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All Journal Majalah Kedokteran Bandung Journal of the Medical Sciences (Berkala Ilmu Kedokteran) The Indonesian Biomedical Journal Universa Medicina Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

Gontar Alamsyah Siregar

Department Of Internal Medicine, Medical Faculty, University Of North Sumatra, Medan, Indonesia

Author-ID : 381791

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis Siregar, Rizqi Arini; Dairi, Leonardo Basa; Siregar, Gontar Alamsyah
Universa Medicina Vol 35, No 3 (2016)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2016.v35.199-205

BackgroundRupture and bleeding from esophageal varices are major complications of portal hypertension and associated with a high mortality rate. Non-invasive serum markers of liver fibrosis could be used as predictors of esophageal varices in cirrhotic patients. The objective of this study was to assess the performance of Forns index as a noninvasive predictor in diagnosing esophageal varices.MethodsA cross-sectional study was done in 51 cirrhotic patients who were admitted to Adam Malik hospital, Medan. Demographic and clinical data were recorded and laboratory tests were performed, so that Forns index could be calculated. The difference between Forns index and size of esophageal varices as determined by endoscopy was tested by independent-t and Mann-Whitney analysis. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios and areas under the receiver operating characteristic curves (AUROC). ResultsOf the 51 patients with esophageal varices included in this study, the size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%). Most patients were of Child-Plug C type (52.6%). There was a significant difference between Forns index and grade of esophageal varices. The AUROC for Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was highly predictive to diagnose large esophageal varices with a sensitivity of 63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%.ConclusionForns index was significantly increased in large esophageal varices. Forns index is a good noninvasive predictor of esophageal varices in cirrhotic patients.

Vascular endothelial growth factor (VEGF) serum levelsof patients with Helicobacter pylori gastritis with cytotoxin-associated gene A positive (CagA+)status Siregar, Wira Prihatin; Siregar, Gontar Alamsyah; Sungkar, Taufik
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 51, No 4 (2019)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Helicobacter pylori (H.pylori) is an agent that causes gastritis and the ulcer of gaster, which are ultimately caused gastric tumors. The prevalence is about 80 % average in developing country and 20-50 % in developed countries. One of the virulence factor iscytotoxin-associated gene A (CagA) that plays a role in the inflammation process,cell proliferation and metaplasia in gastric mucosa. Vascular endothelial growth factor (VEGF)is one of angiogenic factors that plays a role in the process of making new mucosal tissue after the inflammation by H.pylori. The escalation of VEGF expression levels contribute to the beginning of gastric carcinogenesis. The studywas aimed to analyze of VEGF serum levels between CagA(+) and CagA(-) in patients with H.pylori gastritis. Cross sectional study was conducted on 30 patients with H.pylori gastritis after conducted gastroscopy,biopsy and CLO test, which were continued with VEGF serum examination using ELISA test and perfomed PCR test to determinethe CagA status.The data was analyzed with SPSS 22 version andp value <0.05 was considered significant.The results of this study were18 men (60 %) and 12 women (46%) from 30 total subjects, with a median age average was 53.5 years old.Majority ethnic was Batak with 16 subjects (53.3%). Helicobacterpylori gastritis with CagA(+) was about 21 subjects (70%) and H.pylori gastritis with CagA(-) was about 9 subjects (30%). We found that median VEGF serum levels of patients with H.pylori gastritis with CagA(+)[480.3 pg/dL (115.5-2185.2)] significantly higher compared to thatwith CagA(-) [291.1 pg/dL (158.4-556.7)] (p<0.05).In conclusion, the VEGF serum levels ofpatients withH.pylori gastritis with CagA(+) is higher compared to that withCagA(-).

Comparison of Carcinoembryonic Antigen Serum Levels in Colorectal Cancer Patients with Different Histopathological Grades Chandra Agusrly; Taufik Sungkar; Gontar Alamsyah Siregar
Majalah Kedokteran Bandung Vol 52, No 2 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Histopathological grading, which represents the degree of histopathological differentiation, is often used as one of the factors to determine the prognosis of colorectal cancer. However, this grading cannot comprehensively present the clinical features of the disease. Carcinoembryonic antigen (CEA), as a tumor marker tested in the laboratory, is commonly used to determine the diagnosis and prognosis of colorectal cancer. The purpose of this study was to determine differences in CEA serum levels based on the cellular differentiation of colorectal cancer. This was a cross-sectional analytical study on medical records of colorectal cancer patients who were admitted to H. Adam Malik General Hospital Medan, Indonesia from January 2016 to December 2018. As many as 52 medical records of colorectal cancer patients who met the inclusion and exclusion criteria were included in this study. These patients were then divided into three groups based on the histopathological grade: well-differentiated, moderately differentiated, and poorly-differentiated. The Kruskal-Wallis test was then used to compare the CEA levels in these different histopathological grades. Results show that the CEA serum level was different in colorectal cancer patients with different histopathological grades (p=0.020). The CEA level was significantly higher in the poorly-differentiated group than the well-differentiated (p=0.044) and moderately differentiated (p=0.015) groups. Hence, the CEA level of colorectal cancer patients with poorly-differentiated grade is the highest when compared to other grades. Perbandingan Kadar Serum Carcinoembryonic Antigen Berdasar atas Derajat Histopatologi Pada Pasien Kanker Kolorektal Derajat diferensiasi dapat dijadikan sebagai salah satu faktor prognosis pada kanker kolorektal. Namun, penilaian ini tidak dapat menyajikan gambaran klinis penyakit secara komprehensif. Penanda tumor carcinoembryonic antigen (CEA) sebagai penanda tumor yang diuji di laboratorium, umumnya digunakan untuk menentukan diagnosis dan prognosis kanker kolorektal. Tujuan dari penelitian ini adalah menentukan perbedaan kadar serum CEA berdasar atas diferensiasi sel kanker kolorektal. Penelitian ini merupakan penelitian analitik dengan desain bedah lintang dengan menggunakan data rekam medis pasien yang didiagnosis kanker kolorektal di Rumah Sakit Umum Pusat H. Adam Malik, Medan periode Januari 2016 hingga Desember 2018. Sebanyak 52 catatan medis pasien kanker kolorektal yang memenuhi inklusi dan kriteria eksklusi dimasukkan dalam penelitian ini. Derajat diferensiasi dikelompokkan menjadi tiga: derajat baik, sedang, dan buruk. Uji Kruskal-Wallis digunakan untuk membandingkan kadar CEA berdasar atas derajat diferensiasi. Hasil menunjukkan bahwa kadar serum CEA berbeda pada pasien kanker kolorektal dengan nilai histopatologis yang berbeda (p=0,020). Tingkat CEA secara signifikan lebih tinggi pada kelompok berdiferensiasi buruk daripada kelompok berdiferensiasi baik (p=0,044) dan kelompok berdiferensiasi sedang (p=0,015). Oleh karena itu, tingkat CEA pasien kanker kolorektal dengan derajat diferensiasi buruk adalah yang tertinggi jika dibandingkan dengan tingkat lainnya.

Comparison of IL-6, IL-8 Concentrations in H. pylori- and non-H. pylori-associated Gastritis Gontar Alamsyah Siregar; Sahat Salim; Ricky Rivalino Sitepu
The Indonesian Biomedical Journal Vol 6, No 3 (2014)
Publisher : The Prodia Education and Research Institute (PERI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18585/inabj.v6i3.29

BACKGROUND: Helicobacter pylori is a non-invasive microorganism causing intense gastric mucosal inflammatory and immune reaction. The gastric mucosal levels of the proinflammatory cytokines Interleukin 6 (IL-6) and IL-8 have been reported to be increased in H. pylori infection, but the serum levels in H. pylori infection is still controversial. The purpose of this study was to investigate the serum levels of IL-6 and IL-8 in H. pylori infection.METHODS: A cross sectional study was done on eighty consecutive gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, Indonesia from May-October 2014. Histopathology was performed for the diagnosis of gastritis. Rapid urease test for diagnosis of H. pylori infection. Serum samples were obtained to determine circulating IL-6 and IL-8. Univariate and bivariate analysis (independent t test) were done.RESULTS: There were 41.25% patients infected with H. pylori. Circulatory IL-6 levels were significantly higher in H. pylori-infected patients compared to H. pylori negative, but there were no differences between serum levels of IL-8 in H. pylori positive and negative patients.CONCLUSION: The immune response to H. pylori promotes systemic inflammation, which was reflected in an increased level of serum IL-6. Serum levels of IL-8 were not significantly different between H. pylori positive and negative.KEYWORDS: Helicobacter pylori, gastritis, IL-6, IL-8, cytokine

Infection and Colorectal Neoplasm Gontar Alamsyah Siregar; Sahat Halim; Ricky Rivalino Sitepu
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 1 (2015): VOLUME 16, NUMBER 1, April 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Colorectal cancer is a major cause of cancer-related morbidity and mortality. Colorectal cancer is the third most common malignancy and the 4th most common cause of cancer mortality worldwide. A number of infectious agents are considered to be cancer risk factors due to the hypothesis-generating and supportive evidence accumulated to date. It has been estimated that one fifth of all cancer is caused by some infectious agent(s). Infections from certain bacteria, such as Helicobacter pylori (H. pylori), Streptococcus bovis (S. Bovis), viruses, such as human papillomavirus (HPV), human cytomegalovirus (HCMV), and parasites may increase the risk of colorectal cancer. More studies are needed to learn the association of infectious agents with the incidence of colorectal cancer.Keywords: colorectal cancer, infectious agents, malignancy, neoplasms

Correlation between Severity of Dyspepsia and Helicobacter pylori Infection Gontar Alamsyah Siregar; Sahat Halim
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Dyspepsia is a common complaint in clinical practice. Correlation between Helicobacterpylori (H. pylori) and functional dyspepsia had been reported in many studies, but studies that analyzed theseverity of dyspepsia and H. pylori were limited and the results were controversial. This study is about to knowthe correlation between the severity of dyspepsia and H. pylori infection. Method: A retrospective descriptive analysis to patients with dyspepsia at Permata Bunda Hospital, Medan was done in 2010-2014. Simple random sampling was done to get 44 patients with dyspepsia, 22 are H. pylori positive and 22 patients are H. pylori negative. The severity of dyspepsia assessed with Porto Alegre DyspepticSymptoms Questionnaire (PADYQ) scoring instrument. Univariate and bivariate analysis (Chi-square andSpearman correlation) were done using SPSS version 22. Results: Epigastric pain is the most common symptom in dyspepsia patients. There is a correlation betweenulcer type dyspepsia and H. pylori infection (p = 0.030), while dysmotility type and mixed type were not correlated.The severity of epigastric pain has significant positive correlation with H. pylori (r = 0.386; p = 0.01), while theseverity of other symptoms such as nausea, vomit, and abdominal bloating have negative correlation with H.pylori. Dyspepsia total scoring is significantly lower in H. pylori positive than in H. pylori negative (p = 0.033). Conclusion: There is a positive correlation between the severity of epigastric pain and H. pylori infection,negative correlation between the severity of nausea, vomit, and abdominal bloating and H. pylori infection, andcorrelation between lower dyspepsia total scoring and H. pylori infection.Keywords: dyspepsia, Helicobacter pylori, PADYQ, epigastric pain

The Comparison of Serum Malondialdehyde Level Between H. pylori Positive and H. pylori Negative Gastritis Patients Laura Dairi; Gontar Alamsyah Siregar; Taufik Sungkar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Helicobacter pylori is the most common cause of chronic gastritis in the world, meanwhile gastritis caused by non-steroidal anti-inflammatory drugs (NSAIDs) is the most encountered type of gastritis.Increased free radicals caused by Helicobacter pylori can cause damage in gastric mucous. Tissue damage due to free radicals can be examined by measuring malondialdehyde compound. There are many studies thatproves the increased malondialdehyde in gastritis, but those studies commonly done in animal experimentation and malondialdehyde examination in gastric mucous.Method: This is a cross-sectional study of 40 dyspepsia patients who came to endoscopic unit of Adam Malik General Hospital Medan and networking hospitals by using Rome III criteria. Further examination with gastroscopy and biopsy was done to determine gastritis. H. pylori examination was done by using Campylobacterlike organism test (CLO) test. Serum malondiasldehyde level was examined with high performance liquid chromatography (HPLC) method.Results: From total of 40 patients,24 (60%) were men and 16 (40%) were women with an average age of 47years, the majority of the ethnic was Bataknese (57.5%). From 20 patients with H.pylori (+), the average levelof malondialdehyde was 1.58 umol/mL while in 20 other patients with H. pylori (-), malondialdehyde level was 1.19 umol/mL with p value 0.013.We found the mean serum levels of malondialdehyde was higher in H. pyloripositive gastritis than H. pylori negative.Conclusion: Serum Malondialdehyde level was significantly higher in patient with positive H. pylori gastritiscompared to H. pylori negative gastritis.

Comparison of Triiodothyronine (T3), Tetraiodothyronine (T4), Freethyoxine (FT4), Thyroid Stimulating Hormone (TSH) Levels in with Liver Cirrhosis Patients Based on Child-Pugh Score at H. Adam Malik Central General Hospital, Medan Beby Dewi Sartika; Leonardo Basa Dairi; Gontar Alamsyah Siregar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 3 (2018): VOLUME 19, NUMBER 3, December 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Background: The liver is involved in thyroid hormone conjugation and excretion, as well as the synthesis of thyroid binding globulin. T4 and T3 regulate the basal metabolic rate of all cells.Method: The sample of this research was collected crosssectionally on 40 patients with liver cirrhosis based Child-Pugh score. Ultrasonography and Triiodothyronine (T3), Tetraiodothyronine (T4), Freethyoxine (FT4), thyroid stimulating hormone (TSH) levels examinations to know the difference between liver cirrhosis patients with Child-Pugh A, B, and C with ELISA method.Results: Statistical analysis showed there are not found significant differences in T3, T4, FT4, TSH levels in patients with of the liver cirrhosis based on the Child-Pugh score.Conclusion: Not found significant differences in thyroid hormone levels among patients with liver cirrhosis Child-Pugh A, B, and C.

Association Between Degree of Gastritis and Malondialdehyde Level of Gastritis Patients at Adam Malik General Hospital Medan Darmadi Darmadi; Gontar Alamsyah Siregar; Leonardo Basa Dairi
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: The main pathogenesis of gastritis is inflammation which process can not be separated from the role of free radicals. Malondialdehyde (MDA) is a free radical biomarker and which increases in gastritis patients. However, studies on MDA were generally performed on experimental animals or examined MDA in gastric mucosa. The aim of this study is to determine the association of histopathological degrees of gastritis (the degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia) with plasma MDA level.Method: Cross-sectional study of 40 consecutive gastritis patients who came to endoscopic unit of Adam Malik General Hospital Medan, from January to May 2017. Assessment for the severity of chronic inflammation, neutrophil activity, atrophy, and intestinal metaplasia refers to Updated Sydney System. Plasma MDA levels were examined using an HPLC MDA kit. Univariate and bivariate (Chi-square and fisher exact test) analysis were performed with SPSS version 22.Results: A total of 26 patients (65%) were men with an average age of 49.25 years. Lymphocyte infiltration was observed in 100% of specimens, neutrophil infiltration in 37.5%, atrophy in 22.5%, and intestinal metaplasia in 22.5%. There was a significant association between degree of lymphocyte infiltration with MDA level (p = 0.014; PR = 8.667; 95% CI: 1.52-89.52). There was a significant association between degree of neutrophil activity with high MDA level (p = 0.002; PR = 11.33; 95% CI: 2.64-48.74). There was a significant association between degree of atrophy with high level of MDA (p 0.001; PR = 14; 95% CI: 3.4–57.648). There was a significant association between degree of intestinal metaplasia with high MDA level (p = 0.001; PR = 12.5; 95% CI: 3.76-24).Conclusion: There were significant associations between degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia with high level of MDA.

S-Index and APRI Score to Predict Liver Fibrosis Chronic in Hepatitis B and C Patients Elias Tarigan; Leonardo Basa Dairy; Juwita Sembiring; Mabel Sihombing; Gontar Alamsyah Siregar; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Background: A great interest has been dedicated to the development of non invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. The aim of this study was to comparethe accuracy between S-index and aspartate aminotransferase to platelet ratio index (APRI) to FibroScan for predicting liver fibrosis in chronic hepatitis B and C patients.Method: A cross-sectional study was conducted in 40 patients with chronic hepatitis B and C between January 2010 - May 2011 at Division of Gastroentero-hepatology, Department of Internal Medicine, Adam Malik Hospital, Medan. Patients underwent laboratory examination and FibroScan, then used predictive values to assess the accuracy of S-index scores and APRI compared to FibroScan. The analysis was performed using SPSS 15.0.Results: S-index identified significant fibrosis in 87.5% patients with sensitivity (Se) 87.5% and specificity (Sp) 100%. About 67.5% of 40 patients could be identified correctly. S-index also could accurately predict the absence or presence of cirrhosis in 87.5% of the total 40 patients, with NPV 91.7% and PPV 81.25%, respectively. APRI for significant fibrosis has Se 85.7%, Sp 88%, PPV 88.8%, NPV 69.2%; while Se 53%, Sp 88%, PPV 72.7%, NPV 75.8% for liver cirrhosis. AUROC value for S-index was higher than APRI in predicting significant fibrosis and cirrhosis, i.e. 0.938 vs. 0.917 and 0.873 and 0.707, respectively.Conclusion: The S-index has a higher accuracy than APRI in predicting significant fibrosis and cirrhosis in patients with chronic hepatitis B virus and hepatitis C virus infection.Keywords: S-index, APRI score, FibroScan, chronic hepatitis B and C

Co-Authors Agusrly, Chandra Beby Dewi Sartika Betthin Marpaung Chandra Agusrly Dairi, Laura Darmadi Darmadi Darmadi Darmadi Darmadi Darmadi Darmadi Darmadi Dasril Efendi dharma Lindarto, dharma Elias Tarigan Fitri Armanti Karo Ilhamd Imelda Rey Iqbal Sungkar Juwita Sembiring Karo, Fitri Armanti Laura Dairi Leonardo Basa Dairi Leonardo Basa Dairi Leonardo Basa Dairi Leonardo Basa Dairy Lubis, Ainun Lubis, Sri Ningsih Lukman Hakim Zain Lydia Imelda Laksmi Lydia Imelda Laksmi, Lydia Imelda Mabel HM Sihombing, Mabel HM Mabel Sihombing Marpaung, Chairunnisa Fitri Masrul Lubis Panggabean, Lider Olmen Ricky Rivalino Sitepu Ricky Rivalino Sitepu Ricky Rivalino Sitepu Ricky Rivalino Sitepu Ricky Rivalino Sitepu, Ricky Rivalino Rivalino, Ricky Rizqi Arini Siregar, Rizqi Arini Rustam Effendi Rustam Effendi Rustam Effendi Yusuf, Rustam Effendi Sahat Halim Sahat Halim, Sahat Sahat Salim Sartika, Beby Dewi Siregar, Wira Prihatin Sri Maryuni Soetadi Sri Ningsih Lubis Sumondang Pardede Sungkar, Iqbal Sungkar, Iqbal Taufik Sungkar Taufik Sungkar Taufik Sungkar, Taufik Utomo, Edrick Widya Deli Satuti

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