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Abstrak :
ABSTRAK
Latar belakang: Sejak dilaporkan pertama kali pada tahun 1981 di Amerika Serikat, penyebaran Acquired Immune Deficiency Syndrome (AIDS) di seluruh dunia termasuk Indonesia terjadi dengan pesat. Saluran pencernaan merupakan target utama infeksi HIV. Enteropati terjadi pada 15-70% kasus anak. Enteropati dapat terjadi walaupun tanpa gejala gastrointestinal. Kondisi enteropati dapat menimbulkan perburukan gejala gastrointestinal, kegagalan pertumbuhan dan menyebabkan pasien mengarah pada wasting. Enteropati dideteksi dengan pemeriksaan alpha 1 antitripsin. Tujuan: (1) Mengetahui proporsi enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (2) Mengetahui karakteristik enteropati yang terjadi pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. (3) Mengetahui hubungan antara enteropati dengan usia, status gizi, status imunodefisiensi, jenis dan lama terapi ARV serta lama sakit anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Metode: Penelitian potong lintang deskriptif dan analitik yang dilakukan di Poliklinik Alergi Imunologi Departemen Ilmu Kesehatan Anak FKUI- RSCM antara bulan Agustus sampai dengan November 2015 terhadap anak dengan AIDS stadium lanjut berusia 0 - 18 tahun tanpa gejala gastrointestinal. Faktor risiko dianalisis bivariat dan multivariat. Hasil: Total subjek penelitian berjumlah 70 subjek (35 lelaki dan 35 perempuan). Enteropati terjadi pada 31 subjek. Enteropati lebih banyak ditemukan pada anak perempuan, usia >60 bulan, mengalami malnutrisi, tidak ada imunodefisiensi, obat antiretroviral lini kedua dan ketiga, lama pengobatan 0-59 bulan dan lama sakit 059 bulan. Pada analisis bivariat tidak didapatkan faktor risiko yang bermakna. Pada analisis multivariat didapatkan lama sakit 0-59 bulan dengan nilai OR 3,451 (IK95% 1,026-11,610) merupakan faktor risiko yang berperan dalam terjadinya enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal. Simpulan : Proporsi enteropati pada anak dengan AIDS stadium lanjut tanpa gejala gastrointestinal sebanyak 31 dari 70 subjek. Faktor risiko yang berperan adalah lama sakit 0-59 bulan. ABSTRACT
Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.;Background: HIV/AIDS is a global pandemic. Digestive tract is a major target for HIV infection. The digestive-absorptive functions are impaired, occurring in 1570% of children. Enteropathy contributes to gastrointestinal manifestation, growth failure and further immune derangement, leading to wasting. The diagnostic approach includes alpha 1 antitrypsin fecal level. Objective: (1) to describe frequency of enteropathy in advanced stages of AIDS children without gastrointestinal manifestation, (2) to describe characteristic of children with advanced stages of AIDS without gastrointestinal manifestation who develop enteropathy, (3) to investigate the role of age, nutritional status, immunodeficiency status, type and duration of antiretroviral therapy, and duration of illness as risk for enteropathy in advanced stages of AIDS children without gastrointestinal manifestation. Methods: A descriptive and analytic cross-sectional study was conducted at Pediatric Allergy-Immunology Outpatient Clinic RSCM between August to November 2015. The inclusion criteria was advanced stages of AIDS children age 0-18 years old without gastrointestinal manifestation. Risk factors were analyzed with bivariate and multivariate analysis. Results: Seventy children fulfilled the study criteria (35 males and 35 females). Thirty-one subjects were diagnosed as enteropathy. Most subjects are female, age >60 month-old, malnutritional status, no immunodeficiency, received second and third line antiretroviral regimen with duration 0-59 months and duration of illness 0-59 months. Bivariate analysis showed that no factor was significantly associated with enteropathy. Based on multivariate analysis, duration of illness 0-59 months is a significant risk factor with OR 3.451 (CI 1.026-11.610). Conclusions: The proportion enteropathy in advanced stages of AIDS children without gastrointestinal manifestation is 31/70. Patients who had been diagnosed as advanced stage of HIV/AIDS for 0-59 months are more likely to develop enteropathy.

Abstrak :
Obat anti-inflamasi nonsteroid (OAINS) berhubungan dengan meningkatnya insidens komplikasi tukak gastrointestinal yang mendadak dan menetap. Penelitian ini bertujuan untuk menemukan kelainan-kelainan endoskopik yang ditemukan pada duodenum dan jejunum proksimal karena obat OAINS. Tiga puluh delapan pasien yang mengkonsumsi OAINS untuk penyakit arthritis atau rematiknya dimasukkan dalam penelitian ini. Pemeriksaan gastro-duodeno-jejunoskopi dilakukan dengan alat Olympus PCF-10. Gambaran endoskopik entero-gastropati-OAINS dievaluasi dengan sistim skor. Gambaran enterogastropati-OAINS secara endoskopik terlihat berupa hiperemis, erosi dan tukak. Keluhan diare terjadi pada 7,9% pasien dan dispepsia terjadi pada 71,1% pasien. Dari pemeriksaan endoskopi di bulbus duodenum, ditemukan 79% kasus dengan hiperemis, 39,5% kasus dengan erosi dan 7,9% kasus tukak. Di duodenum bagian kedua (pars desendens) ditemukan 28,9% kasus dengan hiperemis, 15,8% kasus dengan erosi dan 2,6% kasus tukak. Di jejunum, ditemukan 7,9% kasus dengan hiperemis, 2,6% kasus dengan erosi dan tidak ditemukan tukak. Disimpulkan bahwa kelainan endoskopik terbanyak yang ditemukan pada enteropati-OAINS yaitu hiperemis. Lokasi kelainan enteropati-OAINS tersering yaitu di bulbus duodenum. (Med J Indones 2005; 14: 225-9)

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Non Steroidal Anti Inflammatory Drugs (NSAID) have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero-gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part) of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb. (Med J Indones 2005; 14: 225-9)

Abstrak :
Radioterapi mempunyai peranan yang penting pada penderita penderita Karsinoma Serviks Uteri dan Karsinoma Ovarium serta Karsinoma Endometrium pascabedah. Tidak didapatkan perbedaan yang bermakna antara ketahanan hidup 5 tahun penderita keganasan ini pada tingkatan penyakit dini yang hanya mendapat radioterapi saja dan yang dilakukan tindakan operasi dengan dilanjutkan radiasi pascabedah. Sebelum digunakan pesawat dengan energi tinggi, radiasi dengan menggunakan pesawat energi rendah mempunyai keterbatasan karena taleransi kulit yang rendah, Pada saat ini dengan penggunaan pesawat berenergi tinggi dapat diberikan dosis radiasi yang jauh lebih tinggi dengan cedera kulit minimal sekalipun untuk tumor tumor yang letaknya dalam. Dengan demikian diharapkan angka kesembuhan lokal yang tinggi, tetapi dengan kemungkinan akan didapatkan efek samping yang lebih tinggi pada organ organ disekitarnya . Organ organ yang patut mendapat perhatian pada radiasi daerah pelvis atau abdomen adalah bull bull, ureter, rektum, kolon sigmoid dan usus halus. Komplikasi pada traktus digestivus berkisar antara rasa tidak enak pada saluran pencernaan, diare dan yang lebih berat dari itu adalah stenosis usus. Pada dosis radiasi yang lebih tinggi dapat terjadi fistulasi yang kadang kadang memerlukan intervensi pembedahan. Dikenal suatu sindroma dengan gejala gejala nyeri pada perut disertai diare yang disebabkan oleh karena adanya asam empedu yang berlebihan didalam kolon. Sindroma ini didapatkan pada penderita dengan penyakit pada ileum dan disebut sebagai Cholerheic Enteropathy. Seperti diketahui pada keadaan normal asam empedu direabsorpsi oleh ileum. Gambaran yang sama dengan " Cholerheic Enteropathy " didapatkan pada pereobaan binatang yang mendapat radiasi. Sehingga dipikirkan bahwa gangguan diatas merupakan faktor yang panting atas terjadinya diare pada penderita yang mendapat radiasi daerah pelvis atau abdomen. Dengan metoda radiasi konvensional yang diberikan 5 kali per minggu, dengan dosis harian 200 cc/hari selama kurang lebih 5 minggu, keluhan diare biasanya mulai timbul pada minggu kedua. Setelah selesai radiasi pada sebagian besar kasus diare akan berhenti atau mereda dalam beberapa minggu. Dilaporkan oleh Newman bahwa terjadi perubahan defekasi pada 12 dari 17 penderita dengan tumor ganas kandungan yang mendapat terapi radiasi. Sedangkan Van Blankestein mendapatkan penurunan reabsorpsi asam empedu pada semua pasien yang mendapat radiasi daerah abdomen. Tujuan penelitian ini adalah untuk mencari jawaban salah satu dari berbagai kemungkinan penyebab diare berlandaskan teori diatas, yakni dengan mendapatkan data data mengenai gambaran kadar asam empedu dalam serum penderita kanker ginekologis yang mendapat terapi radiasi pada daerah pelvis atau abdomen, balk kadar asam empedu dalam keadaan puasa maupun sesudah makan.

Abstrak :
Non-steroidal anti-inflammatory drugs (NSAIDs) is a group of drugs used to treat pain, inflammation, and fever. High consumption of NSAIDs associated with high gastrointestinal side effects. Common complaint from patients, which ranging from mild heartburn to the onset of gastrointestinal bleeding, often complicates the adequate administration of NSAIDs. Various methods have been developed to reduce the likelihood of gastroenteropathy complication. Early diagnosis, appropriate prompt treatment, as well as adequate monitoring will reduce morbidity and mortality from complications due to NSAIDs. This paper will discuss the diagnosis and management of gastro-enteropathy NSAID through approaching the underlying pathophysiology.