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

Gastrointestinal Manifestations in COVID-19 Infection

Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 originating from Wuhan, China, has caused an outbreak throughout the world and caused death. The severe acute respiratory syndrome coronavirus 2 enters the body via the angiotensin-converting enzyme 2 receptor, followed by priming by transmembrane serine protease 2 and provides an overview of the respiratory system’s main clinical manifestations, such as shortness of breath,cough, and fever. The gastrointestinal tract also expresses angiotensin-converting enzyme 2 receptors so that it manifests in the gastrointestinal tract, namely decreased appetite, diarrhea, vomiting, and abdominal pain. Complaints in the gastrointestinal tract can appear first or together with complaints in the respiratory tract. Patients with gastrointestinal symptoms have a more severe disease degree than patients without gastrointestinal symptoms, and the majority have a high fever. When infected by Coronavirus disease 2019, there is a prolonged condition of dysbiosis even though the severe acute respiratory syndrome coronavirus 2 virus has been eliminated, and respiratory symptoms are not available. The expression and distribution of angiotensin-converting enzyme in the oral cavity and the discovery of the severe acute respiratory syndrome coronavirus 2 virus in the feces indicate a potential route of infection from Coronavirus disease 2019 through the fecal orally. Pathological findings in the gastrointestinal tract of Coronavirus disease 2019 patients are still limited and still require further research, especially concerning the association with the patient’s previous history of the disease. For the treatment of Coronavirus disease 2019, so far, there has been no special therapy given. All treatments are supportive. In patients who experience diarrhea, evaluating their dehydration status, monitoring electrolyte abnormalities, antispasmodic drugs, and probiotics have been performed

The Surge of Dengue Cases during COVID-19 in Indonesia

Most healthcare resources in Indonesia have been engulfed by COVID-19 pandemic, and less attention has been given to the rising cases of dengue that has been endemic in many areas of Indonesia. Present study aimed to review the immunopathogenesis of dengue and COVID-19 infection, as well as their prevention strategies. This study is a narrative review based on the research articles and reports published between 2010-2020. A total of 60 articles and reports were obtained and after careful consideration 49 articles and reports were used as references of this study. The immune response in Dengue virus and severe acute respiratory syndrome coronavirus 2 infections aims to eliminate the virus, but it causes an increase in inflammatory mediators (cytokine storm) which can increase vascular permeability and organ damage. Secondary infection of Dengue virus with different strains may allow the occurrence of antibody-dependent enhancement. The possibility of antibody-dependent enhancement in severe acute respiratory syndrome coronavirus 2 infection has been studied in vitro and in animal studies. Dengue virus and severe acute respiratory syndrome coronavirus 2 infections have antigenic similarities and trigger memory B cells. The cross reactions between severe acute respiratory syndrome coronavirus 2 antibodies and Dengue virus antigens may cause false positive on rapid dengue infection serological tests. The prevention and control of Dengue virus and severe acute respiratory syndrome coronavirus 2 infections are based on the transmission mode, and people should comply to the related health protocols

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

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

Pathophysiology of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a large bowel functional disorder characterized by abdominal pain or discomfort and is associated with bowel habit changes without organic disorder. IBS is affected by many factors and is suspected of involving central and peripheral mechanisms, such as gastrointestinal dysmotility, bowel visceral/mucosal hypersensitivity, increased bowel permeability and interaction among the luminal factors including food and bowel microbiota changes, bowel epithelial barrier, mucosa immunity, genetic factor and biopsychosocial and brain gut axis which are suspected to affect IBS pathophysiology. Understanding the various factors and mechanisms underlying IBS helps in the consideration of management and repair of patients’ prognosi

Diagnosis and Management of Ulcerative Colitis

Ulcerative colitis is one part of inflammatory bowel disease and a chronic illness characterized by diffuse inflammation in the colonic mucosa. Ulcerative colitis is also influenced by lifestyle such as smoking, a diet high in sugar and fat, drug use, and stress. Genetic factors also have a role in ulcerative colitis. This study aimed to review the diagnosis and management of ulcerative colitis. The pathogenesis of inflammatory bowel disease is a result of continuous antigen stimulation by commensal enteric bacteria, fungi and viruses causing chronic inflammation in hosts with a genetic disorder and defects in mucosal barrier function as well as immunoregulation. The main clinical symptoms of ulcerative colitis are diarrhea with blood and mucus and abdominal pain. The diagnosis of ulcerative colitis is established based on typical clinical symptoms, stool examination, colonoscopy, and biopsy checks. These steps are performed to confirm the presence of colitis and to exclude infection. A typical endoscopic and histological outcome with negative outcomes from evaluation for infectious diseases will support the diagnosis of ulcerative colitis. Treatment of ulcerative colitis should be adjusted to the severity of the disease, divided into therapeutics for maintenance and therapy for remission. The goal of therapy is to induce and maintain remission conditions to improve patients’ quality of life, reduce long-term steroid requirements and minimize cancer risk. Patients' prognosis is generally quite good despite the often-deteriorating quality of life

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

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