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The Role of Ascitic Paracentesis in Liver Cirrhosis in Improving the Function and Structure of the Heart Juwita Sembiring; Tehar Karo-Karo; Lufti Latif; Lukman Hakim Zain; Pangarapen Tarigan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, NUMBER 1, April 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/4120031-5

Background: Heart abnormalities in cirrhotic patients have been known for five decades, with atria and ventricular dilatation. Pozzi et al reported that in cirrhotic patients with or without ascites, the diastolic function was lower than control. Ascitic paracentesis improved diastolic function. The diameter of both atria was larger in cirrhotic patients with or without ascites. The diastolic diameter of left ventricle did not differ significantly in cirrhotic patients with or without ascites compared to control, but there was an increase after paracentesis. Ejection fraction was lower in cirrhotic and increased after ascitic parancentesis although the increase was not significant. The aim of the Study: To compare the function and structure of the heart before and after ascitic paracentesis in cirrhotic patients. Methods: This study took place from February 2000 to April 2001 in dr. Pringadi Hospital/H.Adam Malik Hospital. There were 18 samples (12 men and 6 women), 15 of which were cirrhotic patients with tense ascites and 3 cirrhotic patients with refractory ascites. The mean age was 51,8 + 8,28 years, the youngest being 29 years and the oldest 65 years. The mean ascitic fluid removed by paracentesis was 7,20 liters with a range of 5 to 9 liters. Immediately following paracentesis, Dextran 40 % was administered at a dose of 8g/ 1L ascitic fluid aspirated. Results: The diameter of the four heart chambers decreased after paracentesis, but the decrease was not statistically significant. There was increase in E/A ratio after ascitic paracentesis, from 0,93 + 0,370 to 1,06 + 0,383 (significant, p0,05), meaning that there was an improvement in diastolic function after ascitic paracentesis. There was also an increase in ejection fraction from 68,99 + 13,26 % to 72,10 + 11,10 %, but this was not significant (p0,05). Conclusion: After paracentesis, there was a significant improvement in diastolic function while the diameter of the four heart chambers decreased and the ejection fraction increased insignificantly. Keywords: Ascitic paracentesis - liver cirrhosis - heart function and structure.

Level of Gastrin Serum and Ulcer Size on Gastric Ulcer Correlated to Helicobacter pylori Infection Dasril Efendi; Rustam Effendi; Leonardo Basa Dairy; Juwita Sembiring; Betthin Marpaung; Mabel Sihombing; Sri Maryuni Soetadi; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1032009113-116

Background: Previously has been defined that peptic ulcer has strongly correlated to Helicobacter pylori (H. pylori) infection. But it hasn’t determined about correlation of gastrin serum level to the ulcer severity on H. pylori infection. The aims of this study were to find the percentage of H. pylori infection on peptic ulcer cases and its correlation to the gastrin serum level. Method: This is analytic cross sectional study in 50 patients with gastric ulcer who came to Adam Malik hospital from February to October 2007. The correlation between gastrin serum level and the size of ulcer with positive and negative Urea Breath Test (UBT) group was analyzed by unpaired student t- test. The correlation between gastrin serum level and ulcer size were investigated with Pearson correlation test and linier regression. Result: Fifty eligible patients, 33 (66%) had positive UBT and 17 (34%) were negative. There were statistically significant difference on gastrin serum level in positive UBT and negative respectively (p = 0.017). There were also significant difference between mean of ulcer size in positive UBT and negative respectively (p = 0.025). There were correlation between gastrin serum level and ulcer size (r = 0.315; p = 0.026). It can predict the increasing ulcer size in 0.012 mm every 1 pg/mL of gastrin serum elevated. Conclusion: Patients with positive UBT has greater ulcer size and higher gastrin level as compared to the negative group. There were positive correlation between gastrin serum level to the size of ulcer in peptic ulcer patients and increase of ulcer size followed with elevated of gastrin serum level. Keywords: Helicobacter pylori infection, gastrin serum level, ulcer size

Aspartate Aminotransferase to Platelet Ratio Index and FibroScan for Predicting Liver Fibrosis with Chronic Hepatitis B Elias Tarigan; Rustam Effendi Yusuf; Leonardo Basa Dairy; Juwita Sembiring; Mabel HM Sihombing; Gontar Alamsyah Siregar; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Non-invasive test have been constructed and evaluated mainly for binary diagnoses. The accuracy of non-invasive tests such as aspartate aminotransferase to platelet ratio index (APRI) and transientelastography/FibroScan should be evaluated especially in clinical practice. The aim of the study was to evaluate the accuracy of detailed fibrosis classification available for APRI and FibroScan to liver biopsy in chronichepatitis B patients.Method: A cross sectional study was conducted in 51 patients with chronic hepatitis B. The patients underwent laboratory test, FibroScan and liver biopsy between April 2011 and July 2013 at Adam Malik Hospital, Medan.Liver biopsy was assessed based on the METAVIR score. Area under receiver operating characteristic curve (AUROC) predictive value was used to evaluate the accuracy of APRI and FibroScan. All data were analyzedusing SPSS 20.0.Results: APRI versus METAVIR diagnosed severe fibrosis and cirrhosis with sensitivity 40% and specificity 83.9%, positive predictive value (PPV) 61.5%, negative predictive value (NPV) 68.4%, positive likelihood ratio(LR) 2.48 and negative LR 0.72 with diagnostic accuracy 66.7%. The AUROC value was 0.619 (95% CI = 0.446 – 0.715); kappa = 0.255; p 0.05. FibroScan versus METAVIR predictive value with sensitivity 75% andspecificity 67.6% were PPV 60%, NPV 67.7%, positive LR 2.31 and negative LR 0.36 with diagnostic accuracy 70.6%. The AUROC value was 0.714 (95% CI = 0.567–0.861); kappa 0.409; p 0.05.Conclusion: FibroScan has better accuracy than APRI for predicting severe fibrosis and cirrhosis in patientswith chronic hepatitis B.Keywords: APRI, FibroScan, liver biopsy, chronic hepatitis B

Diagnostic Findings and ERCP Treatment in Patients with Obstructive Jaundice during two years at H. Adam Malik Hospital, Medan Gontar A. Siregar; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Sutadi; Abiran Nababan; Lukman Hakim Zain; Pengarapen Tarigan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, ISSUE 2, August 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/42200339-42

Background: The methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bile duct in patients with obstructive extrahepatic jaundice. Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP during a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of 10 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed. Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCP, the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (2.8%), bile duct stone 46 cases (43.4%), carcinoma of ampula vater 20 cases (18.9%), CBD tumor 7 cases (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (3.8%), duodenal tumor 1 case (0.9%), carcinoma of ampula vater and bile duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure 16 cases (15.1%). The patients receivied the following treatment: sphyncterotomy 36 cases (51.4%), stent application 11 cases ( 15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases (7.1%). Keywords: ERCP, obstructive jaundice

S-Index and APRI Score to Predict Liver Fibrosis Chronic in Hepatitis B and C Patients Elias Tarigan; Leonardo Basa Dairy; Juwita Sembiring; Mabel Sihombing; Gontar Alamsyah Siregar; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Background: A great interest has been dedicated to the development of non invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. The aim of this study was to comparethe accuracy between S-index and aspartate aminotransferase to platelet ratio index (APRI) to FibroScan for predicting liver fibrosis in chronic hepatitis B and C patients.Method: A cross-sectional study was conducted in 40 patients with chronic hepatitis B and C between January 2010 - May 2011 at Division of Gastroentero-hepatology, Department of Internal Medicine, Adam Malik Hospital, Medan. Patients underwent laboratory examination and FibroScan, then used predictive values to assess the accuracy of S-index scores and APRI compared to FibroScan. The analysis was performed using SPSS 15.0.Results: S-index identified significant fibrosis in 87.5% patients with sensitivity (Se) 87.5% and specificity (Sp) 100%. About 67.5% of 40 patients could be identified correctly. S-index also could accurately predict the absence or presence of cirrhosis in 87.5% of the total 40 patients, with NPV 91.7% and PPV 81.25%, respectively. APRI for significant fibrosis has Se 85.7%, Sp 88%, PPV 88.8%, NPV 69.2%; while Se 53%, Sp 88%, PPV 72.7%, NPV 75.8% for liver cirrhosis. AUROC value for S-index was higher than APRI in predicting significant fibrosis and cirrhosis, i.e. 0.938 vs. 0.917 and 0.873 and 0.707, respectively.Conclusion: The S-index has a higher accuracy than APRI in predicting significant fibrosis and cirrhosis in patients with chronic hepatitis B virus and hepatitis C virus infection.Keywords: S-index, APRI score, FibroScan, chronic hepatitis B and C

Correlation between Thrombopoietin Serum Level and Liver Fibrosis in Chronic Hepatitis Patients Juwita Sembiring
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010135-142

Background: Thrombopoetin (TPO) is a cytokine mainly produced in the liver and is the principal regulator in the humoral control mechanism of thrombopoesis. Presumably TPO production is not adequate in patients suffering from severe necroinflammation and advanced liver fibrosis in chronic hepatitis. The aim of this study was to identify the correlation between serum TPO levels and the degree of liver fibrosis. Method: With analytical cross-sectional design, this sudy analyzed the relationship between the serum TPO level and the degree of liver fibrosis in 62 chronic hepatitis patients from June 2006 to March 2008. The serum level of TPO was examined using the Quantikine human TPO immunoassay, and liver biopsy was performed in accordance to the Metavir scoring system. Results: There were 22 female and 33 male, with age range from 18 to 70 years old. We found that serum TPO levels were negatively correlated with the degree of liver fibrosis in a very significant fashion (r = -0.284, p 0.05). At serum TPO level 16.01 pg/mL or lower, the sensitivity and specificity of serum TPO for diagnosing the severity of the fibrosis were the 64.1% and 70.3% respectively, when the disease process was at F3 or greater level (p = 0.003). There was a significant difference between the degree of liver fibrosis and platelet count (p 0.0001), and significant negative correlation between the degrees of fibrosis with platelet level (r = - 0.783; p = 0.001). Conclusion: There was a significant negative correlation between serum TPO levels and the degree of liver fibrosis in chronic hepatitis patients and significant negative correlation between the degree of liver fibrosis and platelet count. Keywords: chronic hepatitis, liver fibrosis, thrombopoietin

The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital Herryanto Lumbantobing; Leonardo Basa Dairi; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Maryuni Sutadi; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201134-37

Background: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study. Keywords: upper gastrointestinal endoscopy, profile, indications, endoscopic diagnosis

Profile of Colorectal Cancer Patients in Endoscopic Unit at Dr. Pirngadi Hospital - Medan Rustam Effendi; Dasril Efendi; Leonardo Basa Dairy; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Maryuni Soetadi; Gontar Alamsyah Siregar; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 3, December 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/93200878-81

Background: Colorectal cancer is the third most prevalent cancer and the second leading cause of cancer death worldwide every year. Rates of this malignancy vary by country. In Indonesia, the prevalence is estimated to have an increased tendency. The objectives of this sudy was to examine the prevalence and profile of colorectal cancer, which are diagnosed by endoscopic examination. Method: The study was conducted retrospectively, by examining the Result of endoscopic findings of patients with rectal bleeding, altered bowel habit, chronic diarrhea, unexplain abdominal pain, and other signs and symptoms at The Endoscopic Unit Department of Internal Medicine, Dr. Pirngadi hospital from January 2004 to June 2008. Results: We found 197 patients with colorectal cancer (CRC) from 760 patients examined by colonoscopy (25.9%). One hundred and one patients (51.3%) out of 197 CRC patients were female. Most were in the group of age 51-60 years (28.9%). The most frequent ethnic of the patients were Bataknese (46.2%). The most common symptom was rectal bleeding (70.6%). The most common location of CRC was in the rectum (74.6%). Histopathologic Result was adenocarcinoma. Conclusion: The prevalence of colorectal cancer in this study were twenty six percents. Rectal bleeding appeared to be the most common sign in this study. Rectum was the most common site of the cancer. Most of patients were Bataknese. Patients were at advanced stage and most of them were having well-differentiated adenocarcinoma. Keywords: colorectal cancer, rectal bleeding, altered bowel habits, colonoscopy

Nitric Oxide and von Willebrand Factor Levels as Markers of Endothelial Dysfunction in Liver Cirrhosis Juwita Sembiring; Suara Ginting; Abiran Nababan; Lukman Hakim Zain; Pengarapen Tarigan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 3, December 2002
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/33200269-75

Introduction: A number of investigators have shown that endothelial dysfunction in liver cirrhosis can be indicated by increased levels of nitric oxide (NO) and von Willebrand factor (vWF). The cause of this increase is still unclear. It is believe to be correlated with hyperdinamic circulation and endotoxemia, which are common in liver cirrhosis. The Aim of This Study: To compare the levels of NO and vWF in liver cirrhosis patients with those in healthy control subjects, and to investigate whether there is a correlation between levels of NO and vWF with the severity of the disease according to the Child Pugh Criteria Material and Method: This study was conducted from February until June 2001 in 35 liver cirrhosis patients at Dr. Pirngadi and H. Adam Malik Hospital and some private hospitals in Medan. The mean age of patients with liver cirrhosis was 54 + 12.26 years, the youngest being 31 years and the oldest 75 years, and 20 healthy controls while the mean age of the control subject was 55.20 + 13.04 years, the youngest being 31 years and the oldest 76 years. Based on Child Pugh criteria, 9 were classified as Child Pugh class A, 13 in class B, 13 in class C. The criteria for liver cirrhosis were based on clinical examination, laboratory findings and liver ultrasound examination. Cirrhotic patients with hypercolestrolemia, hypertension, heart failure, myocardial infraction, renal failure diabetes, COPD were those on drugs, such as antibiotics and branchodilators were excluded from the study. Result: The mean level of NO in patients with liver cirrhosis was 6.2600 + 4.4456 mM, while the mean NO level in control subjects was 3.2325 + 3.2355 mM, p0.05. The mean level of NO in Child Pugh class A patients was 6.6889 + 3.9757mM, compared to control p0.05; in Child Pugh class B the mean level was 4.8308 + 2.4642 mM compared to control p0.05. There was a significant increase in the level of NO associated with the severity of liver cirrhosis. The mean level of vWF in patients with liver cirrhosis was 399.514 + 175.313% while the mean vWF level in control subjects was 139.100 + 51.144%, p0.05. The mean level of vWF in Child Pugh class A patients was 231.778 ± 43.8576%, compared to control p0.05; in Child Pugh class B was 365.846 + 110.034%, compared to control p0.05, in Child Pugh class C was 549.308 + 164.483%, compared to control p0.05. There was significant increase in the level of vWF correlated with severity of liver cirrhosis. Conclusion: The level of NO was significant higher in liver cirrhosis patients compared to control subjects, but there was no correlation between the increase in the level of NO with the severity of the disease. The levels of vWF was significantly higher in liver cirrhosis patients compared to control, and there was a correlation between increased levels of vWF and the severity of the disease. Key Words: Liver cirrhosis, Child Pugh criteria, nitric oxide (NO), von Willebrand Factor (vWF)

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