranous, cytoplasmic and nuclear compartment with the degree of dysplasia or differentiation of tumor (p > 0.05). Conclusion: Altered subcellular expression of beta catenin occurs as the oncogenic process develops from adenoma into carcinoma. Such finding reflects the importance of beta-catenin in colorectal carcinogenesis. Keywords: beta catenin, colorectal cancer, adenoma, colorectal cancer progressio
Acalculous Cholecystitis Prevalence on Abdominal Ultrasonography Examination of HIV/HCV Co-infection Patients in Cipto Mangunkusumo Hospital
No full textBackground: Acalculous cholecystitis is commonly found in patients with human immunodeficiency virus (HIV) compared to general population. Surprisingly, the signs and symptoms are unremarkable. On the other hand, HIV/hepatitis C virus (HCV) co-infection is a common finding. The aim of this study was to evaluate whether HCV infection has any influence to HIV patients concerning acalculous cholecystitis prevalence. Method: A cross-sectional study was performed in HIV/HCV patients who visited AIDS study group clinic at Cipto Mangunkusumo hospital during September 2008 to February 2009. The patients who met the criteria were examined physically and underwent abdominal ultrasonography. Routine blood count, alanine aminotranferase, aspartate aminotransferase, cluster of differentiation 4 (CD4) and serum albumin were recorded. Results: Of 63 patients underwent ultrasonography examination, we found acalculous cholecystitis in 33 patients (52.3%), cholelithiasis and cholecystitis in 2 patients, and 28 patients were considered normal. Patients with CD4 less than 200 cells, tend to have acalculous cholecystitis more than those who had CD4 more than 200 cells. Conclusion: The prevalence of acalculous cholecystitis among HIV/HCV co-infection is higher compared to those with HIV infection alone. Keywords: acalculous cholecystitis, HIV/HCV co-infection, CD
Factors Found on the First Variceal-Bleeding Episode in Liver Cirrhosis Patients with Portal Hypertension
No full textBackground: The dietary protein restriction that was commonly recommended to hepatic encephalopathy (HE) patients, often leads to malnutrition, whereas malnutrition can deteriorate cirrhosis prognosis. The aims of this study were to find out encephalopathy improvement that was measured by critical flicker frequency (CFF) test and nutritional status by measuring prealbumin level after L-Ornithine L-Aspartate (LOLA) treatment with adequate calories and protein intake in patients with HE. Method: Patients with liver cirrosis who visited Cipto Mangunkusumo hospital on June-October 2009 was evaluated by CFF test using HEPAtonormTM device. Encephalopathy was defined when CFF < 39 Hz. Nutritional status was measured by the mid-arm muscle circumference (MAMC) and was stated as malnutrition when the MAMC was below the 15th percentile. Patients had been treated by 3 x 6 mg LOLA granules for 2 weeks, and adequate calories and protein intake with branched-chain amino acid (BCAAs) substitution. The change of encephalopaty was evaluated by the CFF test and the nutritional status by measuring prealbumin blood level. Results: There were 17 patients with liver cirrhosis who fulfilled the inclusion criteria. The mean CFF Result increased from 34.1 ± 2.5 Hz to 36.5 ± 2.9 Hz after LOLA treatment with the adequate calories and protein intake including BCAAs substitution, which was statistically significant (p < 0.001) compared to before treatment. The prealbumin level also increased significantly compared before treatment, i.e. from 5.4 ± 2.1 mg/dL to 6.4 ± 2.6 mg/dL, p = 0.008. Conclusion: HE patients with malnutrition could be given adequate calorie and protein with BCAAs substitution to improve their nutritional status, and LOLA granules for the improvement of HE. Keywords: minimal hepatic encephalopathy, malnutrition, CFF, LOLA, prealbumin, BCAA