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Archives of Pediatric Gastroenterology, Hepatology, and Nutrition
Published by Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition
ISSN : -     EISSN : 28305442     DOI : -
Core Subject : Health,
Medicine & Pharmacology
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition (APGHN) is the official journal issued by the Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (Perhimpunan Gastroenterologi, Hepatologi, dan Nutrisi Anak Indonesia). APGHN is issued four times in a year and published in English. Previously published in print form as Jurnal Gastrohepatologi Anak Indonesia (JGAI), APGHN is committed to promote scientific development in child’s health through high-quality publication and provides recent updates on pediatric gastroenterology, hepatology, and nutrition for health practitioners and scholars. APGHN accepts original articles, case reports, review articles, medical illustrations and clinical practice guidelines, all of which have been peer-reviewed carefully by our selected experts.
Arjuna Subject : Kedokteran - Pediatrics, Perinatology, and Child Health
Articles 79 Documents
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Nutritional Formula Selection in Pediatric High-Output Stoma with Acute Kidney Injury: A Review Article Anggitha, Gisheila Ruth; Widodo, Ariani Dewi; Singgih, Adrian Himawan
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.208-218

Abstract

Background: High-output stoma (HOS) is a common complication in pediatric patients with ileostomy, often leading to dehydration, electrolyte imbalance, and malnutrition. These complications increase the risk of acute kidney injury (AKI), which is associated with high morbidity and mortality. Nutritional management in children with HOS and AKI is challenging, requiring careful formula selection to maintain adequate energy and protein intake, fluid and electrolyte balance, and optimize gastrointestinal tolerance. Discussion: In children with HOS and AKI, the selection of an appropriate enteral formula represents a critical component of nutritional management, aiming to mitigate dehydration, electrolyte disturbances, and protein-energy malnutrition. Isotonic or mildly hypotonic solutions are preferred to minimize osmotic losses. Electrolyte composition must be adjusted to account for impaired renal handling in AKI. Semi-elemental formulas are generally recommended as first-line therapy due to their enhanced absorptive properties and relatively lower potassium and phosphate content compared with polymeric preparations. Transition to polymeric formulas may be considered once stoma output stabilizes and renal function improves. Elemental formulas are reserved for severe malabsorption, intolerance, or when strict electrolyte restriction is required. Continuous enteral infusion is preferred during the acute phase to reduce stoma output volume and nutrient loss, with a gradual transition to intermittent bolus feeding to promote intestinal adaptation and stimulate gut hormone. Conclusion: Individualized nutritional management is essential in pediatric patients with HOS and AKI. Semi-elemental formulas, electrolyte adjustments based on renal function, and tailored feeding strategies help maintain fluid–electrolyte balance, prevent malnutrition, and support recovery and growth.  
Treatment of Severe Unconjugated Hyperbilirubinemia with Phenobarbitone in Two First-Degree Siblings with Crigler-Najjar Syndrome (CNS) Type 2: A Success Story Kumar, Sachin; Karthik, Siddhavatam Rahul; Pahuja, Gandharav; Chakrabarti, Sarthak; Panda, Prateek Kumar; Sharawat, Indar Kumar
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.201-207

Abstract

Background: Crigler–Najjar syndrome (CNS) type 2 is a rare autosomal recessive disorder of bilirubin conjugation caused by mutations in the UGT1A1 gene. It presents in infancy with unconjugated hyperbilirubinemia that does not respond to phototherapy but improves with phenobarbitone, which enhances residual enzyme activity. Although phenobarbitone remains the cornerstone of treatment, familial recurrence of CNS type 2 is rarely reported in pediatric literature. Case: We report two siblings born to consanguineous parents who presented with progressive jaundice during early infancy. The first child, a 2-month-old boy, had multiple hospitalisations for phototherapy without benefit. Laboratory evaluation revealed total bilirubin of 31 mg/dL with normal liver function and no evidence of hemolysis. Genetic testing confirmed a homozygous UGT1A1 (c.1456T>G; p.Tyr486Asp) mutation. He was treated with phenobarbitone (5–8 mg/kg/day) and calcium phosphate, achieving a bilirubin level <10 mg/dL within 4 weeks. Three years later, his younger sister developed similar unconjugated jaundice from day 4 of life and harboured the same mutation; she responded well to phenobarbitone alone. Both siblings remain well on long-term follow-up. Discussion: This case highlights the genetic basis and favorable response of CNS type 2 to phenobarbitone, which induces hepatic UGT1A1 expression. Familial clustering of CNS 2, though reported in few global studies, is seldom documented from India. Conclusion: Early genetic diagnosis, timely institution of phenobarbitone, and family counselling are critical for successful management of CNS type 2. These cases reaffirm the long-term safety and efficacy of phenobarbitone in familial presentations of this rare disorder.
Pediatric Hepatic Abscess in a Resource-Limited Setting: A Case Report Adinda Paramitha Sukma Damayanti; Khalisah Nurjihany Salsabila; Bethseba Brontang Pulinggomang
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.189-200

Abstract

Background: Liver abscess is a rare but serious pediatric infection, more common in developing regions where malnutrition, poor sanitation, and limited healthcare access increase risk. It is broadly classified into pyogenic and amoebic types, with the latter more prevalent in tropical areas. Symptoms such as fever, abdominal pain, and hepatomegaly are often nonspecific, making diagnosis difficult in low-resource settings. Ultrasound plays a crucial role when advanced diagnostics are unavailable. This case illustrates these challenges in a remote hospital in Eastern Indonesia. Case: A 13-year-old boy presented with right upper quadrant pain, intermittent fever, and hepatomegaly. Ultrasound revealed a 7 × 6 cm hepatic abscess. He received empiric intravenous antibiotics, but due to limited facilities for image-guided drainage, exploratory laparotomy with abscess evacuation was performed. The patient showed steady postoperative improvement, was discharged in good condition, and achieved full recovery on follow-up. Discussion: This case illustrates how resource availability influences diagnostic and therapeutic decisions for pediatric liver abscess. Although ultrasound-guided drainage is the preferred minimally invasive approach, the absence of interventional radiology services required surgical management. The patient’s improvement with empiric antibiotics and intraoperative findings supported a pyogenic etiology, underscoring the value of clinical judgment when microbiological testing is unavailable. In settings such as Eastern Indonesia, early imaging and timely empiric treatment remain crucial to guide care despite limited diagnostic resources. Conclusion: Pediatric liver abscess can still be effectively managed in low-resource settings through prompt diagnosis, empiric therapy, and timely surgical intervention.
Aerobic Exercise as a Therapeutic Strategy in Children and Adolescents with Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) and Obesity: A Systematic Review Fuad, Nerissa Arviana; Annisa Alifianti; Nabila Annisa Harum; William Cheng
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.174-188

Abstract

Background: Metabolic dysfunction-associated Steatotic Liver Disease (MASLD) is the most prevalent chronic liver disease in children and adolescents, particularly those with obesity. MASLD often progresses to serious hepatic and metabolic complications. Although aerobic exercise (AE) is widely recommended as a first-line lifestyle intervention, its therapeutic efficacy remains unclear. This study evaluates the effects of AE on body composition, liver enzyme, lipid profile, metabolic markers, and liver imaging. Methods: A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus, and EBSCOhost. Clinical studies involving AE in pediatric patients (≤18 years) with MASLD and BMI ≥ 85th percentile were independently screened. Result: From 141 records, five studies (3 RCT, 2 Interventional Study) involving 97 children (mean age 13.22±2.24 years) met the inclusion criteria. AE protocols typically consisted of 30-60 minutes sessions, thrice weekly, over 1-12 months. AE intervention had significantly decreased BMI in 2 of 3 studies, and visceral fat in 1 of 2, with no change in lean mass. Significant improvements of AST and ALT (Δ –1.0 to –34.0 and –1.0 to –27.17) were reported in 3 of 5 studies. However, lipid profiles showed inconsistent effects, and most metabolic markers (glucose, insulin, HOMA-IR, adiponectin, leptin) showed no significant changes. Liver imaging from 3 studies reported resolution or reduced MASLD severity. Conclusion: AE provides selective benefits in MASLD-obese children and adolescents.  Improvements were observed in BMI, liver enzymes, and liver imaging, while the effects on lipid and metabolic markers remain inconsistent.
Choledochal Cyst Todani Classification Type IC and Choledocholithiasis Presenting as Recurrent Pancreatitis in a 7-Year-Old Girl – A Case Report Della Sabrina Marta; I Putu Gede Karyana; I Gusti Ngurah Sanjaya Putra; Ni Nyoman Metriani Nesa; Ketut Dewi Kumara Wati; Kadek Deddy Ariyanta
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 5 No. 1 (2026): APGHN Vol. 5 No. 1 February 2026
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.5.1.2026.28-36

Abstract

Background: Choledochal cyst is an uncommon but important cause of biliary pathology in the pediatric population which can lead to choledocholithiasis and recurrent pancreatitis. High clinical suspicion, comprehensive imaging, and multidisciplinary evaluation are essential for accurate diagnosis and treatment. Definitive management is achieved through surgical intervention. Case: A 7-year-old girl experienced recurrent postprandial right upper quadrant and epigastric pain for three years, with fluctuating pancreatic and hepatic enzymes. Initial ultrasound and magnetic resonance cholangiopancreatography (MRCP) revealed ductal dilatation with biliary sludge, while multislice computed tomography (MSCT) suggested autoimmune pancreatitis, leading to temporary steroid response. Symptoms persisted, and contrast-enhanced magnetic resonance imaging (MRI) demonstrated fusiform common bile duct dilatation with debris, confirming Todani type IC choledochal cyst and choledocholithiasis. She underwent laparoscopic cyst and gallbladder excision with Roux-en-Y hepaticojejunostomy. Intraoperative and histological findings verified sludge, gallstones, and chronic cholecystitis. Discussion: Choledochal cysts should be considered in pediatric recurrent pancreatitis, particularly with biliary obstruction. Advanced imaging and differential diagnosis are crucial. Surgical excision with biliary reconstruction is the treatment of choice. Conclusion: Early recognition and timely surgical intervention are essential to prevent long-term complications.
The Correlation Between Low Milk Supply in Breastfeeding and The Severity of Neonatal Hyperbilirubinemia Finanda Nisa Amani; Dianty Anjarsari
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 5 No. 1 (2026): APGHN Vol. 5 No. 1 February 2026
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.5.1.2026.18-27

Abstract

Background: Inadequate breastfeeding can cause neonatal hyperbilirubinemia. Hyperbilirubinemia was the fifth leading cause of neonatal mortality in Indonesia with a prevalence of approximately 5.6%. The severe level of bilirubin concentration can cause life- threatening kernicterus. The study aimed to examine the correlation between low milk supply in breastfeeding and the severity of neonatal hyperbilirubinemia among newborns who were admitted to Assyifa Mother and Child Hospital in Tangerang, Banten. Methods: A cross-sectional study was conducted on 20 neonates diagnosed with unspecified hyperbilirubinemia who were referred to either Emergency Department or Pediatric Department in Assyifa Mother and Child Hospital. Data were obtained from electronic medical records, including information related to mothers and neonates. Data on breast milk supply in breastfeeding mothers were obtained from patient anamnesis records. Statistical analysis was performed using the Fisher’s test with SPSS version 30. Result: Hyperbilirubinemia severity was categorized into three severity levels: level 1 (12-18 mg/dL), level 2 (19-24 mg/dL), level 3 (25-30 mg/dL). There were 8 neonates with adequate breastmilk supply that categorized who were classified into level 2. In contrast, 12 neonates with inadequate breastmilk supply were classified into levels 2 and 3. A significant correlation was found between inadequate breastmilk supply and increased severity of neonatal hyperbilirubinemia (p = 0.042). Higher severity of hyperbilirubinemia was associated with lower quantities of breastfeeding. Conclusion: The study shows a significant correlation between inadequate breastmilk supply in breastfeeding and the severity of neonatal hyperbilirubinemia.
Symptomatic Cholelithiasis in a Male Infant: Two-Year Follow-Up and Surgical Management – A Case Report Gonzalez Plascencia, Manuel; del Rio Robles, Antonio Ignacio
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 5 No. 1 (2026): APGHN Vol. 5 No. 1 February 2026
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.5.1.2026.37-44

Abstract

Background: Infant cholelithiasis is an uncommon and often idiopathic condition, frequently detected incidentally due to nonspecific symptoms. Although spontaneous resolution is common during infancy, the lack of standardized management guidelines complicates decision-making, particularly in symptomatic patients. Long-term data describing the natural history and indications for surgical intervention remain limited. Case: We describe a male infant diagnosed with gallstones at four months of age following recurrent episodes of colicky abdominal pain. Extensive laboratory evaluation excluded hemolytic, metabolic, infectious, and anatomical causes. Serial ultrasonography confirmed persistent gallstones without inflammatory changes. Given the patient’s clinical stability, expectant management with close follow-up was initially chosen, including periodic clinical assessments, annual ultrasound examinations, and biochemical testing. Despite normal growth and normal biochemical results, the patient experienced intermittent recurrent localized abdominal pain over a two-year period. Because of persistent symptoms, definitive surgical management was indicated, and an open cholecystectomy was performed at two years of age. Intraoperative findings revealed two black pigment stones consisting of calcium bilirubinate, without anatomical abnormalities. Postoperative recovery was uneventful, and the patient remained asymptomatic during follow-up. Discussion: This case illustrates the challenges of managing idiopathic infant cholelithiasis, particularly regarding the timing of surgery. While conservative management is appropriate for asymptomatic patients, persistent or recurrent symptoms justify surgical intervention. This extended follow-up provides insight into the persistence of the disease beyond infancy. Conclusion: Individualized management is essential in infant cholelithiasis. This case supports surgical treatment in symptomatic patients with persistent gallstones, even in the absence of identifiable risk factors.
Impact of Biliary Atresia on Neurodevelopment in Children: A Systematic Review Hartaman Putra, Hisyam; Permata Putri, Vanessa; Nafisyah, Sri Wahyuni Evi; Luthfi, Mishbakhul; Nur Ilhami, Rahmat Hidayat; Basuki, Siswanto
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 5 No. 1 (2026): APGHN Vol. 5 No. 1 February 2026
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.5.1.2026.1-17

Abstract

Background: Survival in children with biliary atresia (BA) has improved substantially, shifting clinical focus toward long-term morbidity, including neurodevelopmental outcomes. However, existing evidence remains fragmented, and prior reviews have not comprehensively addressed motor, behavioral, and autism-related domains. This study aimed to synthesize current evidence on neurodevelopmental outcomes in children with BA across cognitive, motor, and behavioral domains, and to identify clinical factors associated with adverse developmental trajectories. Methods: A systematic search of PubMed, Scopus, and Wiley was conducted from database inception to October 17, 2025, following PRISMA 2020 guidelines. Observational studies reporting neurodevelopmental outcomes in children (≤18 years) with BA were included. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist. Due to substantial heterogeneity, a narrative synthesis was performed. Result: Seven studies involving infants to adolescents with BA were included. Motor impairment was the most consistent finding, detectable from early infancy and persisting into later childhood. Cognitive outcomes were heterogeneous, ranging from significant impairment to age-appropriate or above-normative performance in selected cohorts. Behavioral and adaptive difficulties, including attention problems and autism spectrum–related traits, were frequently reported. Markers of disease severity such as unsuccessful Kasai portoenterostomy (KPE), delayed jaundice clearance, growth failure, ascites, and portal hypertension were consistently associated with poorer neurodevelopmental outcomes. Conclusion: Children with BA are at increased risk of multidimensional neurodevelopmental impairment, particularly affecting motor and behavioral domains. Early identification and longitudinal neurodevelopmental surveillance are essential to optimize long-term functional outcomes in this vulnerable population.
Chronotype and Chrononutrition Profiles in Adolescents Obesity Danindra Andri Hidayat; Mifta Khudin; Titis Prawitasari
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 5 No. 1 (2026): APGHN Vol. 5 No. 1 February 2026
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.5.1.2026.45-61

Abstract

Background: Adolescent obesity remains a major global public health challenge. Modern lifestyle factors that disrupt circadian rhythms may exacerbate metabolic dysregulation in adolescents. Chronotype, reflecting innate circadian preferences for sleep-wake and activity timing, and chrononutrition, which emphasizes the alignment of meal timing with circadian rhythms, have gained attention as potential determinants of obesity. However, evidence integrating chronotype and chrononutrition profiles with adolescent obesity remains limited. Therefore, this review aims to synthesize the current evidence on the roles of chronotype and chrononutrition in adolescents obesity. Discussion: Circadian rhythm regulates metabolic, hormonal, and behavioral processes through coordinated central and peripheral clocks. Variations in chronotype and disruptions in circadian alignment influence sleep patterns, meal timing, and metabolic regulation in adolescents. Evidence indicates that chronotype alone does not directly determine obesity risk; rather, its interaction with eating timing, sleep quality, and lifestyle behaviors plays a crucial role. Chrononutrition emphasizes aligning food intake with the biologically active phase, which is associated with improved insulin sensitivity, glycemic control, lipid metabolism, and blood pressure regulation. Determining chronotype and chrononutrition profiles remains challenging. The assessment is predominantly performed using standardized and validated questionnaires. Conclusion: Chronotype and chrononutrition profiles may contribute to the risk of obesity in adolescents. They might be a potential strategy for obesity prevention and management. Nevertheless, current evidence remains limited, and further longitudinal and interventional studies are required to confirm these findings and inform future recommendations.

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