The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Bacterial Infection in Liver Cirrhosis
No full textPatients with liver cirrhosis frequently have infection which can deteriorate further the already impaired liver function. The most common form of infection in this particular patients are spontaneous bacterial peritonitis, urinary tract infection, and respiratory infection. Causative organism mostly Gram negative micro organism and originate from the gastrointestinal tract. The weaken of immune defense mechanism and also the altered gastrointestinal tract motility can explained most of these infection. This paper will review the bacterial infection in liver cirrhosis with some guidance in the management. Key words: Liver cirrhosis, spontaneous bacterial peritonitis, systemic antibiotic treatmen
Early Gastric Cancer
No full textEarly Gastric Cancer (EGC) is a carcinoma limited to the gastric mucosa or submucosa without the involvement of any lymph node. In Indonesia, the prevalence of EGC in 1980 was 2.2% and 1.7% for Jakarta and Medan, respectively. From 1980-1987 in Surabaya, the prevalence was 9.1% from all gastric cancers. Gastric mucosal abnormalities include atrophic gastritis, which is frequently accompanied by achlorhidria or hipochlorhidria and pernicious anemia, and the presence of an ulcer or polyp were believed to be precarcinogenic factors. Environmental factors, life style, age, sex, genetic factors, race, as well as dietary factors, especially intake of foods containing N-nitrosa (N-nitrosa compound) might play a role as risk factors for EGC. H.pylori infection also causes an increased risk for EGC. The diagnosis of EGC is based on physical examination, occult blood in stool sample, cytology, double contrast roentgenologic examination, gastroscopy, gastrobiopsy, and radioactive phosphor. There are no tumor markers specific for EGC. Histologically, EGC is classified into intestinal and diffuse infiltrative EGC. In 1962, the Japanese Research Society for Gastric Cancer made a classification for EGC based on gastroscopy, fluoroscopy, histopathology and microscopic examinations. In Japan, detection for EGC was performed by spraying the gastric mucosa with methylen blue during endoscopy, which will stain intestinal mucosa and spare normal mucosa. Early detection of EGC in Japan was performed through mass screening of people ages 40-50 years with recent dyspepsia, by means of endoscopy, biopsy, and upper GI tract radiological examinations. Endoscopic Ultrasonography (EUS) is the most accurate tool to determine EGC staging, particularly those with non-ulcerative lessions. The choices of treatment for EGC are surgical therapy or Endoscopic Mucosal Resection (EMR). EMR is a localized therapy, and it is indicated for EGC without metastases, for patients unwilling to undergo operation, or for those who are bad candidates for operation. The prognosis for EGC does not depend upon microscopic classification, but mostly on the depth of gastric mucosal invasion, spread to regional lymph nodes, and the presence of distant metastases. By establishing the diagnosis of EGC, the prognosis is usually better, for the treatment can be given at an earlier stage. Key words: Early gastric cancer, diagnosis, treatmen
Fluid Sucralphate in Post Esophageal Varices Ligation Esophageal Ulcer
No full textBackground: One of the complications of esophageal varices ligation is deep ulcer. Sucralphate has
been shown to prevent and heal post ligation esophageal ulcer.
Materials and method: All patients with liver cirrhosis and portal hypertension undergoing esophageal
varices ligation in the year 2000/2001 were included in this study. Using “double-blind random sampling”,
patients were divided into 2 groups, those receiving sucralphate and those receiving placebo for 2 weeks.
Endoscopy of the upper gastrointestinal tract was conducted regularly on the 7th, 10th, and 14th day to
evaluate the diameter of the esophageal ulcer based on the diameter of forceps biopsy. The data were
evaluated using analysis of variance (ANOVA) or kruskal wallis.
Results: Statistically, there was no significant difference in the characteristics of group A patients
receiving sucralphate and group B patients receiving placebo. Only 17 patients from group A and 20 from
group B were allowed to participate in this study. On the 10th day, the average diameter of the esophageal
ulcer in the sucralphate group was significantly smaller than that from the placebo group. (4.74 + 2.02 mm
vs 5.42 + 2.22 mm; p=0.04). On the 14th day, the average diameter of esophageal ulcer in the sucralphate
group was also significantly less than that of the placebo group (0.88 + 1.58 vs 2.99 + 2.04 mm; p < 0.01).
Conclusion:Sucralphate is able to accelerate post esophageal varices ligation esophageal ulcer.
Keywords: sucralphate, esophageal ulcer, esophageal varices ligatio
The Relationship between Gastric Mucosa Mucous Thickness and Gastroscopic Findings in Patients Receiving Non-Steroidal Anti-Inflammatory Drugs
No full textNon-steroid anti-inflammatory drugs (NSAID) can cause gastropathy and gastric mucosa, especially the mucous may play an important prevention role. This cross-sectional, single group study was conducted to know the difference in mucous thickness in antrum or corpus mucosa and the correlation of gastric mucous thickness to gastropathy. Patients who received NSAID from the rheumatology clinic were studied. Healthy subjects of 14 – 65 years old who never received NSAID were included as normal controls. Piroxicam 20 mg daily was given to the patients for 7 days, then gastroscopy and gastric mucosa biopsy with frozen section were performed. Specimens were stained with haematoxyline eosin and thickness of the mucous layer was measured using ocular micrometer. Thirty-two out of 70 patients participated in the study. All cases had hyperemia on gastroscopy with erosions and ulcer in 32 and 9 cases, respectively. The mean thickness of mucosa in distal antrum, proximal antrum and corpus was 28.5 ± 9, 37.4 ± 13.1 and 43.3 ± 13.1 microns, respectively. There was significant relationship between gastric mucosa mucous thickness with gastroscopic findings. In conclusion, this study confirmed that thickness of gastric mucosa mucous has an important role in preventing NSAID gastropathy and dyspeptic complaints in this kind of patients does not suggest abnormalities of gastric mucosa. Key Words: Gastric mucosa mucous thickness, NSAID, gastroscop
Esophageal Varices Bleeding in Portal Hypertension due to Portal Vein and Splenic Vein Obstruction
No full textBased on its relation to the liver sinusoid, increased pressure of portal vein can occur at three levels: presinusoid, sinusoid ,and postsinusoid. Obstruction of the presinusoid veins can be caused by extra- hepatic condition such as venous thrombosis. We reported a case of portal hypertension with esophageal varices bleeding was a result of obstruction due to thrombosis of the splenic vein and portal vein under hypercoagulant conditions due to thrombocytosis. The management of esophageal varices was sclerotherapy while for overcome the thrombosis the patient was given hydroxy urea. Keywords: esophageal varices bleeding, portal hypertension, vein obstructio
Treatment of Chronic Hepatitis C with High Dose Interferon Therapy Experience from Pertamina Central Hospital Jakarta
No full textBackground: Until several years ago, interferon alfa was the only drug with proven benefit for the treatment of chronic Hepatitis C. Several therapy categories such as fixed-dose regimens, induction-dose regimens and escalation-dose regimens are already known. With standard dose interferon therapy of 3 MU, TIW for 6 months, a sustained response rate can ve achieved in only 10-20% of patients. This study reports the Results of treatment of chronic Hepatitis C with high dose interferon therapy of 6 MU, TIW for 6 months. Methods: From February 1996 to February 1998, 15 patients with Hepatitis C were treated with interferon alfa-2b 6 MU, TIW for 6 months. Ultrasound-guided liver-biopsy was performed using the Menghini-Technique (Hepafix). Virological and biochemical responses were assessed at the end of the treatment period at week 24 and at the end of follow-up period at week 48 and up to 2 years later. Virological and biochemical sustained responses were defined as the absence of HCV-RNA, and SGPT concentration within the normal range at both weeks 24 and 48. Histological response was assessed after the end of treatment. Side-effects were observed and noted. Results: Ten out of 15 patients (66.7%) were HCV-RNA negative and 11 out of 15 patients (73.3%) demonstrated ALT within the normal range at week 24. At the end of the follow-up, from week 48 until 2 years later, HCV-RNA negative and normal ALT were found in 6 patients (40%). Histological improvement was found in 4 out of 6 patients. Fever was the most common side-effect and was found in 13 patients, while fatigue was found in 12 patients, myalgia in 11, headache in 10, and anorexia in 11 patients. Conclusion: High dose interferon alfa-2b therapy for the treatment of chronic Hepatitis C can improve the rate of sustained response, but is associated with more side-effects. Key Words: Chronic hepatitis C, Interferon
Nitric Oxide and von Willebrand Factor Levels as Markers of Endothelial Dysfunction in Liver Cirrhosis
No full textIntroduction: A number of investigators have shown that endothelial dysfunction in liver cirrhosis can be indicated by increased levels of nitric oxide (NO) and von Willebrand factor (vWF). The cause of this increase is still unclear. It is believe to be correlated with hyperdinamic circulation and endotoxemia, which are common in liver cirrhosis. The Aim of This Study: To compare the levels of NO and vWF in liver cirrhosis patients with those in healthy control subjects, and to investigate whether there is a correlation between levels of NO and vWF with the severity of the disease according to the Child Pugh Criteria Material and Method: This study was conducted from February until June 2001 in 35 liver cirrhosis patients at Dr. Pirngadi and H. Adam Malik Hospital and some private hospitals in Medan. The mean age of patients with liver cirrhosis was 54 + 12.26 years, the youngest being 31 years and the oldest 75 years, and 20 healthy controls while the mean age of the control subject was 55.20 + 13.04 years, the youngest being 31 years and the oldest 76 years. Based on Child Pugh criteria, 9 were classified as Child Pugh class A, 13 in class B, 13 in class C. The criteria for liver cirrhosis were based on clinical examination, laboratory findings and liver ultrasound examination. Cirrhotic patients with hypercolestrolemia, hypertension, heart failure, myocardial infraction, renal failure diabetes, COPD were those on drugs, such as antibiotics and branchodilators were excluded from the study. Result: The mean level of NO in patients with liver cirrhosis was 6.2600 + 4.4456 mM, while the mean NO level in control subjects was 3.2325 + 3.2355 mM, p<0.05. The mean level of NO in Child Pugh class A patients was 6.6889 + 3.9757mM, compared to control p<0.05; in Child Pugh class B the mean level was 4.8308 + 2.4642 mM compared to control p>0.05. There was a significant increase in the level of NO associated with the severity of liver cirrhosis. The mean level of vWF in patients with liver cirrhosis was 399.514 + 175.313% while the mean vWF level in control subjects was 139.100 + 51.144%, p<0.05. The mean level of vWF in Child Pugh class A patients was 231.778 ± 43.8576%, compared to control p<0.05; in Child Pugh class B was 365.846 + 110.034%, compared to control p<0.05, in Child Pugh class C was 549.308 + 164.483%, compared to control p<0.05. There was significant increase in the level of vWF correlated with severity of liver cirrhosis. Conclusion: The level of NO was significant higher in liver cirrhosis patients compared to control subjects, but there was no correlation between the increase in the level of NO with the severity of the disease. The levels of vWF was significantly higher in liver cirrhosis patients compared to control, and there was a correlation between increased levels of vWF and the severity of the disease. Key Words: Liver cirrhosis, Child Pugh criteria, nitric oxide (NO), von Willebrand Factor (vWF
Detection Of Helicobacter Pylori Infection With Stool Antigen: Comparison With Other Techniques
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 immunoassay
The Diagnostic and Management of Drug Induced Esophagitis
No full textThere are several factors that involve in drug induced esophagitis such as: drugs, esophagus, patients. The drug can cause direct effect to the esophageal mucosa. The drugs that often cause esphagitis: alendronate, tetracycline and its derivates and anti retroviral agents. Most of these drugs can cause esophageal damage due to corrosive nature of the drug. Esophageal factor that can cause the drug induced esophagitis: rheumatic heart disease, enlargement of the left atrium mass and aortal aneorysma. These conditions will disturb drug passage and prolongs drug contact with esophageal mucosa. The patients factor that influences this problem is the patients position when taking the drug, the patients age, the amount of water taken along with the drug, the time when drug was taken, and the amount of saliva. Endoscopy is a good procedure to evaluate the esophageal mucosa and establishing differential diagnosis through direct inspection, biopsy. In the management of esophagitis, PPIs are currently the most effectiveness agents available for treating esophagitis. Esomeprazole, an optical isomer of omeprazole is the first PPI to show greater efficacy than other PPI is in esophagitis healing. Keywords: Esophagitis, drug induced, proton pump inhibitor
Polypectomy of Esophageal Polyp due to Esophagitis
No full textEsophageal polyp can be found by chance during endoscopic examination. Polyps can be formed by changes in the esophageal mucosa due to reflux esophagitis. We report a case of multiple esophageal polyp in a patient with complaints of recurrent regurgitation without heartburn. Endoscopy demonstrated multiple polyps at the distal esophagus. Anatomic pathology evaluation of the polyp demonstrated mucosa lined with squamous epithels demonstrating elongation of the papilla and deposition of acute and chronic inflammatory cells, indicating chronic esophagitis with hyperplastic epithels. In this case, we conducted recurrent ligation of the multiple polyps. Evaluation at 2 weeks after the final ligation demonstrated no polyp remains, and the post-ligation ulcer was found. Evaluation at 1 month following treatment found diminished complaints. From this case, we can conclude that endoscopy is an important investigation modality to establish the diagnosis in cases of chronic gastrointestinal complaints. Ligation is a choice for the management of esophageal polyps. Key words: Esophageal polyp, polipectomy, ligatio