Chudahman Manan

Validation of Rome II criteria for functional gastrointestinal disorders by factor analysis of symptoms in Asian patient sample

Background: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria.

The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period

Backgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study. Keywords : upper gastrointestinal bleeding, endoscopy

Upper Gastrointestinal Malignancy among Dyspepsia Patients in Cipto Mangunkusumo Hospital Jakarta

Background : Upper gastrointestinal (GI) malignancy was still a health problem in all over the world. The prevalence of the upper GI malignancy vary among Asian countries. Data from Indonesia was scarcely reported. The aim of this study is to determine the frequency of upper GI malignancy among dyspepsia patients who underwent esophagoduodenoscopy (EGD) procedure. Method : This is a retrospectives study from subject with dyspepsia that had underwent upper GI endoscopy at the Department of Internal Medicine Cipto Mangunkusumo hospital from January 2005 to December 2007. All complete data from medical report and histopathology appearance will be recorded. Results : Out of 2,116 subjects underwent endoscopy due to dyspepsia, 110 (5.19%) subjects was diagnosed as cancer. This upper GI malignancy consisted of gastric cancer in 63 (2.97%) cases, esophageal cancer 32 (1.51%) and duodenal cancer 15 (0.71%). The mean ages of the subjects was 53.36 ± 10.97 years, age less than 45 years was 20 (18.20%) subjects, more than 45 years was 90 (81.18%), male 71 (64.50%) subjects, female 39 (35.50%). Most of them had alarm signs 96 (87.30%). Histopathology finding showed adeno-carcinoma in 75 (68.20%) cases, signet ring cell carcinoma in 14 (12.70%), squamous cell carcinoma in 8 (7.30%), others in 13 (11.80%). Out of 59 gastric cancer, 48 (76.20%) cases was located at distal part while the rest 11 (17.50%) cases was located at the proximal gaster, and 4 (6.30%) in diffuse. By the ethnics founded Javanese 37 (33.60%) subjects, Betawinese 22 (20.00%), Sundanese 12 (10.90%) and Batak 13 (11.80%) . Conclusions : Upper GI malignancy was found in five percent of subjects with dyspepsia who undergo colonoscopy. The three most frequent malignancies were gastric carcinoma, esophageal carcinoma, and duodenal carcinoma respectively. Most of gastric adenocarcinoma was located at distal stomach. Keywords : upper gastrointestinal malignancy, dyspepsia, endoscopy, alarm sign, histopathology

Hospital-based Survey on Knowledge and Attitude toward Colorectal Cancer Screening among Indonesian Population

Background: Several western countries have recommended colorectal cancer (CRC) screening, however the yield of CRC screening is still low. The acceptability of CRC screening is influenced by people’s knowledge and attitude. This study was conducted to evaluate the knowledge and attitude of Indonesian people toward CRC screening. Method: Adult Indonesian population aged 19–65 years was recruited in this hospital-based survey. Knowledge and attitude toward CRC screening were assessed by using structured questionnaires consisting of nine chapters. Result: There were 614 respondents recruited in this study. Most respondents (36.2%) incorrectly pointed out abdominal pain or pain around anus as the symptom of bowel cancer. Regarding CRC risk factors, eating fruits or vegetables rarely was the most frequent answer (28.5%) encountered. Only one-third (28%) of respondents mentioned colonoscopy as the Method for CRC screening. There were 38.1% of respondents who believed that CRC screening test might be harmful to the body. Up to 70.8% of the respondents agreed and strongly agreed that CRC screening test might cause physical discomfort. Two fifth (41.5%) of respondents believed that CRC screening test was embarrassing. More than half (58.8%) of respondents were afraid of having the CRC screening test. The test was too expensive according to 79.5% of respondents. Conclusion: The knowledge on CRC symptoms, risk factors, and screening tests is still low among Indonesian population. Our study result indicates that the lack of knowledge and the discouraging attitude among Indonesian population will be the major barriers to implement CRC screening in Indonesia. Keywords : colorectal cancer, screening, knowledge, attitude

Management of Paralytic Ileus

Ileus is a pathophysiologic state of inhibited motility in the gastrointestinal tract due to a physical/ anatomic obstruction in the lumen (obstructive ileus) or due to cessation of smooth muscle motor activity in the small intestine and colon. In Internal Medicine, paralytic ileus is most commonly caused by peritonitis, which is most often caused by acute pancreatitis. To establish a diagnosis, several diagnosis evaluation procedures may need to be performed such as laboratory evaluation, radiologic examination, ultrasonography and CT examination. Management of paralytic ileus is aimed at the underlying disease and supportive therapy. With this management paralytic ileus will spontaneously remit. Keywords : paralytic ileus, pathogenesis, diagnosis, management

Candida Esophagitis: A Retrospective Study of Upper Gastrointestinal Endoscopic Grading and the Characteristic Profile

Background: Candida esophagitis is a common abnormality found on esophagogastroduodenoscopy (EGD) procedure in patients with recognizable risk factors. However, the finding is frequently incidental as most of them are asymptomatic. There has been no study on the characteristics of Candida esophagitis in Indonesia. The aim of this study was to describe the degree of Candida esophagitis and its characteristics in patients who underwent EGD procedure at Cipto Mangunkusumo Hospital. Method: A retrospective study was conducted on all EGD procedures at the Gastroenterology Procedure Room, Internal Medicine Department, Cipto Mangunkusumo Hospital, between January 2007 and December 2009 with a total of 2,311 samples. The study was carried out by visually examining all endoscopic procedures and grading them according to the Kodsi severity grading (1976), and evaluating medical records. Data analysis was performed using Microsoft Excel 2007. Results: During the study period, Candida esophagitis was found in 2.6% patients with predominant male (68.9%) and the average age was 49.8 ± 15 years. The chief complaints found were dyspepsia (34.4%), melena (21.3%) and dysphagia (4.9%) and 32.8% patients were asymptomatic. The most frequent risk factors were age ≥ 60 years old (28.3%), proton pump inhibitor or H2 receptor antagonist user (26.4%), and antibiotics (17.0%). Grade II Kodsi candidiasis was the most prevalent degree in this study (44.3%). Conclusion: Candida esophagitis was one frequent finding in endoscopy based on the complaint of dyspepsia in patients with certain risk factors. However, the results of this study still need further validation in prospective studies. Keywords: Candida esophagitis, esophagogastroduodenoscopy, risk factors, grading

Specific Subjective Symptoms for Gastroesophageal Reflux Disease in Ulcer Like Dyspepsia

Background : The Aim of study is to identify specific subjective symptoms for gastroesophageal reflux disease (GERD), GERD proportion in ulcer like dyspepsia and the correlation between specific subjective symptoms for GERD and endoscopic examination Result in ulcer like dyspepsia Methods : A cross-sectional study was conducted in 67 patients with ulcer like dyspepsia. The patient’s history of illness was taken, and physical and endoscopic examinations were performed. A questionnaire on dyspepsia symptoms was completed. Data analysis was performed to identify the correlation between subjective symptoms and endoscopic examination results using chi-square test. T test was performed to determine the correlation between dyspepsia scores and endoscopic results. Result : Subjective symptoms that correlated with endoscopic results were severe epigastric pain (p=0.080) and the absence of bloating (p=0.055). Dyspepsia scores did not correlate with endoscopic examination results (p=0.725). Conclusion : Specific subjective symptoms for GERD in clinical dyspepsia-like ulcer were severe epigastric pain and absence of bloating. The proportion of such symptoms in ulcer like dyspepsia could assist clinical diagnosis of GERD. Keywords : GERD, symptom, dyspepsia

Lower Gastrointestinal Bleeding due to Multiple Polyps in Ileum

The causes of lower gastrointestinal bleeding (hematochezia) are amyloidosis, anal fissure, angiodysplastic lesions, coagulation disorder, colitis, colon cancer, colorectal polyps, Crohn’s disease, diverticulitis, haemorrhoids, etc. This was a case of lower gastrointestinal bleeding due to colonic inflammatoric polyp. This inflammatoric polyps were caused by infection/inflammation and improved after antibiotic and NSAID therapy. Key Words : Colonic inflammatoric polyp, hematochezia.

Current Treatment of Gastroesophageal-Esophagitis Reflux Disease

INTRODUCTION Gastroesophageal reflux disease (GERD) is a condition of reflux of gastric content into the esophagus, which could create clinical symptoms. Reflux can occur under normal conditions, usually related to certain conditions, such as lying down after meals, and during vomiting. If reflux occurs, the esophagus would immediately contract to cleanse the lumen from the refluxate, preventing prolonged contact between the refluxate and the esophageal mucosa. According to the theory of balance (Shay theory), refluxate is an aggressive factor, with acid as its main component, while esophageal motility is a defensive factor, including lower esophageal sphincter tone. Recurrent gastroesophageal reflux accompanied by disturbed cleansing of the esophageal lumen creates an inflammatory process in the esophageal mucosa. This inflammation creates complaints in the patient in the form of heart burn sensations and regurgitation. The incidence of GERD in Asia differs from that of Western countries. In Japan, GERD is found at a rate of approximately 2% each day. Complaints of heartburn are usually brought up among those over 40 years of age. Symptoms are usually mild. The most recent data from the United States reported a weekly prevalence of heartburn ranging from 18-42%. The prevalence of esophagitis in an endoscopic study in Indonesia on 127 patients with dyspepsia was 22.8%, with a milder form in 90% of all cases. Similar data from Japan demonstrated a prevalence rate for esophagitis ranging between 1.29% and 9.96%, with a mild form in 70% of cases. Such low prevalence may be associated to a difference in diet and the number of parietal cells between Asian and Western populations. Current Treatment of Gastroesophageal-Esophagitis Reflux Disease

Demographical Distribution on the Incidence of Helicobacter pylori Infection in Jakarta: Obtaining Samples from 5 Municipalities

Background: Currently, the hospital-based studies on Helicobacter pylori (H. pylori) have demonstrated that the incidence of H. pylori infection tends to decline in Indonesia. On the other hand, no population-based study has ever been conducted. Therefore, our study was performed to evaluate the true incidence of H. pylori found among the population. Method: This study was a surveillance using cross-sectional design. The samples used in our study were randomly selected from 1,645 samples including those from five municapalities of Special Capital Region of Jakarta in 2006. Immunochromatographic test (ICT) was utilized to establish the diagnosis of H. pylori infection. The test has demonstrated high sensitivity and specificity for Indonesian population Results: The seroprevalence of H. pylori infection among 310 patients was 52.3% (162 out of 310 patients) with mean age of 43.48 + 10.45 years. There was no difference regarding seroprevalence in both groups of 40 years of age (52.3% and 52.2%). The highest prevalence of H. pylori infection was found in West Jakarta (66.1%); while the lowest prevalence was found in South Jakarta (41.0%). The incidence of H.pylori infection between those who were alcoholic was equal to those who were not alcoholic (46.2% vs. 52.5%).Similar result was also found between smokers and non-smokers (53.8% vs. 51.8%). Conclusion: In this study, we found that H. pylori seroprevalence remains high in the population. Various seroprevalence of H.pylori infection were found among five municipalities in Jakarta. Keywords: Helicobacter pylori, Jakarta, seroprevalence