The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Portal Hypertensive Enteropathy in Liver Cirrhosis
No full textBackground/Aim: Some studies found that portal hypertension cause complication such as portal hypertensive gastroenterocolopathy. This study was done to find any abnormalities in the small intestinal mucosa and villi of the portal hypertensive patients. Method: Thirty patients with liver cirrhosis, portal hypertension and esophageal varices between 2000 - 2001 were included in this study. A duodenoscopic examination was performed to determine any abnormalities. Biopsy specimens were taken from the descending part of duodenum and the duodenal bulb for histopathological examination. The findings were compared to 37 functional dyspepsia patients. Result: In the duodenal bulb and descending part of duodenum: the width of the villous of the portal hypertensive group was larger than the control (p < 0.001), the diameter of the mucosal villous vessel was larger than in the control (p < 0.001) and the thickness of the mucosal villous vessel wall was thicker than in the control (p < 0.001). Conclusion: There were abnormalities of the mucosa in portal hypertensive enteropathy patients including the mucosal vessel diameter, wall thickness, number of goblet cells. Keywords: portal hypertensive enteropathy, liver cirrhosi
The Prevalence of Hepatitis B Virus in Female Commercial Sex Workers
No full textBackground: The prevalence of hepatitis B infection in Indonesia was about 2-20%. To date, incidence rate of Hepatitis B Virus (HBV) in female Commercial Sex Workers (CSW) in Manado was not known. Objective: To investigate the prevalence and risk factors associated with HBV in female CSW. Methods: This is a descriptive-analytic study with cross-sectional design. Target population was female CSW in Manado. Results: Of 177 subjects, age range 15-49 years (27.87 ± 7.629), the most frequent age were 20-24 years with 56 subjects (31.6%). Serum HBsAg was positive in 8 (4.5%) subjects. Serum HBsAg was positive in 8 of 143 (5.6%) subjects with intercourse frequency > 5 times weekly, 8 of 142 (5.6%) subjects with sexual partner > 5 per week, 1 of 41 (2.4%) subject worked as CSW < 1 year, 7 of 136 (5.1%) subjects worked as CSW for more than a year, and 1 of 110 (0.9%) subjects who used condom. Conclusion: Prevalence rate of hepatitis B in female CSW in Manado was 4.5%. There was significant relationship between condom usage and the prevalence of hepatitis B virus infection. There was relationship with some other risk factors but statistically insignificant. Keywords: hepatitis B virus, prevalence, commercial sex worker, condom usag
Clinical Improvement of Dyspepsia Symptoms Following Eradication Treatment for Helicobacter pylori
No full textThe prevalence of Helicobacter pylori in patients with peptic ulcer in Indonesia is very high. It ranges between 90-100%. In general, patients with gastritis and peptic ulcer usually have dyspepsia symptoms. The pathophysiology of dyspepsia symptoms caused by Helicobacter pylori has not been clearly understood. However, it is assumed that the symptoms are correlated to various factors including inflammation, apoptosis damage, and increased secretion of gastric acid, atrophy and non-atrophy gastritis as well as the development of peptic ulcer. The main objective of treatment for Helicobacter pylori infection is elimination of Helicobacter pylori bacteria. Triple therapy has 80% success rate with no significant adverse events and minimal effect in inducing resistance to antibiotics. The success rate of eradication treatment in patients with peptic ulcer is 90%; while an evaluation on improvement of duodenal ulcus following eradication treatment with one month proton pump inhibitor treatment reveals 90% success rate. Keywords: Helicobacter pylori, improvement, dispepsi
Non-Steroidal Anti-Inflammatory Drugs Prescribing in Patient with Gastrointestinal Risk
No full textConventional NSAID treatment has been consistently associated with gastrointestinal complications including dyspepsia syndrome, gastric ulcer, and upper gastrointestinal tract bleeding. There are some risk factors correlated to these complications, i.e. elderly age, previous history of gastric ulcer, concomitant use with steroid, multiple NSAID administration, high-dose NSAID and concomitant use with anticoagulant. NSAID prescribing with consideration of patient’s risk factor is necessary in order to decrease gastrointestinal complications. Combination therapy of NSAID and mucoprotector agent may be considered to prevent or to treat the NSAID- induced gastrointestinal ulcer Keywords: prescribing, NSAID, gastrointestinal ris
Endoscopic Features of Patients with Bronchial Asthma and Gastroesophageal Reflux Symptoms
No full textBackground: Studies evaluating endoscopic results in patients with bronchial asthma and Gastroesophageal Reflux Disease (GERD) in Gatot Soebroto hospital have never been undertaken. It leads an idea to further study, in order to find a more accurate and rapid management as solution for anticipating asthma attack and complications of bronchial asthma to upper gastrointestinal tract. Methods: A retrospective study was aimed to evaluate endoscopic result of upper gastrointestinal tract in bronchial asthma patients who had GERD symptoms as appropriate to the criteria of 4 major GERD symptoms of Talley 2002. Data was collected in one year period starting from November 2004 to October 2005. Results: Subject characteristics in this study indicated that there were more female patients compared to male with a ratio approaching 3:1 who had such symptoms. Mean age was 38.5 years and ratio of body weight to body height indicated normal weight result and the mean value for duration of asthma was 27 years. Clinical symptoms of GERD found in the present study was in accordance with four majors symptoms of GERD i.e. 32 (100.00%) cases of regurgitation, 29 (90.63%) cases for each of heartburn and non-cardiac chest pain symptom, and 7 (21.88%) cases of difficult / painful swallowing or dys/odinophagia. The endoscopic result of upper gastrointestinal tract had figured of: (1) 4 (12.50%) cases of normal esophagus, (2) 11 (34.40%) cases of non-erosive esophagitis known as Non Erosive Reflux Disease (NERD), and (3) erosive esophagitis which regarding to Los Angeles classification: 15 (46.90%) cases of grade A and 2 (6.20%) cases of grade B. Conclusion: The incidence of esophagitis in accordance with LA classification is extremely high although no severe damage (grade C and grade D) was found. Early anticipation of reflux associated respiratory symptoms and anti-reflux treatment should be considered in order to shorten or to discontinue the asthma attack cycle. Keywords: bronchial asthma, GERD, endoscopy, NER
Peutz Jeghers Syndrome
No full textPeutz-Jeghers Syndrome (PJS) is a rare condition that tends to run in families. Diagnosis of PJS is made if a person has polyps in the gastrointestinal (GI) tract and at least two of the following: polyps in the small bowel, melanin spots, and/or a family history of PJS. The typical clinical manifestation of the disease is associated with complications secondary to intestinal polyps often requiring surgical treatment. A young woman, 29 years old with PJS had been hospitalized in Cipto Mangunkusumo hospital. She was suffering from GI complication secondary to her polyps such as abdominal pain, nausea, vomited every time she takes her meal and milk, anorexia, fatigue, weakness, chronic diarrhea with hematoschezia. Upper and lower endoscopy showed the multiple polyps along from esophagus, gaster, duodenum, and her colon. Histopathology examination confirmed the type of polyps is Peutz Jeghers with the unique morphology consisting of mucosa with interdigitating smooth muscle bundles that yield a characteristic branching tree appearance. We also found the family tree of this patient and it is a good evident how PJS can be inherited in a family. Keywords: Peutz-Jeghers syndrome, melanin spots, polypsr
Laboratorium Diagnosis of Clostridium difficile Infection
No full textClostridium difficile is the most important cause of antibiotic associated diarrhea, and pseudomembranous colitis, a severe infection of the colon. Strain Clostridium difficile produce two potent toxin, toxin A (enterotoxin) and toxin B (cytotoxin). These two toxins are both responsible for the diarrhoea and inflammation seen in patients treated due to infection, especially the broad spectrum antibiotics. Direct detection of Clostridium difficile cytotoxin from faecal specimen using mammalian tissue culture lines is considered the standard diagnostics test of Clostridium difficile infection. This test is very sensitive but requires a minimum two days to complete. In order to improve the threshold of diagnosis and treatment, a number of enzyme immunoassay Methods have been used, with a reported sensitivity to either toxin A or toxin B. Keywords: Clostridium difficile, cytotoxin, diarrhea, enzyme immunoassa
Candidiasis in Malignancy
No full textEsophageal candidiasis presents with a range of clinical findings and is rarely found among immunocompetent patient without predisposing factors. Between 20-50% of patient may be asymptomatic. One of predisposing factor of candidiasis is immunocompromised condition due to malignancy. Dysphagia is the most frequently presented feature of esophageal carcinoma. We demonstrated a case of esophageal candidiasis as one of early clinical presentation in patient with esophageal carcinoma. Keywords: esophageal candidiasis, esophageal carcinom
Immunocompetent Expression of CD4+ T Cell and CD8+ T Cell, TNF-alpha and INF-gamma in Patient with Chronic Hepatitis C
No full textAim: To investigate the expression CD4+ T cell and CD8+ T cell as well as TNF-a and INF-g level on chronic hepatitis C. Methods: This is a cross-sectional study. Forty patients with chronic hepatitis C based on laboratory examination, who were collected from blood transfusion centers at Dr. M. Djamil Hospital. The control group used forty healthy samples. Results: There were 40 chronic hepatitis C cases satisfying the inclusion criteria. We found that CD4+ T cells count 50.35 ± 3.18%; CD8+ T cells count 59.37 ± 3.52%; TNF-a level 22.03 ± 3.72 pg/ml and INF-g level 4.47 ± 1.47 pg/ml. Conclusion: The chronic infection hepatitis C virus have given the effects on the immunocompetent cells which increased of CD4+, CD8+, TNF-a level and INF-g level. Keywords: hepatitis C virus, CD4+ T cell, CD8+ T cell, cytokines TNF-a, INF-
Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin
No full textBackground: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration < 14 g/dl was found to be the risk factor of anemia. Conclusion: Prevalence of anemia was 52.5%. Pretreatment hemoglobin concentration < 14 g/dl was only found to be the risk factors of anemia. Although age > 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy. Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemi