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Irritable Bowel Syndrome (IBS) merupakan penyakit terbanyak pada anak dan remaja pada gangguan saluran cerna fungsional dengan subtipe diare, konstipasi, campuran dan unclassified. Mekanisme patofisiologi belum jelas dan memerlukan pembuktian adanya keterlibatan organik. Tujuan penelitian ini adalah untuk mengetahui epidemiologi IBS, peran infestasi Blastocystis hominis dan integritas mukosa usus dalam etiopatogenesis IBS, dampak IBS terhadap kualitas hidup, serta membuat sistem model prediksi IBS pada remaja.

Penelitian ini berbasis komunitas dengan pendekatan potong lintang komparatif dua kelompok pada remaja dari enam SMA di Palembang. Kriteria Roma III digunakan untuk menegakkan diagnosis IBS beserta kuesioner untuk menentukan faktor risiko. Secara multistage random sampling dibandingkan 70 subjek IBS dan 70 subjek nonIBS. Dilakukan pencatatan riwayat medis, pemeriksaan fisis, pemeriksaan parasit dan biomarker tinja serta kuesioner IBSQOL. Pemeriksaan tinja segar dengan mikroskop untuk mengetahui infestasi Blastocystis hominis. Pemeriksaan kadar alfa-1 antitripsin dan kalprotektin tinja dengan ELISA untuk melihat adanya gangguan integritas mukosa usus. Dampak IBS terhadap kualitas hidup dinilai dengan kuesioner IBSQOL.

Terdapat  454 subjek dengan prevalens IBS 30,2%, terdiri dari subtipe terbanyak yaitu subtipe diare 36,5%, dan yang paling sedikit subtipe konstipasi 18,9%. Uji regresi logistik mendapatkan faktor risiko utama IBS adalah dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan tiga jenis kacang, minuman kemasan, dan riwayat diare (kisaran OR 2,86–1,81). Blastocystis hominis ditemukan pada masing-masing grup sebesar 51,4 vs. 28,6%, dengan perbedaan bermakna (p = 0,006). Tidak ada hubungan bermakna untuk kerusakan mukosa (p = 0,734), tetapi bermakna dengan inflamasi usus (p = 0,039). Terbukti IBS secara bermakna menyebabkan rendahnya kualitas hidup (p = 0,001). Didapatkan 2 model prediksi skoring, yaitu model 1 yang dapat diaplikasikan pada layanan kesehatan primer yang bertujuan sebagai uji tapis dengan menilai faktor risiko. Model 2 diperuntukkan sebagai layanan terapi terkait infestasi Blastocystis pada layanan kesehatan tersier.

Simpulan, prevalens IBS pada remaja di Palembang tinggi dan memiliki faktor risiko utama dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan 3 jenis kacang, minuman kemasan, riwayat diare. Terdapat hubungan yang bermakna antara Blastocystis hominis dan inflamasi usus dengan kejadian IBS pada remaja, serta dampaknya terhadap kualitas hidup membutuhkan penanganan yang komprehensif.

Kata kunci: Blastocystis hominis, integritas mukosa usus, irritable bowel syndrome, kualitas hidup, remaja

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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder and commonly present in children and adolescences, presented as diarrhoea, constipation, mixed or unclassified type. The pathophysiological mechanisms of  IBS are unclear, and still challenging to determine organic disorders. The aim of this study was to investigate the epidemiology of IBS, the role of Blastocystis hominis infestation and intestinal mucosal integrity in the etiopathogenesis of IBS, the impact of quality of lifes, and apply a scoring system to predict the occurrence of IBS among adolescences.

A community-based survey with comparative cross sectional approach was done from six high schools in Palembang. Subjects were recruited using the multistage random sampling divided into two groups (70 subjects IBS and 70 subjects nonIBS). The Rome III criteria were used to establish a diagnosis of IBS along with a questionnaire to determine risk factors,  analyzed for association with Blastocystis hominis infestation, intestinal mucosal integrity, and its impact on quality of life. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones’ medium, PCR and Sequencing of 18S rRNA to determine Blastocystis subtype. Examination of antitrypsin alpha-1 and fecal calprotectin levels by ELISA was done  to determine impaired intestinal mucosal integrity. Impact of IBS on quality of life was done with the IBSQOL questionnaire.

Of the 454 subjects, the prevalence of IBS was 30.2%, consisting of diarrhea subtypes 36.5%, 21.9% mixed, 22.6% Unclassified and 18.9% constipation. The major risk factors for IBS were bullying, girls, ages 14–16 years, history of constipation, eat three kinds of nuts, drink beverages, and history of diarrhea (range OR 2.86–1.81). Blastocystis hominis was detected in each group of 51.4 vs. 28.6% (p = 0.006). There was no significant association for intestinal mucosal permeability (p = 0.734), but it was significant with intestinal inflammation (p = 0.039). Significant impairment of quality of life among IBS adolescences was found (p = 0.001). The IBS prediction score model had 2 models. Model 1 is more applicable in primary health care for sreening IBS based on risk factors. Model 2 only usable for tertiary health care, as management of Blastocystis infestation.

Conclusion, the prevalence IBS among adolescence was high with major risk factors to IBS consisted of bullying, female gender, age between 14–16 years, previous illness of constipation, diet three nuts, drink beverages, previous illness diarrhoea. Significant association with Blastocystis hominis infestation, intestinal inflammation were found, comphrehensive management is needed as for its impact on quality of life.

Keywords. Blastocystis hominis, intestinal integrity, irritable bowel syndrome,   quality of life, Adolescences

 

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Irritable bowel syndrome (IBS) adalah penyakit yang umum pada anak-anak dan remaja, dan mempengaruhi kualitas hidup. Telah ditemukan beberapa faktor risiko IBS, antara lain jenis kelamin, status sosioekonomik, dan gaya hidup. Penelitian mengenai prevalensi, faktor risiko, dan pengaruh IBS pada murid sekolah dasar sangatlah terbatas, khususnya di Indonesia, maka dari itu penelitian ini ditujukan untuk mengetahui faktor risiko, epidemiologi, dan pengaruh IBS terhadap performa akademik dan tingkat absensi. Penelitian potong lintang ini mengikutsertakan murid sekolah dasar di sebuah sekolah negeri di Jakarta. Orangtua diminta untuk mengisi kuisioner yang berisi karakteristik demografik dan kuisioner Rome III. Kami menggunakan metode total sampling. Subjek dikelompokkan menjadi dua kelompok (dengan IBS dan tanpa IBS), guna dibandingkan. Data di analisa menggunakan Pearson Chi-square, dan Mann-Whitney test. Di antara 154 subjek (86 laki-laki dan 68 perempuan) dengan umur median 9,68 tahun, 13 (8,4%) memiliki IBS. Umur, latar belakang pendidikan orangtua, dan kelas tidak berkaitan secara signifikan terhadap IBS. Jenis kelamin berkaitan secara signifikan terhadap IBS dengan perempuan sebagai faktor risiko yang signifikan. Absen tidak terkait secara signifikan dengan IBS, tetapi terlihat bahwa subjek dengan IBS memiliki nilai yang lebih tinggi sedikit dibandingkan dengan subjek tanpa IBS (P = 0.282).

Kesimpulan: Prevalensi IBS adalah 8,4%. Jenis kelamin adalah satu-satunya faktor risiko yang signifikan, dan tingkat absensi dan performa akademik secara statistik tidak signifikan terkait IBS.

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Irritable bowel syndrome (IBS) is a common disorder in children and adolescent, that influence their quality of life. Previous studies have shown that there are several risk factors towards IBS, such as gender, socioeconomic status, and lifestyle. Knowledge regarding the prevalence, risk factors, and impact of IBS in primary school students is very limited, especially in Indonesia, thus this study was aimed to explore the risk factors, epidemiology, and impact of IBS towards academic achievement and school absenteeism. This cross-sectional study included primary school students in a public school in Jakarta. Parents were asked to complete the questionnaires which comprise of demographic characteristics and Rome III questionnaire. We used total sampling. Then, the subjects were separated into two groups (those with IBS and those without IBS) in order to compare between the two. Data were analyzed with Pearson Chi-square, and Mann-Whitney test. Among 154 subjects (86 males and 68 females) with median age of 9.68 years, 13 (8.4%) had IBS. Age, parental education, and grade was not significantly associated with IBS. However, gender was a significant factor towards IBS with females as the significant risk factor. Absence was not significantly associated with IBS, but it is shown that those with IBS had slightly higher average score compared to those without IBS (P = 0.282).

Conclusion: Prevalence of IBS among primary school is 8.4. Gender was the only significant factor associated with IBS and that school absenteeism and academic achievement were not significantly associated with IBS.

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"Irritable bowel syndrome (IBS) is the most common functional disorder of the gastrointestinal tract. As a result of the lack of specific diagnostic testing and absence of circumscribed biology markers of the disease, its diagnosis is based on a myriad of symptoms. The term irritable bowel syndrome was probably first coined in 1944 by Peters and Bargenf. ln 1849, Cumming described the clinical manifestations of Irritable Bowel Syndrome. Irritable bowel syndrome is defined an the basis of the recently modified Rome criteria as the presence of at least l2 weeks (not necessarily consecutive) of abdominal discomfort or pain in the preceding l2 months that cannot be explained by structural or biochemical abnormalities, and that has at least two of the following three features: pain relieved with defecation, an onset associated with a change in the frequency of bowel movements (diarrhea or constipation), or an onset associated with a change inform of stool (loose, watery, or pellet-like). The syndrome can be divided into three subcategories according to the Modmed Rome criteria ll; those with a predominant symptom of diarrhea, constipation, or constipation alternating with diarrhea. There are Several criteria for irritable bowel syndrome, one of which is the Manning criteria applied in many epidemiological and clinical studies to identify irritable bowel syndrome. However, many investigators disagree with this criteria due to a seemingly poor validity in men. In an attempt to bring order to the specialty, consensus-based approach is adopted by a group of international experts, which led to the development ofthe Rome criteria for irritable bowel syndrome (Table l). Extra-intestinal symptoms, including headache, backache, urinary and gynecologic symptoms, and fatigue, are more common in the constipation-predominant subgroup"

"ABSTRAKPenelitian ini adalah suatu studi untuk menentukan apakah M2 Piruvat Kinasedapat dipakai dalam menapis radang usus. Metode penelitian yang digunakanadalah uji diagnostik. Pada penelitian ini direkrut sampel sebanyak 76 orang dandilakukan pemeriksaan kolonoskopi sebagai baku emas dan pemeriksan M2-PKfeses sebagai pemeriksaan yang diuji.Dari hasil penelitian ini didapatkan peran penting M2 Piruvat Kinase untukmenapis radang usus dengan nilai titik potong 1,05 U/ml dibandingkan dengankolonoskopi sebagai baku emas dengan sensitivitas 86,2 %, spesifisitas 81,8%,nilai duga positif 96,6% dan nilai duga negatif 50%. Pemeriksaan M2 PiruvatKinase disarankan dari hasil studi ini untuk menapis radang usus pada pasiendengan masalah saluran cerna bagian bawah.

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ABSTRACTThis is a study to evaluate possibility of M2-PK can be applied as a tool to screenof organic bowel inflammatory. Diagnostic test was used as a methode. In thisstudy 76 patient was recruited, colonoscopy was done as a gold standard and M2-PK faeces test was performed as a diagnostic test.As the result of this study, there is an important role of M2-PK test to screenorganic bowel inflammatory with cut off point >= 1.05 U/mL compared tocolonoscopy as a gold standard with sensitivity 86.2%, specificity 81,8%, positivepredictive value 96,6% and negative predictive value 50%. By this test result, it isstrongly recommended to performed M2-PK faeces test to screen organic bowelinflammatory."

"Inflammatory bowel disease (IBD) has begun to emerge in Indonesia. The disease is further classified into two types, ulcerative colitic (UC) and crohn's disease (CD). Diagnosis of IBD is initiated from symptom findings such as diarrhea, abdominal pain, bleeding diarrhea, and weight loss, and supported by physical examination and additional tests. The options for additional examinations of IBD are mainly endoscopy (esophagogastroduodenoscopy, colonoscopy, and also intestinal endoscopy), imaging the techniques and laboratory examinations either from blood or feces. The application of these modalities should be prompted by sufficient clinical suspicion to promote their efficiency as well as prevent underdiagnosis or overdiagnosis. In primary health care settings, patients with IBD are expected to be recognized for therapy or to use appropriate referral system to warrant a proper treatment."

"ABSTRAKLatar Belakang : Diagnosis Inflammatory Bowel Disease (IBD) masih didasarkan pada pemeriksaan invasif (endoskopi dan histopatologi). Fecal calprotectin merupakan petanda inflamasi intestinal non invasif yang dapat digunakan untuk membedakan IBD dengan penyakit intestinal non inflamasi, namun studi-studi yang ada masih memberikan perbedaan nilai diagnostik dan hubungannya dengan derajat IBD.Tujuan : Membuktikan bahwa pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD. Metode : Penelitian ini adalah studi potong lintang untuk melakukan uji diagnostik. Penelitian dilakukan di beberapa rumah sakit di Jakarta mulai bulan September 2014 sampai Februari 2015. Kurva ROC dibuat untuk mendapatkan nilai diagnostik fecal calprotectin dan uji Krusskal Wallis untuk menilai perbedaan kadar fecal calprotectin menurut derajat IBD.Hasil : Terdapat 71 pasien IBD berdasarkan pemeriksaan kolonoskopi diikutkan dalam penelitian. Dari pasien tersebut didapatkan sebanyak 57 pasien ditetapkan definite IBD berdasarkan pemeriksaan histopatologi. Kadar fecal calprotectin lebih tinggi bermakna pada pasien IBD dibanding yang bukan IBD (553,8 μg/g vs 76,95 μg/g, p < 0,001). Didapatkan nilai titik potong 179,3 μg/g dengan sensitivitas 96% (IK 95% 0,88-0,99), spesifisitas 93% (IK 95% 0,69-0,99) dan Area Under Curve (AUC) 99,5% (IK 95% 0,98-1,00). Didapatkan perbedaan bermakna kadar fecal calprotectin pada masing-masing derajat IBD (p < 0,001).Kesimpulan : Pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD.

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ABSTRACT

Background : Diagnosis of inflammatory bowel disease (IBD) is still based on invasive examination such as endoscopy and biopsy. Fecal calprotectin as a intestinal inflammation marker can used for diagnosis, but studies still had different diagnostic value and it?s correlation with grading of IBD.

Objective : Proving that fecal calprotectin have a high diagnostic value for IBD and correlation with grading of IBD. Methods : A cross sectional study for diagnostic of IBD. This study was conducted at several Hospitals in Jakarta from September 2014 until February 2015. A curve of ROC to determined diagnostic value of fecal calprotectin and Krusskal Wallis analysis to assessed of different value of fecal calprotectin according grade of IBD were made.

Results : Based on colonoscopy, 71 patient IBD were participated in this study. There were 57 patient diagnosis as definite IBD based on histopathology examination. Value of fecal calprotectin for IBD patient was higher than non IBD (553.8 μg/g vs 76.95 μg/g, p < 0,001). Value of fecal calprotectin was 179.3 μg/g as a new cutoff value with sensitivity 96% (CI 95% 0.88-0.99), specificity 93% (CI 95% 0.69-0.99) and Area Under Curve (AUC) 99.5% (CI 95% 0.98- 1.00) for diagnostic IBD. There was significant differences value of fecal calprotectin according every grade of IBD ( p < 0.001 ).

Conclusion : Fecal calprotectin has a high diagnostic value for IBD and correlated with grading of IBD."