Effect of Nonsteroidal Anti-inflammatory Drug (NSAID) in Disease Relapse, Progression, and Development of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis: NSAID and IBD

This systematic review and meta-analysis investigated the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and inflammatory bowel disease (IBD). Pooled analysis showed no significant association in disease relapse (OR 0.97; 95% CI 0.70–1.35; p = 0.86) and disease worsening (OR 2.06; 95% CI 0.92–4.57; p = 0.08) of existing IBD in patients receiving NSAID. In patients without prior IBD diagnosis, NSAID medication was significantly associated with risk of new-onset IBD (OR 1.51; 95% CI 1.19–1.92; p = 0.0008).  Given the varied effects of NSAIDs on IBD, careful management and consideration of dosage and frequency are essential in IBD patients. Despite these insights, the heterogeneity of study designs and small sample sizes in some cases call for further large-scale research to validate these findings

Cancer Stem Cells and Signaling Pathways in Colorectal Cancer

Colorectal cancer (CRC) is the third most common cancer in males, the second in females and is the second leading cause of cancer related death worldwide. Despite recent advances in chemotherapy, and targeted therapy for CRC, the prognosis for patients with advanced cancer has remained poor, due to drug resistance, metastasis and recurrence. A small fraction of cells possess tumor propagation abilities. These are termed “cancer stem cells (CSCs). A subset of colorectal cancer stem cells, may hold a key to controlling cancer. The cancer stem cell (CSC) model suggests that tumors are hierarchically organized, only CSCs possess cancer-promoting potential. The killing of CSCs is thought to be a critical component of effective antitumor therapies. A number of signaling pathways, most notably the Wingless related (Wnt), transforming growth factor-beta (TGF-β), Notch and Hedgehog signaling and other mechanisms have been found to be associated with CSCs in CRC. They play important roles in maintaining the growth and functional integrity of CSC. Many new molecules are now being studied to block theses pathways. Some of the molecules block the self-renewal and induction of apoptosis in CSCs. The design of CSC-targeted interventions is a rational target, and reduce local recurrence and metastasis. This review aims to summarize the issue on CSCs and signaling pathway relevant for CRC, which may lead to more effective therapeutic strategies for CRC

Molecular Diagnostics in Colorectal Cancer

Colorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% of cases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP,1%), rare CRC syndrome < 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of deoxyribonucleic acid (DNA) mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy

FSSG Scale System in Comparison with GERD Questionnaires in Predicting Endoscopic Findings with Reflux Esophagitis

Background:Gastroesophageal reflux diseases(GERD) frequently manifests in varied symptoms other than its classics (heartburn and regurgitation), this variation might hinder its diagnostic effort. Several questionnaires based on symptoms filled by the patients themselves may help in diagnosing GERD without previous endoscopic examination. This study objects to compare endoscopic findings in patients which previously asked to fill the questionnaires (frequency scale for the symptoms of GERD (FSSG)) and GERD questionnaire (GerdQ) in pursuit of reliable and valid instrument to detect GERD before endoscopic approaches. Methods: This study was conducted in cross-sectional design involving 72 patients in Adam Malik Hospital, Medan with symptomps of upper abdominal pain or discomfort with or without heartburn/regurgitation. Subjects were asked to fill both FSSG and GerdQ and underwent endoscopy. Diagnoses made were classified as reflux esophagitis, functional dyspepsia, or other diagnoses. Subsequently we conduct a comparison analysis of both questionnaires' specificity and accuracy using receiver operator curve (ROC) by analyzing the area below the curve. Results: According to endoscopic findings from 72 subjects, we ascertained the following results: 52.8% gastritis, antral ulcer, and esophageal hiatal hernia, 37.5% functional dyspepsia, and reflux esophagitis in 9.7% cases. GerdQ is concluded to be superior in terms of specificity and accuracy compared with FSSG with the following percentages in terms of sensitivity, specificity, accuracy, and p value, respectively: 100%, 23.1%, 61.5%, 0.318 vs. 100%, 73.8%, 86.9%, 0.001. Conclusion: GerdQ is superior compared to FSSG in diagnosing GERD based on clinical symptoms in daily practice

Endoscopic Submucosal Dissection for Colitis-Associated Dysplasia

Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment of endoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one of the therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resection technique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the en bloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusively in expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are still lacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions but also the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be made scrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons, and pathologists specialized in IBDs

Gastrointestinal Problems in HIV/AIDS Patients

Background: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital

Gastrointestinal Problems in HIV/AIDS Patients

Background: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital

Palliative Surgery for Biliary Drainage in an Unresectable Pancreatic Cancer

Pancreatic cancer, known for its rapid progression and poor prognosis, usually presents with obstructive jaundice. Biliary drainage can be achieved by various techniques and approaches, with endoscopic drainage as the preferred method. However, open drainage of the biliary tree is indicated when unresectable tumor is found during resection surgery. This is a case of biliary drainage with a double bypass biliodigestive construction, which could be performed in patients with unresectable cancer in the head of the pancreas presenting with obstructive jaundice and gastric outlet obstruction

Factors affecting HBV DNA suppression in chronic hepatitis B patients treated with tenofovir disoproxil fumarate [version 2; peer review: 2 approved]

Background: This study aims to determine the factors affecting HBV DNA suppression in chronic hepatitis B patients with tenofovir disoproxil fumarate (TDF). Methods: A case-control was carried out from October 2021 to August 2022 on 182 chronic hepatitis B patients who had TDF therapy regularly for 24 weeks at H. Adam Malik and USU Hospitals in Medan, Indonesia. The history of the samples was obtained, followed by physical examination, and blood collection. CTLA-4 polymorphism examination was carried out using real-time PCR, while the serum CTLA-4 levels were assessed with ELISA. Results: The CTLA-4 -1661G>A polymorphism, genotype GG+AG, increased 1.52 times risk of not achieving HBV DNA suppression to TDF compared to genotype AA (p=0.041). High CTLA-4 levels increased 2.28 times risk, high HBV DNA levels increased 2.09 times risk, low ALT levels increased 1.95 times risk of not achieving HBV DNA suppression (p= 0.009, 0.026, 0.036, respectively). There was no relationship between gender, age, ethnicity, obesity, baseline AST, HBeAg, genotype, liver fibrosis and HBV DNA suppression after 24 weeks of treatment (p>0.05). Conclusions: The levels of CTLA-4, HBV DNA, ALT, and CTLA-4 -1661G>A polymorphism have a potential relationship with the suppression of HBV DNA in chronic hepatitis B patients with TDF

FSSG Scale System in Comparison with GERD Questionnaires in Predicting Endoscopic Findings with Reflux Esophagitis

ABSTRACTBackground:Gastroesophageal reflux diseases(GERD) frequently manifests in varied symptoms other than its classics (heartburn and regurgitation), this variation might hinder its diagnostic effort. Several questionnaires based on symptoms filled by the patients themselves may help in diagnosing GERD without previous endoscopic examination. This study objects to compare endoscopic findings in patients which previously asked to fill the questionnaires (frequency scale for the symptoms of GERD (FSSG)) and GERD questionnaire (GerdQ) in pursuit of reliable and valid instrument to detect GERD before endoscopic approaches. Methods: This study was conducted in cross-sectional design involving 72 patients in Adam Malik Hospital, Medan with symptomps of upper abdominal pain or discomfort with or without heartburn/regurgitation. Subjects were asked to fill both FSSG and GerdQ and underwent endoscopy. Diagnoses made were classified as reflux esophagitis, functional dyspepsia, or other diagnoses. Subsequently we conduct a comparison analysis of both questionnaires’ specificity and accuracy using receiver operator curve (ROC) by analyzing the area below the curve. Results: According to endoscopic findings from 72 subjects, we ascertained the following results: 52.8% gastritis, antral ulcer, and esophageal hiatal hernia, 37.5% functional dyspepsia, and reflux esophagitis in 9.7% cases. GerdQ is concluded to be superior in terms of specificity and accuracy compared with FSSG with the following percentages in terms of sensitivity, specificity, accuracy, and p value, respectively: 100%, 23.1%, 61.5%, 0.318 vs. 100%, 73.8%, 86.9%, 0.001. Conclusion: GerdQ is superior compared to FSSG in diagnosing GERD based on clinical symptoms in daily practice.Keywords: reflux esophagitis, GERD, FSSG, GerdQ, endoscopy, Los Angeles classification, heartburn.