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All Journal journal of internal medicine E-Jurnal Medika Udayana Jurnal Penyakit Dalam Udayana The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy ISM (Intisari Sains Medis) : Jurnal Kedokteran Jurnal Ilmiah Sangkareang Mataram The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

I Dewa Nyoman Wibawa

Department Of Clinical Microbiology, Faculty Of Medicine, University Of Udayana, Bali

Author-ID : 414191

Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Social Sciences

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Kadar Resistin Serum Berhubungan Dengan Skor Child-Turcotte Pugh Pada Penderita Sirosis Hati Koncoro, Hendra; Primadharsini, Putu Prathiwi; Mariadi, I Ketut; Somayana, Gde; Suryadarma, I Gusti Agung; Purwadi, Nyoman; Wibawa, I Dewa Nyoman
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Latar Belakang: Sirosis hati (SH) sering disertai tingginya resistensi insulin dan kondisi proinflamasi. Resistin yang merupakan suatu adipokin, diketahui memiliki hubungan dengan resistensi insulin dan inflamasi. Studi-studi resistin pada SH memperlihatkan hasil yang bervariasi. Tujuan penelitian ini adalah untuk mencari hubungan kadar resistin serum dengan skor Child-Turcotte Pugh (CTP) pada penderita SH. Metode: Penelitian observasional, studi potong lintang ini dilaksanakan di RSUP Sanglah dari September 2014 sampai dengan Juni 2015 dengan menggunakan 75 pasien sirosis hati sebagai sampel. Kriteria inklusi mencakup pasien sirosis hati tanpa memandang etiologinya dan berusia 12 tahun atau lebih. Variabel yang diperiksa pada penelitian ini yaitu skor CTP (kadar albumin serum, kadar bilirubin total serum, nilai waktu protrombin, kadar international normalized ratio (INR), tanda ascites, tanda ensefalopati hepatikum), kadar C-reactive protein (CRP), dan kadar resistin serum. Hasil: Enam puluh lima persen dari 75 sampel adalah laki-laki dan sisanya perempuan. Sebelas diantaranya (14,7%) adalah kelas CTP A, 31 (41,3%) kelas CTP B, dan 33 (44%) kelas CTP C. Rerata kadar CRP adalah 15,05 Â± 15,86 mg/L. Rerata kadar resistin adalah 23,39 Â± 17,79 ng/mL. Hasil uji korelasi didapatkan korelasi positif yang sedang antara kadar resistin dan skor CTP (r = 0,438; p < 0,001). Korelasi positif sedang juga didapatkan antara CRP dan resistin (r = 0,478; p < 0,001). Simpulan: Kadar resistin memiliki korelasi sedang dengan skor CTP pada pasien SH. Kadar resistin didapatkan lebih tinggi kadarnya pada SH yang berat. Hal ini menunjukkan adanya kondisi inflamasi dan resistensi insulin seiring dengan peningkatan derajat beratnya SH.

Acute Pancreatitis as a Complication of Choledochal Cyst Koncoro, Hendra; Wibawa, I Dewa Nyoman
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

Choledochal cysts (CCs) are rare congenital disorders of the biliary tree which are associated with biliary tract and pancreatic complications. Its etiology is still unknown, but some evidences suggest that CCs are caused by infection during embryogenesis. The laboratory evaluation reveals abnormalities due to pancreatobiliary complications, such as ascending cholangitis, cholecystitis, and pancreatitis. Radiologic examination may delineate the structural abnormalities occured in CCs and confirm the diagnosis. The major mortality is caused by cholangiocarcinoma. This case discussed the diagnosis and treatment of a 20-year-old male with choledochal cyst and its complications. Management consists of therapy on complication and definitive therapy. Keywords: choledochal cyst, acute pancreatitis, cholecystitis

Upper Gastrointestinal Endoscopy as Diagnostic Test for Detection of Gastric Malignancy in Sanglah Hospital Denpasar Koncoro, Hendra; Primadharsini, Putu Prathiwi; Indrayani, Luh Putulin; Nyoman Wibawa, I Dewa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 1 (2015): VOLUME 16, NUMBER 1, April 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Gastric malignancy is the third most common cause of cancer-related death in the world. Upper gastrointestinal (UGI) endoscopy for detection of gastric malignancy has been used widely in Indonesia. This study aimed to determine the prevalence of gastric malignancy and diagnostic value of UGI endoscopy in detection of gastric malignancy in Sanglah Hospital, Denpasar.Method: A retrospective study on patients undergoing UGI endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between January 2012 and December 2014 was conducted. Endoscopical and histological diagnosis were documented. The diagnostic test of endoscopic diagnosis were conducted by showing its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.Results: One thousand and sixty eight patients with upper gastrointestinal symptoms were subjected to endoscopy between January 2012 and December 2014. Of the 1068 cases, 39 patients were suspected for gastric malignant lesions on UGI endoscopy. During the study period, histopathologically-confirmed gastric malignancy was found in 2.72% patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of UGI endoscopic diagnosis for these neoplastic lesions were 100%, 99.04%, 74.36%, 100%, and 99.06%, respectively.Conclusion: The prevalence of gastric malignancy was higher compared to western countries. Endoscopy is important as diagnostic tool in patients with suspicion of gastric malignancy. Greater suspicion in clinical judgment and carefulness in excluding malignancy through one histopathology negative findings need to be done to reduce the number of misdiagnoses of gastric malignancy.

Detection of Helicobacter pylori CagA gene and Its Association with Endoscopic Appearance in Balinese Dyspepsia Patients Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Wibawa, Ida Bagus Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Helicobacter pylori (H. pylori) infection causes various abnormalities in the stomach. Only particular strain can cause severe problems in the stomach. CagA is a microbial virulent factor which is associated with more severe stomach problems, such as: peptic ulcer and stomach cancer. We would like to know the prevalence of CagA in Balinese population, and the association of H. Pylori CagA status with the severity of endoscopic appearance in dyspepsia patients.Method: Study design being used was analytic cross sectional study, involving 71 dyspepsia patients who underwent upper gastrointestinal endoscopic examination in Surya Husada Hospital and Balimed Hospital in June-December 2013. Sample was chosen in consecutive manner. Later, polymerase chain reaction (PCR) examinations of the stomach mucous biopsy tissue to determine H. pylori infection status and CagA status were performed. Further, Chi square test was used to identify the difference in proportion of H. pylori and CagA between mild and severe endoscopic appearance.Results: In this study, we found that the prevalence of H. pylori infection was 22.5% using PCR examination. Prevalence of CagA positive in H. pylori positive was 62.5%. There was significant association between status of H. Pylori infection and severity of endoscopic appearance (p = 0.038; OR= 2.67; 95% CI = 1.18-6.05). Status of CagA in H. pylori infected patients was not associated with the severity of endoscopic appearance. Additionally, there was significant association between patients’ age and severity of endoscopic appearance.Conclusion: The prevalence of CagA in H. pylori positive was 62.5%. H. pylori infection was associated with severity of endoscopic appearance and CagA status in H. pylori infected patients was not associated with severity of endoscopic appearance.

Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis Budiyasa, Dewa Gde Agung; Ariawan, Yuna; Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Purwadi, Nyoman; Suryadarma, I Gusti Agung
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p < 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis. Keywords: albumin, degree of EV, liver cirrhosis

Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer Koncoro, Hendra; Wibawa, I Dewa Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 3 (2015): VOLUME 16, NUMBER 3, December 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology.

Correlation between Quantitative HBsAg and HBV-DNA in Chronic Hepatitis B Infection Primadharsini, Putu Prathiwi; Wibawa, I Dewa Nyoman
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: Methods used to diagnose and monitor chronic hepatitis B (CHB) by quantitation of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) levels is expensive. Cheaper laboratory test as an additional markeris needed, thus we studied serum quantitative HBsAg to be used as surrogate marker in CHB patients. This study was aimed to investigate correlation between serum quantitative HBsAg and HBV-DNA in CHB patients.Method: In this cross-sectional study, we enrolled 62 CHB patients between January 2010 and December 2012 who had quantitative HBsAg and HBV-DNA assays in a private laboratory at Denpasar. HBV-DNA was measured by real-time polymerase chain reaction and quantitative serum HBsAg was measured by chemiluminescent microparticle immunoassay (CMIA). Stastistical analysis was performed by Mann-Whitney and Spearman’s correlation.Results: Of 62 patients, most subjects were males (82.26%). Mean HBsAg titer of CHB in HBeAg positive and negative patients were 281,000 and 4,900 IU/mL, respectively; while mean HBV-DNA in HBeAg positiveand negative patients were 59,000,000 and 7,530,000 IU/mL, respectively. We found that quantitative HBsAg and HBV-DNA in HBeAg positive and HBeAg negative patients were statistically signi cant (p = 0.0001, p = 0.0001, respectively). Signi cant correlation was found between serum quantitative HBsAg and HBV-DNA (r = 0.737; p= 0.000). Quantitative HBsAg was signi cantly correlated with HBV-DNA in HBeAg-positive subgroup (r = 0.717; p = 0.0001); and signi cant correlation was also found in HBeAg-negative subgroup (r = 0.443; p = 0.006) although the correlation was weak. Conclusion: Quantitative HBsAg has signi cant correlation with HBV-DNA in CHB patients. Keywords: quantitative HBsAg Assay, HBV-DNA, HBeAg, chronic hepatitis B infection

High Incidence of Hepatitis B Virus Infection in Hemodialysis Patients at Sanglah General Hospital and It’s Risk Factors Purnamasidhi, Cokorda Agung Wahyu; Mariadi, I Ketut; Wibawa, I Dewa Nyoman; Kandarini, Yenny
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 3 (2016): VOLUME 17, NUMBER 3, December 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Patients receiving maintenance hemodialysis (HD) are at higher risk for Hepatitis B Virus (HBV) infections than in general population. Strict infection control is essential to prevent nosocomial transmission. We aimed to investigate the incidence of HBV infection in the HD population in Sanglah General Hospital as well as risk factors acquired HBV infection.Method: All adult patients receiving maintenance HD (n=267) in 3 dialysis units at Sanglah Hospital were studied between March to June 2016. In this study, medical record of patients on maintenance hemodialysis were reviewed and the patients were interviewed by the researchers to collect data regarding the serology status of these patients before and during HD, and potential risk factors which could be associated with HBV acquisition.Results: Participant mean age was 54.07 ± 0.80 years and 154 (57.7%) were male.We found 21 patients (7.8%) were sero-positive for HBV (HBsAg positive) with mean titer was 9.26±1.85. Of the sero-positive patients,1 patient (4.8%) were known to be infected before the initiation of HD and 20 patients (95.2%) were infected during HD. Incidence of HBV infection during HD was 7.5% (20/266). Sero-positive patients were younger with mean age was 51.81±2.76 years, had longer time on dialysis and had previous blood transfusions. Risk factors, which significant associated with hepatitis B infection were history of transfusion (p<0.01; OR: 2.49; 95%CI: 1.29-8.18) and duration of hemodialysis (p < 0.01; OR: 1.07; 95% CI: 1.03-3.74).Conclusion: Patients on maintenance HD in Sanglah General Hospital have a high incidence of HBV infection. The factors associated with HBV infection are highly suggestive of nosocomial transmission within HD units. History of transfusion and duration of hemodialysis were significant risk factors for HBV infection in patients receiving maintenance HD.

Acute Tuberculous Appendicitis with Intestinal Obstruction Purnama, Yongkie Iswandi; Wibawa, I Dewa Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, AUGUST 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Tuberculosis (TB) can involve any organs. Tuberculous appendicitis is a rare case. Incidence of primary tuberculous appendicitis is 0.1-0.3% while incidence of secondary tuberculous appendicitis is 1.5-3%. Tuberculous appendicitis occurs in 0.08% of all appendectomy and 0.2% of all TB cases. We reported an acute tuberculous appendicitis with intestinal obstruction. Diagnosis was established based on histopathological findings. Treatments included appendectomy and first category of anti tuberculosis drugs (ATD) for 6 months. This case was reported to add our insight about possibility of TB as an etiology of many pathologic conditions in abdominal cavity.

Drug-induced Esophagitis Juniarta, Pande Made; Wibawa, I Dewa Nyoman
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 2 (2019): VOLUME 20, NUMBER 2, AUGUST 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Esophageal injury could be caused by a various etiology, such as drug administration. Drug-induced esophagitis is a spectrum of esophageal lesions due to drugs that can cause complications of ulceration, perforation and stricture of the esophagus. More than one hundred drugs have been identified to cause damage to the esophageal wall, such as antibiotics, nonsteroidal anti inflammatory drugs (NSAID), alendronate, potassium chloride, anti-hypertension, quinidine, etc. Symptoms of drug induced esophagitis might appear as retrosternal pain, heartburn, odynophagia, dysphagia, weight loss, gastrointestinal bleeding, which also found in other cases of gastrointestinal lesions so they are often misdiagnosed in daily clinical practice. Endoscopic procedure is the first choice in diagnosis of drug-induced esophagitis. The lesion may appear as erosion, bleeding, ulcers, strictures, kissing ulcers, and residual drugs fragment on endoscopy. Management of drug-induced esophagitis are by stopping suspected drugs and educating about the proper drug administration. In severe cases, adequate fluid hydration and parenteral nutrition can be given. Sucralfat forms a protective layer in the area of the lesion, thus accelerates wound healing process. Acid-lowering agents can be considered in cases of reflux esophagitis. Therapeutic endoscopic may indicated in strictures cases, active bleeding due to esophageal ulcers, and retrieval remaining drug fragments that are lodged in the esophagus. While surgery should be reserved for patients with severe complications such as erosion of the mediastinal organs, heart and large blood vessels

Co-Authors - Mulyanto, - Anak Agung Ayu Yuli Gayatri Anak Agung Gde Waisampayana Putra Anak Agung Ketut Yunita Paramita Anwar Santoso Chandrawati, Lily Cokorda Agung Wahyu Purnamasidhi Dewa Gde Agung Budiyasa Dewa Gde Agung Budiyasa Gde Ngurah Idraguna Pinatih Gde Somayana Godfried Erycesar Yeremia Saragih H Da Silva Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendriketa Da Silva, Hendriketa Da I Gusti Agung Suryadarma I Ketut Agus Somia I Ketut Badjra Nadha I Ketut Mariadi I Ketut Sujana I Made Juliana I Made Susila Utama I Putu Arsana I Wayan Dary Ida Ayu Pradnya Paramita Ida Bagus Nyoman Wibawa Indraguna Pinatih, Indraguna Jemi Tubung Juniarta, Pande Made Lily Chandrawati Luh Putulin Indrayani Luh Putulin Indrayani, Luh Putulin Made Wardhana Mario Steffanus Mulyanto NGP Cilik Wiryan Ni Wayan Winarti Nicholas Wijayanto Nyoman Purwadi Pande Made Juniarta Purnama, Yongkie Iswandi Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Putu Shely Prihastuti Renaldy Frederich Nathanael Magat Tjok Istri Anom S Tuti Parwati Wibawa, Ida Bagus Nyoman Yaditta Mirdania Yenny Kandarini Yongkie Iswandi Purnama Yuna Ariawan

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