The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Not a member yet
381 research outputs found
Sort by
Unusual Case of Massive Obscure Gastrointestinal Bleeding: Ectopic Varices in Jejunum Caused by Arteriovenous Malformation
Full text linkSmall bowel ectopic varices is a rare etiology for obscure gastrointestinal bleeding. Ectopic varices in the absence of portal hypertension can be caused by congenital or familial conditions (e.g. malformation of vessel). Bleeding caused by ectopic varices can be massive and life threatening. Single Balloon Enteroscopy (SBE) is one of diagnostic modalities for obscure gastrointestinal bleeding. We report one case of obscure overt gastrointestinal bleeding with sub-acute onset. Previous esophagogastroduodenoscopy and colonoscopy cannot found the source of bleeding. On the enteroscopy we found varices at proximal jejunum with active bleeding during procedure. We applied hemostatic powder to stop the bleeding and proceed to surgery. Surgery was performed by enteroscopy guide. The jejunum section with varices was resected and the pathology confirmed the malformation of arteriovenous. Currently there is no available guideline or randomized study for the treatment of ectopic varices. Treatment options include ligation, sclerotherapy, surgery and interventional radiology. In this patient we choose surgery because of massive gastrointestinal bleeding
Colorectal Cancer: Epidemiological Trends, Screening, and Inheritability
Full text linkColorectal cancer is one of the most common cancer worldwide. The incidence and mortality trend in different areas of the world varies. Colorectal cancer incidence and mortality are increasing in some countries. There are also epidemiological shift towards younger age (below 40). Most common non-invasive screening tests are fecal immunochemistry test (FIT) and fecal occult blood test (FOBT). Both have good sensitivity. The best invasive method for colorectal screening is still colonoscopy. Hereditary colorectal cancer is an important factor in younger age colorectal cancer. Familial adenomatous polyposis and Lynch syndrome are most common hereditary CRC. In familial or hereditary CRC, the chance of developing the cancerous form of the disease is nearly inevitable. Genetic testing may benefit the patients and their future progenies
Red Cell Distribution Width to Platelet Ratio is not Inferior than Aspartate Aminotransferase to Platelet Ratio Index Score in Predicting Liver Fibrosis in Chronic Hepatitis B Patients at Sanglah General Hospital Denpasar
Full text linkBackground: Red cell distribution width to platelet ratio (RPR) is known to be associated with a degree of liver fibrosis in patients with hepatitis B. This study aims to compare the under curve area, sensitivity, specificity, positive predictive value, and negative predictive value between RPR and aspartate aminotransferase to platelet ratio index (APRI) score with degree of fibrosis.Method: This study is a retrospective study, data taken from medical records of all chronic hepatitis B patients examined by Fibroscan at Sanglah General Hospital Denpasar, Bali from January 2016 to February 2018.Results: Ninety eight patients with chronic hepatitis B, 81 patients were recovered after exclusion of patients with chronic kidney disease, malignancy, and dengue haemorrhagic fever (DHF). In receiver operating characteristic (ROC) analysis, obtained area under the ROC curve (AUC) at RPR of 0.816, and at APRI score 0.797. In RPR with cut off 0.066 the sensitivity was 76.9%, specificity 78.6%, PPV 79.5%, NPV 73.8%. While APRI score with cut off 0.85 got 69.2% sensitivity, specificity 76.2%, PPV 73.0%, and NPV 72.7%. According to Kappa test, we found kappa coefficient 0.653 (p < 0.05).Conclusion: In predicting severe liver fibrosis in chronic hepatitis B patients, RPR is not inferior than APRI score, and may be used as a diagnostic marker, with 65.3% conformity
Comparison of Triiodothyronine (T3), Tetraiodothyronine (T4), Freethyoxine (FT4), Thyroid Stimulating Hormone (TSH) Levels in with Liver Cirrhosis Patients Based on Child-Pugh Score at H. Adam Malik Central General Hospital, Medan
Full text linkBackground: The liver is involved in thyroid hormone conjugation and excretion, as well as the synthesis of thyroid binding globulin. T4 and T3 regulate the basal metabolic rate of all cells.Method: The sample of this research was collected crosssectionally on 40 patients with liver cirrhosis based Child-Pugh score. Ultrasonography and Triiodothyronine (T3), Tetraiodothyronine (T4), Freethyoxine (FT4), thyroid stimulating hormone (TSH) levels examinations to know the difference between liver cirrhosis patients with Child-Pugh A, B, and C with ELISA method.Results: Statistical analysis showed there are not found significant differences in T3, T4, FT4, TSH levels in patients with of the liver cirrhosis based on the Child-Pugh score.Conclusion: Not found significant differences in thyroid hormone levels among patients with liver cirrhosis Child-Pugh A, B, and C.
Correlation Between Esophageal Varices and Lok Score as a Non-invasive Parameter in Liver Cirrhosis Patients
No full textBackground: Bleeding from gastro-esophageal varices is the most serious and life-threatening complication of cirrhosis. Endoscopic surveillance of esophageal varices in cirrhotic patients is expensive and uncomfortable for the patients. Therefore, there is a particular need for non-invasive predictors for esophageal varices. The aim of the present study was to evaluate association of esophageal varices and Lok Score as non-invasive parameter in liver cirrhosis patients.Method: This is a cross-sectional study of patients admitted at the Adam Malik hospital Medan between September to December 2014 with a diagnosis of cirrhosis based on clinical, biochemical, ultrasound, and gastroscopy. Lok Score was calculated for all patients, tabulated and analyzed.Results: Among 76 patients with esophageal varices, 55.3% was due to hepatitis B virus (HBV). The majority of patients were Child C with only 13,2% being Child Pugh class A. Majority of the population had F2 esophageal varices (42,1%), F1 (32,9%), and F3 (25%). There is significance difference between Lok Score and grading of esophageal varices, Lok score is higher in Large esophageal varices compared with small esophageal varises (0.92 ± 0.14 vs. 0.70 ± 0.29; p = 0.001). Lok Score cut-off value of > 0,9141 was highly predictive in the diagnosis large esophageal varices with a sensitivity of 74.5%, specificity of 72%, positive predictive value of 84%, negative predictive value 58%, and accuracy was 73.7%.Conclusion: Lok Score was significantly associated with esophageal varices. Lok score is a good non-invasive predictor of large esophageal varices in cirrhotic patients.
Primary Hepatic Lymphoma in a 32-year-old Male
No full text A 32-year-old male came with right upper abdominal pain with a mass increasing in size since the last 6 months, with no other typical symptoms. The physical findings revealed right upper abdominal mass, rubbery consistence, irregular surface, rounded edge, unclear border, immobile, without any tenderness. Other physical examination revealed normal findings, without any lymphadenopathy at another site. The laboratory findings revealed non-reactive hepatitis B and C markers, normal AFP, slightly increased LDH. Plain chest X-ray showed elevated right hemidiaphragm, and a large mass sized ± 14.18 x 8.56 x 12.56 cm compressing the liver. We’ve done biopsy with ultrasound guiding on the mass, and the histological examination revealed that it was lymphoma with negative CD20. The diagnosis was established as primary hepatic lymphoma and the patient was then given chemotherapy
Small Bowel Malignancy in Patient with Obscure Gastrointestinal Bleeding in Cipto Mangunkusumo Hospital, Diagnosed Using Double Balloon Enteroscopy: A Case Series
Full text linkSmall bowel malignancy is still a rare case as a cause of gastrointestinal bleeding. The symptoms of small bowel malignancy are not specific. One of the symptoms is obscure gastrointestinal bleeding. Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent gastrointestinal bleeding when the result esophagogastroduodenoscopy and colonic endoscopy is negative. OGIB accounts for approximately 5% of all gastrointestinal bleeding events. Most OGIB events are attributable to small bowel disease. Double-balloon enteroscopy, also known as push-and-pull enteroscopy is an endoscopic technique for visualization of the small bowel. Here we present 5 cases of small bowel tumours in patient with obscure gastrointestinal bleeding who underwent double balloon enteroscopy at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Three patients had confirmed gastrointestinal stromal tumour (GIST) from the histopathology examination, while 2 patients were diagnosed with adenocarcinoma
Expression of Hepcidin and Growth Differentiation Factor 15 (GDF-15) Levels in Thalassemia Patients with Iron Overload and Positive Anti Hepatitis C Virus
No full textBackground: Thalassemia patients who undergo life-long recurrent blood transfusion will experience iron overload in various organs including the liver and possibly suffer from chronic hepatitis C infection which may lead to liver impairment. The liver produces hepcidin, a hormone which plays role in the regulation of iron level in the blood. Various factors may influence hepcidin level in the blood. Chronic hepatitis C causes iron overload and liver impairment. Liver impairment and haemolytic anaemia due to haemoglobinopathy will suppress hepcidin production. Anaemia stimulates growth differentiation factor 15 (GDF-15) to increase erythropoiesis and suppress hepcidin production. Iron overload causes increase in hepcidin level. Presence of factors which decrease or increase hepcidin production will express various levels of hepcidin. This study aimed to identify the expression of hepcidin and GDF-15 levels in thalassemia patients with iron overload and positive anti-HCV. Information on hepcidin and GDF-15 levels are beneficial in the management of iron overload in thalassemia with positive anti-HCV.Method: This study was a descriptive analytic study in thalassemia patients who had received recurrent blood transfusion ≥ 12 times, suffered from iron overload (transferrin saturation > 55% and ferritin > 1,000 ng/mL), which consisted of 31 individuals with positive anti-HCV and 27 individuals with negative anti-HCV. This study was performed in Thalassemia Centre Department of Child Health and Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, in October 2011–January 2012. Serum hepcidin and GDF-15 examinations were performed using enzyme-linked immunosorbent assay (ELISA) method. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) examinations were performed using colorimetry method. Data on ferritin and transferrin saturation were obtained from medical records in the last 3 months. Data was analysed using SPSS Windows version 17 software.Results: Characteristics of subjects in this study included ferritin level, transferrin saturation, AST, and ALT were 5,289 (SD 2,492) ng/mL, 96.7 (SD 9.2)%, 41.8 (SD 26.7) U/L, and 50.6 (24.9) U/L, respectively. It was obtained that the hepcidin levels were within the normal limits with median of 51.5 (19-166) pg/mL, while GDF-15 levels were higher than the normal range with median of 1,936 (643-2,475) pg/mL. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV groups, with p value of 0.842 and 0.115, respectively.Conclusion: We obtained that the hepcidin levels were within normal limits and GDF-15 levels were higher than the normal range. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV group.
Microscopic Examination of Fecal Leukocytes as a Simple Method to Detecting Infective Colitis in Children
Full text linkVarious pathogenic bacteria are reported as the cause of infectious colitis in children. Infectious colitis does not have a specific sign, therefore an accurate examination is required. The implementation of fecal cultures accompanied with drug resistance tests often have constraints, beside the relatively expensive costs, longer times are needed, and not all health care facilities have required instruments. On the other hand, this condition requires an immediate antibiotic therapy, so that the infection should not be continued. In daily practice, it is not uncommon to find diarrhea with the amount of fecal leukocyte < 10/hpf with pathogenic bacteria on the examination of the fecal culture.Cross-sectional study was conducted to observe the pattern of bacterial distribution in children’s fecal who have acute diarrhea and the correlation between the existence of pathogenic bacteria and the number of leukocytes in the fecal, as well as antibiotic resistance patterns. The population of this study is children with age of 6 months old - 18 years old who were suffering from acute diarrhea with the amount of fecal leucocyte ≥ 5/hpf, who recruited from polyclinic or patient admitted at Cipto Mangunkusumo Hospital and Fatmawati General Hospital, Jakarta. Based on examinations of fecal cultures and PCR, Salmonella sp and C. dificille were found subsequently in 2 children (33.3%), Enterophatogenic E. Coli(EPEC) and Shigella were found subsequently in 1 child (16.7%). Based on the ROC curve, it was found that there was no intersection of maximum and minimal leukocyte value with the midline, whereas the best sensitivity and specificity value was found at the cut-off point of 8.5, hence the cut-off point of leukocytes was determined at < 8 and > 8. The sensitivity value was 83.3% and the specificity value was 45.1%. The antibiotic sensitivity test showed that one child infected by EPEC was sensitive to ciprofloxacin. Two children infected by Salmonella, were still sensitive to chloramphenicol, cotrimoxazole, cefixime, and ceftriaxone. Two children infected by C. Difficile were sensitive to ceftriaxone, and 1 child infected by Shigella was sensitive to cefixime, ceftriaxone and ciprofloksazine
Safety of Annona muricata Extract Supplementation for Colorectal Cancer Patients
Full text linkBackground: People have used Annona muricata leaves traditionally as tea drinks. Traditional use of A. muricata leaves is as an infusion which is closed to water extract. The potential health benefit of A. muricata tea leaves that is traditionally used for maintaining health which lately is being used by cancer patients. Therefore it is urgent to verify the safety of A. muricata leaves extract. Method: A randomized double blind placebo controlled trial was conducted on 30 colorectal cancer out patients who had undergone primary tumor resection. Twenty eight subjects completed the study, divided into two groups, namely ethanol-soluble fraction of A. muricata leaves water extract (ESFAM) (n = 14), and placebo (n = 14) for 8 weeks. Peripheral blood samples were withdrawn from subjects by venipuncture at baseline and at the end of the study period.Results: The effect on bone marrow can be considered to be safe. The measure in indices of organs function, i.e liver and kidney also showed similar results and within normal range after supplementation. The dose given to the subjects is safe and highly tolerable, as shown by very few (6.7%) of patients complained intolerable adverse effects. Conclusion: This study indicates the safety of ESFAM supplementation.