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"This volume provides a history of Eosinophilic Esophagitis (EoE), a basic understanding of the physiology of the eosinophil, and a current understanding of the pathophysiology and genetics of EoE. The emphasis is on clinical applications including presenting symptoms, diagnosis and treatment options for patients with EoE. Written by both pediatric and adult experts in the fields of gastroenterology, allergy and pathology. Providing practical information useful in the treatment of patients."

"Esophageal polyp can be found by chance during endoscopic examination. Polyps can be formed by changes in the esophageal mucosa due to reflux esophagitis. We report a case of multiple esophageal polyp in a patient with complaints of recurrent regurgitation without heartburn. Endoscopy demonstrated multiple polyps at the distal esophagus. Anatomic pathology evaluation of the polyp demonstrated mucosa lined with squamous epithels demonstrating elongation of the papilla and deposition of acute and chronic inflammatory cells, indicating chronic esophagitis with hyperplastic epithels. In this case, we conducted recurrent ligation of the multiple polyps. Evaluation at 2 weeks after the final ligation demonstrated no polyp remains, and the post-ligation ulcer was found. Evaluation at 1 month following treatment found diminished complaints. From this case, we can conclude that endoscopy is an important investigation modality to establish the diagnosis in cases of chronic gastrointestinal complaints. Ligation is a choice for the management of esophageal polyps"

"Gastroesophageal reflux disease (GERD) is a condi-tion of reflux of gastric content into the esophagus, whichcould create clinical symptoms. Reflux can occur under normal conditions, usually related to certain conditions, such as lying down after meals and during vomitting. If reflux occurs, the esophagus would immediately contract to cleanse the lumen from refluxate, preventing prolonged contact between the refluxate and the esophageal mucosa."

"From the l9th of July to the l9?' of October 1999, we conducted a study to evaluate the diagnostic capabilities/benefits of the double contrast barium esophagogram in patients with esophagitis. The sample patients were taken from patients with reflux-type dyspepsia who visited the out patient clinic of the Sub-department of Gastroenterology ofthe Department of Internal Medicine of the Faculty of Medicine of the University of indonesia/Cipto Mangunkusumo Hospital, Jakarta. During the duration of study 32 patients fulfilled the criteria for inclusion, and did not fulfill the criteria for exclusion. All of the subjects underwent double contrast barium esophagogram, Bernstein lest, and endoscopy of the upper gastrointestinal tract, as well as biopsy of the lower third esophageal mucosa. The chief complaints for reflux type dyspepsia were found in the following order: pyrosis/heartburn (56.26%), acid/sour taste in the mouth (12.5%), chest pain (9.3 8%), swallowing disturbance (6.25%). breathing difficulties (6.25%), belching (6.25%), and palpitation (3.12%) From the 32 patients with reflux type dyspepsia that underwent double contrast barium esophagogram, 10 patients (3l. 25%) were found positive for esophagitis, and the remaining 22 patients were found to be negative (68.75%). Bernstein test found 11 patients (34.37%) positive and 21 (65.63%) negative, while endoscopy of the upper gastrointestinal tract showed positive esophagitis in 25 patients (78. 13%) and negative in 7 patients (2l.87%). The degree of accordance between double contrast barium esophagogram and the Bernstein test or even a combination of the two was unsatisfactory in diagnosing esophagitis in reflux type dyspepsia. Based on this, this study concludes that double contrast barium esophagogram and Bernstein are incapable of replacing endoscopic examination in establishing the diagnosis of esophagitis. "

"AbstrakEosinophilic inflammation in combination with immunoglobulin E (IgE) production is a characteristic feature of atopic dermatitis. Although activated T-helper type (Th) 2 cells play critical roles in the local accumulation and activation of eosinophils, whether they induce eosinophilic skin inflammation, independent of the IgE-mediated pathway has been unclear. To address the functional role of T cells in allergic skin diseases, we herein transferred Th1/Th2-differentiated or naive DO11.10 T cells into unprimed BALB/c mice. Ovalbumin-specific Th2 cells, as well as eosinophils, accumulated in the skin upon antigen challenge, despite the absence of antigen-specific IgE. Neither antigen-specific Th1 nor naive T cells induced eosinophil accumulation, although Th1 cells by themselves migrated into the skin. Interleukin (IL)-4, IL-5, and eotaxin were specifically produced in the skin of antigen-challenged, Th2 cell-transferred mice, whereas interferon (IFN)-γ and regulated on activation, normal T cell expressed and secreted (RANTES) were preferentially produced in Th1 cells-transferred mice. Production of monocyte chemoattractant protein (MCP)-1 and MCP-3 was enhanced by both Th1 and Th2 cells. The accumulation of eosinophils and Th2 cells in the skin was suppressed by both dexamethasone and FK506, indicating an essential role of Th2 cells in eosinophil recruitment. We conclude that Th2 cells can induce eosinophilic infiltration into the skin in the absence of antigen-specific IgE."

"Background: Esophagitis implies an organic damage of the esophagus due to several pathophysiologic factors, predominantly: (1) degree of gastric acid secretion (gastric pH), whereabouts are rapidly or slowly to be mucosal breaks onto esophagus were under the influe nced by: (a) gastric pH 54 and (b) the contact of gastric acid into esophageal mucosal. (2) Lower esophageal sphincter (LES) as a important lactor lor antifetlux mechanisms, which antireflux mechanism cannot senre as a barrier system whenever tone of LES comes down until 510 mml-lg that causes feeble resting LES pressure. Esophageal injuries are recognized endoscopicaliy by the presence of the Savary-Millers classification (1985), but there are not definitely which ones principally to pathophysiologic factor. Methods: This was a consecutive non-random sampling cross sectional study Thirty subject from 127 patients with dyspepsia undergoing elective upper-endoscopic examination with collecting of the gastric juice and biopsies of tower esophageal mucosal, also esophageal manometric examination. Before that, clinical inclusive and exclusive criterias until laboratory examination were performed. Significant interval was 95%. Analyzing data with Fisher?s Exact Test One-Tail to correlate between gastric pH and hypotonic LES into esophagitis. Results: Esophagilis prevalence was 22. 8%. Fisher's Exact Test One-Tail to correlate esophagitis with gastric pH E 4 was significant (p=0.013798), but with hypotonic LES (tones of LES S 10 mmHg) was not (p=0.60269). The combined roles or' gastric pH and tones of LES into esophagitis are included: (1) Frequency of roles of pH E 4 and hypotonic LES are 48.2% (2) Frequency of role of pH < 4 without hypotonic of LES are 33.3%. (3) Frequency of role of hypotonic LES without pH S4 are 11. 1% and (4) Frequency of esophagitis without roles of pH $4 and hypotonic ol LES are 7.4%. Conclusions: The sum of gastric pH 5 4 and hypotonic of LES together are more than each separate factor. Onto statistically was significant between esophagitis and gastric pH, but there is no correlation with tones ol LES. So, gastric pH plays a more important role than LES."

"Latar belakang: Rinosinusitis kronik (RSK) merupakan sebuah masalah kesehatan global. Berdasarkan keberadaan polip hidung, RSK dikategorikan menjadi RSK dengan dan tanpa polip hidung. Rinosinusitis yang memiliki gejala persisten walaupun mendapatkan tata laksana yang tepat disebut sebagai rinosinusitis refrakter. Kondisi ini dapat menyebabkan tatalaksana berlebih terkait kegagalan dalam tindakan pembedahan. Terdapat banyak faktor yang berperan dalam patogenesis RSK refrakter, seperti infiltrasi eosinofil, biofilm dan asma.Tujuan penelitian: Mengetahui pengaruh infiltrasi eosinofil, biofilm dan asma terhadap RSK dengan polip hidung bilateral refrakter.Metode: Penelitian ini menggunakan desain cross-sectional dan melibatkan 37 pasien RSK dengan polip hidung bilateral di RSUPN Cipto Mangunkusumo. Data diambil dari rekam medis (jenis kelamin, usia, atopi, dan asma) dan hasil pemeriksaan preparat blok paraffin polip hidung (infiltrasi eosinofil dan biofilm). Analisis data dilakukan menggunakan Statistical Program for Social Science (SPSS) for Windows versi 20.Hasil: Kejadian refrakter ditemukan pada 29 subjek (78,4%). Berdasarkan analisis bivariat, tidak terdapat asosiasi yang bermakna antara infiltrasi eosinofil, biofilm, asma, atopi, usia, dan jenis kelamin dengan kejadian RSK dengan polip hidung bilateral refrakter (p>0,05). Kesimpulan: Tidak terdapat pengaruh signifikan dari infiltrasi eosinofil, biofilm dan asma terhadap RSK dengan polip hidung bilateral refrakter.

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Background: Chronic rhinosinusitis (CRS) is a global health issue. Based on the existence of nasal polyps, CRS is further categorized into CRS with and without nasal polyps. Rhinosinusitis that show persistent symptoms despite suitable treatment is referred to as refractory rhinosinusitis. This condition could cause over-treatment due to failed surgery. There are a lot of factors that contribute towards the pathogenesis of refractory CRS, such as eosinophil infiltration, biofilm, and asthma

Aim: To assess the impact of eosinophil infiltration, biofilm, and asthma towards refractory CRS with bilateral nasal polyps.

Methods: This is a cross-sectional study involving 37 CRS with bilateral polyp nasal patients at Dr. Cipto Mangunkusumo National General Hospital. Data were obtained from medical records (sex, age, atopy, and asthma) and nasal polyp paraffin block examination (eosinophil infiltration and biofilm). Data analysis was performed using Statistical Program for Social Science (SPSS) for Windows version 20.

Results: 29 subjects (78,4%) had refractory CRS with bilateral nasal polyps. Based on bivariate analysis, no significant association was shown between eosinophil infiltration, biofilm, and asthma, age, and sex and refractory CRS with bilateral nasal polyps."

"Latar belakang: Laporan mengenai hubungan obesitas dan GERD semakin meningkat dalam beberapa tahun terakhir. Dengan meningkatnya pemahaman mengenai mekanisme GERD, diketahui terdapat peran sitokin proinflamasi dan adipositokin yang banyak terdapat di jaringan lemak viseral. Pada beberapa populasi di dunia, ketebalan lemak viseral diketahui berhubungan dengan meningkatnya insiden esofagitis erosif.Tujuan: Mengetahui profil ketebalan lemak viseral pasien GERD di RSCM.Metode: Penelitian ini merupakan studi potong lintang pada 56 subyek GERD. Subyek direkrut secara konsekutif pada bulan April hingga Oktober 2018 di RSUPN Cipto Mangunkusumo, Jakarta. Pemilihan subyek GERD berdasarkan Gastroesophageal Reflux Disease Questionnaires(GERDQ) dan pengukuran tebal lemak viseral menggunakan ultrasonografi. Erosi esofagus ditegakkan berdasarkan hasil endoskopi saluran cerna bagian atas. Analisis bivariat digunakan untuk menentukan perbedaan ketebalan lemak viseral antara grup esofagitis dan non-esofagitis.Hasil: Lebih dari separuh subyek penelitian ini menderita erosive reflux disease(ERD) (55,4%), didominasi oleh pasien dengan esofagitis kelas A berdasarkan klasifikasi Los Angeles sebanyak 64,5%. Rerata ketebalan lemak viseral grup NERD sedikit lebih rendah daripada grup ERD (47,9 mm untuk NERD dan 49,0 mm utk ERD). Terdapat kecenderungan peningkatan rerata ketebalan lemak viseral seiring dengan peningkatan derajat esofagitis (47,6 mm untuk esofagitis derajat A, 50,0 mm untuk esofagitis derajat B, dan 53,5 mm untuk esofagitis derajat C).Kesimpulan: Subjek ERD lebih banyak daripada NERD pada populasi GERD di RSUPN Cipto Mangunkusumo. Rerata ketebalan lemak viseral subjek NERD lebih rendah daripada ERD. Terdapat kecenderungan peningkatan rerata ketebalan lemak viseral seiring dengan peningkatan derajat esofagitis.

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Background: Reports about thecorrelation between obesity and GERD had been increasedin the past few years. Along with the increasing understanding of GERD, there are roles of proinflammatory cytokines and adipocytokines which are mostly contained in abdominal fat tissue. In several populations, visceral fat thicknessis associated with the increased incidence of erosive esophagitis.

Objective: To determine visceral fat thickness profile in GERD population in Cipto Mangunkusumo National General Hospital.

Methods: A cross-sectional study of 56 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between April and Oktober 2018 at Cipto Mangunkusumo National Hospital in Jakarta. Gastroesophageal Reflux Disease Questionnaires (GERDQ) were used to select research subjects and Ultrasonography examination was used to determine visceral fat thickness. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Bivariate analysis was used to determine visceral fat thickness difference between esophagitis and non-esophagitis group.

Results: More than half of this research subject were patients who suffer erosive reflux disease(55,4%), which dominated by patient with esophagitis class A, regarding to Los Angeles (LA) classifications, there were 64,5% of all ERD patients. The mean visceral fat thickness in erosive reflux disease (ERD) group slightly higher than in non-erosive reflux disease (NERD) group (49,0 mm vs 47,9 mm respectively). There is an increasing trend in mean visceral fat thickness as the esophageal erosion progresses (47.6 mm for grade A, 50.0 mm for grade B, and 53,5 for grade C).

Conclusion: ERD is more common than NERD in Cipto Mangunkusumo General Hospital's GERD population. The mean visceral fat thickness in ERD group is higher than in NERD group. There is an increasing trend in mean visceral fat thickness as the esophageal erosion progresses."

"Latar belakang: Kanker esofagus dilaporkan sebagai penyebab kematian keenam dari seluruh jenis kanker yang ada di seluruh dunia. Salah satu faktor risiko terjadinyakeganasan esofagus, terutama adenokarsinoma esofagus adalah gastroesophageal reflux disease (GERD). Diagnosis dini GERD sangat penting karena esofagitis refluks kronismerupakan faktor risiko utama terjadinya Barret esofagus, yang merupakan lesi prekursor terjadinya adenokarsinoma esofagus.Tujuan penelitian ini adalah untuk mengetahui ekspresi p53 dan Ki67 pada esofagitis refluks derajat ringan, esofagitis refluks derajat berat dengan kriteria Esohisto dan Barret esofagus. Bahan dan cara: Penelitian ini merupakan penelitian deskriptif dengan desainpenelitian potong lintang, dengan melakukan pulasan imunohistokimia p53 dan Ki67 pada 76 kasus sampel yang terbagi menjadi 30 kasus esofagitis refluks derajat ringan, 14 kasus esofagitis refluks derajat berat, dan 32 kasus Barret esofagus di Departemen Patologi Anatomik Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto mangunkusumo (FKUI/RSCM) tahun 2016-2018.Hasil: Ekspresi p53 positif pada 54 kasus sampel (71,1%), terbanyak pada Barret esofagus sebanyak 28 kasus (51,9%). Ekspresi Ki67 tinggi pada 46 kasus (60,5%), terbanyak pada esofagitis refluks derajat berat sebanyak 12 kasus (85,7%) Kesimpulan: Ekspresi p53 dan Ki67 pada esofagitis refluks derajat berrat dan Barret esofagus lebih tinggi dibanding dengan esofagitis refluks derajat ringan.

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Background: Esophageal cancer is reported as the sixth leading cause of death from all types of cancer worldwide. One of the risk factors for esophageal malignancy, especially esophageal adenocarcinoma is gastroesophageal reflux disease (GERD). Early diagnosis of GERD is very important because chronic reflux esophagitis is a major risk factor for Barrett esophagus, which is a precursor lesion to esophageal adenocarcinoma. The aim of this study was to determine p53 and Ki67 expression in mild reflux esophagitis, severe reflux esophagitis with the criteria of Esohisto and Barrett esophagus. Materials and methods: This study is a descriptive study with a cross-sectional design, by performing immunohistochemical results of p53 and Ki67 in 76 sample cases which were divided into 30 cases of mild reflux esophagitis, 14 cases of severe reflux esophagitis, and 32 cases of Barret esophagus in the Department Anatomical Pathology, Faculty of Medicine, University of Indonesia / Cipto Mangunkusumo Hospital (FKUI / RSCM) 2016-2018. Results: P53 positive expression in 54 sample cases (71.1%), most in Barret esophagus

as many as 28 cases (51.9%). Ki67 expression was high in 46 cases (60.5%), most in severe reflux esophagitis as many as 12 cases (85.7%) Conclusion: The expression of p53 and Ki67 in severe reflux esophagitis and Barrett esophagus was higher than in mild reflux esophagitis."