The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
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Response Evaluation of Patients Undergoing Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma with Respect to Tumour Size, Number of Lesion, and Alpha-Fetoprotein (AFP) Level
Get PDFBackground: Transarterial chemoembolization (TACE) is widely used as a palliative treatment for unresectable hepatocellular carcinoma (HCC). TACE is also used as bridging therapy before liver transplantation to avoid tumour progression and considered for downstaging to fulfill tumour resection or liver transplantation criterias. This study aimed to evaluate response of TACE in unresectable HCC according to changing of tumour size, number of lesion, and AFP level.Method: Retrospectively, we evaluate 69 HCC patients who underwent TACE in Dr. Soetomo General Hospital in January 2012-June 2015, including their age, sex, aetiologies, and Barcelona Clinic Liver Cancer/BCLC staging. Laboratory examinations such as complete blood count (hemoglobin/Hb, leucocyte, thrombocyte), liver function test (aspartate aminotransferase/AST, alanine aminotransferase/ALT, bilirubin, albumin, international normalized ratio/INR), alpha-fetoprotein/AFP level, and abdominal CT-scan were performed before and 1 month post-TACE. Data was analysed using paired t-test.Results: 69 patients with mean age of 51.81 ± 12.8 years old, predominantly 76.8% males, the most common aetiology was hepatitis B 68.1%, 92.8% BCLC B, 64.3% with stable disease, none achieved complete response, 97.1% had tumour size > 5 cm, 69.6% had single tumour, and 55.7% had AFP level >1000 ng/mL. There was a significant increase in tumour size and number of lesions in 1 month post-TACE that were approximately 1.76 cm and 2.33, respectively, and there was no significant difference between AFP level before and 1 month post TACE.Conclusion: In 1 month post TACE evaluation, there was a significant increase of tumour size and number of lesion, but there was no significant alteration in AFP level. TACE might be performed repeatedly with shorter evaluation interval than 1 month to achieve better response
Dyspepsia and Depression, Anxiety, Stress Scales (DASS) Score
Get PDFBackground: Dyspepsia is a constellation of symptoms referable to the gastroduodenal region of the upper gastrointestinal tract. Emotional disturbances are often associated with dyspepsia and have been proposed as one of the possible causes of dyspepsia. This study was aimed to evaluate the difference between the severity of dyspepsia using porto alegre dyspeptic symptoms questionnaire (PADYQ) and emotional disturbances using depression, anxiety, stress scales (DASS).Method: This study was a cross-sectional analytical study. All the subjects were evaluated using PADYQ and DASS. PADYQ is classified into four categories (no, mild, moderate and severe dyspepsia symptoms). Data was analyzed using Independent t-test and Mann-Whitney test. A p < 0.05 was considered as statistically significant.Results: There were 90 subjects that enrolled in this study, consisted of 47 (52.2%) males and 43 (47.8%) females. Thirty three (36.7%) subjects had PADYQ score was < 6, while it was ≥ 6 in the other 57 (63.3%) subjects. DASS scores were significantly different in subjects without dyspepsia symptoms compared to subjects with dyspepsia symptoms. There is a difference in DASS scores between subjects with different categories of dyspepsia symptoms (p < 0.05). Conclusion: There was a difference in the severity of emotional disturbances among subjects with dyspepsia symptoms and without dyspepsia symptoms. The severity of emotional disturbances parallel with the severity of dyspepsia. Evaluation of emotional disturbances in case of dyspepsia will be helpful in the management of dyspepsia
The Prevalence, Profile, and Risk Factor of Patients with Ulcerative Colitis at Dr. Saiful Anwar Malang General Hospital
Get PDFBackground: The prevalence ulcerative colitis (UC) in RSCM Jakarta in 1991-1995 is 2.5%. The disease affects men and women at similar rates or slightly more common in women than in men. Age of onset follows a bimodal pattern, with a peak at 15-25 years and a smaller one at 55-65 years, although the disease can occur in people of any age. The precise etiology of UC is not well understood. UC is precipitated by a complex interaction of environmental (cigarretes, diet, non-steroidal anti-inflammatory drug/NSAID, etc), genetic, and immunoregulatory factors. This study aimed to identify the prevalence, profile and risk factor of ulcerative colitis in Dr. Saiful Anwar General Hospital Malang.Method: This is a retrospective survey analysis from medical record which was taken from 2170 patients who underwent colonoscopy in Dr. Saiful Anwar General Hospital Malang from January 2010 to December 2014. Demographic setting (sex, age), clinical features, lifestyle, diagnosis based on colonoscopy were analyzed as the variables.Results: Total patients with UC was 176 patients. The prevalence of UC during 2010-2014 was 8.2% at Dr. Saiful Anwar General Hospital. There was a similar prevalence of sex between male and female patients, in which 95 (53.4%) were male and 81 (46.6%) were female. The average age of patients with UC was 41,6 years. Most patients were presented with abdominal pain (32.90%) and weight loss (42.1%). The diagnosis based on colonoscopy were pancolitis (36%), proctosigmoiditis/proctitis (31.81%), and left-sided colitis (21.9%). The risk factors of UC identified in this study were current smoker, use of NSAIDs/traditional herbs/potion and fiber diet. Majority of ulcerative colitis study samples were non-smoker (75%), not consuming herbal treatment/NSAID (60.22%), and rarely consuming fiber (36.93%). There is a significan correlation between frequency of fiber diet and UC (r = -0.106, p = 0.000).Conclusion: The prevalence of UC was 8.2% in our hospital with men and women were equally affected, and average age was 41.6 years. Patients presented with various clinical symptoms, most are abdominal pain and weight loss. The most frequent diagnosis were pancolitis, proctosigmoiditis/proctitis, and leftside colitis. There is a significant correlation between frequency of fiber diet and UC (r = -0.106, p = 0.000).Keywords : ulcerative colitis, prevalence, profile, risk factor
Achalasia: A Review of Etiology, Pathophysiology, and Treatment
Get PDFAchalasia was a condition marked by peristaltic movement absent in lower esophageal sphincter and segment that hypertonic result in imperfect relaxation during food ingestion. Achalasia incidence did not differ between men and women, account for 1 in 100.000 people every year with prevalence of 10 in 100.000 people, unrelated specifically with ethnic, and has its highest incidence on 30-60 age group.Based on its etiology, it was divided into primary and secondary Achalasia, while based on its motility, it was into hypermotil, hypomotil, and amotil Achalasia. Until present, several therapeutic modalities were available to treat Achalasia, among them was pharmacology therapy, botulinum toxin injection via endoscopy, pneumatic dilatation, Heller myotomy surgery, and Per Oral Endoscopy Myotomy (POEM)
Diagnosis and Treatment of Small Intestinal Bacterial Overgrowth
Get PDFSmall Intestinal Bacterial Overgrowth (SIBO) is a clinical condition, in which excess amounts of bacteria are found in small intestine. SIBO occurred when normal homeostatic mechanism which control enteric bacteria population disrupted. Elderly patients are more vulnerable to SIBO which can be caused by two conditions, which are gastric acid reduction and disproportionately drugs consumption which then caused hypomotility. There are several methods to diagnose SIBO, but diagnose often begin with suspicion and history of risk factors of SIBO. There are two most frequent tests in SIBO diagnostic, which are bacterial culture examination and breath test. Treatments of SIBO are: (1) Treatment of underlying disease and improvement of medical condition; (2) Eradication of excess bacterial growth; (3) Resolve nutritional deficiencies which related to SIBO
Gastroesophageal Reflux Disease Questionnaire (GerdQ) is an Easy and Useful Tool for Assessing GERD
No full textMolecular Diagnostics in Colorectal Cancer
Get PDFColorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% of cases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP,1%), rare CRC syndrome < 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of deoxyribonucleic acid (DNA) mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy
Gastric Mucous Atrophy and Metaplasia in Patient with Helicobacter pylori Infection
No full textBackground: Helicobacter pylori (H. pylori) is one of the most common bacteria found in human and cause chronic infection. Recent study conducted in one of private hospitals in Jakarta shows that there is a trend of declining prevalance of H. pylori from 12.5% in 1998 to 2.9% in 2005. The aim of this study is to obtain` the prevalance of gastric atrophy and metaplasia in patients with H. pylori infection based on histopathology.Method: This was a case control study between June to August 2014 with 69 cases and 71 controls using medical records datas and histopathology results. Control sample was taken consecutively from patient undergone esophagogastroduodenoscopy procedure in 2013.Results: The average age for patient with H. pylori was 51 years slightly higher than patient with negative H. pylori (p > 0.05). Generally, the prevalence rate among males was slightly lower than females (p > 0.05). From Histopathology findings, active chronic gastritis was found in 62.3% patients with positive H. pylori than only 12.7% in patient with negative H. pylori (95% CI = 4.86-26.7; OR = 11.31). Mild and moderate atrophy was higher among H. pylori positive (p = 0.09). gastric mucous metaplasia was also higher (10% vs. 1.4%) among positive H. pylori patient (p = 0.03).Conclusion: H. pylori infection can cause atrophy and metaplasia in gastric mucosa. Prevalence of gastric metaplasia caused by H. pylori infection is lower in this study compared to the same study abroad
Correlation Between Serum Thrombopoietin Level and Cirrhosis Clinical Stage in Liver Cirrhosis Patients in Mohammad Hoesin Palembang Hospital and Palembang BARI Hospital
No full textBackground: Thrombopoietin (TPO) is a cytokine mainly produced in the liver that regulate humoral control mechanism of thrombopoesis. Presumably, TPO production is decrease in patients with liver cirrhosis which interfere platelet production. The aim of this study was to identify the correlation between serum TPO levels and the clinical stage of liver cirrhosis.Method: With analytical cross sectional design, this sudy analyzed the correlation between the serum TPO level and the clinical stage of liver cirrhosis according to Child-Pugh classification in 32 liver cirrhosis patients and 30 healthy subjects from March 2015 to August 2015. The serum level of TPO was examined using the Quantikine human TPO immunoassay.Results: There were 13 females and 19 males patients aged 19 to 67 years old. Serum TPO level were lower in patients with liver cirrhosis (65.65 ± 28.97 pg/mL) than in healthy subjects (98.16 ± 41.25 pg/mL, p < 0.005). Serum TPO levels were negatively correlated with clinical stage of liver cirrhosis in a moderate strength of correlation (r = -0.516, p = 0.002). There were no correlation between serum TPO level and platelet count (r = 0.186; p = 0.309), but a significant negative correlation between the clinical stage of liver cirrhosis and platelet counts (r = - 0.361; p = 0.042).Conclusion: There was a significant negative correlation between serum TPO levels and the clinical stage of liver cirrhosis according to Child-Pugh classification