The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People
No full textBackground: There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods: Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results: The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion: Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm. Keywords: normal, duodenum, jejunum, terminal ileum, histological appearances, villous height, villous width, crypt heigh
The Pathophysiology Gastroesophageal Reflux Disease
No full textABSTRACT The incidence of Gastroesophageal Reflux Disease (GERD), especially in Indonesia, is increasing with the change of community life-style. Also, the doctors’ perception in understanding clinical manifestation of GERD is alike in addition to the development of diagnostic facilities such as endoscopy in Indonesia. The GERD incidence in Indonesia is as high as the incidence in developed countries. Esophageal reflux develops in physiological condition, which may be found in normal individual. GERD development is caused by anatomical and physiological disorders such as hereditary or acquired factor; and other factors that may be categorized into offensive factors such as gastric acid, pepsin, bile acid, trypsin and disturbance in defensive factors such as hypotensive Lower Esophageal Sphincter (LES), Transient Lower Esophageal Sphincter Relaxations (TLESR), hiatal hernia, disrupted saliva production, esophageal peristaltic disorder; as well as other factors such as genetic, diet, or certain drugs. Imbalance of such factors may cause pathological repeated esophageal reflux which may damage esophageal mucosa and lead to GERD development including all of complications. Keywords: esophageal reflux, GERD, LE
Eosinophilic Esophagitis
No full textThe frequency of eosinophilic esophagitis (EE) cases is increasing along with increased understanding among doctors about EE. In the beginning, EE is mostly found in children population. It was first reported in adults by Landres on 1978. The prominent EE symptoms in adults are dysphagia and solid food impaction. Endoscopic examination reveals mucous ring of esophagus, white plaque on the mucosa. The diagnosis is supported by positive result of eosinophils, which forms infiltration on the mucosaof > 20 eosinophils/ high power field in the distal or middle esophagus. Treatment by using diet and corticosteroid, either topical or systemic, shows adequate results. Immunomodulator treatment is promising, but it needs further investigation with larger sample. No consensus have been reached for EE, therefore it may affect the diagnosis, treatment and epidemiology data. Keywords: esophagus, eosinophil, dysphagia, ring of esophagu
Management of Esophageal Foreign Body
No full textForeign body ingestion is a common clinical problem. Objects such as coin, safety pin, meat bolus, bone, denture, etc. are often ingested. They lodge in certain part of esophagus, which may be asymptomatic or develop some symptoms of esophagus or respiratory tract. Plain radiography is indicated for every patient with a known or suspected foreign body. It may appear as radiopaque or radiolucent images. A number of methods can be used to remove esophageal foreign bodies, including: observation, endoscopy, rigid esophagoscopy, Foley catheter extraction, bougienage and sometimes administration of LES relaxant or surgery. Application of those strategies is selected based on the type and location of foreign bodies. Five cases had been managed by different strategies, i.e. two cases were successfully managed by endoscopy; a case was managed through careful observation; another case was managed by pushing object into stomach using endoscopic approach; and the other case was fail when it was managed by Foley catheter but then it was successfully managed by rigid esophagoscopy at ENT Department. All of cases had been managed without any complication. Keywords: esophageal foreign body, foreign body ingestion, procedure remova
Gastrointestinal Stromal Tumors: A Rare Neoplasm Presenting with Gastrointestinal Bleeding
No full textGastrointestinal stromal tumors (GIST) are rare tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. GISTs occur throughout the GI tract but are usually located in the stomach and small intestine. GISTs are known with myoid, neural or mixed features of differentiation. Clinical findings are gastrointestinal bleeding, abdominal pain, and weight loss. GISTs express a heterogeneous clinical course not easily predicted. The histologic features that correlate best with development of recurrence and metastasis are mitotic activity, tumor size and the presence of tumor necrosis and most recently, mutation in the c-kit gene. Some authors specifically use the term GIST to refer to only those mesenchymal tumors that express CD117, whereas others believe that the diagnosis can be made in the absence of CD117 positivity based on clinical and morphologic features. Surgical resection remains the treatment of choice, since chemotherapy and radiation are ineffective. Long-term follow-up is imperative and recurrence rates are high. We report the case of a 60 years old female patient who presented with intermittent melena, chronic dyspepsia, and anemia. Upper digestive tract endoscopy showed a submucosal tumor, broad-based, centrally ulcerated, projection of >5 cm in the gastric corpus-antral wall as the cause of the upper gastrointestinal bleeding. Endoscopic biopsies were negative for neoplastic changes. After triple eradication therapy of Helicobacter pylori and treatment continued with proton pump inhibitor agent, the patient underwent distal gastrectomy with Billroth-I reconstruction. Histopatological studies on the surgical resection specimen revealed a GIST of smooth muscle with spindle cell, no evidence of mitotic activity but of uncertain biological behavior. One year after surgery the patient is was improved with no signs of residual malignancy. However, metastases were found later in the liver in the next two year. Keywords: GIST, stromal tumor, surgery, C-ki
Upper Gastrointestinal Symptoms and Climate Exchange in Indonesian Hajj Pilgrims: Community Based Study Islamic Year 1427
No full textBackground: Upper gastrointestinal symptoms rank among the three most common diseases for Indonesian hajj pilgrims in last 4 years. The prevalence was 22-34% per hajj season. Most of the cases were dyspepsia syndrome and Gastro Esophageal Reflux Disease (GERD). The internal risk factor of Upper gastrointestinal symptoms is largely known, but not for external factor such as environment and climate. Aim: To examine the association between climate exchange and upper gastrointestinal symptoms Methods: Dynamic population of 204,941 Indonesian Hajj Pilgrims in Islamic year 1427 were included for this study. Multiphase screening in Indonesia found the prevalence of upper gastrointestinal symptoms was 3.32%. Prospective follow up for upper gastrointestinal symptom-based on community health services (flight group/kloter and maktab policlinic/polimaktab) and hospital base (Sub Balai Pengobatan Haji Indonesia, Balai Pengobatan Haji Indonesia [BPHI] and Saudi Arabia hospital) was conducted in Saudi Arabia. Results: The incidence rate of the upper gastrointestinal symptoms was 2.4 per mile (95% CI = 1.8 -3.1). There was no significant difference among male and female p = 0.279 (95% CI = 0.18- 5.3) and there was significant difference among work area (Daker) p = 0.001 (95% CI = 50.4-182.5). There was no significant correlation between upper gastrointestinal symptoms and temperature or humidity in 3 work area (p = 0.155) Mecca, Medina and Jeddah. Conclusion: There was no significant correlation between climate exchanges to the upper gastrointestinal symptoms. Keywords: upper gastrointestinal symptoms, Indonesian Hajj Pilgrims, dyspepsia, GER
The Detection of H pylori In Gastric Mucosal Biopsy Specimens by PCR Using Primers Derived From Ure C Gene in Patients with Dyspepsia
No full textBackground: The detection of Helicobacter pylori (H. pylori) in gastric biopsy specimens can be done using CLO (Campylobacter Like Organism) test and histopatological examination, but the sensitivity of both Method is influenced by the density of the bacteria in the sample. Beside that, the coccoid form is detected with difficulty by histology and need immunohistochemical stain to confirm. PCR can be used for the detection of both spiral and coccoid form of the bacteria. Objective: To detect the genome of H. pylori by Polymerase Chain Reaction (PCR) using primers derived from ureC gene of the bacteria in gastric biopsy specimen from patients with dyspepsia. Methods: Gastric biopsy specimen from 179 patients with dyspepsia in the endoscopic unit Mataram hospital. The biopsy was taken from antrum and corpus and put into sterile saline for the culture of H. pylori and put into 70% ethanol solution for the PCR. The specimen for bacterial culture was carried soon to microbiology laboratory and plated into the appropriate media and grown in microaerophilic condition in CO2 incubator. The PCR was done using primers derived from ureC. Result: The H. pylori genome was detected in 79 of 179 biopsy sample (44.13%). The bacterial culture was positive for H. pylori in 22 (12%). The PCR result was positive in 10/35 of patient with normal endoscopy (28.57%). From 22 patients with duodenal ulcer without gastric ulcer the PCR was positive in 15 (68.18%). In patient with gastric ulcer without duodenal ulcer the PCR was positive in 9 patients (42.08%). From 7 patient with combined gastric and duodenal ulcer the PCR was positive in 5 (71.43%), in 3 patient with gastric cancer the PCR was positive in 1 (33.33%). Conclusion: The study showed that 44.13% of patient with dyspepsia in Mataram hospital was positive for H. pylori by PCR. Keywords: detection of Helicobacter pylori, gastric mucosal biopsy specimen, polymerase chain reaction, ureC gen
Diagnosis and Management of Blastocystis Hominis Infection in Patient with HIV-AIDS
No full textThe incidence of AIDS/HIV infection has been increasing worldwide. Patients with AIDS/HIV infection is at high risk to get opportunistic infection which is often become life-threatening. Common infections associated with AIDS/HIV are tuberculosis (TB) infection and viral hepatitis. Commensal organism found in human body is actually not pathogenic. Blastocystis hominis is generally considered as commensal organism of intestinal tract and might cause opportunistic infection in patients with AIDS. We reported a case of young male patient with AIDS/HIV infection and evidence of opportunistic infection of Blastocystis hominis found in ascitic fluid along with concomitant lung TB and viral hepatitis. Patient was well-responded to treatment of B. Hominis. Keywords: AIDS/HIV infection, opportunistic infection, Blastocystis homini
Chronic Diarrhea Caused by Amebic Colitis and Inflammatory Bowel Disease
No full textThe diagnosis of intestinal amebiasis is easily established based on colonoscopy, i.e. there is a specific characteristic of ulcer/lesion “discrete flask-shape ulcer” with normal mucosa among the ulcers. However, most patients with amebic colitis have non-specific clinical manifestations and their colonoscopy findings are hardly distinguished from inflammatory bowel disease. In the present case, the patient had a chief complaint of chronic bleeding diarrhea and abdominal pain. The fecal analysis found trophozoites of Entamoeba histolytica. Serology test (sero-amebic) revealed negative result. The colonoscopy examination reveals hyperemic mucosa, edema, and multiple ulcers with various sizes covered with fragile and easily bleed debris, from the rectum to ascending colon, rigid colon, narrowing lumen and tumor/mass appearance on ascending colon. The differential diagnosis was severe amebic colitis and inflammatory bowel disease. Based on the colonoscopy biopsy, we found an active chronic colitis along with dysplasia. The patient received management and treatment of severe amebic colitis and inflammatory bowel disease. Keywords: amebic colitis, bleeding diarrhea, fecal analysis, colonoscopy, biopsy, inflammatory bowel diseas
Gastroesophageal Reflux Disease in Push Up and Sit Up Exercise
No full textBackground: Several factors involve in GERD are hypotension of Lower Esophageal Sphincter (LES), Transient Lower Esophageal Sphincter (TLES) relaxation, delayed gastric emptying and esophageal hiatal hernia. Bent over and supine position like push up and sit up exercise in this study, are known as trigger factors for GERD which can cause hypotension of the LES, TLES relaxation and transdiaphragmatic pressure resulted in increased diaphragmatic nerves activation. Aim: The purpose of this study was to investigate the occurrence of GERD in push up and sit up exercise. Materials and Methods: This is an experimental study; subjects were healthy male aged 18-21 years. Patients data were collected after fulfilling the selection criteria as described in the study protocol. χ2 analysis or Fischer’s exact test analysis was applied to determine the statistical significance of difference between push up and sit up. There were 30 subjects in the study, 15 subjects in push up group and 15 subjects in sit up group. Result: Three subjects (10%) were dropped out and 27 subjects (90%) were endoscopied. In the sit up group, 13 subjects (87%) were endoscopied, 9 subjects (70%) had normal endoscopy and 4 subjects (30%) had mucosal breaks. In push up group, 14 subjects (93%) were endoscopied, 6 subjects (43%) had normal endoscopy and 8 subjects (57%) had mucosal breaks. There was no significant difference between push up and sit up group with χ2 analysis or Fischer’s exact test (p = 0.322). Conclusion: There was more likely GERD in push up group than in sit up group, but the difference was not significant. Keywords: push up exercise; sit up exercise, gastroesophageal reflux disease (GERD