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"ABSTRAKLatar Belakang : Diagnosis Inflammatory Bowel Disease (IBD) masih didasarkan pada pemeriksaan invasif (endoskopi dan histopatologi). Fecal calprotectin merupakan petanda inflamasi intestinal non invasif yang dapat digunakan untuk membedakan IBD dengan penyakit intestinal non inflamasi, namun studi-studi yang ada masih memberikan perbedaan nilai diagnostik dan hubungannya dengan derajat IBD.Tujuan : Membuktikan bahwa pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD. Metode : Penelitian ini adalah studi potong lintang untuk melakukan uji diagnostik. Penelitian dilakukan di beberapa rumah sakit di Jakarta mulai bulan September 2014 sampai Februari 2015. Kurva ROC dibuat untuk mendapatkan nilai diagnostik fecal calprotectin dan uji Krusskal Wallis untuk menilai perbedaan kadar fecal calprotectin menurut derajat IBD.Hasil : Terdapat 71 pasien IBD berdasarkan pemeriksaan kolonoskopi diikutkan dalam penelitian. Dari pasien tersebut didapatkan sebanyak 57 pasien ditetapkan definite IBD berdasarkan pemeriksaan histopatologi. Kadar fecal calprotectin lebih tinggi bermakna pada pasien IBD dibanding yang bukan IBD (553,8 μg/g vs 76,95 μg/g, p < 0,001). Didapatkan nilai titik potong 179,3 μg/g dengan sensitivitas 96% (IK 95% 0,88-0,99), spesifisitas 93% (IK 95% 0,69-0,99) dan Area Under Curve (AUC) 99,5% (IK 95% 0,98-1,00). Didapatkan perbedaan bermakna kadar fecal calprotectin pada masing-masing derajat IBD (p < 0,001).Kesimpulan : Pemeriksaan fecal calprotectin memiliki nilai diagnostik yang tinggi untuk mendiagnosis IBD serta berhubungan dengan derajat IBD.

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ABSTRACT

Background : Diagnosis of inflammatory bowel disease (IBD) is still based on invasive examination such as endoscopy and biopsy. Fecal calprotectin as a intestinal inflammation marker can used for diagnosis, but studies still had different diagnostic value and it?s correlation with grading of IBD.

Objective : Proving that fecal calprotectin have a high diagnostic value for IBD and correlation with grading of IBD. Methods : A cross sectional study for diagnostic of IBD. This study was conducted at several Hospitals in Jakarta from September 2014 until February 2015. A curve of ROC to determined diagnostic value of fecal calprotectin and Krusskal Wallis analysis to assessed of different value of fecal calprotectin according grade of IBD were made.

Results : Based on colonoscopy, 71 patient IBD were participated in this study. There were 57 patient diagnosis as definite IBD based on histopathology examination. Value of fecal calprotectin for IBD patient was higher than non IBD (553.8 μg/g vs 76.95 μg/g, p < 0,001). Value of fecal calprotectin was 179.3 μg/g as a new cutoff value with sensitivity 96% (CI 95% 0.88-0.99), specificity 93% (CI 95% 0.69-0.99) and Area Under Curve (AUC) 99.5% (CI 95% 0.98- 1.00) for diagnostic IBD. There was significant differences value of fecal calprotectin according every grade of IBD ( p < 0.001 ).

Conclusion : Fecal calprotectin has a high diagnostic value for IBD and correlated with grading of IBD."

"Gastro Esophageal Reflux Disease)  adalah suatu kondisi terjadinya refluks isi lambung ke dalam esophagus yang menyebabkan  berbagai gejala klinis. Penyebab dari GERD sudah banyak diketahui namun patofisiologi  densitas saraf pleksus Meissner dan pleksus Aurbach di daerah gastroesofagus junction (GEJ) akibat pemberian senyawa nitrat (NO₃) sehingga menyebabkan  GERD belum diketahui.

Metode : Membuat model hewan  GERD dan menilai variabel-variabel   pengaruh senyawa nitrat  di daerah GEJ menggunakan tikus wistar usia 10-12 minggu dengan berat badan 200-300 gram yang  dibagi dalam 4 kelompok :  kontrol (n=12) dan  kelompok perlakuan (n=36). Pada kelompok perlakuan dilakukan pemberian senyawa nitrat masing kelompok (n=12)  sebanyak 1 ml, 1.5 ml dan 2 ml  NaNO₃ . Pada hari ke 2,4,6 dan 8 setelah   puasa dan diberikan  senyawa nitrat, sebanyak 3 tikus dari setiap kelompok dianalisis menggunakan pemeriksaan biokimia, histologi, histokimia dan imunohistokimia (IHK).

Hasil: Tikus  model GERD berhasil dibuat. Dimana  pada hari ke 2 terdapat korelasi antara NO luminal dengan  fibroblast, NO jaringan dengan perpanjangan lamina propria, penebalan sel basal dengan limfosit, hiperplasi sel basal dengan  IHK IL6 dan perpanjangan lamina propria dengan  limfosit.  Pada hari ke 4 didapat korelasi antara NO luminal dengan penebalan sel basal, NO luminal dengan GSH, penebalan  sel basal dengan GSH, dan korelasi limfosit dengan IHK IL6.  Pada ke 6 terdapat korelasi antara NO luminal dengan FGF₂. Pada hari ke 8 didapati  korelasi antara NO luminal dengan densitas saraf pleksus Meissner dan pleksus Auerbach didapat korelasi kuat dan bermakna ( r = 0,758 dan p = 0,004) , penebalan sel basal dengan fibroblas , limfosit dengan fibroblast, IHK IL6 dengan fibroblast dan IHK FGF₂ dengan penebalan sel basal.

Kesimpulan: Pemberian senyawa NO₃ meningkatkan kadar NO luminal yang mengakibatkan  perubahan morfologi makrokopis dan mikroskopis, penurunan antioksidan endogen, inflamasi serta peningkatan densitas saraf pleksus Meissner dan pleksus Auerbach didaerah sfingter GEJ sehingga menyebabkan terjadinya GERD.

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Background: GERD (Gastro Esophageal Reflux Disease) is a condition with reflux of gastric contents into the esophagus which causes various clinical symptoms. The causes of GERD have been  known but the pathophysiology of the density of the Meissner plexus nerve and the Aurbach plexus in the gastroesofagus junction region (GEJ) due to administration of nitrate (NO₃) compounds is not known unknown.

Methods: GERD animal models were prepared to asses the variables affected by nitrate compounds in the GEJ area using wistar mice aged 10-12 weeks with a weight of 200-300 grams divided into 4 groups: control (n = 12) and treatment group (n = 36). In the treatment group, nitrate compounds were given as NaNO3 in each group (n = 12) with the doses of 1 ml, 1.5 ml and 2 ml. On days 2,4,6 and 8 after fasting and gavage of nitrates, 3 rats from each group were sacrificed, and esophageal tissue was taken for biochemical, histological, histochemical and immunohistochemical (IHC) examinations.

Results: GERD model rats were successfully made. On day 2, there was a significant correlation between luminal NO level with fibroblasts, tissue NO with extension of lamina propria, thickening of basal cells with lymphocytes, basal cell hyperplasia with IL6 IHC and extension of lamina propria with lymphocytes. On day 4, there was a correlation between luminal NO and basal cell thickening, luminal NO with GSH, basal cell thickening with GSH, and lymphocyte with IL6 IHK. On day 6, we found a significant correlation between luminal NO and FGF2. On day 8, there was a correlation between luminal NO and the density of Meissner plexus nerve and Auerbach plexus with a strong and significant correlation (r = 0.758 and p = 0.004), thickening of basal cells with fibroblasts, lymphocytes with fibroblasts, IL6 IHC with fibroblasts and FGF2 IHC with thickening of basal cells.

Conclusion: The administration of NO₃ compounds increases luminal NO levels which results in changes in macroscopic and microscopic morphology, decreased endogenous antioxidants, inflammation and increased density of Meissner plexus nerve and Auerbach plexus in the area of the GEJ sphincter leading to development of GERD."