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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 799 Documents
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Etiology of Upper Gastrointestinal Bleeding: A Five-Year Study at a Tertiary Hospital Muzellina, Virly Nanda; Andarini, Liovicinie; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/27120263-9

Abstract

Background: Upper Gastrointestinal bleeding is a common medical condition requiring prompt treatment and endoscopic evaluation. Identifying the causes is crucial for enhancing patient outcomes and guiding clinical decisions. This study aims to evaluate the etiologies of hematemesis and melena over the past five years.Methods: This study analyzed patient records retrospectively who underwent upper gastrointestinal endoscopy at the Gastrointestinal Endoscopy Center in Cipto Mangunkusumo Hospital, Jakarta, Indonesia between 2019 and 2023. Statistical analysis was performed using SPSS version 26.0.Results: Between 2019 and 2023, 5,721 patients underwent upper gastrointestinal endoscopy, with 1,090 (19.1%) due to upper gastrointestinal bleeding. Among these, 593 were male (54.4%) and 497 were female (45.6%), with a mean age of 54.4 ± 15.12 years. The largest age group affected was 40-59 years, comprising 451 cases (41.4%). Of the 1,090 patients, 262 (24%) presented with hematemesis, 654 (60%) with melena, and 174 (16%) with both symptoms. Non-variceal bleeding was identified in 913 cases (83.8%), while variceal causes accounted for 177 cases (16.2%). Erosive gastritis was the leading cause of upper GI bleeding (408 cases, 37.4%), followed by peptic ulcers (270 cases, 24.8%). Among peptic ulcer cases, 136 (50.4%) were located in the stomach. Additionally, cancer was a cause in 104 cases (9.5%), with duodenal cancer being the most common (48 cases, 46.2%).Conclusion: This study identified erosive gastritis as the leading cause of upper gastrointestinal bleeding, followed by peptic ulcers and varices.
Challenges and Gaps in the Management of Chronic Hepatitis C Infection: Insight from A Tertiary Hospital in Indonesia Chandrawati, Lily; Permatadewi, Cecilia Octaria; Hutami, Hesti Triwahyu; Indiarso, Didik; Purnomo, Hery Djagat
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202645-50

Abstract

Background: Hepatitis C virus (HCV) infection remains a significant public health burden in Indonesia, affecting approximately 2.5 million people. The introduction of direct-acting antivirals (DAAs) has revolutionized HCV management by offering highly effective and well-tolerated treatment options. Since 2017, Indonesia has implemented an HCV cascade of care and a government-funded DAA program to support the World Health Organization (WHO) goal of HCV elimination by 2030. However, challenges in diagnostic accessibility and treatment follow-up continue to hamper progress. This study aims to evaluate the implementation of the HCV cascade of care at Dr. Kariadi General Hospital, Semarang, Indonesia.Methods: A retrospective descriptive study was conducted at Dr. Kariadi General Hospital, which included data from patients who tested positive for anti-HCV antibodies between January 2019 and November 2024. HCV treatment was categorized into five stages: (1) positive anti-HCV antibody test, (2) HCV RNA test, (3) positive HCV RNA result, (4) treatment initiation, and (5) sustained virologic response 12 weeks post-treatment (SVR12). Data analysis was performed using SPSS Statistics version 26. Categorical variables were expressed as frequencies and percentages, and findings were presented as numbers and proportions across each stage of the care cascade.Results: Among 317 patients with positive anti-HCV antibody results (55% men, 45% women; median age: 56 years), 280 (88%) underwent HCV RNA testing, and 213 (76%) were confirmed positive. Of these, 185 patients (87%) initiated treatment, 144 (78%) completed therapy, and 108 (75%) achieved SVR12.Conclusion: This study shows that significant gaps remain at various stages of the HCV care cascade, particularly in confirmatory HCV RNA testing, treatment initiation, and post-treatment follow-up.
ERCP–PTBD Rendezvous Method in a Patient with Pancreatic Head Carcinoma and Duodenal Infiltration: A Case Report Darnindro, Nikko; Pribadi, Rabbinu Rangga; Mulyana, Edi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2712026101-106

Abstract

Advanced pancreatic head cancer with tumor infiltration into the duodenum is capable of distorting the anatomy and is extremely challenging for selective biliary cannulation during ERCP. In these situations, the ERCP–PTBD rendezvous method served as a valuable alternative. Therefore, this case report aimed to describe the case of a 75-year-old man who presented with obstructive jaundice. On examination, the patient was tachycardic and febrile (38.0°C), with pale conjunctivae and marked scleral icterus. A palpable mass was observed in the epigastric region, and laboratory evaluation showed a total bilirubin level of 18.64 mg/dL. Furthermore, MRCP showed a mass in the pancreatic head infiltrating the duodenum, leading to significant intra- and extrahepatic biliary dilatation. The patient was initially subjected to transhepatic biliary drainage (PTBD), followed by an ERCP using the rendezvous method due to the tumor-related distortion of the papilla. During this procedure, a guidewire was advanced through the PTBD tract and navigated under fluoroscopy into the duodenum, facilitating biliary access and successful placement of a biliary stent. Two days after the intervention, the condition improved, with bilirubin decreasing to 8.91 mg/dL, and the patient was subsequently discharged in stable condition. This case showed the rendezvous method as an effective alternative biliary drainage strategy for patients in whom conventional ERCP was hindered by tumor-related anatomical alterations.
Correlation Between Serum Soluble PD-1, CD8+ , CD4+ T Lymphocyte Counts and Liver Stiffness in Antiviral-Naïve Chronic Hepatitis B Patients Aliana, Rizki; Yuristo, Eddy; Legiran, Legiran; Suprianto, Imam; Busro, Vidi Orba; Astoni, Muhamad Ayus; Sya'roni, Anjab Akmal; Suyata, Suyata; Zaky, Samy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202610-18

Abstract

Background: Chronic hepatitis B (CHB) disease is a major global health problem with a high burden in Asia, including Indonesia. Liver stiffness measurement by transient elastography is a non-invasive key tool to assess fibrosis severity. The immune response in CHB involves T cell exhaustion marked by elevated soluble PD-1 (sPD-1) and changes in T lymphocyte subsets, which may influence fibrosis progression. This study aimed to assess the correlation between serum sPD-1, CD4+, and CD8+ T lymphocyte counts and liver stiffness in antiviral-naïve CHB patients.Methods: A cross-sectional study was conducted among 60 untreated CHB patients at Mohammad Hoesin Hospital, Palembang, Indonesia. The sPD-1 was measured by ELISA, while CD4+ and CD8+ T cell counts were determined via flow cytometry. Liver stiffness was assessed by transient elastography. Spearman correlation and multivariate linear regression were used to analyze associations between immune markers and liver stiffness.Results: Serum sPD-1 showed a significant positive correlation with liver stiffness (r = 0.481, p 0.001), while CD8+ T lymphocyte count was negatively correlated (r = –0.553, p 0.001). CD4+ T lymphocyte count showed no significant bivariate correlation (r = –0.189, p = 0.149). In the multivariate analysis, sPD-1 (β = 0.050, p 0.001), CD4+ T cells (β = –0.018, p = 0.001), and AST (β = 0.061, p = 0.005) were independent predictors of liver stiffness.Conclusion: Serum sPD-1 and CD4+ T-lymphocyte count are independently associated with liver stiffness in antiviral-naïve CHB patients. These findings suggested the involvement of immune exhaustion and liver injury in HBV-related fibrosis.
Improving Aetiological Diagnosis of Travellers’ Diarrhoea Using Multiplex PCR Gastrointestinal Panels: A Retrospective Cross-Sectional Study from a High-Travel Tropical Setting -, Bryananda; -, Linda; Kurnianingrum, Ni Made Ari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202651-59

Abstract

Background: Travellers’ diarrhoea is a leading cause of acute gastroenteritis (AGE) worldwide. In Indonesia, diagnosis still relies largely on conventional stool microscopy despite its limitations, while access to multiplex PCR gastrointestinal (GI) panels remains limited. This study provides an early comparison between multiplex PCR and routine stool microscopy for AGE in a high-travel setting in Indonesia.Methods: A retrospective cross-sectional study of patients presenting with AGE was conducted at a private international hospital in Bali (January 2024-June 2025). All patients underwent stool microscopy and multiplex PCR GI panel testing. Descriptive, bivariate, and multivariable analyses assessed patient characteristics, pathogen distribution, and associations with microscopy findings.Results: A total of 114 patients were included (mean age 36.1 ± 14.4 years; 55.3% male). Multiplex PCR detected bacterial pathogens in 88.6% of cases, viral pathogens in 41.2%, and parasitic pathogens in 3.5% of cases. The most common bacteria were enteropathogenic Escherichia coli (47.4%), enteroaggregative E. coli (28.1%), and Campylobacter spp. (26.3%), while norovirus (11.4%) predominated among viruses. Routine stool microscopy parameters showed no meaningful association with bacterial or viral detection. Importantly, erythrocytes were independently associated with lower odds of viral infection (AOR 0.09; 95% CI 0.01–0.71) and higher odds of parasitic infection (AOR 8.16; 95% CI 1.05–63.41).Conclusion: Multiplex PCR substantially improves pathogen detection and clarifies the microbial profile of travellers’ diarrhoea in Bali. Although stool microscopy has limited diagnostic value, the presence of erythrocytes may provide a useful interpretive clue when molecular diagnostics are unavailable
Immune Checkpoint Inhibitors (ICI) in the Functional Cure of Hepatitis B: A Narrative Review Putra, I Komang Wisuda Dwija; Mariadi, I Ketut; Somayana, Gde
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202660-69

Abstract

Chronic hepatitis B (CHB) remains a major global health burden, largely due to the persistence of covalently closed circular DNA (cccDNA) within infected hepatocytes, which hinders complete viral eradication despite long-term antiviral therapy. In recent years, immune checkpoint inhibitors (ICIs) have emerged as a potential therapeutic strategy by restoring exhausted antiviral immune responses. This review explores the mechanisms of action of ICIs, their current application in hepatitis B virus (HBV) infection, and their potential role in achieving a functional cure. Available evidence indicates that ICIs targeting programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte–associated protein 4 (CTLA-4) are capable of partially restoring HBV-specific T-cell function and reducing intrahepatic cccDNA transcriptional activity. Early-phase clinical studies have demonstrated encouraging outcomes, including declines in hepatitis B surface antigen (HBsAg) levels and occasional HBsAg loss; however, consistent achievement of a functional cure remains limited. Notably, combination strategies involving ICIs with therapeutic vaccines or nucleos(t) ide analogues appear to enhance antiviral efficacy compared with monotherapy. In conclusion, ICIs represent a promising adjunctive approach for CHB treatment and may contribute to the pursuit of a functional cure. Nevertheless, further well-designed clinical trials are required to establish their long-term safety, optimal treatment combinations, and effectiveness, particularly in HBV-endemic populations.
Validation Study of the Cirrhosis Acute Gastrointestinal Bleeding Score as Predictor Mortality in Patients with Liver Cirrhosis and Upper Gastrointestinal Bleeding Mariadi, I Ketut; Hardian, Harris; Alamsyah, Ajib Zaim; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Nyoman Gita Kharisma; Pamungkas, Kadek Mercu Narapati; Somayana, Gde; Wira Nugraha, Komang Agus; Sindhughosa, Dwijo Anargha; bin Abd Rahman, Mohamad Fadli
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202619-26

Abstract

Background: The Cirrhosis Acute Gastrointestinal Bleeding (CAGIB) score was developed as a mortality predictor by integrating a range of clinical and laboratory parameters. This research seeks to validate the efficacy of the CAGIB score in predicting in-hospital mortality among cirrhotic patients experiencing upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital.Methods: This study is a prospective observational study employing a validation test approach. A total of 161 patients diagnosed with liver cirrhosis and upper gastrointestinal bleeding (UGIB) at Ngoerah Hospital were enrolled. Receiver Operating Characteristic (ROC) analysis was utilized to evaluate the prognostic capability of the CAGIB score in predicting mortality and to identify the optimal cutoff point. Validation was conducted by assessing the CAGIB score's sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).Results: The analysis of the CAGIB score as a predictor of mortality yielded an area under the curve (AUC) value of 0.83, with the optimal cutoff point determined at ≥ -4.66, based on the point farthest from the diagonal line on the ROC curve. The 95% Confidence Interval (CI) ranged from 0.777 to 0.897. Validation testing of the CAGIB score as a predictor of in-hospital mortality demonstrated a sensitivity of 80.8%, specificity of 70.5%, PPV of 69.4%, and NPV of 81.6%.Conclusion: The CAGIB score has been demonstrated to serve as a valid predictor of mortality, exhibiting commendable sensitivity and specificity, along with satisfactory positive and negative predictive values. The optimal cutoff points appropriately reflect the demographic and clinical characteristics of the cirrhosis patient population with UGIB at Ngoerah Hospital
Immune Checkpoint Inhibitors (ICIs) on Patients With Hepatitis B Virus Infection: A Promising Approach for Achieving HBsAg Loss Girawan, Dolvy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/27120261-2

Abstract

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The Role of Immunotherapy in Hepatocellular Carcinoma (HCC) Fatimah, Nurhayani; Yoga, Vesri; -, Arnelis; Miro, Saptino
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 27, No 1 (2026): VOLUME 27, NUMBER 1, April, 2026
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/271202670-79

Abstract

Hepatocellular carcinoma (HCC) is an aggressive primary liver malignancy with a historically poor prognosis and limited treatment options. It accounts for approximately 75–85% of all liver cancer cases worldwide, with an estimated global incidence of about 9.5 per 100,000 person-years. According to GLOBOCAN 2022, the liver cancer mortality-to-incidence ratio in Indonesia is 0.99, indicating that nearly all patients diagnosed with HCC die from the disease. Systemic therapy, primarily sorafenib, a targeted therapy approved since 2007, has long been the mainstay for advanced cases, but it offers limited clinical benefit. In recent years, immunotherapy, particularly immune checkpoint inhibitors (ICIs), has significantly altered the therapeutic approach to HCC. These agents function by inhibiting regulatory pathways such as PD-1/PD-L1 and CTLA-4, thereby enhancing immune-mediated tumor clearance. Clinical trials, such as IMbrave150, have shown that combining atezolizumab and bevacizumab leads to notable improvements in both overall and progression-free survival compared to sorafenib, resulting in its approval as a first-line treatment. Similarly, combinations like durvalumab with tremelimumab have shown encouraging efficacy. Nonetheless, therapeutic resistance remains a challenge, often driven by the immunosuppressive tumor microenvironment. Emerging strategies, such as next-generation checkpoint blockades, adoptive cell therapy, therapeutic cancer vaccines, and oncolytic virotherapy, are under investigation to improve response rates. This review discusses current progress in immunotherapy for HCC, addresses clinical limitations, and explores potential future directions to enhance treatment success.

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