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All Journal The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Abdul Aziz Rani

Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta

Author-ID : 357720

Health Professions Medicine & Pharmacology

Published : 36 Documents Claim Missing Document

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Colorectal Cancer Metastasis of and the Risk Factors Soefyani, Ahmad; Rani, Abdul Aziz; Simadibrata, Marcellus; Abdullah, Murdani; Krisnuhoni, Ening
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them < 40 years old, 37.2% patients 41-60 years old, and 29.4% patients > 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis. Keywords: colorectal cancer, metastasis, well-differentiated, poorly-differentiated

National Consensus on the Use of Sedation Drugs in the Gastrointestinal Endoscopic Procedures Daldiyono, Daldiyono; Rani, Abdul Aziz; Simadibrata, Marcellus; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Abdullah, Murdani; Marki, Indra; Renaldi, Kaka
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

Gastrointestinal endoscopy is rapidly developing and several gastrointestinal endoscopy equipment are available for both diagnostic and therapeutic purposes. Proper sedation is critical in performing endoscopic procedures, both for patients and physicians. This consensus is used as a guideline and not as a legal standard in performing endoscopic services. This consensus explained the definition, indication, contraindication, and complication prevention during sedation. Factors affecting the need of sedation is patient factors, procedure factors, and sedation level. Diagnostic or therapeutic upper gastrointestinal tract endoscopy which not complicated can be performed with minimal sedation or moderate sedation, while deep sedation can be considered for longer and more complex procedures. Furthermore, assessment and selection of sedation was explained, followed by the guide to choose pharmacological sedation and analgesics. Currently, diazepam, midazolam, propofol, fentanyl, and pethidine is the most likely used sedation during gastrointestinal endoscopy, with midazolam as the preferred medication of choice. This consensus also explained the antidote of each drug and the recovery after procedure. This consensus aimed to improve gastrointestinal endoscopic procedure services in Indonesia.

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

Dyspeptic Syndrome in Urban Population of Jakarta Simadibrata, Marcellus; Abdullah, Murdani; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Manan, Chudahman; Rani, Abdul Aziz; Santi, Aan; Rahajeng, Ekowati
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 2, August 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Dyspeptic syndrome is experienced by many patients who visit general practitioners and gastroenterologist. In Indonesia, a small number of epidemiological data about dyspeptic syndrome are available. The aim of this study was to obtain data on prevalence, characteristics and factors/lifestyle associated with dyspeptic syndrome in urban population of Jakarta. Method: The study was conducted by interview to 1,645 respondents representing the population of Jakarta in the year 2007 using the Steps WHO version 1.4 instruments. The selection of respondents was performed by multistage cluster random sampling, i.e. each municipality is represented by one district and each was represented by a number of villages and respondents interviewed at random. Dyspeptic syndrome is defined whenever there is one or more complaints of nausea, vomiting, belching, epigastric pain, no appetite, early satiety, bloating. Scoring was performed for each category of questions using wstep1 method prior to the analysis. Data analysis was performed with Chi-square test or t-test. Results: Of the 1,645 respondents, the prevalence of dyspeptic syndrome was 58.1%. The most apparent clinical complaint ranges consecutively, i.e. nausea 30.1%, epigastric pain 28.7%, bloating 23.8%, etc. Dyspeptic syndrome is significantly more often experienced by female respondents (p < 0.001). Dyspeptic syndrome were more common in respondents who have less/no fruit (p < 0.001) and vegetables (p = 0.049) intake. Dyspeptic syndrome is more common in respondents with anxiety and depression (p < 0.001) also in respondents who consume non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001). Conclusion: Prevalence of dyspeptic syndrome in Jakarta urban population is 58.1%. Dyspeptic syndrome was more common in female, respondents who have less / no fruit and vegetables intake, in respondents who experienced anxiety and depression and respondents who consume NSAIDs. Keywords: dyspeptic syndrome, Jakarta, urban population, prevalence

Total Lymphocyte Count as a Nutritional Parameter in Hospitalized Patients Gunarsa, Ralph Girson; Simadibrata, Marcellus; Syam, Ari Fahrial; Timan, Ina Susianti; Setiati, Siti; Rani, Abdul Aziz
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 2, August 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Nowadays, there are still many malnourished patients during hospitalization, which comprises around 45-50% patients. Malnutrition is related to increased mortality and morbidity rate; therefore, nutritional state should be assessed in hospitalized patients. Total lymphocyte count (TLC) is related to decreased body function in malnutrition and it is a means of nutritional assessment. Until now, there is no data showing association between malnutrition and TLC in hospitalized patients in Indonesia. The objective of this study was to identify the association between malnutrition and TLC < 1,200 cell/mm3 in hospitalized patients. Method: This study was a cross-sectional study. Subjects were new patients hospitalized at internal medicine ward of Cipto Mangunkusumo Hospital. Patients were collected by consecutive sampling. We conducted the study between April and May 2008. Fifty four patients were assessed for malnutrition by the subjective global assessment (SGA) and they also had undergone complete blood count. TLC was numbered with routine complete blood count test. Patients were classified into malnutrition according to SGA. TLC was classified with cut-off point of 1,200 cell/mm3. Statistical analysis included Chi-square test, which was used to compare proportion. Results: There were 52% malnourished patients, 33% patients with TLC < 1,200 cell/mm3, 57% patients with malnutrition and TLC < 1,200 cell/mm3. This study showed that there was an association between malnutrition and TLC < 1,200 cell/mm3 (p = 0.001). Moreover, there was also significant association between severe malnutrition (SGA C) with TLC < 900 cell/mm3 (p = 0.02). Conclusion: There is an association between malnutrition and TLC < 1,200 cell/mm3. Keywords: malnutrition, total lymphocyte count, body mass index, subjective global assessment

Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy Siregar, Lianda; Rani, Abdul Aziz; Manan, Chudahman; Simadibrata, Marcellus; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 3, December 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them. Keywords: non-variceal upper gastrointestinal bleeding, Rockall score, elective endoscopy, outcome variables

Identification and Stenting of Malignant Obstructive Jaundice : Determining the Success Rates of ERCP Oto, Budi Tan; Fauzi, Achmad; Syam, Ari Fahrial; Simadibrata, Marcellus; Abdullah, Murdani; Makmun, Dadang; Manan, Chudahman; Rani, Abdul Aziz; Daldiyono, Daldiyono
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: Malignant and benign lesions may cause obstructive jaundice. The treatment of these conditions includes biliary stenting drainage, percutaneous transhepatic biliary drainage (PTBD), or surgical procedures. In advanced malignant jaundice, stent placement often turns out to be difficult. The aim of this study was to determine the success rates of malignant obstructive jaundice detection utilising endoscopic retrograde cholangiopancreatography (ERCP) and its stent placement procedure. Method: We conducted a retrospective study in 139 patients who undergone ERCP in Cipto Mangunkusumo Hospital between October 2004 and July 2008. Data was analyzed descriptively with SPSS version 17.0. Results: Of 139 study subjects, 131 (94.2%) of them had clinical obstructive jaundice (direct bilirubin > indirect bilirubin level). There were 73 (55.7) male patients, with age range of 20-84 years. Among 114 patients with identified cause of obstruction, 57 (50%) patients had undergone stent placement; however, only 32 (56.1%) patients had successful stent placement. Our descriptive analysis showed that age and sex did not affect the stent success rates, and malignancy was showed to be a factor of stent failure. Conclusion: ERCP appears to be reliable enough for identifying the cause of obstructive jaundice in most patients. In this study, the achieved success rate of stent placement is more than 50%. Moreover, such rate is lower in the malignant obstructive jaundice than the non-malignant counterparts. Papillary carcinoma is the most frequent cause of malignant obstructive jaundice. Keywords: ERCP, obstructive jaundice, stenting, malignancy

The Role of Esophageal pH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis Manan, Chudahman; Rani, Abdul Aziz; Setyawati, Katharina; Abdullah, Murdani; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Simadibrata, Marcellus
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

Gastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal endoscopic result but still having refractory reflux symptoms against proton pump inhibitor medication; detecting refractory reflux in patients chest pain following the heart evaluation; evaluating patients with otolaryngologic manifestations (laryngitis, pharyngitis, chronic cough) of the esophageal reflux disease after therapeutic failure of 4-weeks proton pump inhibitor treatment; and looking for correlation between adult onset gastro-esophageal reflux disease and non-allergic asthma. Keywords: gastro-esophageal reflux disease, esophagus pH-metry, symptoms-reflux correlation

Expression of Cyclooxygenase Enhances Tumor Invasion and Metastasis in Human Gastric Carcinoma Abdullah, Murdani; Rani, Abdul Aziz; Hardjodisastro, Daldiyono; Otsuka, Hiroyuki; Sato, Tadashi; Kojima, Yuichiro; Fujino, Masayuki A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 2, August 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Expression of COX-2 in vitro has been shown to have a number of cellular effects including increasing proliferation, reducing apoptosis promoting angiogenesis, decreasing E-cadherin expression and increasing invasive/metastatic potential. Aims: To determine the role of COX-2 in the development and metastasis potential of gastric carcinoma in human subjects. Methods: Tissue samples were obtained from surgically removed specimens of 48 patients with primary gastric adenocarcinoma who underwent gastrectomy from January 1998 to December 1999. The specimens were stained for HE while COX-2 expressions in cancer fold and antrum site were evaluated immunohistochemically. Expression of COX-2 was defined as positive when either one of cancer lesion or antrum site showed immunoreactivity. Results: Preliminary result from 12 out of 48 cases, COX-2 immunoreactivity was detected in 50% (6 of 12 specimens). Expression of COX-2 were more frequent in tumor with serosal invasion (5 of 6 specimens), lymph node metastases (3 of 3 specimens), tumor size more than 4 cm and were significant, statistically (p<0.05). The expression of COX-2 in well differential carcinoma type was similar with in poorly differentiated carcinoma type. Conclusion: COX-2 expression in gastric carcinoma tissue is correlated closely with tumor size, serosal invasion and lymph node metastases, indicating that COX-2 is involved in the growth and metastases of gastric carcinoma. Keywords: Gastric carcinoma, cyclooxygenase-2, invasion, immunochemistry

Obesity as a Risk Factor of Erosive Gastroesophageal Reflux Disease Sijabat, Hotmen; Simadibrata, Marcellus; Syam, Ari Fahrial; Susalit, Endang; Albar, Djulzasri; Rani, Abdul Aziz
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 2, August 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Gastroesophageal reflux disease (GERD) is a pathological condition of esophagus caused by reflux of gastric content or gastric juice with multifactorial etiologies. Some complications may occur such as: ulcer, bleeding, stricture, Barret’s esophagus and esophageal adenocarcinoma. One of risk factors that currently taken into concern is obesity. Our study aimed to identify obesity and abdominal obesity as the risk factor in the development of erosive GERD and to recognize that abdominal obesity is more important factor compared to obesity itself as the risk factor on the incidence of erosive GERD.. Method: Our study was a cross-sectional study. Data was obtained from eligible patients at Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia between June and September 2009 Results: Samples were 74 patients with mean age of 48.61 ± 8.64 years. The proportion of female patients was larger than male (60.81% vs. 39.19%). The endoscopic assessment of upper gastrointestinal tract based on Los Angeles Classification included: Grade A esophagitis: 27.03%, Grade B: 16.21%, Grade C: 4.05%, Grade D: 1.35%. Obesity (odds ratio (OR) 17.160; 95% confidence interval (CI) 5.219 – 56.418, p = 0.000) and abdominal obesity (OR 10.371, 95% CI 3.260 – 32.915; p = 0.000) has been proven as risk factors in the development of erosive GERD. Conclusion: There is a correlation between obesity and abdominal obesity as risk factors on the development of erosive GERD. Obesity becomes a more important factor compared to abdominal obesity as the risk factor on the development of erosive GERD. Keywords: erosive gastroesophageal reflux disease, obesity, abdominal obesity, risk factor

Co-Authors A.A. Ketut Agung Cahyawan W Aan Santi Achmad Fauzi Ahmad Soefyani Ahmar Abyadh Ali Imron Yusuf Ari Fahrial Syam Bona Adhista Budi Tan Oto Chudahman Manan Dadang Makmun Daldiyono Daldiyono Daldiyono Hardjodisastro Deddy Gunawanjati Dedy Gunawanjati Sudrajat Dharmika Djojoningrat Diah Rini Handjari Djulzasri Albar Dolly Dolven Kansera Ekowati Rahajeng Ellen Susanti Elli Arsita Endang Susalit Ening Krisnuhoni Fajar Raditya Fauzi Ahmad Muda Fransiska Hardi Fumiaki Kitahara Gunawanjati Sudrajat Hayatun Nufus Hiroyuki Otsuka Hotmen Sijabat Ina Susianti Timan Indra Marki Irsan Hasan Jacobus Albertus Jane Estherina Jeffri Gunawan Joseph JY Sung Julwan Pribadi Kaka Renaldi Katharina Setyawati Lianda Siregar Marcellus Simadibrata Masayuki A Fujino Masayuki A. Fujino Moch Ikhsan Mokoagow Murdani Abdullah Nata Pratama Novie Rahmawati Zirta Nur Rasyid Nurul Akbar Pamela Abineno Pamela Abineno Damaledo Paulus Kusnanto Pradana Suwondo Raden Nur Ista Ralph Girson Gunarsa Riahdo Saragih Rino Alvani Gani Rizki Yaruntradhani Ruswhandi Martamala Salius Silih Sedijono Sedijono Seri Mei Maya Ulina Siti Setiati Steven Sumantri Suhardjono Suhardjono Sumaryono Sumaryono Suryantini Suryantini Suzana Ndraha Tadashi Sato Tjahjadi Robert Tedjasaputra Unggul Budihusodo Widyasari Kumala Yuichiro Kojima

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