The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Mucus Thickness of the Gastric Mucosa and Helicobacter pylori Infection in Dyspeptic Patients with or without Diabetic Symptom
No full textBackground: Chronic Helicobacter pylori (H. pylori) infection affects the mechanisms of gastric mucosal protection. In patients with diabetes mellitus, data on the prevalence of H. pylori infection are scanty and contradictory. We have examined, using histological fixation technique, the thickness of the adherent mucus gel layer in the gastric mucosal and H. pylori infection in dyspeptic patients with or without diabetes. Method: A cross-sectional study was conducted in 86 dyspeptic patients consisted of 43 diabetics and 43 non-diabetics patients. In all cases, upper gastrointestinal endoscopy were performed, measurement of the gastric corpus and antral mucus thickness was carried out at the corpus and antral biopsy specimens were snap frozen and cryostat sections were stained using a hematoxyline eosin. One biopsy within 2 cm of the pylorus was examined for detection of H. pylori status by using polymerase chain reaction (PCR). Results: In all sections the mucus layer was continuous. At the gastric corpus and antrum, the mucus thickness of diabetic patients was thinner than non diabetic patients: 35.2 ± 2.2 µ m and 43.9 ± 3.8 µ vs 45.2 ± 2.5 µ m and 51.2 ± 2.2 µ m. The results were significantly different (p = 0.001). The difference of H. pylori prevalence between diabetics (52.5%) and nondiabetics patients (47.5%) was not significant (p = 0.67). Conclusion: This study shows a significant thinning of the adherent mucus gel layer both in diabetic patients and H. pylori-positive individuals. No difference has been found between patients with H. pylori infection and diabetes mellitus. Keywords: mucus thickness, Helicobacter pylori infection, diabetic patien
Upper Gastrointestinal Malignancy among Dyspepsia Patients in Cipto Mangunkusumo Hospital Jakarta
No full textBackground: Upper gastrointestinal (GI) malignancy was still a health problem in all over the world. The prevalence of the upper GI malignancy vary among Asian countries. Data from Indonesia was scarcely reported. The aim of this study is to determine the frequency of upper GI malignancy among dyspepsia patients who underwent esophagoduodenoscopy (EGD) procedure. Method: This is a retrospectives study from subject with dyspepsia that had underwent upper GI endoscopy at the Department of Internal Medicine Cipto Mangunkusumo hospital from January 2005 to December 2007. All complete data from medical report and histopathology appearance will be recorded. Results: Out of 2,116 subjects underwent endoscopy due to dyspepsia, 110 (5.19%) subjects was diagnosed as cancer. This upper GI malignancy consisted of gastric cancer in 63 (2.97%) cases, esophageal cancer 32 (1.51%) and duodenal cancer 15 (0.71%). The mean ages of the subjects was 53.36 ± 10.97 years, age less than 45 years was 20 (18.20%) subjects, more than 45 years was 90 (81.18%), male 71 (64.50%) subjects, female 39 (35.50%). Most of them had alarm signs 96 (87.30%). Histopathology finding showed adeno-carcinoma in 75 (68.20%) cases, signet ring cell carcinoma in 14 (12.70%), squamous cell carcinoma in 8 (7.30%), others in 13 (11.80%). Out of 59 gastric cancer, 48 (76.20%) cases was located at distal part while the rest 11 (17.50%) cases was located at the proximal gaster, and 4 (6.30%) in diffuse. By the ethnics founded Javanese 37 (33.60%) subjects, Betawinese 22 (20.00%), Sundanese 12 (10.90%) and Batak 13 (11.80%). Conclusions: Upper GI malignancy was found in five percent of subjects with dyspepsia who undergo colonoscopy. The three most frequent malignancies were gastric carcinoma, esophageal carcinoma, and duodenal carcinoma respectively. Most of gastric adenocarcinoma was located at distal stomach. Keywords: upper gastrointestinal malignancy, dyspepsia, endoscopy, alarm sign, histopatholog
Multiple Lesion of the Colon and Ileocaecal Valve in Patient with Colitis Tuberculosis with Positive Bacilli Examination in the Stool
No full textIt is sometimes hard to establish the diagnosis of colon tuberculosis because the ulceration features on ileocaecal valve and caecum are not specific. Moreover, biopsy of lesion area can only provide 60-80% detection. The lesions usually include linear or transversal ulcer, nodule, abnormal form of ileocaecal valve and caecum, inflammatory polyp and irregular multiple fibrous bands. We report a case of colon tuberculosis in a 32-years-old woman with giant ulcer and pseudopolyps at ileus terminalis and ileocaecal junction detected by colonoscopy, in addition to multiple ulcers along the colon, starting from rectum to ascending colon. By fecal examination, positive Acid Fast Test (AFT) result was found and by chest X-ray, tuberculosis features were also found. Keywords: tuberculosis colitis, multiple ulcers in colon, giant ulcer, pseudopolyp, fecal AFT, colonoscop
Vasoactive Intestinal Peptide-Secreting Tumor
No full textVasoactive intestinal peptide-secreting tumor (VIPoma) is one of the tumors which cause “ watery diarrhea, hypokalemia, hypochlorhydria and acidosis syndrome” (WDHHA syndrome). These tumor caused by to non-insulin-secreting pancreatic islet tumor that associated with elevated vasoactive intestinal polypeptide (VIP) plasma level. VIP is a potent stimulator of gut cyclic adenosine monophosphate (cAMP) production, which leads to massive secretion of water and electrolytes mainly potassium. Over expression of VIP causes diarrhea and cancerous growth. The other clinical features of VIPomas such as hypercalcemia, abdominal discomfort, tetany, facial flushing are associated with the actions of VIP, which stimulate intestinal secretion, inhibit gastric acid secretion. VIP also regulates the synthesis, secretion, and action of neuroendocrine hormones such as secretin, glucagon, prostaglandin E, somatostatin and pentagastrin as well as cytokines and chemokines. Diagnosis is based on clinical, laboratory test show elevation VIP level, electrolyte and acid base imbalance also imaging such as CT scan or magnetic resonance imaging (MRI) which shows primary tumor in the pancreas and metastasis especially in the liver. Somatostatin receptor scintigraphy may be useful in identifying extrapancreatic VIPomas, i.e. the sympathetic chain, colon, bronchus and occult or distant metastases. Initial treatment is to correct volume, electrolyte, and acid-base abnormalities with intravenous normal saline, potassium chloride, and, sodium bicarbonate. Somatostatin or long acting ocreotide is effective in reducing serum VIP levels and promptly controlling diarrhea. Interferon alpha and glucocorticoid may be useful for reducing symptoms. Surgical resection depends on staging of pancreatic tumor. Keywords: VIPoma, WDHHA syndrome, VIP, non insulin secreting pancreatic islet tumo
Measuring HBsAg and HBV DNA Levels in Cilegon
No full textBackground: Implication of measuring HBsAg level is still not recognized well. The aim of this study to recognize the correlation of serum HBsAg level and serum HBV DNA level between in HBeAg positive patients and HBeAg negative patients. Method: Quantitative serum HBV DNA were collected retrospectively between January 2006 and May 2009. We stratified the patients into four groups, that were; HBeAg positive and (a) ALT > 2 x upper limited normal (UNL) (group A),( b) ALT < 2 x UNL (group B), HBeAg negative and:( a) ALT > 2 x UNL (group C) (b) ALT < 2 x UNL (group D). We studied the correlation of serum HBsAg and HBV DNA level in each group. In addition, we also studied the accuracy of HBsAg titers to predict serum HBV DNA levels in each group by using receiver operating characteristic (ROC) curve analysis. Results: Eighty nine patients were recruited in this study. Most of them 63 (70%) were male; the mean age of the patients was 38.49 ± 11.21 years. The number of patients with HBeAg positive and negative were 28 and 61 respectively. Based on the group stratification, the A, B, C and D groups we found 16, 12, 11, 50 respectively. There was a positive correlation between HBsAg titers and HBV DNA level in HBeAg positive patients but it was statistically not significant. Similar result was also found in HBeAg negative patients. There were positive correlation in group A, C, and D but they were not statistically significant. In group B the correlation was negative (r = -0.40). We found 100% sensitivity and 100% specificity of predicting serum HBV DNA levels in group A with HBsAg cut-off level of 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL. In group B, C and D the accuracy to predict serum HBV DNA level were not so good . Conclusion: There were positive correlation between HBsAg titers and HBV DNA levels in HBeAg positive and HBeAg negative patients as demonstrated in the three group stratification; however, the correlation was negative in group HBeAg positive and ALT < 2 x UNL. We found excellent (100%) specificity and sensitivity for predicting serum HBV DNA level in group HBeAg positive and ALT > 2 x UNL with HBsAg cut-off level 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL; while in other groups, the correlation were not so good. Keywords: serum HBsAg level, serum HBV DNA level, hepatitis B, correlatio
Ileal Endometriosis
No full textEndometriosis at the ileum site is a rare case and among the difficult cases of endometriosis. Intestinal endometriosis may cause obstructing symptoms, which is difficult to be distinguished from malignant or inflammatory disease. We report a case of 33-year-old woman, who admitted to the hospital because of sub-ileus intestinal obstruction. She underwent one session laparoscopy and laparatomy operation. Her ileum showed obstruction because of stenosis and adhesion with an ovarian brown cyst. She experienced terminal ileal resection, ileocaecostomy anastomosis, followed by laparatomy ovarial cystectomy and appendectomy. Microscopic evaluation of the intestine revealed vascular congestion, lymph nodes inflammation, and typical endometrial glands in the muscle layer of ileum. There was no sign of malignancy. These findings led to the diagnosis of ileal endometriosis. The ovarian cyst was actually the endometrial cyst of the ovary. Keywords: sub-ileus obstructive, ileal endometriosis, endometrial cys
Hemobilia after 49-days Accidental Hepatic Trauma and Twice Perihepatic Packing
No full textHemobilia occurs in only 1.2–5% of patients with accidental liver trauma. Clinical presentation of hemobilia include one symptom and two signs known as the classic Quinke triad, upper abdominal pain, upper gastrointestinal bleeding and jaundice. This report describes a case of patient with hemobilia that had been diagnosed 49 days after accidental hepatic trauma and twice perihepatic packing. A 29-year old man with hematemesis melena came to the hospital with the history of hepatic accidental trauma and had already received twice perihepatic packing treatment. At first, the esophagogastroduodenoscopy could only find gastritis and duodenal ulcer. Subsesquently, the ultrasonography revealed liver hematoma. Diagnosis of hemobilia was made when bleeding exiting from the ampulla of Vater which then was confirmed by the second esophagogastroduodenoscopy. Surgery had been planned but the patient and his family had refused the procedure. Hemobilia should be considered in patients presenting with gastrointestinal blood loss after liver injury. The diagnosis is confirmed by esophagogastroduodenoscopy and angiography. Modalities used to stop bleeding include angiography with embolization, surgical intervention, observation, and electro- coagulation or photocoagulation. Keywords: hematemesis, melena, liver injury, hemobilia, esophagogastroduodenoscop
Hospital-based Survey on Knowledge and Attitude toward Colorectal Cancer Screening among Indonesian Population
No full textBackground: Several western countries have recommended colorectal cancer (CRC) screening, however the yield of CRC screening is still low. The acceptability of CRC screening is influenced by people’s knowledge and attitude. This study was conducted to evaluate the knowledge and attitude of Indonesian people toward CRC screening. Method: Adult Indonesian population aged 19–65 years was recruited in this hospital-based survey. Knowledge and attitude toward CRC screening were assessed by using structured questionnaires consisting of nine chapters. Result: There were 614 respondents recruited in this study. Most respondents (36.2%) incorrectly pointed out abdominal pain or pain around anus as the symptom of bowel cancer. Regarding CRC risk factors, eating fruits or vegetables rarely was the most frequent answer (28.5%) encountered. Only one-third (28%) of respondents mentioned colonoscopy as the Method for CRC screening. There were 38.1% of respondents who believed that CRC screening test might be harmful to the body. Up to 70.8% of the respondents agreed and strongly agreed that CRC screening test might cause physical discomfort. Two fifth (41.5%) of respondents believed that CRC screening test was embarrassing. More than half (58.8%) of respondents were afraid of having the CRC screening test. The test was too expensive according to 79.5% of respondents. Conclusion: The knowledge on CRC symptoms, risk factors, and screening tests is still low among Indonesian population. Our study result indicates that the lack of knowledge and the discouraging attitude among Indonesian population will be the major barriers to implement CRC screening in Indonesia. Keywords: colorectal cancer, screening, knowledge, attitud
Early Experiences with Percutaneous Endoscopic Gastrostomy in Pondok Indah Hospital
No full textBackground: Percutaneous endoscopic gastrostomy (PEG) is only recently being introduced in Indonesia with limited clinical experience. Clinical study of patients underwent PEG is very limited. This study was aimed to evaluate clinical profile of patients underwent PEG in a private hospital in Jakarta. Method: A retrospective study was done to patients underwent PEG in Pondok Indah hospital, Jakarta using medical record. Clinical data collected were patients’ demographics, diagnosis of underlying disease, indication for PEG insertion, and follow-up visits. Results: Ten cases were found between 2000 and 2008, six among them were men. All but one cases aged more than 50 years. Ninety percents of the patients had cerebrovascular disorder as their primary diagnosis and 60% of the main indication was dysphagia. Conclusion: No procedure-related major complications and death has occurred. This procedure was safe and potentially be offered to more widely clinical settings. Keywords: dysphagia, percutanelus endoscopic gastrostomy, enteral feedin
