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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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Early Acute Liver Failure In Severe Acute Hepatitis B Gontar Alamsyah Siregar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 3, December 2002
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/33200297-98

Early acute liver failure is defined by the presence of a drop below 50% of the normal prothrombine ratio, jaundice, and clotting factors of less than 50% in any patient with acute liver disease. Clinical features and laboratory manifestations of viral hepatitis range from unapparent disease, asymptomatic infection, to culminant disease, which has the highest mortality rate of up to over 80 %. We report a case of a 22-year old man who was treated in a private hospital with early acute liver failure caused by hepatitis B infection. The diagnosis was based on clinical symptoms and laboratory test Results such as jaundice, hepatomegaly, ascites, 34% prothrombine ratio, elongated prothrombine time (37,1 seconds), hypoalbuminemia (1,9 g/dL), hyperbillirubinemia (total billirubin 26,35 mg/dL, direct billirubin 16,66 mg/dL, HbsAg (+), IgM anti- HBc (+), IgM anti HAV (-), and anti HCV (-). The patient suffered from jaundice for 6 weeks and on the third week, he suffered from ascites. He had improved clinical condition and laboratory test results with conservative therapy after the seventh week. At the end of the tenth week, the patient’s clinical condition and laboratory test results had reached normal, with HBsAg (-) and HBsAb (+). Whether or not interferon should have been given to this patient is still arguable. Key words: Early acute liver failure, Severe acute hepatitis B

Comparison of Alpha-Fetoprotein Level in Varying Severity Degree of Hepatocellular Carcinoma Assesed with the Barcelona Clinic of Liver Cancer During 2015-2016 in Haji Adam Malik General Hospital Medan Gontar Alamsyah Siregar; Sri Ningsih Lubis
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 1 (2017): VOLUME 18, NUMBER 1, April 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Presently, the reference staging system to evaluate the prognosis of HCC is The Barcelona Clinic Liver Cancer (BCLC) system. The aim of the study was to identify the comparison of alpha-fetoprotein (AFP) level in varying severity degree of HCC patient assessed with BCLC.Method: This retrospective observational study used patients’ medical record hospitalized for HCC between January 1st 2015 until December 31st 2016 in Adam Malik Hospital. From 166 HCC patients with AFP, liver function test (LFT), home sleep test (HST), ultrasonography (USG), and computerized tomography (CT) scan liver 3 phase were included in this study. The comparison of AFP in severity of HCC based on BCLC system was analyzed.Results: About 77.7% HCC patients were male. The mean age was 52 ± 13.63 years. The most cause of HCC was hepatitis B infection. Median AFP was 574.97 ng/mL. According to the BCLC staging system, 12 patients were classified as stage A (7.2%), 54 patients stage B (32.5%), 76 patients stage C (45.8%) and 24 patients stage D (14.5%). There’s significance difference value of AFP in varying stage of BCLC for HCC, which the highest value in BCLC stage D, followed by C, B and A (p = 0,001)Conclusion: There’s significance difference value of AFP in varying stage of BCLC for HCC patients.

Risk Factors of Chronic Atrophic Gastritis Gontar Alamsyah Siregar; Lydia Imelda Laksmi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Chronic atrophic gastritis is a well-established precursor of gastric cancer. The development of atrophic chronic gastritis is multifactorial, involving the environment as well as host responses to the Helicobacter pylori (H. pylori) infection. The aim of this study is to determine prevalence and risk factors of chronic atrophic gastritis.Method: The study was a cross sectional study on gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, from May-October 2014. A simple random sampling was performed to obtain 50 patients. Data concerning sociodemographic factors and H. pylori status were collected. H. pylori were considered positive from the positive results of the campylobacter like organism (CLO) test. Univariate and bivariate analyses were performed using the SPSS 22 with 95% confidence interval. Bivariat analysis was performed using a Chi-square test. Results: Prevalence of chronic atrophic gastritis was 40%. There were associations between age and chronic atrophic gastritis (95% CI = 1.05-2.80; p = 0.021; OR = 1.73), body mass index and chronic atrophic gastritis (95% CI = 1.1-3.1; p = 0.011; OR = 1.85), and H.pylori infection and chronic atrophic gastritis (95% CI = 1.23-4.88; OR = 2.45; p = 0.001). There were no associations between gender, ethnicity, or rural-urban classification and chronic atrophic gastritis (p 0.05).Conclusion: Elderly status, low BMI, and H. pylori infection are risk factors for the development of chronic atrophic gastritis. Keywords: chronic atrophic gastritis, Helicobacter pylori, gastric atrophy, body mass index

Dyspepsia and Depression, Anxiety, Stress Scales (DASS) Score Gontar Alamsyah Siregar; Sahat Halim; Ricky Rivalino Sitepu
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 1 (2016): VOLUME 17, NUMBER 1, April 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Dyspepsia is a constellation of symptoms referable to the gastroduodenal region of the upper gastrointestinal tract. Emotional disturbances are often associated with dyspepsia and have been proposed as one of the possible causes of dyspepsia. This study was aimed to evaluate the difference between the severity of dyspepsia using porto alegre dyspeptic symptoms questionnaire (PADYQ) and emotional disturbances using depression, anxiety, stress scales (DASS).Method: This study was a cross-sectional analytical study. All the subjects were evaluated using PADYQ and DASS. PADYQ is classified into four categories (no, mild, moderate and severe dyspepsia symptoms). Data was analyzed using Independent t-test and Mann-Whitney test. A p 0.05 was considered as statistically significant.Results: There were 90 subjects that enrolled in this study, consisted of 47 (52.2%) males and 43 (47.8%) females. Thirty three (36.7%) subjects had PADYQ score was 6, while it was ≥ 6 in the other 57 (63.3%) subjects. DASS scores were significantly different in subjects without dyspepsia symptoms compared to subjects with dyspepsia symptoms. There is a difference in DASS scores between subjects with different categories of dyspepsia symptoms (p 0.05). Conclusion: There was a difference in the severity of emotional disturbances among subjects with dyspepsia symptoms and without dyspepsia symptoms. The severity of emotional disturbances parallel with the severity of dyspepsia. Evaluation of emotional disturbances in case of dyspepsia will be helpful in the management of dyspepsia.

The Differences Level of Resistin between Positive and Negative Helicobacter pylori Gastritis and its Correlation with Nutritional Status Widya Deli Satuti; Gontar Alamsyah Siregar; Dharma Lindarto; Imelda Rey
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 2 (2020): VOLUME 21, NUMBER 2, August 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Background: H. pylori gastritis can be related to people with obesity and metabolic syndrome. The mechanism underlying the relationship between them is suspected to be caused by adipocytokine called resistin. Objective: to analyze the difference level of resistin between positive and negative H. pylori gastritis patients and their relationship with nutritional status.Method: This cross sectional study was done in the Gastroenterology department of General Hospital Adam Malik, Medan, from May to October 2019. Patients with gastritis diagnosed by endoscopy underwent rapid urease test (RUT), resistin, albumin, hemoglobin tests, also body mass index (BMI) and waist circumference (WC) were measured.Results: Sixty gastritis patients found by endoscopic examination, 29 (48.33%) was H. pylori positive and 31 (51.67%) was negative. No significant differences were found between BMI, WC, and albumin against H. pylori gastritis with p values 0.099, 0.055, and 0.528, respectively. Hemoglobin was found significant with a p 0.009. The mean resistin in the positive H. pylori group was 7.62 ng/ml while the negative was 3.23 ng/ml, and statistically significant (p 0.001). There was a strong positive correlation between resistin levels with BMI and WC (BMI p 0.01, r 0.577; WC p 0.001, r 0.592).Conclusion: Resistin levels in gastritis with H. pylori positive are higher than H. pylori negative, body mass index and waist circumference have a strong relationship with resistin levels in patients with positive H. pylori gastritis, hemoglobin is lower in H. pylori positive than negative gastritis.

Profile of Colorectal Cancer Patients in Endoscopic Unit at Dr. Pirngadi Hospital - Medan Rustam Effendi; Dasril Efendi; Leonardo Basa Dairy; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Maryuni Soetadi; Gontar Alamsyah Siregar; Lukman Hakim Zain
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: 10.24871/93200878-81

Background: Colorectal cancer is the third most prevalent cancer and the second leading cause of cancer death worldwide every year. Rates of this malignancy vary by country. In Indonesia, the prevalence is estimated to have an increased tendency. The objectives of this sudy was to examine the prevalence and profile of colorectal cancer, which are diagnosed by endoscopic examination. Method: The study was conducted retrospectively, by examining the Result of endoscopic findings of patients with rectal bleeding, altered bowel habit, chronic diarrhea, unexplain abdominal pain, and other signs and symptoms at The Endoscopic Unit Department of Internal Medicine, Dr. Pirngadi hospital from January 2004 to June 2008. Results: We found 197 patients with colorectal cancer (CRC) from 760 patients examined by colonoscopy (25.9%). One hundred and one patients (51.3%) out of 197 CRC patients were female. Most were in the group of age 51-60 years (28.9%). The most frequent ethnic of the patients were Bataknese (46.2%). The most common symptom was rectal bleeding (70.6%). The most common location of CRC was in the rectum (74.6%). Histopathologic Result was adenocarcinoma. Conclusion: The prevalence of colorectal cancer in this study were twenty six percents. Rectal bleeding appeared to be the most common sign in this study. Rectum was the most common site of the cancer. Most of patients were Bataknese. Patients were at advanced stage and most of them were having well-differentiated adenocarcinoma. Keywords: colorectal cancer, rectal bleeding, altered bowel habits, colonoscopy

A Comparison of the Endoscopic and Histopathological Findings of Upper Gastrointestinal Mucosa with Helicobacter pylori infection Gontar Alamsyah Siregar; Sumondang Pardede
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, ISSUE 3, December 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/43200375-79

Helicobacter pylori infects the gastric mucosa or the duodenal wall undergoing gastric meteplasia, and is found in nearly 100% of chronic gastritis and duodenal ulcers. Helicobacter pylori produces urease that converts urea into ammonia, which will protect the organism from the acidic environment and will cause further damage to the gastrointestinal mucosa. Helicobacter pylori can be detected through histopathological evaluation, macroscopic endoscopy, serologic test, urea breath test, biopsy urease test, culture and stool analysis. Histiopathologically, Helicobacter pylori infection demonstrates neutrophil infiltration into the gastric mucosa, classified as focal infiltration. We conducted a prospective study of 50 chronic dyspeptic patients. We took their history, performed physical examinations, gastroscopy with judgement for macroscopic endoscopic appearance, histopathology from biopsy specimens, and the CLO test. There were 50 chronic dyspeptic patients in the study, with an age ranging from 23-81 years, and a mean age 49±12 year. Most of them were male (33 cases). There were 17 female cases. From the CLO test, there were 30 cases with CLO (+) and 20 cases CLO (-). From the 30 cases with CLO (+), 22 were male and 8 female. Gastroscopy revealed 25 cases of gastric ulcer, 7 duodenal ulcer, 2 gastric cancer, 15 gastritis, and 30 gastropathy. A gastroscopic appearance of chronic dyspepsia with positive Helicobacter pylori were found mostly in gastric ulcer (18 cases), followed by duodenal ulcer (6 cases), gastritis (5 cases) and one case of gastric cancer. A gastroscopic appearance of chronic dyspepsia with negative Helicobacter pylori were found mostly in gastritis 10 cases, while the remaining in gastric ulcer (7 cases), gastric cancer (2 cases), and a case of duodenal ulcer. Gastroscopy revealed 15 cases of gastritis. From the 5 gastritis cases with CLO (+), 3 cases had lesions located at the antrum and 2 cases at the corpus, while from the remaining 10 cases of gastritis with CLO (-), 8 cases had lesions located at the antrum, and 2 at the corpus. The time to colonization was shortest in duodenal ulcer (grade IV), followed by gastric ulcer (grade II) and gastritis (grade I) in CLO (-) examination. From cases of gastritis with CLO (+), 4 were moderate cases and one case severe, while from cases of gastritis with CLO (-) there were 7 mild cases, and 3 moderate cases with no severe case found. Keywords: Endoscopic findings, histopathology, Helicobacter pylori.

The Comparison of Tnf α (Tumor Necrosis Factor α) Serum Levels Between Cytotoxin - Associated Gene A (Caga) Positive and Negative in Patients with Gastritis Helicobacter pylori Fitri Armanti Karo; Leonardo Basa Dairi; Gontar Alamsyah Siregar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Helicobacter pylori (H. pylori) infection is the common cause of chronic gastritis in the world that is around 80% in addition to other causes such as autoimmune diseases, drugs, idiopathic and others. The pathogenesis of H. pylori associated with virulence factors consisting of cytotoxin - associated gene A (CagA) and vacuolating cytotoxin A (Vaca). In the case of gastritis occurred acute and chronic inflammatory responses and activation cytokines that cause inflammation of mucous which TNF-α levels increased in patients gatritis H. pylori. Levels of serum TNF-α was found higher in patients infected with H. pylori with CagA positive. The purpose of this study is to investigate the comparison between TNF-α serum level in H. pylori gastritis patients with Cag A (+) and CagA (-).Method: The study was conducted with a cross-sectional design in 30 patients with dyspepsia, using PADYQ score. We performed gastroscopy, biopsy, and CLO test to prove the existence of H. pylori. Furthermore, we used PCR to assess CagA (+) and CagA (-), and ELISA method to measure TNF-α serum level.Results: From 30 subjects, 18 men (60%), 12 women (40%), and the mean age was 53.5 years, the majority of the ethnic was Bataknese (53.3%), patients with H. pylori gastritis with CagA (+) were 21 (70%) and patients with H. pylori gastritis with CagA (-) were 9 (30%). We found the mean serum levels of TNF-α was higher (3.48) in H. pylori gastritis with CagA (+) than the CagA (-) (1.29) with p value was 0.001.Conclusion: We found increased serum levels of TNF-α in patients with CagA (+) compared to Cag A (-) H. pylori gastritis.

Comparison of Endoscopic Findings with Gastroesophageal Reflux Disease Questionnaires (GerdQ) and Reflux Disease Questionnaire (RDQ) for Gastroesophageal Reflux Disease in Medan Gontar Alamsyah Siregar; Sahat Halim; Ricky Rivalino Sitepu
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 3 (2015): VOLUME 16, NUMBER 3, December 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Background: There are many questionnaires that have been developed to diagnose gastroesophageal reflux disease (GERD), i.e. reflux disease questionnaire (RDQ), and the recently developed, gastroesophageal reflux disease questionnaires (GerdQ). In this study, we tried to compare GerdQ and RDQ in terms of sensitivity and specificity to diagnose GERD and its relationship with endoscopic findings.Method: This study was a cross sectional analytical study. Subsequently, all the subjects were evaluated using the GerdQ and RDQ, then underwent esophagogastroduodenoscopy examination. The severity of endoscopically observed reflux esophagitis was graded with the Los Angeles classiﬁcation. All endoscopy was performed by well-trained doctor.Results: A total of 85 patients were examined, 34 (40%) patients had reflux esophagitis at endoscopy examination, including 15 (44.1%) cases of grade A, 11 (32.3%) cases of grade B, 4 (11.8%) cases of grade C, and 4 (11.8%) cases of grade D. Analysis study using sensitivity, specificity, and receiver operating characteristic (ROC) test showed that GerdQ had sensitivity (49%), specificity (91%), and an area under the ROC of 0.701 (p value = 0.002). RDQ had sensitivity (24%), specificity (91%), and an area under the ROC of 0.574 (p value = 0.253). Taking 11 as the cut off point for GerdQ, a maximal sensitivity of 73.5%, specificity of 82.4%, and an area under the ROC of 0.779 was achieved.Conclusion: GerdQ and RDQ can be used to help diagnose GERD, but GerdQ is more superior than RDQ in diagnosing GERD. A multi-center study with larger samples is needed to determine the best GerdQ’s cut off point in Indonesia.

Correlation Between TNF- α and Degree of Gastritis Ricky Rivalino Sitepu; Darmadi Darmadi; Gontar Alamsyah Siregar
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: TNF- α is a cytokine that plays an active role in the pathogenesis of gastritis. The correlation of TNF-α levels in the gastric mucosa with the severity of gastritis has long been known. However, few studies have assessed TNF-α levels in serum of gastritis patients. This study aims to evaluate correlation between serum TNF-α level with the degree of gastritis based on histopathology.Method: A cross sectional study on eighty gastritis patients that fulfilled the inclusion criteria underwent serum TNF-α examination, endoscopy, and biopsy. Rapid urease test was used for diagnosis of H. pylori infection. The severity of gastritis based on lymphocyte infiltration, neutrophil infiltration, atrophy, and intestinal metaplasia according to Updated Sydney System. Univariate and bivariate analysis (Chi-square, fisher's exact, spearman correlation, and independent T-test) were done using SPSS version 22.Results: There were 41.25% patients infected with Helicobacter pylori. Serum TNF-α levels in the infected group were significantly higher compared to negative H. pylori (p 0.05). There was significant positive correlation between serum TNF-α levels and degree of gastritis based on lymphocyte infiltration (r = 0.333; p = 0.003).Conclusion: There was a significant positive correlation between serum TNF-α level with the severity of gastritis based on lymphocyte infiltration.

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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