Survival of Pancreatic Cancer Simadibrata, Marcellus
The Indonesian journal of gastroenterology, hepatology, and digestive endoscopy (Jakarta),
07/2020, Volume:
20, Issue:
2
Journal Article
Urease is an enzyme produced by diverse bacterial species including normal flora, non pathogens, and pathogens such as Proteus mirabilis, Staphylococcus saprophyticus, Klebsiella pneumonia, ...Citrobacter freundii, Enterobacter cloacae Helicobacter spp and Helicobacter pylori. Urease is central in Helicobacter pylori metabolism and virulence, important for colonization in the gastric mucosa. Urease catalyzes the hydrolysis of urea to ammonia and carbamate. This ammonia product can be examined by Urease biopsy test and Urea breath test such as 14C-Urea Breath Test or 13C-Urea Breath Test.Previously, the Urea breath test was intended to detect an increase in ammonia which is a urease product in the gastric mucosa produced by pathogenic gastric bacteria, such as Helicobacter pylori, etc.Acute and chronic gastritis caused by infection with these pathogenic bacteria infection turned out to be positive on Urea breath test. Indirectly, the results of the urea breath test are also related to the presence of inflammation in acute and chronic gastritis, regardless of whether the cause is Helicobacter pylori or other urease-producing pathogenic bacteria.The use of the urea breath test indirectly in diagnosing acute and chronic gastritis should be studied further. The use of the urea breath test is indeed very important to assist health services in countries and regions with limited endoscopic facilities, especially developing countries.We know that the prevalence of Helicobacter pylori infection in causing acute and chronic gastritis by examination of Urea breath test in Indonesia is not too high, ranging from 2-11.2%. So that is why more studies on non-Helicobacter pylori producing urease pathogens are needed, which can appear as a false positive urea breath test.
We investigated the gut microbiota in patients with non-alcoholic fatty liver disease (NAFLD) and its correlation with fibrosis and steatosis stratified by body mass index, as reflected in the ...controlled attenuation parameter and transient elastography values. A cross-sectional study was performed on 37 patients with NAFLD at Cipto Mangunkusumo National General Hospital from December 2018 to March 2019. The gut microbiota was investigated in fecal samples with 16S RNA sequencing using the MiSeq next-generation sequencing platform (Illumina). NAFLD was more common in patients with metabolic syndrome. Firmicutes, Bacteroidetes, and Proteobacteria were the predominant phyla. Bacteroides was more dominant than Prevotella, contrary to the results of previous studies on healthy populations in Indonesia. Microbiota dysbiosis was observed in most samples. The gastrointestinal microbiota diversity was significantly decreased in patients with NAFLD, high triglyceride levels, and central obesity. The Firmicutes/Bacteroidetes ratio correlated with steatosis and obesity, whereas some of the other species in lower taxonomy levels were mostly associated with steatosis and obesity without fibrosis. Proteobacteria was the only phylum strongly correlated with fibrosis in patients with an average body mass index. The gut microbiota diversity was decreased in patients with NAFLD, high triglyceride levels, and central obesity, and certain gut microbes were correlated with fibrosis and steatosis.
Diagnostic Approach and Management of Solid Pancreatic Mass Puspadina, Shafira; Simadibrata, Marcellus
The Indonesian journal of gastroenterology, hepatology, and digestive endoscopy (Jakarta),
12/2022, Volume:
23, Issue:
3
Journal Article
Open access
The pancreas is a complex organ in which a suspicious lesion can appear which can be benign or malignant. Clinical manifestation can guide the clinician to choose the appropriate tests such as ...autoimmune tests, tumor markers, imaging with ultrasonography (USG), computerized tomography (CT), magnetic resonance imaging (MRI), or magnetic resonance cholangiopancreatography (MRCP), and endoscopic or surgical tissue biopsy. Pancreatic nodule therapy is tailored to the nature of the nodule, etiology-appropriate therapy for benign nodules or surgery, chemotherapy, and radiotherapy for cancerous nodules. Knowledge of the diagnostic approach of pancreatic solid mass is important for clinician to make prompt and accurate treatment for patients and to prevent unnecessary examination or intervention.
Inflammatory bowel disease (IBD) in the form of ulcerative colitis (UC) and Crohn's disease (CD) has multifactorial etiology and multiple inflammatory pathways. Newer treatments with biologic agents ...are used as an adjunct to conventional therapy. Biological agents such as anti-TNF, anti-integrin, and anti-interleukin are believed to be able to overcome the inflammation that underlies the occurrence of IBD. The “step up” approach in IBD therapy uses conventional drugs with low potency but fewer side effects as the first line, followed by biologic agents as second line therapy. However, the result is often a delay in the management of severe complications of IBD. A “top down” approach is currently being used to successfully prevent severe complications of IBD by using biologic agents early. Biological agent therapy can be initiated in moderate to severe IBD either in combination or sequentially. But in the end, various parameters must be considered before starting the use of biologic agents such as drug effectiveness, safety profile, drug availability, price, and patient preferences.
Background: Ulcerative colitis (UC), a chronic inflammatory disease that can cause bloody diarrhea, remains a major global disease burden. While Helicobacter pylori infection is postulated to be able ...to reduce the occurrence of UC, its role in the disease itself remains contentious. Hence, this meta-analysis aims to examine whether H. pylori infection can lower the chance of developing UC.Method: A systematic search was conducted through three electronic databases, namely Cochrane, PubMed, and Embase, with the addition of individual hand searching to analyze the association between ulcerative colitis and H. pylori infection in the adult population. Relevant articles selected through eligibility criteria were assessed for quality by using the Newcastle-Ottawa Scale. Furthermore, a random-effects meta-analysis was conducted to estimate the pooled odd ratios (ORs) along with their 95% confidence intervals (CIs). Higgins test and funnel plots were also conducted.Results: A total of 11,498 patients with UC and 356,130 controls from 22 studies were included in the meta-analysis. Included studies showed fair or good quality. Good quality was achieved with the minimum score of 3 stars for selection, 1 star for comparability, and 2 stars for outcome/exposure, while fair quality was achieved with the minimum score of 2 stars for domain, 1 star for comparability, and 2 stars for outcome/exposure. Our findings indicated that H. pylori infection was associated with lower odds of UC pooled ORs 0.51 (95% CI: 0.46-0.56)), albeit moderate heterogeneity (I2= 54%, p = 0.002). Furthermore, publication bias was not found.Conclusion: The present study adds to the growing body of evidence supporting the potential protective effects of H. pylori infection on the occurrence of UC. However, further primary research with prospective study design needs to be conducted to confirm our findings.
H. pylori is a common human pathogen and it is estimated that approximately 50% of the world's population are infected. Furthermore it's prevalence infection in Indonesia is 20% but much higher among ...several ethnic groups (Papuans 42.9%, Batak 40.0%, and Bugis 36.7%). H. pylori’s growth and survival has been shown to be sensitive to a variety of antimicrobial agents. The success of the treatment depends on susceptibility, dosage, formulation, dose frequency, the use of adjuvants such as anti-secretory drugs, antacids or probiotics, and duration of treatment. The treatment for H. pylori infection keep evolving and the triple therapy, levofloxacin, was replaced by CLR in triple therapy for 14-day with eradication rates over 90%. Sequential therapy, also achieved a higher cure rate against clarithromycin-resistant strains than a 7 and 10 day triple therapy. Triple bismuth therapy and quadruple bismuth therapy are used less frequently due to their inherent complexity, the large number of tablets four times a day, side effects, and lack of support from pharmaceutical companies. Inclusively, vonoprazan is also a good choice that is fully effective from day one. The role of the probiotics is unclear and is not recommended in consensus groups. Two mucolytic agents, erdosteine and N-acetylcysteine (NAC), were found to increase it's eradication efficiency clinical trials when administered in supplementation with triple therapy but are not commonly used because of the need for high doses, and increased medical costs. therefore, H. pylori resistant management should be adapted to the results of the the culture of resistance and the guidelines of existing resistance patterns.
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