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Abstrak :
Gastroesophageal reflux disease (GERD) is a condi- tion 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 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.

Abstrak :
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. ......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.

Abstrak :
Latar belakang: Pada saat puasa Ramadhan, terjadi penurunan rerata pH lambung dan memendeknya selisih waktu antara makan terakhir dan jam tidur sehingga memperberat keluhan Penyakit Refluks Gastroesofageal (Gastro-esophageal Reflux Disease, disingkat GERD). Sementara itu juga terjadi keteraturan jadwal makan, dan perubahan dalam kebiasaan merokok dan alkohol. Meski demikian, belum diketahui dengan pasti keluhan penyakit GERD selama berpuasa Ramadhan. Tujuan: Mengetahui pengaruh puasa Ramadhan terhadap keluhan GERD. Metode: Penelitian ini merupakan studi longitudinal yang mengevaluasi keluhan GERD pada pasien yang menjalani puasa Ramadhan. Penelitian dilakukan selama bulan Juli (Ramadhan) sampai bulan Oktober (tiga bulan setelah Ramadhan) 2015. Subjek penelitian yang didapatkan melalui metode consecutive sampling ini dikelompokkan menjadi kelompok berpuasa Ramadhan (n=66) dan kelompok tidak berpuasa Ramadhan (n=64). Evaluasi dilakukan antara kedua kelompok tesebut, dan antara bulan Ramadhan dengan di luar bulan Ramadhan pada kelompok berpuasa, dengan menggunakan kuesioner GERD (GERD-Q) yang telah diterjemahkan dalam bahasa Indonesia. Hasil: Pada kelompok yang berpuasa Ramadhan, terdapat perbedaan median nilai GERD-Q yang bermakna secara statistik (nilai p < 0,01) antara bulan Ramadhan dengan nilai median 0, dan di luar bulan Ramadhan dengan nilai median yang meningkat menjadi 4. Sementara itu, bila dilakukan analisis untuk membandingkan median nilai GERD-Q antara kelompok yang berpuasa Ramadhan dan tidak, juga didapatkan perbedaan yang bermakna (nilai p < 0,01). Simpulan: Pada subjek yang menjalani puasa Ramadhan, keluhan GERD dirasakan lebih ringan saat menjalani puasa Ramadhan dibandingkan di luar bulan Ramadhan. Di bulan Ramadhan, keluhan GERD lebih ringan dirasakan oleh subjek yang menjalani puasa Ramadhan dibandingkan subjek yang tidak menjalani puasa Ramadhan. ......Background: During Ramadan fasting, increasing gastric acid levels as a result of prolong fasting can precipitate symptoms of Gastroesophageal Reflux Disease (GERD). Meanwhile, lifestyle changes during Ramadan (such as smoking cessation) can relieve its symptoms. To the best of our knowledge, this is the first study to evaluate effect of Ramadan fasting on GERD. Objective: The purpose of this study was to determine the effect of Ramadan fasting on GERD symptoms. Method: This is a longitudinal study done in July (Ramadan) to October (three months after Ramadan) 2015. Using consecutive sampling method, a total of 130 GERD patients participated in this study. Patients were divided into two groups: patients who underwent Ramadan fasting (n=66), and patients who didn?t undergo fasting (n=64). The evaluation was done using Indonesian version of GERD questionnaire (GERD-Q) between the two groups, and between Ramadan month and non-Ramadan month of Ramadan fasting group. Results: In Ramadan fasting group, there was a statistically significant difference (p < 0.01) in median of GERD-Q during Ramadan month and non-Ramadan month (median GERD-Q 0 and 4 respectively). Statistically significant difference (p < 0.01) was also found between Ramadan fasting group and non-fasting group. Conclusion: In Ramadan fasting group, GERD symptoms were lighter during fasting month (Ramadan). During Ramadan month, GERD symptoms were also lighter in Ramadan fasting group than in non-fasting group.

Abstrak :
Latar belakang. Refluks gastroesofagus (RGE) dengan gejala klinis regurgitasi merupakan manifestasi gastrointestinal yang sering dijumpai pada bayi. Penelitian menunjukkan bahwa prevalens regurgitasi menurun setelah usia 6 bulan sedangkan gejala klinis penyakit refluks gastroesofagus (PRGE) didapatkan pada anak di atas 1 tahun yang memiliki riwayat regurgitasi sering pada usia di atas 6 bulan. Infant gastroesophageal reflux questionnaire (I-GERQ) merupakan sarana diagnosis PRGE yang tidak invasif dan memiliki nilai prediktif positif yang baik. Tujuan. Penelitian ini bertujuan untuk mengetahui insidens PRGE, karakteristik bayi yang mengalami regurgitasi, skor I-GERQ dan gejala yang berkaitan dengan PRGE, faktor-faktor risiko yang berkaitan dengan gejala regurgitasi yang menetap hingga akhir pemantauan, dampak regurgitasi terhadap peningkatan berat badan dan pola makan Metode. Penelitian longitudinal prospektif pada subjek dengan regurgitasi minimal 1x/hari setidak-tidaknya 4x/minggu. Kriteria eksklusi adalah bayi atopi, mengi berulang, dicurigai alergi susu sapi, kelainan neurologis, terdiagnosis tuberkulosis, riwayat operasi saluran cerna sebelumnya, pernah mencapat terapi antogonis reseptor H2 atau penghambat pompa proton. Subjek sesuai PRGE jika skor I-GERQ >7, dan dirujuk ke Rumah Sakit Cipto Mangunkusumo. Pemantauan dilakukan setiap bulan pada subjek dengan I-GERQ ≤ 7, dengan menilai skor I-GERQ dan pengukuran antropometris. Hasil. Sebanyak 131 dari 352 subjek yang memenuhi kriteria penelitian. Subjek sebagian besar berusia 6 bulan (51,1%), status antropometris sesuai (85,5%), dan mendapat asupan dengan median frekuensi 14 (5-15) x/hari. Median skor I-GERQ saat awal pemantauan adalah 4 (3-7). Sebanyak 81,9% subjek mencapai skor I-GERQ nol saat akhir pemantauan. PRGE didapatkan pada 1 subjek saat pemantauan pertama dengan gejala berat badan sulit naik, regurgitasi 3-5x/hari, volume regurgitasi >15 mL. Variabel pemberian ASI eksklusif, paparan rokok, keluarga dengan alergi, keluarga dengan RGE, dan terapi non-farmakologis tidak berkaitan dengan gejala regurgitasi yang menetap hingga akhir pemantauan. Gejala regurgitasi hingga akhir pemantauan didapatkan pada 13,7% subjek yang mengikuti saran terapi non-farmakologis dibandingkan dengan 86,4% yang tidak mendapat dan tidak mengikuti edukasi (p = 0,14). Perbedaan rerata z-score berat badan berdasarkan usia pada subjek yang masih mengalami gejala regurgitasi hingga akhir pemantauan adalah -0,006 ± 0,357 (IK 95% -0,164; 0,152), p = 0,939. Kesulitan makan didapatkan pada 19 subjek dan 17 diantaranya tidak lagi mengalami regurgitasi saat akhir pemantauan. Simpulan. Insidens PRGE adalah 0,7%. Sebagian besar subjek mencapai skor I-GERQ saat akhir pemantauan. Terapi non-farmakologis walaupun tidak bermakna secara statistik dengan gejala regurgitasi yang menetap hingga akhir pemantauan namun didapatkan perbedaan proporsi. Gangguan peningkatan berat badan dan kesulitan makan tidak berhubungan dengan gejala regurgitasi yang menetap hingga akhir pemantauan. Kata kunci: bayi, refluks gastroesofagus, penyakit refluks gastroeosfagus, infant gastroesophageal reflux questionnaire ......Background. Regurgitation as symptom of gastroesophageal reflux (GER) is a common gastrointestinal manifestation in infant. Publications showed that regurgitation will decrease after 6 month old; whereas symptoms of gastroesophageal reflux disease (GERD) is more prevalent in children with history of frequent regurgitation after 6 month old. Infant gastroesophageal reflux questionnaire (I-GERQ) is a non-invasive diagnostic tool for GERD with high positive predictive value. Aim. To investigate the incidence of GERD, characteristics of infants with regurgitation, I-GERQ score and manifestation of GERD, risk factors that related with regurgitation symptom that persists at the end of follow-up, correlation of regurgitation with weight gain and feeding problems. Method. A Longitudinal prospective study in subjects with regurgitation at least 1 time/day; 4 times/week. We excluded infants with atopy, recurrent wheezing, probable cow milk allergy, diagnosed as tuberculosis, neurologic disorder, history of gastrointestinal surgery, history of H2 receptor antagonist or proton pump inhibitor treatment. I-GERQ score and anthropometric status were measured at enrollment. Subjects with GERD (I-GERQ >7) were referred to Cipto Mangunkusumo Hospital. Follow-up of I-GERQ, body weight, and body length in every month were performed in subjects with I-GERQ ≤7. Results. 131 of 352 subjects fulfilled the criteria. Subject mostly were 6 month old (51.1%), normal anthropometric status (85.5%), and have frequent intake with median 14 (5 – 15) times/day. Median of I-GERQ at enrollment were 4 (3 – 7), and at the end of follow-up 81.9% subjects reached I-GERQ score 0. GERD were found in 1 subject at first month follow-up with poor weight gain, regurgitation 3-5 times/day, regurgitation>15 mL. Exclusively breastfeeding, smoke exposure, family history of allergy and GER, and non-pharmacotherapy were not related with regurgitation that persists until 3 months follow-up. Regurgitation at the end of follow-up were found in 13.7% subjects who complied with non-pharmacotherapy; compared to 86.4% who have not complied nor had educated (p = 0.14). Mean difference of weight for age z-score in subjects with regurgitation at the end of follow-up were -0.006 ± 0.357 (95%CI -0.164; 0.152), p = 0.939. Feeding problems were found in 19 subjects while 17 of them no longer have regurgitation symptom at the end of follow-up Conclusion. Incidence of GERD is 0.7%. Most of subjects reached I-GERQ 0 at the end of follow up. Non-pharmacotherapy showed no statistically significant with regurgitation symptom at the end of follow up, but we found proportion difference. Weight gain and feeding problems are not related with regurgitation symptom that persists at the end of follow up

Abstrak :
Penyakit Refluks Gastroesofageal (PRGE) adalah salah satu penyakit anak yang sering terlambat didiagnosis sehingga mengakibatkan gangguan nutrisi dan kognitif di kemudian hari. Tujuan penelitian ini adalah mengetahui prevalensi, gambaran klinis, dan faktor risiko PRGE pada anak yang dilakukan prosedur endoskopi saluran cerna atas di RSCM pada januari 2017 – juli 2018. Penelitian ini menggunakan metode potong lintang dengan mengambil data PRGE yang didiagnosis secara klinis yang dibuktikan dengan pemeriksaan patologi anatomik. Analisis bivariat antara pasien yang terbukti PRGE secara patologi anatomik dan yang tidak dan selanjutnya dilakukan analisis multivariat. Pada penelitian ini ditemukan bahwa prevalensi PRGE pada anak yang dilakukan prosedur endoskopi saluran cerna atas di RSCM adalah 34%, dengan gambaran klinis pada anak PRGE terbanyak pada usia 10–18 tahun (47%), status nutrisi yang baik,lebih,& obesitas (65%), nyeri perut (55%), mual (57%), muntah (65%), nyeri dada (37%), waterbrash (27%) dan halitosis (35%). Tidak terbukti faktor usia, hematemesis, anemia, penyakit komorbid, dan status nutrisi sebagai faktor risiko terjadinya PRGE (P > 0,05) Terdapat beberapa gejala klinis yang cenderung muncul pada anak yang mengalami PRGE yaitu usia 10–18 tahun, status nutrisi baik, lebih, & obesitas, Nyeri perut, mual, muntah, nyeri dada, waterbrash, dan halitosis. ......Gatroesophageal Reflux Disease (GERD) is a pediatric disease that are often late to diagnose and may cause nutritional and cognitive disorder in the future. This research was done to determine the prevalence, clinical manifestations,and risk factors of GERD  in children that undergoes Esophagogastroduodenoscopy from january 2017 – july 2018. This research uses cross sectional method by collecting data of GERD that are clinically diagnosed and proven by anatomical pathology examenation. Bivariate analysis are done between anatomical pathologically proven and unproven patient. Multivariate analysis (logistic regression) are then performed. This research finds that the prevalence of GERD in children that undergoes esophagogastroduodenoscopy is 34%. Clinical manifestations in children with GERD are children aged 10–18 years old (47%), good,excess,and obese nutritional status (65%), abdominal pain (55%), nausea (57%), vomiting (65%), chest pain (37%), waterbrash (27%), and halitosis (35%). Age, hematemesis, anemia, comorbid condition, and nutritional status are not proven as risk factor of GERD (P > 0,05) There are a few clinical manifestation thaht tends to appear in children with GERD which are Age 10–18, good, excess, and obese nutritional status, abdominal pain, nausea, vomiting, chest pain, waterbrash, and halitosis.

Abstrak :
ABSTRAK
Gastroesophageal reflux disease (GERD) merupakan suatu kondisi patologis yang disebabkan oleh refluks kandungan lambung ke dalam esofagus. GERD memiliki dampak yang besar terhadap penderitanya baik secara fisik, psikologik, sosial maupun ekonomi. Penurunan kualitas hidup dan produktifitas kerja sering ditemukan pada penderita GERD. Berbagai terapi farmakologis telah dikembangkan, namun belum memberikan hasil yang optimal. Hal tersebut mendorong pengembangan modalitas terapi lain, salah satunya akupunktur tanam benang. Penelitian ini bertujuan untuk mengetahui efektifitas terapi kombinasi akupunktur tanam benang dan medikamentosa terhadap gejala dan kualitas hidup penderita GERD. Uji klinis acak tersamar ganda dengan pembanding dilakukan terhadap 52 penderita GERD yang dialokasikan secara acak ke dalam kelompok kombinasi akupunktur tanam benang dan medikamentosa (kelompok perlakuan) atau kelompok akupunktur sham dan medikamentosa (kelompok kontrol). Akupunktur tanam benang dilakukan pada titik CV12 Zhongwan, ST36 Zusanli dan BL21 Weishu sebanyak 2 kali dengan interval 15 hari. Skor GERDQ, RQS dan SF-36 digunakan untuk mengukur keluaran terapi. Hasil penelitian menunjukkan bahwa penurunan skor GERDQ pada kelompok perlakan lebih besar dari kelompok kontrol (p<0,001) dan peningkatan skor RQS serta peningkatan skor seluruh komponen SF-36 pada kelompok perlakuan lebih besar dibanding kelompok kontrol (p<0,001). Kesimpulan penelitian adalah terapi kombinasi akupunktur tanam benang dan medikamentosa lebih efektif dalam mengurangi gejala dan meningkatkan kualitas hidup penderita GERD dibandingkan dengan terapi medikamentosa saja ABSTRACT
Gastroesophageal reflux disease (GERD) is a pathological condition caused by reflux of gastric contents into the esophagus. It has been shown that GERD has significant impact on patients either physically, psychologically, socially or economically. Impaired of quality of life and working productivity are common in GERD patients. Various pharmacological therapies have been developed, but not yet provide optimal results. It encourages the development of other therapeutic modalities, such as acupoint catgut embedment. The aim of this study was to establish the effect of acupoint catgut embedment combine with medical treatment on symptom and quality of life of GERD patients. A double-blind randomized controlled trial involved 52 GERD patients randomly allocated into catgut embedding therapy with medication group (treatment group) or medication only group (control group). Catgut embedding therapy was given 2 times at CV12 Zhongwan, ST36 Zusanli and BL21 Weishu every 15 days. GERDQ, RQS and SF-36 were used to measure the primary outcomes. The result shown, the decreased of GERDQ scores at treatments group significant higher than control groups (p<0,001), the increased of RQS score and all of SF-36 components scores at treatment group significant higher than control group (p<0,001). The result suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of GERD patients.;Gastroesophageal reflux disease (GERD) is a pathological condition caused by reflux of gastric contents into the esophagus. It has been shown that GERD has significant impact on patients either physically, psychologically, socially or economically. Impaired of quality of life and working productivity are common in GERD patients. Various pharmacological therapies have been developed, but not yet provide optimal results. It encourages the development of other therapeutic modalities, such as acupoint catgut embedment. The aim of this study was to establish the effect of acupoint catgut embedment combine with medical treatment on symptom and quality of life of GERD patients. A double-blind randomized controlled trial involved 52 GERD patients randomly allocated into catgut embedding therapy with medication group (treatment group) or medication only group (control group). Catgut embedding therapy was given 2 times at CV12 Zhongwan, ST36 Zusanli and BL21 Weishu every 15 days. GERDQ, RQS and SF-36 were used to measure the primary outcomes. The result shown, the decreased of GERDQ scores at treatments group significant higher than control groups (p<0,001), the increased of RQS score and all of SF-36 components scores at treatment group significant higher than control group (p<0,001). The result suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of GERD patients.;Gastroesophageal reflux disease (GERD) is a pathological condition caused by reflux of gastric contents into the esophagus. It has been shown that GERD has significant impact on patients either physically, psychologically, socially or economically. Impaired of quality of life and working productivity are common in GERD patients. Various pharmacological therapies have been developed, but not yet provide optimal results. It encourages the development of other therapeutic modalities, such as acupoint catgut embedment. The aim of this study was to establish the effect of acupoint catgut embedment combine with medical treatment on symptom and quality of life of GERD patients. A double-blind randomized controlled trial involved 52 GERD patients randomly allocated into catgut embedding therapy with medication group (treatment group) or medication only group (control group). Catgut embedding therapy was given 2 times at CV12 Zhongwan, ST36 Zusanli and BL21 Weishu every 15 days. GERDQ, RQS and SF-36 were used to measure the primary outcomes. The result shown, the decreased of GERDQ scores at treatments group significant higher than control groups (p<0,001), the increased of RQS score and all of SF-36 components scores at treatment group significant higher than control group (p<0,001). The result suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of GERD patients.;Gastroesophageal reflux disease (GERD) is a pathological condition caused by reflux of gastric contents into the esophagus. It has been shown that GERD has significant impact on patients either physically, psychologically, socially or economically. Impaired of quality of life and working productivity are common in GERD patients. Various pharmacological therapies have been developed, but not yet provide optimal results. It encourages the development of other therapeutic modalities, such as acupoint catgut embedment. The aim of this study was to establish the effect of acupoint catgut embedment combine with medical treatment on symptom and quality of life of GERD patients. A double-blind randomized controlled trial involved 52 GERD patients randomly allocated into catgut embedding therapy with medication group (treatment group) or medication only group (control group). Catgut embedding therapy was given 2 times at CV12 Zhongwan, ST36 Zusanli and BL21 Weishu every 15 days. GERDQ, RQS and SF-36 were used to measure the primary outcomes. The result shown, the decreased of GERDQ scores at treatments group significant higher than control groups (p<0,001), the increased of RQS score and all of SF-36 components scores at treatment group significant higher than control group (p<0,001). The result suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of GERD patients.;Gastroesophageal reflux disease (GERD) is a pathological condition caused by reflux of gastric contents into the esophagus. It has been shown that GERD has significant impact on patients either physically, psychologically, socially or economically. Impaired of quality of life and working productivity are common in GERD patients. Various pharmacological therapies have been developed, but not yet provide optimal results. It encourages the development of other therapeutic modalities, such as acupoint catgut embedment. The aim of this study was to establish the effect of acupoint catgut embedment combine with medical treatment on symptom and quality of life of GERD patients. A double-blind randomized controlled trial involved 52 GERD patients randomly allocated into catgut embedding therapy with medication group (treatment group) or medication only group (control group). Catgut embedding therapy was given 2 times at CV12 Zhongwan, ST36 Zusanli and BL21 Weishu every 15 days. GERDQ, RQS and SF-36 were used to measure the primary outcomes. The result shown, the decreased of GERDQ scores at treatments group significant higher than control groups (p<0,001), the increased of RQS score and all of SF-36 components scores at treatment group significant higher than control group (p<0,001). The result suggested that acupoint-catgut embedment combined with medical treatment is more effective than medical treatment in alleviating symptoms and enhancing the quality of life of GERD patients.

Abstrak :
BACKGROUND: type 2 diabetes mellitus (T2DM) and gastroesophageal reflux disease (GERD) are commonly seen in the geriatric population. This study aimed to investigate the prevalence, risk factors, and alarm-symptoms incidence of GERD among elderly patients with T2DM in a rural area of Central Sulawesi. METHODS: this cross-sectional study was conducted from July-September 2019 in Public Health Center of Beteleme, Central Sulawesi. Patients aged ≥60 years old, newly or previously diagnosed with T2DM according to the 2019 American Diabetes Association (ADA) criteria or to the 2015 Indonesian Society of Endocrinology (PERKENI) criteria, were consecutively recruited. We excluded patients being on proton-pump inhibitor or H2-receptor antagonist therapy or having a history of gastric or esophageal surgery. GERD was diagnosed in patients with the score of ≥8 based on the Indonesian version of GERD questionnaire (GERD-Q). RESULTS: among 60 elders with T2DM, 28.3% (95% confidence interval [CI], 16.9-39.7) had GERD. Statistical analysis showed that GERD was significantly associated with consumption frequency of tea (p=0.019) and coffee (p=0.015). No significant relationship was found between gender (p=0.562), obesity (p=0.803), achievement of blood glucose-level control (p=0.478), duration of T2DM (p=0.304), and type of antihyperglycemic drugs (p=0.202) with GERD. Unintentional weight loss was the leading alarm symptom (47.1%; 95%CI, 23.4%-70.8%) found across the GERD group. CONCLUSION: GERD was prevalent among elderly patients with diabetes. Frequent consumption of either tea or coffee was associated with GERD. Alarm symptoms need further evaluation to screen for complications.

Abstrak :
Penyakit refluks gastroesofagus (GERD) merupakan kondisi kronik yang terjadi akibat asam lambung naik ke esofagus. COVID-19 dapat memperburuk gejala GERD dan berdampak pada fungsi pernapasan. Latihan diafragma mampu memperbaiki gejala GERD, namun efektivitasnya pada orang dewasa dengan GERD pasca COVID-19 belum pernah diteliti. Penelitian ini bertujuan untuk menguji efektivitas latihan diafragma modifikasi terhadap gejala GERD, tekanan inspirasi maksimal (TIM), ekskursi diafragma, dan fungsi paru. Penelitian ini merupakan uji klinis acak tersamar tunggal pada bulan September 2022 sampai April 2023 di Rumah Sakit Persahabatan. Dari data rekam medis terdapat 364 pasien yang mengalami gejala gastrointestinal persisten. Dari data pasien tersebut, 302 pasien mengalami gejala sebelum COVID-19 dan 62 pasien setelah COVID19. Sebanyak 55 pasien memenuhi kriteria inklusi dan lolos kriteria eksklusi. Selanjutnya dialokasikan secara random pada kelompok uji (n = 25) dan kontrol (n = 25), dan 5 pasien menjalani penelitian pendahuluan. Latihan diafragma selama empat minggu terdiri atas latihan diafragma modifikasi atau latihan diafragma standar. Evaluasi dilakukan 30 hari setelah latihan pertama. Dibandingkan dengan kelompok kontrol, kelompok uji menunjukkan peningkatan bermakna pada tekanan inspirasi maksimal (TIM; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 dan 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), ekskursi diafragma kanan (4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 dan 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), dan ekskursi diafragma kiri (4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 dan 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Selain itu, baik kelompok uji sebelum-dan-sesudah maupun kelompok kontrol mengalami penurunan bermakna pada skor GERDQ (10,44 ± 2,00 vs. 1,84 ± 2,17 dan 8,64 ± 0,57 vs. 3,32 ± 1,49), dengan nilai p < 0,001. Latihan diafragma meningkatkan nilai kapasitas vital paksa (KVP), tidak meningkatkan nilai volume ekspirasi paksa detik pertama (VEP1) maupun rasio antara volume ekspirasi paksa detik pertama dan kapasitas vital paksa (VEP1/KVP), tidak bermakna secara statistik (p > 0,05). Latihan diafragma modifikasi pada orang dewasa setelah COVID-19 dengan GERD meningkatkan TIM dan ekskursi diafragma, serta mengurangi gejala refluks gastroesofageal yang terlihat dari perbaikan skor GERDQ. ......Gastroesophageal reflux disease (GERD) is a common chronic condition characterized by stomach acid reflux into the esophagus. COVID-19 may worsen GERD symptoms and impact respiratory function. Diaphragmatic training has demonstrated potential effectiveness in managing GERD symptoms, but its effectiveness in adults with GERD after COVID-19 is unknown. This study aimed to examine the effectiveness of modified diaphragmatic training (MDT) on GERD symptoms, maximum inspiratory pressure (MIP), diaphragmatic excursion, and lung function in this population. This single-blinded randomized control trial was conducted from September 2022 to April 2023 at Persahabatan Hospital. The research team evaluated the medical records of 364 patients presenting persistent gastrointestinal symptoms; among these potential participants, 302 reported symptoms before COVID-19 infection, while 62 developed symptoms after being infected with COVID-19. After applying the study's inclusion and exclusion criteria, a total of 55 patients were selected and randomly assigned to either the intervention group (n = 25) or the control group (n = 25), and 5 patients were enrolled in the preliminary research. The intervention phase consisted of four weeks of diaphragmatic training, wherein participants received either modified diaphragmatic training (MDT) or standard diaphragmatic training. Following the training period, a follow-up assessment was conducted 30 days from the initiation of the intervention. In comparison to the control group, the intervention group demonstrated significant improvements in maximum inspiratory pressure (MIP; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 and 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), right diaphragmatic excursion (RDE; 4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 and 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), and left diaphragmatic excursion (LDE; 4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 and 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Additionally, both the pre–post-intervention group and the control group exhibited significant reductions in GERDQ scores (10.44 ± 2.00 vs. 1.84 ± 2.17 and 8.64 ± 0.57 vs. 3.32 ± 1.49, respectively), with a p-value < 0.001. Diaphragmatic training resulted in increased forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), these differences were not statistically significant in both groups (p > 0,05). MDT in adults post-COVID-19 with GERD enhanced MIP and diaphragmatic excursion, along with a reduction in symptoms of GERD as evidenced by improvements in GERDQ scores.

Abstrak :
Berdasarkan penelitian Suherman et al, prevalensi gastroesophageal reflux disease (GERD) di Indonesia sudah mencapai angka yang cukup tinggi yaitu sebesar 27,4 % pada tahun 2016. GERD merupakan penyakit yang tidak mematikan tetapi akan menyebabkan penyakit yang sangat serius jika tidak ditangani dengan baik. Tantangan pada obat yang digunakan dalam pengobatan GERD saat ini adalah efek samping, gastric retention time yang singkat, dan bioavaibilitas yang rendah. Oleh sebab itu, pembuatan mikropartikel terapung dengan kandungan ekstrak Moringa oleifera merupakan solusi yang tepat. Mikropartikel yang mengandung ekstrak Moringa oleifera akan dibuat menggunakan metode non-solvent evaporation method dengan memanfaatkan polimer yang memiliki densitas rendah seperti HPMC K4M dan EC sehingga didapatkan mikropartikel terbaik yaitu, D1H4 dengan yield (95,2%), nilai ekstrak dalam mikropartikel (0,058 mgQE/g ekstrak), entrapment efficiency (1,16%), loading capacity (1,21%), %rilis kumulatif flavonoid (jam 24, 21,87%), dan kemampuan mengapung (1 jam) yang baik. Selain itu, mikropartikel alginat dengan kandingan natrium bikarbonat dan ekstrak Moringa oleifera melalui ionotropic gelation method akan didapatkan mikropartikel terbaik yaitu, D4X4A10 dengan freeze dried yang memiliki nilai yield (151,82%), nilai ekstrak dalam mikropartikel (0,057 mgQE/g ekstrak), entrapment efficiency (2,85%), loading capacity (0,61%), %rilis kumulatif flavonoid (jam 24, 33,875%) , dan kemampuan mengapung (90%, 8 jam) yang baik. Karakteristik mikropartikel lainnya seperti scanning electron microscopy (SEM) dan ukuran mikropartikel diukur melalui pengujian. ......According to research by Suherman et al., the prevalence of gastroesophageal reflux disease (GERD) had reached a rather high percentage which is 27.4% in 2016. GERD is not a life-threatening disease however proper handling of GERD will reduce the possibility of developing other chronic disease associated with GERD. Challenge in designing drugs as a treatment for GERD are the side effects, brief gastric retention time, and low bioavailability. Thus, floating microparticles containing Moringa oleifera extract is the right solution to overcome the challenges. Microparticles containing Moringa oleifera extract will be constructed by non-solvent evaporation method by utilizing low-density polymers such as HPMC K4M and EC resulting D1H4 as the best formulation with characteristics, yield (95,2%), extract in particles (0,058 mgQE/g ekstrak), entrapment efficiency (1,16%), loading capacity (1,21%), % flavonoid cumulative release (jam 24, 21,87%), and floating capacity (1 hr). In addition, microparticles made by ionotropic gelation methods using alginate in entrapping Moringa oleifera extract and sodium bicarbonate are used as an additional treatment for gastric acid neutralization resulting freezed dryed microparticles D4X4A10 with characteristics yield (151,82%), extract in particles (0,057 mgQE/g ekstrak), entrapment efficiency (2,85%), loading capacity (0,61%), % flavonoid cumulative release (jam 24, 33,875%) , dan floating capacity (90%, 8 hr). Other characteristics of the microparticles such as scanning electron microscopy (SEM) and microparticle size will also be determined.

Abstrak :
PURPOSE: Laparoscopic fundoplication (LF) has become a standard operative procedure for GERD-related diseases in Japan, although meta-analyses have mainly evaluated findings from Western countries. The propensity score matching method was used to compare and investigate the treatment outcomes of two fundoplication procedures (the Nissen and Toupet methods).

METHODS: Among 474 patients who underwent initial LF from December 1994 to April 2016, we extracted 401 cases (Nissen: 92 cases, Toupet: 309 cases), excluding 73 patients in whom follow-up was insufficient. We then matched 126 of these patients (63 per group).

RESULTS: The esophageal acid reflux time (%) was 12.2:2.8, being higher in the Nissen group than in the Toupet group (p < 0.001). Regarding the surgical outcome, the amount of bleeding was higher in the Nissen group (p = 0.001), and the number of hospitalization days following surgery was longer (p = 0.003). Furthermore, a significantly rate of postoperative difficulty in swallowing (%) was observed in the Nissen group, at 13:0 (p = 0.004). The recurrence rate (%) was 8:3, with no difference between the two groups (p = 0.243).

CONCLUSIONS: Although there was no marked difference in the recurrence rate between the two procedures, postoperative dysphagia was observed at a higher frequency with the Nissen method than the Toupet method.