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Colonic Tuberculosis: a high Index of Suspicion Syam, Ari F; Chen, Khie; Rumende, C Martin; A, Djumhana; Abdullah, Murdani; SM, M Usman; Rajabto, Wulyo
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

Tuberculosis remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tract. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to nonspecific sign and symptoms. In endemic areas, correct diagnoses were made only 50% of the time. Without a high index of suspicion of the disease, it has been rarely diagnosed correctly. We reported a case of colonic tuberculosis in 18 years old female patient with lung tuberculosis.Endoscopic examination showed ulcerative mucosa, ‘halo lesion’, and pseudopolyp while PPD skin test, sputum smear and histopathological examination of endoscopic biopsy revealed negative for tuberculosis infection. The presence of lung tuberculosis had made high index of suspicion of colonic tuberculosis. Standard regimen of antituberculosis therapy was given and the patient showed good clinical response. Keywords: high index suspicion, colonic tuberculosis

Hematochezia in Young Patient Due to Crohn’s Disease Simadibrata, Marcellus; Syam, Ari F; Lubis, Anna Mira; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 2, August 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Crohn’s disease encompasses a spectrum of clinical and pathological patterns, affecting the gastrointestinal (GI) tract with potential systemic and extraintestinal complications. The disease can affect any age group, but the onset is most common in the second and third decade. Lower GI bleeding is one of its clinical features. Surgical intervention is required in up to two-thirds of patients to treat intractable hemorrhage, perforation, obstruction or unresponsive fulminant disease. We reported a case of Crohn’s disease in young male who suffered from severe lower GI bleeding (hematochezia) as the clinical features. Lower GI endoscopy revealed ulceration at the distal ileum surrounded by fibrotic tissue as a source of bleeding and a tumor mass at mesocolon. Upper GI endoscopy was unremarkable. Histopathologyc examination concluded multiple ulceration with chronic ischemic condition, appropriate to Crohn’s disease. The patient underwent emergency surgical intervention (subtotal colectomy and ileustomy), and his condition was improved. Keywords: hematochezia, young male, Crohn’s disease, surgery

Abdominal Tuberculosis: Diagnostic and Management Problems Simadibrata, Marcellus; A, Iskandar; Dwimartutie, Noto; Sulaiman, Andri; Pitoyo, Ceva W; Syam, Ari F; Loho, Tony
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatitis

Management of Complicated Colonic Diverticulosis Abdullah, Murdani; Abdullah, Arman A; Humardani, Ariadi; Syam, Ari F; Basyir, Ibrahim
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Prevalence of diverticular disease has been increasing worldwide in concert with the development of industrial era and the alteration of diet pattern to low dietary fiber. Mean age of patients is 60 years; peak incidence at age more than 50 years, 20% less than 50 years, 2-8% less than 40 years. About 50 - 90% of diverticular disease are left-sided especially sigmoid, while in Asian people are mostly right sided. The usual complaint of patient is abdominal pain. Complications that may occur due to diverticulosis are diverticulitis, abscess, fistula, obstruction and bleeding. The presence of complicated diverticulosis can be evaluated by plain X-rays, CT-scan, barium with contrast, ultrasonography and colonoscopy in addition of laboratory examination. The management of complicated diverticulosis usually consists of combination of medical therapy and surgery. Proper and immediate treatment will influence the prognosis of patients. Keywords: diverticular diseases, diverticulitis, abscess, fistula, obstruction, bleeding

Diagnosis and Management of Barret's Esophagus Wijaya, Adi; D, Dharmika; Syam, Ari F; Lalisang, Toar JM
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

Incidence of esophageal adenocarcinoma is increasing in western countries and has poor prognosis due to late diagnosis. Barrett’s esophagus is considered as premalignant lesion in which some of squamous epithelium in distal esophagus has been replaced by metaplastic columnar ephithelium. It occurs as complication of longstanding gastroesophageal reflux. Endoscopic examination is very important for early detection especially in patients with chronic symptoms of gastroesophageal reflux disease (GERD) for more than 5 years. Aggressive antireflux treatment may reduce the risk of esophageal carcinoma. However, no single therapeutic modality had been proven superior compare to others, but until now surgery remains the most popular treatment of choice in the management of Barrett’s esophagus. Keywords: Barrett’s esophagus,GERD, premalignant lesion, management

The Prevalence and Risk Factors of GERD among Indonesian Medical Doctors Syam, Ari F; Hapsari, Puspita FC; Makmun, Dadang
Makara Journal of Health Research Vol. 20, No. 2
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Background: Based on our knowledge, the study of gastrointestinal reflux disease (GERD) among certain profession has never been conducted. The aim of this study is to determine the prevalence and risk factors of GERD among Indonesian doctors. Methods: A consecutive study involving 515 doctors was conducted in October 2015. The GerdQ score was used to the diagnosis of GERD and determined its impact on daily life. All possible risk factors were also analysed. Results: A total of 515 subjects completed the questionnaire. The mean age of them was 41.37 ± 11.92 years old. Fifty-five percent of them were male and 60.6% general practitioners. The prevalence of GERD was 27.4% of which 21.0% was had GERD with low impact on daily life, and 6.4% was GERD with high impact on daily life. The statistically significant risk factors of GERD was found in age > 50 y.o (p = 0.002; OR = 2.054), BMI > 30 kg/m2 (p = 0.016; OR = 2.53), and smokers (p = 0.031; OR = 1.982). Sex and education level were not found significant statistically as the risk factors of GERD. Conclusions: The prevalence of GERD among Indonesian physician was 27.4%. We found that age over 50 y.o, obesity and smoking habit were the risk factors of GERD in Indonesian doctors.

Hematochezia in Young Patient Due to Crohn’s Disease Anna Mira Lubis; Marcellus Simadibrata; Dadang Makmun; Ari F Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 2, August 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/72200654-56

Crohn’s disease encompasses a spectrum of clinical and pathological patterns, affecting the gastrointestinal (GI) tract with potential systemic and extraintestinal complications. The disease can affect any age group, but the onset is most common in the second and third decade. Lower GI bleeding is one of its clinical features. Surgical intervention is required in up to two-thirds of patients to treat intractable hemorrhage, perforation, obstruction or unresponsive fulminant disease. We reported a case of Crohn’s disease in young male who suffered from severe lower GI bleeding (hematochezia) as the clinical features. Lower GI endoscopy revealed ulceration at the distal ileum surrounded by fibrotic tissue as a source of bleeding and a tumor mass at mesocolon. Upper GI endoscopy was unremarkable. Histopathologyc examination concluded multiple ulceration with chronic ischemic condition, appropriate to Crohn’s disease. The patient underwent emergency surgical intervention (subtotal colectomy and ileustomy), and his condition was improved. Keywords: hematochezia, young male, Crohn’s disease, surgery

Diagnosis and Management of Barret's Esophagus Adi Wijaya; Dharmika D; Ari F Syam; Toar JM Lalisang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/62200542-47

Incidence of esophageal adenocarcinoma is increasing in western countries and has poor prognosis due to late diagnosis. Barrett’s esophagus is considered as premalignant lesion in which some of squamous epithelium in distal esophagus has been replaced by metaplastic columnar ephithelium. It occurs as complication of longstanding gastroesophageal reflux. Endoscopic examination is very important for early detection especially in patients with chronic symptoms of gastroesophageal reflux disease (GERD) for more than 5 years. Aggressive antireflux treatment may reduce the risk of esophageal carcinoma. However, no single therapeutic modality had been proven superior compare to others, but until now surgery remains the most popular treatment of choice in the management of Barrett’s esophagus. Keywords: Barrett’s esophagus,GERD, premalignant lesion, management

Management of Complicated Colonic Diverticulosis Ariadi Humardani; Ari F Syam; Murdani Abdullah; Ibrahim Basyir; Arman A Abdullah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200611-15

Prevalence of diverticular disease has been increasing worldwide in concert with the development of industrial era and the alteration of diet pattern to low dietary fiber. Mean age of patients is 60 years; peak incidence at age more than 50 years, 20% less than 50 years, 2-8% less than 40 years. About 50 - 90% of diverticular disease are left-sided especially sigmoid, while in Asian people are mostly right sided. The usual complaint of patient is abdominal pain. Complications that may occur due to diverticulosis are diverticulitis, abscess, fistula, obstruction and bleeding. The presence of complicated diverticulosis can be evaluated by plain X-rays, CT-scan, barium with contrast, ultrasonography and colonoscopy in addition of laboratory examination. The management of complicated diverticulosis usually consists of combination of medical therapy and surgery. Proper and immediate treatment will influence the prognosis of patients. Keywords: diverticular diseases, diverticulitis, abscess, fistula, obstruction, bleeding

Abdominal Tuberculosis: Diagnostic and Management Problems Noto Dwimartutie; Iskandar A; Marcellus Simadibrata; Ari F Syam; Ceva W Pitoyo; Andri Sulaiman; Tony Loho
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 7, ISSUE 1, April 2006
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/71200621-27

Abdominal tuberculosis, as one of the manifestations of extrapulmonary tuberculosis, may involve gastrointestinal tract, peritoneum, mesenteric lymph nodes, liver, and also spleen. Most patients have constitutional symptoms of fever, pain, diarrhea, constipation, alternating constipation and diarrhea, weight loss, anorexia and malaise. It also has an insidious course without any specific laboratory, radiological or clinical findings and makes it difficult to diagnosis. Anti tuberculosis treatments with initiation phase for 2 months and continue with continuation phase for 7 months is effective. Steroids may be used to reduce acute inflammation and limit delayed fibrotic complications. We report a male patient with abdominal tuberculosis involving peritoneum, liver, colon, paraaorta lymph nodes, and spleen, which at first suggested as a malignancy. Drug induced hepatitis due to anti tuberculosis drug during treatment was emerged and substituted with other regimen. After given anti tuberculosis treatment and steroid as adjunctive treatment, the clinical condition of patient was improved. Keywords: abdominal tuberculosis, anti tuberculosis treatment, drug induced hepatitis

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