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Abstrak :
ABSTRAK Latar Belakang. Irritable bowel syndrome (IBS) merupakan nyeri perut berulang pada remaja yang paling banyak terjadi. Irritable bowel syndrome pada remaja akan menimbulkan gangguan yang serius berupa masalah perilakunya. Tujuan. Menganalisis hubungan antara masalah perilaku dengan Irritable bowel syndrome pada remaja di Kota Palembang. Metode. Penelitian ini adalah studi potong lintang. Semua siswa SMA Nurul Iman dilakukan pencatatan meliputi karakteristik umum, pemeriksaan fisik berupa berat badan dan Tinggi badan. Selanjutnya dilakukan uji Rome III (Irritable bowel syndrome) dan PSC-17 (masalah perilaku). Analisis statistik yang digunakan adalah analisis bivariat dengan uji chi-square. Hasil. Dari semua siswa SMA Nurul Iman didapatkan 180 subyek yang memenuhi kriteria inklusi dan tidak memenuhi kriteria eksklusi. Prevalens IBS sebanyak 58 subyek (32,2%) yang terdiri dari 22 subyek dengan IBS subtipe konstipasi, 23 subyek dengan IBS subtipe diare dan 13 subyek dengan IBS subtype campuran. Prevalens masalah perilaku sebesar 40,6% yang terdiri dari 28,9% masalah perilaku internalisasi, 2,8% masalah eksternalisasi, 0,6% masalah perilaku perhatian dan 8,4% variasi dari 3 gangguan. Faktor risiko terjadinya IBS antara lain: mengonsumsi daging olahan, teh, makan terburu-buru, serta dibully. Terdapat hubungan yang bermakna antara IBS dengan masalah perilaku (p=0,001). Nilai Odds Ratio yang diberikan sebesar 3,015 (IK95%=1,580-5,754) Simpulan. Remaja yang mengalami IBS akan mengalami masalah perilaku.

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ABSTRACT Background. Irritable Bowel Syndrome (IBS) is the most common recurrent abdominal pain in adolescence, causing serious impairments on behavioral problems. To date, there have no studies on IBS and behavioral problems in Palembang. Objective. To assess for an association between IBS and behavioral problems in adolescences in Palembang. Methods. Subjects in this cross-sectional study were adolescences who attended Nurul Iman high school. Their general characteristics, developmental history and physical examination results (including weight and height) were recorded. We administered the Criteria Rome III for IBS and the Pediatric Symptom Checklist 17 (PSC 17) for behavioral problems. Data was analyzed by Chi-square test. Results. We enrolled 180 adolescences as student in Nurul Iman high school. Prevalences of IBS was 32,2%, consisting of subtype IBS constipation (37,9%), subtype IBS Diarrhea (39,7%), and subtype IBS Mixed (22,4%). The prevalence of behavioral disorders was 40,6%, consisting of internalization (28,9%), externalization (2,8%), attentive problems (0,6%) and various combinations of three problems (8,4%). A significant association was found between IBS and behavioral problems (P=0.001; OR=3.015 95%CI=1.580-5.754). Conclusion. IBS is significantly associated with behavioral problems.

Abstrak :
ABSTRAK
Latar belakang: Sakit perut berulang SPB merupakan penyebab terbanyak dari sakit kronis pada anak. Irritable bowel syndrome IBS merupakan salah satu penyebab terbanyak dari SPB, ditandai oleh nyeri/ rasa tidak nyaman pada perut dan perubahan fungsi saluran cerna. Patofisiologi IBS saat ini banyak dihubungkan dengan gangguan pada mikroflora usus. Belum ada data tentang mikroflora usus pada anak dengan IBS di Indonesia.Tujuan: Mengetahui pola mikroflora saluran cerna pada anak penderita IBS dan anak sehat berusia 13-18 tahun di Indonesia.Metode: Penelitian kasus-kontrol dilakukan pada 22 anak penderita IBS dan 28 kontrol pada anak usia 13-18 tahun di SMP dan SMA di Jakarta Pusat. Diagnosis IBS menggunakan kriteria Rome III. Usia, jenis kelamin, pendidikan dicatat saat awal penelitian. Spesimen feses dikumpulkan lalu diperiksa jumlah Bifidobacterium dan Enterobacteriaceae.Hasil: Penderita IBS terbanyak dari perempuan 17/22 dengan median usia 16 tahun. Nilai median Bifidobacterium spp sebesar 138,95 rentang 0,2 ndash;22.735,8 pada kelompok IBS dan 232,5 rentang 1,9 ndash;38.985,6 CFU/gram pada kelompok kontrol. Tidak ada perbedaan bermakna Bifidobacterium antara kedua kelompok p=0,493 . Nilai median Enterobacteriaceae sebesar 58,9 rentang 2,5 ndash;9.577,8 CFU/gram pada kelompok IBS dan 85 rentang 12,1 ndash;3.139,4 CFU/gram pada kelompok kontrol. Tidak ada perbedaan bermakna Enterobacteriaceae antara kedua kelompok p=0,938 .Simpulan: Tidak didapatkan perbedaan bermakna antara jumlah Bifidobacterium dan Enterobacteriaceae pada kelompok IBS maupun kontrol. Terdapat kecenderungan peningkatan jumlah Enterobacteriaceae pada kelompok IBS dan peningkatan jumlah Bifidobacterium pada kelompok kontrol.Kata kunci: irritable bowel syndrome, mikroflora usus, Bifidobacterium, Enterobacteriaceae "hr>" "ABSTRACT
" Background Recurrent abdominal pain RAP is the most frequent cause of chronic pain in children. Irritable bowel syndrome IBS is one of the most occuring type of RAP, marked with abdominal pain discomfort and changes in bowel movement. The current pathophysiology of IBS is associated with alterations of gut microflora. Currently, there is no data about gut microflora in children with IBS in Indonesia.Aim To evaluate gut microflora in healthy children and children with IBS aged 13 18 years old in Indonesia.Methods A case control study was conducted to 22 IBS children and 28 healthy subjects aged 13 18 years old at junior high school and senior high school in Central Jakarta. Irritable bowel syndrome diagnosed using Rome III criteria. Age, sex, and level of education were recorded. Stool samples were collected and investigated for Bifidobacterium and Enterobacteriaceae.Result Most of the IBS subjects were females 17 22 with a median age 16 years old. The median value of Bifidobacterium spp was 138.95 range 0.2 ndash 22,735.8 for the IBS subjects and 232.5 range 1.9 ndash 38,985.6 CFU gram on healthy subjects with no statistical difference p 0,493 . The median value of Enterobacteriaceae was 58.9 range 2.5 ndash 9,577.8 on IBS subjects and 85 range 12.1 ndash 3,139.4 CFU gram on healthy subjects with no statistical difference p 0,938 .Conclusion There was no statistical difference for Bifidobacterium and Enterobacteriaceae on either IBS or healthy subjects. There was an increasing tendency of Enterobacteriaceae on IBS subjects and increasing tendency of Bifidobacterium on healthy subjects.Keywords irritable bowel syndrome, gut microflora, Bifidobacterium, Enterobacteriaceae

Abstrak :
Irritable bowel syndrome (IBS) is the most common functional disorder of the gastrointestinal tract. As a result of the lack of specific diagnostic testing and absence of circumscribed biology markers of the disease, its diagnosis is based on a myriad of symptoms. The term irritable bowel syndrome was probably first coined in 1944 by Peters and Bargenf. ln 1849, Cumming described the clinical manifestations of Irritable Bowel Syndrome. Irritable bowel syndrome is defined an the basis of the recently modified Rome criteria as the presence of at least l2 weeks (not necessarily consecutive) of abdominal discomfort or pain in the preceding l2 months that cannot be explained by structural or biochemical abnormalities, and that has at least two of the following three features: pain relieved with defecation, an onset associated with a change in the frequency of bowel movements (diarrhea or constipation), or an onset associated with a change inform of stool (loose, watery, or pellet-like). The syndrome can be divided into three subcategories according to the Modmed Rome criteria ll; those with a predominant symptom of diarrhea, constipation, or constipation alternating with diarrhea. There are Several criteria for irritable bowel syndrome, one of which is the Manning criteria applied in many epidemiological and clinical studies to identify irritable bowel syndrome. However, many investigators disagree with this criteria due to a seemingly poor validity in men. In an attempt to bring order to the specialty, consensus-based approach is adopted by a group of international experts, which led to the development ofthe Rome criteria for irritable bowel syndrome (Table l). Extra-intestinal symptoms, including headache, backache, urinary and gynecologic symptoms, and fatigue, are more common in the constipation-predominant subgroup

Abstrak :

Irritable Bowel Syndrome (IBS) merupakan penyakit terbanyak pada anak dan remaja pada gangguan saluran cerna fungsional dengan subtipe diare, konstipasi, campuran dan unclassified. Mekanisme patofisiologi belum jelas dan memerlukan pembuktian adanya keterlibatan organik. Tujuan penelitian ini adalah untuk mengetahui epidemiologi IBS, peran infestasi Blastocystis hominis dan integritas mukosa usus dalam etiopatogenesis IBS, dampak IBS terhadap kualitas hidup, serta membuat sistem model prediksi IBS pada remaja.

Penelitian ini berbasis komunitas dengan pendekatan potong lintang komparatif dua kelompok pada remaja dari enam SMA di Palembang. Kriteria Roma III digunakan untuk menegakkan diagnosis IBS beserta kuesioner untuk menentukan faktor risiko. Secara multistage random sampling dibandingkan 70 subjek IBS dan 70 subjek nonIBS. Dilakukan pencatatan riwayat medis, pemeriksaan fisis, pemeriksaan parasit dan biomarker tinja serta kuesioner IBSQOL. Pemeriksaan tinja segar dengan mikroskop untuk mengetahui infestasi Blastocystis hominis. Pemeriksaan kadar alfa-1 antitripsin dan kalprotektin tinja dengan ELISA untuk melihat adanya gangguan integritas mukosa usus. Dampak IBS terhadap kualitas hidup dinilai dengan kuesioner IBSQOL.

Terdapat  454 subjek dengan prevalens IBS 30,2%, terdiri dari subtipe terbanyak yaitu subtipe diare 36,5%, dan yang paling sedikit subtipe konstipasi 18,9%. Uji regresi logistik mendapatkan faktor risiko utama IBS adalah dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan tiga jenis kacang, minuman kemasan, dan riwayat diare (kisaran OR 2,86–1,81). Blastocystis hominis ditemukan pada masing-masing grup sebesar 51,4 vs. 28,6%, dengan perbedaan bermakna (p = 0,006). Tidak ada hubungan bermakna untuk kerusakan mukosa (p = 0,734), tetapi bermakna dengan inflamasi usus (p = 0,039). Terbukti IBS secara bermakna menyebabkan rendahnya kualitas hidup (p = 0,001). Didapatkan 2 model prediksi skoring, yaitu model 1 yang dapat diaplikasikan pada layanan kesehatan primer yang bertujuan sebagai uji tapis dengan menilai faktor risiko. Model 2 diperuntukkan sebagai layanan terapi terkait infestasi Blastocystis pada layanan kesehatan tersier.

Simpulan, prevalens IBS pada remaja di Palembang tinggi dan memiliki faktor risiko utama dibully, perempuan, usia 14–16 tahun, riwayat konstipasi, makan 3 jenis kacang, minuman kemasan, riwayat diare. Terdapat hubungan yang bermakna antara Blastocystis hominis dan inflamasi usus dengan kejadian IBS pada remaja, serta dampaknya terhadap kualitas hidup membutuhkan penanganan yang komprehensif.

Kata kunci: Blastocystis hominis, integritas mukosa usus, irritable bowel syndrome, kualitas hidup, remaja

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Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder and commonly present in children and adolescences, presented as diarrhoea, constipation, mixed or unclassified type. The pathophysiological mechanisms of  IBS are unclear, and still challenging to determine organic disorders. The aim of this study was to investigate the epidemiology of IBS, the role of Blastocystis hominis infestation and intestinal mucosal integrity in the etiopathogenesis of IBS, the impact of quality of lifes, and apply a scoring system to predict the occurrence of IBS among adolescences.

A community-based survey with comparative cross sectional approach was done from six high schools in Palembang. Subjects were recruited using the multistage random sampling divided into two groups (70 subjects IBS and 70 subjects nonIBS). The Rome III criteria were used to establish a diagnosis of IBS along with a questionnaire to determine risk factors,  analyzed for association with Blastocystis hominis infestation, intestinal mucosal integrity, and its impact on quality of life. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones’ medium, PCR and Sequencing of 18S rRNA to determine Blastocystis subtype. Examination of antitrypsin alpha-1 and fecal calprotectin levels by ELISA was done  to determine impaired intestinal mucosal integrity. Impact of IBS on quality of life was done with the IBSQOL questionnaire.

Of the 454 subjects, the prevalence of IBS was 30.2%, consisting of diarrhea subtypes 36.5%, 21.9% mixed, 22.6% Unclassified and 18.9% constipation. The major risk factors for IBS were bullying, girls, ages 14–16 years, history of constipation, eat three kinds of nuts, drink beverages, and history of diarrhea (range OR 2.86–1.81). Blastocystis hominis was detected in each group of 51.4 vs. 28.6% (p = 0.006). There was no significant association for intestinal mucosal permeability (p = 0.734), but it was significant with intestinal inflammation (p = 0.039). Significant impairment of quality of life among IBS adolescences was found (p = 0.001). The IBS prediction score model had 2 models. Model 1 is more applicable in primary health care for sreening IBS based on risk factors. Model 2 only usable for tertiary health care, as management of Blastocystis infestation.

Conclusion, the prevalence IBS among adolescence was high with major risk factors to IBS consisted of bullying, female gender, age between 14–16 years, previous illness of constipation, diet three nuts, drink beverages, previous illness diarrhoea. Significant association with Blastocystis hominis infestation, intestinal inflammation were found, comphrehensive management is needed as for its impact on quality of life.

Keywords. Blastocystis hominis, intestinal integrity, irritable bowel syndrome,   quality of life, Adolescences

 

Abstrak :
Terdapat empat faktor yang dapat mempengaruhi tingkat stres mahasiswa keperawatan, yaitu faktor pendidikan, persiapan klinis, kepercayaan dan keuangan. Keempat faktor stres tersebut dapat berdampak ke salah satu penyakit secara fisiologis yaitu gejala sindrom iritasi usus besar. Sehingga penelitian ini dianalisis menggunakan uji Gamma untuk mengidentifikasi hubungan antara tingkat stres pendidikan, persiapan klinis, kepercayaan dan keuangan dengan gejala sindrom iritasi usus besar pada mahasiswa keperawatan. Pengumpulan data menggunakan kuesioner Stress in Nursing Students Scale (SINS) dan Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Desain penelitian yang digunakan adalah cross sectional dengan teknik sampel proportionate stratified random sampling melalui rumus perhitungan besaran sampel slovin, sehingga melibatkan 212 mahasiswa tanpa sistem drop out. Hasil penelitian ini menunjukan bahwa tingkat stres pendidikan, persiapan klinis, kepercayaan dan keuangan berhubungan signifikan, arah korelasi positif dengan kekuatan korelasi yang lemah terhadap gejala sindrom iritasi usus besar pada mahasiswa keperawatan. Oleh karena itu, dapat di simpulkan bahwa Semakin tinggi tingkat stres pendidikan, persiapan klinis, kepercayaan dan keuangan maka akan mengalami tingkat gejala sindrom iritasi usus besar semakin tinggi juga. ...... There are four factors which can influence the stress level of nursing students, namely education, clinical preparation, confidence and finance. The four stress factors can have an impact on one of physiologically diseases is the irritable bowel syndrome symptoms. So this study analyzed using Gamma test to identify the relation between stress levels of education, clinical preparation, confidence and finance with symptoms of irritable bowel syndrome in nursing students. Data collection using the Stress in Nursing Students Scale (SINS) and Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) questionnaire. The research design used is cross sectional with a proportionate stratified random sampling technique by means of the slovin sample unit calculation formulae, so that it involves 212 nursing students without drop out system. The results of this study indicate that the stress level of education, clinical preparation, confidence and finance is significantly related, positively correlated with a weak correlation strength to irritable bowel syndrome symptoms in nursing students. Therefore, it can be concluded that the higher the level of stress in education, clinical preparation, confidence and finance, the higher the level of irritable bowel syndrome symptoms, too.