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Gastrointestinal Amyloidosis: Diagnostic Approach and Treatment Catarina Budyono; Achmad Fauzi; Dadang Makmun
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

Amyloidosis is a disease marked by deposition of misfolded proteins, known as amyloids, in the extracellular space, including gastrointestinal tract. According to the precursor protein, amyloidosis is classified into six types; all of which can be involved in the gastrointestinal tract. Amyloidosis has weight loss and gastrointestinal bleeding as the most frequent symptoms. Gastrointestinal tract biopsy is diagnostic in most cases of amyloidosis and Congo red stain is used to confirm the amyloid proteins deposit. Treatment of amyloidosis consists of controlling symptoms, terminating protein formation and deposit, and treating the underlying diseases. Chemotherapy might be applied depends on the type of amyloidosis.

Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly Abigail Prasetyaningtyas; Perdana Aditya Rahman; Aru Wisaksono Sudoyo; Achmad Fauzi
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

Lemmel’s syndrome, also known as duodenal diverticulum obstructive jaundice, is a rare cause of benign obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when PAD is present, in the absence of cholelithiasis or other detectable obstacle. Diagnosing Lemmel’s syndrome could be challenging, but being aware of this condition is important to avoid mismanagement and it begins with identification of PAD, while interpreting any bile duct imaging. It can be misinterpreted as periampullary tumors, biliary stones, or pancreatic pseudocyst. Symptomatic patients can be successfully managed endoscopically in many cases but surgical management would be necessary in selected cases.We present a patient with benign obstructive jaundice caused by Lemmel’s syndrome who was successfully treated with endoscopic sphicterectomy. A 67 years old female presented to the emergency department with chief complaint of jaundice. The patient was assesed to have obstructive jaundice cause by a duodenal mass, elevation of transaminase enzime supected caused by drug induced liver injury, hypertension (controlled), and anterior extensive coronary ischemia. Endoscopic retrograde cholangiopancreatografi (ERCP) showing mutiple giant diverticle in second part of duodenum, stenosis of the distal CBD with compression of diverticular extra luminal as a differential diagnosis. Endoscopic ultrasound (EUS) was performed to exlude a periampullary tumor, resulting distal CBD stenosis due to compression of multiple periampullary diverticula (PAD). We performed an endoscopic sphinterectomy (EST) and the stent was removed. A further evaluation of the tuberculous lymphadenitis was planned as outpatient setting. One month follow-up, no recurence of jaundice was observed.

Role of Proton Pump Inhibitor in the Management of Acid-Related Disorders Elli Arsita; Achmad Fauzi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Proton pump inhibitor (PPI) is the strongest inhibitor to gastric acid secretion. PPI is effective in all gastricacid disorders, such as: peptic ulcer, gastroesofageal reflux disease, non steroid anti inflammatory drugs (NSAIDs)gastropathy, and Zollinger-Ellison syndrome. Several studies comparing one PPI to another. Although somedifferences have been reported, there are small differences with unclear clinical importance.PPI has side effects that may be related to diarrhea due to Clostridium difficile, pneumonia, hip fracture, vitamin B12 deficiency, and IgE mediated allergic reaction. Several studies revealed strong association but havelimitation in design and sampel size. PPI therapy should be according to indication, dose, and appropriate period.Keywords: proton pump inhibitor, gastric acid disorder, indication, dose, period ABSTRAKPenghambat pompa proton (PPP) adalah inhibitor paling kuat terhadap sekresi asam lambung. PPPefektif untuk terapi semua gangguan asam lambung termasuk ulkus peptikum, penyakit gastroesofageal reflux,gastropati karena obat anti inflamasi non steroid (OAINS), dan sindrom Zollinger-Ellison. Beberapa penelitianmembandingkan beragam PPP satu dengan yang lainnya. Walaupun dilaporkan ada beberapa perbedaan,namun besaran perbedaannya kecil dan tidak jelas kepentingan klinisnya.PPP kemungkinan berkaitan dengan efek samping diare karena Clostridium difficile, pneumonia, frakturpanggul, defisiensi vitamin B12, dan reaksi alergi yang dimediasi IgE. Beberapa penelitian menunjukkanhubungan yang kuat namun memiliki keterbatasan desain dan besaran sampel. Terapi PPP harus sesuai denganindikasi, dosis, dan jangka waktu yang tepat.Kata kunci: penghambat pompa proton, gangguan asam lambung, indikasi, dosis, jangka waktu

The Use of Balanced Scorecard to Support Achievement of Business Plan in Digestive Endoscopy Center, 2013 Murdani Abdullah; Dadang Makmun; Achmad Fauzi; Aan Santi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 2 (2014): VOLUME 15, NUMBER 2, August 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Digestive Endoscopy Center, Cipto Mangunkusumo Hospital was established in 2011 in which the concept was developed as center of excellence (CoE). The business plan was created based on safety and patient satisfaction, fast, accurate, quality and one stop services. 2013 is the 2nd year in Digestive Endoscopy Center business plan development and it is expected to increase in many aspects. The aim of this study is to measure the performance of business plan in Digestive Endoscopy Center.Method: This study was conducted from April-December 2013 with quantitative method and cross sectional studies on 76 subjects and also used secondary data from endoscopy’s reports. The balanced scorecard contains 4 measurements, such as financial approach, customer approach, internal process approach, and learning and growth approach. Results: The financial approach resulted that income from 2 types of patients (cash and insurance) were increased in 2013. The customer approach resulted a high satisfaction rate with mean 4.69 of 5 for patient satisfaction and the employee satisfaction increased in 2013 (mean: 3.88 of 5) and in 2010 (mean: 3.64 of 5). Internal process approach was measured using facilities and infrastructure discovered is increased too. Learning and growth approach resulted that accumulation of trainings, achievement of target of the trainings was increased.Conclusion: The achievement of bussiness plan has been evaluated using balanced scored card and showed that there is a balance on the financial approach, customer approach, internal process approach, and learning and growth approach.Keywords: business plan, digestive endoscopy center, balance scorecard

Demographical Distribution on the Incidence of Helicobacter pylori Infection in Jakarta: Obtaining Samples from 5 Municipalities Ari Fahrial Syam; Achmad Fauzi; Murdani Abdullah; Marcellus Simadibrata; Dadang Makmun; Chudahman Manan; Abdul Aziz Rani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 2 (2014): VOLUME 15, NUMBER 2, August 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Currently, the hospital-based studies on Helicobacter pylori (H. pylori) have demonstrated that the incidence of H. pylori infection tends to decline in Indonesia. On the other hand, no population-based study has ever been conducted. Therefore, our study was performed to evaluate the true incidence of H. pylori found among the population.Method: This study was a surveillance using cross-sectional design. The samples used in our study were randomly selected from 1,645 samples including those from five municapalities of Special Capital Region of Jakarta in 2006. Immunochromatographic test (ICT) was utilized to establish the diagnosis of H. pylori infection. The test has demonstrated high sensitivity and specificity for Indonesian populationResults: The seroprevalence of H. pylori infection among 310 patients was 52.3% (162 out of 310 patients) with mean age of 43.48 + 10.45 years. There was no difference regarding seroprevalence in both groups of 40 year and 40 years of age (52.3% and 52.2%). The highest prevalence of H. pylori infection was found in West Jakarta (66.1%); while the lowest prevalence was found in South Jakarta (41.0%). The incidence of H.pylori infection between those who were alcoholic was equal to those who were not alcoholic (46.2% vs. 52.5%).Similar result was also found between smokers and non-smokers (53.8% vs. 51.8%).Conclusion: In this study, we found that H. pylori seroprevalence remains high in the population. Various seroprevalence of H.pylori infection were found among five municipalities in Jakarta.Keywords: Helicobacter pylori, Jakarta, seroprevalence

Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma Yaldiera Utami; Achmad Fauzi
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

Aim: to evaluate the comparison of palliative treatment using esophageal stenting alone or in combination with radiotherapy.Method: Patient/problem, intervention, comparison, and outcome (PICO) system were used. We conduct a searching in PubMed site. The next process was selection by reading all articles (10 articles). There were 9 articles excluded from analysis. We finally choose one randomized trial study written by Javed A, Pal S, Dash NR, Ahuja V, Mohanti BK, Vishnubhatla S, et al goes to the critical appraisal step.Results: The result of this study showed that dysphagia scores improved significantly in both groups, in patients with inoperable esophageal cancer treated with esophageal stenting alone (group I) and a combination of esophageal stenting and radiotherapy (group II) following stent insertion. However, dysphagia relief was more sustained in Group II than in Group I (7 vs. 3 months, p = 0.002).Conclusion: In this evidence-based case report (EBCR), we reported a man who suffered from dysphagia caused by inoperable esophageal carcinoma. Based on the critical appraisal of the randomized trial collected previously from PubMed with specific criterias, we conclude that a combination of esophageal stent and radiotherapy effectively prolongs duration of dysphagia relief and improves the overall survival, without increasing the incidence of complications.

Comprehensive Management of Helicobacter pylori Infection Abdul Ghaffar Hamzah; Achmad Fauzi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 22, No 2 (2021): VOLUME 22, NUMBER 2, August 2021
Publisher : The Indonesian Society for Digestive Endoscopy

Helicobacter pylori (Hp) infection is a chronic gram-negative bacterial infection, that infects the epithelium of the stomach. This prevalence is very high and varies depending on factors such as geographical location, ethnicity, age, and socioeconomic. The key management of Hp infection is accurate diagnosis and treatment. The H. pylori diagnostic examination consists of non-invasive and invasive tests, the most common non-invasive tests are serological tests, urea breath tests (UBT), and stool antigen tests, while invasive tests are rapid urease tests, histopathology, culture, and PCR. The goal of H. pylori eradication is to heal peptic ulcers and reduce the risk of gastric cancer. Eradication therapy that is recommended worldwide and used in Indonesia is the triple drug combination therapy consisting of a PPI, clarithromycin and amoxicillin or metronidazole for 14 days. The success of eradication therapy is highly dependent on the choice of therapeutic regimen, patient compliance in taking multi-drugs with possible drug side effects, and the sensitivity of H. pylori strains to the antibiotics consumed.

Diagnosis and Treatment of Small Intestinal Bacterial Overgrowth Toman Nababan; Achmad Fauzi
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

Small Intestinal Bacterial Overgrowth (SIBO) is a clinical condition, in which excess amounts of bacteria are found in small intestine. SIBO occurred when normal homeostatic mechanism which control enteric bacteria population disrupted. Elderly patients are more vulnerable to SIBO which can be caused by two conditions, which are gastric acid reduction and disproportionately drugs consumption which then caused hypomotility. There are several methods to diagnose SIBO, but diagnose often begin with suspicion and history of risk factors of SIBO. There are two most frequent tests in SIBO diagnostic, which are bacterial culture examination and breath test. Treatments of SIBO are: (1) Treatment of underlying disease and improvement of medical condition; (2) Eradication of excess bacterial growth; (3) Resolve nutritional deficiencies which related to SIBO.

Gastrointestinal Endoscopy in the Time of Covid-19 Pandemic: Current Guidelines and Experience From Indonesian Tertiary Endoscopy Centre Hasan Maulahela; Jaffray DP Rambak; Hilda Nurmalihah; Kaka Renaldi; Achmad Fauzi; Murdani Abdullah; Marcellus Simadibrata; Ari F Syam; Roy Soetikno; Dadang Makmun
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

Coronavirus disease-19 (COVID-19) is a respiratory disease caused by novel SARS-CoV-2. The disease has become a global pandemic since March 2020. Transmission of the disease is rapid and contagious through droplets and contaminated environments. Meanwhile, gastrointestinal endoscopy is a procedure that has a high risk of transmitting COVID-19. Proper strategies are needed to prevent transmission of the virus in the endoscopic unit. Some literature has published the guidelines for prevent COVID-19 in endoscopic units such as guidelines by AGA, APSDE, ESGE and ESGENA. These guidelines state that strategies for prevent the COVID-19 transmission in endoscopy unit must be done from before the procedure, during the procedure until after the procedure. These strategies must be followed by all patients and health care providers who working in endoscopy units.

Diagnostic Approach to Gastroesophageal Reflux Disease: The Role of GERD Questionnaire and PPI Test Ummu Habibah; Achmad Fauzi
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

Gastroesophageal Reflux Disease (GERD), according to American College of Gastroenterology (ACG), is symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus. In most patients with GERD, showed no abnormalities in the endoscopic picture. This is what underlies the importance of a diagnostic tool in the form of assessment for the degree of severity of the disease based on symptoms, response to therapy and effect on the patients’ quality of life. This diagnostic tool is then formulated in the form of a questionnaire (GERD Questionnaire). Response to treatment with proton pump inhibitor (PPI) drugs is also often used to support the diagnosis of this disease.DIAMOND study is a large study which aim to assess the accuration of the questionnaire and use of PPI test. Diagnostic method with questionnaire modality and followed by PPI test have sensitivity and specificity value, which are relatively similar to the symptoms-based diagnoses performed by general practitioners or gastroenterologist, as well as when compared to endoscopy and esophageal pH monitoring. Although the diagnosis by methods of questionnaires and PPI test is not the most ideal test in term of accuracy, but these tests are not expensive, readily available and worked mainly on primary health care. These test methods are favored compared to other tests.

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