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All Journal The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

C Rinaldi A Lesmana

Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Author-ID : 628925

Health Professions Medicine & Pharmacology

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Articles

The Prevalence of Reflux Esophagitis in the Elderly and Its Associated Risk Factors Lesmana, Laurentius A; Pakasi, Levina S; Simanjuntak, Waldemar; Angga, Billy; A Lesmana, Cosmas Rinaldi
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: Reflux esophagitis is a common problem in the elderly. Compare to the Western Countries, esophageal cancer where reflux esophagitis is the most predominant risk factor is considered rare in Asia. Many other risk factors have not been well studied especially in most Asian countries. The objective of this study is to evaluate the presence of reflux esophagitis in elderly patients and its associated risk factors.Method: This was a cross-sectional study in elderly patients who underwent upper gastrointestinal endoscopy. Patients who received long-term proton pump inhibitor (PPI) therapy, suffered from gastrointestinal malignancies, recently receiving chemotherapy agents, diagnosed with cerebrovascular disease or Helicobacter pylori infection were excluded. Statistical analyses were performed using the SPSS software version 17.00 (SPSS Inc., Chicago, Illinois, USA).Results: A total of 238 elderly patients were enrolled. Patients’ mean age was 69.8 ± 6.8 years old. Reflux esophagitis was found in 22 (9.2%) patients. Several comorbidities were found in these patients, such as diabetes, hypertension, coronary artery disease, chronic kidney disease, and liver cirrhosis. The only factor that associated with reflux esophagitis was the presence of hiatus hernia esophagus (p = 0.038). However, reflux esophagitis seemed to be more found in the elderly patients who have history of reflux inducing drugs consumption without any proton pump inhibitor (PPI) protection.Conclusion: Reflux esophagitis is still a major problem in the elderly. The presence of hiatus hernia might give an important consideration of upper gastrointestinal endoscopy screening. However, it would be a debate matter with regards to the cost burden and the low risk of esophageal cancer in Asian countries.

Pharmacological and Non-Pharmacological Treatment in Non-Alcoholic Fatty Liver Disease Lesmana, Rinaldi A; Aditya, Perdana
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease, from steatosis to liver cirrhosis in individual who does not consume alcohol in significant amount. The prevalence of NAFLD in Indonesia was estimated around 30%, this condition related to the increased incidence of metabolic disorders. Current understanding of NAFLD pathogenesis is the third-hit theory, in which insulin resistance resulting in free fatty acid accumulation that triggers inflammation causing fibrosis and hepatocyte death, and these conditions are not followed by adequate hepatocyte proliferation.Treatment of NAFLD requires both non-pharmacologic and pharmacologic interventions. Life style intervention includes restricting calories, low saturated fat and low sugar diet, and also physical activity. Bariatricsurgery remains controversial since in several study participants had experienced deterioration of disease. There are no definitive treatment for NAFLD currently. Treatment is aimed to improved insulin sensitivity, decreased oxidative stress and inflammation. Several agents use for treatment of NAFLD are insulin sensitizer (metformin and glitazones), statin, omega-3, vitamin E, ursodeoxycholic acid, orlistat, pentoxyphylline, and losartan.Keywords: NAFLD, treatment, pharmacologic, non-pharmacologic

Impact of Endoscopic Ultrasound (EUS) Procedure in Pancreatico-biliary Disorders in Indonesia Lesmana, Laurentius A; Sulaeman, Andri Sanityoso; Hasan, Irsan; Gani, Rino Alvani; Lesmana, Cosmas Rinaldi A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 1 (2017): VOLUME 18, NUMBER 1, April 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Pancreato-biliary disorders are the challenging disorders in gastroenterology practice. It is well-known that endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure in managing pancreato-biliary disorders. However, imaging modalities such as abdominal CT scan and MRI has been successfully reduced the unnecessary ERCP to avoid several potential complications. Recently, endoscopic ultrasound (EUS) procedure has become an important tool due to the limitation of imaging modalities in pancreato-biliary disorders. Its ability which is not only for diagnostic, but also for therapeutic purpose has given a new insight for most gastroenterologists in their daily practice. However, the investment, cost, and the proper training curriculum are still debatable in most developing countries, especially in Indonesia.

Quantification Hepatitis B Surface Antigen: Does It Really Matter in Clinical Practice? Lesmana, C Rinaldi A
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

...

Choledocholithiasis during Pregnancy: Multimodal Approach Treatment Philipi, Benny; Koncoro, Hendra; Lesmana, Cosmas Rinaldi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 1 (2016): VOLUME 17, NUMBER 1, April 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Pregnancy is an important risk factor for growth of choledochal stones. Since choledocholithiasis encountered during pregnancy, which is also a possible cause of pancreatitis and cholangitis, may be the reason for serious morbidity and mortality both for the mother and the fetus, it should be treated. In this article, the results and reliability of endoscopic retrograde cholangiopancreatography (ERCP) application on a pregnant woman accompanied with percutaneous biliary procedures are presented. We report a case of 33-year-old woman at 19th week of gestation with cholestatic jaundice due to a common bile duct (CBD) stone managed by endoscopic retrograde cholangiopancreatography (ERCP). The patient had post ERCP pancreatitis which resolved with medical management. Percutaneous cholecystostomy was also performed to control source of infection in the gallbladder. ERCP is the first procedure that will be preferred in the treatment of choledocholithiasis in pregnancy with the right indications provided that proper precautions have been taken. Possible harmful effects of ionized radiation on fetus during fluoroscopy should be minimalized by giving in short periods and low doses.Keywords:

Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management Lesmana, Rinaldi A; Darnindro, Nikko
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Hepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.Keywords: hepatitis A, prolonged cholestasis, steroid therapy

Efficacy of Combination Sofosbuvir, Pegylated-Interferon, and Ribavirin for Treatment of Hepatitis C Virus Genotype 1 Infection in Indonesia Jasirwan, Chyntia Olivia Maurine; Hasan, Irsan; Gani, Rino Alvani; Kalista, Kemal Fariz; Sulaiman, Andri Sanityoso; Kurniawan, Juferdy; Lesmana, Cosmas Rinaldi A; Hanif, Muhammad Yusuf
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 2 (2018): VOLUME 19, NUMBER 2, August 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: The presence of direct-acting antiviral (DAA) has improved the treatment of HCV infection and making it more preferable than Pegylated-interferon (PegIFN) and Ribavirin (RBV) based treatment. However, treatment with all DAA combination regimen is limited and expensive in low health care affordability country including Indonesia. The appearance of generic sofosbuvir (SOF) facilitate the utilization of SOF plus PegINF with or withour RBV combination. Therefore, in this study we assessed the efficacy of SOF+RBV and SOF+RBV+PegINF combination for treatment of chronic hepatitis C infections patient with genotype 1 in IndonesiaMethod: We performed retrospective study comprising 128 patients in Cipto Mangunkusumo Hospital with chronic hepatitis C, genotype 1, infection. 36 patients was treated with PegINF+SOF+RBV and 92 patients was treated with SOF+RBV with the duration of therapy was 12 and 24 weeks in both arms. The primary endpoint was sustained virologic response after treatment completion (SVR12)Results: In the end of treatment, 99.2% patients achieved undetected HCV RNA in 12 weeks and 24 weeks duration of therapy (100% in PegINF+SOF+RBV group and 98.9% in SOF+RBV group). The SVR12 of PegINF+SOF+RBV reach 100% meanwhile The SVR12 of SOF+RBV reach 88%. No different in SVR12 between cirrhotic and non-cirrhotic patient in PegINF+SOF+RBV group while in SOF+RBV group, the SVR12 was lower in cirrhotic patients (82.9%) compared to non-cirrhotic patients (92.2%). In multivariate analysis, HIV co-infection is associated with lower SVR12 in SOF+RBV group.Conclusion: 12 weeks and 24 weeks of PegINF+SOF+RBV and SOF+RBV is effective in the treatment of genotype 1 chronic hepatitis C infection

Co-Authors Alvin Nursalim Andri Sanityoso Andri Sanityoso Sulaiman Angga, Billy Ari Fahrial Syam Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Hanif, Muhammad Yusuf Hendra Koncoro Ignatius R Tenggara, Ignatius R Irsan Hasan Juferdy Kurniawan Kemal Fariz Kalista, Kemal Fariz Laurentius A Lesmana, Laurentius A Lutfie Lutfie, Lutfie Nikko Darnindro Pakasi, Levina S Perdana Aditya, Perdana Philipi, Benny Rino A Gani Rino Alvani Gani Suhendro Suwarto, Suhendro Sulaeman, Andri Sanityoso Taufiq Taufiq Ummi Ulfah Madina, Ummi Ulfah Waldemar Simanjuntak Willy Brodus Uwan, Willy Brodus

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