The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Helicobacter pylori Infection in Children with Recurrent Abdominal Pain
No full textRecurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAP. Typically, the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H. pylori infection in Indonesian children with RAP. The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAP. Mucosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27.7%. Histologic evidence of gastritis was present in 94.1% children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegative’s children were found to be H. pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be performed for a longer time of period to clarify this issue. Keywords: H. pylori infection, IgG antibody to H. pylori, upper GI endoscopy, RAP, recurrent abdominal pai
Non-Surgical Biliary Drainage on Biliary Obstruction due to Malignancy
No full textSurgery is still the golden standard of curative therapy for malignant biliary obstruction, but only 10- 20% of cases considered resectable. Therefore, palliative therapy to relieve pain, cholestasis, and biliary obstruction, is the main treatment for most patients. The development of percutaneous transhepatic biliary drainage and endoscopic biliary drainage had brought about minimally invasive treatment for malignant biliary obstruction, which had lower morbidity and mortality than surgical drainage. The choice of drainage technique depends on type of tumor, site of obstruction, also the available expert and instrumentation. Keywords: malignant biliary obstruction, percutaneous transhepatic biliary drainage, therapeutic endoscopic retrograde cholangiopancreatograph
Management of Gastroesophageal Reflux Disease (GERD)
No full textEven though there are still no epidemiological data on the prevalence of Gastro Esophageal Reflux Disease (GERD) in Indonesia, data from The Division of Gastroenterology Department of Internal Medicine Cipto Mangunkusumo Hospital demonstrate signs of esophagitis in 22.8% of all patients with dyspepsia who underwent endoscopic examination. Western countries report a higher rate of GERD than Asian and African countries, possibly due to dietary factors and increased obesity. Besides adequate history and physical examination, there are many other supporting examinations that could be performed to establish the diagnosis of GERD, especially endoscopy of the upper gastrointestinal tract and 24-hour esophageal pH monitoring. Even though this condition is rarely fatal, GERD patients should still receive adequate management. Most patients demonstrate a satisfactory response towards therapy, which includes life-style modification as well as medication. Currently, the drugs of choice for GERD are proton-pump inhibitors. A combination of proton-pump inhibitors and prokinetics produces a better effect. Patients resistant to medical treatment or those with recurrent esophageal stricture should be considered for anti-reflux surgery. Keywords: gastroesophageal reflux, diagnosis, prokinetics, proton-pump inhibitor
Primary Lymphoma of The Gastrointestinal Tract
No full textChronic hepatitis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) is still a major problem in terms of progressive liver damage, prevention and therapy in most parts of the world. Unfortunately, to date, there is still no specific and effective therapy for HBV. No therapy can be given to carrier, non- replicative and asymptomatic patients of chronic HBV infection. Lamivudine or alpha-interferon can be used for treatment of compensated, chronic hepatitis B infection with significant increase of aminotransferase. Approximately 40 % of patients can have seroconversion with this form of therapy. Chronic hepatitis D virus infection can be treat with alpha-interferon and in the final stage, may undergo liver transplantation. For chronic hepatitis C virus infection, alpha-interferon with ribavirin have been shown to have a better efficacy than alpha-interferon alone where the efficacy can reach 39 – 49 %. Keywords: hepatitis, interferon, lamivudin,ribaviri
Crohn’s disease, diagnosis, and management
No full textCrohn’s disease is a rare chronic inflammatory bowel diseases. The cause could be genetic factors, infection, immunology and psychological factors. The exact diagnosis is determined by colonoscopy and histopathology examination. Keywords: Inflammatory bowel disease, Crohn’s diseas
Acute pancreatitis as a complication of dengue fever
No full textAcute pancreatitis is a rare complication of dengue fever that usually occurs without hyperglycemia. We report one patient of dengue fever with a complication of acute pancreatitis. A 28 year old male was referred from a private clinic to Dr. Cipto Mangunkusumo hospital, because of fever and abdominal pain since two days before admission. The physical examination showed slight fever and epigastric pain. The laboratory examination revealed leukocytosis, thrombocytopenia and increased levels of serum amylase and lypase. The diagnosis of dengue infection was made after the finding the IgM for dengue virus. After 12 days of hospitalization, the patient’s clinical signs and symptoms and laboratory findings were within normal limits. Key words: acute pancreatitis, dengue feve
Histopathological pattern of gastric biopsies of Helicobacter pylori positive patients in Sardjito General Hospital, Yogyakarta
No full textObjective: To determine the gastric histopathological types of H. pylori positive patients. Materials and Methods: Study design was prospective study. Consecutive patients who were suffering chronic dyspepsia underwent endoscopic examination between August 1998 and December 1999. The biopsy specimens were taken from the gastric antrum and corpus and sent to the pathologist for histopathological typing and H. pylori examinations. H. pylori were also confirmed with CLO and IgG- Helicobacter pylori test. Results: There were 92 patients (48 male (M) and 44 female (F)) who underwent endoscopical gastric biopsies between August 1998 and December 1999. Fifty six (60.87%) patients suffered from chronic superficial gastritis, 11 (11.96%) from chronic atropic gastritis, 2 (2.17%) from chronic gastritis with metaplasia, 3 (3.27) from gastric ulcer, and 2 (2.17%) from gastric signet-ring cell carcinoma. Twenty one (22.8%) patients was found to be H. pylori positive based on histopathologic examination with CLO and IgG-H. pylori tests. Those were 5 (8.90%) patients with chronic superficial gastritis, 7 (63.63%) chronic atrophic gastritis, 3 (100%) gastric ulcer, 2 (100%) chronic gastritis with metaplasia, 1 (50%) signet-ring carcinoma. The age range of the H. pylori positive patients were between 16 and 76 years old. Conclusion: There were twenty one (22.8%) H. pylori positive patients out of 92 endoscopied patients and a high percentage tendency of H. pylori positively in chronic atrophic gastritis, gastric ulcer, and chronic gastritis with metaplasia, although most of the patients had chronic superficial gastritis. Further study with larger sample is needed to get clearer picture of H. pylori distribution based on gastric histopathological types. Key words: histopathological type, gastric biopsy, H. pylori, gastriti
Helicobacter pylori in dyspeptic patients in M. Jamil Hospital-Padang
No full textObjective: Helicobacter pylori infection is probably the most common infection caused by pathogenic bacteria and affects more than half of the world population. These bacteria caused many gastroduodenal pathology such as chronic active gastritis, peptic ulcer and gastric malignancy. This study investigated Helicobacter pylori infections in dyspeptic patients. Materials & Methods: Forty dyspeptic patients were examined using upper gastrointestinal endoscopy and biopsy for histopathologic examination. Results: The symptom of the dyspeptic patients were epigastric tenderness (100%). Endoscopic abnormalities were found in 39 (97.5%) cases. The gastric abnormalities were chronic antral gastritis in 24 (60%), esophagitis and gastritis in 7 (17.5%), and gastric ulcer in 3 (7.5%). Twenty four out of 40 patients had anti-Helicobacter pylori positive (60%) and histopathologic examination were positive 18 (45%). The histopathologic examination found atrophy in 18 (45%), MN in 18 (45%), PMN in 18 (45%), and metaplastic in 4 (10%). Conclusion : The prevalence of Helicobacter pylori in dyspeptic patients were 60% (serology) and 45% (histopathology). Keywords: Helicobacter pylori, dyspeptic, serology, histopatholog
Optimum treatment regimens for Helicobacter pylori infection
No full textThe treatment of Helicobacter pylori infection includes of current standard triple therapies consisting of a proton pump inhibitor, clarithromycin and amoxicillin or metronidazole on the basis of simplicity, safety, and efficacy. There are several factors determining the success of H. pylori eradication treatment. They include the components of a treatment regimen, the treatment duration, patient compliance, the presence of resistant or virulent strains of Helicobacter pylori and possibly the patient’s gastric acid secretory status. PPI, clarithromycin 500 mg, amoxicillin 1 g or metronidazol 400 mg, all given bid for 7 days are the most commonly used combination regimens. RBC-based triple therapies, furazolidone or rifabutin containing regimens can be used as an alternative approach to PPI-based triple therapies in areas where bacterial resistant strains of H. pylory are concerned. Keywords: treatment, Helicobacter pylori, PPI, clarithromycin, amoxicillin, metronidazole, PAM, PMC, PAC, RB