The Prevalence and Risk Factors of GERD Among Indonesian Medical Doctors

Background: Based on our knowledge, the study of gastrointestinal reflux disease (GERD) among certain profession has never been conducted. The aim of this study is to determine the prevalence and risk factors of GERD among Indonesian doctors. Methods: A consecutive study involving 515 doctors was conducted in October 2015. The GerdQ score was used to the diagnosis of GERD and determined its impact on daily life. All possible risk factors were also analysed. Results: A total of 515 subjects completed the questionnaire. The mean age of them was 41.37 ± 11.92 years old. Fifty-five percent of them were male and 60.6% general practitioners. The prevalence of GERD was 27.4% of which 21.0% was had GERD with low impact on daily life, and 6.4% was GERD with high impact on daily life. The statistically significant risk factors of GERD was found in age >50 y.o (p = 0.002; OR = 2.054), BMI >30 kg/m2 (p = 0.016; OR = 2.53), and smokers (p = 0.031; OR = 1.982). Sex and education level were not found significant statistically as the risk factors of GERD. Conclusions: The prevalence of GERD among Indonesian physician was 27.4%. We found that age over 50 y.o, obesity and smoking habit were the risk factors of GERD in Indonesian doctors.&nbsp

Mirizzi Syndrome in Gallstone Complication

Mirizzi syndrome is a rare complication of gallstone which is characterized by the presence of gallstone impaction in cystic duct that leads to inflammatory stricture in the biliary duct and results in obstructive jaundice. In this report, we highlighted the diagnostic approach and management of Mirizzi syndrome in a 58 year-old male complaining of nausea, vomiting, and appearing jaundice. The role of imaging such as abdominal ultrasonography in depicting the characteristics of Mirizzi syndrome was also discussed and compared the findings with the classification of the disease in the literature. In this patient, Mirizzi syndrome was suspected by the appearance acoustic shadow in the gallbladder with dilated cystic duct suggesting the impaction of common bile duct (CBD). We performed endoscopic retrograde cholangiopancreatography (ERCP) as both diagnostic and therapeutic modalities by which we allowed sphingterectomy to evacuate the gallstone. However, due to the risk of further stone evacuation, the procedure was followed by elective cholecystectomy

Current Diagnostic Approach of Inflammmatory Bowel Disease

Inflammatory bowel disease (IBD) has begun to emerge in Indonesia. The disease is further classifiedinto two types, ulcerative colitis (UC) and Crohn\u27s disease (CD). Diagnosis of IBD is initiated from symptomfindings such as diarrhea, abdominal pain, bleeding diarrhea, and weight loss, and supported by physicalexamination and additional tests. The options for additional examinations of IBD are mainly endoscopy (esophagogastroduodenoscopy, colonoscopy, and also intestinal endoscopy), imaging techniques, and laboratory examinations either from blood or feces. The application of these modalities should be prompted by sufficientclinical suspicion to promote their efficiency as well as prevent underdiagnosis or overdiagnosis. In primaryhealth care settings, patients with IBD are expected to be recognized for therapy or to use appropriate referralsystem to warrant a proper treatment

Role of Double Balloon Enteroscopy in the Diagnosis of Obscure Gastrointestinal Bleeding

Obscure gastrointestinal bleeding (OGIB) is bleeding in the digestive tract which persist or recur and with unclear aetiology. OGIB is one of the important problems in the gastrointestinal field due to difficulty in diagnosing the aetiology and determining the source of digestive tract bleeding in patients. In diagnosing the cause of OGIB, clinical approach through history taking and physical examination still have important roles. Most of the sources of bleeding in OGIB is from the small intestine, which cannot be reached by esophagogastroduodenoscopy (EGD) or colonoscopy. Therefore, role of diagnostic tool which is able to perform total enteroscopy becomes important in diagnosing the cause of OGIB.Double balloon enteroscopy (DBE) technique is a safe endoscopy procedure which may use oral or even rectal approach. In finding the cause of OGIB, where most of the lesions is found in the proximal region of the small intestine, oral approach is more beneficial. When bleeding is not found after conventional endoscopy is performed, it needs to be suspected that the source might come from the small intestine. Currently, the two main modalities which can be used in the evaluation are video capsule endoscopy (VCE) and DBE. However, based on cost effectiveness DBE without prior VCE has benefit because it can also administer therapy in the abnormalities being found

Manajemen Peningkatan Kompetensi Aparatur (Studi Tentang Implementasi Kebijakan Reformasi Sumber Daya Kediklatan Pada Badan Diklat Kementerian Dalam Negeri RI)

Penelitian ini dilatarbelakangi oleh masih rendahnya kompetensi dan produktivitas PNS sehingga sulit untuk mencapai efesiensi dan efektivitas dalam penyelenggaraan pemerintahan.Pendidikan dan pelatihan atau Diklat merupakan bagian integral dari pengembangan sumberdaya manusia. Badan Diklat Kementerian Dalam Negeri (Badiklat Kemendagri) memiliki posisi yang sangat strategis dalam USAha mengembangkan kompetensi sumber daya manusia aparatur. Dengan posisinya yang strategis ini, Badiklat Kemendagri dituntut melakukan reformasi penyelenggaraan diklat yang berbasis kompetensi. Secara umum penelitian ini bertujuan mendeskripsikan, memahami, dan memaknai tentang implementasi kebijakan reformasi sumber daya kediklatan di Badiklat Kemendagri. Penelitian ini menggunakan pendekatan kualitatif, bersifat interpretatif dan naturalistik. Pengumpulan data melalui wawancara mendalam yang didukung dengan studi observasi dan dokumentasi. Teknik analisis data dilakukan secara induktif melalui tahapan reduksi data, penyajian data, dan menarik kesimpulan.Temuan hasil penelitian ini menunjukkan implementasi reformasi dalam aspek sumber daya kediklatan masih belum optimal. Hal ini antara lain diindikasikan dengan: (1) belum optimalnya pelaksanaan analisis kebutuhan diklat (AKD) yang merupakan langkah pertama dalam proses penyelenggaraan diklat; (2) kondisi kurikulum pada sebagian diklat masih mengacu pada kurikulum lama sehingga terdapat materi ajar yang kurang relevan; (3) reformasi persyaratan peserta terus diupayakan karena sampai saat ini masih cukup banyak peserta pada penyelenggaraan diklat tidak memenuhi kriteria yang telah ditetapkan baik dari segi jumlah maupun kualifikasi; (4) jumlah widyaiswara 15 orang dengan usia berkisar 50 sampai 64 tahun menunjukkan adanya ketimpangan rasio antara jumlah dan jenis diklat terhadap ketersediaan widyaiswara. Namun, tahun 2010 telah dilaksanakan kebijakan rekruitmen widyaiswara dari CPNS dan berlatar belakang pendidikan minimal S2; (5) telah dilakukan berbagai upaya perbaikan sarana dan prasarana pembelajaran. Namun, belum semua materi diklat menggunakan fasilitas e-learning, akibat dari terbatasnya SDM yang menguasai IT. Sarana perpustakaan kurang di optimalkan pemanfaatannya, demikian pula koleksi buku maupun relevansinya perlu pengembangan; (6) masalah keterbatasan pembiayaan APBN telah membatasi jumlah target group (peserta) dalam beberapa penyelenggaraan diklat. Namun, dengan diterapkannya PNBP dapat menambah jumlah target group; (7) evaluasi diklat lebih ditekankan pada evaluasi proses dan output, sedangkan evaluasi outcome [dampak] belum dilaksanakan secara terencana. Reformasi sumber daya kediklatan terus berjalan seiring dengan target waktu yang telah ditetapkan hingga tahun 2014. Akhirnya, penelitian ini menawarkan sebuah strategi alternatif model manajemen peningkatan kompetensi aparatur yang didasarkan pada pendekatan empat komponen sistem yang saling berkaitan dalam satu siklus kegiatan dan menekankan pada pelaksanaan uji kompetensi serta sertifikasi sumber daya manusia diklat melalui penetapan standar, sehingga dapat tercipta tata kelola pemerintahan yang baik [good governance] dan akuntabel. This research is driven by low competence and productivity of civil public servants which makes the efforts to achieve efficiency and effectiveness in governance being very difficult. Training and education is an integral part of human resource development. Education and training bodies\u27 ministry of home affairs has a very strategic position in the efforts to develop civil public servants human resources competence. They are expected to do reform in education and training establishment which is based on competence. Generally, this research aims to describe, understand, and interpret the implementation of policy reforms at the education and training bodies\u27 ministry of home affairs. This research used a qualitative approach, interpretative and naturalistic. Data is collected through in-depth interviews supported by observational studies and documentation. The data analysis technique performed inductively through the stages of data reduction, data presentation, and draw conclusions. The findings of this research shows that the implementation of reforms in terms of education and training resources is still not optimal. This is indicated by: (1) training needs analysis as the first step of education and training process which is not yet optimized; (2) the curriculum in most training is still referring to the old curriculum which means there is an insufficient relevant teaching materials; (3) reform of the requirements of the participants was still ongoing because there are still a lot of participants in the education and training who not meet the established criteria in terms of quantity and qualifications; (4) the number of lecturers are 15 people with ages ranging from 50 to 64 years. It means there are inequity ratio between the number and type of education and training on the availability of lecturers. In 2010, the lecturer\u27s recruitment policy coming from civil public servant candidates with minimal educational background of master degree has begun to be implemented; (5) various efforts to improve learning infrastructure has started to be done however, not all of the training material have used e-learning facilities, this is because the limitation of available human resources with information technology mastery. The library is not fully used and the book collection and its relevance should be developed further; (6) the limitation of state budget financing abilities have limited the number of target group/participants in the implementation of education and training however, the implementation of non-tax revenues can increase the number of target groups; (7) evaluation of education and training are emphasized on the evaluation process and output, while the evaluation of outcomes has not been implemented in a planned manner. The reform of education and training resources continue to go hand in hand with the target time that has been set up in 2014.Finally, this research offers an alternative model of civil public servant competence improvement management which is based on the approach of four interrelated components of the system in a single cycle of activity and emphasis on the implementation of competency test and the certification of education and training human resources through the establishment of certification standards, in order to create good governance and accountable governance

Gastrointestinal Amyloidosis: Diagnostic Approach and Treatment

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

Management of Recurrent Cholangitis in Patient with Iatrogenic Bile Duct Stricture

Iatrogenic bile duct stricture is the most common causes of benign bile duct stricture. Several studies reported that approximately 80% of benign strictures occur following injury during a cholecystectomy. Strictures of the biliary tract have a broad spectrum of manifestations, ranging from mild elevation of liver enzymes to life-threatening infections such as cholangitis, liver abscess, and biliary cirrhosis. Moreover, due to its indolent course with subtle clinical manifestations, diagnosis is often delayed and most patients present with a protracted, complicated course. We reported a case of 26 years old female with recurrent cholangitis due to iatrogenic bile duct stricture. Biliary drainage through endoscopic approach followed by surgical procedure was selected as strategic management for the patient

Gastric PH Comparison Between Mild and Severe Cirrhotic Portal Hypertensive Gastropathy

Background: One of the causes of upper gastrointestinal bleeding in patients with liver cirrhosis is thepresence of portal hypertensive gastropathy (PHG). The prevalence of PHG in patients with liver cirrhosis isquite high but there is still inconsistency regarding the studies about gastric pH in cirrhosis patient. The aim of this study is to compare the gastric pH in mild and severe PHG due to liver cirrhosis.Method: Cross sectional method with consecutive sampling was done to all liver cirrhotic patients who came to Clinic of Gastroenterology and Hepatology in Cipto Mangunkusumo hospital from March to May 2014. Sixtytwo patients with portal hypertensive gastropathy underwent endoscopy to measure the degree of gastropathy based on Mc Cormack classification ad the mean basal gastric pH using pH-metric.Results: There are 50 (80.6%) male patients and 12 (19.4%) female patients participated in this study. Portal hypertensive gastropathy is mostly caused by hepatitis C (56.5%), hepatitis B (32.3%), non-hepatitis (8.1%) and alcohol (3.2%). The mean of gastric pH in all liver cirrhosis patients with portal hypertensive gastropathy was 2.13.The mean gastric pH in liver cirrhosis patient with mild portal hypertensive gastropathy (2.00 mEq/L) was lower than the gastric pH in severe portal hypertensive gastropathy (2.25 mEq/L) with significant differences (p<0.05)Conclusion: The gastric pH in liver cirrhosis patient between mild and severe portal hypertensive gastropathy are significantly differen