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All Journal Paediatrica Indonesiana The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Badriul Hegar
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Health Professions Medicine & Pharmacology

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Natural Evolution of Regurgitation in Children Aged 12-24 Months: A 1-year Cohort Study Badriul Hegar; Fatima Safra Alatas; Muzal Kadim; Nina Dwi Putri; Wahyu Ika Wardhani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 1, April 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (326.871 KB) | DOI: 10.24871/141201313-18

Abstract

Background: There are very limited cohort studies regarding long term outcome of gastroesophageal reflux diseases (GERD), especially until 24 months old. The aim of this study is to see the natural history of GERD in12-24 months old children based on their clinical signs and symptoms.Method: Prospective one year population base cohort study involving 262 children. Their regurgitation history and GERD symptoms were recorded every two months.Results: Two hundred and  fivety three children completed the study. Seventy three children (27.8%) were still having regurgitation when they were 6 months old, 44 (16.7%) until 9 months old, and 24 (9.2%) until 12months old. During 12 months follow-up the prevalence and frequency of regurgitation decreased to 2.4% and 1.2% in the age of 18 and 24 months respectively. Infant with regurgitation at 6 months old were 13.2 times more likely to have regurgitation at 12 months old (RR = 13.2; 95% CI = 4.8-36.6). Prevalence of regurgitation after 18 months old were 37 times higher risk compared to those not regurgitating at the age of 12 months (RR = 37; 95% CI = 2.2–613.9). GERD symptoms were higher in children that were still regurgitating until 9 months old 64.5% (RR = 2.3; 95% CI = 1.7-3.0) compared to those only experiencing until 6 months old 54.7% (RR = 1.3; 95% CI = 1.7-3.0).Conclusion: Regurgitation decrease during 12-24 months old period. The history of regurgitation in 6 and 9 months old is related to the probability to become GERD in 12-24 months old period. Keywords: gastroesophageal reflux, children 12-24 months, GERD symptoms
Gastric Inflammatory Fibroid Polyp in Children Badriul Hegar; Tatang Puspanjono
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: 10.24871/82200763-66

Abstract

Inflammatory fibroid polyp (IFP) constitutes as a chronic inflammatory lesion that is generally located in the gastric (gastric inflammatory fibroid polyp). The lesion originates from the submucosal tissue of the gastrointestinal tract and progress into a polypoid mass. Inflammatory fibroid polyp is rarely found in children and the cause is not definitely known. A case of a four-year old boy with recurrent paleness for 3 months has been reported. At the beginning, the patient was suspected of haemolytic anaemia. Except the hemoglobin level ( 5 g/dL), other laboratorium examination did not support the working diagnosis. During the last one months period, the patient also complained of recurrent abdominal pain and vomiting. On the abdominal ultrasonography (USG) and endoscopy, a mass that covered most of the gastric lumen was detected. Based on that finding, gastrectomy and mass removal were conducted. The pathologic anatomy examination proved the presence of an inflammatory fibrous polypoid. Follow-up untill 12 months showed no any complaint and abnormalities on endoscopic examination. Since there was no consensus regarding the follow-up period following the procedure, the evaluation of this patient would be conducted every 2-3 years. Keywords: inflammatory fibroid polyp, tumor, gastric, children
Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases Badriul Hegar; Yvan Vandenplas
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 3, December 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (277.402 KB) | DOI: 10.24871/1232011171-178

Abstract

Gastroesophageal reflux is a normal physiologic process occurring in healthy infants. Symptoms due to gastro-esophageal reflux diseases (GERD) are troublesome when they have adverse effects on the well- being of the patient. A thorough history and physical examination is generally sufficient to establish a clinical diagnosis of uncomplicated infant with gastroesophageal reflux. Poor weight gain is a warning sign. Irritability and regurgitation are associated with a wide range of physiologic and pathologic conditions. Heartburn or substernal burning is a reliable indicator for GERD in adolescents. Barrett esophagus does occur in children with severe chronic reflux. GERD is commonly cited as a cause of dysphagia; however, there are no strong pediatric data demonstrating this relationship. An etiologic role for reflux in reactive airways disease, such as asthma, has not been established. No test can determine whether reflux is causing recurrent pneumonia. Data showing the correlation between reflux and upper airway disease is weak, consisting mainly of case descriptions. Sandifer syndrome is an uncommon, but specific manifestation of GERD. Children with cerebral palsy are at particularly high risk of GERD. Similarly, children with certain genetic syndromes such as Cornelia de Lange and Down syndrome are prone to GERD. A higher prevalence of GERD and its complications has been reported in patients with a variety of chronic respiratory disorders including bronchopulmonary dysplasia and cystic fibrosis. GERD treatment is frequently administered to premature infants. However, the true prevalence of GERD is unknown. Keywords: gastroesophageal reflux diseases, infants, children
The Role of Supporting Examinations on the Diagnosis of Chronic Diarrhea in Children Deddy S Putra; Muzal Kadim; Pramita G D; Badriul Hegar; Aswitha Boediharso; Agus Firmansyah
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: 10.24871/82200735-39

Abstract

Background: Etiology of chronic diarrhea can be established through non-invasive examination such as stool examination and stool culture. Colonoscopy is an invasive Method, which is occasionally needed to discover the etiology of chronic diarrhea. Objective: To recognize the characteristics of chronic diarrhea based on stool examination and colonoscopy results. Methods: Descriptive study on patients with chronic diarrhea who came to Cipto Mangunkusumo hospital since 1 June to 31 August 2005. Laboratory tests were conducted in accordance with clinical indication. Data was presented in distribution tables. Results: There were 41 patients with chronic diarrhea. Stool examination were performed only in 38 patients with negative-gram infection (86.8%). Stool cultures were performed in 27 patients with positive results of non-pathogenic Escherichia coli (85.2%). Stool parasite examination and concentration tests were performed in 17 patients, with 47.0% positive results as follow: Microsporidia 29.4%, Blastocystis hominis 11.8% and Giardia lamblia 5.9%. Colonoscopy examinations were performed in 6 patients and all patients indicated ulcerative colitis appearance with 50% histopathological impression of infective colitis. Conclusion: Stool examination in chronic diarrhea primarily indicates positive infection. Bacterial stool culture mostly includes non-pathogenic Escherichia coli, while parasite stool examination largely includes Microsporidia. Biopsy examination tends to reveal infective colitis. Keywords: chronic diarrhea, parasite stool, colonoscopy
Esophagus and Its Function Related to Gastro-esophageal Reflux Badriul Hegar; Aldo Reynaldo; Yvan Vandenplas
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (320.109 KB) | DOI: 10.24871/1332012166-173

Abstract

ABSTRACTThe main function of the esophagus is to transport food from the mouth into stomach. Anatomical structures, innervations and blood supplies are needed in order to transport the food into stomach. Mastication stimulates the parasympathetic nerves that regulate salivary, gastric and pancreatic secretion. Saliva secretion stimulates swallowing and increases primary esophageal peristalsis, helps in clearing the esophagus from refluxed material. Swallowing induces peristaltic of esophagus that propulses a solid bolus down the esophagus into the stomach.      Innervations are important for esophagus to do its function. One of the most important is coordination between the various reflexes. Delayed clearance of acid from the esophageal and decreased pressure of the lower sphincter esophagus (LES) are the major mechanisms involved in the development of esophagitis. The resistance of the mucosa to the noxious effect of the refluxed material (acid, pepsin, chymotrypsin and trypsin, bile, etc.) is different from person to person. The LES pressure is a defense mechanisms to prevent gastro-esophageal reflux disease (GERD). The LES pressure decreases postprandially. The frequency of postprandinal GER is related to the meal size. Gastric bolus feeding is related to greater intragastric pressure causes more of transient LES relaxations. Osmolality and volume of the feeding slow gastric emptying and incrase postprandial GER. The occurrence of GERD is associated with whether or not the preventive factors are functioning. Other preventive factors for GERD are esophageal peristalsis, secretion and mucosal resistance, gravity and position, the LES tone and angle of his. Patient with GERD should be searched for any disturbances on those factors. Keywords: gastroesophageal reflux diseases, lower esophageal sphincter, esophagitis, peristaltic 
Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children Badriul Hegar; Anita Juniatiningsih
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 3, December 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/93200875-77

Abstract

Background: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitoring
Recurrent Abdominal Pain in Children Sulaiman Yusuf; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 2, August 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/72200642-45

Abstract

Recurrent abdominal pain is one of the most common symptoms found in children. Description of abdominal pain is important in determining the etiologic cause. Organic pain must be ruled out first before suspecting psychogenic cause of pain. However, Children and infant are likely having difficulties in describing abdominal pain. Referred pain may lead to misdiagnosis. Alarm symptoms of abdominal pain are important indices and must be recognized. Careful and complete anamnesis and physical examination play critical role in management approach of recurrent abdominal pain in children and determine whether medical therapy only or combination with surgical intervention is considered necessary. Keywords: recurrent abdominal pain, children, alarm symptom
Orocaecal Transit Time in Chronic Diarrhea Marcellus Simadibrata; Paulus Simadibrata; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/63200567-70

Abstract

Background: The diagnosis and treatment of chronic diarrhea is sometimes difficult. Orocaecal transit time may explained some pathogenesis mechanism in chronic diarrhea. Methods: Twenty six chronic diarrhea patients and 35 normal adult subjects were included in this study. After fasting for at least 10 hours, subjects were asked to drink 20 ml (13.3 g) lactulose, then performed the breath hydrogen test. If there were an increment of H2 concentration 10 ppm in ½ -1 hour, the subject was considered as rapid transit time. If an increment of H concentration 10 ppm in 1 - 2 hour, the subject was considered as normal transit time. If an increment of H2 concentration 10 ppm in 2 - 3 hour,the subject was considered as delayed transit timeResults: In the chronic diarrhea group, 10 (38.4%) had rapid OCTT, 15 (57.6%) had normal OCTT and only 1 (4%) had delayed OCTT. In the normal adults group, 2 (5.7%) had rapid OCTT, 22 (62.9%) had normal OCTT and 11 (31.4%) had delayed OCTT. The difference was statistically significant (p 0.001). The mean value of OCTT in chronic diarrhea and normal adults were 84.23 + 39.82 min vs. 114.00 + 51.35 min (p = 0.027). Conclusions: The rapid OCTT was more likely to be found in the chronic diarrhea patients compare to normal adults significantly. The mean OCTT in chronic diarrhea was shorter than the mean OCTT in normal adults.   Keywords: orocaecal transit time, OCTT, chronic diarrhea
Intestinal Amebiasis in Children with Bloody Diarrhea Budi Purnomo; Badriul Hegar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (497.627 KB) | DOI: 10.24871/1222011105-108

Abstract

Background: Amebiasis affects more than 50 million people each year, resulting in 100,000 deaths. Entamoeba histolytica (E. histolytica) is clearly pathogenic causing intestinal infection that varies from asymptomatic to fulminant colitis. Appropriate diagnosis and treatment of amebiasis in children is important to avoid serious complication, such as hepatic abscesses. Bloody diarrhea is a classic symptom, which is often used as screening for intestinal amebiasis. This study aimed to know the prevalence of intestinal amebiasis and other clinical and laboratory characteristics in children with bloody diarrhea who visited Harapan Kita Women and Children Hospital, Jakarta. Method: This was a retrospective descriptive study. Data was obtained by evaluating medical records at Harapan Kita Women and Children Hospital Jakarta, from January 2009 to December 2010. The data included age, sex, morphology of E. histolytica, blood hemoglobin level and leukocyte count, as well as fecal leukocytes and erythrocytes. Diagnosis was confirmed by finding trophozoites in 3 consecutive stool specimens. Statistical analysis was performed using SPSS program. Results: Trophozoite forms were found in 58/889 (6.5%) children with bloody diarrhea. There were 40 (58.8%) boys, and 27 (39.7%) children were ≤ 1 years old. Fourteen (20.6%) children had anemia, 49 (72.1%) children had fecal leukocytes 10 and 51 (75%) children had fecal erythrocytes 5; however, only 21 (30.9%) children with blood leukocytes count 14,000 u/L. Conclusion: Intestinal amebiasis is common in children with bloody diarrhea, especially infants. Increased fecal leukocytes and erythrocytes are often found in intestinal amebiasis; however, blood leukocyte count may not increase. Keywords: children, intestinal tract, amebiasis
Co-Authors Agus Firmansyah Aldo Reynaldo Anis Karuniawati Anita Juniatiningsih Ari Prayogo Aria Kekalih Aswitha Boediharso Aswitha D. Budiarso Budi Purnomo Deddy S Putra Deny Sofia Diah Rini Endang Poerwati F M Susanto Fatima Safira Alatas, Fatima Safira Fatima Safra Alatas Lara Fillekes Marcellus Simadibrata Mardjanis Said Muzal Kadim Nina Dwi Putri Nuraini I Susanti Paulus Simadibrata Pramita G D Reynaldo Reynaldo Rianita Syamsu Sri Rezeki S Hadinegoro Sulaiman Yusuf Taralan Tambunan Tatang Puspanjono Wahyu Ika Wardhani Yovita Ananta Yvan Vandenplas