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All Journal E-Jurnal Medika Udayana Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran MEDICINUS The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Gde Somayana
Divisi Gastroentero Hepatologi, Departemen Penyakit Dalam, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Denpasar, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia Mariadi, I Ketut; Somayana, Gde; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023235

Abstract

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.
Sebuah Kasus Pankreatitis Kronis pada Seorang Pria dengan Karsinoma Kaput Pankreas Gerry Setiawan; Gde Somayana
MEDICINUS Vol. 38 No. 10 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/t993my22

Abstract

Chronic pancreatitis is a progressive inflammatory disease of the pancreas which leads to loss of exocrine and endocrine function, and is considered difficult to diagnose in the early stage. It is crucial for physicians to have a deep understanding indiagnosed and treated the disease as this could affect the patient’s quality of life and help to prevent further complications.Case report: A 51-year-old male patient, presented to the emergency unit with epigastric pain. Patients also reported yellowing of the eyes and body, followed by dark-colored urine and pale stools. The patient also experienced unintentionalweight loss. Physical examination indicated icteric conjunctiva. Laboratory test result demonstrated the patient had abnormal liver function test and elevated of tumor marker CA 19-9. After underwent magnetic resonance cholangiopancreatography (MRCP), and based on other collected clinical data, it was concluded that the patient had a pancreatic head carcinoma with cholestatic jaundice manifestation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to release the cholestatic obstruction, subsequently his condition was gradually improved. On follow-up evaluation, the patient underwent endoscopic ultrasonography (EUS) examination, and revealed to have chronic pancreatitis also with multiple stones in the pancreas. This case report will discuss the diagnostic approach and possible treatment for the patient with such condition.
Pseudomyxoma Peritonei Mimicking Liver Cirrhosis: A Case Report and Literature Review Paramita, Diah Pradnya; Somayana, Gde
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202688-94

Abstract

Pseudomyxoma peritonei (PMP) is a rare condition caused by rupture of a primary mucinous tumor, followed by dissemination of tumor cells within the peritoneal cavity and excessive mucin production. The signs and symptoms are generally nonspecific, making early diagnosis difficult. We present a man, age 57, who showed abdominal distention accompanied by nausea and vomiting for approximately four months, which was referred to as liver cirrhosis. Carcinoembryonic antigen level was elevated and postoperative histology revealed low-grade peritoneal mucinous neoplasia. The signs and symptoms of PMP are generally nonspecific, making it difficult to diagnose earlier and leading to delayed appropriate treatment. Computed tomography (CT) scan is the preferred imaging modality for determining the extent of the disease preoperatively. Elevated tumor marker level, especially CEA, CA19-9, and CA-125, is usually suggestive of the diagnosis of PMP. Immunohistochemistry was used to determine the origin of primary malignancy. PMP management needs to be individualized; therefore, discussion among multidisciplinary teams is needed. Currently, the most common treatment option is cytoreductive surgery (CRS) in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) and has been associated with improved survival in several studies. However, if there are limitations in therapeutic modalities or patient populations, alternative therapies can be used. This case report aims to highlight the diagnostic challenges of pseudomyxoma peritonei presenting as ascites that mimics liver cirrhosis.
Immune Checkpoint Inhibitors (ICI) in the Functional Cure of Hepatitis B: A Narrative Review Putra, I Komang Wisuda Dwija; Mariadi, I Ketut; Somayana, Gde
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202660-69

Abstract

Chronic hepatitis B (CHB) remains a major global health burden, largely due to the persistence of covalently closed circular DNA (cccDNA) within infected hepatocytes, which hinders complete viral eradication despite long-term antiviral therapy. In recent years, immune checkpoint inhibitors (ICIs) have emerged as a potential therapeutic strategy by restoring exhausted antiviral immune responses. This review explores the mechanisms of action of ICIs, their current application in hepatitis B virus (HBV) infection, and their potential role in achieving a functional cure. Available evidence indicates that ICIs targeting programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) are capable of partially restoring HBV-specific T-cell function and reducing intrahepatic cccDNA transcriptional activity. Early-phase clinical studies have demonstrated encouraging outcomes, including declines in hepatitis B surface antigen (HBsAg) levels and occasional HBsAg loss; however, consistent achievement of a functional cure remains limited. Notably, combination strategies involving ICIs with therapeutic vaccines or nucleos(t) ide analogues appear to enhance antiviral efficacy compared with monotherapy. In conclusion, ICIs represent a promising adjunctive approach for CHB treatment and may contribute to the pursuit of a functional cure. Nevertheless, further well-designed clinical trials are required to establish their long-term safety, optimal treatment combinations, and effectiveness, particularly in HBV-endemic populations.
Validation Study of the Cirrhosis Acute Gastrointestinal Bleeding Score as Predictor Mortality in Patients with Liver Cirrhosis and Upper Gastrointestinal Bleeding Mariadi, I Ketut; Hardian, Harris; Alamsyah, Ajib Zaim; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Nyoman Gita Kharisma; Pamungkas, Kadek Mercu Narapati; Somayana, Gde; Wira Nugraha, Komang Agus; Sindhughosa, Dwijo Anargha; bin Abd Rahman, Mohamad Fadli
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202619-26

Abstract

Background: The Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score was developed as a mortality predictor by integrating a range of clinical and laboratory parameters. This research seeks to validate the efficacy of the CAGIB score in predicting in-hospital mortality among cirrhotic patients experiencing upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital.Methods: This study is a prospective observational study employing a validation test approach. A total of 161 patients diagnosed with liver cirrhosis and upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital were enrolled. Receiver Operating Characteristic (ROC) analysis was utilized to evaluate the prognostic capability of the CAGIB score in predicting mortality and to identify the optimal cutoff point. Validation was conducted by assessing the CAGIB score's sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).Results: The analysis of the CAGIB score as a predictor of mortality yielded an area under the curve (AUC) value of 0.83, with the optimal cutoff point determined at ≥ -4.66, based on the point farthest from the diagonal line on the ROC curve. The 95% Confidence Interval (CI) ranged from 0.777 to 0.897. Validation testing of the CAGIB score as a predictor of in-hospital mortality demonstrated a sensitivity of 80.8%, specificity of 70.5%, PPV of 69.4%, and NPV of 81.6%.Conclusion: The CAGIB score has been demonstrated to serve as a valid predictor of mortality, exhibiting commendable sensitivity and specificity, along with satisfactory positive and negative predictive values. The optimal cutoff points appropriately reflect the demographic and clinical characteristics of the cirrhosis patient population with UGIB at Ngoerah Hospital
Co-Authors Alamsyah, Ajib Zaim bin Abd Rahman, Mohamad Fadli Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Putu Itta Sandi Lesmana Dwijo Anargha Sindhughosa, Dwijo Anargha Gerry Setiawan Godfried Erycesar Yeremia Saragih Hardian, Harris Hendra Koncoro Hendra Koncoro I Dewa Nyoman Wibawa I Gusti Agung Suryadarma I Ketut Mariadi I Nyoman Hardana Sasmita Purthana I Putu Darmayasa IDN Wibawa Jessica Raphaela Pranata Kumbara, Cokorde Istri Yuliandari Krisnawardani Made Wardhana Magat, Renaldy Frederich Nathanael Nyoman Purwadi Pamungkas, Kadek Mercu Narapati Paramita, Diah Pradnya Putra, I Komang Wisuda Dwija Putu Prathiwi Primadharsini Wayan Arlis Saputra Wira Nugraha, Komang Agus