HUBUNGAN TOPOGRAFI GASTRITIS ATROFI DAN POLIMORFISME IL-8 -251 DENGAN KEJADIAN PENYAKIT REFLUKS GASTROESOFAGEAL Penelitian Analitik Observasional Di RSUD Dr Soetomo Surabaya Divisi Gastroentero-Hepatologi

Latar Belakang: Penyakit refluks gastroesofageal telah menjadi salah satu masalah gastrointestinal yang sering dijumpai di seluruh dunia. Prevalensi penyakit refluks gastroesofageal di negara barat dilaporkan sebesar 10-20%, sedangkan di Asia, kejadian penyakit ini menunjukkan angka yang lebih rendah yakni sebesar 5%. Di Indonesia, prevalensi penyakit refluks gastroesofageal mengalami peningkatan seiring dengan peningkatan prevalensi di Asia dan Amerika. Topografi mukosa gaster yang mengalami perubahan histologi telah banyak dilaporkan memiliki korelasi terhadap berbagai penyakit gastrointestinal. Studi lain juga melaporkan bahwa salah satu jenis sitokin yaitu IL-8 memiliki hubungan dengan penyakit refluks gastroesofageal melalui jalur inflamasi yang terjadi pada mukosa gaster. Tujuan: Mengetahui hubungan hubungan antara topografi gastritis atrofi dan polimorfisme IL-8 -251 dengan penyakit refluks gastroesofageal. Metode: Penelitian analitik observasional dengan desain cross-sectional yang dilakukan di poli dan unit Endoskopi Divisi Gastroentero-Hepatologi Departemen Ilmu Penyakit Dalam di RSUD Dr. Soetomo Surabaya, yang dilaksanakan mulai September 2018 hingga Januari 2019. Subjek diwawancara menggunakan GERDQ, dilakukan pemeriksaan endoskopi, biopsi dan pemeriksaan histologi serta polimorfisme IL-8-251. Analisis data menggunakan uji fisher dan chi-square. Hasil: Hasil uji fisher antara gastritis atrofi antrum dengan penyakit refluks gastroesofageal menghasilkan nilai p=0,046 (p< 0,05), hal ini menunjukkan bahwa terdapat hubungan yang bermakna. Sedangkan antara gastritis atrofi korpus dengan penyakit refluks gastroesofageal yang diuji menggunakan uji chi-square menghasilkan nilai p=0,532 (p> 0,05), sehingga diantara keduanya tidak terdapat hubungan yang bermakna. Sama halnya dengan hasil uji chisquare antara polimorfisme IL-8 -251 dengan penyakit refluks gastroesofageal, nilai p=0,788 (p> 0,05) juga menunjukkan tidak adanya hubungan yang bermakna. Kesimpulan: Didapatkan hubungan positif bermakna antara topografi gastritis atrofi antrum dengan kejadian penyakit refluks gastroesofageal. Sedangkan, pada gastritis atrofi korpus dan polimorfisme IL-8-251 dengan kejadian penyakit refluks gastroesofageal tidak terdapat hubungan positif yang bermakna

Association of Metabolic Syndrome with Albuminaria in Diabetes Mellitus Type-2

Background : Metabolic syndrome is a risk factor for cardiovascular disease as well as the occurrence of chronic kidney disease. According to the IDF, the metabolic syndrome is diagnosed when central obesity obtained with 2 or more metabolic abnormalities that include impaired glucose metabolism, increased blood pressure, hypertriglyceridemia, and low HDL-C. Several previous studies reported an significant association found between the metabolic syndrome with albuminuria. In Indonesia, the association of metabolic syndrome with albuminuria in type 2 diabetes have not been.reported. Objectives : To investigate the association of metabolic syndrome with albuminuria in type 2 diabetes patients. Methods : This is an analytic observational study, cross-sectional design in type 2 diabetes mellitus patients and we studied 131 subjects. Criteria metabolic syndrome according to IDF consensus and albuminuria assessed using the ACR method and the classification of albuminuria was based on consensus of Perkeni 2006. As for Statistical analysis using spearman correlation and Mann-whitney test. Significance level used was 0.05. Results : Of the 131 type 2 diabetes patients with metabolic syndrome were found normoalbuminuria proportion 65.4%, microalbuminuria 27.1% and macroalbuminuria 7.5%. Obtained a significant association between systolic blood pressure with albuminuria, p = 0.000, r = 0.325. Fasting blood sugar with albuminuria, p = 0.01, r = 0.223. But not found significant association between diastolic blood pressure with albuminuria, p = 0.153, r = 0.125, waist circumference with albuminuria, p = 0.311, r = 0.089, low HDL with albuminuria p = 0.771, r = -0.025. Hypertriglyceridemia with albuminuria, p = 0.727 and r=0,031. Conclusion : The results of this study indicate a strong association between the components of metabolic syndrome, systolic blood pressure with albuminuria, and fasting blood sugar with albuminuria. Whereas diastolic blood pressure, waist circumference, low HDL, and hypertriglyceridemia were not found significant associations

Response Evaluation of Patients Undergoing Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma with Respect to Tumour Size, Number of Lesion, and Alpha-Fetoprotein (AFP) Level

Background: Transarterial chemoembolization (TACE) is widely used as a palliative treatment for unresectable hepatocellular carcinoma (HCC). TACE is also used as bridging therapy before liver transplantation to avoid tumour progression and considered for downstaging to fulfill tumour resection or liver transplantation criterias. This study aimed to evaluate response of TACE in unresectable HCC according to changing of tumour size, number of lesion, and AFP level.Method: Retrospectively, we evaluate 69 HCC patients who underwent TACE in Dr. Soetomo General Hospital in January 2012-June 2015, including their age, sex, aetiologies, and Barcelona Clinic Liver Cancer/BCLC staging. Laboratory examinations such as complete blood count (hemoglobin/Hb, leucocyte, thrombocyte), liver function test (aspartate aminotransferase/AST, alanine aminotransferase/ALT, bilirubin, albumin, international normalized ratio/INR), alpha-fetoprotein/AFP level, and abdominal CT-scan were performed before and 1 month post-TACE. Data was analysed using paired t-test.Results: 69 patients with mean age of 51.81 ± 12.8 years old, predominantly 76.8% males, the most common aetiology was hepatitis B 68.1%, 92.8% BCLC B, 64.3% with stable disease, none achieved complete response, 97.1% had tumour size > 5 cm, 69.6% had single tumour, and 55.7% had AFP level >1000 ng/mL. There was a significant increase in tumour size and number of lesions in 1 month post-TACE that were approximately 1.76 cm and 2.33, respectively, and there was no significant difference between AFP level before and 1 month post TACE.Conclusion: In 1 month post TACE evaluation, there was a significant increase of tumour size and number of lesion, but there was no significant alteration in AFP level. TACE might be performed repeatedly with shorter evaluation interval than 1 month to achieve better response

Diagnostic values of helicobacter pylori stool antigen immunochromatographic method compared to histopathology in dyspepsia patient

Background: Helicobacter pylori infection often leads to complaints of dyspepsia. Enforcement of infection still relies on invasive histopathological methods through endoscopic and biopsy procedures. Helicobacter pylori stool antigen (HpSA) is a method of rapid immunochromatography that is not invasive and relatively inexpensive. We determined the diagnostic value of HpSA examination of immunochromatographic methods compared to histopathological examination as the gold standard for diagnosing H. pylori infection. Methods: HpSA examination was used to identify H. pylori infection by its ability to detect H. pylori antigen from stool of dysepeptic patients .Its diagnostic values including sensitivity, specificity, positive predictive value and negative predictive value was determined by comparing them to those of histopathologic examination as gold standard. Results: From 93 dyspeptic patients, pre-test probability of H. pylori infection using histopathologic examination showed result as much as 17.2 . The sensitivity, specificity, positive predictive value and negative predictive value of HpSA immunochromatographic methods were 38, 94, 55 and 88, respectively. A positive probability ratio of 5.78 increased the post-test probability for H. pylori infection by 37.8. A negative probability ratio of 0.68 increased the post-test probability of not being infected with H. pylori by 5.4. Conclusion: The diagnostic value of HpSA examination of immunochromatographic methods was not good enough to exclude or diagnose H. pylori infection in dyspeptic patients. © 2019, Yerevan State Medical University. All rights reserved

Helicobacter pylori density and expression of gastric mucosal interleukin-8 in dyspeptic patients

Background: The density of the H. pylori colonies is associated with more severe clinical manifestations, chronic infections, ineffective therapy responses and malignant events. Interleukin-8 (IL-8) is one of cytokines that plays a role in the inflammatory process that results in gastric mucosal damage. We determined the association between H. pylori density and gastric mucosal IL-8 expression in dyspeptic patients. Methods: H. pylori density was determined using histopathology based on Updated Sydney System. IL-8 levels were measured using immunohistochemistry from the gastric biopsy. Results: There was significant difference between gastric mucosal IL-8 expression obtained in gastric mucosal gland epithelium (p = 0.028) at mild and high density of H. pylori (p = 0.013). There was a correlation between H. pylori density with gastric mucosal IL-8 expression of glandular epithelium (r = 0.622; p = 0.004), surface epithelium (r = 0.510; p = 0.026), and inflammatory cells (r = 0.054; = 0.028). Conclusion: We found a significant positive correlation between H. pylori density and gastric mucosal IL-8 expression in dyspeptic patients. © 2019, Yerevan State Medical University. All rights reserved

Management for a Patient with Barret’s Esophagus: A Case Report

Barrett's esophagus (BE) is a displacement of the squamocolumnar border (SCJ) site to proximal to the gastroesophageal junction (GEJ) accompanied by the presence of intestinal metaplasia. BE develops when reflux-induced stomach acid destroys the squamous epithelial layer of the esophagus and this lesion heals via a metaplasia process in which the damaged squamous epithelial layer is replaced by columnar colon-type epithelium. BE prevalence in the general population is about 1.6-1.7%. Patients with gastroesophageal reflux disease (GERD) may progress to BE. This report concerns two cases of patients with Barrett's esophagus. In both these patients BE was found without dysplasia. A diagnosis was made on the basis of anamnesis, physical examination, laboratory, radiological, endoscopy and anatomical pathology. The management of BE is aimed at three main objectives: reduction of symptoms due to GERD, avoiding progression to strictures and ulcers, and preventing progression to adenocarcinom a. Both patients were given a PPI, a prokinetic and chemoprevention NSAID which achieved clinical improvement. Neither patient had ablation, photodynamic or mucosal resection. BE survival is much better than in groups without BE (5 years survival 61% vs. 28%, P = 0.001

Evaluation of one-year lamivudine and telbivudine therapy on chronic hepatitis b patients: Based on biochemical, virological and fibrosis status in dr. soetomo general hospital

Background: Lamivudine and telbivudine are still the recommended treatment for hepatitis B, especially in Indonesia. However, no conclusive results on evaluation of the lamivudine and telbivudine therapy in Dr. Soetomo hospital in one-year therapy. Objective: To evaluate one-year Lamivudine and Telbivudine based on Hepatitis B Virus DNA, alanine aminotransferase, aspartat aminotransferase to platelet ratio index score, fibrosis-4, raid plasma reagin, platelet to lymphocite ratio score, transient elastography and liver biopsy. Methods: This is analytic observational study and carried out by evaluating secondary data from medical record in Dr. Soetomo hospital. Results: Significant decreased of Hepatitis B Virus DNA, normalization of alanine aminotransferase, improvement of aspartat aminotransferase to platelet ratio index, PLR and Transient elastography in one year each of lamivudine (p = 0.00; p=0.00; p = 0.00; p = 0.00; p = 0.00) and telbivudine group (p = 0.00; p=0.00; p = 0.00; p = 0.00; p =0.00). In HbeAg negative and positive patients, there were no significant different between lamivudine and telbivudine based on Hepatitis B Virus DNA reduction, normalization of alanine aminotransferase, improvement of aspartat aminotransferase to platelet ratio index score, fibrosis-4, platelet ratio index, transient elastography and liver biopsy. However, there was significant difference between lamivudine and telbivudine based on raid plasma reagin score in HBeAg positive patient (p = 0.013). Conclusion: There were no significant difference between lamivudine and telbivudine oneyear therapy based on biochemical, virological, and fibrosis status in Dr. Soetomo hospital. © 2019, Yerevan State Medical University. All rights reserved

Diagnostic values of helicobacter pylori stool antigen immunochromatographic method compared to histopathology in dyspepsia patient

Background: Helicobacter pylori infection often leads to complaints of dyspepsia. Enforcement of infection still relies on invasive histopathological methods through endoscopic and biopsy procedures. Helicobacter pylori stool antigen (HpSA) is a method of rapid immunochromatography that is not invasive and relatively inexpensive. We determined the diagnostic value of HpSA examination of immunochromatographic methods compared to histopathological examination as the gold standard for diagnosing H. pylori infection. Methods: HpSA examination was used to identify H. pylori infection by its ability to detect H. pylori antigen from stool of dysepeptic patients .Its diagnostic values including sensitivity, specificity, positive predictive value and negative predictive value was determined by comparing them to those of histopathologic examination as gold standard. Results: From 93 dyspeptic patients, pre-test probability of H. pylori infection using histopathologic examination showed result as much as 17.2%. The sensitivity, specificity, positivepredictive value and negative predictive value of HpSA immunochromatographic methods were 38%, 94%, 55% and 88%, respectively. A positive probability ratio of 5.78 increased the post-test probability for H. pylori infection by 37.8%. A negative probability ratio of 0.68 increased the post-test probability of not being infected with H. pylori by 5.4%. Conclusion: The diagnostic value of HpSA examination of immunochromatographic methods was not good enough to exclude or diagnose H. pylori infection in dyspeptic patients

Transient Elastography as Non-Invasive Examination of Hepatic Fibrosis

Over the past decade, significant advances have been made in the noninvasive assessment of liver fibrosis in patients with chronic liver disease. Transient elastography appears to be excellent in assessing liver fibrosis. For the interpretation of liver stiffness measurements, the doctor should know the disease clinically, biologically and morphologically and its parameters. In chronic liver disease, especially in chronic hepatitis C, the value of liver stiffness is strongly correlated with fibrosis stage according to the histology score. Patients with similar fibrosis but high alanine aminotransferase levels tend to have higher liver stiffness values, especially in chronic hepatitis B, and diagnostic performance for low-stage fibrosis can be affected when ALT is elevated. Transient elastography is an excellent tool for early detection of cirrhosis. Although TE cannot completely fulfill the need for liver biopsy, it can be used as an important noninvasive tool that allows the setting up of more efficient and custom management strategies for patients with chronic liver diseas

Acute Liver Failure

Acute liver failure is a sudden decline in liver function with jaundice, coagulopathy (INR ≥ 1.5) and hepatic encephalopathy in patients with no history of liver disease and it emerges in less than 26 weeks. The interval between the occurrence of yellow symptoms and hepatic encephalopathy of less than 7 days is hyperacute, 8-28 days is called acute, and more than 28 days but less than 26 weeks is called subacute. If the interval is more than 6 months, it is called chronic liver failure. The etiology of most cases is due to the use of acetaminophen. The treatment of ALF should be performed in the ICU to minimize the risk of infection, cerebral edema, bleeding, respiratory failure, and other organ function disorders. The prognosis of ALF depends on the degree of encephalopathy, prolongation of prothrombin time, serum bilirubin level, and kidney functio