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All Journal journal of internal medicine E-Jurnal Medika Udayana Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Jurnal Ilmiah Sangkareang Mataram The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

I Dewa Nyoman Wibawa

Department Of Clinical Microbiology, Faculty Of Medicine, University Of Udayana, Bali

Author-ID : 414191

Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Social Sciences

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Association Between Red Cell Distribution Width (RDW)/Platelet Ratio and Degree of Fibrosis in Patient with Chronic Hepatitis B Yaditta Mirdania; I Ketut Mariadi; IDN Wibawa
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: Histological examination of the liver remains the gold standard of assessing liver cirrhosis. However, this examination is an invasive method with many complications. This study aims to determine therelationship between degree of liver fibrosis with red cell distribution width (RDW)/platelet ratio which can then be used as non-invasive diagnostic method of liver fibrosis.Method: This was a retrospective study, the data of hematological profiles including hemoglobin, RDW, and platelet was taken from medical records of all chronic hepatitis B patients undergoing Fibroscan at Sanglah Hospital in January 2016 to February 2017.Results: Of 58 patients, 10 patients was excluded due to chronic kidney disease, malignancy and coincide with hepatitis C and HIV. The analysis using Kruskal-Wallis test, found a significant relationship betweenRDW/platelet ratio with degree of fibrosis in chronic hepatitis B (p 0.05). Of the 48 patients, 23 patients with mild-moderate fibrosis (metavir F0-2) and 25 patients with severe fibrosis (metavir F3-4) were found. In ROCanalysis, the AUC was 0.734, using cut off 0,065 RDW/platelet ratio predict severe fibrosis about 7% sensitivity, specificity 73.9%, positive prediction value 73.1%, and negative prediction value 70.8%.Conclusion: The RDW/platelet ratio can be used as a noninvasive diagnostic test of liver fibrosis in chronic hepatitis B patients.

Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer Hendra Koncoro; I Dewa Nyoman Wibawa
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

Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology.

Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Dewa Gde Agung Budiyasa; Yuna Ariawan; I Ketut Mariadi; I Dewa Nyoman Wibawa; Nyoman Purwadi; I Gusti Agung Suryadarma
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201123-27

Background: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis. Keywords: albumin, degree of EV, liver cirrhosis

Acute Pancreatitis as a Complication of Choledochal Cyst Hendra Koncoro; I Dewa Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 2, August 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Choledochal cysts (CCs) are rare congenital disorders of the biliary tree which are associated with biliary tract and pancreatic complications. Its etiology is still unknown, but some evidences suggest that CCs are caused by infection during embryogenesis. The laboratory evaluation reveals abnormalities due to pancreatobiliary complications, such as ascending cholangitis, cholecystitis, and pancreatitis. Radiologic examination may delineate the structural abnormalities occured in CCs and confirm the diagnosis. The major mortality is caused by cholangiocarcinoma. This case discussed the diagnosis and treatment of a 20-year-old male with choledochal cyst and its complications. Management consists of therapy on complication and definitive therapy. Keywords: choledochal cyst, acute pancreatitis, cholecystitis

A Two Generation of Familial Adenomatous Polyposis Lily Chandrawati; I Dewa Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 3 (2019): VOLUME 20, NUMBER 3, December 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Familial adenomatous polyposis (FAP) is a part of genetic polyposis syndrome which is caused by germline mutation in the adenomatous polyposis coli (APC) gene located in chromosome 5q21. The pathognomonic features is formation of hundreds to thousands of colorectal adenoma in late childhood and increase in size and number during adolescence. If left untreated, almost 100% patients will develop colorectal cancer by the age 50 years. We present a case of 26 year old male who complain of rectal bleeding, diarrhea, abdominal bloating, and has multiple polyps on colonoscopic finding. Two years ago, his father was diagnosed with polyposis coli and transverse colon adenocarcinoma. The patient was planned for preventive total colectomy. In conclussion, surgery remains the cornerstone treatment of FAP and surveillance program for early detection of cancer for all family member is very important to reduce colorectal cancer-related mortality.

High Incidence of Hepatitis B Virus Infection in Hemodialysis Patients at Sanglah General Hospital and It’s Risk Factors Cokorda Agung Wahyu Purnamasidhi; I Ketut Mariadi; I Dewa Nyoman Wibawa; Yenny Kandarini
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 3 (2016): VOLUME 17, NUMBER 3, December 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Patients receiving maintenance hemodialysis (HD) are at higher risk for Hepatitis B Virus (HBV) infections than in general population. Strict infection control is essential to prevent nosocomial transmission. We aimed to investigate the incidence of HBV infection in the HD population in Sanglah General Hospital as well as risk factors acquired HBV infection.Method: All adult patients receiving maintenance HD (n=267) in 3 dialysis units at Sanglah Hospital were studied between March to June 2016. In this study, medical record of patients on maintenance hemodialysis were reviewed and the patients were interviewed by the researchers to collect data regarding the serology status of these patients before and during HD, and potential risk factors which could be associated with HBV acquisition.Results: Participant mean age was 54.07 ± 0.80 years and 154 (57.7%) were male.We found 21 patients (7.8%) were sero-positive for HBV (HBsAg positive) with mean titer was 9.26±1.85. Of the sero-positive patients,1 patient (4.8%) were known to be infected before the initiation of HD and 20 patients (95.2%) were infected during HD. Incidence of HBV infection during HD was 7.5% (20/266). Sero-positive patients were younger with mean age was 51.81±2.76 years, had longer time on dialysis and had previous blood transfusions. Risk factors, which significant associated with hepatitis B infection were history of transfusion (p0.01; OR: 2.49; 95%CI: 1.29-8.18) and duration of hemodialysis (p 0.01; OR: 1.07; 95% CI: 1.03-3.74).Conclusion: Patients on maintenance HD in Sanglah General Hospital have a high incidence of HBV infection. The factors associated with HBV infection are highly suggestive of nosocomial transmission within HD units. History of transfusion and duration of hemodialysis were significant risk factors for HBV infection in patients receiving maintenance HD.

Positive Correlation between Degree of Liver Cirrhosis and N Terminal–Pro Brain Natriuretic Peptide (NT-pro-BNP) Mario Steffanus; IDN Wibawa; I Ketut Badjra Nadha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 2 (2015): VOLUME 16, NUMBER 2, August 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Liver cirrhosis (LC) is a chronic disease characterized by damage of liver parenchyme with wide fibrosis and nodules formation. One of LC complications is cirrhotic cardiomyopathy (CC). CC is diagnosed when there are more than one of the following signs: diastolic dysfunction (DD), systolic dysfunction (SD), enlargement of the cardiac chamber, electrophysiology dysfunction, and increasing of natriuretic peptide such as N Terminal–Pro Brain Natriuretic Peptide (NT-proBNP). The aim of this study was to determine the correlation between degree of liver cirrhosis and increasing of the NT-proBNP.Method: Cross-sectional analytic study was performed with 72 LC patients from May 2014 to May 2015 in Sanglah General Hospital, Denpasar. Degree of liver cirrhosis was determined by child turcotte pugh (CTP) criteria and NT-proBNP was examined by electro chemiluminescence immunoassay (ECLIA) method. LC patients with other disorders which can cause the increase of NT-proBNP were excluded. Statistical analysis used was Spearman’s correlation test. Results: Of 72 LC patients, 79.2% were male. Patients with CTP A were 9 (12,5%), CTP B 19 (26,4%) and CTP C 44 (61,19%). Median of NT-proBNP in CTP A was 112 pg/mL, CTP B 130 pg/mL, and CTP C 315 pg/ml. There was a strong possitive correlation between degree of liver cirrhosis and NT-proBNP (r = 0.686; p = 0.000). In this study, there was also significant comparison between NT-proBNP and CTP A,B, and C (p = 0,000) and there was no significant relation between NT-proBNP and those cofounding variables (p 0.05).Conclusion: there was a strong possitive correlation between degree of LC and NT-proBNP.

Red Cell Distribution Width to Platelet Rasio is not inferior than Aspartate Aminotransferase to Platelet Ratio Indeks Score in Predicting Liver Fibrosis in Chronic Hepatitis B Patients at Sanglah General Hospital Denpasar Jemi Tubung; I Ketut Mariadi; IDN Wibawa
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: Red cell distribution width to platelet ratio (RPR) is known to be associated with a degree of liver fibrosis in patients with hepatitis B. This study aims to compare the under curve area, sensitivity, specificity, positive predictive value, and negative predictive value between RPR and aspartate aminotransferase to platelet ratio index (APRI) score with degree of fibrosis.Method: This study is a retrospective study, data taken from medical records of all chronic hepatitis B patients examined by Fibroscan at Sanglah General Hospital Denpasar, Bali from January 2016 to February 2018.Results: Ninety eight patients with chronic hepatitis B, 81 patients were recovered after exclusion of patients with chronic kidney disease, malignancy, and dengue haemorrhagic fever (DHF). In receiver operating characteristic (ROC) analysis, obtained area under the ROC curve (AUC) at RPR of 0.816, and at APRI score 0.797. In RPR with cut off 0.066 the sensitivity was 76.9%, specificity 78.6%, PPV 79.5%, NPV 73.8%. While APRI score with cut off 0.85 got 69.2% sensitivity, specificity 76.2%, PPV 73.0%, and NPV 72.7%. According to Kappa test, we found kappa coefficient 0.653 (p 0.05).Conclusion: In predicting severe liver fibrosis in chronic hepatitis B patients, RPR is not inferior than APRI score, and may be used as a diagnostic marker, with 65.3% conformity.

Acute Tuberculous Appendicitis with Intestinal Obstruction Yongkie Iswandi Purnama; I Dewa Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, August 2019
Publisher : The Indonesian Society for Digestive Endoscopy

Tuberculosis (TB) can involve any organs. Tuberculous appendicitis is a rare case. Incidence of primary tuberculous appendicitis is 0.1-0.3% while incidence of secondary tuberculous appendicitis is 1.5-3%. Tuberculous appendicitis occurs in 0.08% of all appendectomy and 0.2% of all TB cases. We reported an acute tuberculous appendicitis with intestinal obstruction. Diagnosis was established based on histopathological findings. Treatments included appendectomy and first category of anti tuberculosis drugs (ATD) for 6 months. This case was reported to add our insight about possibility of TB as an etiology of many pathologic conditions in abdominal cavity.

Detection of Helicobacter pylori CagA gene and Its Association with Endoscopic Appearance in Balinese Dyspepsia Patients I Ketut Mariadi; I Dewa Nyoman Wibawa; Ida Bagus Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Helicobacter pylori (H. pylori) infection causes various abnormalities in the stomach. Only particular strain can cause severe problems in the stomach. CagA is a microbial virulent factor which is associated with more severe stomach problems, such as: peptic ulcer and stomach cancer. We would like to know the prevalence of CagA in Balinese population, and the association of H. Pylori CagA status with the severity of endoscopic appearance in dyspepsia patients.Method: Study design being used was analytic cross sectional study, involving 71 dyspepsia patients who underwent upper gastrointestinal endoscopic examination in Surya Husada Hospital and Balimed Hospital in June-December 2013. Sample was chosen in consecutive manner. Later, polymerase chain reaction (PCR) examinations of the stomach mucous biopsy tissue to determine H. pylori infection status and CagA status were performed. Further, Chi square test was used to identify the difference in proportion of H. pylori and CagA between mild and severe endoscopic appearance.Results: In this study, we found that the prevalence of H. pylori infection was 22.5% using PCR examination. Prevalence of CagA positive in H. pylori positive was 62.5%. There was significant association between status of H. Pylori infection and severity of endoscopic appearance (p = 0.038; OR= 2.67; 95% CI = 1.18-6.05). Status of CagA in H. pylori infected patients was not associated with the severity of endoscopic appearance. Additionally, there was significant association between patients’ age and severity of endoscopic appearance.Conclusion: The prevalence of CagA in H. pylori positive was 62.5%. H. pylori infection was associated with severity of endoscopic appearance and CagA status in H. pylori infected patients was not associated with severity of endoscopic appearance.

Co-Authors - Mulyanto, - Anak Agung Ayu Yuli Gayatri Anak Agung Gde Waisampayana Putra Anwar Santoso Chandrawati, Lily Cokorda Agung Wahyu Purnamasidhi Dewa Gde Agung Budiyasa Dewa Gde Agung Budiyasa Dwijo Anargha Sindhughosa, Dwijo Anargha Gde Ngurah Idraguna Pinatih Gde Somayana Godfried Erycesar Yeremia Saragih H Da Silva Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendriketa Da Silva, Hendriketa Da I Gde Raka Widiana I Gusti Agung Suryadarma I Ketut Agus Somia I Ketut Badjra Nadha I Ketut Mariadi I Ketut Sujana I Made Juliana I Made Susila Utama I Putu Arsana I Wayan Dary Ida Bagus Nyoman Wibawa Imro'ati, Tri Asih Indraguna Pinatih, Indraguna Jemi Tubung Juniarta, Pande Made Kumbara, Cokorde Istri Yuliandari Krisnawardani Lily Chandrawati Luh Putulin Indrayani Luh Putulin Indrayani, Luh Putulin Made Wardhana Magat, Renaldy Frederich Nathanael Mario Steffanus Mulyanto Nefertiti, Eva Pravitasari NGP Cilik Wiryan Ni Wayan Winarti Nicholas Wijayanto Nyoman Purwadi Pande Made Juniarta Paramita, Anak Agung Ketut Yunita Paramita, Ida Ayu Pradnya Prihastuti, Putu Shely Purnama, Yongkie Iswandi Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Titong Sugihartono Tjok Istri Anom S Tuti Parwati Wibawa, Ida Bagus Nyoman Widodo, Budi Yaditta Mirdania Yenny Kandarini Yongkie Iswandi Purnama Yuna Ariawan

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