The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Intestinal Amebiasis: Diagnosis and Management
No full textIntestinal amebiasis is an infection due to Entamoeba Histolytica and has the highest prevalence in tropical countries, including Indonesia. Amebiasis is responsible for approximately 70,000 deaths annually every year. High prevalence is found especially in endemic area which had poor hygiene and sanitation or crowded population. Human is the main reservoir, while the disease can be transmited by mechanical vector such as cokckroach and flies. Making diagnosis of intestinal amebiasis sometimes can be a problem. Clinical presentation and disease severity may be varied. Complication due to late management of the disease can be fatal. Lifestyle education, early diagnosis and proper management of amebiasis are very important measures to promote by health workers. Keywords: intestinal amebiasis, diagnosis, managemen
Helicobacter pylori Infection in Idiopathic Chronic Urticaria
No full textHelicobacter pylori (Hp) infection is the most common chronic bacterial infection in human. The role of Hp infection in various GI disorders had been widely accepted. However, further studies have found new extragastrointestinal involvement such as urticaria. Chronic urticaria is a common disorder that has complex pathophysiologic mechanism. As mater of fact, etiology remains unclear in most of the cases. This condition is called Idiopathic Chronic Urticaria. Several studies had shown high prevalence of Hp infection in patients with ICU and improved symptoms after eradication therapy of Hp. This observation had suggested that Hp has important role as etiologic factor in some cases of ICU. The presence of Hp infection and its role in ICU should be proven before initiating eradication therapy, so that irrational used of drugs and antibiotics resistance can be prevented. Keywords: Helicobacter pylori, Idiopathic Chronic Urticari
Gastroduodenal Mucosal Integrity and Influencing Factors
No full textGastroduodenal mucosal integrity has important role in the pathogenesis of gastroduodenal ulcer. It depends on imbalance between aggressive and defensive factors. However, many experts believe that defensive factors has more dominant role. Maintenance of gastrointestinal endothelial integrity appears to define the “cytoprotection” phenomenon and, as discussed below, is a critical component of NSAID- induced GI injury and a potential target for therapeutic intervention. Keywords: mucosal integrity, aggressive factors, defensive factor, cytoprotectio
Chronic Diarrhea Due to Intestinal Amyloidosis
No full textAmyloidosis is a rare disease, when diagnosed it’s incurable and mostly affect over 40 years old male. Diagnostic is confirmed if histopathologic stained positive with Congo red and evidence of monoclonal protein. Survivals for untreated patients are 13 months in primary amyloidosis but if secondary to other chronic disease and systemic, survival could be 3-4 years. It can not be prevented but when affected, control of the underlying illness can prevent progression of amyloidosis. We report a rare case of a 67 year old male, who came with chronic diarrhea. The stool analysis, there were no negative gram microorganisme found, only food maldigestion and fungus infection. Stool analyze from parasitology department were found microspore, but the stool culture were sterile. The patient underwent colonoscopy which revealed hyperemis mucosa in rectum, sigmoid, descending & transverse colon. From the biopsy was concluded intestinal amyloidosis. We treated the patient symptomatically and couldn’t find the underlying inflammatory disease which causes the problem. Keywords: secondary amyloidosis, chronic diarrhea, malabsorption, colonoscopy, protein electrophoresi
Pancreatic Exocrine Insufficiency in Chronic Diarrhea
No full textBackground: One of the causes of chronic diarrhea is pancreatic exocrine insufficiency. Chronic diarrhea cases are commonly encountered in Indonesia. Materials & methods: All patients with chronic diarrhea at hospitals in Jakarta were included in this study and dyspeptic patients were used as control subjects. The study and control subjects must submit their stool for fecal pancreatic elastase-1 examination at a private laboratory in Jakarta. Mild/moderate pancreatic exocrine insufficiency was defined if the concentration was between 100 - 200 mg E1/g stool. Severe pancreatic exocrine insufficiency was defined if the concentration was below 100 mg E1/g stool. The data was analyzed using Fisher or Kruskal-Wallis tests. Results: There were 32 chronic diarrhea patients with a male to female ratio of 19/13 (59.38%/40.62%). The most frequent age range was 50-59 years old (39.5%). The characteristics (sex, age and race) of chronic diarrhea patients were matched with the characteristics of dyspeptic patients as control subjects (p > 0.05). The fecal elastase-1 results in chronic diarrhea displayed greater pancreatic exocrine insufficiency (< 200 mg E1/g stool) than in dyspepsia (control) (> 200 mg E1/g stool, p < 0.001). The mean fecal elastase-1 Result in chronic diarrhea and in dyspepsia were 316.29 + 195.44 vs. 475.93 + 65.33 mg E1/g stool (p < 0.001). Six patients (18.74%) were established as having severe pancreatic exocrine insufficiency. Seven patients (21.88%) were found with mild/moderate pancreatic exocrine insufficiency. Conclusion: Pancreatic exocrine insufficiency was found frequently in chronic diarrhea Keywords: pancreatic exocrine insufficiency, chronic diarrhea, fecal pancreatic elastase-
Management of Pyogenic Liver Abscess and Empyema as Its Complication
No full textPyogenic liver abscess may have serious complications that need specific management. We reported a case of a young male patient aged 24 years old and complained of abdominal enlargement since 2 (two) weeks before. Abdominal ultrasound revealed multiple liver abscesses. Liver aspiration was performed and about 500 cc of yellowish purulent fluid was drained. During hospitalization the symptoms of fever and shortness of breath were getting worse although adequate antibiotic treatment had been given. Chest X-ray examination showed elevated right hemidiaphragm and right pleural effusion. Thoracocentesis and proof puncture showed purulent fluid. He was diagnosed with empyema as a complication of pyogenic liver abscess. Water Sealed Drainage (WSD) was performed to evacuate the fluid and he was given antibiotics. The patient’s condition improved in several days. Keywords: Pyogenic liver abscess, complication, empyem
Diagnosis and Management of Barret's Esophagus
No full textIncidence of esophageal adenocarcinoma is increasing in western countries and has poor prognosis due to late diagnosis. Barrett’s esophagus is considered as premalignant lesion in which some of squamous epithelium in distal esophagus has been replaced by metaplastic columnar ephithelium. It occurs as complication of longstanding gastroesophageal reflux. Endoscopic examination is very important for early detection especially in patients with chronic symptoms of gastroesophageal reflux disease (GERD) for more than 5 years. Aggressive antireflux treatment may reduce the risk of esophageal carcinoma. However, no single therapeutic modality had been proven superior compare to others, but until now surgery remains the most popular treatment of choice in the management of Barrett’s esophagus. Keywords: Barrett’s esophagus,GERD, premalignant lesion, managemen
Treatment of Chronic Hepatitis B
No full textChronic hepatitis B is still a major health problem in Indonesia. Unfortunately, to date, treatment of chronic HBV (Hepatitis B virus) infection had not shown satisfactory Result. Monotherapy with alpha interferon or lamivudine have been widely used as treatment of chronic HBV. However, treatment response to Alpha interferon in Asian people was not satisfactory (15% - 20%), while monotherapy with lamivudine was not sufficient to eradicate HBV in chronically infected patients and commonly induce drug resistance. The occurrence of chronic hepatitis B resistant to lamivudine had encouraged development of newer agents such as adefovir, entecavir, emtricitabine and nucleoside analog. New therapeutic strategy using combination therapy should be considered if there is no sufficient response to monotherapy. Keywords: Treatment, chronic hepatitis B, combination therap
Emerging Cases of Hepatitis C Virus and Human Immunodeficiency Virus Co-infection Among Narcotics Abusers in Pondok Indah Hospital, Jakarta
No full textBackground: Narcotics and psychoactive substances abuse, particularly by intravenous route, currently is a major health problem affecting young Indonesian people. Consequently, there is an increasing incidence of blood-borne viral diseases, including hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. This study was aimed to investigate the prevalence of HCV and HIV co-infection among narcotics abusers in Pondok Indah Hospital, Jakarta. Method: This was a cross-sectional study in Pondok Indah Hospital, Jakarta using patients’ medical records. Data from patients with the diagnosis of mental and behavioral disorders due to various psychoactive substances and HIV-related diseases were retrieved to obtain demographic characteristics, history of drug abuse and serological testing. Patients were excluded if there were another organic mental disorders found or a history of blood transfusion prior to infection. Results: There were 157 cases of drug abuse collected between January 2000 and May 2005, 85.4% were men and their median age was 24 years old. The peak age group was 21-25 years old. Injection drug users (IDUs) were found in 72% of cases. Anti-HCV total antibody was found in 45.2% cases, including 2 non-IDUs, while anti-HIV antibody and combined anti-HCV/anti HIV antibodies were found in 13.4% and 7.6% cases, respectively. Anti-HCV positive patient are significantly younger than anti- HCV negative patients (27.9 + 8.2 vs. 23.7 + 4.4 years, p < 0.001), while the duration of use was not significantly correlated with HCV infection. Neither age nor duration of use was statistically significant with the presence of anti-HIV antibody. However, there is a significant correlation between the duration of drug abuse with HCV and HIV co-infection (6.0 + 3.0 vs. 4.1 + 2.8 years, p = 0.027). Conclusion: The prevalence of HCV and HIV co-infection among narcotics abusers in Pondok Indah Hospital was 7.6%. The emerging cases of hepatitis C and HIV infections during the last several years was significantly related to the increasing numbers of narcotics abusers. Keywords: hepatitis C virus, human immunodeficiency virus, co-infection, injection drug user
Tuberculous Splenic Abscesses as an Etiology in Prolonged Fever
No full textExtra-pulmonary tuberculosis covers all forms of tuberculosis in which the disease process occurs outside the lungs. Tuberculosis is one of the common infectious causes of splenic enlargement, but tuberculous splenic abscess is a rare presentation. We report the finding of tuberculous multiple splenic abscesses in a young male patient aged 33 years with prolonged fever. The main clinical feature was fever for 6 months prior to admission. Abdominal ultrasound revealed the spleen was normal in size but showed multiple abscesses. CT scan abdomen showed splenomegaly with multiple solid nodules. Patient underwent laparatomy and splenectomy, the spleen indeed showed multiple abscesses. Histopatology Result showed Langhan’s multi nucleated giant cells, caseous necrosis. The patients was diagnosed to have tuberculous multiple abscesses of the spleen. The patient was started on daily short-course antituberculosis drugs with isoniazid, rifampicin, pyrazinamide and ethambutol. He responded well to oral antituberculosis treatment. Keywords: prolonged fever, abdominal ultrasound, CT scan abdomen, tuberculosis, multiple splenic abscesses, splenectom