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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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Pendekatan Diagnosis pada Pasien dengan Primary Sclerosing Cholangitis (PSC): Sebuah Laporan Kasus I Putu Aris Govindha Putra; I Ketut Mariadi
MEDICINUS Vol. 39 No. 5 (2026): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/pznw5k98

Abstract

Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disorder of unknown etiology, characterized by inflammation, fibrosis, and narrowing of the intrahepatic and/or extrahepatic bile ducts. The discovery of commonclinical manifestations of cholestasis, whose etiology is difficult to determine, makes PSC cases a challenge for clinicians. We reported the case of a 20-year-old female who presented with the chief complaint of jaundice lasting 6 months.Symptoms included pruritus, tea-colored urine, pale stools, decreased appetite and body weight, and the appearance of bruising without trauma. The patient underwent several examinations, including laboratory tests, ultrasound, CT scan,and magnetic resonance cholangiopancreatography (MRCP), which showed a blockage and narrowing of the bile ducts. The first endoscopic retrograde cholangiopancreatography (ERCP) included biliary stent placement, but the complaints persisted, so a repeat ERCP was performed, revealing a biliary tract stricture. The initial diagnosis was PSC with severe acute cholangitis and coagulopathy. Patient was treated with antibiotics, steroids, and ursodeoxycholic acid (UDCA). In clinical practice, the recognition and confirmation of the diagnosis, as well as the management of PSC remain challenging. This case highlights the importance of early recognition and suspicion as well as comprehensive treatment of PSC to prevent further complications.
Immune Checkpoint Inhibitors (ICI) in the Functional Cure of Hepatitis B: A Narrative Review Putra, I Komang Wisuda Dwija; Mariadi, I Ketut; Somayana, Gde
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202660-69

Abstract

Chronic hepatitis B (CHB) remains a major global health burden, largely due to the persistence of covalently closed circular DNA (cccDNA) within infected hepatocytes, which hinders complete viral eradication despite long-term antiviral therapy. In recent years, immune checkpoint inhibitors (ICIs) have emerged as a potential therapeutic strategy by restoring exhausted antiviral immune responses. This review explores the mechanisms of action of ICIs, their current application in hepatitis B virus (HBV) infection, and their potential role in achieving a functional cure. Available evidence indicates that ICIs targeting programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) are capable of partially restoring HBV-specific T-cell function and reducing intrahepatic cccDNA transcriptional activity. Early-phase clinical studies have demonstrated encouraging outcomes, including declines in hepatitis B surface antigen (HBsAg) levels and occasional HBsAg loss; however, consistent achievement of a functional cure remains limited. Notably, combination strategies involving ICIs with therapeutic vaccines or nucleos(t) ide analogues appear to enhance antiviral efficacy compared with monotherapy. In conclusion, ICIs represent a promising adjunctive approach for CHB treatment and may contribute to the pursuit of a functional cure. Nevertheless, further well-designed clinical trials are required to establish their long-term safety, optimal treatment combinations, and effectiveness, particularly in HBV-endemic populations.
Validation Study of the Cirrhosis Acute Gastrointestinal Bleeding Score as Predictor Mortality in Patients with Liver Cirrhosis and Upper Gastrointestinal Bleeding Mariadi, I Ketut; Hardian, Harris; Alamsyah, Ajib Zaim; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Nyoman Gita Kharisma; Pamungkas, Kadek Mercu Narapati; Somayana, Gde; Wira Nugraha, Komang Agus; Sindhughosa, Dwijo Anargha; bin Abd Rahman, Mohamad Fadli
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202619-26

Abstract

Background: The Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score was developed as a mortality predictor by integrating a range of clinical and laboratory parameters. This research seeks to validate the efficacy of the CAGIB score in predicting in-hospital mortality among cirrhotic patients experiencing upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital.Methods: This study is a prospective observational study employing a validation test approach. A total of 161 patients diagnosed with liver cirrhosis and upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital were enrolled. Receiver Operating Characteristic (ROC) analysis was utilized to evaluate the prognostic capability of the CAGIB score in predicting mortality and to identify the optimal cutoff point. Validation was conducted by assessing the CAGIB score's sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).Results: The analysis of the CAGIB score as a predictor of mortality yielded an area under the curve (AUC) value of 0.83, with the optimal cutoff point determined at ≥ -4.66, based on the point farthest from the diagonal line on the ROC curve. The 95% Confidence Interval (CI) ranged from 0.777 to 0.897. Validation testing of the CAGIB score as a predictor of in-hospital mortality demonstrated a sensitivity of 80.8%, specificity of 70.5%, PPV of 69.4%, and NPV of 81.6%.Conclusion: The CAGIB score has been demonstrated to serve as a valid predictor of mortality, exhibiting commendable sensitivity and specificity, along with satisfactory positive and negative predictive values. The optimal cutoff points appropriately reflect the demographic and clinical characteristics of the cirrhosis patient population with UGIB at Ngoerah Hospital
Co-Authors Alamsyah, Ajib Zaim bin Abd Rahman, Mohamad Fadli 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 Hardian, Harris Hendra Koncoro Hendra Koncoro Hendra Koncoro I Dewa Nyoman Wibawa I Gusti Agung Suryadarma I Nyoman Astika I Putu Aris Govindha Putra 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 Putra, I Komang Wisuda Dwija Putu Prathiwi Primadharsini Saturti, Tjokorda Istri Anom Triyanayasa, I Nyoman Tubung, Jemi Wayan Arlis Saputra Wibawa, Ida Bagus Nyoman Wira Gotera Wira Nugraha, Komang Agus Yaditta Mirdania Yenny Kandarini Yuna Ariawan