Helicobacter Pylori, Induced Gastric Cells Apoptosis

Gastric epithelial cells apoptosis induced by Helicobacter pylori depends on microbial and host factors. Apoptosis on mitochondrial level by Bcl2 family protein is the main pathway for Helicobacter pylori induced gastric epithelial cells apoptosis, though there are roles for apoptosis through Fas receptors or TNF. Imbalance between proliferation and apoptosis gastric epithelial cells determines the risk for neoplastic transformation. Increase of gastric epithelial cells apoptosis seems to have an obligation for initiating secondary hyperproliferative response. If altruistic cellular death fails to oppose this process, uncontrollable cellular growth leading to neoplastic transformation will occur

Histopathological Pattern of Gastric Biopsies of Helicobacter Pylori Positive Patients in Sardjito General Hospital, YOGYAKARTA

Objective: To determine the gastric histopathological types of H. pylori positive patients. Materials and Methods: Study design was prospective study. Consecutive patients who were suffering chronic dyspepsia underwent endoscopic examination between August 1998 and December 1999. The biopsy specimens were taken from the gastric antrum and corpus and sent to the pathologist for histopathological typing and H. pylori examinations. H. pylori were also confirmed with CLO and IgG- Helicobacter pylori test. Results: There were 92 patients (48 male (M) and 44 female (F)) who underwent endoscopical gastric biopsies between August 1998 and December 1999. Fifty six (60.87%) patients suffered from chronic superficial gastritis, 11 (11.96%) from chronic atropic gastritis, 2 (2.17%) from chronic gastritis with metaplasia, 3 (3.27) from gastric ulcer, and 2 (2.17%) from gastric signet-ring cell carcinoma. Twenty one (22.8%) patients was found to be H. pylori positive based on histopathologic examination with CLO and IgG-H. pylori tests. Those were 5 (8.90%) patients with chronic superficial gastritis, 7 (63.63%) chronic atrophic gastritis, 3 (100%) gastric ulcer, 2 (100%) chronic gastritis with metaplasia, 1 (50%) signet-ring carcinoma. The age range of the H. pylori positive patients were between 16 and 76 years old. Conclusion: There were twenty one (22.8%) H. pylori positive patients out of 92 endoscopied patients and a high percentage tendency of H. pylori positively in chronic atrophic gastritis, gastric ulcer, and chronic gastritis with metaplasia, although most of the patients had chronic superficial gastritis. Further study with larger sample is needed to get clearer picture of H. pylori distribution based on gastric histopathological types

How to Negotiate Difficult Colonoscopy to Optimize Cecal Intubation Rate

Colonoscopy is the current standard method for evaluating colon. Cecal intubation rate is an important indicator of colonoscopy quality. In up to 10–20% colonoscopies, cecal intubation may be considered difficult.There are several consequences of low cecal intubation rate: it limits the efficacy of colonoscopy, increasing risk of complications and cost, and missing in detecting adenoma colorectal or other abnormal mucosa lesion.Failure to intubate the cecal can be a result of: (1) patients factors (female, older, diverticular disease, history of abdominal surgery, low body mass index, history of constipation, laxative use); (2) endoscopist factors (prior experience, the specific techniques and instrument used; (3) or some combination thereof. In an effort to solve these problems endoscopist should increase their technical manoeuvres (minimizing inflation and looping, using water–aided method, appropriate use of positional changes and abdominal pressure) and use various accessories methods (inserting a biopsy forceps through the biopsy channel, pediatric colonoscopy, variable stiffness colonoscopy)

Endoscopic Findings and Histopathological Pattern in Patients with Chronic Dyspepsia at Panti Rapih Hospital Jogjakarta

Background: To determine the relationship between clinical manifestation of chronic dyspepsia and endoscopic findings along with histopathological pattern by descriptive analysis. Methods: This study was a retrospective study. Subjects were patients with chronic dyspepsia who underwent endoscopic examination and gastric biopsy between June 2005 and July 2006. Result: There are 10.17% normal endoscopic results of 79 patients with chronic dyspepsia and almost 90% show abnormal result in endoscopic examination. The histopathological pattern is normal in 2.53% and 97.47% demonstrate abnormal result. The prevalence of Helicobacter pylori due to gastric ulcer is 1.26% and chronic atrophic gastritis is 3.80%. Conclusion: Most of chronic dyspepsia patients have abnormal endoscopic and histopathologic result

Melanosis Coli

Melanosis coli is a brownish discoloration of the colonic mucosa caused by the accumulation of pigment in macrophages of the lamina propria. We reported a 62 years old woman with prolonged constipation since 10 years ago. She underwent haemorhoidectomy when 17 years old. Since 4 years ago she regularly comsumted herbal laxative. On 27 january 2015 underwent colonoscopy at Sardjito hospital Yogyakarta. Colonoscopic examination revealed Melanosis coli

The Role of Insulin Resistance in Diabetic Patients with Chronic Liver Disease

Background: The association between diabetes and chronic liver disease has been well documented. However, the mechanism remains unknown. The aim of this study was to investigate the insulin resistance in chronic liver disease and normal liver in diabetic patient. Method: A total of 31 diabetic, non-alcoholic patients with multiple oral hypoglycemic drugs, either with or without lipid abnormalities were enrolled in this study. Subjects were recruited from outpatient clinic of Department of Endocrine at Dr. Sardjito Hospital, Jogjakarta, Indonesia from May-June 2004. This was a cross sectional study. Fasting insulin and glucose level, liver function test, body mass index, and the presence of fatty liver by ultrasound were examined. Insulin resistance was estimated by calculating fasting insulin and glucose plasma level as the homeostasis model assessment (HOMA) index ratio. Data was described with mean ± SD and analyzed by independent sample t-test. Results: Thirty one patients were enrolled to the study, i.e. 8 patients with normal liver and 23 patients with fatty liver. Only 14 patients agreed to continue the study including 10 patients with fatty liver and 4 patients with normal liver. Mean of age was 59.1 ± 8.7 and mean value of BMI was 24.62 ± 3.05. The liver function test revealed normal Results. Triglyceride, cholesterol, fasting glucose level, and HOMA index (2.77 ± 1.95 vs. 1.66 ± 1.02) in patients with fatty liver were higher than patients with normal liver. No correlation was found between fasting insulin level as well as HOMA index and mean value of BMI (obese and non-obese) as well as hypertension. There was significant correlation between triglyceride level and fasting insulin among fatty liver patients (p = 0.048; CI 95% -7.404; -0.032). Conclusion: The non-alcoholic fatty liver disease in diabetic patients with normal liver enzymes and multiple oral hypoglycemic drugs appear to be related with insulin resistance and hypertriglyceridemia

Gallstones and Choledocolithiasis with Severe Cholestatic Jaundice in Beta-Thalasemia Intermedia Patient

Geographically, b-thalassemia can be found in many countries including in Indonesia. Thalassemia intermedia referred to patients as being ‘too haematologically severe to be called minor, but too mild to be called major\u27. Patients with thalassemia intermedia usually present themselves to medical attention in later childhood or even adulthood and are sustainable without the need for regular transfusion therapy. Three main factors are responsible for the clinical sequele of thalassemia intermedia: chronic anemia, ineffective erythropoiesis, and iron overload.There are many complications related to b-thalassemia intermedia such as gastroentero-hepatology diseases (splenomegaly, gallstones, choledocolithiasis, predispose patients to liver fibrosis and cirrhosis), vascular, endocrine and bone diseases. About 55-63% thalassemia intermedia patients suffer from gallstone with 68–85% of these patients undergo cholecystectomy, and 67-90% patients undergo splenectomy. Therefore, ultrasound examination is required to be performed regularly during illness and before patient underwent surgery or splenectomy to detect the presence of gall stones. In this case report a patient with gallstones and choledocholithiasis was reported. Severe cholestatic jaundice in b-thalassemia intermedia was diagnosed six months before hospitalization. The patient underwent open cholecystectomy and exploration common bile duct stones

Colorectal Cancer in Young Patient: a Distinguished Disease Entity?

Background: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients (< 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher's exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients < 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p < 0.05 was considered as significant. Results: Sixteen young aged (< 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p < 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habit