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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Syafruddin AR Lelosutan
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Medicine & Pharmacology

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The Role of Gastric Acidity and Lower Esophageal Sphincter Tone on Esophagitis in Patients with Dyspepsia Syafruddin AR Lelosutan; Chudahman Manan; Busjra M. Nur
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 3, December 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2320016-11

Abstract

Background: Esophagitis implies an organic damage of the esophagus due to several pathophysiologic factors, predominantly: (1) degree of gastric acid secretion (gastric pH), whereabouts are rapidly or slowly to be mucosal breaks onto esophagus were under the influenced by: (a) gastric pH £ 4 and (b) the contact of gastric acid into esophageal mucosal. (2) Lower esophageal sphincter (LES) as a important factor for antireflux mechanisms, which antireflux mechanism cannot serve as a barrier system whenever tone of LES comes down until £ 10 mmHg that causes feeble resting LES pressure. Esophageal injuries are recognized endoscopically by the presence of the Savary-Miller’s classification (1985), but there are not definitely which ones principally to pathophysiologic factor.Methods: This was a consecutive non-random sampling cross sectional study. Thirty subject from 127 patients with dyspepsia undergoing elective upper-endoscopic examination with collecting of the gastric juice and biopsies of lower esophageal mucosal, also esophageal manometric examination. Before that, clinical inclusive and exclusive criterias until laboratory examination were performed. Significant interval was 95%. Analyzing data with Fisher’s Exact Test One-Tail to correlate between gastric pH and hypotonic LES into esophagitis. Results: Esophagitis prevalence was 22.8%. Fisher’s Exact Test One-Tail to correlate esophagitis with gastric pH £ 4 was significant (p=0.013798), but with hypotonic LES (tones of LES £ 10 mmHg) was not (p=0.60269). The combined roles of gastric pH and tones of LES into esophagitis are included: (1) Frequency of roles of pH £ 4 and hypotonic LES are 48.2%. (2) Frequency of role of pH £ 4 without hypotonic of LES are 33.3%. (3) Frequency of role of hypotonic LES without pH £ 4 are 11.1% and (4) Frequency of esophagitis without roles of pH £ 4 and hypotonic of LES are 7.4%. Conclusions: The sum of gastric pH £ 4 and hypotonic of LES together are more than each separate factor. Onto statistically was significant between esophagitis and gastric pH, but there is no correlation with tones of LES. So, gastric pH plays a more important role than LES.    Key words: gastric pH, tones of LES, roles of pH and tones of LES, esophagitis
Endoscopic Features of Patients with Bronchial Asthma and Gastroesophageal Reflux Symptoms Syafruddin AR Lelosutan; Agus Dwi Susanto; Ruswhandi M
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 3, December 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/73200667-71

Abstract

Background: Studies evaluating endoscopic results in patients with bronchial asthma and Gastroesophageal Reflux Disease (GERD) in Gatot Soebroto hospital have never been undertaken. It leads an idea to further study, in order to find a more accurate and rapid management as solution for anticipating asthma attack and complications of bronchial asthma to upper gastrointestinal tract. Methods: A retrospective study was aimed to evaluate endoscopic result of upper gastrointestinal tract in bronchial asthma patients who had GERD symptoms as appropriate to the criteria of 4 major GERD symptoms of Talley 2002. Data was collected in one year period starting from November 2004 to October 2005. Results: Subject characteristics in this study indicated that there were more female patients compared to male with a ratio approaching 3:1 who had such symptoms. Mean age was 38.5 years and ratio of body weight to body height indicated normal weight result and the mean value for duration of asthma was 27 years. Clinical symptoms of GERD found in the present study was in accordance with four majors symptoms of GERD i.e. 32 (100.00%) cases of regurgitation, 29 (90.63%) cases for each of heartburn and non-cardiac chest pain symptom, and 7 (21.88%) cases of difficult / painful swallowing or dys/odinophagia. The endoscopic result of upper gastrointestinal tract had figured of: (1) 4 (12.50%) cases of normal esophagus, (2) 11 (34.40%) cases of non-erosive esophagitis known as Non Erosive Reflux Disease (NERD), and (3) erosive esophagitis which regarding to Los Angeles classification: 15 (46.90%) cases of grade A and 2 (6.20%) cases of grade B. Conclusion: The incidence of esophagitis in accordance with LA classification is extremely high although no severe damage (grade C and grade D) was found. Early anticipation of reflux associated respiratory symptoms and anti-reflux treatment should be considered in order to shorten or to discontinue the asthma attack cycle. Keywords: bronchial asthma, GERD, endoscopy, NERD
Do Hepatic Encephalopathy Patients Really Need a Low Protein in Their Diet Untung Sudomo; Syafruddin AR Lelosutan; Ruswhandi Ruswhandi; Nurul Akbar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8 ISSUE 2 August 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/82200753-56

Abstract

Hepatic encephalopathy (HE) is an extra hepatic complication of liver cirrhosis. The clinical manifestation of HE is a reflection of a low-grade cerebral edema due to astrocyte swelling as a consequence of hyperammonia. HE mostly is induced by precipitating factors. Correcting these identifiable precipitating factors can alleviate this complication. In the past, liver cirrhosis patients were recommended to lower their protein intake. It was assumed that by limiting protein intake, the ammonia production would lower, which can lead to HE recovery. This approach, on the other hand, had worsened the nutritional status that already present in most patients with HE. There are some ways to overcome these problems without restricting protein intake including balance diet, using Branch Chain Amino Acids (BCAA), and frequent small portion diet.   Keywords: hepatic encephalopathy, astrocytes swelling, ammonia, liver cirrhosis, BCAA
Co-Authors Agus Dwi Susanto Busjra M. Nur Chudahman Manan Chudahman Manan Nurul Akbar Nurul Akbar Ruswhandi M Ruswhandi Ruswhandi Untung Sudomo