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Inflammatory bowel disease in Indonesian children Badriul Hegar; Yovita Ananta; Diah Rini
Paediatrica Indonesiana Vol 47 No 6 (2007): November 2007
Publisher : Indonesian Pediatric Society

Inflammatory bowel disease (IBD) is a term usedto describe two disorders associated withgastrointestinal inflammation: Crohnâ€™s disease(CD) and ulcerative colitis (UC). The incidenceof IBD is higher in developed countries, while there isunpublished data of pediatric IBD in Indonesia.Clinical manifestations of IBD vary, consist ofgastrointestinal (such as diarrhea and abdominal pain)and extraintestinal manifestations. Definite diagnosisof IBD is based on endoscopy and histopathology. Themanagement includes pharmacotherapy, nutrition,surgery, and psychotherapy. This disorder has a highrecurrence rate, where CDâ€™s recurrence rate is higherthan UC.1,2

Gastroesophageal reflux in children with chronic recurrent cough Mardjanis Said; Rianita Syamsu; Taralan Tambunan; Badriul Hegar
Paediatrica Indonesiana Vol 44 No 5 (2004): September 2004
Publisher : Indonesian Pediatric Society

Background Gastroesophageal reflux (GER) is reported to beone of the most common causes of chronic recurrent cough (CRC).In Indonesia, so far there is no published data concerning GER inchildren with CRC.Objectives To determine the prevalence of GER in children withCRC in general, and asthma in particular; and to describe the clini-cal profile associated with GER in these children.Methods This was a cross sectional study on children with CRCwho were investigated for GER using 24-hour esophageal pHmonitoring. GER was graded based on reflux index (RI) stated inpHmetry results i.e., mild (RI=5-10%), moderate (RI>10-20%), andsevere (RI>20%).Results Among 48 children with CRC, GER was detected in 22(46%) of them (mild GER in 14, moderate in 3, and severe in 5children). In 35 children with asthma, which is the most frequentcause of CRC in our hospital, GER was detected in 15. The preva-lence of GER increased parallel with the frequency of cough epi-sodes i.e., 10/27 in children with infrequent episodes of cough, 4/10 in children with frequent episodes of cough, and 8/11 in chil-dren with persistent cough. Clinical profiles associated with GERin these children were persistent/ frequent episodes of CRC andundernutrition.Conclusions The prevalence of GER in children with CRC was46%, and in those with asthma was 15/35. The clinical profilesassociated with GER are persistent/frequent episodes of CRCand undernutrition

Lactose malabsorption in junior high school children Aswitha D. Budiarso; Deny Sofia; Sri Rezeki S Hadinegoro; Badriul Hegar
Paediatrica Indonesiana Vol 43 No 2 (2003): March 2003
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi43.2.2003.46-50

Background The prevalence of lactose malabsorption varieswidely throughout the world. Only people of Caucasian geneticbackground continue to produce high amount of lactase throughoutadulthood. Previous studies in Indonesia revealed that theprevalence of lactose malabsorption was 21-58% in children aged3-11 years.Objective To determine the prevalence of lactose malabsorptionin the older age group and whether a change in milk drinking habitcan affect it.Methods A cross sectional descriptive study was conducted on98 children aged between 12 and 14 years (junior high school) inJakarta. Lactose malabsorption was evaluated with LactometerBreath Hydrogen Test (Hoek Loes, Amsterdam). Milk drinking habitwas recorded, and drinking at least 1 glass of milk everyday since6 months or more before the study was considered as regular milkdrinking.Results This study showed 73% of the children had lactose malabsorption.Regular milk drinking habit was found in 32 (33%) childrenand lactose malabsorption occurred in 26. From 66 childrenwho were irregular milk drinkers, lactose malabsorption was foundin 46 (70%). Lactose intolerance was about the same in both groups.Conclusion There was an increasing prevalence of lactose malabsorptionin older children. Milk drinking habit is a major concernto review the practical implications of lactose malabsorption.

Irritable bowel syndrome and its associated factors in adolescents Lara Fillekes; Ari Prayogo; Fatima Safira Alatas; Badriul Hegar
Paediatrica Indonesiana Vol 54 No 6 (2014): November 2014
Publisher : Indonesian Pediatric Society

Background Irritable bowel syndrome (IBS) is a commonfunctional gastrointestinal disorder. Increasing prevalences havebeen reported in Asian adolescent populations, however, therehave been few reports on Indonesian adolescents.Objective To investigate the prevalence of IBS and associatedfactors among adolescents in Jakarta.Methods This cross-sectional study included senior high schoolstudents in a district of Jakarta. Students were asked to fillquestionnaires based on the Rome III criteria for IBS. They werethen divided into groups: those with IBS and those without IBS,for the purposes of comparison.Results Out of 232 adolescents (145 females and 87 males) withmean age of 16.06 (SD 0.91) years, 14 (6.0%) had IBS. Elevenout of 14 adolescents with IBS reported upper abdominal painas well as periumbilical/lower abdominal pain. Irritable bowelsyndrome was not associated with socioeconomic status, food anddrink habits, the use of antibiotics, or scolding as a parental formof discipline. However, a significant higher proportion in the useof corporal punishment was found in IBS adolescents comparedto the non-IBS (P=0.034). In addition, stress related to scolding,as a parental form of discipline was more likely to be found in theIBS group than in the non-IBS group (P=0.019).Conclusion The prevalence of IBS among adolescents in Jakartais 6%, which is lower compared to those of other Asian countries.Corporal punishment at home and stress related to scolding athome are found to be associated with IBS.

Upper Gastrointestinal Endoscopy and Histopathology Appearance in Indonesian Children with Recurrent Epigastric Pain F M Susanto; Badriul Hegar; Agus Firmansyah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 3, December 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/83200767-70

Background: Recurrent Epigastric Pain (REP) is a clinical symptom frequently found in children. Data of the correlation between duration of illness, frequency of illness, associated symptoms of REP and the abnormality of endoscopic and histopathologic appearance are still limited, especially in Indonesia. The role of Helicobacter pylori (H. pylori) infection in causing organic abnormalities of the gastrointestinal tract (GIT) is also still controversial. Aim:To know the endoscopic and histopathologic appearance and the prevalence of Helicobacter pylori infection, 169 children with REP was performed for endoscopic and histopathologic examination in Department of Pediatric, Cipto Mangunkusumo hospital. Result:Endoscopic and histopathologic abnormalities were found significantly in children who suffered from REP more than 9 months and more than 6 times during 3 months of period. Conclusion: Endoscopic and histopathologic examinations should be considered in children with REP. Keywords: recurrent abdominal pain, epigastric pain, Helicobacter pylori, endoscopy and histopathology

Helicobacter pylori Infection in Children with Recurrent Abdominal Pain Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2220011-4

Recurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAP. Typically, the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H. pylori infection in Indonesian children with RAP. The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAP. Mucosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27.7%. Histologic evidence of gastritis was present in 94.1% children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegative’s children were found to be H. pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be performed for a longer time of period to clarify this issue. Keywords: H. pylori infection, IgG antibody to H. pylori, upper GI endoscopy, RAP, recurrent abdominal pain

Biliary Atresia in Infants with Cholestasis Budi Purnomo; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 3, December 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Cholestasis is a pathological condition due to impaired secretion and excretion of bile into the duodenum. The etiology should be found within golden period age ( 10 weeks of life) in order to get better outcome. Biliary atresia is characterized by total obstruction of extrahepatic biliary system. The cause is unknown. The only effective treatment is Kasai procedure, which should be done at 8 weeks age or less. The aim of this study was to observe the pattern of cholestasis cases in infants. Method: A descriptive study was conducted on 63 patients with cholestasis at the Harapan Kita Woman and Children Hospital, Jakarta between January 2008 and December 2009. Data was obtained from the computerized medical record database system. Statistical analysis was performed using SPSS program. Results: There were 63 infants, include of 40 (63.5%) boys. Age at admission were 80.2 (30-207) days. The laboratory findings included mean serum levels of hemoglobin 8.9 g/dL, conjugated bilirubin 12 mg/dL, alanine transaminase 149 u/L, aspartate transaminase 236 u/L, alkaline phospatase 582 u/L and gamma-glutamyl transpeptidase level 326 u/L. Biliary atresia was diagnosed in 8 (12.7%) infants by abdominal ultrasonography examination, cholangiography and liver biopsy. Kasai procedure (portoenterostomy) was performed to all those infants. Two of those infants died. Conclusion: Cholestasis has become one of the most common problem found in infants. Biliary atresia should always be considered as one of the cause, since early diagnosis and immediate treatment are needed to provide a good outcome. Keywords: cholestasis, biliary atresia, Kasai procedure

Zinc Supplementation in Children with Acute Diarrhea of Invasive Bacterial and Non-bacterial Infection Endang Poerwati; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 2, August 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Diarrhea is one of the manifestations of gastrointestinal disorder. In Indonesia, diarrhea is still one of the leading causes of death in infants and children. Diarrhea requires a rational and comprehensive management to deliver an optimal result. This study was aimed to assess the effectiveness of zinc supplementation in children with acute diarrhea of invasive bacterial infection. Method: A cross-sectional study was performed in 74 children aged 2-14 years with acute diarrhea, who visited the Outpatient Clinic, Pasar Rebo Hospital Jakarta, between January and June 2011. The inclusion criteria were patients had suffered diarrhea for 1-7 days. Based on fecal analysis Results, subjects were divided into group A (non-infectious) and group B (infectious). All children received zinc supplementation. Results: The mean value of subject age was 46.6 months in group A and 81.3 months in group B. The mean frequency of diarrhea prior to zinc supplementation was 7.5 times/day in group A and 7.8 times/day in group B. Duration of diarrhea before zinc supplementation was 52.6 hours in group A and 45.4 hours in group B. On the seventh day, there was no subject of both groups who still suffered from diarrhea. Although the duration of diarrhea in group A was shorter than group B, no significant difference was found (62.4 hours vs 66.8 hours, p = 0.07). Conclusion: Zinc supplementation shows similar efficacy in children with acute diarrhea caused by invasive bacterial infection and those without bacterial infection as well. Keywords: acute diarrhea, invasive diarrhea, zinc supplementation

Proton Pump Inhibitors Therapy in Children with Gastroesophageal Reflux Aldo Reynaldo; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Proton pump inhibitors (PPI) has been widely used by clinicians to treat diseases that require suppression of gastric acid. PPI work by inhibiting the proton pump in gastric parietal cells.In adult patients, PPI hasbeen widely studied and showed effective results and safe. This result make PPI positioning as the first choice medicine in the treatment of diseases that require suppression of gastric acid. As the primary choice therapy, PPI administration has been increased not only in adults but also in children.PPI is often administered to children with a diagnosis of gastroesophageal reflux disease (GERD) which defined as symptoms or complications caused by gastroesophageal reflux (GER). GERD diagnosis in children is quite difficult, so it is common to find that diagnosis is established only by the basis of clinical symptoms, resulting in overdiagnosis and over-treatment of GERD. The use of PPI in children still needs further study andcan not be inferred based on adult studies. Inappropropriate PPI prescription without indication will increase side effect, risk and also harm the children. Thus, it is important to know the indications, side effects and safety of PPI therapy in children.Keywords: proton pump inhibitor, children, gastroesophageal reflux disease

Microscopic Examination of Fecal Leukocytes as a Simple Method to Detect Infective Colitis in Children Nuraini I Susanti; Reynaldo Reynaldo; Aria Kekalih; Anis Karuniawati; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, AUGUST 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Various pathogenic bacteria are reported as the cause of infectious colitis in children. Infectious colitis does not have a specific sign, therefore an accurate examination is required. The implementation of fecal cultures accompanied with drug resistance tests often have constraints, beside the relatively expensive costs, longer times are needed, and not all health care facilities have required instruments. On the other hand, this condition requires an immediate antibiotic therapy, so that the infection should not be continued. In daily practice, it is not uncommon to find diarrhea with the amount of fecal leukocyte 10/hpf with pathogenic bacteria on the examination of the fecal culture.Method: Cross-sectional study was conducted to observe the pattern of bacterial distribution in children’s fecal who have acute diarrhea and the correlation between the existence of pathogenic bacteria and the number of leukocytes in the fecal, as well as antibiotic resistance patterns. The population of this study is children with age of 6 months old - 18 years old who were suffering from acute diarrhea with the amount of fecal leucocyte ≥ 5/hpf, who recruited from polyclinic or patient admitted at Cipto Mangunkusumo Hospital and Fatmawati General Hospital, Jakarta.Results: Based on examinations of fecal cultures and PCR, Salmonella sp and C. dificille were found subsequently in 2 children (33.3%), Enterophatogenic E. Coli(EPEC) and Shigella were found subsequently in 1 child (16.7%). Based on the ROC curve, it was found that there was no intersection of maximum and minimal leukocyte value with the midline, whereas the best sensitivity and specificity value was found at the cut-off point of 8.5, hence the cut-off point of leukocytes was determined at 8 and 8. The sensitivity value was 83.3% and the specificity value was 45.1%.Conclusion: The antibiotic sensitivity test showed that one child infected by EPEC was sensitive to ciprofloxacin. Two children infected by Salmonella, were still sensitive to chloramphenicol, cotrimoxazole, cefixime, and ceftriaxone. Two children infected by C. Difficile were sensitive to ceftriaxone, and 1 child infected by Shigella was sensitive to cefixime, ceftriaxone and ciprofloksazine.

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