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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Rino Alvani Gani
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Medicine & Pharmacology

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Gastric Mucosa Mucous Layer Thickness in Liver Cirrhosis with Portal Hypertensive Gastropathy Compare to Functional Dyspepsia Loli J Simanjuntak; Chudahman Manan; Marcellus Simandibrata; Vera Yuwono; Rino Alvani Gani; Sabarinah Prasetyo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 2, August 2004
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/52200448-57

Abstract

Background: This study aimed to investigate gastric mucosa mucous layer thickness in portal hypertensive gastropathy (PHG) compare to normal mucosa in functional dyspepsia and its correlation with several variables such as child class, severity of esophageal varices and gastropathy. Methods: Biopsy specimens were taken from the antrum and corpus from both group of patients with PHG and functional dyspepsia. The specimen was given cryometric for frozen section. Tissue were sliced by sagital section 11 µm, placed in object glass, fixed and stained to evaluate mucous thickness and giemsa stained to observe Helicobacter pylori. Measurement of mucous thickness was done upward muscularis mucosa started from upper epithelial layer from foveale tip until outer mucous layer on 15 points which were marked randomly and calculate the mean value by micrometer (µm). Results: Mean value of antral mucous thickness in PHG was 13.30 ± 6.5 µm, while in the functional dyspepsia it was 25.59 ± 5.66 µm. Statistical analysis for both kinds of mucous thickness was p0.001. Mean corpus mucous thickness in PHG was 10.6 ± 6.81 µm, while mucous thickness in dyspepsia was 32.54 ± 6.51 µm. Statistical analysis revealed p0.001. This result showed significant difference of mucous thickness of antrum and corpus statistically between PHG and dyspepsia as control group. Conclusion: The study had proven the presence of decreased gastric mucosa mucous layer thickness in corpus and antrum in PHG. Thus, therapeutic approach to increase mucous thickness must be considered in patients with PHG. Keywords: Gastric mucosa, PHG, liver cirrhosisemistry
The Effect of Domperindone on Intestinal Motility and Bacterial Overgrowth in Patients with Liver Cirrhosis Yustar Mulyadi; Rino Alvani Gani; Murdani Abdullah; Hamzah Shatri
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 3, Desember 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (363.612 KB) | DOI: 10.24871/1332012130-135

Abstract

ABSTRACTBackground: Spontaneous bacterial peritonitis (SBP) is a common serious complication of liver cirrhosis mainly caused by bacterial translocation (BT) into ascites fluid. The most essential issue that affects BT is small intestinal bacterial overgrowth (SIBO), which usually caused by gastrointestinal dysmotility. This study was aimed to evaluate the prokinetic effects of domperidone on gastrointestinal motility and small intestinal bacterial overgrowth and the correlation between restoration of motility and the incidence of SIBO in patients with liver cirrhosis.Method: A cross-over double blind clinical trial was conducted on patients who were treated at the ward and outpatient clinic from Division of Hepatology in Cipto Mangunkusumo Hospital, Jakarta and Soedarso Hospital, Pontianak between September 2010 and March 2011. All patients suffered from liver cirrhosis with ascites, gastrointestinal dysmotility and SIBO were included in the study. Out of 34 eligible patients, 16 patients received placebo and 18 patients received prokinetics (domperidone). Wilcoxon test was performed to analyze the comparison of SIBO before and after treatment in the placebo group; while paired T-test was employed for the prokinetics (domperidone) group. To evaluate improved balance of SIBO in the placebo and domperidone group, a Chi-square test was performed.Results: In the placebo group, 61.8% patients experienced SIBO; while in the prokinetics group, SIBO occurred only in 2.9% patients. Restored gastrointestinal motility took place in the prokinetics group with reduced median value for orocaecal transit time from 120 minutes into 90 minutes (p = 0.0001). In contrast, it went worse in the placebo group, i.e. from 90 minutes into 110 minutes (p = 0.002). There was a significant correlation between restored gastrointestinal motility and SIBO (p = 0.0001). Similarly, so does the effect of administering prokinetic agent on restored gastrointestinal motility (p = 0.0001) and SIBO (p = 0.0001).Conclusion: The administration of prokinetics has been proven effective to restore gastrointestinal motility that may lead to reduced incidence of SIBO in patients with liver cirrhosis. Keywords: prokinetics, breath hydrogen test, dysmotilitas, bacterial overgrowth 
Hepatitis B Virus Double Mutations is There any Role in Pathogenesis of Hepatocellular Carcinoma in Young Patients Andri Sanityoso Sulaiman; Rino Alvani Gani; Irsan Hasan; Andi Utama; Susan Tai; Griscalia Christine
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: 10.24871/103200996-98

Abstract

Background: The incidence of hepatocellular carcinoma (HCC) below age 40 years old in our institution were relatively high compared with other institutions in Asia. Hepatitis B virus (HBV) basal core promoter (BCP) double mutations correspond with increasing age. The aim of this study was to know if there was any role of HBV double mutations in young HCC patients. Method: A descriptive study was performed on HBV related HCC patients in Cipto Mangunkusumo Hospital in May 2006-November 2008. Patient were recruited consecutively and divided in to two groups, below 40 and above 40 years old. The genotypes were examined by polymerase chain reaction (PCR) method. The alpha feto protein (AFP) values were diagnosed based on ELISA method. The BCP A1762T/G1764A double mutations were examined by direct sequencing. Results: There were 49 HBV related HCC samples consist of 14 (28.5%) samples with age below 40 years old and 35 (71.5%) samples with age above 40 years old. We only found two genotype, genotype B was dominant in patients with HBV related HCC compare to genotype C, 43 (88%) and 6 (12%) respectively. The increasing of AFP level above 400 ng/mL was only found in about half of the samples, 7 (50%) 40 years old, 19 (54%) 40 years old. Double mutations of A1762T/G1764A in BCP occurred in 5 (36%) 40 years old, 15 (43%) 40 years old. Conclusion: The incidence of HBV related HCC in young patients were relatively high. The proportion of patients with AFP level 400 ng/mL in patients below 40 years old were higher compared to patients above 40 years.   Keywords: hepatocellular carcinoma, BCP double mutation, HBV genotype
Efficacy and Safety of In-Asia-manufactured Interferon alpha-2b in Combination with Ribavirin for Therapy of Naïve Chronic Hepatitis C Patients: A Multicenter, Prospective, Open-Label Trial Nurul Akbar; Ali Sulaiman; Rino Alvani Gani; Irsan Hasan; Laurentius Lesmana; Andri Sanityoso; Sjaifoellah Noer; FX Pridady; Soemarno Soemarno
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/10120097-13

Abstract

Background: An open-label, multi center and non-comparative study was conducted to evaluate the efficacy and safety of a more affordable in-Asia-manufactured interferon á-2b product in combination with ribavirin to treat naïve chronic hepatitis C patients. Method: Thirty chronic naïve hepatitis C patients were treated with in-Asia-manufactured interferon   a-2b subcutaneously 3 MIU thrice weekly and ribavirin 800-1,200 mg daily for 48 weeks. Follow-up was done until 24 weeks after the end of treatment. Efficacy was assessed by examining serologic and biochemical parameters at pre and post-treatment. Safety was assessed by evaluating clinical symptoms and laboratory parameters. Results: The virological response and sustained virological response rates of all Hepatitis C Virus (HCV) genotypes were 83.3% and 76.7% respectively. Post-treatment, 80% patients had significant alanine transaminase (ALT) decreased into normal level and remained normal in 76.7% patients at 24th week follow up period. At that time, the ALT level and sustained virological response were lower in HCV genotypes 1 and 4 than in non-1 and non-4 genotypes. The most frequent adverse event was flu-like syndrome. Conclusion: The efficacy and safety study on combination therapy of in-Asia-manufactured interferon a-2b and ribavirin has shown a good result based on the current standard of interferon alpha and ribavirin combination therapy. Keywords: interferons, combination drug therapy, chronic hepatitis C, treatment efficacy, safety
The Role of Specific Cellular Immune System in Chronic Hepatitis C Ihsanil Husna; Nurul Akbar; Rino Alvani Gani; Unggul Budihusodo; Nanang Sukmana
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/512004%p

Abstract

Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune response
Hepatocellular Carcinoma (HCC) Surveillance – Comprehensive Management in Liver Cirrhosis Patients Rino Alvani Gani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (287.531 KB) | DOI: 10.24871/1832017137-139

Abstract

Nutrition Management on Acute Pancreatitis Ralph Girson Gunarsa; Rino Alvani Gani; Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8, ISSUE 1, April 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/81200716-19

Abstract

Pancreatitis is an inflammatory process in pancreas. Clinical manifestation of acute pancreatitis can be mild to severe. Mortality rate is high in severe acute pancreatitis. Etiology of acute pancreatitis generally remains obscured. Supportive management is important in acute pancreatitis. Nutrition is important part in acute pancreatitis. Patient should not be given enteral nutrition temporarily and meanwhile parenteral nutrition must provide sufficient amount of calories and nutritional requirements. Immune nutrition should also be considered. In mild acute pancreatitis, oral realimentation can be started in 3rd-7th day. In severe acute pancreatitis with prolonged fasting, gradual enteral nutrition via nasoenteral tube is recommended Keywords: nutrition, acute pancreatitis, enteral nutrition
Combination Therapy of Sorafenib and Transarterial Chemoembolization in Management of Hepatoma Bhanu S Kumar; Andri Sanityoso; Ari Fahrial Syam; Rino Alvani Gani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (835.542 KB) | DOI: 10.24871/142201390-96

Abstract

Incidence of hepatocellular carcinoma (HCC) continues to increase in developing countries and rank 5th in male and 7th in female. Main cause being reported is chronic hepatitis B in Asian region. Treatment of choice for HCC is liver resection, however it is oftenly not possible to be performed as the disease has entered advanced stage. Due to the less choice of treatment in HCC, one of the several other alternatives has been considered is transarterial chemoembolization (TACE) which is applied in patients who cannot undergo resection or ablation therapy, failure of therapy. However limitation of TACE is very high recurrence rate of HCC. Sorafenib is ananti-angiogenic medicine approved as first systemic drug in HCC therapy. Several studies stated the benefits of combination therapy of TACE and Sorafenib administration to prevent HCC recurrence. Success rate of thiscombination therapy reaches control disease rate of 100% based on response evaluation criteria in solid tumors (RECIST) from European Association for the Study of the Liver (EASL).Keywords: TACE, sorafenib, liver cancer, HCC
Artificial Ascites in Radiofrequency Ablation for Liver Cancer Rino Alvani Gani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (359.311 KB) | DOI: 10.24871/1832017140-147

Abstract

Background: Radio Frequency Ablation (RFA) is one of the treatment modality for liver tumor either as primary tumor as well as secondary malignancy. Occasionally, a good ablation can’t be performed due to the tumor location. To assists the ablation in this particular case, some fluid can be deposited inside the abdomen which is called as artificial ascites. The aim of this study is to report and evaluate the method of artificial ascites in RFAMethod: This was a case series study consist of 19 consecutive patients that had been treated with ultrasound-guided RFA using artificial ascites from 2014 to 2017.Result: Artificial ascites was successfully performed in all 19 patients (100%) with total of 53 hepatocellular carcinoma (HCC) lesions in 34 RFA’s sessions and tumor size ranges from 10mm to 50mm. Most of the tumors were primary tumor (14/19). 9 patients had single tumor and 10 patients had multiple tumors and most of the tumor were located in segment 5 (14/53). Artificial ascites was performed using 5% dextrose in water (D/W)solution ranging from 500ml to 1500ml. No adverse effect occurred during and after the procedure.Conclusion: Percutaneous RFA using artificial ascites technique was safe and effective fortreating HCC
Non-Invasive Assessment and Evaluation of Portal Hypertension in Patients with Liver Cirrhosis Indra Marki; Rino Alvani Gani; Marcellus Simadibrata; Chudahman Manan
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/22200121-28

Abstract

Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding.    Keywords: liver cirrhosis, portal hypertension, doppler ultrasonography
Co-Authors Ali Sulaiman Andi Utama Andri Sanityoso Andri Sanityoso Sulaiman Ari Fahrial Syam Bambang Sutopo Bhanu S Kumar Chudahman Manan Chyntia Olivia Maurine Devy Serevina Dyah Ratna Budiani Ening Krisnuhoni Epistel Pangujian Simatupang Evy Yunihastuti FX Pridady Griscalia Christine Hamzah Shatri Ihsanil Husna Indra Marki Irsan Hasan Irsan Hasan Kuntjoro Harimurti Laurentius Lesmana Lies Luthariana Loli J Simanjuntak Marcellus Simadibrata Marcellus Simandibrata Murdani Abdullah Nanang Sukmana Nurul Akbar Ralph Girson Gunarsa Ratu Ratih Kusumayanti Sabarinah Prasetyo Sjaifoellah Noer Soemarno Soemarno Susan Tai Unggul Budihusodo Vera Yuwono Yustar Mulyadi