The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Advanced Gastric Cancer in a Young Patient
No full textGastric cancer remains the second most common cancer in the world, and is usually found in men, especially those over 50 years of age. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable. We reported a rare case of young female patient aged 23 years old with advanced gastric carcinoma. The main clinical features were epigastric discomfort, vomiting, and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, nodular lesion, ulcerative and hemorrhagic. The histopathologic examination revealed mucinous gastric carcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy was performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life. Keywords: Gastric cancer, young patien
Management of Upper Gastrointestinal Bleeding due to NSAID Gastropathy that is Unresponsive to Ranitidine
No full textNon steroidal anti-inflammatory drugs (NSAIDS) are now commonly used in clinical practice. On the other hands, this drug could result severe complication such as bleeding and perforation. In such condition, proton pump inhibitor can be used to stop bleeding than H2 antagonists. We reported one cases of upper gastrointestinal bleeding due to NSAID gastropathy that was unresponsive to Ranitidine. The treatment was suitable to proton pump inhibitor that could overcome upper gastrointestinal bleeding
The Role of Sclerotherapy in Children
No full textIntroduction: Endoscopic sclerotherapy to control variceal bleeding in adults has been proven to be useful. Complications from this procedure that have been reported include esophageal stricture, perforation, mediastinitis and recurrent bleeding. This procedure has increasingly been used in pediatric patients, thus increasing the incidence of its complications. The purpose of this study: To report the effect of sclerotherapy in variceal bleeding Method: All patients that underwent sclerotherapy since 1989 were included in the study and were followed up until December 1999. We recorded the frequency of injections, recurrent bleeding, and gastropathy. Results: During the last ten years, we have used sclerotherapy in 26 patients. The varices were secondary to intrahepatic portal hypertension. The average age at initial sclerotherapy was 7 years (ranging from 1-12 years). Two patients died following initial sclerotherapy. Nine patients could not be followed up and 17 patients were under monitoring for 2-10 years. Four patients died after 2-8 years of follow up due to the underlying diseases. Complete obliteration of all varices was obtained in 12 cases, minimal residual varices in four and 1 case was unfavorable for injection. Six patients (35.3%) suffered from recurrent bleeding; 4 patients had minimal residual varices (1 year follow up), and 2 patients had complete obliteration (3 years follow up). Gastropathy was found in 6 patients after 12 to 32 sessions of injection. Complications such as perforation or stricture were not found. Conclusions: Sclerotherapy is a very useful technique to control variceal bleeding in children. We found recurrent bleeding and gastropathy in 35.3% patients. Other complications were not found. Keywords: Sclerotherapy, children, endoscopy varices esophagu
The Efficacy of Trimethoprim-sulfamethoxazole Compared to Ciprofloxacin in The Treatment of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites
No full textBackground: The incidence of spontaneous bacterial peritonitis (SBP) is 7 to 23%, and the associated mortality rate is 25 to 40% (Rimola 1992). The aim of this study was to evaluate the efficacy of trimethoprim-sulfamethoxazole compared to ciprofloxacin in the treatment of SBP in cirrhotic patients with ascites. Materials and Method: This prospective randomized double blind study included 43 cirrhotic patients with ascites (25 males, 18 females, ages 23-75 years, one female patient died prior to laboratory evaluation) enrolled between May 1999 and June 2000, at the Department of Internal Medicine of Mohammad Hoesin General Hospital /the Medical Faculty of Sriwijaya University of Palembang, South Sumatera. Twenty-three patients (53.4%) with SBP were eligible for the study, all were randomized. Patients were divided into 2 groups (13 in group I, and 10 in group II), those receiving trimethoprim- sulfamethoxazole 960 mg once daily for 10 days and those receiving ciprofloxacin 1000 mg once daily for 10 days. Statistically, there was no significant difference in the characteristics of the 2 groups. Results: The incidence of SBP in our study was 53.4% (23 patients out of 43 cirrhotic patients with ascites). The Results of the study demonstrate that trimethoprim-sulfamethoxazole and ciprofloxacin are both effective (91.6% and 90%) in the treatment of SBP. There was a significant decrease in ascitic fluid PMN count after 10 days treatment with both of the drugs (p=0.001 and p=0.000). There was no statistically significant difference (t-test) between the two groups in decreasing the ascitic fluid PMN count after the treatment (p=0.664). Conclusion: Trimethoprim-sulfamethoxazole and ciprofloxacin has similar efficacy in the treatment of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Keyword: Trimethoprim-sulfamethoxazole, ciprofloxacin, spontaneous bacterial peritonitis
Orocecal Transit Time in Normal Adults at Cipto Mangunkusumo National General Hospital, Jakarta
No full textHelicobacter pylori has been known as a cause of chronic gastritis, a predisposition to gastric and duocenal ulcers, and a class I gastric carcinogen. Throughout the world, H. pylori infection is very common, reaching 40% -50% of the population in developed nations and 80% – 90% of the population in developing nations. Several techniques have been used to detect H. pylori infection, such as the urea breath test, rapid urease test, serological test, as well as biopsies of gastric or duodenal tissues for culture and histopathology. In this review article, we will discuss a relatively new method to detect H. pylori antigen in stools with enzyme immunoassay, and comparisons with other standard techniques. However, the H. pylori stool antigen test is not yet commercially available in Indonesia.Key words: Helicobacter pylori - stool antigen - enzyme immunoassa
Risk Factors for Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis and Ascites
No full textSpontaneous bacterial peritonitis (SBP) is one of serious complication of liver cirrhosis. Most of the patient with SBP have severe reduced liver function that clasified as Child Plugh class C. There are other risk factors for SBP such as poor nutritional status, GI bleeding, intravascular catheter insertion, ascites fluid protein concentration of less than 1 g/L, large volume paracentesis, urinary tract infection and respiratory tract infection. The management of SBP is mainly the administration of proper antibiotics. The antibiotic of choice for the emperial treatment is cefotaxim. Keywords: sbp,liver cirrhosis, risk factor, ascite
Non Helicobacter pylori - Duodenal Ulcer in a Liver Cirrhosis Patient
No full textPeptic ulcer is an clearly marginated ulceration in mucosal membran that can penetrate until muscularis layer and resulted from imbalance between aggressive factor (gastric acid and pepsin) and defensive factor (gastric mucous, bicarbonate and prostaglandin, mucosal blood flow, and cell replacement). Factors that can act as aggressive factor include H. pylori, NSAID, and smoking. Duodenal ulcer is frequently associated with H. pylori, in which Helicobacter pylori is found in 95 - 100% of duodenal ulcer patients.. It was reported, a 39 years old female patient with cirrhosis hepatis who suffered from melena in which endoscopic examination revealed duodenal ulcer as a source of bleeding.There was no H. pylori, based on serologic examination (IgG antiHP) and culture. The ulcer is suspected caused by NSAID based on history of using traditional medicine that may contain NSAID. Treatment with proton pump inhibitor and sucralfate can heal the ulcer after two week treatment. Keywords: H. pylori, duodenal ulcer – liver cirrhosi
Hepatitis A Virus Infection in Guillain-Barré Syndrome
No full textProdromal factors of Guillain-Barré syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS. We report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM anti HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period
Early Acute Liver Failure In Severe Acute Hepatitis B
No full textEarly acute liver failure is defined by the presence of a drop below 50% of the normal prothrombine ratio, jaundice, and clotting factors of less than 50% in any patient with acute liver disease. Clinical features and laboratory manifestations of viral hepatitis range from unapparent disease, asymptomatic infection, to culminant disease, which has the highest mortality rate of up to over 80 %. We report a case of a 22-year old man who was treated in a private hospital with early acute liver failure caused by hepatitis B infection. The diagnosis was based on clinical symptoms and laboratory test Results such as jaundice, hepatomegaly, ascites, 34% prothrombine ratio, elongated prothrombine time (37,1 seconds), hypoalbuminemia (1,9 g/dL), hyperbillirubinemia (total billirubin 26,35 mg/dL, direct billirubin 16,66 mg/dL, HbsAg (+), IgM anti- HBc (+), IgM anti HAV (-), and anti HCV (-). The patient suffered from jaundice for 6 weeks and on the third week, he suffered from ascites. He had improved clinical condition and laboratory test results with conservative therapy after the seventh week. At the end of the tenth week, the patient’s clinical condition and laboratory test results had reached normal, with HBsAg (-) and HBsAb (+). Whether or not interferon should have been given to this patient is still arguable. Key words: Early acute liver failure, Severe acute hepatitis
Alterations in Blood Ammonium Level and Psychometric Test in Patients with Liver Cirrhosis after a Tempe Diet
No full textBackground: Hepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non- ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion. Study aim: To determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet). Method: This is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group is given a tempe diet, while the second (control) group is given liver diet II/III (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT). Results: In the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories. Conclusion: A 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test. Keywords: lever cirrhosis, hepatic encephalopathy, tempe diet, numeric connection test, child-pugh criteri