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Natural Evolution of Regurgitation in Children Aged 12-24 Months: A 1-year Cohort Study Hegar, Badriul; Alatas, Fatima Safra; Kadim, Muzal; Putri, Nina Dwi; Wardhani, Wahyu Ika
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 1, April 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: There are very limited cohort studies regarding long term outcome of gastroesophageal reflux diseases (GERD), especially until 24 months old. The aim of this study is to see the natural history of GERD in12-24 months old children based on their clinical signs and symptoms.Method: Prospective one year population base cohort study involving 262 children. Their regurgitation history and GERD symptoms were recorded every two months.Results: Two hundred and fivety three children completed the study. Seventy three children (27.8%) were still having regurgitation when they were 6 months old, 44 (16.7%) until 9 months old, and 24 (9.2%) until 12months old. During 12 months follow-up the prevalence and frequency of regurgitation decreased to 2.4% and 1.2% in the age of 18 and 24 months respectively. Infant with regurgitation at 6 months old were 13.2 times more likely to have regurgitation at 12 months old (RR = 13.2; 95% CI = 4.8-36.6). Prevalence of regurgitation after 18 months old were 37 times higher risk compared to those not regurgitating at the age of 12 months (RR = 37; 95% CI = 2.2–613.9). GERD symptoms were higher in children that were still regurgitating until 9 months old 64.5% (RR = 2.3; 95% CI = 1.7-3.0) compared to those only experiencing until 6 months old 54.7% (RR = 1.3; 95% CI = 1.7-3.0).Conclusion: Regurgitation decrease during 12-24 months old period. The history of regurgitation in 6 and 9 months old is related to the probability to become GERD in 12-24 months old period. Keywords: gastroesophageal reflux, children 12-24 months, GERD symptoms

Proton Pump Inhibitors Therapy in Children with Gastroesophageal Reflux Reynaldo, Aldo; Hegar, Badriul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Proton pump inhibitors (PPI) has been widely used by clinicians to treat diseases that require suppression of gastric acid. PPI work by inhibiting the proton pump in gastric parietal cells.In adult patients, PPI hasbeen widely studied and showed effective results and safe. This result make PPI positioning as the first choice medicine in the treatment of diseases that require suppression of gastric acid. As the primary choice therapy, PPI administration has been increased not only in adults but also in children.PPI is often administered to children with a diagnosis of gastroesophageal reflux disease (GERD) which defined as symptoms or complications caused by gastroesophageal reflux (GER). GERD diagnosis in children is quite difficult, so it is common to find that diagnosis is established only by the basis of clinical symptoms, resulting in overdiagnosis and over-treatment of GERD. The use of PPI in children still needs further study andcan not be inferred based on adult studies. Inappropropriate PPI prescription without indication will increase side effect, risk and also harm the children. Thus, it is important to know the indications, side effects and safety of PPI therapy in children.Keywords: proton pump inhibitor, children, gastroesophageal reflux disease

Zinc Supplementation in Children with Acute Diarrhea of Invasive Bacterial and Non-bacterial Infection Poerwati, Endang; Hegar, Badriul
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: Diarrhea is one of the manifestations of gastrointestinal disorder. In Indonesia, diarrhea is still one of the leading causes of death in infants and children. Diarrhea requires a rational and comprehensive management to deliver an optimal result. This study was aimed to assess the effectiveness of zinc supplementation in children with acute diarrhea of invasive bacterial infection. Method: A cross-sectional study was performed in 74 children aged 2-14 years with acute diarrhea, who visited the Outpatient Clinic, Pasar Rebo Hospital Jakarta, between January and June 2011. The inclusion criteria were patients had suffered diarrhea for 1-7 days. Based on fecal analysis Results, subjects were divided into group A (non-infectious) and group B (infectious). All children received zinc supplementation. Results: The mean value of subject age was 46.6 months in group A and 81.3 months in group B. The mean frequency of diarrhea prior to zinc supplementation was 7.5 times/day in group A and 7.8 times/day in group B. Duration of diarrhea before zinc supplementation was 52.6 hours in group A and 45.4 hours in group B. On the seventh day, there was no subject of both groups who still suffered from diarrhea. Although the duration of diarrhea in group A was shorter than group B, no significant difference was found (62.4 hours vs 66.8 hours, p = 0.07). Conclusion: Zinc supplementation shows similar efficacy in children with acute diarrhea caused by invasive bacterial infection and those without bacterial infection as well. Keywords: acute diarrhea, invasive diarrhea, zinc supplementation

Microscopic Examination of Fecal Leukocytes as a Simple Method to Detecting Infective Colitis in Children Susanti, Nuraini I; Reynaldo, Reynaldo; Kekalih, Aria; Karuniawati, Anis; Hegar, Badriul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, August 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Various pathogenic bacteria are reported as the cause of infectious colitis in children. Infectious colitis does not have a specific sign, therefore an accurate examination is required. The implementation of fecal cultures accompanied with drug resistance tests often have constraints, beside the relatively expensive costs, longer times are needed, and not all health care facilities have required instruments. On the other hand, this condition requires an immediate antibiotic therapy, so that the infection should not be continued. In daily practice, it is not uncommon to find diarrhea with the amount of fecal leukocyte < 10/hpf with pathogenic bacteria on the examination of the fecal culture.Cross-sectional study was conducted to observe the pattern of bacterial distribution in children’s fecal who have acute diarrhea and the correlation between the existence of pathogenic bacteria and the number of leukocytes in the fecal, as well as antibiotic resistance patterns. The population of this study is children with age of 6 months old - 18 years old who were suffering from acute diarrhea with the amount of fecal leucocyte ≥ 5/hpf, who recruited from polyclinic or patient admitted at Cipto Mangunkusumo Hospital and Fatmawati General Hospital, Jakarta. Based on examinations of fecal cultures and PCR, Salmonella sp and C. dificille were found subsequently in 2 children (33.3%), Enterophatogenic E. Coli(EPEC) and Shigella were found subsequently in 1 child (16.7%). Based on the ROC curve, it was found that there was no intersection of maximum and minimal leukocyte value with the midline, whereas the best sensitivity and specificity value was found at the cut-off point of 8.5, hence the cut-off point of leukocytes was determined at < 8 and > 8. The sensitivity value was 83.3% and the specificity value was 45.1%. The antibiotic sensitivity test showed that one child infected by EPEC was sensitive to ciprofloxacin. Two children infected by Salmonella, were still sensitive to chloramphenicol, cotrimoxazole, cefixime, and ceftriaxone. Two children infected by C. Difficile were sensitive to ceftriaxone, and 1 child infected by Shigella was sensitive to cefixime, ceftriaxone and ciprofloksazine.

Gastroesophageal Reflux: Are There Differences of Characteristic in Infants and Children Hegar, Badriul; Juniatiningsih, Anita
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 3, December 2008
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Gastroesophageal reflux (GER) is an involuntary passage of gastric contents into the esophagus. GER in infancy is usually a physiologic reflux whereas GER in children more than 12 months old is often considered as a pathologic reflux although without any clinical complications. This consideration may lead over-treatment of GER in children. The objective of this study was to find out the difference of GER characteristic in ‘healthy’ infants and children. Method: Cross sectional study in children age 0-36 months at Cipto Mangunkusumo Hospital Jakarta during 2005-2007 with inclusion criteria: clinically healthy, regurgitations/vomits ³ 4 times/day, well nourished and other etiologies of vomiting had been excluded. The characteristic of GER was evaluated by esophageal pH monitoring (pH-metri) included number of reflux episodes, reflux duration > 5 minutes, and reflux index. Results: Sixty children were enrolled in the study; consisting 30 infants (age 0-12 months) and 30 children (age 13-36 months). The median number of reflux in infants was 18 ( range1-19), whereas the median in children was 17 (range 3-27) ( p = 0.47). The median number of reflux > 5 minutes was 2 (range 0-2), whereas the median in children was 3 (0-30) (p = 0.85). The median reflux index in infants was 4.5% (range 0.6%-22.9%) whereas the median in children was 6.35% (0.1%-87.%) (p = 0.34). Conclusion: The characteristic of GER in ‘healthy’ infants and children were not significantly different; however reflux index > 5% (pathologic GER) was seen in children age 13-36 months. Clinical course monitoring are important in infants and children with GER. Keywords: gastroesophageal reflux, regurgitation, infant, children, pH monitoring

Breastfeeding for Gut Infant Health Hegar, Badriul; Vandenplas, Yvan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Infants react sensible to dietary changes because the gut physiology and functionality is not fully mature. The first few months of life is the 'window of opportunity' for optimal physical growth and development, cognitive development, and emotional and social development. Exclusive breastfeeding is recommended for the first 6 months of life. Breast milk is important for the maturation of the infant’s digestive system. Potentially protective factors are present in higher amounts in feces from breast-fed infant than from formula-fed infants. The amount of intestinal bifidobacteria in breastfed infants is higher than in formula-fed babies. Mother's milk protects against infection because it contains different factors with immologic properties. The differences in protein fractions between human and cow milk are impressive. The human milk oligosaccharides are the third most important nutritional component are fermented in the colon, making the environment in the colon suitable for the growth of bifidobacteria and lactobacillus.

Upper Gastrointestinal Endoscopy and Histopathology Appearance in Indonesian Children with Recurrent Epigastric Pain Susanto, F M; Hegar, Badriul; Firmansyah, Agus
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 3, December 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Recurrent Epigastric Pain (REP) is a clinical symptom frequently found in children. Data of the correlation between duration of illness, frequency of illness, associated symptoms of REP and the abnormality of endoscopic and histopathologic appearance are still limited, especially in Indonesia. The role of Helicobacter pylori (H. pylori) infection in causing organic abnormalities of the gastrointestinal tract (GIT) is also still controversial. Aim:To know the endoscopic and histopathologic appearance and the prevalence of Helicobacter pylori infection, 169 children with REP was performed for endoscopic and histopathologic examination in Department of Pediatric, Cipto Mangunkusumo hospital. Result:Endoscopic and histopathologic abnormalities were found significantly in children who suffered from REP more than 9 months and more than 6 times during 3 months of period. Conclusion: Endoscopic and histopathologic examinations should be considered in children with REP. Keywords: recurrent abdominal pain, epigastric pain, Helicobacter pylori, endoscopy and histopathology

Orocaecal Transit Time in Chronic Diarrhea Simadibrata, Marcellus; Simadibrata, Paulus; Hegar, Badriul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: The diagnosis and treatment of chronic diarrhea is sometimes difficult. Orocaecal transit time may explained some pathogenesis mechanism in chronic diarrhea. Methods: Twenty six chronic diarrhea patients and 35 normal adult subjects were included in this study. After fasting for at least 10 hours, subjects were asked to drink 20 ml (13.3 g) lactulose, then performed the breath hydrogen test. If there were an increment of H2 concentration 10 ppm in ½ -1 hour, the subject was considered as rapid transit time. If an increment of H concentration 10 ppm in 1 - 2 hour, the subject was considered as normal transit time. If an increment of H2 concentration 10 ppm in 2 - 3 hour,the subject was considered as delayed transit timeResults: In the chronic diarrhea group, 10 (38.4%) had rapid OCTT, 15 (57.6%) had normal OCTT and only 1 (4%) had delayed OCTT. In the normal adults group, 2 (5.7%) had rapid OCTT, 22 (62.9%) had normal OCTT and 11 (31.4%) had delayed OCTT. The difference was statistically significant (p < 0.001). The mean value of OCTT in chronic diarrhea and normal adults were 84.23 + 39.82 min vs. 114.00 + 51.35 min (p = 0.027). Conclusions: The rapid OCTT was more likely to be found in the chronic diarrhea patients compare to normal adults significantly. The mean OCTT in chronic diarrhea was shorter than the mean OCTT in normal adults. Keywords: orocaecal transit time, OCTT, chronic diarrhea

Helicobacter pylori Infection in Children with Recurrent Abdominal Pain Hegar, Badriul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Recurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAP. Typically, the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H. pylori infection in Indonesian children with RAP. The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAP. Mucosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27.7%. Histologic evidence of gastritis was present in 94.1% children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegative’s children were found to be H. pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be performed for a longer time of period to clarify this issue. Keywords: H. pylori infection, IgG antibody to H. pylori, upper GI endoscopy, RAP, recurrent abdominal pain

Soy Infant and Extensively Hydrolyzed Formula as Therapeutic Formula for Cow’s Milk Protein Allergy Reynaldo, Aldo; Hegar, Badriul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 2 (2014): VOLUME 15, NUMBER 2, August 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Cow’s milk protein allergy (CMPA) is a food allergy mostly suffered by children aged < 3 years that can be mediated by IgE or non-IgE or both. The prevalence of CMPA in children is heterogeneous between populations. Meta-analysis study showed that the prevalence was 2-3% in infants and < 1% in children aged < 6 years. Although the prevalence is quite small but proper management is very important because it affects the quality of life of children and to avoid the risk of anaphylactic reaction that threatens life. Therapy for CMPA is to avoid cow's milk protein and its derivatives; it is also recommended for breast-feeding mothers to do the same. Therapeutic milk formulas that can be given is extensively hydrolyzed formula (eHF) or soy infant formula (SIF). The selection of formula became adebate, especially about the safety, effectiveness and cost. Keywords: cow milk protein allergy, soy infant formula, extensively hydrolyzed formula

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