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Badriul Hegar
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Gastroesophageal reflux in children Badriul Hegar; Yvan Vandenplas
Paediatrica Indonesiana Vol 51 No 6 (2011): November 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.6.2011.361-71

Abstract

Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In older children and adolescents, history and physical examination may be sufficient to diagnose gastroesophageal reflux disease (GERD).Endoscopically-visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures acidic, weakly acidic, non-acidic and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GERER. Barium contrast radiography is not useful for the GERERD diagnosis, but may be used to detect anatomic abnormalities. Parental education, guidance, and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GERER. Use of a thickened, commercially available anti-regurgitation formula by preference, may decrease visible regurgitation. Buffering agents, alginate and sucralfate, can be beneficial if used as needed for occasional heartburn. Proton-pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs).
Using iron profiles to identify anemia of chronic disease in anemic children with tuberculosis Reni Wigati; Endang Windiastuti; Badriul Hegar
Paediatrica Indonesiana Vol 51 No 4 (2011): July 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.4.2011.217-22

Abstract

Background Anemia of chronic disease (ACD) is commonly found in patients with chronic inflammation or infection. By examining soluble transferrin receptor or bone marrow iron, ACD was found in 80% of anemic adult tuberculosis (TB) patients. Iron profile, another tool to differentiate ACD from iron deficiency anemia (IDA), is both less expensive and less invasive. Few studies have been reported on iron profiles of anemic children with TB in Indonesia.Objective We aimed to use iron profiles to determine the proportion of ACD in anemic children with tuberculosis.Methods A cross-sectional study on anemic children with TB who came to Cipto Mangunkusumo Hospital and Tebet Puskesmas (community health center) was performed in September-November 2010. Iron profiles included the measurements of serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TF), and serum ferritin (SF).Results Our study comprised of 66 subjects, with a median age of 3.8 years (6 months–18 years). Most subjects had normal SI (85%), normal TIBC (71%), low transferrin saturation (51%), and normal SF (71%). Only 10 children had iron homeostasis disorder and 6 of these were diagnosed as having ACD. Thus, iron profiles failed to prove that iron metabolism was disturbed. The profile of children with organ-specific TB was more consistent with ACD compared to the profile of childhood TB. [SI 29.1 (11-83) vs 44 (10-151) μg/dL; TIBC 239.3 (100.80) vs 299.0 (58.51) μg/dL; TF 18.3 (4-100) vs 15 (1-53) %; and SF 154 (34.9-655) vs 36.1 (2.5-213.4) μg/L].Conclusion The proportion of ACD (9%) diagnosed by using iron profiles was not as high as previously reported. Further research using newer techniques is needed to detect ACD in anemic children with TB. [
Reflux esophagitis in children with feeding problems: A preliminary study Lia Mulyani; Badriul Hegar; Alan R. Tumbelaka; Ening Krisnuhoni
Paediatrica Indonesiana Vol 50 No 5 (2010): September 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (388.663 KB) | DOI: 10.14238/pi50.5.2010.284-90

Abstract

Background Untreated gastroesophageal reflux can cause reflux esophagitis, a condition characterized by damage to the esophageal mucous layer due to exposure to caustic gastric contents. Manifestation of esophagitis in young children include feedingproblems, irritability, and back􀀳arching. Persistent esophagitis may cause growth failure, gastric bleeding, and anemia. Reflux esophagitis should be considered an etiology of feeding problems, especially in children with a history of gastroesophageal reflux during infancy.Objective The purpose of this study is to detennine the prevalence of reflux esophagitis in children with feeding problems.Methods A cros-sectional study was done in November 2007 to April 2008. Children under 5 years of age with feeding problems and a history of regurgitation or vomiting started from age 6 months or more underwent endoscopy and biopsy examinations. Reflux esophagitis was diagnosed based on the Los Angeles classification of endoscopic examination.Results Reflux esophagitis was diagnosed in 18 of 21 children with feeding problems and a history of regurgitation or vomiting. Most subjects were boys aged 12 to36 months. Feeding problems has lasted for more than 6 months, regurgitation or vomitingfor more than 12 months, and suffered from mild malnutrition. Vomiting was observed to be a common symptom in children with reflux esophagitis.Conclusion The prevalence of reflux esophagitis in children with feeding problems and a history of regurgitation or vomiting started from age ≥ 6 months is high, therefore it will influence treatment.
Indonesian pediatricians’ understanding and management of infant regurgitation based on Rome IV criteria Fransesco Bernado Hubert Jonathan; Agus T. Sridevi; Brahmantyo A. Wicaksono; Dewi Friska; Badriul Hegar
Paediatrica Indonesiana Vol 62 No 6 (2022): November 2022
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi62.6.2022.373-81

Abstract

Background The diagnostic criteria of infant regurgitation have been well elucidated in the Rome IV criteria and pediatricians have been informed of them. However, as a functional disorder, infant regurgitation is susceptible to misdiagnosis and inappropriate management. Objective To assess pediatricians’ diagnostic knowledge of and therapeutic approach to infant regurgitation. Methods We conducted a cross-sectional, analytical study using a questionnaire based on Rome IV criteria for infant regurgitation diagnosis and standardized guidelines for management. The questionnaire was face-level validated by an expert and tested for both reliability and correlation using 30 test respondents. The questionnaire was then distributed electronically to 131 randomized pediatricians, who were members of the Indonesian Pediatric Society DKI Jakarta branch and graduated from pediatric residency within year 2005-2019. Results Sixty-seven (51%) pediatricians reported applying the Rome IV criteria in daily clinical practice. Pediatricians who used Rome IV as their source of knowledge achieved mean and median diagnostic knowledge scores of 14.87 (SD 2.540) and 16 (range 8–20), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ diagnostic understanding (P=0.110), and mean and median therapeutic knowledge scores of 9.10 (SD 2.264) and 10 (range 4–12), respectively, with no significant correlation between the usage of ROME IV and the pediatricians’ therapeutic approach (P=0.486). Pediatricians’ diagnostic knowledge and therapeutic approach were not significantly different with regards to their practice experience, specialist institution, workplaces, and source of information. Conclusion The majority of pediatricians surveyed have good diagnostic and therapeutic knowledge scores with regards to handling of Rome IV infant regurgitation.
Co-Authors Agus T. Sridevi Alan R. Tumbelaka Brahmantyo A. Wicaksono Dewi Friska Endang Windiastuti Ening Krisnuhoni Fransesco Bernado Hubert Jonathan Lia Mulyani Reni Wigati Yvan Vandenplas