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Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention Cahyono, Suharjo Broto; Neneng Rasari, Neneng Rasari; Bayupurnama, Putut; Maduseno, Sutanto; Nurdjanah, Siti
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20â30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogues

Colorectal Cancer in Young Patient: A Distinguished Disease Entity? Nurdjanah, Siti; Taroeno, Suryo; Bayupurnama, Putut; Maduseno, Sutanto; Ratnasari, Neneng
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients (< 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher’s exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients < 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p < 0.05 was considered as significant. Results: Sixteen young aged (< 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p < 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habits Keywords: Young aged colorectal cancer patients, cross sectional analysis, clinical and histological difference

Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment Triwikatmani, Catharina; Bayupurnama, Putut; Maduseno, Sutanto; Ratnasari, Neneng; Indrarti, Fahmi; Nurdjanah, Siti
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: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p < 0.001). Re-bleeding and recurrence rates were 38.64% and 84.21% for endoscopic sclerotherapy, and 25.93% and 70% for endoscopic band ligation (p > 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices. Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxis

Non-alcoholic Fatty Liver Disease Related to Metabolic Syndrome: a Case-control Study Ratnasari, Neneng; Senorita, Hemi; Adie, Riska Humardewayani; Bayupurnama, Putut; Maduseno, Sutanto; Nurdjanah, Siti
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

Background: Non-alcoholic fatty liver disease (NAFLD) is a benign condition, but it can go for years and progress to liver cirrhosis or eventually to liver cancer. Metabolic syndrome (MS) is a condition associated with NAFLD. This study was aimed to know the risk factors of NAFLD related to metabolic syndrome. Method: A case-control study was performed in NAFLD patients with or without MS and healthy individuals. All subjects were recruited from population that underwent routine medical check-up at Sardjito Hospital, Jogjakarta, during March 2007–August 2008. Diagnosis of NAFLD is defined based on clinical and liver ultrasound findings. Diagnosis of MS is defined by International Diabetes Federation on criteria for the diagnosis of MS. Data were analyzed by using T-test, ANOVA and linear regression. Odds ratio (OR) (95% CI and p < 0.05) was calculated by cross-tab analysis. Results: There were 84 patients enrolled in the study (group I = 30 NAFLD + MS subjects; group II = 26 NAFLD patients; group III = 28 healthy). The data showed statistically significant Results in waist circumference, systole blood pressure, fasting glucose, triglyceride, high density lipoprotein (HDL) cholesterol level, homeostasis models assessment index ratio (HOMA-IR), free fatty acid (FFA), and adiponectin. The ANOVA and linear regression test among NAFLD groups showed significant difference only on HDL-cholesterol and FFA level. The lowest OR was 1.674 for HDL-cholesterol and highest OR was 13.571 for triglyceride. Conclusion: The independent factors of NAFLD related to metabolic syndrome are FFA and HDL- cholesterol level, even though a decreasing of HDL-cholesterol level has a lowest risk of NAFLD. Keywords: NAFLD, metabolic syndrome, FFA, adiponectin, HDL-cholesterol

Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient Triwikatmani, Catharina; Bayupurnama, Putut; Maduseno, Sutanto; Ratnasari, Neneng; Indrarti, Fahmi; Nurdjanah, Siti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p < 0.05. Results: During the period of May 1st - September 30th 2007, there were 36 eligible patients. The mean value of zinc serum levels was 63.70 ± 24.85 µg/dL. There were 24 (66.67%) patients with hypozincemia. The mean value of 24-hour-urinary zinc excretion was 787.52 ± 570.20 µg. There were 19 (52.8%) patients with urinary zinc excretion > 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume. Keywords: liver cirrhosis, serum zinc level, urinary zinc excretion

Ultrasound-Diagnosed Non-Alcoholic Fatty Liver Disease among Medical Check Up Patients Cahyono, Suharjo B; Bayupurnama, Putut; Ratnasari, Neneng; Maduseno, Sutanto; Nurdjanah, Siti
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

Background: Non-alcoholic fatty liver disease (NAFLD) is recognised as one of the most important causes of chronic liver disease and has become an important health issue in many countries. The aim of the study wasto evaluate the prevalence and risk factors of NAFLD patients based on ultrasound diagnosed in medical check up setting.Method: In this study, of 2,105 patients undergoing medical check up in Charitas Hospital, Palembang between January 2011 to August 2013, 115 NAFLD patients and 113 non-NAFLD patients as controls were included. Diagnosis of NAFLD was based on ultrasound appearance, patients did not consume alcohol, with negative HBsAg and hepatitis C virus antibodies.Results: The prevalence of NAFLD in medical check up patients was 7.9% whereas 39% patients had normal body mass index (BMI) (< 25 kg/m2). Patients with NAFLD compared with non-NAFLD patients had higher values of BMI (p < 0.001), triglycerides (p = 0.001), aspartate aminostransferase (AST) (p < 0.001), alanine aminotransferase (ALT) (p < 0.001), fasting glucose (p = 0.002), and lower HDL cholesterol (p = 0.001). Obesity was the strongest associated factor for NAFLD (95% CI = 1.87-7.85; OR = 3.83; p < 0.001), followed by high glucose levels (95% CI = 1.38 - 8.31; OR = 3.83; p = 0.008) and hypertriglyceridemia (95% CI = 1.38 - 4.11;OR = 2.38; p = 0.002).Conclusion: About 7.9% patients suffered from NAFLD. Approximately 39% medical check up patients had NAFLD with normal BMI. Obesity, hypertriglyceridemia and high glucose levels were the risk factors for NAFLD.Keywords: non-alcoholic liver disease, body mass index, prevalence, metabolic syndrome

The Quality of Life of Patients with Liver Cirrhosis Hospitalized at Dr. Sardjito Hospital, Yogyakarta Maduseno, Sutanto; Nurdjanah, Siti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 2, August 2002
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Liver cirrhosis is a chronic and irreversible disease. The patients quality of life (QOL) may be impaired because of long-standing burden of the disease. This research was a cross-sectional study conducted at Dr. Sardjito Hospital, Yogyakarta to determined the QOL of patients with liver cirrhosis who hospitalized in this institution. The parameter for the QOL was measured according to Spitzer index. Sixty-five patients with liver cirrhosis of various etiology were abled to be studied. The number of male and female patients were almost equal (30 and 35 respectively). There was a reduction in QOL in both male (21/30) and female (28/35) but no significant different between this variable. There was a significant positive correlation between Child criteria, and nutritional status with QOL (r=0.68, p<0.05 and r=0.37, p<0.05). It was concluded that Child criteria and nutritional status were positively correlated with QOL. Key words: Liver cirrhosis, quality of life, nutritional status

Correlation between the Severity of Liver Cirrhosis (Chil-Pugh Score) and QTc Interval Prolongation Saksana, Rachmad Aji; Bayupurnama, Putut; Indrarti, Fahmi; Ratnasari, Neneng; Maduseno, Sutanto; Triwikatmani, Catharina; Nurdjanah, Siti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

ABSTRACT Background:Liver cirrhosis causes changes in cardiovascular system. Electrographic (ECG) abnormality commonly found in cirrhosis patients is QT interval prolongation. It is part of cirrhotic cardiomyopathy. QTc interval prolongation is correlated to the incidence of life-threatening arrhythmias. The objective of this study was to recognize the correlation between the severity of liver cirrhosis and QTc interval prolongation in patients with liver cirrhosis at Sardjito General Hospital, Jogjakarta.Method: The design of this study was cross-sectional. The subjects were hospitalized patients with liver cirrhosis at the Department of Internal Medicine, Sardjito Hospital, Jogjakarta between January 2011 and March 2012. ECG was performed in all patients and QTc interval was measured. The severity of liver cirrhosis was determined by Child-Pugh score. Spearman correlation analysis was used to determine the correlation between variables of QTc interval prolongation and Child-Pugh score.Results: A total of 73 patients were enrolled, including 51 (69.9%) male and 22 (31.1%) female patients with mean age of 54.05 ± 12.55 years (range 20-80). Liver cirrhosis was caused by hepatitis B virus in 36 (49.3%) patients, hepatitis C virus in 20 (27.4%) patients and other causes in 19 (26%) patients. The Child-Pugh score for liver cirrhosis was found as follows: child A in 10 (13.6%) patients, child B in 27 (36.9%) patients and child C in 36 (49.3%) patients. The correlation between the severity of liver cirrhosis and QTc interval prolongation was weak (r = 0.255; p = 0.029).Conclusion:Severity of liver cirrhosis has a weak positive correlation with QTc interval prolongation. Keywords: liver cirrhosis, QTc interval, Child-Pugh score

The Role of Insulin Resistance in Diabetic Patients with Chronic Liver Disease Ratnasari, Neneng; Nurdjanah, Siti; Bayupurnama, Putut; Maduseno, Sutanto
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 1, April 2008
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: The association between diabetes and chronic liver disease has been well documented. However, the mechanism remains unknown. The aim of this study was to investigate the insulin resistance in chronic liver disease and normal liver in diabetic patient. Method: A total of 31 diabetic, non-alcoholic patients with multiple oral hypoglycemic drugs, either with or without lipid abnormalities were enrolled in this study. Subjects were recruited from outpatient clinic of Department of Endocrine at Dr. Sardjito Hospital, Jogjakarta, Indonesia from May-June 2004. This was a cross sectional study. Fasting insulin and glucose level, liver function test, body mass index, and the presence of fatty liver by ultrasound were examined. Insulin resistance was estimated by calculating fasting insulin and glucose plasma level as the homeostasis model assessment (HOMA) index ratio. Data was described with mean ± SD and analyzed by independent sample t-test. Results: Thirty one patients were enrolled to the study, i.e. 8 patients with normal liver and 23 patients with fatty liver. Only 14 patients agreed to continue the study including 10 patients with fatty liver and 4 patients with normal liver. Mean of age was 59.1 ± 8.7 and mean value of BMI was 24.62 ± 3.05. The liver function test revealed normal Results. Triglyceride, cholesterol, fasting glucose level, and HOMA index (2.77 ± 1.95 vs. 1.66 ± 1.02) in patients with fatty liver were higher than patients with normal liver. No correlation was found between fasting insulin level as well as HOMA index and mean value of BMI (obese and non-obese) as well as hypertension. There was significant correlation between triglyceride level and fasting insulin among fatty liver patients (p = 0.048; CI 95% -7.404; -0.032). Conclusion: The non-alcoholic fatty liver disease in diabetic patients with normal liver enzymes and multiple oral hypoglycemic drugs appear to be related with insulin resistance and hypertriglyceridemia. Keywords: fatty liver, diabetic, insulin resistance

Factors that Influence Cecal Intubation Rate in Unsedated Patients during Colonoscopy Cahyono, Suharjo B; Bayupurnama, Putut; Ratnasari, Neneng; Triwikatmani, Catharina; Indrarti, Fahmi; Maduseno, Sutanto; Nurdjanah, Siti
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Successful cecal intubation is a primary quality indicator in colonoscopies and the mostimportant factor in detecting abnormal lesion in the colon. There are many factors that influence cecal intubationrate during colonoscopy procedure. The aim of this study is to evaluate the factors that influence cecal intubationrate in unsedated patients during colonoscopy. Method: A retrospective study of colonoscopy performed at Sardjito General Hospital, Jogjakarta, from January 2012 to August 2013. Age, sex, bowel preparation, indication for colonoscopy, colonoscopist, andreasons of incomplete colonoscopy from 564 colonoscopy reports were recorded and analysed. Results: Overall successful cecal intubation rate was 408 (72.34%). Causes of incomplete colonoscopywere patients discomfort or pain 41.66%, looping/redundant 28.85%, poor bowel preparation 18.59%, fixation/adhesion 6.41%, and bleeding risk 4.49%. Female was more unsuccessful in cecal intubation than male (31.50%vs. 24.05%; p = 0.048). The successful cecal intubation rates for gastroenterologists compared to gastroenterology(GI) fellows were 77.92% vs. 49.55%; p < 0.001, and poor bowel preparation was more difficult to reach cecalthan good preparation (57.58% vs. 23.69%; p < 0.001). Multivariate logistic regression analysis demonstratedthat female and poor bowel preparation were independently associated with lower cecal intubation rate, andgastroenterologists were independently associated less unsuccessful to reach cecal. Conclusion: The overall successful cecal intubation rate was still below the set standard. Several identifiedfactors that may predict lower of cecal intubation rate: the skill and experience of colonoscopists (GI fellows),poor bowel preparation and female.Keywords: cecal intubation rate, colonoscopy, unsedated colonoscopy

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