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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Kaka Renaldi
Division Of Gastroenterology, Pancreatobiliary, And Digestive Endoscopy Department Of Internal Medicine, Faculty Of Medicine, Universitas Indonesia/ Dr. Cipto Mangunkusumo National General Hospital, Jakarta
Medicine & Pharmacology

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Clinical Study of DLBS2411, a Mucoprotector and Proton Pump Inhibitor Bioactive Fraction Derived From Cinnamomum burmanii, on the Intragastric Acidity Tjandrawinata, Raymond Rubianto; Abdullah, Murdani; Simadibrata, Marcellus; Susanto, Liana W; Renaldi, Kaka
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 1 (2025): VOLUME 26, NUMBER 1, April, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/261202543-54

Abstract

Background: DLBS2411, A bioactive fraction derived from the bark of Cinnamomum burmanii has been developed to address acid-related gastrointestinal disorders. This study evaluated the pharmacodynamic effect of DLBS2411 on the 24-hour intragastric acidity in healthy adults.  Methods: In a 3-arm, parallel, double-blind, randomized, placebo-controlled clinical trial, healthy subjects received a single dose of DLBS2411 (250 mg or 500 mg) or placebo. Gastric pH was monitored, analyzed and profiled over 24 hours. Results: Of a total of 54 enrolled male subjects, 47 subjects (87.04%) were eligible for the analysis. The mean 24-hour intragastric pH for DLBS2411 250 mg and 500 mg was 2.29 ± 0.42 and 2.13 ± 0.50, respectively, both higher than placebo (1.93 ± 0.70). Differences were more pronounced during the first 12 hours (daytime). DLBS2411 250 mg and 500 mg reached a gastric pH 4 significantly faster (129.9 ± 128.2 and 92.9 ± 106.8 minutes) compared to placebo (196.9 ± 99.7 minutes). No serious adverse events occurred. All adverse events were mild and had been resolved by the end of study, confirming the safety and tolerability of DLBS2411 at the dose of 250 and 500 mg. Conclusion: DLBS2411 effectively suppressed the intragastric acidity and demonstrated a good safety profile in healthy adults. These findings warrant further studies of DLBS2411 in patients with gastric acid-related disorders. Keywords: Alternative medicine, DLBS2411 cinnamomum burmanii, healthy volunteers, intragastric-acidity, proton pump inhibitors
Gastrointestinal Bleeding in Small Bowel Arteriovenous Malformation: A Case Report Renaldi, Kaka; -, Aisyah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 1 (2025): VOLUME 26, NUMBER 1, April, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/261202584-87

Abstract

Arteriovenous malformations of the gastrointestinal tract (AVM) can occasionally result in gastrointestinal bleeding. Less than 5% of nonvariceal upper gastrointestinal bleeding is caused by gastrointestinal AVMs, a relatively uncommon cause of GI bleeding. Clinical symptoms that they might present include intussusception, persistent anemia, overt or obscure GI bleeding, and abdominal pain. A 41-year-old male patient presented with a 7-year history of recurrent melena. An initial enteroscopy showed spurting bleeding in the jejunum with histological examination showing AVM with ectopic pancreas. The patient underwent laparotomy with resection, anastomosis, and the construction of a new duodenojejunostomy. The patient complained of recurrent melena during three years of postoperative follow-up. The patient underwent laparotomy resection of the ileum to ascending colon, ileostomy, and splenectomy. Histological examination of the bleeding duodenal mucosa confirmed an arteriovenous malformation. The patient then underwent endoscopic hemostasis using hemoclips and was treated with coil embolization. In abdominal CT, angiographic evaluation showed no visible picture of vascular malformations. Intestinal AVMs are rare but should be considered as the differential diagnosis in patients with recurrent gastrointestinal bleeding. Endoscopic hemostasis, surgical resection, and angiographic intervention can be considered as treatments for AVM.Keywords: Arteriovenous malformation, gastrointestinal bleeding, small bowel
Abscess Formation Secondary to Bowel Perforation as Initial Presentation of Crohn's Disease: A Case Report Renaldi, Kaka; Hidayat, Leonardus Wibowo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025184-187

Abstract

Crohn's Disease is a gastrointestinal disorder that is more prevalent in the Asian population. Clinical features, such as diarrhea, abdominal pain, and hematochezia, are common manifestations of Crohn's Disease. A 23-year-old male patient presented with a 2-month history of abdominal pain and a mass-like appearance in the right flank. A colonoscopy was performed, which suggests Crohn's Disease. Abdominal CT scan revealed abscess formation. Clinical improvement was not achieved despite the optimization of 5-ASA treatment and the addition of steroids. Abscess drainage was performed, which later revealed ileo-colon perforation with severe adhesion, which was treated with ileo-colon resection, followed by double barrel ileo-colostomy. The pain was improved after surgery and optimization of 5-ASA, steroids, and azathioprine. Intestinal abscess formation should be considered one of the manifestations of Crohn's Disease, which also needs to be investigated for possibilities of perforation. Adequate surgical and medical management can be used to achieve and maintain remission and prevent another intestinal complication. This case report aims to raise awareness of intestinal abscesses due to bowel perforation in Crohn's disease patients.
Faktor-Faktor yang Berhubungan dengan Gejala Depresi pada Pasien Insomnia Usia Lanjut di Rawat Jalan Pratiwi, Amalia Nur; Wahyudi, Edy Rizal; Kusumaningrum, Profitasari; Shatri, Hamzah; Rinaldi, Ikhwan; Gani, Rino Alvani; Wijaya, Ika Prasetya; Susilo, Adityo; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Abstract

Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia. Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score >5 (indicating insomnia) were included as study subjects. Data were collected through interviews, covering sociodemographic characteristics, level of loneliness, duration of insomnia, depressive symptoms [Geriatric Depression Scale–15 (GDS-15) items], functional status [Barthel Activities of Daily Living (B-ADL)], cognitive status [Mini-Mental State Examination (MMSE)], nutritional status [Mini Nutritional Assessment (MNA)], and chronic diseases [Cumulative Illness Rating Scale for Geriatrics (CIRSG) score]. Results. The study included 209 elderly subjects with insomnia, with a mean age of 72.88 (SD 6.98) years, and a depression prevalence of 6.7%. Bivariate analysis showed significant associations between dependency (PR 5.24; 95% CI 1.50 – 18.29), malnutrition (PR 11.54; 95% CI 4.77 – 27.92), and chronic disease with a CIRSG score ≥9 (PR 4.15; 95% CI 1.18 – 14.50) and depressive symptoms in elderly patients with insomnia. No significant associations were found between sociodemographic factors, loneliness, duration of insomnia, or cognitive status and depression. Multivariate logistic regression analysis revealed a statistically significant association between malnutrition and depressive symptoms (p < 0.001). Conclusions. There is a significant association between malnutrition and depressive symptoms in elderly outpatients with insomnia. Further cohort studies are recommended to explore the causal relationship between malnutrition and depression in elderly patients with insomnia.
The Effectiveness of a High-Protein Liquid Dietary Supplementation in Improving Nutritional Status of Malnourished Patients in Hospital Care: a Preliminary Study Simadibrata, Marcellus; Abdullah, Murdani; Witjaksono, Fiastuti; Muzellina, Virly Nanda; Utari, Amanda Pitarini; Wulandari, Yohannessa; Wijayanti, Ari; Mustikarani, Dewi; Haloho, Raja Mangatur; Rachman, Aditya; Simadibrata, Daniel Martin; Mutiara, Rizka; Renaldi, Kaka
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 1 (2022): VOLUME 23, NUMBER 1, April 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (671.108 KB) | DOI: 10.24871/231202243-51

Abstract

Background: Malnutrition is a very common problem in hospitalized patients. Based on studies conducted in various countries, the prevalence of hospital malnutrition ranges from 20-45%. Hospital malnutrition can occur as a result of insufficient nutrient intake, impaired absorption of nutrients in the gastrointestinal (GI) tract, loss of nutrients due to disease, or increased metabolic requirement during illness. Nutrition is the basis for the healing process as it requires good nutrients through various enzymatic reactions. Some studies have shown that hospital malnutrition increases morbidity, mortality, prolongs the duration of hospitalization, and delays recovery. To improve nutritional status, a high-protein diet can be given. Liquid diet is one of the alternative forms of nutrition because it is easier to swallow.Method: This study was a double-blind randomized controlled trial conducted to assess the effectiveness of high protein liquid dietary supplementation in malnourished hospitalized patients. The patients were assessed for their nutritional status based on ESPEN 2015 criteria. Patients who experienced malnutrition will be divided into 2 groups, namely the control group which was given normal protein liquid diet, while the intervention group was given high protein liquid diet supplementation as much as 2 bottles (200 mL) per day for 7-10 days. Furthermore, the nutritional status of the patient was assessed.Results: By administering high-protein liquid diet supplementation, there was a tendency to increase the strength of the right handgrip in 3 subjects (50%), the tendency to increase body mass index (BMI) in 3 subjects (50%), Subjective Global Assessment (SGA) score improved in 2 subjects with mild/moderate malnutrition (33.3%) and 1 subject with normal nutrition (16.7%), and the tendency to increase the fat-free mass in 3 subjects (50%).Conclusion: The administration of high protein liquid dietary supplementation tended to increase the strength of the right handgrip, BMI, SGA score, and body fat-free mass index.
Effectivity of Extracorporeal Shock Wave Lithotripsy (ESWL) and Stenting vs. Stenting Only for Difficult Common Biliary Duct Stones: A Retrospective Analysis Maulahela, Hasan; Rumagesan, Djahalia; Abdullah, Murdani; Makmun, Dadang; Renaldi, Kaka; Simadibrata, Marcellus; Shatri, Hamzah; Fauzi, Achmad; Tandan, Manu
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 1 (2023): VOLUME 24, NUMBER 1, April, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/241202323-29

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) alone may not be sufficient for treating difficult common bile duct stones. To address this challenge, several other modalities exist, including extracorporeal shock wave lithotripsy (ESWL) and biliary stent placement. This study aims to investigate the effectiveness of ESWL following biliary stent placement, in comparison to biliary stent placement alone , in the treatment of difficult common bile duct stones.Methods: A retrospective cohort study was conducted using medical record data from the Gastrointestinal Endoscopy Center Registry of Dr. Cipto Mangunkusumo General National Hospital. This study evaluated 126 subjects with difficult bile stones, who were divided into two groups: one group received biliary stent placement alone, while the other underwent extracorporeal shock wave lithotripsy (ESWL) following biliary stent placement. The effectiveness of each treatment was assessed based on the rate of complete clearance of bile stones.Results: Of the total participants, 72 underwent ESWL following biliary stent placement, while 54 received biliary stent placement alone. The rate of complete stone clearance was 69.1% in the ESWL group and 64.8% in the stent-only group. However, the addition of ESWL as an adjuvant therapy did not result in a statistically significant improvement (p = 0.703; 95% CI: 0.816–1.351). Normal body mass index was a factor that influences the effectiveness of ESWL after biliary stent placement (p = 0.002).Conclusion: The ESWL procedure as adjuvant therapy following biliary stent placement has the same level of effectiveness as biliary stent placement alone.
Recurrent Esophageal Stricture as a Result of Esophageal Diverticulum: Case Report Renaldi, Kaka; Prabowo, Muhamad Reza
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 1 (2023): VOLUME 24, NUMBER 1, April, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/241202383-88

Abstract

Esophageal stricture is a disorder that limiting patients’ capability to get adequate intake. Dysphagia and regurgitation are main problem that makes patient admit to the hospital. There are several causes that narrowing esophageal lumen; those could be intraluminal or extraluminal. Esophageal diverticulum is one of a kind. It is not easy to establish the diagnosis of diverticulum in esophagus segment since supporting examination needed were complex. Esophageal stricture treatment should be interdisciplinary approach because inappropriate management would increase risk of complication and lowering patient’s quality of life. The management of esophageal diverticulum could be challenging and its prognosis depends on the patient’s characteristic and comorbidity.
Co-Authors -, Resultanti Abdul Aziz Rani Abdul Aziz Rani Achmad Fauzi Achmad Fauzi Achmad Fauzi ACHMAD FAUZI Aditya Rachman Aditya Rachman Aditya Rachman, Aditya Adityo Susilo, Adityo Aisyah - Amanda P Utari, Amanda P Amanda Pitarini Utari Andika Indrarespati Anshari Saifuddin Anshari Saifuddin, Anshari Anthony Eka Wijaya Anthony Eka Wijaya Ari F Syam Ari F Syam Ari Fahrial Syam Ari Wijayanti Atikah Isna Fatya Batara Bisuk Chudahman Manan Chudahman Manan Dadang Makmun Daldiyono Daldiyono Daldiyono Daldiyono Daniel Martin Simadibrata Daniel Martin Simadibrata E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Elli Arsita Elli Arsita Ening Krisnuhoni Fatya, Atikah Isna Fiastuti Witjaksono Firman, Fauzan Hertrisno Friatna, Yudha Haloho, Raja Mangatur Harini Oktadiana Harini Oktadiana, Harini Hasan Maulahela Hasan Maulahela Hasan Maulahela, Hasan Hidayat, Leonardus Wibowo Hilda Nurmalihah Hosea, Fransiscus Nikodemus Ika Prasetya Wijaya Ikhwan Rinaldi Indah Situmorang Indra Marki Indra Marki Indrarespati, Andika Jaffray DP Rambak Jeffri Gunawan Kusumaningrum, Profitasari Marcellus Simadibrata Marcellus Simadibrata Marcellus Simadibrata Marcellus Simadibrata Marcellus Simadibrata Meutia Gebrina Meutia Gebrina, Meutia Murdani Abdullah Murdani Abdullah Murdani Abdullah Murdani Abdullah Murdani Abdullah Mustika Dian Permana Mustikarani, Dewi Mutiara, Rizka Muzellina, Virly Nanda Nury Dyah Nury Dyah, Nury Permana, Mustika Dian Prabowo, Muhamad Reza Pradana Soewondo Pradana Soewondo Pratiwi, Amalia Nur Rabbinu Rangga Pribadi Rabbinu Rangga Pribadi Raja Mangatur Haloho Raja Mangatur Haloho Raymond R. Tjandrawinata Rezky Aulia Nurleili, Rezky Aulia Rino Alvani Gani Rizka Mutiara Roy Soetikno Rudy Kurniawan Rumagesan, Djahalia Saskia Aziza Nursyirwan Saskia Aziza Nursyirwan Saskia Aziza Nursyirwan, Saskia Aziza Shakinah, Sharifah Sharifah Sakinah Simadibrata, Daniel Martin Susanto, Liana W Tandan, Manu Teddy Septianto Wulandari, Yohannessa Yohannessa Wulandari