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All Journal journal of internal medicine E-Jurnal Medika Udayana Universa Medicina Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran MEDICINUS The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
I Ketut Mariadi
Division Of Gastroenterology And Hepatology, Department Of Internal Medicine, Udayana University/Sanglah General Hospital, Bali
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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C-Reactive Protein and Interleukin-6 Correlated with Resistin Level in Liver Cirrhosis I Ketut Mariadi; Hendra Koncoro; I Dewa Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 1 (2020): VOLUME 21, NUMBER 1, April 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (136.339 KB) | DOI: 10.24871/211202017-21

Abstract

Background: The incidence of insulin resistance is very high in liver cirrhosis. Resistin is thought to be one of the factors contributing to the occurrence of insulin resistance. Liver Cirrhosis is a chronic inflammatory condition. C-reactive protein (CRP) and interleukin-6 (IL-6) are inflammatory mediators, which are associated with the severity of liver damage. Resistin also increases in liver cirrhosis. This study aimed to determine whether CRP and IL-6 levels were correlated with resistin levels in patients with liver cirrhosis.Method: An analytic cross-sectional study was conducted, in cirrhosis patients, to determine CRP and IL-6 levels as markers of the inflammatory process and blood resistin levels.Results: In this study was found, CRP and IL-6 levels were associated with the severity of liver cirrhosis. Resistin levels are associated with the severity of cirrhosis of the liver. CRP and IL-6 levels are positively correlated with resistin levels and as independent predictors of resistin levels.Conclusion: This study concluded that CRP and IL-26 levels are correlated with resistin levels and as independent predictors of resistin levels in liver cirrhosis patients.
FAKTOR RISIKO DAN GAMBARAN ESOFAGOGASTRODUODENOSKOPI PENGGUNA OBAT ANTI INFLAMASI NON-STEROID DI RSUP SANGLAH TAHUN 2016-2018 Magat, Renaldy Frederich Nathanael; Wibawa, I Dewa Nyoman; Somayana, Gde; Mariadi, I Ketut
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i01.P07

Abstract

The use of non-stereoidal anti-inflammatory drugs (NSAIDs) for a certain time and dose can cause abnormalities in the digestive tract ranging from asymptomatic, ulcers, bleeding to perforation. This study aims to determine the distribution of the proportion of patients with abnormality in gastric and duodenal due to NSAIDs based on esophagogastroduodenoscopy (EGD) results, age, gender, H. Pylori infection, type of NSAIDs, history of smoking, history of anticoagulants, history of corticosteroids and risk factors for EGD abnormalities in the gastric and duodenal due to NSAIDs use at Sanglah General Hospital in 2016-2018. This study is a retrospective cross-sectional study based on the medical records of patients who underwent endoscopy at Sanglah General Hospital in 2016-2018. The sampling technique was total sampling, then all data were analyzed using bivariate analysis of the chi-square test and multivariate logistic regression analysis. From 92 patients who met the criteria, men (54.3%) and women (45.7%) with the majority of the age group ³ 60 years (95.7%), EGD abnormalities were obtained in the form of superficial gastritis (33.7%), erosival gastritis (28.3%), gastric ulcer (28.3%), duodenal ulcer (5.4%). With ulcer characteristic are Forrest III (90.3%) and single (74.2%). The majority of patients used non-selective NSAIDs (94.5%), namely ketorolac 30 mg (40.2%). From the biopsy examination, the patient had H. pylori infection (20.5%). Based on medical records, the patients had a history of smoking (59.8%). Patients also found a history of use of anticoagulants (16.3%) and corticosteroids (35.9%). In this study, there was a significant relationship between H. pylori infection and severe EGD abnormalities in NSAID users (P = 0.012). In this study, there were no independent risk factors for severe EGD abnormalities in NSAID users, but there was a significant relationship between H. pylori infection and severe EGD abnormalities in NSAID users Keywords : NSAIDs, EGD, EGD abnormalities in NSAIDs user.
Renal Safety of Tenofovir Alafenamide versus Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B Patients: An Evidence-based Case Report Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024368

Abstract

ABSTRACTBackground: Treatment modalities for chronic hepatitis B infection (CHB) are interferon and antiviral. The most commonly used antiviral is tenofovir disoproxil fumarate (TDF), however it is known to have nephrotoxicity. Recently, a new antiviral tenofovir alafenamide (TAF) has been developed, which also inhibits hepatitis B virus (HBV). This study aimed to compare the renal safety of TAF and TDF.Method: Literature searching was conducted in PubMed/Medline and Cochrane databases, with modified keywords as “chronic hepatitis B”, “tenofovir alafenamide”, “tenofovir disoproxil fumarate”, “renal” with BOOLEAN logic. The articles obtained will be selected and will be carried out for critical appraisal about validity, importance, and applicability.Results: Four studies of double-blind randomized-clinical trials (RCT) were obtained for analysis. The antiviral effects of TAF and TDF groups were not significantly different. The increase in serum creatinine of TAF group was significantly smaller than TDF group in three studies (p 0.05). While one study showed no significant difference (p = 0.32). The decrease in eGFR (estimated-Glomerular Filtration Rate) in the TAF group was smaller than TDF in three studies (p 0.001), whereas one study found an increase in eGFR in the TAF group (p = 0.00034). There were no severe side effects found in both study groups.Conclusion: Based on the scientific evidence obtained, TAF has more renal safety than TDF. Although the antiviral effect is not significantly different.  Keywords: chronic hepatitis B, tenofovir alafenamide, tenofovir disoproxil fumarate, renal function
Severity of Liver Injury and Its Relation to Clinical Outcome and Duration of Hospitalization in COVID 19 Patients Kumbara, Cokorde Istri Yuliandari Krisnawardani; Mariadi, I Ketut; Somayana, Gde; Wibawa, I Dewa Nyoman; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202447-52

Abstract

Background: Coronavirus Disease 2019 (COVID-19) can affect not only the respiratory system but also other organs such as the liver. Liver injury tends to occur in severe disease of COVID-19 patients and might contribute to clinical outcomes for patients. This study aimed to find the relationship between the severity of liver injury with clinical outcome and duration of hospitalizations.Methods: This study was a retrospective study of hospitalized COVID-19 patients period April 2020 to April 2021. The inclusion criteria were severe COVID-19 patients who developed a liver injury. The severity of the liver injury was classified into mild, moderate, and severe. The relationship between the severity of liver injury with clinical outcome and duration of hospitalization was analyzed. Univariate and logistic regression were used. Results: 90 samples fill the inclusion criteria. The liver injury severity was statistically significantly related to clinical outcome patients (p= 0.047), which is the increase in liver injury severity resulting in poor clinical outcomes. No significant relationship was found between the severity of liver injury with the duration of hospitalization.Conclusion: liver injury increases mortality in severe COVID-19 patients.
Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation Dewi, Ni Nyoman Gita Kharisma; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202427-33

Abstract

BackgroundCirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.Aim of StudyEvaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.MethodWe conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical recordResultOf the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosisConclusionIn addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.
Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia Mariadi, I Ketut; Somayana, Gde; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023235

Abstract

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.
Association Between Bile Reflux and Gastric Mucosal Damage Severity in Patients with Dyspepsia Saturti, Tjokorda Istri Anom; Mariadi, I Ketut; Triyanayasa, I Nyoman; Sindhughosa, Dwijo Anargha; Kuwai, Toshio
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024295

Abstract

Background: Bile acid reflux stands out as a notable risk factor for dyspepsia. Among patients with bile acid reflux, common endoscopic findings include mucosal erythema, the presence of bile acid on the mucosa, erosions, hyperrugosity, and gastric mucosal atrophy. This study aims to elucidate the association between bile acid levels in gastric fluid and the degree of gastric mucosal damage.Methods: This cross-sectional study involved dyspeptic patients who underwent endoscopic examination at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital. Bile acid analysis was conducted through the enzymatic calorimetric method, while assessment of mucosal damage relied on the Lanza score, evaluated independently by two observers. Mucosal damage severity was categorized as either mild (score 0-2) or severe (score 3-5). Statistical analyses included Cohen’s kappa for interobserver agreement, bivariate analysis, and logistic regression.Results: Of the 99 subjects involved in the study, 58.6% were male. H. pylori antibodies were detected in 21% of the participants, while 48% exhibited a pH below 2.77. Additionally, 48% reported a history of NSAID consumption. The mean bile acid level in gastric fluid was 156.07 μmol/L, with a median of 170.09 μmol/L (categorized as high if ≥ 170.09 μmol/L, and low if 170.09 μmol/L). During endoscopic examination, mild mucosal damage was observed in 61%, and severe damage in 39% (kappa 1, P 0.001). A statistically significant relationship between gastric f luid bile acid levels and mucosal damage was evident (P 0.05).Conclusion: This study concludes that there was a relationship between the level of bile acid in gastric fluid and the degree of mucosal damage.
Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis Pamungkas, Kadek Mercu Narapati; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Luh Putu Yunia; Dewi, Ni Nyoman Gita Kharisma; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.313-320

Abstract

BackgroundDespite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. MethodsThis retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. ResultsA low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
 Hepatic Encephalopathy in a Postpartum Patient with Chronic Hepatitis B: A Case Report  Priska Harsanti Devi; I Ketut Mariadi
MEDICINUS Vol. 39 No. 2: MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/7n0pqt23

Abstract

Decompensated liver cirrhosis in the postpartum period is rarely reported, particularly in association with chronic hepatitisvB infection. We presented the case of a 33-year-old woman who developed decreased level of consciousness one day afterdelivery. She had no prior history of chronic illness, although her father had passed away from complications of hepatitisvB. Clinical findings included jaundice, ascites, and hepatic encephalopathy. Laboratory results revealed reactive HBsAg, hypoalbuminemia, elevated liver enzymes, hyponatremia, hypokalemia, and markedly elevated total bilirubin. Abdominalultrasound demonstrated cirrhosis with splenomegaly and ascites. The patient was diagnosed with Child-Turcotte-Pughclass C cirrhosis with grade II ascites, grade II hepatic encephalopathy, chronic hepatitis B, and esophageal varices. She received supportive treatment including lactulose, albumin transfusion, and antiviral therapy with tenofovir, resulting inclinical and biochemical improvement after one month. This case highlighted the importance of early screening for hepatitis B during pregnancy to prevent potentially fatal postpartum hepatic decompensation.
"Steakhouse Syndrome" pada Pasien Dewasa di RSUP Prof. dr. I.G.N.G. Ngoerah, Denpasar Ni Made Ayu Dwipayanti; I Ketut Mariadi
MEDICINUS Vol. 39 No. 3 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/tvmwhd73

Abstract

Esophageal obstruction by foreign body is a common emergency condition, third rank after upper and lower gastrointestinal bleeding. This condition may be life-threatening, depending on the type of ingested object, the location of the obstruction, the patient’s condition, and the time interval from the incident until the treatment is given. The annual incidence has been reported to be 13 per 100,000 of the general population. We report the case of a 30-year-old female patient who presented with difficulty swallowing for two days prior to hospital admission after eating beef steak. This complaint was accompanied by chest pain and a burning sensation. Examination revealed a patent airway, with no complications such as hematemesisor abnormal breath sounds. Upper gastrointestinal endoscopy showed a food blockage (a mass of insufficiently chewed steak) in the esophagus, located 20 cm from the teeth, with erosion of the surrounding mucosa. This location is consistentwith previous studies showing that, in adults, about 68% of obstructions occur in the distal esophagus, between the aortic arch and the lower esophageal sphincter (LES). In this case, no medications were administered to relax the smooth muscles of the LES. The steak was pushed from the esophagus into the stomach using endoscopy. The obstruction was successfully removed, and the patient’s symptoms resolved. In conclusion, the patient’s symptoms were caused by an acute steak mass, known as “steakhouse syndrome”.
Co-Authors Cokorda Agung Wahyu Purnamasidhi Derryl Ravertio Timothy Subroto Dewa Gde Agung Budiyasa Dewa Gde Agung Budiyasa Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Putu Itta Sandi Lesmana Dwijo Anargha Sindhughosa, Dwijo Anargha Gde Somayana Godfried Erycesar Yeremia Saragih Hendra Koncoro Hendra Koncoro Hendra Koncoro I Dewa Nyoman Wibawa I Gusti Agung Suryadarma I Nyoman Astika I Wayan Surya Ardiana Ida Ayu T risha Kundalini Ida Bagus Nyoman Wibawa IDN Wibawa Itta Sandi Lesmana Dewi Jemi Tubung Jessica Raphaela Pranata Kadek Mercu Narapati Pamungkas Kumbara, Cokorde Istri Yuliandari Krisnawardani Kuwai, Toshio Made Wardhana Magat, Renaldy Frederich Nathanael Mirdania, Yaditta N Purwadi Ni Made Ayu Dwipayanti Nyoman Purwadi Pamungkas, Kadek Mercu Narapati Pande Ketut Kurniari Prasenah Subramaniam Priska Harsanti Devi Putu Prathiwi Primadharsini Saturti, Tjokorda Istri Anom Triyanayasa, I Nyoman Tubung, Jemi Wayan Arlis Saputra Wibawa, Ida Bagus Nyoman Wira Gotera Yaditta Mirdania Yenny Kandarini Yuna Ariawan