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"Dual antiplatelet therapy (DAPT) is the mainstay of secondary prevention treatment for acute coronary syndrome (ACS) and ischemic stroke, especially after coronary intervention. DAPT consists of aspirin and P2Y12 receptor inhibitor (e.g. clopidogrel), and the use of DAPT has been increased over time. The most serious and common adverse effect is gastrointestinal bleeding. Guidelines in managing such condition are available among Gastroenterologist Societies and Cardiologist Societies. Most guidelines are consistent with each other to continue the use of aspirin while withholding P2Y12. However, European Society of Cardiologist (ESC) guideline in 2017 recommends P2Y12 receptor inhibitor as the preferred antiplatelet for patient with upper gastrointestinal bleeding. This review will look on the guidelines and other supporting evidence for the justification on the antiplatelet of choice."

"Penelitian ini bertujuan mengidentifikasi gambaran kejadian masalah gastrointestinal pada mahasiswa asing di Universitas Indonesia. Desain penelitian deskriptif dengan pendekatan potong lintang, melibatkan 64 sampel yang dipilih dengan teknik convenient sampling. Instrumen yang digunakan ialah kuesioner yang dimodifikasi dari penelitian sebelumnya. Analisis data univariat distribusi frekuensi.Hasil penelitian menunjukkan 82,8% mahasiswa asing di Universitas Indonesia pernah mengalami masalah gastrointestinal selama berada di Indonesia. 46,3% responden menyatakan sering mengalami keluhan sakit perut, yang merupakan manifestasi umum pada berbagai jenis gangguan gastrointestinal. Penelitian lebih lanjut diperlukan untuk mengeksplorasi berbagai faktor pola makan dan gaya hidup yang memengaruhi kejadian masalah gastrointestinal pada mahasiswa asing di Universitas Indonesia.

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This study aimed to identify the description of gastrointestinal problems on foreign students in Universitas Indonesia. Descriptive study with a cross-sectional design, involving 64 samples whom were selected with convenient sampling method. A questionnaire which was modified from previous research was used.

The result showed that 82,8% foreign students of Universitas Indonesia had experienced gastrointestinal problems during in Indonesia, which indicates high prevalence. 46,3% respondents often experience abdominal discomfort which is the common manifestation of various gastrointestinal disorders. A further research is needed to explore and elaborate the related factors such as consumption pattern and lifestyle which significantly affect the gastrointestinal problems finding on foreign students in Universitas Indonesia."

"Latar belakang: Cedera gastrointestinal akut kerap terjadi pada pasien dengan sakit kritis. Fungsi saluran menjadi salah satu pertimbangan dalam pemberian nutrisi pasien. Komplikasi pada saluran cerna dapat menghambat pemberian nutrisi enteral yang lebih direkomendasikan. Oleh karena itu, penelitian ini bertujuan untuk melihat hubungan derajat cedera gastrointestinal akut dengan capaian nutrisi enteral pada pasien anak sakit kritis. Metode: Penelitian ini memiliki desain studi potong lintang menggunakan data sekunder dari rekam medis pasien anak sakit kritis yang dirawat di PICU RSCM dari September 2019 sampai Agustus 2020. Cedera gastrointestinal akut dikelompokkan berdasarkan klasifikasi WGAP ESICM. Asupan nutrisi diambil dari data rekam medis pasien. Data dianalisis menggunakan Uji Saphiro-Wilk dilanjutkan Uji Kruskal-Wallis untuk mengetahui hubungan derajat cedera gastrointestinal akut dengan capian nutrisi enteral pasien. Data diolah menggunakan aplikasi IBM SPSS for windows versi 20.Hasil: Sampel penelitian berjumlah 26 pasien. Median presentase capaian nutrisi enteral hari ketiga (% laju metabolik basal) setiap derajat yaitu derajat satu 40,08 (0-144,39); dua 0,00 (0-219); tiga 19,10 (0,00-38,20); dan empat 0,00 (0,00-130,30) dengan hasil uji Kruskal-Wallis (p=0,904). Tidak terdapat hubungan bermakna antara lama capaian 25% nutrisi enteral dengan derajat cedera gastrointestinal akut (Kruskal-Wallis, p=0,556). Pada penelitian, faktor lain seperti status gizi (p=0,952), penggunaan ventilator mekanik (p=0,408), dan riwayat pascaoperasi (p=0,423) tidak mempengaruhi presentase nutrisi enteral hari ketiga. Kesimpulan: Pada pasien anak kritis, tidak terdapat hubungan yang bermakna antara derajat cedera gastrointestinal akut dengan capaian nutrisi enteral.

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Background: Acute gastrointestinal injury (AGI) is usually found in critically ill patients. Gastrointestinal function can determine the route od nutritional therapy. Gastrointestinal abnormalities may delay enteral nutrition therapy in patients. Therefore, this study aims to determine the association between the association between acute gastrointestinal injury and enteral nutrition outcome in critically ill children.

Methods: This study had a cross-sectional study design using the medical records of critically ill children in PICU RSCM from September 2019 until August 2020. AGI patients was classified based on WGAP ESIM grading system. Nutritional outcomes were assessed using data from medical record. Data were analyzed the Kruskal-Wallis test to determine the association between acute gastrointestinal injury and enteral nutrition outcomes. The Data were analysed using SPSS for windows version 20.

Results: The study sample was 26 patients. The medians of day three enteral nutrition percentage were grade one 40,08 (0-144,39); grade two 0,00 (0-219); grade three 19,10 (0,00-38,20); dan grade four 0,00 (0,00-130,30) with Kruskall-walis test result (p=0,904). There was no significant association between AGI and the duration of 25% basal metabolic rate (Kruskal-Wallis, p=0,556). In this study, Other factors such as nutritional status (p=0,952), ventilator usage (p=0,408), and post-operative history (p=0,423) did not associate with day three enteral nutrition percentage.

Conclusion: In critically ill children, there was no significant association between the acute gastrointestinal injury and the outcome of enteral nutrition."

"Gangguan pencernaan merupakan isu global dengan hasil  studi epidemiologi lebih dari 40% orang diseluruh dunia mengalami gangguan pencernaan. Salah satu faktor diet yang berhubungan dengan gangguan pencernaan yaitu jenis makanan yang dikonsumsi. Masyarakat Minahasa memiliki kebiasaan mengkonsumsi makanan berempah dan pedas. Tujuan penelitian ini adalah untuk mengidentifikasi hubungan antara mengonsumsi makanan minahasa berempah dan pedas dengan gejala gangguan pencernaan. Penelitian ini merupakan penelitian cross-sectional yang melibatkan 212 sampel berusia 18-60 tahun yang sesuai dengan kriteria inklusi dan eksklusi. Pengambilan sampel menggunakan teknik consecutive sampling. Hasil penelitian menunjukkan bahwa setelah dikontrol dengan variabel perancu, terdapat hubungan antara konsumsi makanan berempah dan pedas dengan gejala gangguan pencernaan (nilai p 0.015<0.05) OR 2.523 (95% CI: 1.197-5.319). Pasien yang mengonsumsi makanan berempah dan pedas berisiko 2.523 kali mengalami gejala gangguan pencernaan. Peneliti merekomendasikan perawat untuk melakukan asuhan keperawatan secara komperhensif sebagai educator dan fasilitator untuk mengoptimalkasn kesehatan masyarakat yang mengonsumsi makanan berempah dan pedas serta faktor lainnya yang berisiko  dengan gejala gangguan pencernaan. Bagi pelayanan kesehatan dan pemerintah daerah dapat menyusun rencana strategi dalam upaya pencegahan maupun penanganan gangguan pencernaan terkait konsumsi makanan berempah dan pedas dengan tetap melestarikan kekhasan budaya setempat.

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Gastrointestinal disorders are a global issue with the epidemiology study results of more than 40% of people around the world experiencing digestive disorders. A dietary factor associated with indigestion is the type of food consumed. Minahasa people habitually consume spicy foods. The aim of this study was to identify the relationship between consuming spicy Minahasan food and symptoms of indigestion. This study was a cross-sectional study involving 212 samples aged 18-60 years who complied with the inclusion and exclusion criteria. Consecutive sampling technique was used. After control for confounding variables, there was an association between consuming spicy foods and gastrointestinal symptoms (p value 0.015<0.05) OR 2.523 (95% CI: 1.197-5.319). Patients who consume spicy foods are at risk of 2.523 times to experience gastrointestinal symptoms. Furthermore, Researchers recommend nurses to provide comprehensive nursing care as educators and facilitators to optimize the health of people who consume spicy foods and other risk factors associated with gastrointestinal symptoms. For health services and government can establish a strategic plan in preventing and treating gastrointestinal disorders related to the consumption of spicy food while preserving the characteristics of local culture."

"Approximately 60% of patients who die due to melanoma have gastrointestinal metastases at autopsy, yet ante mortem diagnosis is uncommon. The small bowel is the most frequent intestinal site of metastasis and prognosis is very poor with a median survival after operation was 6.2 months (range: 1-42 months). Bowel metastases may appear radiologically as polypoid mucosal lesions, submucosal nodules, diffuse infiltration with thickening of the intestinal wall, or serosal implants. Bowel obstruction due into intussusceptions is common clinical presentation of gastrointestinal metastasis; other presentation include gastrointestinal bleeding, perforation and large masses.We reported a case of m eta static melanoma to small bowel, whose had hematemesis melena, abdominal pain, diarrhea and weight loss without primary cutaneus melanoma. Gastroduodenoscopy appeared normal. The ultrasonography of bowel showed a"doughnut" configuration with concentric rings of bowel wall. Left lateral decubitus abdominal radiographies showed free air appearances. Laparatorny reported three location of invaginalion (intussuception) with multiple polyposis at ileo-jejttnal segment (29 pieces of polyp) and jejunum perforation. Resection and end-to end anastomosis of the. affected segment had been performed with no serious complication after this. Miscroscopical examination of specimen showed metasiatic melanoma malignant in 3 lymph nodes. Eight weeks later patients died with distant metastases to brain."

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Latar Belakang: Perdarahan akut gastrointestinal bagian atas memiliki angka mortalitas dan morbiditas yang signifikan. Asam traneksamat telah terbukti bermanfaat dalam kasus perdarahan postoperatif dan postpartum. Namun, data mengenai efektivitas asam traneksamat untuk kasus ini masih terbatas.

Metode: Kami telah melakukan uji klinis terkontrol acak tersamar. Pasien yang memenuhi kriteria adalah dewasa (usia ≥ 18 tahun) dengan gejala hematemesis, melena, atau keduanya baik yang datang ke unit gawat darurat atau sedang dirawat di rumah sakit antara 1 Juli 2018 sampai 31 Desember 2019. Pasien secara acak dimasukan ke dua kelompok (asam traneksamat dan plasebo). Luaran utama yang diamati adalah perdarahan ulang yang didefinisikan sebagai kejadian hematemesis, melena, atau keduanya yang berkaitan dengan takikardia atau syok hipovolemik atau pengurangan hemoglobin > 2 g/dL setelah keberhasilan terapi endoskopi atau farmakologis. Perdarahan ulang ini diamati sampai 28 hari pascarandomisasi. Uji klinis ini teregistrasi di clinicaltrials.gov, NCT03540368Hasil: Terdapat 42 pasien yang masuk dalam uji klinis ini, 19 di kelompok asam traneksamat dan 23 di plasebo. Penggunaan asam traneksamat tidak berhubungan dengan penurunan kejadian perdarahan ulang (hazard ratio 1,055 [IK 95% 0,284 – 3,923]) maupun mortalitas (hazard ratio 0,960 [IK 95% 0,218 – 4,229]). Terdapatsatu kasus tromboemboli pada masing-masing kelompok. Uji klinis dihentikan lebih awal karena kemungkinan futilitas yang signifikan dan risiko kejadian tromboemboli.Kesimpulan: Tidak diperoleh perbedaan bermakna frekuensi perdarahan ulang kasus perdarahan akut saluran cerna bagian atas antara kelompok asam traneksamat dibandingkan plasebo.

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Background: Acute upper gastrointestinal bleeding (AUGIB) has a significant mortality and morbidity rate. Tranexamic acid has been shown to be beneficial in postoperative and postpartum hemorrhage cases. However, there are limited data exist regarding the effectiveness of tranexamic acid in AUGIB.

Method: We carried out a double-blind randomized controlled trial. Eligible patients were adults (aged  ≥ 18 years) with hematemesis, melena, or both who presented to the emergency department or were hospitalized between July 1, 2018 and December 31, 2019. Patients were randomly assigned to two treatment groups (tranexamic acid or placebo). The primary endpoint was rebleeding, defined as the occurrence of hematemesis, melena, or both associated with tachycardia or hypovolemic shock or reduction in hemoglobin (> 2 g/dL) after successful endoscopic or pharmacological therapy. The occurrence of rebleeding was monitored up to 28 days after randomization. This study was registered at clinicaltrials.gov, NCT03540368Results: Forty-two patients were enrolled, 19 to the tranexamic acid and 23 to the placebo group. Tranexamic acid use was not associated with a reduction in rebleeding (hazard ratio 1.055 [95% CI 0.284 – 3.923]) or mortality (hazard ratio 0.960 [95% CI 0.218 – 4.229]). One thromboembolic event occurred in each group. Clinicaltrials were terminated early because of the significant possibility of futility, and the risk of thromboembolic events.Conclusion: No significant difference was noted in the frequency of rebleeding after AUGIB between patients treated with tranexamic acid compared with placebo.

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"Latar belakang: Mortalitas pascaoperasi dan komplikasi respiratorik berat telah didokumentasikan pada pasien COVID-19 pada berbagai studi. Namun, belum terdapat penelitian yang secara khusus mengevaluasi luaran dari laparatomi gawat darurat dengan perforasi gastrointestinal selama pandemi COVID-19 tahun 2020.Metode: Studi dilakukan dengan desain observasional retrospektif sejak bulan Desember 2020-Februari 2021. Pasien perforasi gastrointestinal berusia lebih dari 15 tahun yang menjalani laparotomi gawat darurat diinklusi dalam penelitian. Luaran yang dievaluasi adalah mortalitas dan morbiditas, yang meliputi sindrom distres pernapasan akut (ARDS), reoperasi, durasi perawatan di rumah sakit, sepsis, admisi ke ruang perawatan intensif (ICU), dan infeksi daerah operasi (IDO).Hasil: Terdapat 117 pasien pascalaparotomi yang direkrut dalam penelitian ini, dengan 95 (81,2%) pasien tidak terinfeksi SARS-CoV-2. Median usia untuk kelompok non-COVID dan kelompok COVID secara berturut-turut sebesar 41 (14¬92) tahun dan 39 (15¬77) tahun. Mortalitas umum tercatat pada angka 23,9%. Pasien perforasi COVID-19 yang menjalani tindakan laparotomi memiliki risiko yang lebih tinggi untuk mengalami kematian, ARDS, dan sepsis, serta mendapatkan tindakan reoperasi dibandingkan pasien non-COVID, dengan risiko odds masing-masing sebesar 2,769 (95% IK; 1,032–7,434), 8,50 (95% IK; 2,939–24,583), 3,36 (95% IK; 1,292–8,735), dan 3,69 (95% IK; 1,049–13,030). Tidak terdapat perbedaan antara pasien perforasi gastrointestinal yang terkonfirmasi COVID-19 dan pasien non-COVID dalam hal risiko IDO, lama durasi perawatan, dan admisi ke ICU. Usia, sepsis, dan ARDS merupakan faktor prognostik bermakna untuk mortalitas COVID-19.Simpulan: Pasien perforasi gastrointestinal pascalaparotomi yang terkonfirmasi COVID-19 memiliki risiko mortalitas, ARDS, sepsis, dan menjalani tindakan reoperasi yang lebih tinggi dibandingkan pasien non-COVID.

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Background: Postoperative mortality and severe respiratory complications have been documented in COVID-19 patients in various studies. However, no studies specifically evaluate the outcome of emergency laparotomy with gastrointestinal perforation during the 2020 COVID-19 pandemic.Methods: The study was conducted with a retrospective observational design from December 2020-February 2021. Patients with gastrointestinal perforations aged more than 15 years who underwent emergency laparotomy were included in the study. The outcomes evaluated were mortality and morbidity, which included acute respiratory distress syndrome (ARDS), reoperation, duration of hospital stay, sepsis, admission to the intensive care room (ICU), and surgical site infections (SSI).Results: There were 117 post-laparotomy patients recruited, with 95 (81.2%) COVID-19 negative patients. The median ages for the non-COVID group and the COVID group were 41 (14¬92) years and 39 (15¬77) years. General mortality was recorded at 23.9%. Patients with perforated COVID-19 who underwent laparotomy had a higher risk of dying, ARDS, and sepsis, as well as receiving re-surgery than non-COVID-19 patients, with an odds risk of 2.769 each (95% CI; 1,032–7,434), 8,50 (95% CI; 2,939–24,583), 3.36 (95% CI; 1,292–8,735), and 3.69 (95% CI; 1,049¬ – 13,030). There was no difference between gastrointestinal perforated patients with confirmed COVID-19 and non-COVID-19 patients in terms of risk of SSI, length of stay, and admission to the ICU. Age, sepsis, and ARDS are significant prognostic factors for COVID-19 mortality.Conclusion: Post-laparotomy confirmed gastrointestinal perforation patients with COVID-19 have a higher risk of mortality, ARDS, sepsis, and undergoing reoperation than non-COVID-19 patients."

"Latar Belakang: Preeklampsia - eklampsia merupakan penyebab utama morbiditas dan mortalitas ibu dan bayi di dunia khususnya negara-negara sedang berkembang dengan insidensidi Indonesia berkisar 8,6%. Pemberian aspirin diharap dapat menjadi solusi pencegahan preeklampsia bagi ibu hamil dengan risiko tinggi untuk menurunkan terjadi persalinan prematur, berat badan bayi yang rendah, serta turut meningkatkan angka mortalitas dan morbiditas perinatal. Tujuan: Mengetahui keluaran penggunaan aspirin dosis rendah pada ibu hamil dengan risiko tinggi preeklampsia. Metode: Studi ini merupakan kohort retrospektif. Melibatkan 695 subjek ibu hamil dengan risiko tinggi preeklampsia yang dibagi menjadi dua kelompok dengan terapi aspirin dosis rendah dan tanpa terapi. Hasil: Angka kejadian preeklampsia pada kelompok aspirin lebih rendah (8.9%) secara bermakna (odds ratio 0.37; 95% confidence interval, 0.26 hingga 0.54; P = <0.001) dibandingkan kelompok kontrol (14.8%). Pada kelompok aspirin penurunan angka kejadian preeklampsia lebih rendah secara bermakna pada pasien luaran kehamilan kurang dari 34 minggu dibanding luaran kehamilan > 34 minggu (odds ratio 0.117; 95% confidence interval, 0.048 hingga 0.282; P = <0.001). Kesimpulan: Pada studi ini, pemberian aspirin dosis rendah pada ibu dengan risiko tinggi preeklampsia terjadi penurunan insiden preeklampsia secara bermakna dan penurunan luaran kehamilan kurang dari 34 minggu

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Background: Preeclampsia - eclampsia is the main cause of maternal and infant morbidity and mortality in the world, especially developing countries such as Indonesia with incident about 8.6%. We hoped that aspirin can be a solution to prevent preeclampsia for pregnant women with a high risk of preeclampsia to reducing preterm labor, low birth weight, and also increasing perinatal mortality and morbidity. Objective: To determine the output of using low-dose aspirin in pregnant women with a high risk of preeclampsia. Method: This study was a retrospective cohort. Involves 695 pregnant women with a high risk of preeclampsia and divided into two groups with low-dose aspirin therapy and without therapy. Results: The incidence of preeclampsia in the aspirin group was significantly lower (8.9%) (odds ratio 0.37; 95% confidence interval, 0.26 to 0.54; P = <0.001) compared to the control group (14.8%). In the aspirin group the decrease in the incidence of preeclampsia was significantly lower in patients with pregnancy outcomes less than 34 weeks compared with pregnancy outcomes more than 34 weeks (odds ratio 0.117; 95% confidence interval, 0.048 to 0.282; P = <0.001). Conclusion: In this study, administration of low-dose aspirin to women with a high risk of preeclampsia resulted in a significant decrease in the incidence of preeclampsia and a reduction in pregnancy outcomes of less than 34 weeks."

"Penggunaan obat yang bekerja pada saluran cerna perlu dilakukan kajian farmakologi, khususnya di depo Instalasi Gawat Darurat (IGD). Pelayanan kefarmasian di IGD perlu perhatian khusus karena biasanya menangani pasien yang dalam kondisi kritis. Kajian farmakologi dapat mengetahui efek utama obat, interaksi obat dan efek samping dari obat. Sehingga dapat memberikan terapi yang tepat dan aman kepada pasien.Prosedur kajian literatur yaitu dengan cara pengumpulan dan analisis data yang dilakukan dengan mencari studi pustaka dan observasi. Dalam hal ini, landasan teori untuk penelitian diperoleh melalui pencarian pustaka yang berasal baik dari buku, jurnal lain maupun dari sumber terpercaya lainnya. Selain itu, analisis data serta informasi yang digunakan dilakukan dengan metode observasi yaitu pengamatan dan penelitian farmakologi dari obat-obat yang bekerja pada saluran cerna.Kajian farmakologi obat saluran cerna, khususnya farmakokinetik dan farmakodinamik untuk obat Simetikon, H2 Receptor Blocker, Proton Pump Inhibitor (PPI) dan SukralfatMemberikan informasi kepada sejawat tenaga kesehatan terkait farmakologi obat saluran cerna yang diberikan.

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The use of drugs that act on the gastrointestinal tract needs to be studied pharmacologically, especially in the Emergency Room (ER). Pharmacy services in the emergency room need special attention because they usually treat patients who are in critical condition. Pharmacological studies can determine the main effects of drugs, drug interactions, and side effects of drugs. So that it can provide appropriate and safe therapy to patients. Literature review procedures, namely by collecting and analyzing data are carried out by searching literature and observation. In this case, the theoretical basis for the research is obtained through a literature search that originates from books, other journals, and from other reliable sources. In addition, the analysis of data and information used was carried out using the observation method, namely observation and pharmacological research of drugs that act on the gastrointestinal tract. Pharmacological studies of gastrointestinal drugs, especially pharmacokinetics, and pharmacodynamics for Simethicone, H2 Receptor Blockers, Proton Pump Inhibitors (PPI), and Sucralfate Provide information to fellow health workers regarding the pharmacology of the gastrointestinal drugs given."