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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Abdul Aziz Rani
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Medicine & Pharmacology

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Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy Lianda Siregar; Abdul Aziz Rani; Chudahman Manan; Marcellus Simadibrata; Dadang Makmun
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 3, December 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (582.439 KB) | DOI: 10.24871/1232011140-145

Abstract

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them. Keywords: non-variceal upper gastrointestinal bleeding, Rockall score, elective endoscopy, outcome variables
Hemobilia after 49-days Accidental Hepatic Trauma and Twice Perihepatic Packing Dedy Gunawanjati Sudrajat; Gunawanjati Sudrajat; Ellen Susanti; Sumaryono Sumaryono; Ari Fahrial Syam; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 2, August 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/102200985-89

Abstract

Hemobilia occurs in only 1.2–5% of patients with accidental liver trauma. Clinical presentation of hemobilia include one symptom and two signs known as the classic Quinke triad, upper abdominal pain, upper gastrointestinal bleeding and jaundice. This report describes a case of patient with hemobilia that had been diagnosed 49 days after accidental hepatic trauma and twice perihepatic packing. A 29-year old man with hematemesis melena came to the hospital with the history of hepatic accidental trauma and had already received twice perihepatic packing treatment. At first, the esophagogastroduodenoscopy could only find gastritis and duodenal ulcer. Subsesquently, the ultrasonography revealed liver hematoma. Diagnosis of hemobilia was made when bleeding exiting from the ampulla of Vater which then was confirmed by the second esophagogastroduodenoscopy. Surgery had been planned but the patient and his family had refused the procedure. Hemobilia should be considered in patients presenting with gastrointestinal blood loss after liver injury. The diagnosis is confirmed by esophagogastroduodenoscopy and angiography. Modalities used to stop bleeding include angiography with embolization, surgical intervention, observation, and electro- coagulation or photocoagulation.   Keywords: hematemesis, melena, liver injury, hemobilia, esophagogastroduodenoscopy
Effects of BCAA Enteral Nutrition to the Change of Nutritional Status and Hepatic Encephalopathy Parameters in Liver Cirrhosis Patient with Hepatic Encephalopathy Achmad Fauzi; Unggul Budihusodo; Nurul Akbar; Pradana Suwondo; Suhardjono Suhardjono; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 2, August 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/102200956-62

Abstract

Background: This study was also conducted to determine the effects of high-branched chain amino acid (BCAA) enteral supplementation on altered nutritional status parameters (including plasma prealbumin) and hepatic encephalopathy parameters in liver cirrhosis patients with hepatic encephalopathy. Method: Our study was a randomized, single-blinded experimental study comparing between control group of liver cirrhosis patients with standard hospital liver diet (40 kcal/kgBW/day for male and 35 kcal/kgBW/day for female; protein 1.25 g/kgBW/day) and experimental group of liver cirrhosis patients with liver diet modification high in BCAA supplementation, which had similar protein and calorie calculation as the control group. Results: Subclinical hepatic encephalopathy prevalence was 32%. In the experimental group, prealbumin plasma, arm circumference, body weight and body mass index (BMI) increased; whereas in the control group, prealbumin plasma, arm circumference, body weight and BMI decreased (p 0.05). In experimental group, the ammonia level significantly decreased (p 0.01). Clinical hepatic encephalopathy, flapping tremor, the number connection test (NCT) did not show significant changes between the two groups. However, there was worsening trend in the control group. Level of albumin, bilirubin, AST, ALT did not show any significant difference between both groups. Conclusion: High-BCAA enteral supplementation which is administered to liver cirrhosis patients with hepatic encephalopathy for 14 days could improve plasma prealbumin level, arm circumference, body weight, BMI and could decrease the plasma ammonia level. However, it does not improve Fischer ratio, psychometric test and electroencephalography   Keywords: malnutrition, liver cirrhosis, BCAA, Fisher ratio
Pancreatic Exocrine Insufficiency in Chronic Diarrhea Marcellus Simadibrata; Daldiyono Hardjodisastro; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 1, April 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/6120054-9

Abstract

Background: One of the causes of chronic diarrhea is pancreatic exocrine insufficiency. Chronic diarrhea cases are commonly encountered in Indonesia. Materials methods: All patients with chronic diarrhea at hospitals in Jakarta were included in this study and dyspeptic patients were used as control subjects. The study and control subjects must submit their stool for fecal pancreatic elastase-1 examination at a private laboratory in Jakarta. Mild/moderate pancreatic exocrine insufficiency was defined if the concentration was between 100 - 200 mg E1/g stool. Severe pancreatic exocrine insufficiency was defined if the concentration was below 100 mg E1/g stool. The data was analyzed using Fisher or Kruskal-Wallis tests. Results: There were 32 chronic diarrhea patients with a male to female ratio of 19/13 (59.38%/40.62%). The most frequent age range was 50-59 years old (39.5%). The characteristics (sex, age and race) of chronic diarrhea patients were matched with the characteristics of dyspeptic patients as control subjects (p 0.05). The fecal elastase-1 results in chronic diarrhea displayed greater pancreatic exocrine insufficiency ( 200 mg E1/g stool) than in dyspepsia (control) ( 200 mg E1/g stool, p 0.001). The mean fecal elastase-1 Result in chronic diarrhea and in dyspepsia were 316.29 + 195.44 vs. 475.93 + 65.33 mg E1/g stool (p 0.001). Six patients (18.74%) were established as having severe pancreatic exocrine insufficiency. Seven patients (21.88%) were found with mild/moderate pancreatic exocrine insufficiency. Conclusion: Pancreatic exocrine insufficiency was found frequently in chronic diarrhea Keywords: pancreatic exocrine insufficiency, chronic diarrhea, fecal pancreatic elastase-1
Colorectal Cancer Metastasis of and the Risk Factors Ahmad Soefyani; Abdul Aziz Rani; Marcellus Simadibrata; Murdani Abdullah; Ening Krisnuhoni
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/11120107-10

Abstract

Background: Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them 40 years old, 37.2% patients 41-60 years old, and 29.4% patients 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis. Keywords: colorectal cancer, metastasis, well-differentiated, poorly-differentiated
The Discrepancy of Colonoscopical and Histopathological Findings in Infectious Colitis: Focus on Amebic Colitis Salius Silih; Marcellus Simadibrata; Murdani Abdullah; Abdul Aziz Rani; Irsan Hasan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009105-109

Abstract

Background: Result of colonoscopic examination in infectious colitis was varying. The aim of this study was to recognize the correlation between colonoscopical and histopathological findings in patients with infectious colitis at Cipto Mangunkusumo hospital, Jakarta. Method: A cross-sectional study had been conducted. There were 227 patients with infectious colitis with unidentified etiology and 17 patients with amebic colitis. In both groups, several variables had been studied including sex, age group and indication of colonoscopy by using Chi-square test. The relationship between hematochezia and amebic colitis event was also studied by using Chi-square test. To recognize the ability of colonoscopy test in diagnosing amebic colitis, we conducted diagnostic test by searching the sensitivity and specificity. Result: In both groups of infectious colitis, we found male more frequent than female. There was a significant difference mean of age in both group of infectious colitis (p = 0.04). The mean age of amebic colitis group was younger (35.86 ± 14.36 years) than the other infectious colitis group (45.34 ± 15. 90 years). The incidence of amebic colitis was more frequent in hematochezia than in non -hematochezia (p 0.001). The sensitivity and specificity of colonoscopy in diagnosing amebic colitis were 35% and 97%, respectively. Conclusion: There was a tendency of developing amebic colitis in patients with hematochezia than non-hematochezia. In diagnosing the presence of amebic colitis, colo noscopy examination has lo w sensitivity and high specificity.   Keywords: discrepancy, infectious colitis, amebic colitis, colonoscopy, histopathological finding
Diagnostic Value of Barium Esophagogram and Bernstein Test in Patients with Esophagitis Juwanto Juwanto; Chudahman Manan; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 1, April 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2120015-13

Abstract

From the 19th of July to the 19th of October 1999, we conducted a study to evaluate the diagnostic capabilities/benefits of the double contrast barium esophagogram in patients with esophagitis. The sample patients were taken from patients with reflux-type dyspepsia who visited the out patient clinic of the Sub-department of Gastroenterology of the Department of Internal Medicine of the Faculty of Medicine of the University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta. During the duration of study, 32 patients fulfilled the criteria for inclusion, and did not fulfill the criteria for exclusion. All of the subjects underwent double contrast barium esophagogram, Bernstein test, and endoscopy of the upper gastrointestinal tract, as well as biopsy of the lower third esophageal mucosa. The chief complaints for reflux type dyspepsia were found in the following order: pyrosis/heartburn (56.26%), acid/sour taste in the mouth (12.5%), chest pain (9.38%), swallowing disturbance (6.25%), breathing difficulties (6.25%), belching (6.25%), and palpitation (3.12%). From  the  32  patients  with  reflux  type  dyspepsia  that  underwent  double  contrast  barium esophagogram, 10 patients (31.25%) were found positive for esophagitis, and the remaining 22 patients were found to be negative (68.75%). Bernstein test found 11 patients (34.37%) positive and 21 (65.63%) negative, while endoscopy of the upper gastrointestinal tract showed positive esophagitis in 25 patients (78.13%) and negative in 7 patients (21.87%). The degree of accordance between double contrast barium esophagogram and the Bernstein test or even a combination of the two was unsatisfactory in diagnosing esophagitis in reflux type dyspepsia. Based on this, this study concludes that double contrast barium esophagogram and Bernstein are incapable of replacing endoscopic examination in establishing the diagnosis of esophagitis.    Keywords: esophagitis, esophagogram, Bernstein test
Influence of Fucoidan in Mucus Thickness of Gastric Mucosa in Patients with Chronic Gastritis Kaka Renaldi; Marcellus Simadibrata; Ari Fahrial Syam; Abdul Aziz Rani; Ening Krisnuhoni
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (574.172 KB) | DOI: 10.24871/122201179-84

Abstract

Background: Chronic gastritis is commonly found with complains of dyspepsia, which may decrease work productivity. Imbalance between agressive and defensive factors is the cause of chronic gastritis. Therapy is mostly directed to the agressive factors, particularly gastric acid and very few studies are directed on defensive factors. Mucus is the first defense mechanism of gastric mucosa. Fucoidan is a phytopharmaca, which is thought to increase the thickness of gastric mucosa. The objective of this study was to know the thickness of gastric mucosa in patients with chronic gastritis and to evaluate the effect of fucoidan to the gastric mucosa thickness in patients with chronic gastritis. Method: In this double-blinded randomized clinical trial study, 41 patients in the Endoscopy Unit Cipto Mangunkusumo Hospital between October 2009 and October 2010 were enrolled consecutively. Selected patients were divided into 2 groups: a group was given fucoidan and another group was given placebo. Statistical analysis was done using T-test. Results: Of 41 chronic gastritis patients, only 34 patients completed this study. There was difference of mucus thickness of gastric mucosa in patients with chronic gastritis; in the antrum 42.59 µ m (± 8.67) and in the corpus 44.28 µ m (± 9.64). This study also showed that fucoidan administration increased the mucus thickness in the antrum by 7.42 µ m and in the corpus by 7.74 µ m compared to placebo significantly. Conclusion: Fucoidan increased the mucus thickness of gastric mucosa in patients with chronic gastritis. Keywords: mucus thickness, chronic gastritis, fucoidan
Motility Indole Urease as An Alternative Diagnostic Method for Identifying Helicobacter pylori Infection Widyasari Kumala; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2220015-7

Abstract

Background: The prevalence of Helicobacter pylori (H. pylori) infection in the world is quite high, especially in developing countries.  Usually the patient shows no specific symptoms and chronic gastritis therefore becomes chronically infected. The complication of the infection is the development of peptic ulcer, which is a predisposing factor for gastric carcinoma. Early diagnosis is an important step to avoid these complications by providing immediate accurate therapy. Methods: In this study, the CLO, MIU (Motility Indole Urease) tests and culture were conducted on 131 biopsy samples of the stomach antrum mucous tissue taken from chronic dyspepsia patients from several hospitals in Jakarta. In the CLO test, biopsy tissue was put in a small well agar to be incubated at room temperature. In the MIU test the biopsy tissue sample was submerged in the small MIU tube agar with a depth of approximately 2/3 rds from the surface, and then incubated at room temperature. Another piece of biopsy tissue was cultured micro-aerophylically.  The CLO and MIU tests are considered positive if the color changes from yellow to red, and are considered negative if there is no color change within 24 hours. Results: Compared to culture, the CLO test demonstrated 38% sensitivity, 96% specificity, 94% positive predictive value and 52% negative predictive value, whereas the Results of the MIU test aga inst culture method showed 76% sensitivity,   89% specificity, 88% positive predictive value, and   78% negative predictive value. Conclusion: The MIU test that showed high sensitivity and specificity, and thus could be further developed as an alternative diagnostic method for H. pylori infection.    Keywords: MIU,CLO, H. pylori infection
Characteristic Profiles of Parasitic and Fungal Infections in Acute Diarrhea Marcellus Simadibrata; Suzana Ndraha; Tjahjadi Robert Tedjasaputra; Ari Fahrial Syam; Achmad Fauzi; Murdani Abdullah; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 3, December 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (553.035 KB) | DOI: 10.24871/1232011146-150

Abstract

Background: Diarrhea has been widely encountered in developing countries, including Indonesia. This study aimed to investigate the incidence of parasites and fungal infections, which also constitutes the etiologies of acute diarrhea. Method: A cross-sectional study was performed involving 93 patients. Patients with chief complaint of acute diarrhea were recruited at five hospitals in Jakarta, Indonesia during the period of November 2008 until May 2009. Acute diarrhea was defined as passing watery or soft stools with frequency of more than three times per day, weighted more 200 g per day, and occurred in less than 15 days duration. They were asked to collect their stool to the laboratory for further parasites and fungal detection. Results: This study showed that 41 out of 93 patients (44.09%) were found to be infected with parasites or fungi. The most common microorganism found was Candida albicans in 18 (19.35%) patients. Other parasites encountered in the stool samples were Blastocystis hominis, Entamoeba histolytica, Entamoeba coli, Giardia lamblia. The presenting clinical symptoms of the patients were fever (44.87%), bloating (41.03%), nausea (39.74%), oliguria (39.74%), cephalgia (35.90%), vomiting (24.36%), and tenesmus (19.23%). Conclusion: The incidence of parasitic and fungal infections in patients with acute diarrhea constitutes nearly half of all cases of infection-caused diarrhea. The most commonly encountered microorganism is Candida albicans. Keywords: parasites, fungi, acute diarrhea
Co-Authors Aan Santi ACHMAD FAUZI Ahmad Fauzi Ahmad Soefyani Ahmar Abyadh Ali Imron Yusuf Ari Fahrial Syam Bona Adhista Budi Tan Oto Chudahman Manan Dadang Makmun Daldiyono Daldiyono Daldiyono Hardjodisastro Deddy Gunawanjati Dedy Gunawanjati Sudrajat Dharmika Djojoningrat Diah Rini Handjari Djulzasri Albar Dolly Dolven Kansera DWI SURYANTO Ekowati Rahajeng Ellen Susanti Elli Arsita Endang Susalit Ening Krisnuhoni Fajar Raditya Fransiska Hardi Fumiaki Kitahara Gunawanjati Sudrajat Hiroyuki Otsuka Hotmen Sijabat Ina Susianti Timan Indra Marki Irsan Hasan Jacobus Albertus Jane Estherina Jeffri Gunawan Joseph JY Sung Julwan Pribadi Kaka Renaldi Katharina Setyawati Lianda Siregar Marcellus Simadibrata Masayuki A Fujino Masayuki A. Fujino Moch Ikhsan Mokoagow Murdani Abdullah Nata Pratama Novie Rahmawati Zirta Nur Rasyid Nurul Akbar Pamela Abineno Pamela Abineno Damaledo Paulus Kusnanto Pradana Suwondo Raden Nur Ista Ralph Girson Gunarsa Riahdo Saragih Rizki Yaruntradhani Ruswhandi Martamala Salius Silih Sedijono Sedijono Seri Mei Maya Ulina Siti Setiati Steven Sumantri Suhardjono Suhardjono Sumaryono Sumaryono Suryantini Suryantini Suzana Ndraha Tadashi Sato Tjahjadi Robert Tedjasaputra Unggul Budihusodo Widyasari Kumala Yuichiro Kojima