The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Upper Gastrointestinal Endoscopy and Histopathology Appearance in Indonesian Children with Recurrent Epigastric Pain
No full textBackground: Recurrent Epigastric Pain (REP) is a clinical symptom frequently found in children. Data of the correlation between duration of illness, frequency of illness, associated symptoms of REP and the abnormality of endoscopic and histopathologic appearance are still limited, especially in Indonesia. The role of Helicobacter pylori (H. pylori) infection in causing organic abnormalities of the gastrointestinal tract (GIT) is also still controversial. Aim:To know the endoscopic and histopathologic appearance and the prevalence of Helicobacter pylori infection, 169 children with REP was performed for endoscopic and histopathologic examination in Department of Pediatric, Cipto Mangunkusumo hospital. Result:Endoscopic and histopathologic abnormalities were found significantly in children who suffered from REP more than 9 months and more than 6 times during 3 months of period. Conclusion: Endoscopic and histopathologic examinations should be considered in children with REP. Keywords: recurrent abdominal pain, epigastric pain, Helicobacter pylori, endoscopy and histopatholog
Emergency Abdominal Surgery in Patient with Liver Cirrhosis
No full textThe number of patients with cirrhosis who require surgery is increasing. Therefore, it can be expected that a growing number of patients with cirrhosis will undergo surgery. Patients with cirrhosis are at particularly at high risk for morbidity and mortality due to the stress of surgery and the effects of general anesthesia. The risk for morbidity and mortality are influenced by the type of surgery and the extent of liver dysfunction. In patient with cirrhosis who undergo emergent abdominal surgery the mortality rate may reach 50%. The Child-Pugh score is used to predict perioperative morbidity and mortality rates for patients undergoing intra-abdominal surgery. The mortality rate patient with Child Classification A was 10%, Child Classification B was 31% and Child Classification C was 76%. So, an approach to perioperative risk assessment, evaluation, and management of the cirrhosis patients who is a surgical candidate is very crucial. We reported a case of an elderly male patient with liver cirrhosis who would undergo emergent abdominal surgery. Keywords: liver cirrhosis, emergency surgery, child pugh classificatio
The Clinical Significance of CYP450 in Gastrointestinal Tract
No full textCytochromes P450 (CYP450) is a super-family of multigenes bound to heme and also a catalysator enzyme. Cytochrome P450s (1, 2, and 3) are the most important enzymes for biotransformation of drugs administered through gastrointestinal tract. The gastrointestinal tract is the first part of immune system against all of oral xenobiotics. Drug interaction may be predicted but it is hardly prevented. Thus, it frequently becomes clinical problem. CYP450 polymorphism may influence effective drug metabolism, which consequently will affect drug response and good therapeutic effect. Poor metabolizers need only a small dose of drug to bring on drug response but extensive or ultra-rapid metabolizers will need a large dose of drug. The unexpressed CYP2E1, one of the CYP families, may influence cancer incidence. However, it is still controversial. Keywords: CYP450, xenobiotics, biotransformation of drugs, gastrointestinal trac
The Pathogenic Triad of Chronic Cough: Postnasal Drip Syndrome, Asthma, and Gastroesophageal Reflux Disease
No full textChronic cough, lasting for 3 weeks or more, is one of the most common symptoms for which adult patients seek medical attention. The pathogenic triad of chronic cough is Postnasal Drip Syndrome (PNDS), Asthma, and Gastroesophageal Reflux Diseases (GERD) are the vast majority etiology of chronic cough in non-smoker adult with normal chest X-ray. The clinical investigations that should be performed are spirometry pre-post bronchodilator and bronchoprovocation testing for asthma; plain sinus radiograph and or computed tomographic imaging of the sinus for PNDS due to sinusitis; gastro-intestinal investigation 24 hours oesophageal pH monitoring and upper gastrointestinal endoscopy for GERD. Keywords: chronic cough, postnasal drip syndrome, asthma, gastroesophageal reflux diseas
Do Hepatic Encephalopathy Patients Really Need a Low Protein in Their Diet
No full textHepatic encephalopathy (HE) is an extra hepatic complication of liver cirrhosis. The clinical manifestation of HE is a reflection of a low-grade cerebral edema due to astrocyte swelling as a consequence of hyperammonia. HE mostly is induced by precipitating factors. Correcting these identifiable precipitating factors can alleviate this complication. In the past, liver cirrhosis patients were recommended to lower their protein intake. It was assumed that by limiting protein intake, the ammonia production would lower, which can lead to HE recovery. This approach, on the other hand, had worsened the nutritional status that already present in most patients with HE. There are some ways to overcome these problems without restricting protein intake including balance diet, using Branch Chain Amino Acids (BCAA), and frequent small portion diet. Keywords: hepatic encephalopathy, astrocytes swelling, ammonia, liver cirrhosis, BCA
Nutrition Management on Acute Pancreatitis
No full textPancreatitis is an inflammatory process in pancreas. Clinical manifestation of acute pancreatitis can be mild to severe. Mortality rate is high in severe acute pancreatitis. Etiology of acute pancreatitis generally remains obscured. Supportive management is important in acute pancreatitis. Nutrition is important part in acute pancreatitis. Patient should not be given enteral nutrition temporarily and meanwhile parenteral nutrition must provide sufficient amount of calories and nutritional requirements. Immune nutrition should also be considered. In mild acute pancreatitis, oral realimentation can be started in 3rd-7th day. In severe acute pancreatitis with prolonged fasting, gradual enteral nutrition via nasoenteral tube is recommended Keywords: nutrition, acute pancreatitis, enteral nutritio
The Role of Supporting Examinations on the Diagnosis of Chronic Diarrhea in Children
No full textBackground: Etiology of chronic diarrhea can be established through non-invasive examination such as stool examination and stool culture. Colonoscopy is an invasive Method, which is occasionally needed to discover the etiology of chronic diarrhea. Objective: To recognize the characteristics of chronic diarrhea based on stool examination and colonoscopy results. Methods: Descriptive study on patients with chronic diarrhea who came to Cipto Mangunkusumo hospital since 1 June to 31 August 2005. Laboratory tests were conducted in accordance with clinical indication. Data was presented in distribution tables. Results: There were 41 patients with chronic diarrhea. Stool examination were performed only in 38 patients with negative-gram infection (86.8%). Stool cultures were performed in 27 patients with positive results of non-pathogenic Escherichia coli (85.2%). Stool parasite examination and concentration tests were performed in 17 patients, with 47.0% positive results as follow: Microsporidia 29.4%, Blastocystis hominis 11.8% and Giardia lamblia 5.9%. Colonoscopy examinations were performed in 6 patients and all patients indicated ulcerative colitis appearance with 50% histopathological impression of infective colitis. Conclusion: Stool examination in chronic diarrhea primarily indicates positive infection. Bacterial stool culture mostly includes non-pathogenic Escherichia coli, while parasite stool examination largely includes Microsporidia. Biopsy examination tends to reveal infective colitis. Keywords: chronic diarrhea, parasite stool, colonoscop
Adenoid Cystic Carcinoma of the Esophagus
No full textAdenoid cystic carcinoma is an extremely rare case of the esophagus. We present a female patient, aged 76 years who present with dysphagia and weight loss for the last three month. On endoscopy there was a luminal narrowing in the middle third of the esophagus. Diagnosis was challenging due to the stenosis and the tumor size. Histopathological confirmation was obtained by subcarinal fine-needle aspiration biopsy. This type of cancer is very aggressive with short survival time. Further studies are needed to define optimal treatment. Keywords: dysphagia, adenoid cystic carcinom
Serum Biochemical Markers of Liver Fibrosis
No full textProgressive liver fibrosis with development of cirrhosis is a feature of almost all chronic liver diseases. Carriers of hepatitis B and C virus are at increased risk of developing cirrhosis, hepatic decompensation/insufficiency, hemorrhage, and hepatocellular carcinoma (HCC). Therefore, periodic evaluations of these patients are necessary. Fibrosis is deleterious but variable consequence of chronic inflammation. It is characterized by deposition of extra cellular matrix component leading to distortion of hepatic architecture with impairment of liver microcirculation and liver cell function. Although liver biopsy is the gold standard for assessment of liver fibrosis, it has several disadvantages. Considering these limitations and patient redundancy to undergo liver biopsy, it is vital that non -invasive predictors/ Methods for assessment of liver fibrosis be developed and validated. Application of this Method could be used to evaluate the efficacy of treatment, which is a simple and meaningful way. Recently, clinical investigators have been searching for noninvasive serum markers of fibrosis, which have the following characteristics: they must be reliable, accurate, reproducible and easy to perform. Several markers or combination of several markers have shown promise for the detection of advanced fibrosis, although their sensitivities for detecting milder fibrosis are poor. Non -invasive laboratory bio-markers of liver fibrosis might be applied to patients who either have contra-indication or refuse liver biopsy for management of their chronic liver diseases. Keywords: hepatitis B virus, liver fibrosis, liver biops
Abdominal Tuberculosis: Diagnostic and Management Problems
No full textAbdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatiti