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The Comparison of Serum Malondialdehyde Level Between H. pylori Positive and H. pylori Negative Gastritis Patients Laura Dairi; Gontar Alamsyah Siregar; Taufik Sungkar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Helicobacter pylori is the most common cause of chronic gastritis in the world, meanwhile gastritis caused by non-steroidal anti-inflammatory drugs (NSAIDs) is the most encountered type of gastritis.Increased free radicals caused by Helicobacter pylori can cause damage in gastric mucous. Tissue damage due to free radicals can be examined by measuring malondialdehyde compound. There are many studies thatproves the increased malondialdehyde in gastritis, but those studies commonly done in animal experimentation and malondialdehyde examination in gastric mucous.Method: This is a cross-sectional study of 40 dyspepsia patients who came to endoscopic unit of Adam Malik General Hospital Medan and networking hospitals by using Rome III criteria. Further examination with gastroscopy and biopsy was done to determine gastritis. H. pylori examination was done by using Campylobacterlike organism test (CLO) test. Serum malondiasldehyde level was examined with high performance liquid chromatography (HPLC) method.Results: From total of 40 patients,24 (60%) were men and 16 (40%) were women with an average age of 47years, the majority of the ethnic was Bataknese (57.5%). From 20 patients with H.pylori (+), the average levelof malondialdehyde was 1.58 umol/mL while in 20 other patients with H. pylori (-), malondialdehyde level was 1.19 umol/mL with p value 0.013.We found the mean serum levels of malondialdehyde was higher in H. pyloripositive gastritis than H. pylori negative.Conclusion: Serum Malondialdehyde level was significantly higher in patient with positive H. pylori gastritiscompared to H. pylori negative gastritis.

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

Association Between Degree of Gastritis and Malondialdehyde Level of Gastritis Patients at Adam Malik General Hospital Medan Darmadi Darmadi; Gontar Alamsyah Siregar; Leonardo Basa Dairi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, AUGUST 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Background: The main pathogenesis of gastritis is inflammation which process can not be separated from the role of free radicals. Malondialdehyde (MDA) is a free radical biomarker and which increases in gastritis patients. However, studies on MDA were generally performed on experimental animals or examined MDA in gastric mucosa. The aim of this study is to determine the association of histopathological degrees of gastritis (the degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia) with plasma MDA level.Method: Cross-sectional study of 40 consecutive gastritis patients who came to endoscopic unit of Adam Malik General Hospital Medan, from January to May 2017. Assessment for the severity of chronic inflammation, neutrophil activity, atrophy, and intestinal metaplasia refers to Updated Sydney System. Plasma MDA levels were examined using an HPLC MDA kit. Univariate and bivariate (Chi-square and fisher exact test) analysis were performed with SPSS version 22.Results: A total of 26 patients (65%) were men with an average age of 49.25 years. Lymphocyte infiltration was observed in 100% of specimens, neutrophil infiltration in 37.5%, atrophy in 22.5%, and intestinal metaplasia in 22.5%. There was a significant association between degree of lymphocyte infiltration with MDA level (p = 0.014; PR = 8.667; 95% CI: 1.52-89.52). There was a significant association between degree of neutrophil activity with high MDA level (p = 0.002; PR = 11.33; 95% CI: 2.64-48.74). There was a significant association between degree of atrophy with high level of MDA (p 0.001; PR = 14; 95% CI: 3.4–57.648). There was a significant association between degree of intestinal metaplasia with high MDA level (p = 0.001; PR = 12.5; 95% CI: 3.76-24).Conclusion: There were significant associations between degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia with high level of MDA.

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

Early Acute Liver Failure In Severe Acute Hepatitis B Gontar Alamsyah Siregar
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: 10.24871/33200297-98

Early acute liver failure is defined by the presence of a drop below 50% of the normal prothrombine ratio, jaundice, and clotting factors of less than 50% in any patient with acute liver disease. Clinical features and laboratory manifestations of viral hepatitis range from unapparent disease, asymptomatic infection, to culminant disease, which has the highest mortality rate of up to over 80 %. We report a case of a 22-year old man who was treated in a private hospital with early acute liver failure caused by hepatitis B infection. The diagnosis was based on clinical symptoms and laboratory test Results such as jaundice, hepatomegaly, ascites, 34% prothrombine ratio, elongated prothrombine time (37,1 seconds), hypoalbuminemia (1,9 g/dL), hyperbillirubinemia (total billirubin 26,35 mg/dL, direct billirubin 16,66 mg/dL, HbsAg (+), IgM anti- HBc (+), IgM anti HAV (-), and anti HCV (-). The patient suffered from jaundice for 6 weeks and on the third week, he suffered from ascites. He had improved clinical condition and laboratory test results with conservative therapy after the seventh week. At the end of the tenth week, the patient’s clinical condition and laboratory test results had reached normal, with HBsAg (-) and HBsAb (+). Whether or not interferon should have been given to this patient is still arguable. Key words: Early acute liver failure, Severe acute hepatitis B

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

A Comparison of the Endoscopic and Histopathological Findings of Upper Gastrointestinal Mucosa with Helicobacter pylori infection Gontar Alamsyah Siregar; Sumondang Pardede
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, ISSUE 3, December 2003
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/43200375-79

Helicobacter pylori infects the gastric mucosa or the duodenal wall undergoing gastric meteplasia, and is found in nearly 100% of chronic gastritis and duodenal ulcers. Helicobacter pylori produces urease that converts urea into ammonia, which will protect the organism from the acidic environment and will cause further damage to the gastrointestinal mucosa. Helicobacter pylori can be detected through histopathological evaluation, macroscopic endoscopy, serologic test, urea breath test, biopsy urease test, culture and stool analysis. Histiopathologically, Helicobacter pylori infection demonstrates neutrophil infiltration into the gastric mucosa, classified as focal infiltration. We conducted a prospective study of 50 chronic dyspeptic patients. We took their history, performed physical examinations, gastroscopy with judgement for macroscopic endoscopic appearance, histopathology from biopsy specimens, and the CLO test. There were 50 chronic dyspeptic patients in the study, with an age ranging from 23-81 years, and a mean age 49±12 year. Most of them were male (33 cases). There were 17 female cases. From the CLO test, there were 30 cases with CLO (+) and 20 cases CLO (-). From the 30 cases with CLO (+), 22 were male and 8 female. Gastroscopy revealed 25 cases of gastric ulcer, 7 duodenal ulcer, 2 gastric cancer, 15 gastritis, and 30 gastropathy. A gastroscopic appearance of chronic dyspepsia with positive Helicobacter pylori were found mostly in gastric ulcer (18 cases), followed by duodenal ulcer (6 cases), gastritis (5 cases) and one case of gastric cancer. A gastroscopic appearance of chronic dyspepsia with negative Helicobacter pylori were found mostly in gastritis 10 cases, while the remaining in gastric ulcer (7 cases), gastric cancer (2 cases), and a case of duodenal ulcer. Gastroscopy revealed 15 cases of gastritis. From the 5 gastritis cases with CLO (+), 3 cases had lesions located at the antrum and 2 cases at the corpus, while from the remaining 10 cases of gastritis with CLO (-), 8 cases had lesions located at the antrum, and 2 at the corpus. The time to colonization was shortest in duodenal ulcer (grade IV), followed by gastric ulcer (grade II) and gastritis (grade I) in CLO (-) examination. From cases of gastritis with CLO (+), 4 were moderate cases and one case severe, while from cases of gastritis with CLO (-) there were 7 mild cases, and 3 moderate cases with no severe case found. Keywords: Endoscopic findings, histopathology, Helicobacter pylori.

The Comparison of Tnf α (Tumor Necrosis Factor α) Serum Levels Between Cytotoxin - Associated Gene A (Caga) Positive and Negative in Patients with Gastritis Helicobacter pylori Fitri Armanti Karo; Leonardo Basa Dairi; Gontar Alamsyah Siregar
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

Background: Helicobacter pylori (H. pylori) infection is the common cause of chronic gastritis in the world that is around 80% in addition to other causes such as autoimmune diseases, drugs, idiopathic and others. The pathogenesis of H. pylori associated with virulence factors consisting of cytotoxin - associated gene A (CagA) and vacuolating cytotoxin A (Vaca). In the case of gastritis occurred acute and chronic inflammatory responses and activation cytokines that cause inflammation of mucous which TNF-α levels increased in patients gatritis H. pylori. Levels of serum TNF-α was found higher in patients infected with H. pylori with CagA positive. The purpose of this study is to investigate the comparison between TNF-α serum level in H. pylori gastritis patients with Cag A (+) and CagA (-).Method: The study was conducted with a cross-sectional design in 30 patients with dyspepsia, using PADYQ score. We performed gastroscopy, biopsy, and CLO test to prove the existence of H. pylori. Furthermore, we used PCR to assess CagA (+) and CagA (-), and ELISA method to measure TNF-α serum level.Results: From 30 subjects, 18 men (60%), 12 women (40%), and the mean age was 53.5 years, the majority of the ethnic was Bataknese (53.3%), patients with H. pylori gastritis with CagA (+) were 21 (70%) and patients with H. pylori gastritis with CagA (-) were 9 (30%). We found the mean serum levels of TNF-α was higher (3.48) in H. pylori gastritis with CagA (+) than the CagA (-) (1.29) with p value was 0.001.Conclusion: We found increased serum levels of TNF-α in patients with CagA (+) compared to Cag A (-) H. pylori gastritis.

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