Clinical Outcome Controversy in Helicobacter pylori Infection

H. pylori infection can manifest as intestinal and extraintestinal disease. In this review, we summarize several factors that cause differences in clinical manifestations of H. pylori infection. Host inflammatory response and bacterial virulence are key in determining the pattern of acid secretion and gastritis. The acid level factor that has a greater effect, not H. pylori infection itself. Gastritis predominant in the gastric in the initial phase will produce higher acid and trigger GERD. H. pylori is also the cause of gastric adenocarcinoma. Different vacA genotypes are related to the risk of clinical manifestations such as peptic ulcer or gastric cancer. However, there is variance prevalence in some countries which can be explained through a combination of several factors including age at infection, virulence factors of H. pylori, host genetic profile, and environmental factors. Besides, important differences were found at a locus in CagA H. pylori which resulted in differences in clinical outcomes in the form of gastritis or MALT lymphoma. H. pylori infection alone is not enough to trigger idiopathic thrombocytopenic purpura (ITP). Additional triggers are needed to obtain an anti-platelet autoimmune response at ITP associated with H. pylori. Therefore, the difference in clinical manifestations of H. pylori infection remains controversial. H. pylori is not only a single cause, but the host and environmental factors also contribute to producing different responses

Manifestasi Klinis Sistem Kardiovaskulras Pada Covid-19 dengan Badai Sitokin

Coronavirus disease-19 (Covid-19) merupakan penyakit infeksi virus corona baru yang disebabkan oleh severe acute respiratory syndrome corona virus-2 (SARS-CoV-2), pertama kali muncul di Wuhan, China pada awal Desember 2019 dan menyebar dengan cepat ke seluruh dunia (lebih dari 7.700.000 kasus yang dikonfirmasi pada 14 Juni 2020) (wu, et al., 2020). Covid-19 sekarang menjadi pandemi global dengan jutaan orang terdampak dan jutaan lainnya berisiko tertular. Covid-19 memengaruhi banyak sistem organ terutama paru-paru dan jantung. Peningkatan biomarker jantung, terutama troponin dan/atau kreatin kinase MB, sering terjadi pada pasien Covid-19 (Bavishi, et al., 2020; de Figueiredo Neto, et al., 2020)

Double Pylorus in Upper Gastrointestinal Bleeding

Double pylorus, also known as acquired double pylorus, is a rare condition defined as a gastrointestinal fistula connecting stomach antrum and duodenal bulb. The prevalence of double pylorus ranges from 0.001 to 0.4% by esophagogastroduodenoscopy (EGD). Although the etiology is unknown, the formation of double pylorus is related to Helicobacter pylori infection and the use of non-steroidal anti-inflammatory drugs (NSAID). The development of the occurrence of double pylorus is still unknown, but many systemic diseases play a role. We present the case of a 59-year-old man who was admitted to Dr. Soetomo General Hospital with hematemesis and melena. The patient had a history of diabetes mellitus since 3 years and consumption of medicinal herbs for myalgia, which was suspected of NSAIDs for the past 5 months. The patient had anemia with hemoglobin at 8.3 g/dL, enterogenous azotemia with blood urea nitrogen 28 mg/dL and serum creatinine 1.14 mg/dL. At EGD, double pylorus was found and accompanied by gastric ulcer, a giant white base ulcer, part of it covered by clotting without any sign of active bleeding. Biopsy revealed chronic inactive gastritis, and no H. pylori was found. Treatment mainly depends on gastrointestinal acid suppression through a proton pump inhibitor (PPI). The patient was given a high-dose PPI and a mucosal protective agent. He was treated for 1 week and had improved complaints