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All Journal Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Farahdina Shahnaz
Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Medicine & Pharmacology

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Duodenal Stenosis: A Case Report Cindy Gisella Zahrany; Farahdina Shahnaz; Muzal Kadim
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 2 No. 1 (2023): APGHN Vol. 2 No. 1 February 2023
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.2.1.2023.32-9

Abstract

Background: Congenital duodenal stenosis in pediatric patients was often underreported due to its non-conspicuous signs and symptoms. Diagnosing duodenal stenosis is often challenging as this disease causes partial intestinal obstruction and thus presents with more indolent and atypical clinical manifestations. This case report aims to describe the atypical case of pediatric duodenal stenosis which presented with recurrent vomiting and poor weight gain as well as highlight some of the diagnostic challenges. Case: A 7-month-old girl was admitted to the emergency room with chief complaint of recurrent vomiting in the last 2 days prior to hospital admission. Patient had a history of recurrent bilious vomiting at the age of 3 days old with a frequency of 3-4 times a day and were admitted to the hospital for 2 weeks. Parents also reported of poor weight gain in the last 3 months. Abdominal X-Ray series showed dilatation of the small intestines immediately after pylorus and stack of coins sign. Esophageal endoscopic evaluation showed signs of severe GERD with a pyloric gap as well as a suspicion of a duodenal web Discussion: Congenital obstruction at the duodenum may occurs due to intrinsic or extrinsic etiology. Failure of duodenal re-canalization during the 8-10th week of embryological development is thought to be the main cause of intrinsic duodenal obstruction (atresia, stenosis or duodenal web). The appearance of clinical manifestation of duodenal stenosis depends on the degree of stenosis itself. Conclusion: Congenital duodenal stenosis may present with atypical presentations in neonates which requires clinicians to be fully aware of this diagnosis to ensure timely therapy. The main management of duodenal stenosis is surgery, however fluid administration, decompressing as well as other supportive treatment are equally crucial to ensure better outcome for the patient.
Pediatric Gastroesophageal Reflux Disease (GERD): A Literature Review Farahdina Shahnaz; Yuda Satrio Wicaksono; Himawan Aulia Rahman
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 2 No. 2 (2023): APGHN Vol. 2 No. 2 May 2023
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.2.2.2023.46-60

Abstract

Background: Gastroesophageal reflux disease (GERD) is a condition where stomach contents reflux into the esophagus, causing discomfort and complications. It is most prevalent in infants (26.9%) and lesser in children under 10 (3.2%) and over 10 years old (10.1%). Discussion: GERD is caused by frequent relaxations of the lower esophageal sphincter (LES), allowing stomach contents to escape into the esophagus. Symptoms vary with age, with infants experiencing regurgitation and irritability, while older children may have heartburn and nausea. Diagnosis requires differentiating GERD from similar conditions and may involve various tests, though their primary use lacks sufficient evidence. Nonpharmacological treatments include thickened feeding, reducing feeding volume but increasing frequency and possibly eliminating cow's milk protein. Pharmacological treatments include Proton Pump Inhibitors (PPIs), and Histamine Receptor Antagonists (H2RAs), though their efficacy varies. Prokinetics are generally not recommended due to lack of evidence. If all these treatments fail, anti-reflux surgery such as fundoplication can be considered. Conclusion: The hallmark of GERD is the presence of esophagitis during endoscopy. However, Barrett’s esophagus is rare in pediatric GERD patients. Factors indicating a worse prognosis include early onset age, an initial GERD diagnosis, and the need for PPI or combination of H2RA and PPI treatment.
Co-Authors Cindy Gisella Zahrany Himawan Aulia Rahman Muzal Kadim Yuda Satrio Wicaksono