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"This textbook provides a comprehensive and state-of-the-art overview of the major issues specific to the field of pediatric gastroenterology, hepatology, and nutrition. The first part of the book, Gastroenterology and Nutrition, presents in a systematic way the overall scope of issues encountered by children (newborn to teenagers) suffering from disorders of the gastrointestinal tract, pancreas and/or presenting nutritional issues. These chapters are structured in logical sections to facilitate consultation and include major topics ranging from congenital disorders to gastrointestinal problems of the newborn, infectious diseases of the gastrointestinal tract, and approach to nutritional problems in the various pediatric ages. The second part of the book, Hepatology, is articulated in a series of chapters which present a comprehensive review of congenital and acquired disorders of the biliary tract and liver. This section also includes a critical analysis of available diagnostic and therapeutic procedures and future perspectives.  Written by experts in the field, Textbook of Pediatric Gastroenterology, Hepatology and Nutrition: A Comprehensive Guide to Practice constitutes a much needed, innovative resource combining updated, reliable and comprehensive information with agile consultation for a streamlined approach to the care of children with such disorders."

"latar belakang : Esofagitis refluks merupakan kondisi yang cukup sering ditemukan pada pasien usia lanjut. kejadian kanker esofagus, dimana esofagitis merupakan faktor resiko penting masih dianggap jarang di kebanyakan negara Asia. banyak faktor risiko lain penyebab kejadian kanker esofagus masih banyak belum diketahui. studi ini ditujukan untuk mencari prevalensi esofagitis refluks pada pasien usia lanjut faktor-faktor yang berhubungan.metode: studi ini adalah studi potong lintang pada kelompok usia lanjut yang menjalani prosedur pemeriksaan endoskopi saluran cerna atas. pasien yang sudah mendapatkan terapi penghambat pompa proton jangka panjang pasien dengan kegemasan saluran cerna, pasien yang baru saja mendapatkan obat kemoterapi, pasien dengan kelainan otak dan pembuluh darah dan juga pasien yang terbukti terdapat infeksi kuman H. pylori dieksklusi analisis statistik dilakukan dengan menggunakan program SPSS versi 17 (Chicago, IIlinois, USA).hasil : dari 238 pasien usia lanjut didapatkan esophagitis refluks sebanyak 22 (9,2%) pasien, rerata usia pasien adalah 69.8± 6.8 tahun. beberpa komorbiditas yang ditemukan seperti, diabetes, hipertensi, penyakit jantung korner, penyakit ginjal kronik, dan sirosis hari. satu-satunya faktor yang berhubungan dengan kejadian esofagitis refulks adalah adanya hernia hiatus esofagus (p = 0,038), tetai, esofagitis refulks cenderung ditemukan lebih banyak pada pasien usia lanjut yang memilki riwayat konsumsi obat yang bisa ,encetuskan kondisi refulks tanpa adanya perlindungan anti asam.simpulan: esofagitis refluks masih merupakan masalah besar pada pasien usia lanjut. terdapatnya hernia hiatus bisa memberikan pertimbangan penting untuk dilakukanya pemeriksaan penyaring endoskopi saluran cerna atas. tetapi hal ini masih menjadi perbedaan dengan mempertimbangkan beban biaya dan rendahnya kejadian kanker esofagus di sebagian besar negara Asia."

"latar belakang:perdarahan dari varises gastro-esophageal adalah komplikasi yang paling serius dan menyebabkan kematian pada penderita sirosis hati. Serveilans Endoskopi varises esofagus pada pasieun sirosis mahal dan tidak nyaman untuk pasien. tujuan dari penelitian ini adalah untuk mengevaluasi hubungan varises esofagus dan Lok Score sebagai parameter non-invasif pada pasien sirosis hati.metode : penelitian potong lintang dari pasien yang dirawat di Rumah Sakit Adam Malik Medan antara bulan September hingga Desember 2014 dengan diagnosis sirosis berdasarkan klinis, biokimia, ultrasonografi, dan gastroskopi. Lok Score dihitung untuk pasien, ditabulasi, dan dianalisis.hasil : di antara 26 pasien sirosis hati dengan varises esofagus, 55.3% disebabkan oleh infeksi hepatitis B virus. sebagian besar populasi penelitian memilki klasifikasi Child-Pugh C dan hanya 13,2% memilki Child-Pugh kelas A. Mayoritas populasi penelitian memilki varises esofagus F2(42,1$), F1(32,9), dan F3 (25%)."

"Latar belakang. Kombinasi spray lidokain dan anestetika intravena saat ini merupakan pilihan utama pada prosedur endoskopi saluran cerna, namun spray lidokain mempunyai kekurangan berupa iritasi lokal, mual, muntah dan rasa pahit. Gel lidokain merupakan alternatif pilihan anestetik lokal. Gel lidokain memiliki keuntungan karena dapat mengurangi gesekan mukosa dengan endoskop saat insersi serta memungkinkan pemberian lidokain yang tebal dan lengket sehingga menghasilkan anestesia lokal yang lebih baik pada rongga mulut dan orofaring dibandingkan spray lidokain. Pada penelitian ini kami ingin mengetahui perbandingan keefektifan gel lidokain dengan spray lidokain dalam mengurangi jumlah penggunaan propofol. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap pasien endoskopi saluran cerna atas dengan sedasi di Rumah Sakit Cipto Mangunkusumo pada bulan Juli-September 2015. Sebanyak 52 subyek diambil dengan metode consecutive sampling dan dibagi ke dalam 2 kelompok (kelompok gel lidokain 2% dan spray lidokain 10%). Pasien secara acak diberikan gel lidokain 2% atau spray lidokain 10% sebagai anestetik lokal. Total dosis propofol, angka kejadian gag refleks, hipotensi, bradikardia, dan desaturasi dicatat pada masing-masing kelompok. Analisis data dilakukan dengan uji t-test tidak berpasangan. Hasil. Rerata dosis propofol berbeda bermakna diantara 2 kelompok, dimana rerata dosis propofol pada grup gel lidokain 2% adalah 186,92±43,52 mg, sedangkan rerata dosis propofol pada grup spray lidokain 10% adalah 218,85±61,01 mg (p=0.035, IK 95%=31,92). Simpulan. Gel lidokain 2% lebih efektif dibandingkan spray lidokain 10% dalam mengurangi dosis propofol pada pasien endoskopi saluran cerna atas.

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Background. A combination of lidocaine spray and intravenous anesthetics is currently the common choice in gastrointestinal endoscopy procedures, but lidocaine spray has some side efects like local irritation, nausea, vomiting and bitter taste. Lidocaine jelly is an alternative choice of local anesthetic. Lidocain jelly reduce friction of endoscope and enables to apply thick and sticky lidocaine resulting in better local anesthesia in the oral cavity and oropharynx compared to lidocaine spray. In this study, we want to compare the effectiveness between lidocaine jelly and lidocaine spray to reduce the propofol dose.

Methods. This study was a randomized double-blind control trial on upper gastrointestinal endoscopy patiens with sedation in Cipto Mangunkusumo Hospital in July to September 2015. A total of 52 subjects were taken with consecutive sampling method and divided into 2 groups (2 % lidocaine jelly group and 10% lidocaine spray group). Patients were randomly given 2% lidocaine jelly or 10% lidocaine spray as a local anesthetic. Total propofol dose, the incidence of gag reflex, hypotension, bradycardia and desaturation recorded in each group. Data analysis was performed by unpaired t-test.

Results. Mean propofol dose significantly different between 2 groups. The Mean propofol dose 2% lidocaine jelly was 186.92 ±43.52 mg, while the mean propofol dose in10% lidocaine spray group was 218.85 ± 61.01 mg (p = 0.035, CI 95% = 31.92).

Conclusion. 2% Lidocaine gel was more effective than 10% lidocaine spray in reducing the propofol dose in patients with upper gastrointestinal endoscopy."

"Successful cecal intubation is a primary quality indicator in colonoscopies and the most important factor in detecting abnormal lesion in the colon. There are many factors that influence cecal intubation rate during colonoscopy procedure. The aim of this study is to evaluate the factors that influence cecal intubation rate in unsedated patients during colonoscopy. A retrospective study of colonoscopy performed at Sardjito General Hospital, Jogjakarta, from January 2012 to August 2013. Age, sex, bowel preparation indication for colonoscopy, colonoscopist, and reasons of incomplete colonoscopy from 564 colonoscopy reports were recorded and analysed. Overall successful cecal intubation rate was 408 (72.34%). Causes of incomplete colonoscopy were patients discomfort or pain 41.66%, looping / redundant 28.85%, poor bowel preparation 18.59%, fixation / adhesion 6.41%, and bleeding risk 4.49%. Female was more unsuccessful in cecal intubation than male (31.50% vs 24.05%;p=0.048). the successful cecal intubation rates for gastroenterologist compared to gastroenterology (GI) fellows were 77.92% vs 49.55%; p<0.001). Multivariate logistic regression analysis demonstrated that female and poor bowel preparation were independently associate with lower cecal intubation rate and gastroenterologists were independently associated less unsuccessful to reach cecal. The overall successful cecal intubation rate was still below the set standard. Several identified factors that may predict lower of cecal intubation rate : the skill and experience of colonoscopists (GI fellows), poor bowel preparation and female."

"ABSTRAKThalassemia patients who undergo life-long recurrent blood transfusion will experience iron overload in various organs including the liver and possibly suffer from chronic hepatitis C infection which may lead to liver impairment. The liver produces hepcidin, a hormone which plays role in the regulation of iron level in the blood. Various factors may influence hepcidin level in the blood. Chronic hepatitis C causes iron overload and liver impairment. Liver impairment and haemolytic anaemia due to haemoglobinopathy will suppress hepcidin production. Anaemia stimulates growth differentiation factor 15 (GDF-15) to increase erythropoiesis and suppress hepcidin production. Iron overload causes increase in hepcidin level. Presence of factors which decrease or increase hepcidin production will express various levels of hepcidin. This study aimed to identify the expression of hepcidin and GDF-15 levels in thalassemia patients with iron overload and positive anti-HCV. Information on hepcidin and GDF-15 levels are beneficial in the management of iron overload in thalassemia with positive anti-HCV.Method: This study was a descriptive analytic study in thalassemia patients who had received recurrent blood transfusion ≥ 12 times, suffered from iron overload (transferrin saturation > 55% and ferritin > 1,000 ng/mL), which consisted of 31 individuals with positive anti-HCV and 27 individuals with negative anti-HCV. This study was performed in Thalassemia Centre Department of Child Health and Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, in October 2011–January 2012. Serum hepcidin and GDF-15 examinations were performed using enzyme-linked immunosorbent assay (ELISA) method. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) examinations were performed using colorimetry method. Data on ferritin and transferrin saturation were obtained from medical records in the last 3 months. Data was analysed using SPSS Windows version 17 software.Results: Characteristics of subjects in this study included ferritin level, transferrin saturation, AST, and ALT were 5,289 (SD 2,492) ng/mL, 96.7 (SD 9.2)%, 41.8 (SD 26.7) U/L, and 50.6 (24.9) U/L, respectively. It was obtained that the hepcidin levels were within the normal limits with median of 51.5 (19-166) pg/mL, while GDF-15 levels were higher than the normal range with median of 1,936 (643-2,475) pg/mL. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV groups, with p value of 0.842 and 0.115, respectively.Conclusion: We obtained that the hepcidin levels were within normal limits and GDF-15 levels were higher than the normal range. There was no significant difference of hepcidin and GDF-15 levels between positive and negative anti-HCV group."

"ABSTRAKTuberculosis was still a global health problem. Beside lung, tuberculosis also manifest in other organs, one among them  is in abdominal organs. Abdominal tuberculosis was a complex disease with unspecific sign and symptoms so that its diagnostic procedure was not rarely inconclusive. We reported a 24 years old woman with chief complain of worsening abdominal pain in all region, accompanied by nausea, vomiting, bloating, and  absent bowel movement. She also had a fresh bloody stool. She had an active pulmonary tuberculosis on initiation phase treatment. Physical examination suggest a bowel obstruction sign with distended abdomen and increase bowel sound. Colonoscopy procedure findings was a mass that obstruct bowel lumen in ileocaecal region, suggest for malignancy similar to computerized tomography (CT) scan result, but pathlogic result showed an active colitis without any sign of malignancy. Because of its contradiction, the second colonoscopy was performed and concluded as intestinal tuberculosis, matched with second pathologic examination. Although polymerase chain reaction (PCR) tuberculosis (TB) showed a negative result, a further clinical judgement concluded this as an intestinal tuberculosis case. Patient was finally treated as intestinal tuberculosis with first-line antituberculosis drugs and planned to have colonoscopy evaluation. After general condition was good and obstructive ileus sign was relieved, patient planned for outpatient care."

"ABSTRAKGallstone is a crystal deposit which is formed in the gallbladder or bile duct. Gallstone is classified into cholesterol stone, pigment stone (black and brown), and mixed stone. Mechanism which underlies the formation of cholesterol or pigment gallstone is different. Information on chemical component of the stone will assist the management and prevention of its recurrence. Analysis of gallstone component can be performed by colorimetry method or even gas liquid chromatography (GLC). Chemical component analysis of gallstone by colorimetry includes examination of cholesterol, bilirubin, and calcium. Stone is classified as cholesterol stone if the cholesterol content is > 80%, pigment stone if cholesterol content is < 20%, and mixed stone if cholesterol content is 25-80%. Gallstone analysis by GLC method is conducted by separation of fatty acid chain and evaluation of fatty acid quantity in the methylester derivatives form, which is fatty acid methyl estered. Fatty acid content in cholesterol stone (310.09 + 49.7 mg/gram) is higher compared to pigment stone (55.59 +7.71 mg/gram). Saturated to unsaturated fatty acid (S/U) ration in cholesterol stone (8.6 + 3.1) is higher compared to pigment stone (4.8 + 1.5)."