The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Level of Gastrin Serum and Ulcer Size on Gastric Ulcer Correlated to Helicobacter pylori Infection
No full textBackground: Previously has been defined that peptic ulcer has strongly correlated to Helicobacter pylori (H. pylori) infection. But it hasn’t determined about correlation of gastrin serum level to the ulcer severity on H. pylori infection. The aims of this study were to find the percentage of H. pylori infection on peptic ulcer cases and its correlation to the gastrin serum level. Method: This is analytic cross sectional study in 50 patients with gastric ulcer who came to Adam Malik hospital from February to October 2007. The correlation between gastrin serum level and the size of ulcer with positive and negative Urea Breath Test (UBT) group was analyzed by unpaired student t- test. The correlation between gastrin serum level and ulcer size were investigated with Pearson correlation test and linier regression. Result: Fifty eligible patients, 33 (66%) had positive UBT and 17 (34%) were negative. There were statistically significant difference on gastrin serum level in positive UBT and negative respectively (p = 0.017). There were also significant difference between mean of ulcer size in positive UBT and negative respectively (p = 0.025). There were correlation between gastrin serum level and ulcer size (r = 0.315; p = 0.026). It can predict the increasing ulcer size in 0.012 mm every 1 pg/mL of gastrin serum elevated. Conclusion: Patients with positive UBT has greater ulcer size and higher gastrin level as compared to the negative group. There were positive correlation between gastrin serum level to the size of ulcer in peptic ulcer patients and increase of ulcer size followed with elevated of gastrin serum level. Keywords: Helicobacter pylori infection, gastrin serum level, ulcer siz
Abdominal Disturbances among Dengue Fever Patients
No full textBackground: Abdominal disturbances are common symptoms found in approximately 40% of patients with dengue fever, which frequently cause significant morbidity. This study was developed as an attempt to understand the effect of plasma leakage in dengue hemorrhagic fever; particularly on ab dominal problems. Method: The study was conducted in hospitalized patients who were diagnosed with dengue fever and dengue hemorrhagic fever (based on the 1997 WHO criteria for DHF) at Fatmawati hospital, Jakarta, Indonesia. Abdominal ultrasonography (USG) was done on the fourth to sixth day in every patient and when necessary, endoscopy was done. Data were analyzed by Chi-square test. Results: Fifty-three (54.6%) patients had abdominal pain, 81 (83.5%) patients had nausea, 45 (46.4%) patients had excessive vomiting and 28 (28.9%) patients had diarrhea. Forty-seven (48.4%) patients had their aspartate aminotransferase (AST) elevated more than two fold of the Upper Normal Limit (UNL) level; 19 (20%) patients had their alanine aminotransferase (ALT) level elevated two fold higher than the UNL. Amylase was found to be two fold higher than the UNL only in 2 (2%) patients. Lipase level elevated two fold higher than the UNL in 11 (11.3%) patients. USG imaging showed that thickening of the gallbladder wall (over 3 mm) were observed in 83 (85.6%) patients. Endoscopic procedures showed erosive features particularly in the antrum, including edema of the gastric mucosa and widening of the gastric mucosa folding in four patients, while 4 (4.12%) patients had melena. Conclusion: Abdominal disturbances such as abdominal pain, vomiting, melena, liver enlargement and abnormal liver function as well as thickening of the gallbladder wall more than five mm are significantly high in patients with dengue hemorrhagic fever. Keywords: abdominal disturbances, plasma leakage, dengue hemorrhagic feve
Effects of BCAA Enteral Nutrition to the Change of Nutritional Status and Hepatic Encephalopathy Parameters in Liver Cirrhosis Patient with Hepatic Encephalopathy
No full textBackground: This study was also conducted to determine the effects of high-branched chain amino acid (BCAA) enteral supplementation on altered nutritional status parameters (including plasma prealbumin) and hepatic encephalopathy parameters in liver cirrhosis patients with hepatic encephalopathy. Method: Our study was a randomized, single-blinded experimental study comparing between control group of liver cirrhosis patients with standard hospital liver diet (40 kcal/kgBW/day for male and 35 kcal/kgBW/day for female; protein 1.25 g/kgBW/day) and experimental group of liver cirrhosis patients with liver diet modification high in BCAA supplementation, which had similar protein and calorie calculation as the control group. Results: Subclinical hepatic encephalopathy prevalence was 32%. In the experimental group, prealbumin plasma, arm circumference, body weight and body mass index (BMI) increased; whereas in the control group, prealbumin plasma, arm circumference, body weight and BMI decreased (p < 0.05). In experimental group, the ammonia level significantly decreased (p < 0.01). Clinical hepatic encephalopathy, flapping tremor, the number connection test (NCT) did not show significant changes between the two groups. However, there was worsening trend in the control group. Level of albumin, bilirubin, AST, ALT did not show any significant difference between both groups. Conclusion: High-BCAA enteral supplementation which is administered to liver cirrhosis patients with hepatic encephalopathy for 14 days could improve plasma prealbumin level, arm circumference, body weight, BMI and could decrease the plasma ammonia level. However, it does not improve Fischer ratio, psychometric test and electroencephalography Keywords: malnutrition, liver cirrhosis, BCAA, Fisher rati
The Profile of Colonoscopy Examination Results in Surabaya Hajj General Hospital
No full textBackground: Colonoscopy is the most accurate examination to diagnose abnormalities in ileum terminalis, caecum, colon (ascendent, tranversum and descendent), sigmoid and rectum at present time. The aim of this study was to obtain the profile of colonoscopy examination in Surabaya Hajj General hospital. Method: One hundred and fifty patients who have undergone colonoscopy at Endoscopy Unit of Internal Medicine Department of Surabaya Hajj General Hospital were observed from July 1st, 2008 until October 30th, 2009. Result: There were 87 (58.0%) male and female patients 63 (42.0%) female subjects. Most subjects were at 51-70 years age group of 69 patients (46.0%). The results of colonoscopy examination were as follows: hemorrhoid in 38 subjects (25.3%), colorectal cancer in 32 subject (21.3%), colitis 25 subjects (16.7%), inflammatory bowel disease (IBD) in 15 subjects (10.0%), polyp in 8 subjects (5.3%), diverticulum in 5 subject (3.3%), redundant in 5 subject (3.3%), reduced peristaltic in 3 subject (2.0%), the mass pressure from external colon in 2 subject (1.3%), scybala in 2 subject (1.33%), adhesion in 3 subject (2.0 %), poor/dirty preparation in 6 subject (4.0%) and normal in 6 subject (4.0%). Conclusion: There were four major groups of disease found by colonoscopy in our sunjects including hemorrhoid, colorectal cancer, colitis and IBD. Our study found that colorectal cancer has the greatest number, paticularly the rectosigmoid cancer. Keywords: colonoscopy, colitis, rectosigmoid, IBD,colorectal cance
Tuberculous Peritonitis Presenting Acute Recurrent Pancreatitis
No full textTuberculosis (TB), one of the oldest diseases known to affect humans, is a major cause of death worldwide. TB is still a major problem in Indonesia. This disease, which is caused by bacteria of the Mycobacterium tuberculosis, usually affects the lungs, although other organs are involved in up to one- third of cases. Approximately 95% cases of TB and 98% death because of TB occur in developing country. Gastrointestinal tuberculosis is uncommon, making up 3.5% of extrapulmonary cases in the United States. This kind of TB may involve gastrointestinal tract, peritoneal, lymph nodes, or solid intraabdominal organs (viscera). A 17 years old male admitted to hospital with TB peritonitis presenting unusual clinical manifestation. At the first admission patients was diagnosed with acute pancreatitis based on elevation of amylase and lipase level up to 285 and 2,046 U/L and after finishing further examination, patients suffered from tuberculous peritonitis which based on literature manifested some gastrointestinal disorders. Diagnostic confirmation was accomplished by conducting serum-ascites albumin gradient (SAAG) of < 1.1 g/dL, peritoneal thickening and the presence of ascites with fine mobile septations on ultrasound, positive polymerase chain reaction (PCR) TB from ascitic fluid. Patients received conventional antitubercular therapy for 12 months of rifampicin, isoniazid, pyrazinamide, and ethambutol. The addition of corticosteroids for the first two or three months of treatment may reduce the incidence of late complications arising from adhesive disease, such as small bowel obstruction. Keywords: mycobacterium tuberculosis, tuberculous peritonitis, PCR, serum-ascites albumin gradien
The Profile of Hospitalized Patients with Esophageal Cancer at Dr. Cipto Mangunkusumo General National Hospital in 2002-2008
No full textBackground: Esophageal cancer is a rare but fatal disease. Neither data nor patterns of the disease have been published in Indonesia. Therefore, we aim to identify the profiles of patients with esophageal cancer who were hospitalized at Cipto Mangunkusumo hospital. The objective of our study was to recognize the prevalence of esophageal cancer, characteristics of the disease, diagnostic procedures and the treatment. Method: This was a retrospective study. The data was obtained from medical records of patients with esophageal cancer who were hospitalized at Cipto Mangunkusumo hospital from 2002 to 2008. Results: Twenty three patients, 13 males, were diagnoses with esophageal cancer during 2002–2008. All diagnoses were confirmed by histological examinations. Almost all patients were anemic at first presentation, but hipoalbuminemia were observed only in three patients. CT scan examination was more superior to chest X-ray and abdominal ultrasonography on detecting distant metastasis. Esophageal mass at 1/3 proximal of esophagus was found in four patients during endoscopic examination; while seven patients had esophageal mass located at 1/3 mid-portion of esophagus and 12 patients had esophageal mass located at 1/3 distal of the esophagus. Histological findings showed that 11 patients had adeno-carcinomas, eight patients had squamous cell carcinomas, three patients had squamous- adenocarcinomas and a patient was suspected to have sarcoma. Therapeutic measures had been done for 10 patients including gastrostomia in six patients, gastroesophageal resection in two patients and two patients received chemotherapy. Conclusion: We found that adenocarcinomas is more common than squamous-cell carcinomas among patients with esophageal cancer. Almost all esophageal cancer patients came to the hospital in late stage. Keywords: esophageal cancer, adenocarcinomas, squamous-cell carcinomas, squamous- adenocarcinomas, sarcoma
Diarrhea in HIV Infection
No full textDuring the last decade, there has been an increase of immunocompromized patients all around the world; that mostly due to pandemic of Human Immunodeficiency Virus (HIV) infection. Chronic diarrhea as one of common symptoms in patients with HIV infection has different etiology compared to immunocompetent patients. Initial approach of diarrhea in HIV infection may be conducted by evaluating the temporal relationship between the development of diarrhea and the administration of antiretroviral, especially the protease inhibitor agents; which is then followed by fecal analysis/examination for pathogenic bacteria and protozoa as well as endoscopy examination. Biopsy examination of intestinal mucosa is necessary for HIV enteropathy or diarrhea due to microsporidia, which is confirmed further by electron microscopy. The etiology of chronic diarrhea in HIV patients may also different, depend on the cluster of differentiation count value of all patients. Based on such differences, it is necessary to have adequate approach, recognition and understanding in the management of chronic diarrhea, especially for HIV patients. Keywords: diarrhea, infection, H
Post-Endoscopic Retrograde Cholangiopancreatography Complications at Dr. Cipto Mangunkusumo General Hospital
No full textBackground: This study retrospectively evaluated post-endoscopic retrograde cholangiopancreatography (ERCP) complications at Cipto Mangunkusumo hospital in order to improve management of a subsequent prospective study of post-ERCP complications.Method: The indications, findings, diagnostic or therapeutic procedure, cannulation, devices used during the procedure, and complications of patients treated consecutively with ERCP between January 2004 and November 2008 were evaluated retrospectively.Results: Of 176 ERCP patients who were initially evaluated, 38% had undergone diagnostic ERCP and 62% therapeutic ERCP. The median age of the patients was 49 years (range 18–80 years); 95 (53.9%) were male. Only 54 of these 176 procedures could be evaluated for post-ERCP complications. A computed tomographic abdominal scan or magnetic resonance cholangio-pancreatography was performed in 23 (42.6%) patients and a biliary sphincterotomy in 14 (25.9%) patients. The overall complication rate was 33.3%: 14.8% after diagnostic ERCP and 18.5% after therapeutic ERCP. The complications after diagnostic ERCP were pancreatitis in 3 (15%) patients, cholangitis in 3 (15%) patients, hemorrhage in 1 (5%) patient, pancreatitis and hemorrhage in 1 (5%) patient; the complications after therapeutic ERCP were pancreatitis in 6 (17.6%) patients, cholangitis in 3 (8.8%) patients, hemorrhage in none, and concomitant pancreatitis with hemorrhage in 1 (2.9%) patient. No significant difference was observed between the complication rates and the type of ERCP performed.Conclusion: There were no differences in the complications after diagnostic and therapeutic ERCP. As our study shows the post-ERCP complication rate to be higher than those of other large retrospective and prospective studies, we must evaluate it in a prospective study.Keywords: post-ERCP, complications, therapeutic ERCP, diagnostic ERC
The Discrepancy of Colonoscopical and Histopathological Findings in Infectious Colitis: Focus on Amebic Colitis
No full textBackground: Result of colonoscopic examination in infectious colitis was varying. The aim of this study was to recognize the correlation between colonoscopical and histopathological findings in patients with infectious colitis at Cipto Mangunkusumo hospital, Jakarta. Method: A cross-sectional study had been conducted. There were 227 patients with infectious colitis with unidentified etiology and 17 patients with amebic colitis. In both groups, several variables had been studied including sex, age group and indication of colonoscopy by using Chi-square test. The relationship between hematochezia and amebic colitis event was also studied by using Chi-square test. To recognize the ability of colonoscopy test in diagnosing amebic colitis, we conducted diagnostic test by searching the sensitivity and specificity. Result: In both groups of infectious colitis, we found male more frequent than female. There was a significant difference mean of age in both group of infectious colitis (p = 0.04). The mean age of amebic colitis group was younger (35.86 ± 14.36 years) than the other infectious colitis group (45.34 ± 15. 90 years). The incidence of amebic colitis was more frequent in hematochezia than in non -hematochezia (p < 0.001). The sensitivity and specificity of colonoscopy in diagnosing amebic colitis were 35% and 97%, respectively. Conclusion: There was a tendency of developing amebic colitis in patients with hematochezia than non-hematochezia. In diagnosing the presence of amebic colitis, colo noscopy examination has lo w sensitivity and high specificity. Keywords: discrepancy, infectious colitis, amebic colitis, colonoscopy, histopathological findin
The Result Discrepancies between Histological and PCR Method for Detecting Helicobacter pylori in Patients with Dyspepsia due to Inappropriate Preparation before Endoscopy
No full textBackground: False negative result of Helicobacter pylori (H. pylori) detection in gastric tissue can be due to inappropriate preparation before endoscopy. The objectives of this study is to compare the result of H. pylori detection in gastric biopsy by histological method and ure C polymerase chain reaction (PCR) in patients with dyspepsia who underwent upper gastrointestinal (GI) endoscopy without preparations other than six hours fasting before endoscopy. Method: We obtained 156 paraffin blocks of gastric endoscopic biopsy samples, taken from antrum and corpus of patients with dyspepsia who underwent endoscopic examination at the Endoscopy Unit of Biomedika hospital, Mataram. All biopsy samples were stained with Hematoxylin and Eosin for tissue diagnosis and Giemsa stain for detecting H. pylori Ure C PCR were done on all blocks. Cag PCR were performed on all Ure C PCR positive samples. Results: Of 156 paraffin blocks, only 17 blocks (10.9%) were positive for H. pylori by histological examination. All of the 17 samples showed positive results on PCR method. Of 156 paraffin blocks, positive results were found in 73 patients (45.9%) by ure C PCR method. The PCR method has increased the positivity rates of H. pylori more than four times compared to histological method. This study showed that the rate of cag a was 63.0%. Conclusion: Ure C PCR is superior to histological examination in patients who did not stop consuming acid supressor drug and antibiotic two weeks prior to endoscopy. This phenomenon can be explained by the change of spiral form into coccoid form of H. pylori, which is hardly detected using Giemsa stain. Keywords: Helicobacter pylori, histology, ureC, Cag a, PC