The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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National Consensus on the Use of Sedation Drugs in the Gastrointestinal Endoscopic Procedures
Full text linkGastrointestinal endoscopy is rapidly developing and several gastrointestinal endoscopy equipment are available for both diagnostic and therapeutic purposes. Proper sedation is critical in performing endoscopic procedures, both for patients and physicians. This consensus is used as a guideline and not as a legal standard in performing endoscopic services. This consensus explained the definition, indication, contraindication, and complication prevention during sedation. Factors affecting the need of sedation is patient factors, procedure factors, and sedation level. Diagnostic or therapeutic upper gastrointestinal tract endoscopy which not complicated can be performed with minimal sedation or moderate sedation, while deep sedation can be considered for longer and more complex procedures. Furthermore, assessment and selection of sedation was explained, followed by the guide to choose pharmacological sedation and analgesics. Currently, diazepam, midazolam, propofol, fentanyl, and pethidine is the most likely used sedation during gastrointestinal endoscopy, with midazolam as the preferred medication of choice. This consensus also explained the antidote of each drug and the recovery after procedure. This consensus aimed to improve gastrointestinal endoscopic procedure services in Indonesia.
A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis
Full text linkSuperior mesenteric vein (SMV) thrombosis caused by acute appendicitis is quite rare nowadays. These conditions occurs secondary to infection in the region drained by the portal venous system. In this case, we report a successfully treated case of SMV thrombosis and liver abscess associated with appendicitis with antibiotics and anticoagulant.Early diagnosis and prompt treatment are basic to a favorable clinical course
Successful Therapy in A 20 Years Old Male with Acute Pancreatitis
No full textAcute pancreatitis is an inflammation at pancreas that can be caused by biliary tract disease, alcohol and metabolic disorder. We presented a 20 years old male with acute pancreatitis, he was obese and had history of alcohol abuse came with severe abdominal pain. There is increasing amylase and lipase level, and his abdominal CT scan showed infiltrate peripancreatic, mesenteric, and left anterior pararenal space, hepatomegaly and mild ascites. Patient was given supportive treatment such as parenteral nutrition, analgetic, PPI, and also octreotide. With proper diagnosis and optimal treatment, patient was successfully treated without any complication
Impact of Endoscopic Ultrasound (EUS) Procedure in Pancreatico-biliary Disorders in Indonesia
No full textPancreato-biliary disorders are the challenging disorders in gastroenterology practice. It is well-known that endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure in managing pancreato-biliary disorders. However, imaging modalities such as abdominal CT scan and MRI has been successfully reduced the unnecessary ERCP to avoid several potential complications. Recently, endoscopic ultrasound (EUS) procedure has become an important tool due to the limitation of imaging modalities in pancreato-biliary disorders. Its ability which is not only for diagnostic, but also for therapeutic purpose has given a new insight for most gastroenterologists in their daily practice. However, the investment, cost, and the proper training curriculum are still debatable in most developing countries, especially in Indonesia
Melanosis Coli
Full text linkMelanosis coli is a brownish discoloration of the colonic mucosa caused by the accumulation of pigment in macrophages of the lamina propria. We reported a 62 years old woman with prolonged constipation since 10 years ago. She underwent haemorhoidectomy when 17 years old. Since 4 years ago she regularly comsumted herbal laxative. On 27 january 2015 underwent colonoscopy at Sardjito hospital Yogyakarta. Colonoscopic examination revealed Melanosis coli
Procalcitonin Level Differences in Patients with Liver Cirrhosis Without Bacterial Infection
No full textBackground: Procalcitonin level can increase in patients with liver cirrhosis without bacterial infection. The aim of this study is to identify the role of procalcitonin in patients with liver cirrhosis without bacterial infection.Methods: Cross-sectional study was performed to patients with liver cirrhosis without bacterial infection. In patients, we performed procalcitonin level examination and bacterial infection identification. Further, we analysed them to know the procalcitonin level difference in patients with compensated and decompensated liver cirrhosis without bacterial infection.Results: We obtained 39 patients with liver cirrhosis without bacterial infection, male 61.5% with compensated condition found in 17 patients and decompensated in 22 patients. We found significant difference in the average of procalcitonin level in decompensated patients (0.738ng/mL ± 1.185) compared to compensated (0.065ng/mL ± 0.022).Conclusion: Procalcitonin level increased in patients with liver cirrhosis without bacterial infection. The level in decompensated patients were higher compared to compensated patients
Concomitant Case of Primary Biliary Cirrhosis and Autoimmune Hemolityc Anemia Responding to Corticosteroid and Ursodeoxycholic Acid in Young Woman
Full text linkPrimary biliary cirrhosis (PBC) is an autoimmune liver disease of unknown etiology and is characterized by chronic progressive cholestasis with destruction of the small intrahepatic bile ducts and associated most commonly with antimitochondrial antibodies. PBC is most common in women and is often associated with other autoimmune disease such as autoimmune hemolityc anemia (AIHA), rheumatoid arthritis, thyroiditis, and systemic lupus eritomatosus. We report one case, a 20 years old woman with AIHA have been treated by corticosteroid since last year and she came to the outpatient department (OPD) with fatique and jaundice. The result of laboratory were haemoglobin 8.7 mg/dL, white blood cell 8700 mg/dL, coomb test +2, total bilirubin 33.2 mg/dL, direct bilirubin 29.3 mg/dL, γGT: 297 mg/dL and alkalyphospatase: 158 mg/dL. The result of Abdominal CT scan showed the size of liver and spleen increased and normal common bile duct (CBD). The result of ANA test, anti-nuclear (ANA) and antimitochondrial M2 (AMA M2) antibodies were positive. From the physical examination, laboratory and CT scan Abdomen; the diagnose of this patient was AIHA with PBC. After treatment with corticosteroid (prednison 1mg/kg/day) and ursodeoxicholic acid (UDCA) for several weeks, the clinical manifestation of PBC such as jaundice getting better (the laboratory result: total bilirubin 2.7 mg/dL, direct bilirubin 1.5 mg/dL, gamma GT 80 mg/dL)
CagA and VacA Gene Expression in Helicobacter pylori Infected Patients in Dr. Soetomo General Hospital
Full text linkMarshall and Warren had discovered helicobacter pylori in 1982 and known as the main pathogen caused infection on human’s stomach. Helicobacter pylori is a bacillus spiral and gram negative bacteria which is motile as it has almost six flagella on one side of its body (unipolar). There are strain type I, intermediate and type II. Strain type I has cytotoxin associated gene A (cagA) and vacuolating cytotoxin gene A (vacA) while strain type II has vacuolating cytotoxin gene A (vacA). Because of cag pathogenicity island (PAI), strain type I has the tendency to cause the infection become more malignant. This study was conducted by using descriptive purposeful sampling method on patients in endoscopy department of internal medicine in the division of hepatology gastroentero Dr. Soetomo starting from October 20 until November 25, 2015. The aim of this study is to determine whether the stool sample shows cagA gene and or vacA gene. The data was proceed by observation through the results of PCR assays to look at the genes that are expressed by Helicobacter pylori. DNA was extracted from stool by using QIAamp (Qiagen) stool kit. Results of the study show only one patient positive for vacA gene while cagA gene is none from ten patients. DNA examinations with different concentrations and temperatures also show the same results. One sample from the stool specimen shows positive for strain type II, indicates it only has vacA gene. PCR examination through gastric biopsy is known has higher specificity
High Incidence of Hepatitis B Virus Infection in Hemodialysis Patients at Sanglah General Hospital and It’s Risk Factors
Full text linkBackground: Patients receiving maintenance hemodialysis (HD) are at higher risk for Hepatitis B Virus (HBV) infections than in general population. Strict infection control is essential to prevent nosocomial transmission. We aimed to investigate the incidence of HBV infection in the HD population in Sanglah General Hospital as well as risk factors acquired HBV infection.Method: All adult patients receiving maintenance HD (n=267) in 3 dialysis units at Sanglah Hospital were studied between March to June 2016. In this study, medical record of patients on maintenance hemodialysis were reviewed and the patients were interviewed by the researchers to collect data regarding the serology status of these patients before and during HD, and potential risk factors which could be associated with HBV acquisition.Results: Participant mean age was 54.07 ± 0.80 years and 154 (57.7%) were male.We found 21 patients (7.8%) were sero-positive for HBV (HBsAg positive) with mean titer was 9.26±1.85. Of the sero-positive patients,1 patient (4.8%) were known to be infected before the initiation of HD and 20 patients (95.2%) were infected during HD. Incidence of HBV infection during HD was 7.5% (20/266). Sero-positive patients were younger with mean age was 51.81±2.76 years, had longer time on dialysis and had previous blood transfusions. Risk factors, which significant associated with hepatitis B infection were history of transfusion (p<0.01; OR: 2.49; 95%CI: 1.29-8.18) and duration of hemodialysis (p < 0.01; OR: 1.07; 95% CI: 1.03-3.74).Conclusion: Patients on maintenance HD in Sanglah General Hospital have a high incidence of HBV infection. The factors associated with HBV infection are highly suggestive of nosocomial transmission within HD units. History of transfusion and duration of hemodialysis were significant risk factors for HBV infection in patients receiving maintenance HD
The Association between Metaplasia and Gastric Malignancy with Helicobater pylori Infection
Full text linkBackground: Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer disease, gastric mucosa metaplasia, and gastric malignancy. The hypothesis of this study is whether there’s an association between metaplasia and gastric malignancy with H. pylori infection.Method: We conducted a retrospective study on 1.127 dyspepsia subjects who performed endoscopy between 2001 to 2011 at a hospital in North Jakarta. Data is obtained based on endoscopy and histopathology data. Investigation of H. pylori in this study using histopathology examination.Results: Of the 1.127 dyspepsia subjects who performed endoscopy and biopsy, there were 130 (11,54%) H. pylori-positive subjects. Gender proportion was composed of 55,37% men and 44,63% women, with median age was 47 years. On the histopathology examination, we obtained 45 metaplasia subjects with median age of 45 years and 7 malignancy subjects with median age of 64 years. Metaplasia was found in 33 of 997 (3,31%) H. pylori-negative subjects and 12 of 130 (9.23%) H. pylori-positive subjects. All gastric malignancy subjects had H. pylori-negative results.Conclusion: There was an association between metaplasia and H. pylori infection, but no association between gastric malignancy and H. pylori infection