The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Gastroesophageal Reflux Disease in Obesity
No full textIncidence of gastroesophageal reflux disease (GERD) has been significantly increased, and nearly 25% of the population has experienced GERD. It appears to be correlated to an increasing number of obesity in the population (BMI >30 kg/m2). Mechanism of the GERD is affected by multifactor. Increased intra-abdominal pressure is considered as one of risk factors for GERD. The development of GERD is virtually associated with a down turning of lower esophageal sphincter tonus, increased transient lower esophagus sphincter relaxation (TLESR), and decreased capacity of esophageal clearance. Management of GERD in obesity includes weight loss treatment, pharmacotherapy by using prokinetics, H2 -receptor antagonists, proton pump inhibitor and surgical approach including fundoplication, gastric banding and vertical banded gastroplasty. Keywords: GERD, obesity, BMI, TLESR, weight loss, abdominal pressur
Gallstone and Diabetes Mellitus
No full textDiabetes Mellitus (DM) is a metabolic disease which has high prevalence among the population. The prevalence is increasing in accordance to life style changes in the society. Gallstone is frequently found in diabetic patients especially in women with type 2 DM. Nevertheless, studies on the prevalence of gallstone among diabetic patients population have shown inconsistent/contradictive results. Insulin resistance which is frequently found in type 2 DM patients is the underlying factor that correlates obesity, central adiposity, and low physical activity with gallstone disease. Two important physiological reasons in diabetic patients that may increase the risk of gallstone formation are: (1) Increased total cholesterol synthesis that causes bile becomes more easily transformed into cholesterol stone (lithogenic); (2) Diabetic patients have larger size and probably reduced motility of the gallbladder that cause increased formation of cholesterol crystals. However, recent study demonstrated that DM that merely exists without any contribution of other factors is not significant to increase the risk of gallstone formation. The gallstone management in diabetic patients is the same as the management in non-diabetic patients. Elective surgery with laparoscopic cholecystectomy is the treatment of choice for symptomatic cases. Drug treatment is indicated for patients with cholesterol stone, small stone (diameter <5 mm), and well-functioned cystic duct. Keywords: diabetes mellitus, gallstone, insulin resistance, cholesterol synthesis, motility, laparoscopic cholecystectom
Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children
No full textBackground: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitorin
Protein Energy Malnutrition in Liver Cirrhosis
No full textProtein-energy malnutrition is common in patients with liver cirrhosis, especially in advanced and severe stage. Liver cirrhosis patients with malnutrition have increasing risk to get post-operative complication and mortality. The etiology of malnutrition is multifactorial. Substrate metabolism in liver cirrhosis is characterized by insulin resistance, influencing the transport and elimination of nonoxidative glucose by muscle. Protein turnover occurs in normal rate or it may increase with the increasing of protein degradation. Oxidation and metabolic clearance of fat are normal in patients with liver cirrhosis. Most clinicians used to feed patients with liver disease with a common sense approach, otherwise many investigators suggest the use of nutritional supplements and specialized formulations aggressively, in older to correct pre-existing protein-calorie malnutrition and to stimulate hepatic regeneration. Keywords: malnutrition, liver cirrhosis, branched-chain amino aci
Dilatation Treatment for Esophageal Strictures
No full textA patient with adjustment disorder and depression had experienced a suicide temptation by ingesting corrosive substance since 6 months before her hospital admission. On the first day care, she only can swallow “soft-fluid diet” which is given very slowly. Subsequently, the patient had a series of dilatation treatment guided by fluoroscopy and demonstrated a very impressive result. On the first dilatation, a 7 mm dilator was used, and then respectively 9, 10, 5, 12, 8 and 14 mm dilator was applied. We needed to perform three sessions of dilatation until the 9 mm dilator can be inserted. After the second dilatation, the patient had started to be able to eat refine porridge and subsequently rice porridge with soft vegetables and side dishes. At the end of treatment, she had already been able to eat normally. The general management of esophageal stricture by using dilator will be discussed in this article. Keywords: stricture, corrosive substance, dilatation treatment, dysphagi
Seroprevalence Study of HbsAg positive in Entrant Candidates of Specialist Doctoral Program at Dr. Kariadi Hospital Semarang
No full textBackground: Hepatitis B Virus (HBV) infection is one of main diseases that infects human kind and constitutes a serious health problem in community. As a consequence of their job, health personnel have gained higher risk to HBV infection. Medical personnel (doctors) are determined as one of the high-risk group of the HBV infection through blood transmission.The objective of this study was to determine the prevalence of HBsAg positive in doctors who were entrant candidates of medical specialist program at Dr. Kariadi hospital. Method: The study was conducted retrospectively by reviewing medical record of 1,145 doctors who were entrant candidates of medical specialist program at Dr. Kariadi hospital since April 2000 to October 2004. The HBsAg assay as a marker of HBV infection was analyzed by EIA (Enzyme Immuno Assay) Method. Results: Among the 1,145 doctors examined , the range of age was 29.34 ± 3.04 years, and more than 3-year work period as doctor was 64% (733/1,145), and less than 3-year work period as doctor was 36% (412/1,145). The prevalence of HBsAg positive in population was 3.9% (45/1,145). The seropositive of HBsAg in the group of doctors with more than 3-year work period was significantly higher than the group with less than 3-year work period (5.1% (38/73) vs. 1.6% (7/412) with p < 0.05. Conclusion: The prevalence of HBsAg positive in doctors who were entrant candidates of specialist doctoral program at Dr. Kariadi hospital was 3.9%. The prevalence of infection was higher in the group of doctors with more than 3-year work period. Keywords: prevalence, HBsAg, docto
The Absence of Urease Enzymatic Activity of Helicobacter pylori Coccoid Form
No full textBackground: Helicobacter pylori (H. pylori) is a gram negative and pleomorphic bacteria that able to change its morphology according to the environment. The objective of the study was to determine the biochemical and some genetic characteristic of coccoid form of H. pylori induced by starvation, aerobiosis and antibiotic. Method: The material of the study is an isolate of spiral form of CagA positive H. pylori grown from gastric biopsy specimen of a patient with chronic gastritis. The CagA positive isolate was subcultured in liquid media containing the sheep sera. The sample was divided into three groups each group consist of 27 tube. Each tube contained 109 CFU of H. pylori bacteria/ml in 4 ml liquid media. So the experiment was performed in 3 replicates. In the first group of sample, coccoid form was induced by a prolonged culture under microaerophilic condition without the addition of fresh media, in the second group by aerobiosis, while in the third group by addition of 0.1 µg amoxycillin/ml cultured in microaerophilic condition. Periodic sampling was done every day to calculate the percentage of coccoid form, to observe the possibility to regrow the spiral form and for serial electron microscopic observation. One tube is picked up in every periodic sampling. In tubes containing antibiotic the periodic sampling was done one hourly. Detection of cagA and ureA gene was done by Polymerase Chain Reaction (PCR) with appropriate primers. Results: The time needed for the development of coccoid form: Length of time from the start of the experiment needed to reach 100% coccoid form was: 49 days in microaerophilic with starvation, 28 days in aerobiosis with starvation, and 13.5 days in antibiotic. result of biochemical test: Urease enzymatic activity was only positive in spiral form. All samples of coccoid form due to all the 3 stressors did not show any urease enzymatic the activity. PCR of ureA gene: All samples of spiral and coccoid form showed positive band of ureA gene and cagA gene. Western blot of protein CagA, urease A and urease B: Western blot analysis showed that in spiral form and all coccoid form band of urease A and urease B is clearly seen,while cagA in Western blot only clearly seen in spiral form but it is absent in cocoid form. Conclusion: Troughout the cycle of coccoid form the urease gene responsible for the production of urease and cagA gene responsible for virulence was in intact condition. However, despite the presence of urease protein in coccoid form the urease enzymatic activity was absent. This fact has several diagnostic and clinical implications. Keywords: urease enzymatic activity, coccoid form, Helicobacter pylor
Approach to the Patient with Accidentally Swallowing a Needle
No full textPeople are capable of ingesting, inserting, or injecting themselves or others with all manner of foreign objects. Ingested or inserted foreign bodies may cause bowel obstruction or perforation; which lead to severe hemorrhage, abscess formation, or septicemia; or distant embolization. Fortunately, once a foreign body has reached the stomach, it has an 80-90% chance of passage. All sharp foreign bodies should be removed before they pass from the stomach because 15-35% of these will cause intestinal perforation, usually in the area of the ileocecal valve. The abdominal radiograph should be made and repeated to confirm the location of foreign bodies. If a sharp foreign body does not progress for three consecutive days, surgical intervention should be considered and, if the patient becomes symptomatic, surgical intervention will be necessary. In this case, the patient had accidentally swallowed needle 2 days prior to admission, with no complaint any symptoms of abdominal discomfort, and no bloody stools. Observation is the treatment of choice for this case, since needle had passed stomach and reached colon, and it is hoped that the needle pass through without any complication. Keywords: sharp foreign bodies, needle, swallowin
Intractable Diarrhea due to Secondary Gastrointestinal Amyloidosis in a Patient with History of Leprosy
No full textAmyloidosis is not a single disease but a term for diseases that share a common feature: the extracellular deposition of pathologic insoluble fibrillar proteins in organs and tissues. In both primary and secondary amyloidosis, the most commonly involved organ system is the gastrointestinal system, with the colon being the most frequently involved organ. A 30 years-old male, complained of diarrhea since 4 months prior to admission. The colonoscopy examination revealed pancolitis, ileitis, and the result from histopathological examination showed chronic destructive ileocolitis with 40-70% amyloidosis of mucosa. The abdominal ultrasonography showed chronic cholecystitis, multiple cholelithiasis and minimally ascites. The esophagogastroduodenoscopy revealed candida esophagitis, erosive pangastritis grade V, pyloring gapping, erosive duodenitis, bile reflux gastritis and esophagitis, and the result from histo-pathological examination showed amyloidosis on gastric mucosa.The immunofixation electrophoresis was negative for monoclonal light chains, and the serum protein electrophoresis showed normal pattern. Enteral and parenteral nutritional therapy were given. Secondary infection was treated by antibiotics. Complication and organ failure occured lately. This chalenging case demonstrated complicated management of gastestinal amyloidosis. Keywords: gastrointestinal amyloidosis, intractable diarrhea, lepros
Correlation of CagA-Positive Strains of Helicobacter pylori with Topographic Distribution and Chronic Gastritis Grading
No full textBackground: CagA gene is a marker for the presence of Cag pathogenicity island. CagA-positive strains of Helicobacter pylori can identify individuals who have higher risk of developing gastrointestinal diseases. Aim: To discover the correlation of CagA status of Helicobacter pylori with topographic localization of Helicobacter pylori and chronic gastritis grading. Methods: Gastric biopsy specimens were taken from 104 patients. The specimens were obtained from gastric antrum, corpus and incisures for histological and polymerase chain reaction (PCR) studies. The histological chronic gastritis was assessed semi-quantitatively (grades 0-3). The PCR was used for detecting Helicobacter pylori genes and CagA strain. Topographic localization of Helicobacter pylori was classified as gastric antrum and corpus. Results: There were 33 (86.8%) CagA-positive strains of 38 patients with Helicobacter pylori-positive genes. There were no significant differences between topographic localization of Helicobacter pylori - either in the gastric antrum (rho = 0.14, p = 0.40) nor in the corpus (rho = 0.27, p =0.10) and the CagA status of Helicobacter pylori. Conclusion: CagA gene status of Helicobacter pylori does not determine chronic gastritis grading and gastric topographic localization. Keywords: chronic gastritis, cagA gene, Helicobacter pylori, gastric antrum, gastric corpus