The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment
No full textBackground: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p < 0.001). Re-bleeding and recurrence rates were 38.64% and 84.21% for endoscopic sclerotherapy, and 25.93% and 70% for endoscopic band ligation (p > 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices. Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxi
Complicated Benign Peptic Stricture of the Esophagus
No full textPeptic esophageal stricture secondary to gastroesophageal reflux is an important cause of esophageal stenosis and dysphagia. Symptoms of peptic strictures are usually insidious but progressive beginning with dysphagia to solids followed by dysphagia to liquids. It was estimated to occur in up to 20% of untreated patients, which has decreased significantly since the era of proton pump inhibitor therapy. The presence of esophageal reflux stricture is typically diagnosed by means of a barium esophagogram, although endoscopy may have both diagnostic and therapeutic value. Treatment usually involves dilation combined with acid- suppressive therapy. We reported a 43-year-old patient with complicated benign peptic stricture of the esophagus that finally underwent esophageal resection, a rarely therapeutic option. Keywords: gastroesophageal reflux disease, benign peptic esophageal stricture, dysphagia, esophageal dilatation, surgical treatmen
The Effectiveness of Emergency Endoscopic Retrograde Cholangiopancreatography in Patients with Severe Acute Cholangitis
No full textBackground: The aim of this study was to assess the frequency, indications, yield and outcome of emergent endoscopy retrograde cholangiopancreatography (ERCP) in severe acute cholangitis patients. Method: Records of all cholangitis patients undergoing ERCP were reviewed over a six months period. Indications, findings, therapeutic interventions and survival were analyzed. Indications for urgent drainage were temperature greater than 38ºC, increasing abdominal pain, jaundice and any organ involvement. Results: Of 80 ERCPs, 19 (23.75%) were severe acute cholangitis patients underwent emergency ERCP. The common bile duct was the duct of interest in all patients and was cannulated in 100%. The most common findings were choledocholithiasis (42.1%) and pancreatic head cancer (42.1%), followed by cholangiocarcinoma (10.5%) and papil vater carcinoma (5.3%). There were 12 (63.2%) septic shock patients with systolic blood pressure less than 90 mmHg and heart rate greater than 90 beats/minute who required inotropic drugs. Endoscopic biliary drainage was performed using 8.5 F biliary stent (73.7%) or common bile duct (CDB) stones removal (26.3%). The overall 30 days mortality was 0. Conclusion: Emergency ERCP in severe acute cholangitis is associated with improvement of clinical and some laboratory parameters without a complication of acute pancreatitis. In cases of chIoledocholithiasis, it can be performed with stone extraction as well as stent insertion Keywords: severe acute cholangitis, emergent ERCP, endoscopic stenting in difficult hilar biliary strictur
Colitis Tuberculosis
No full textTuberculosis (TB) is a significant public health problem worldwide. Indonesia is a country with the third highest prevalence of TB in the world after China and India. TB infection can attack all organs of the human body. TB in digestive system is one of the extrapulmonary TB manifestations and comprises of 3- 16% of all extrapulmonary TB cases. This type of TB may affect digestive system, peritoneum, mesentery lymphatic glands, liver, and spleen. Digestive system is affected in 66-75% of patients with abdominal TB. The ileocaecal region is most commonly affected. The manifestation of abdominal TB is not specific. Precise diagnostic approach and supporting results are needed to determine final diagnosis. However, there is no single examination adequate enough to diagnose abdominal TB. If the diagnosis can be established early, this disease could then be managed with conventional anti-TB drugs. Treatment for both 6-9 months period and 18-24 months period has been proven effective in management of extrapulmonary TB. In countries with high abdominal TB prevalence, initiation of anti-TB therapy is allowed if there are the clinical features present. Diagnosis can be determined when the patient has therapeutic response against the the anti-TB treatment. Keywords: tuberculosis, colitis, extrapulmonary, antituberculosis drug
Risk Factors for the Occurrence of Erosive Esophageal in Patients with Dyspepsia
No full textBackground: The prevalence of erosive esophagitis tends to increase recently. It induces higher medical expense, loss of working time, and decreases quality of life. However the study on risk factors of erosive esophagitis scarcely reported in Indonesia. This study aimed to find the association between age, sex, smoking, alcohol drinking, body mass index, hiatal hernia, the use of non steroidal anti-inflammatory drugs (NSAID), and drugs that decrease lower esophageal sphincter (LES) tone with the occurrence of erosive esophagitis in dyspeptic patients. Method: A case-control study was conducted on patients with dyspepsia who underwent upper gastrointestinal endoscopy procedure and had been interviewed to determine risk factors for erosive esophagitis in July - September 2008. The association between risk factors and the occurrence of erosive esophagitis were analyzed using Chi-square, which subsequently revealed p < 0.25, this variable included in multivariate analysis. Result: There were 135 patients fulfilled criteria; 45 patients as cases and 90 patients as controls. The association was found between the occurrence of erosive esophagitis in dyspeptic patients and smoking more than 15 cigarette/day (OR 15.43; p = 0.00; CI 95% 4.77-49.88), the use of NSAID (OR 9.49; p = 0.00; CI 95% 2.77-32.53) and the consumption of drugs that decrease LES tone (OR 3.56; p = 0.02; CI 95% 1.26-10.02). Conclusion: Smoking more than 15 cigarettes/day, use of NSAID and drugs that decrease LES tone is a risk factors for the occurrence of erosive esophagitis. Keywords: erosive esophagitis, NSAID, smoking, drugs that decrease LES ton
Primary Gastrointestinal Tract Lymphoma
No full textExtranodular lymphomacanbe found in almostallorgan. One third of the cases found in gastrointestinal(GI) tract, whichisthemost commonformofextranodular lymphoma.All thesubtypesof lymphomamayoccurasprimarylesionalongingastrointestinaltract,butthemostcommonformis B-celldiffuse largecelllymphoma.DiseasesthatlinkedwithGItractlymphomaareinflammatorybowel disease, celiac disease,Helicobacter pylori, virus infection,collagen diseaseandionicradiation.This reportdescribed a40yearsoldmanwith recurrentbloodystoolandcolon lymphomawasblamedas the sourceofbleeding withitsmanagementoflymphoma. Keywords:lymphoma, gastrointestinaltract,extranodular
Frequency Scale for the Symptoms of GERD Score for Gastroesophageal Reflux Disease in Koja Hospital
No full textBackground: The frequency scale for the symptoms of GERD (FSSG) was a specific questionnaire to gastroesophageal reflux disease (GERD), which has been validated against the endoscopic findings in Japan. The high score FSSG is one of the factors related to failure of proton pump inhibitor (PPI) mono therapy. The purpose of this study is to determine FSSG score in patients with GERD at Koja hospital, in order to predict the need for combination therapy of PPI with pro- kinetic drug or PPI only. Method: Dyspeptic patients which had have heartburn and/or regurgitation were collected in the period of March until July 2010. The FSSG score was obtain containing 12 questions which consisted of seven questions for reflux symptoms and five questions for dysmotility/dyspeptic symptoms. Results: There were 129 patients, 51 (39.5%) males and 78 (60.5%) females, mostly in the age group of < 40 years (55.8%), body mass index of most patients (66.6%) were normal, only 12.4% were overweight. FSSG score revealed the mean of total score of 17.6 ± 6.9. From 129 dyspepsia patients who complained heartburn and or regurgitation, obtained 121 (94%) met criteria for GERD with cutoff eight. The mean of reflux score was 7.4 ± 4.6 while the mean of dyspeptic/dysmotility score was 10.1 ± 4. Thus from 129 patients studied, the symptoms of dyspeptic/dysmotility more dominant than symptoms of reflux Conclusion: GERD patients in Koja hospital have a high mean FSSG score, whereas dysmotility symptoms was proved to be more dominant than acid reflux Keywords: GERD, FSSG, dyspeptic/dysmotility score, reflux scor
The Role of Fecal Occult Blood Test in Screening of Colorectal Cancer and Inflammatory Bowel Disease
No full textColorectal cancer (CRC) and inflammatory bowel disease (IBD) are a quite common colon disease in the world. The World Gastroenterology Organization (WGO) recommends screening test to detect colorectal cancer, i.e. fecal occult blood test (FOBT) and colonoscopy. Diagnosis of CRC is established based on a good history taking, clinical manifestation, physical examination and laboratory examination. Other supporting laboratory tests include routine laboratory test of hemoglobin for detecting anemia, examination of bleeding stool either macroscopically or microscopically. Radiographic examination, either colon in loop or colonoscopy (if such modalities are available), shall be performed to confirm the occurrence of cancer mass in the colon. Moreover, biopsy examination is carried out to obtain the histopathological feature of tumor mass or the type of cancers. WGO has made a guideline for CRC screening, which consists of 6 cascades, which depend on the risk of colorectal cancer and local facilities available. There are several kinds of FOBT, but the most frequently used include three methods, i.e.: the FOBT guaiac base/traditional, the fecal immunochemical test (FIT) and the FOB + transferrin rapid test (OT 102c & OT 103c). FIT and FOB + transferrin rapid test have a quite high sensitivity and specificity in detecting the lower gastrointestinal tract bleeding caused by colorectal cancer and IBD. Keywords: FOBT, colorectal cancer, IB
Endoscopic Feature of Upper Gastrointestinal Bleeding Patient in Soedarso General Hospital Pontianak
No full textBackground: Gastrointestinal tract hemorrhage is an emergency condition most commonly caused by rupture of the esophageal varices with a mortality rate between 25-30% of cases. Gastrointestinal endoscopy is an accurate diagnostic used modality to identify lesions and locate bleeding in the upper gastrointestinal tract. The aims of this study were to determine the endoscopic features of upper gastrointestinal bleeding patients and distribution based on age and sex. Method: Retrospective study of endoscopic Results of upper gastrointestinal bleeding patients in Soedarso hospital, Pontianak, between January - June 2008. Results: There were 114 patients consisting of 75 (65.79%) male and 39 (34.21%) female. The findings from endoscopic examination were 46 (40.35%) cases of gastric ulcers, 23 (20.17%) cases of esophageal varices, 20 (17.54%) cases of errosive gastritis, 17 (14.91%) cases of duodenal ulcer, and 4 (3.5%) cases of esophageal mass/gastric mass. Conclusion: In this study the most common cause of upper gastrointestinal bleeding is gastric ulcer and it occurs more often in males compared to females. Keywords: endoscopic feature, upper gastrointestinal, gastric bleedin
Colorectal Cancer Metastasis of and the Risk Factors
No full textBackground: Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them < 40 years old, 37.2% patients 41-60 years old, and 29.4% patients > 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis. Keywords: colorectal cancer, metastasis, well-differentiated, poorly-differentiate