Aziz Rani

Helicobacter pylori management in ASEAN: The Bangkok consensus report

Helicobacter pylori (H. pylori) infection remains to be the major cause of important upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric adenocarcinoma, and mucosa‐associated lymphoid tissue lymphoma. H. pylori management in ASEAN: the Bangkok consensus report gathered key opinion leaders for the region to review and evaluate clinical aspects of H. pylori infection and to develop consensus statements, rationales, and grades of recommendation for the management of H. pylori infection in clinical practice in ASEAN countries. This ASEAN Consensus consisted of 34 international experts from 10 ASEAN countries, Japan, Taiwan, and the United States. The meeting mainly focused on four issues: (i) epidemiology and disease association; (ii) diagnostic tests; (iii) management; and (iv) follow‐up after eradication. The final results of each workshop were presented for consensus voting by all participants. Statements, rationale, and recommendations were developed from the available current evidence to help clinicians in the diagnosis and treatment of H. pylori and its clinical diseases.

Changing trends in gastrointestinal malignancy in Indonesia: The Jakarta experience

Aims: To identify changing trends in gastrointestinal cancer incidence in Indonesia according to age, gender, histopathology, and cancer location. Methods: We examined retrospectively the demography, cancer location, and pathological characteristics of 295 consecutive gastrointestinal cancer patients admitted to Cipto Mangunkusumo National General Hospital in 2002–2006. We compared these data with data from 343 gastrointestinal cancer patients admitted in 2007–2011. The data were analyzed by chi-square, analysis of variance, Kolmogorov–Smirnov, and Mann–Whitney U tests using SPSS 21.0. Results: The most prevalent gastrointestinal cancers in 2002–2006 and 2007–2011 were colorectal cancer (76.3% and 71.4%), followed by gastric cancer (15.6% and 14.9%), esophageal cancer (7.4% and 7.6%), and duodenal cancer (0.7% and 6.1%).There was an increase in esophageal adenocarcinoma prevalence from 36.4% to 69.2% (p = 0.023). The mean age at diagnosis of esophageal cancer decreased from 53.02 ± 13.12) to 50.43 ± 11.93) years (p = 0.031). The percentage of patients with gastric cancer aged 30–60 years increased from 60.9% to 82.4% (p = 0.018) and the percentage of patients aged > 60 years decreased from 34.8% to 13.7% (p = 0.015). In the histopathological analysis of gastric cancer, the prevalence of adenocarcinoma increased from 58.7% to 78.4% (p = 0.036), whereas the prevalence of signet ring cell carcinoma decreased from 21.7% to 5.9% (p = 0.022). The prevalence of gastric cancer lesions extending to >1 location increased from 2.2% to 27.5% (p = 0.001).The frequency of duodenal cancer among women increased non significantly from 0% to 52.4% (p = 0.261). The demography, histopathology, and location of colorectal cancers did not change between the two periods. Conclusions: Our study shows some changing trends in gastrointestinal malignancy in Indonesia in terms of demography, histopathology, and the location of cancers from 2002–2006 to 2007–2011.

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. Keywords : Chronic diarrhea, non-infective

Long-term study of endoscopic sclerotherapy in Jakarta, Indonesia

Esophageal varices bleeding is the most common cause of upper gastrointestinal bleeding in Indonesia. The frequency of variceal bleeding varies from about 20 85% of all upper gastrointestinal bleeding in this country 1-5. Endoscopic sclerotherapy has been proved effective in stopping bleeding, but reducing the rebleeding rate and improving survival is still a mayor clinical challenge 6. The authors commenced now endoscopic sclerotherapy in 1983, and it is a common practice in many hospitals. The purpose of this study was to evaluate the efficacy of endoscopic sclerotherapy for bleeding esophageal varices, and to estimate the morbidity and mortality related to this procedure in the longterm period.