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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
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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Upper Gastrointestinal Endoscopy as Diagnostic Test for Detection of Gastric Malignancy in Sanglah Hospital Denpasar Hendra Koncoro; Putu Prathiwi Primadharsini; Luh Putulin Indrayani; I Dewa Nyoman Wibawa
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (151.749 KB) | DOI: 10.24871/16120152-6

Abstract

Background: Gastric malignancy is the third most common cause of cancer-related death in the world. Upper gastrointestinal (UGI) endoscopy for detection of gastric malignancy has been used widely in Indonesia. This study aimed to determine the prevalence of gastric malignancy and diagnostic value of UGI endoscopy in detection of gastric malignancy in Sanglah Hospital, Denpasar.Method: A retrospective study on patients undergoing UGI endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between January 2012 and December 2014 was conducted. Endoscopical and histological diagnosis were documented. The diagnostic test of endoscopic diagnosis were conducted by showing its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.Results: One thousand and sixty eight patients with upper gastrointestinal symptoms were subjected to endoscopy between January 2012 and December 2014. Of the 1068 cases, 39 patients were suspected for gastric malignant lesions on UGI endoscopy. During the study period, histopathologically-confirmed gastric malignancy was found in 2.72% patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of UGI endoscopic diagnosis for these neoplastic lesions were 100%, 99.04%, 74.36%, 100%, and 99.06%, respectively.Conclusion: The prevalence of gastric malignancy was higher compared to western countries. Endoscopy is important as diagnostic tool in patients with suspicion of gastric malignancy. Greater suspicion in clinical judgment and carefulness in excluding malignancy through one histopathology negative findings need to be done to reduce the number of misdiagnoses of gastric malignancy.
C-Reactive Protein and Interleukin-6 Correlated with Resistin Level in Liver Cirrhosis I Ketut Mariadi; Hendra Koncoro; I Dewa Nyoman Wibawa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 1 (2020): VOLUME 21, NUMBER 1, April 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (136.339 KB) | DOI: 10.24871/211202017-21

Abstract

Background: The incidence of insulin resistance is very high in liver cirrhosis. Resistin is thought to be one of the factors contributing to the occurrence of insulin resistance. Liver Cirrhosis is a chronic inflammatory condition. C-reactive protein (CRP) and interleukin-6 (IL-6) are inflammatory mediators, which are associated with the severity of liver damage. Resistin also increases in liver cirrhosis. This study aimed to determine whether CRP and IL-6 levels were correlated with resistin levels in patients with liver cirrhosis.Method: An analytic cross-sectional study was conducted, in cirrhosis patients, to determine CRP and IL-6 levels as markers of the inflammatory process and blood resistin levels.Results: In this study was found, CRP and IL-6 levels were associated with the severity of liver cirrhosis. Resistin levels are associated with the severity of cirrhosis of the liver. CRP and IL-6 levels are positively correlated with resistin levels and as independent predictors of resistin levels.Conclusion: This study concluded that CRP and IL-26 levels are correlated with resistin levels and as independent predictors of resistin levels in liver cirrhosis patients.
FAKTOR RISIKO DAN GAMBARAN ESOFAGOGASTRODUODENOSKOPI PENGGUNA OBAT ANTI INFLAMASI NON-STEROID DI RSUP SANGLAH TAHUN 2016-2018 Magat, Renaldy Frederich Nathanael; Wibawa, I Dewa Nyoman; Somayana, Gde; Mariadi, I Ketut
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i01.P07

Abstract

The use of non-stereoidal anti-inflammatory drugs (NSAIDs) for a certain time and dose can cause abnormalities in the digestive tract ranging from asymptomatic, ulcers, bleeding to perforation. This study aims to determine the distribution of the proportion of patients with abnormality in gastric and duodenal due to NSAIDs based on esophagogastroduodenoscopy (EGD) results, age, gender, H. Pylori infection, type of NSAIDs, history of smoking, history of anticoagulants, history of corticosteroids and risk factors for EGD abnormalities in the gastric and duodenal due to NSAIDs use at Sanglah General Hospital in 2016-2018. This study is a retrospective cross-sectional study based on the medical records of patients who underwent endoscopy at Sanglah General Hospital in 2016-2018. The sampling technique was total sampling, then all data were analyzed using bivariate analysis of the chi-square test and multivariate logistic regression analysis. From 92 patients who met the criteria, men (54.3%) and women (45.7%) with the majority of the age group ³ 60 years (95.7%), EGD abnormalities were obtained in the form of superficial gastritis (33.7%), erosival gastritis (28.3%), gastric ulcer (28.3%), duodenal ulcer (5.4%). With ulcer characteristic are Forrest III (90.3%) and single (74.2%). The majority of patients used non-selective NSAIDs (94.5%), namely ketorolac 30 mg (40.2%). From the biopsy examination, the patient had H. pylori infection (20.5%). Based on medical records, the patients had a history of smoking (59.8%). Patients also found a history of use of anticoagulants (16.3%) and corticosteroids (35.9%). In this study, there was a significant relationship between H. pylori infection and severe EGD abnormalities in NSAID users (P = 0.012). In this study, there were no independent risk factors for severe EGD abnormalities in NSAID users, but there was a significant relationship between H. pylori infection and severe EGD abnormalities in NSAID users Keywords : NSAIDs, EGD, EGD abnormalities in NSAIDs user.
The Psychometric Hepatic Encephalopathy Score for Diagnosis of Minimal Hepatic Encephalopathy in Liver Cirrhosis Patient Kumbara, Cokorde Istri Yuliandari Krisnawardani; Wibawa, I Dewa Nyoman; Widiana, I Gde Raka
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202440-46

Abstract

Introduction: The psychometric hepatic encephalopathy score (PHES) is a tool that can be considered as a gold standard for detecting minimal hepatic encephalopathy (MHE) in liver cirrhosis patients. The PHES must be standardized based on the local healthy population before it can be used. The purpose of this study is to standardize the PHES with Indonesian local populations and set the cutoff point of PHES so it can be used to detect MHE in liver cirrhosis patients.Methods: PHES were administered to all enrolled subjects, which are healthy subjects and cirrhosis without overt encephalopathy subjects. The PHES consists of 5 psychometric tests. The influencing factors of PHES were assessed, and equations were developed to predict the expected result of each test. Diagnosis of MHE was built upon the deviation from the normal range value of PHES.Results: In total, 236 subjects participated in this research. The influencing factors of PHES of this study were age and education years. With the cutoff point of PHES less than -4, the prevalence of MHE was 37.7%, of which 7.6%, 50%, and 50% had Child-Turcotte-Pugh (CTP) grade A, B, and C respectively.Conclusions: The standardized version of PHES can be used to diagnose MHE in Indonesian liver cirrhosis patients. The PHES in this study were affected by age and education years. MHE was diagnosed if the PHES was less than -4. The incidence of MHE was found to increase along with the increase of the liver disease severity
Severity of Liver Injury and Its Relation to Clinical Outcome and Duration of Hospitalization in COVID 19 Patients Kumbara, Cokorde Istri Yuliandari Krisnawardani; Mariadi, I Ketut; Somayana, Gde; Wibawa, I Dewa Nyoman; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202447-52

Abstract

Background: Coronavirus Disease 2019 (COVID-19) can affect not only the respiratory system but also other organs such as the liver. Liver injury tends to occur in severe disease of COVID-19 patients and might contribute to clinical outcomes for patients. This study aimed to find the relationship between the severity of liver injury with clinical outcome and duration of hospitalizations.Methods: This study was a retrospective study of hospitalized COVID-19 patients period April 2020 to April 2021. The inclusion criteria were severe COVID-19 patients who developed a liver injury. The severity of the liver injury was classified into mild, moderate, and severe. The relationship between the severity of liver injury with clinical outcome and duration of hospitalization was analyzed. Univariate and logistic regression were used. Results: 90 samples fill the inclusion criteria. The liver injury severity was statistically significantly related to clinical outcome patients (p= 0.047), which is the increase in liver injury severity resulting in poor clinical outcomes. No significant relationship was found between the severity of liver injury with the duration of hospitalization.Conclusion: liver injury increases mortality in severe COVID-19 patients.
Oxidative Stress and the Severity of Gastroesophageal Reflux Disease: Is There Any Correlation? Imro'ati, Tri Asih; Sugihartono, Titong; Widodo, Budi; Nefertiti, Eva Pravitasari; Wibawa, I Dewa Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/253202445-52

Abstract

Background: Oxidative stress plays a crucial role in the inflammatory response of the oesophageal epithelium; hence, therapies that affect oxidative stress may be a new approach in GERD management.  The objective is to analyze and determine the correlation between Total Oxidant Status (TOS), Total Antioxidant Status (TAS), and Oxidative Stress Index (OSI) with severity of GERD.Methods: This is an observational analytic study using a cross-sectional design,that  conducted at the Endoscopic Unit of three hospitals in Surabaya, which held from June 2020 to March 2021. The 18 to 60 years old subjects who meet the GERD-Q score 8-18 and not meet the exclusion criteria undergo an endoscopic examination to determine the GERD severity and blood test. Data analysis was using the Spearman rank correlation test.Results: This study indicates that most subjects are women, with mean age 39.31±10.99 years, most are GERD grade A, the mean value of TOS, TAS, ISO respectively is 5.18±1.60, 1.58±0.18, and 3.36±1.35. The laboratory test results show insignificant different based on GERD degree.  There is a non-significant positive correlation between TOS and GERD severity, a significant negative correlation  between TAS and  GERD severity, and a significant positive correlation between OSI and GERD severity (respectively, r = 0.121, p = 0.266 vs r = -0.323, p = 0.044 vs r = 0.345, p = 0.033).Conclusion:  The TAS and OSI may be correlated to the GERD severity but still need further investigations. 
Multimodal Treatment of Cystic Echinococcosis Paramita, Anak Agung Ketut Yunita; Wibawa, I Dewa Nyoman
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: 10.24871/241202372-82

Abstract

Cystic echinococcosis is a zoonotic disease that is caused by the larval stages of cestodes species and belongs to the genus Echinococcus. Echinococcus granulosus (E. granulosus) causes cystic echinococcosis which is global and wider in its distribution than alveolar echinococcosis. Endemic areas of E. granulosus are Russia, Eastern Europe, the Middle East, China, and South America based on data from the World Health Organization (WHO). Incidence rates are 50 per 100,000 person-years. The life cycle of E. granulosus requires both an intermediate host and a definitive host. A human accidentally becomes an intermediate host. Upon infection, cyst formation mostly occurs in the liver (70%). At the first, the infection is usually asymptomatic. Diagnosis of cystic echinococcosis can be done by imaging techniques (ultrasound or CT/MRI), serum serologic testing for antibodies against hydatid antigens, and immunologic testing. In general, there are four different management modalities for cystic echinococcosis, such as surgery, percutaneous therapy surgery, chemotherapy, and watchful waiting.
Diagnosis and Management of Chylous Ascites Prihastuti, Putu Shely; Wibawa, I Dewa Nyoman
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: 10.24871/241202363-71

Abstract

Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. This usually occurs due to trauma and rupture of the lymphatics or increased peritoneal lymphatic pressure secondary to obstruction. The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic or cardiogenic. Since malignancy and cirrhosis account for about two-thirds of all the cases of CA in Western countries. The diagnosis of CA is based on the distinct characteristic of the ascitic fluid which includes a milky appearance and a triglyceride level of 200 mg/dL. The management consists of identifying and treating the underlying disease process, dietary modification, and diuretics. Treatment with nutritional optimization and management of the underlying etiology are the cornerstones of therapy. When conservative measures fail, other interventions such as octreotide/somatostatin analogues, surgical ligation, embolization and transjugular intrahepatic portosystemic shunt in patients with cirrhosis can be considered.
Occult Hepatitis B Infection in Kidney Transplant Patients Paramita, Ida Ayu Pradnya; Wibawa, I Dewa Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 3 (2022): VOLUME 23, NUMBER 3, December 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2332022226-233

Abstract

Occult hepatitis B infection (OBI) is still a topic of debate worldwide. It is defined as the presence of hepatitis B virus (HBV) DNA in serum and/or liver from HBsAg-negative subjects. OBI may lead to the development of cirrhosis and hepatocellular carcinoma. It continues to present several unique challenges in organ transplantation despite the availability of an effective vaccine to prevent HBV infection and the introduction of oral therapy to treat HBV infection. HBV reactivation following organ transplantation can occur even in recipients with absent hepatitis B surface antigen and remains an important cause of morbidity and mortality. Concerning OBI complications, the screening of HBV DNA by the highly sensitive molecular means should be implemented for both recipients of organ transplant and organ transplant donors especially in highly endemic areas of HBV. In the era of potent antivirals and with evolving knowledge, HBsAg (+) renal transplant candidates and recipients can be monitored and successfully treated. Kidney organs from HBsAg-negative and anti-HBc–positive donors should be considered for transplant candidates after weighing the risk-benefit ratio. All transplant candidates should receive HBV vaccination if they are not immune to facilitate receipt of an organ from a donor with anti-HBc seropositivity.
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