Impact of Low Fiber Diet on Gastrointestinal Disorders

Fiber is not digested or absorbed in the small intestine. The main site of action of fiber is in the colon. In the colon, fiber will increase stool output and frequency, increase stool water, dilute the colonic content, reduce the toxins, bile acid, increase colonic fermentation and also stimulate probiotic growth. Some meta-analysis of observational epidemiologic and case control studies have found a protective effect of dietary fiber against colon cancer that increase with intake. Therefore, the high fiber diet is healthy recommendation to prevent various gastrointestinal disorders

Dyspepsia in Nonsteroidal Anti-inflammatory Drugs Gastropathy

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) gastropathy is a common complication, which has characteristic symptoms of dyspepsia syndrome. Mostly, it includes epigastric discomfort with bloating and nausea. The aim of this study was to provide evidences that clinical symptoms of dyspepsia are related to macroscopic changes of gastric form in rats, which are expected to be applied in human. Method: The study was conducted in 20 white rats (Rattus norvegicus, Sprague-Dawley strain) at the Department of Pathology and Clinical Reproduction, Bogor Agricultural University between January and December 2008. The rats were divided to treatment group and control group and each group consisted of 10 rats. Acetyl salicylic acid (ASA/aspirin) was administered at 400 mg dose, diluted in distilled water and was given to the treatment group using gastric cannula, once daily for three days period; while the control group had received aquabidest only. Subsequently, necropsies were conducted for both groups, followed by macroscopic observation and measurement of sagittal and transversal diameter. Gastric incisions along the minor curvature were performed in both groups to recognize any macroscopic changes of gastric mucosa. ANOVA test was utilized for data analysis, which was followed by Duncan test when the results were significant. Results: Gastric diameters in treatment group with positive lesion were significantly different from the control group and the treatment group with negative lesion on anthrum/pylorus region, with p < 0.05. Conclusion: Prominent gastric dilatation at anthrum/pylorus region found in the treatment group may become the initial cause and signs of dyspepsia in human

Difficulties in Making Diagnosis of Inflammatory Bowel Disease: Several Cases Analysis

Inflammatory bowel disease (IBD) is rarely found in clinical practice. However, the incidence of IBD seems to have increased recently. Generally, the patients will come to hospital with chief complaint of chronic diarrhea with or without hematochezia. We reported two cases of IBD in which they had been misdiagnosed as colitis tuberculosis based on colonoscopy examination. Treatment of anti tuberculosis drugs had made no clinical improvement. Further evaluation suggested the diagnosis of IBD. They responded very well clinically after treated as IBD. This case report reminds us to consider the diagnosis of IBD in patient with chronic diarrhea and ulceration in colonic mucosa at colonoscopy

Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People

Background: There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods: Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results: The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion: Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm

Diseases in Chronic Non-infective Diarrhea

Background: Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea. Methods: We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray. Result: Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn's disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc. Conclusion: The most frequent abnormality found in chronic non-infective diarrhea was maldigestion

National Consensus on the Use of Sedation Drugs in the Gastrointestinal Endoscopic Procedures

Gastrointestinal endoscopy is rapidly developing and several gastrointestinal endoscopy equipment are available for both diagnostic and therapeutic purposes. Proper sedation is critical in performing endoscopic procedures, both for patients and physicians. This consensus is used as a guideline and not as a legal standard in performing endoscopic services. This consensus explained the definition, indication, contraindication, and complication prevention during sedation. Factors affecting the need of sedation is patient factors, procedure factors, and sedation level. Diagnostic or therapeutic upper gastrointestinal tract endoscopy which not complicated can be performed with minimal sedation or moderate sedation, while deep sedation can be considered for longer and more complex procedures. Furthermore, assessment and selection of sedation was explained, followed by the guide to choose pharmacological sedation and analgesics. Currently, diazepam, midazolam, propofol, fentanyl, and pethidine is the most likely used sedation during gastrointestinal endoscopy, with midazolam as the preferred medication of choice. This consensus also explained the antidote of each drug and the recovery after procedure. This consensus aimed to improve gastrointestinal endoscopic procedure services in Indonesia

Clinical Effects of an Amino Acid and Glucose Solution in Non-surgical Gastrointestinal Patients of Internal Medicine

Background: This study was performed to assess the efficacy and safety of intravenous amino acid and glucose solution with electrolytes in non-surgical gastrointestinal patients. Method: This single, open, and pre-post study was conducted in the internal medicine ward at Cipto Mangunkusumo Hospital between June 2007 and March 2008. Patients were administered solution of amino acid, glucose, and electrolytes via peripheral vein at a dose of 1000 mL/day for one week period. Non-operative gastroenterology patients with age between 16 and 65 years were eligible in this study; patients were excluded if they had diabetes mellitus, severe hepatic or renal dysfunction, electrolyte disturbance, and obesity. The data were analyzed by paired t-test and McNemar test using SPSS version 16. Results: Fifteen patients consisted of 8 (53.5%) female, mean age was 38.47 ± 14.73 years. The body mass index (BMI) at screening was 14.50 ± 2.11 kg/m2. Patients\u27 BMI increased in day-1, day-3, and day- 7 into 14.5; 14.58; 14.80 kg/m2, respectively (p < 0.05). The increasing of prealbumin, albumin, transferin, and total protein were 7.30 mg/dL vs 11.16 mg/dL; p = 0.018; 2.71 g/dL vs 3.12 g/dL; p = 0.024; 102.37 mg/dL vs 141.95 mg/dL; p = 0.016; 6.24 g/dL vs 6.85 g/dL; p = 0.019, respectively. The clinical symptoms of nausea and weakness in patients decreased from 53.3% to 6.7%; p = 0.016, and 66.7% to 6.7%; p = 0.004. Conclusion: This parenteral nutrition solution was effective to improve clinical nutrition parameters

The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period

Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), < 40 years (242 cases; 16.8%). The causes of bleeding in patients whose age > 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal Malignancy was also found to be the etiology of bleeding in this study