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Mucus Thickness of the Gastric Mucosa and Helicobacter pylori Infection in Dyspeptic Patients with or without Diabetic Symptom Albertus, Jacobus; Rani, Abdul Aziz; Simadibrata, Marcellus; Abdullah, Murdani; Syam, Ari Fahrial; Gani, Rino Alvani; Subekti, Imam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Chronic Helicobacter pylori (H. pylori) infection affects the mechanisms of gastric mucosal protection. In patients with diabetes mellitus, data on the prevalence of H. pylori infection are scanty and contradictory. We have examined, using histological fixation technique, the thickness of the adherent mucus gel layer in the gastric mucosal and H. pylori infection in dyspeptic patients with or without diabetes. Method: A cross-sectional study was conducted in 86 dyspeptic patients consisted of 43 diabetics and 43 non-diabetics patients. In all cases, upper gastrointestinal endoscopy were performed, measurement of the gastric corpus and antral mucus thickness was carried out at the corpus and antral biopsy specimens were snap frozen and cryostat sections were stained using a hematoxyline eosin. One biopsy within 2 cm of the pylorus was examined for detection of H. pylori status by using polymerase chain reaction (PCR). Results: In all sections the mucus layer was continuous. At the gastric corpus and antrum, the mucus thickness of diabetic patients was thinner than non diabetic patients: 35.2 ± 2.2 µ m and 43.9 ± 3.8 µ vs 45.2 ± 2.5 µ m and 51.2 ± 2.2 µ m. The results were significantly different (p = 0.001). The difference of H. pylori prevalence between diabetics (52.5%) and nondiabetics patients (47.5%) was not significant (p = 0.67). Conclusion: This study shows a significant thinning of the adherent mucus gel layer both in diabetic patients and H. pylori-positive individuals. No difference has been found between patients with H. pylori infection and diabetes mellitus. Keywords: mucus thickness, Helicobacter pylori infection, diabetic patient

Microscopic Colitis in Patients with Diarrhea of Unknown Etiology: Diagnosis and Treatment Albertus, Jacobus
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Chronic diarrhea is a common reason for referral to a gastroenterologist. Microscopic colitis (MC) is fairly common cause of chronic non-bloody diarrhea. Microscopic colitis which was previously regarded rare, now has emerged as a common cause of chronic diarrhea. The condition is characterized clinically by chronic non bloody diarrhea, a macroscopically normal or near-normal colonic mucosa, but microscopic examination of mucosal biopsies reveals diagnostic histopathological changes. Microscopic colitis mainly includes two diseases, collagenous colitis (CC) and lymphocytic colitis (LC). In CC the most characteristic feature is thickening of the sub-epithelial collagen layer (SCL) beneath the basal membrane intra-epithelial lymphocyte (IEL) infiltration although not asprominent as in LC. The diagnosis of LC relies on a characteristic increase of IELs, which exceeds 20 IEL/100 surface epithelial cells compared with < 5 IEL/100 surface epithelial cells in normal colonic mucosa. Randomized controlled trials (RCTs) assessing therapies for microscopic colitis have been performed. A previously published review showed that budesonide was effective in producing both clinical and histological responses in patients with collagenous colitis. This review will focus on epidemiology, clinical features and treatment of MC. Keywords: chronic diarrhea, microscopic colitis, lymphocytic and collagenous colitis

Helicobacter pylori Infection in Superficial Gastritis, Erosive Gastritis and Gastric Ulcer Albertus, Jacobus; Rani, Abdul Aziz; Simadibrata, Marcellus; Abdullah, Murdani; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 2, August 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Helicobacter pylori (H. pylori) infection leads to inflammation of the gastric mucosa. It damages the gastric epithelium and related to the risk of developing gastric cancer. Over time, it may develop into the development of glandular atrophy and intestinal metaplasia. This study was aimed to evaluate the histological features of gastric mucosa, including H. pylori infection in patients with endoscopically found superficial gastritis, erosive gastritis and gastric ulcer. Method: Subjects with abdominal complaints who underwent consecutive upper gastrointestinal endoscopy were prospectively selected at Tugurejo Hospital between November 2004 and December 2010. Eligible subjects were those with endoscopic diagnosis of superficial gastritis, erosive gastritis or gastric ulcer. The biopsy specimens were taken from the corpus, angulus and antrum of all the patients. Giemsa and hematoxylin-eosin staining were used for the histological diagnosis H. pylori and gastric mucosa inflammation. Results: The overall prevalence of H. pylori infection in superficial gastritis, erosive gastritis and gastric ulcer were 24.3%. There was significant difference between H. pylori infection rate in antrum of patients with superficial gastritis 19.4%, erosive gastritis 26.3%, and gastric ulcer 34.7%. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H. pylori- positivity was 12.5%, 14.0%; erosive gastritis 26.3%, 16.6%; and of gastric ulcer 38.9%, 29.3%; respectively. However, there was no significant difference. Conclusion: Patients with gastric ulcer have H. pylori infection, atrophic gastritis and metaplasia intestinal more than superficial gastritis and erosive gastritis. Progression of the gastric ulcer to atrophic gastritis and intestinal metaplasia is related to H. pylori infection. Keywords: Helicobacter pylori infection, superficial gastritis, erosion and ulcer

Helicobacter pylori Infection in Superficial Gastritis, Erosive Gastritis and Gastric Ulcer Jacobus Albertus; Abdul Aziz Rani; Marcellus Simadibrata; Murdani Abdullah; Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 2, August 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Helicobacter pylori (H. pylori) infection leads to inflammation of the gastric mucosa. It damages the gastric epithelium and related to the risk of developing gastric cancer. Over time, it may develop into the development of glandular atrophy and intestinal metaplasia. This study was aimed to evaluate the histological features of gastric mucosa, including H. pylori infection in patients with endoscopically found superficial gastritis, erosive gastritis and gastric ulcer. Method: Subjects with abdominal complaints who underwent consecutive upper gastrointestinal endoscopy were prospectively selected at Tugurejo Hospital between November 2004 and December 2010. Eligible subjects were those with endoscopic diagnosis of superficial gastritis, erosive gastritis or gastric ulcer. The biopsy specimens were taken from the corpus, angulus and antrum of all the patients. Giemsa and hematoxylin-eosin staining were used for the histological diagnosis H. pylori and gastric mucosa inflammation. Results: The overall prevalence of H. pylori infection in superficial gastritis, erosive gastritis and gastric ulcer were 24.3%. There was significant difference between H. pylori infection rate in antrum of patients with superficial gastritis 19.4%, erosive gastritis 26.3%, and gastric ulcer 34.7%. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H. pylori- positivity was 12.5%, 14.0%; erosive gastritis 26.3%, 16.6%; and of gastric ulcer 38.9%, 29.3%; respectively. However, there was no significant difference. Conclusion: Patients with gastric ulcer have H. pylori infection, atrophic gastritis and metaplasia intestinal more than superficial gastritis and erosive gastritis. Progression of the gastric ulcer to atrophic gastritis and intestinal metaplasia is related to H. pylori infection. Keywords: Helicobacter pylori infection, superficial gastritis, erosion and ulcer

Microscopic Colitis in Patients with Diarrhea of Unknown Etiology: Diagnosis and Treatment Jacobus Albertus
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Chronic diarrhea is a common reason for referral to a gastroenterologist. Microscopic colitis (MC) is fairly common cause of chronic non-bloody diarrhea. Microscopic colitis which was previously regarded rare, now has emerged as a common cause of chronic diarrhea. The condition is characterized clinically by chronic non bloody diarrhea, a macroscopically normal or near-normal colonic mucosa, but microscopic examination of mucosal biopsies reveals diagnostic histopathological changes. Microscopic colitis mainly includes two diseases, collagenous colitis (CC) and lymphocytic colitis (LC). In CC the most characteristic feature is thickening of the sub-epithelial collagen layer (SCL) beneath the basal membrane intra-epithelial lymphocyte (IEL) infiltration although not asprominent as in LC. The diagnosis of LC relies on a characteristic increase of IELs, which exceeds 20 IEL/100 surface epithelial cells compared with 5 IEL/100 surface epithelial cells in normal colonic mucosa. Randomized controlled trials (RCTs) assessing therapies for microscopic colitis have been performed. A previously published review showed that budesonide was effective in producing both clinical and histological responses in patients with collagenous colitis. This review will focus on epidemiology, clinical features and treatment of MC. Keywords: chronic diarrhea, microscopic colitis, lymphocytic and collagenous colitis

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