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Murdani Abdullah
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Divisi Gastroenterologi, Departemen Ilmu Penyakit Dalam, FKUI/RSUPN Dr. Cipto Mangunkusumo, Jl. Diponegoro No. 71 Jakarta 10430 Indonesia
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The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Published by The Indonesian Society for Digestive Endoscopy
ISSN : 14114801     EISSN : 23028181     DOI : -
Core Subject : Health,
Medicine & Pharmacology
The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy is an academic journal which has been published since 2000 and owned by 3 Societies: The Indonesian Society of Gastroenterology; Indonesian Association for the Study of the Liver; The Indonesian Society for Digestive Endoscopy. The aim of our journal is to advance knowledge in Gastroenterology, Hepatology, and Digestive Endoscopy fields. We welcome authors for original articles, review articles, and case reports in the fields of Gastroenterology, Hepatology, and Digestive Endoscopy.
Arjuna Subject : Kedokteran - Ilmu Pencernaan
Articles 11 Documents
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Search results for , issue "VOLUME 12, NUMBER 1, April 2011" : 11 Documents clear
Effect of L-ornithine-L-aspartate Therapy on Low-Grade Hepatic Encephalopathy in Patients with Liver Cirrhosis Martha Iskandar; Irsan Hasan; Unggul Budihusodo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201138-43

Abstract

Background: Minimal hepatic encephalopathy (MHE) is an abnormal condition of psychometric testing before hepatic encephalopathy (HE) condition reducing quality of life and survival rate. Impractical instrument, the psychometric hepatic encephalopathy score (PHES), has been recommended in diagnosing MHE. The new critical flicker frequency (CFF) has good precision and accuracy for diagnosing MHE. Oral L-ornithine-L-aspartate (LOLA) may increase ammonia detoxification. The aim of this study was to recognize the effect of oral LOLA on low-grade HE by investigating the mean value of CFF. Method: We included 31 patients with liver cirrhosis and low-grade HE (MHE, HE grade 1 and 2) at the outpatient clinic of hepatology, Cipto Mangunkusumo hospital between November 2009 and March 2010. It was a double-blind, randomized, placebo-controlled clinical trial. Oral LOLA was administered in a dose of 18 g/day, 3 times daily for 14 consecutive days. At the end of the study, there were 27 cirrhotic patients with CFF value 38 Hz; 14 patients had received LOLA and 13 patients had placebo. Statistic analysis was performed by using the Mann-Whitney U test. Results: The mean value of CFF in LOLA group after treatment (39.3 Hz) was significantly different than the placebo group (36.04 Hz); (p = 0.027). Ammonia level decreased in LOLA group from 118.7 into 109.1 µ mol/L. In placebo group, it increased from 106.9 into 147.5 µ mol/L with p = 0.275 (before); p = 0.052 (after). Conclusion: Oral LOLA may improve the value of CFF and is likely to decrease blood ammonia level in patients with low-grade HE.   Keywords: low-grade hepatic encephalopathy, oral LOLA, CFF improvement, ammonia detoxification
Management of Autoimmune Hepatitis Supriono Supriono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201150-56

Abstract

Autoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology. Although the pathogenetic mechanism of AIH is still unknown, an underlying genetic predisposition and the association of the disease with certain human leukocyte antigens (HLAs) have been suggested. The molecular mimicry has been proposed as a pathogenetic mechanism for AIH. The diagnosis of AIH is based on a constellation of clinical, serological, and histopathological findings. The International Autoimmune Hepatitis Group (IAIHG) proposed diagnosis criteria in 1993, which were revised in 1999. In 2008, the IAIHG decided to devise a simplified scoring system for wider applicability in routine clinical practice. Based on clinical and serological parameters, AIH cases have been categorized into three subtypes: type-1 AIH, type-2 AIH and type-3 AIH. The therapeutic guidelines of AIH include immunosuppressive agent with corticosteroid and usually in combination with azathioprine. Starting dose of prednisone monotherapy is 60 mg daily, which should be tapered slowly over a 1 week period to a maintenance dose of 20 mg daily. The other regimen is used in combination with azathioprine, prednisone dose is started at 30 mg and tapered 10 to 5 mg every week until a maintenance dose of 10 mg is achieved. Azathioprine is given at the dose of 50 mg daily. In the very few patients that do not tolerate or have significant side effects to gold standard therapy, alternative immunosuppressive drugs should be given. Other powerful immunosuppressive drugs and molecular interventions are being developed based on recent insights into pathogenic pathways, emerging pharmacologic agents, and new technologies. Keywords: autoimmune hepatitis, pathogenesis, diagnosis, management
Non-endoscopic Examination as Predictor of Varices Degree in Liver Cirrhosis Patients Who have Experienced Esophageal Variceal Bleeding Paulus Kusnanto; Marcellus Simadibrata; Irsan Hasan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201115-22

Abstract

Background: Standard diagnosis for determining the degree of varices is by endoscopy. However, sometimes there are obstacles in the implementation of endoscopy. Based on the factors, we need to know the parameters of non-endoscopic examination which include ascites, splenomegaly, thrombocytopenia, Child-Pugh, portal vein diameter as a predictor of the degree of liver cirrhosis patients with varices who have experienced esophageal variceal bleeding. Method: The study design was cross-sectional study. The study was conducted on hospitalized patients in Cipto Mangunkusumo hospital, Gatot Subroto hospital, and Kraton hospital from September 2008 to November 2009. The patients were liver cirrhosis patients with history of upper gastrointestinal bleeding, no present bleeding, and hemodynamically stable. Examination of predictor factors in the patients such as ascites, splenomegaly, thrombocytopenia, Child-Pugh and portal vein diameter were done. Statistical analysis was performed with student’s t-test, Mann-Whitney test, and stepwise multivariable logistic regression. Results: The study involved 44 patients with liver cirrhosis who have esophageal variceal bleeding. Based on the results of endoscopic examination, large varices (F3) were found in 21 (47.73%) patients, small varices (F1 F2) in 23 (52.27%) patients, located on the distal esophagus extending to the medial (86.4%), with red color sign present (54.5%). Results of non-endoscopic examination such as splenomegaly, ascites, thrombocytopenia, portal vein diameter and Child-Pugh score was known not to be associated with the degree of esophageal varices (p 0.05). Conclusion: Non-endoscopic examination was not related to the degree of varices in liver cirrhosis patients who have experienced esophageal variceal bleeding. Keywords: esophageal variceal bleeding, liver cirrhosis, predictor factors, endoscopic criteria
To Assess the Size of Esophageal Varices for Prediction of Variceal Bleeding Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/12120111-

Abstract

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Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Dewa Gde Agung Budiyasa; Yuna Ariawan; I Ketut Mariadi; I Dewa Nyoman Wibawa; Nyoman Purwadi; I Gusti Agung Suryadarma
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201123-27

Abstract

Background: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis.   Keywords: albumin, degree of EV, liver cirrhosis
Cytokeratin 7 and Cytokeratin 19 Expressions in Oval Cells and Mature Cholangiocytes as Diagnostic and Prognostic Factors of Cholestasis Dyonesia Ary Harjanti; Ening Krisnuhoni; Santoso Cornain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201128-33

Abstract

Background: The activity of liver progenitor cells as bipotent liver stem cells, such as the oval cells, has been observed. The presence of oval cells and mature cholangiocytes forming hepatobiliary ductules may be applied to distinguish extrahepatic and intrahepatic cholestasis of the infants. Method: This cross sectional study was performed on 40 paraffin-embedded sections consisting of 2 groups of 20 cases with extrahepatic and intrahepatic cholestasis of the infants from histophatological examination in Cipto Mangunkusumo hospital Jakarta between January 2000 and September 2011. The liver fibrosis grading was reevaluated by hematoxylin and eosin and also trichrome staining. The specimens were tested by immunohistochemical staining for cytokeratin (CK) 7 and CK 19 expressions in oval cells and mature cholangiocytes. The correlation between CK7/CK19 expressions in oval cells and liver fibrosis were analyzed by Spearman’s correlation test. Results: Expressions of CK7 and CK 19 on oval cells and mature cholangiocytes performed in hepatobiliary ductules, were significantly higher in extrahepatic than intrahepatic cholestasis with p 0.05. CK7 and CK19 expressions in oval cells showed strong correlation with the degree of liver fibrosis with r = 0.793; p 0.05 for CK 7 and r = 0.827; p 0.05 for CK 19. Conclusion: Expressions of CK7 and CK19, in oval cells and mature cholangiocytes, were higher at extrahepatic than intrahepatic cholestasis. Expressions of CK7 and CK19 in oval cells were directly proportional to the degree of liver fibrosis in cholestasis of the infants.   Keywords: cholestasis, oval cell, cholangiocytes, fibrosis, CK7, CK19
Pancreatic Pseudocyst with Colonic Perforation Complication Angga Pramudita; Marcellus Simadibrata; Achmad Fauzi; Nisan Soeheri
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201164-69

Abstract

Pancreatic pseudocyst is one of complications of both acute and chronic pancreatitis. It is a rare clinical condition. The incidence is low ranging between 1.6 and 4.5%, or 0.5-1 per 100,000 adults annually. The clinical manifestations range from asymptomatic to severe acute abdomen due to complications. Acute complications may include bleeding, infection, rupture and perforation of the gastrointestinal tract; while chronic complications are gastric and biliary obstruction as well as thrombosis of portal vein. We present a case report of a 38-year-old male with complaints of abdominal pain, fatigue, nausea and vomiting containing undigested food and yellow liquid. On clilnical examination, the patient was found to be fatigue, having enlarged abdomen, unpalpable liver and spleen, no signs of shifting dullness was detected. We found an abdominal mass in the left upper and lower quadrant sized 20 x 10 cm accompanied with epigastric pain on palpation. Abdominal ultrasonography revealed a cystic lesion on the head of pancreas with differential diagnosis of pseudocyst. The abdominal computed tomography (CT-scan) showed a lesion arising from pancreas, extending into abdominal cavity and part of left groint and attaching to left intestinal in the abdomen, part of gastric region and left diaphragm. A diagnosis of pancreatitis was suspected with differential diagnosis of pancreatic mass and peritonitis. It is a case report of pancreatic pseudocyst with acute complication of colonic perforation. Keywords: pseudocyst, pancreatitis, pancreatitis complication, colonic perforation
Levels of Adiponectin and Soluble Tumor Necrosis Factor-α Receptor 2 (sNFαR2) in Obese Males with or without Fatty Liver Agus Sulaeman; Syarifuddin Wahid; Ali Sulaiman; Gatot Susilo Lawrence
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (529.549 KB) | DOI: 10.24871/12120111-7

Abstract

Background: Increased lipolysis in obese patients will cause elevated free-fatty acid level leading to insulin resistance. There are varied inflammatory cytokines (sTNFαR2) and anti-inflammatory cytokines (adiponectin) in obese patients, with and without fatty liver (FL). The aim of this study was to determine sTNFαR2 and adiponectin levels in obese patients with and without fatty liver. Method: This study was an observational study with cross-sectional approach, which was conducted between September 2008 and August 2009. The patients were 94 obese male with waist circumference ≥ 90 cm based on criteria of the International Diabetes Federation. Fatty liver was detected by ultrasonography; while adiponectin and sTNFαR2 levels in blood were analyzed by using ELISA Method and blood examination at the clinical laboratory. Results: Levels of adiponectin and sTNFαR2 were different between obese patients with and without FL. The adiponectin level was 3.10 ± 1.14 in patients with FL and was 3.52 ± 1.07 in patients without FL; while the sTNFαR2 were 23.92 ± 6.00 (FL) and 20.61 ± 5.29 (without FL). In patients with low adiponectin level ( 3.33 µ g/L) and high sTNFαR2 level ( 21.78 pg/dL), there was relatively higher occurrence of fatty liver compared to the other patients. Conclusion: Obese patients with fatty liver have higher sTNFαR2 level than patients without fatty liver. Moreover, obese patients with fatty liver have lower adiponectin level compared to patients without fatty liver. Patients with low adiponectin level and high sTNFαR2 level have higher incidence of fatty liver than subjects with high adiponectin level and low sTNFαR2 level. Keywords: adiponectin, soluble tumor necrosis factor α receptor 2 (sTNFαR2), obese, fatty liver
The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital Herryanto Lumbantobing; Leonardo Basa Dairi; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Maryuni Sutadi; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201134-37

Abstract

Background: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study. Keywords: upper gastrointestinal endoscopy, profile, indications, endoscopic diagnosis
Pancreatic Cancer: Review of Etiology, Clinical Features, Diagnostic Procedures, Treatment and Mesothelin Role Guntur Darmawan; Marcellus Simadibrata
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201144-49

Abstract

Pancreatic cancer is one with high mortality cancer in the world. Ninety percent of pancreatic cancer is pancreatic adenocarcinoma. Various factors is associated with an increased risk of pancreatic cancer including age, sex, race, genetic, history of chronic pancreatitis, diabetes mellitus, gallstone, obesity, Helicobacter pylori infection, smoking, diet, and polution exposure. A lot of cases were diagnosed in late stadium due to non-specific early clinical symptoms, and also, until now, there is no examination tool that may screen pancreatic cancer in the earliest stage. Total surgery resection is the therapy of choice in the early stadium of pancreatic cancer, and other therapy modalities are chemotherapy, radiotherapy. Combination of these modalities is frequently used in order to increase the effectiveness of therapy. Mesothelin, a surface glycoprotein on normal mesothelial cells, is overexpressed in pancreatic cancer; therefore, although it is not a cancer specific antigen, it can be used in diagnostic and treatment of pancreatic cancer. Several studies about mesothelin application in pancreatic cancer have been performed; however, more studies are needed to improve the application of mesothelin on pancreatic cancer. Keywords: pancreatic cancer, risk factor, therapy, mesothelin

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