Background: Bacterial translocation plays a critical role in the pathogenesis of systemic inflammation in cirrhosis, particularly in cases related to chronic Hepatitis B infection. Lipopolysaccharide-binding protein (LBP) is a key acute-phase reactant that reflects exposure to endotoxins, yet its relationship with portal hypertension remains poorly defined. This study aimed to evaluate the correlation between serum LBP levels and spleen stiffness, a non-invasive marker of portal hypertension in patients with Hepatitis B-related cirrhosis. Methods: A cross-sectional study was conducted on 50 patients with Hepatitis B-related cirrhosis at Dr. Mohammad Hoesin Hospital, Palembang, between September and December 2024. Serum LBP levels were measured, and spleen stiffness was assessed using transient elastography. Laboratory parameters, clinical characteristics, and virologic profiles were analyzed. Correlation analyses were performed using Pearson’s or Spearman’s correlation tests, as appropriate. Results: The mean serum LBP level was 20.49 ± 7.34 μg/mL, while the mean spleen stiffness was 71.69 ± 17.74 kPa. A negative but non-significant correlation was observed between serum LBP levels and spleen stiffness (r = -0.263, p = 0.065). Serum LBP levels showed significant negative correlations with total, direct, and indirect bilirubin levels, as well as transaminase levels (AST and ALT), but not with platelet count, HBV DNA levels, or coagulation parameters. Conclusion: In patients with Hepatitis B-related cirrhosis, serum LBP may reflect systemic inflammatory activity rather than the severity of portal hypertension. Further studies are needed to determine its prognostic value in cirrhotic complications.
Background: The oxidative stress caused by diabetes mellitus (DM) damages hepatocytes and reduces liver function. In this context, flavonoids and acetogenins found in soursop (Annona muricata L.) leaf have hepatoprotective and antioxidant qualities. Therefore, this study aimed to assess the effect of Annona muricata leaf extract on hepatocyte index and hepatic histopathology in diabetic Wistar rats. Methods: In a laboratory experiment, 16 male Wistar rats weighing 100–150 g and aged 2-3 months were given a high-fat diet and an injection of streptozotocin (27.5 mg/kg BW) to induce type 2 diabetes. Rats were placed in a randomized posttest-only control group. For 21 days, these experimental animals were split into two groups at random, namely control (n = 8) receiving aquadest, and treatment group (n = 8) receiving Annona muricata leaf extract at a dose of 100 mg/kg BW. Hematoxylin-eosin staining was used to analyze hepatic histopathology, and a quantitative evaluation of hepatocyte index was conducted. The independent t-test and Mann-Whitney U test were adopted to assess the data. Results: There was a significant difference (p=0.041) in hepatocyte index between treatment and control groups. Treatment group had less hepatocyte deterioration than the control, according to histopathological scoring (p=0.037). Conclusion: Diabetic Wistar rats treated with Annona muricata leaf extract showed better hepatocyte index and decreased hepatic degeneration, suggesting hepatoprotective potential
Many individuals worldwide suffer from functional dyspepsia (FD), a chronic digestive disorder characterized by symptoms in the absence of observable structural abnormalities within the gastrointestinal system. This condition significantly impacts the quality of life and healthcare expenditures. Although the precise etiology of FD remains incompletely understood, recent research indicates that low-grade inflammation, particularly within the duodenum, constitutes a substantial component of its pathophysiology. Such inflammation involves immune system dysregulation, activation of mast cells and eosinophils, and the secretion of pro-inflammatory cytokines, which collectively contribute to duodenal inflammation. This inflammatory response disrupts the enteric nervous system and elevates visceral hypersensitivity. Hypersensitivity and diminished gastric motility are associated with dysbiosis of the gut microbiota and Helicobacter pylori infection, and these associations are mediated via the gut-brain axis. Increasing evidence suggests that alterations in the duodenal microbiota may underlie immunological irregularities and FD. Recent therapeutic approaches, including probiotics, antihistamines, and leukotriene inhibitors, have demonstrated promise in addressing the inflammatory pathways implicated in FD. The purpose of this review is to examine current evidence concerning the role of inflammation in the pathogenesis of FD and to consider its potential implications for the development of novel therapeutic strategies. A deeper understanding of these underlying processes may facilitate the development of effective, targeted treatments, thereby improving patient outcomes.
Background: Non-Hodgkin lymphoma (NHL) is one of the most common lymphoid neoplasms, frequently presenting with extranodal involvement, including the lower gastrointestinal tract and mesentery. Accurate diagnosis requires integration of clinical data, histopathological features, and immunohistochemical (IHC) markers. However, evidence regarding clinical characteristics and IHC profiles of NHL in these anatomical sites remains limited. Therefore, this study aimed to describe the clinical characteristics and IHC profile (CD20 and CD3) of NHL involving the lower gastrointestinal tract and mesentery at Margono Soekarjo Purwokerto General Hospital during 2022-2024. Methods: The experiment was conducted using a retrospective descriptive design with secondary data from medical records. The study population included patients diagnosed with NHL of the lower gastrointestinal tract and mesentery, fulfilling inclusion and exclusion criteria. Extracted variables comprised age, sex, residence, tumor site, and IHC results (CD20 and CD3). Subsequently, the data extracted were analyzed using univariate descriptive statistics. Results: The results showed that 40 patients met eligibility criteria, with the majority being 40–60 years (57.5%) and predominantly men (60%). Tumors were most frequently located in the caecum (32.5%) and mesentery (27.5%), with the majority of patients residing in Banyumas (25%). IHC analysis showed that 37 patients (92.5%) had CD20 positivity, consistent with B-cell NHL, while 3 patients (7.5%) expressed CD3 positivity, indicating T-cell NHL. Conclusion: Lower gastrointestinal and mesenteric NHL predominantly affected middle-aged men, most commonly involving the caecum, with B-cell type as the predominant subtype.
Budd-Chiari syndrome (BCS) is a medical condition caused by a partial or complete obstruction of hepatic venous outflow. Epidemiologically, BCS was considered rare, and its infrequent diagnosis was attributed to limited diagnostic tools and low clinical awareness. Therefore, this review aimed to enhance clinicians' awareness, from accurate diagnosis to appropriate management of patients with BCS. The symptoms experienced by patients ranged from asymptomatic cases to fulminant forms of the disease. Imaging methods, such as Doppler ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), were often used to establish the diagnosis. The primary treatment for BCS included anticoagulants, typically warfarin or low-molecular-weight heparin (LMWH). Depending on the patient's clinical status, more invasive therapeutic interventions could also be necessary.
Gastrointestinal (GI) bleeding is a common condition that can be life-threatening and requires prompt diagnosis and treatment. In younger adults without significant comorbidities, GI bleeding presents a diagnostic challenge, as it is uncommon and requires thorough evaluation to identify the underlying cause. Chronic excessive alcohol consumption is a significant yet often underrecognized risk factor. In recent studies, the term alcohol-associated bowel disease (ABD) has been introduced to describe GI problems mainly related to alcohol consumption. We present a case of a 29-year-old male with a history of chronic alcohol use who presented with melena and hematochezia. Laboratory evaluation revealed anemia and hypoalbuminemia, while abdominal ultrasonography revealed moderate fatty liver disease. Esophagogastroduodenoscopy confirmed erosive gastroduodenitis with a mucosal break greater than 5 mm, accompanied by esophageal candidiasis and grade B esophagitis. Meanwhile, colonoscopy confirmed the diagnosis of ulcerative colitis with active erosive ulcer bleeding. This case highlights severe mixed GI bleeding associated with chronic alcohol use, which may be classified as ABD. This case report aimed to demonstrate the importance of considering ABD in a relatively healthy young adult presenting with mixed and severe gastrointestinal bleeding
The management of ulcerative colitis is primarily focused on the prevention of complications, remission sustenance, and enhancement of overall quality of life. However, long-term use of various pharmacological therapies can be associated with several side effects, including myelosuppression, hepatitis, lupus-like syndrome, and an increased risk of malignancy. These limitations have led to the search for safer therapeutic options, including bioactive compounds such as Beta-1,3/1,6-D-Glucan with immunomodulatory properties. Ganoderma lucidum contains Beta-1,3/1,6-D-Glucan as a principal bioactive compound extracted from its mycelium. Despite the broad therapeutic properties, exploration into its role specifically for ulcerative colitis patients remains scarce. Therefore, this case series aimed to explore the potential role of Beta-1,3/1,6-D-Glucan derived from Mycelium extract of Ganoderma lucidum in managing ulcerative colitis.
Background: Breast milk is the optimal source of infant nutrition, with formula feeding serving as an alternative when exclusive breastfeeding is not feasible. Feeding modalities may influence behavioral (crying), gastrointestinal (stool consistency), and dermatological manifestations. However, population-based comparative data in Indonesia remain scarce. Therefore, this study aimed to evaluate and compare the prevalence and patterns of symptoms between exclusively and non-exclusively breastfed infants. Methods: An analytical cross-sectional study was conducted at an outpatient clinic in Tangerang, Indonesia, utilizing structured parental interviews and clinical evaluations. A total of 290 healthy participants aged 0–12 months were enrolled, including 260 exclusively and 30 non-exclusively breastfed infants. Symptom severity over the preceding week was assessed using the standardized Cow’s Milk-related Symptom Score (CoMiSS™) framework, while chi-square and Fisher's Exact Tests were used to analyze symptom prevalence and co-occurrence patterns. Results: No significant differences were observed between the exclusively and non-exclusively breastfed groups in terms of abnormal stool consistency (8.5% vs. 10.0% ), increased crying duration (5.4% vs. 3.3% ), or skin rashes (41.2% vs. 40.0% ). There was no co-occurring symptom between stool consistency and crying in either group. No infant showed concurrent gastrointestinal and behavioral symptoms, with or without dermatological symptoms. Skin rashes were highly prevalent across the sample (~41%), but had no statistical association with gastrointestinal or behavioral manifestations. Conclusion: Feeding methods do not influence the clinical patterns of common infantile symptoms. Furthermore, stool abnormalities and excessive crying present as distinct entities rather than a unified cluster, offering reassurance to clinicians and parents managing these benign variations.
Chronic hematochezia is a clinical presentation with a broad differential diagnosis. Among infectious causes of hematochezia, amoebic colitis due to Entamoeba histolytica requires early consideration, particularly in tropical and endemic regions. However, the diagnosis of amoebic colitis is often challenging due to the limited sensitivity of stool examination, leading to delayed treatment. Therefore, this case report aims to explore the limitations of stool examination and emphasize the important role of colonoscopy and histopathology in establishing the diagnosis of amoebic colitis in patients with persistent symptoms. The diagnostic challenge was shown by the case of a 49-year-old man presenting with hematochezia for more than one month, accompanied by intermittent fever and abdominal bloating. Initial stool examination showed numerous erythrocytes and leukocytes, but no trophozoites or cysts of E. histolytica were identified. Due to persistent symptoms, colonoscopy was performed and showed pancolitis with multiple large irregular ulcers covered with friable debris that bled easily throughout the colon. Histopathological examination confirmed the presence of flask-shaped ulcers containing amoebic trophozoites, establishing the diagnosis of amoebic colitis. The patient was treated with metronidazole 750 mg three times daily for 10 days, resulting in complete resolution of hematochezia. This case showed that a negative stool examination did not exclude amoebic colitis. In patients with high clinical suspicion and persistent symptoms, colonoscopy and histopathological evaluation played a crucial role in confirming the diagnosis and enabling timely treatment. This report also showed the importance of a comprehensive diagnostic method to prevent delays in the management of amoebic colitis in endemic regions.
Gallbladder polyps (GP) are defined as elevations of gallbladder wall that protrude into the lumen. These elevations are commonly detected incidentally during abdominal ultrasonography and predominantly asymptomatic. Based on malignant potential, gallbladder polyps are broadly classified into neoplastic and non-neoplastic types. Although most cases remain clinically silent, some patients may present with right upper quadrant pain, localized tenderness, and, in certain instances, a palpable mass in the upper abdomen. Abdominal ultrasound (US) remains the primary modality for both diagnosis and surveillance of gallbladder polyps. In general, a polyp size of ≥10 mm serves as a key threshold for considering cholecystectomy. However, additional risk factors such as age 60 years, primary sclerosing cholangitis, Asian ethnicity, and sessile morphology should also be considered in clinical decision-making. Therefore, this review aimed to enhance clinical awareness and inform appropriate management strategies for patients with gallbladder polyps.
Background: Abdominal ultrasound is an essential competency for internists, although traditional workshop often lack structured learning strategies and measurable skill outcomes. To address this limitation, mastery learning offers deliberate practice, standardized assessment, and competency-based progression. However, the use of mastery learning in abdominal ultrasound training for internists remains limited. Therefore, this study aimed to evaluate the feasibility and effectiveness of applying mastery learning principles within a point-of-care basic upper abdominal ultrasound workshop designed for internists. Methods: A prospective study was conducted during the JIMDACE 2025 upper abdominal ultrasound workshop. Participants were subjected to pre- and post-training assessments across six targeted skills using a standardized checklist based on the Expert Performance Method. Subsequently, real-time feedback was provided during hands-on sessions. The scores obtained were analyzed using the Wilcoxon signed-rank test, followed by the calculation of effect size. Results: The results showed that the total scores of all 13 participants included in the final analysis improved from 1.750 (±1.571) at pre-test to 5 (range 0–6) at post-test. Furthermore, significant improvements were observed overall (p=0.001). Conclusion: The mastery learning-based workshop significantly improved abdominal ultrasound competence among internists, showing feasibility and strong educational impact. This method showed potential as a foundation for future structured ultrasound training programs.
Background: Acute appendicitis is a frequent cause of emergency surgery in children, but diagnosis can be challenging due to nonspecific clinical presentations, particularly in younger age groups. Therefore, this study aimed to describe the demographic characteristics of pediatric patients with suspected appendicitis, evaluate the diagnostic utility of the Pediatric Appendicitis Score (PAS), and the duration of postoperative care in the pediatric intensive care unit (PICU). Methods: This retrospective cross-sectional observational study included 15 pediatric patients with an acute abdomen who underwent exploratory laparotomy. PAS was applied, with histopathology as the reference standard, and postoperative PICU admission was performed for all patients. The variables collected were demographic data, PAS, histopathology results, and PICU length of stay. Diagnostic performance was also evaluated using sensitivity, specificity, predictive values, diagnostic accuracy, and area under the curve (AUC). Results: The results showed that histopathologically confirmed appendicitis was more common in older children and was associated with a higher mean. Using a cutoff value ≥6, PAS showed a sensitivity of 55.6% and specificity of 83.3%, while receiver operating characteristic analysis obtained moderate discriminative ability (AUC 0.704). Postoperative PICU length of stay tended to be shorter in confirmed cases, without statistical significance (p = 0.475). Conclusion: Pediatric appendicitis in the tertiary center predominantly affected children aged 5–18 years. The PAS showed moderate diagnostic accuracy, with good specificity but limited sensitivity. Although confirmed cases also tended to have shorter PICU stays, further studies comprising larger patient populations should be carried out to confirm and strengthen these results.
Background: HER2 is a proto-oncogene and therapeutic target in advanced gastric adenocarcinoma. Reports on its association with clinicopathological features and prognosis remain inconsistent. This study aimed to evaluate the relationship of clinical, endoscopic, and histopathological features with HER2 expression and its impact on two-year survival. Methods: A retrospective cohort study was conducted among patients ≥18 years with newly diagnosed gastric adenocarcinoma at four hospitals in Jakarta (2015–2019). Eligible cases had complete records and paraffin blocks. HER2 was assessed by immunohistochemistry and CISH using ToGA criteria. Chi-square/Fisher’s tests evaluated associations, while survival was analysed with Kaplan-Meier and Cox regression. Results: Among 122 patients, 15 (12.3%) were HER2-positive. More frequent expression was observed in liver metastases than in non-liver metastases (17.6% vs. 10.2%), in Borrmann type I/II than in Borrmann type III/IV (16.1% vs. 9.1%), in moderately rather than in poorly differentiated tumors (14.3% vs. 11%), and in intestinal-type rather than in diffuse/mixed-type tumors (13.9% vs. 10%); however, none were statistically significant. Median survival was 5 months in HER2-positive patients and 4 months in HER2-negative patients. HER2 was not significantly associated with two-year survival (HR [95% CI] = 1.12 [0.61, 2.06]). Mortality in patients with palliative therapy was higher than that of those with definitive/therapeutic therapy (76.8% vs 75.8%; HR = 1.547 [1.022, 2.343]). The combination of resection and chemotherapy intervention provided a protective effect on mortality with HR = 0.456 [0.219, 0.95]. There was a significant association between resection-chemotherapy combination therapy and survival in subjects with negative HER2 expression (HR = 0.409 [0.176, 0.947]. Conclusion: In this study, HER2 expression in gastric adenocarcinoma was 12.3%. HER2 expression tended to be higher in liver metastases, Borrmann type I/II, moderate differentiation, and intestinal type histopathology results. Combination therapy with resection and chemotherapy had a protective effect on mortality in this study. Median survival in HER2-positive patients was higher than in HER2-negative patients, but HER2 expression status was not a prognostic factor for two-year survival in gastric adenocarcinoma
Background: Insulin resistance, genetic susceptibility, oxidative stress, and inflammation lead to the development of non-alcoholic fatty liver disease (NAFLD). Alpha lipoic acid (ALA) has demonstrated benefits in enhancing insulin sensitivity and reducing inflammatory reactions in both human and animal studies. This study aims to determine the effectiveness of ALA against NAFLD. Methods: Detailed searches were conducted across several databases, including PubMed, CENTRAL, Europe PMC (medRxiv and bioRxiv), EBSCOhost (Medline), and ProQuest, using keywords such as lipoic acid, metabolic-associated fatty liver disease, steatohepatitis, and non-alcoholic fatty liver disease. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Result: Four studies were included in which the ALA effect was compared with placebo or no intervention. A significant reduction in BMI (p0.001), lipid profiles (p0.05), glycemic markers (p0.05), liver enzymes (p0.05), oxidative stress (p0.05), and fibrosis score (p0.05) was seen in NAFLD patients with ALA supplementation. Conclusion: This study shows that ALA may help manage NAFLD. However, further research is required to establish robust evidence.
Hyperuricemia has gained clinical interest due to emerging evidence of its association with various diseases, such as hypertension, diabetes mellitus, cardiovascular disease, chronic kidney disease, and fatty liver. Gut dysbiosis has been suggested to be linked to hyperuricemia, as the gastrointestinal tract is responsible for approximately one-third of the total human uric acid excretion. Alterations in gut microbiota composition have been observed in individuals with hyperuricemia.. Probiotics have regained popularity due to their beneficial health effects, and several studies have shown their potential as a dietary intervention for hyperuricemia. This review aims to examine the intestinal dysbiosis in individuals with hyperuricemia and explore the role of probiotics in ameliorating uric acid levels.
Intussusception is commonly found in the early years of infancy but is considered rare in adult patients. There are no specific symptoms for intussusception in adults, as it is typically seen in infants; hence, radiology imaging is a major key to determining the diagnosis. We presented a case where a 77-year-old male patient presented with persistent abdominal pain, distension, and bloody stool 4 days before an emergency department (ED) visit. The patient was referred from another healthcare facility after receiving a normal result of USG. A 3-view abdominal x-ray was performed, which revealed ileus with large bowel obstruction. The abdominal CT-scan later revealed a sausage-like sign, suggestive of a colo-colic intussusception with a large mass of fat as the leading point and pneumo-peritoneum. Abdominal CT-Scan showed the detailed imaging of how and where the intussusception is occurring and what seems to be the root problem. The laparotomy surgery report also confirmed the colo-colic intussusception with lipoma as the primary cause. Hence, radiology plays a crucial role in diagnosing the tumor leading to intussusception in the preoperative setting. Among the imaging techniques, abdominal CT scan has emerged as the preferred method due to its high sensitivity and ability to provide detailed information, which is essential for therapeutic management. This case report aimed to highlight the importance of radiological imaging, particularly abdominal CT scan, in diagnosing adult intussusception with a neoplastic leading point, and to present a rare case of colo-colic intussusception caused by a lipoma in an elderly patient.
Background: Liver cirrhosis is a chronic progressive disease associated with substantial morbidity and mortality. Although clinical management often emphasizes physical outcomes, assessment of health-related quality of life (HRQoL) provides a more comprehensive evaluation of patient well-being. A validated multidimensional instrument for HRQoL assessment is SF-36 (36-Item Short Form Health Survey). Therefore, this study aims to compare HRQoL among patients with chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC) using Indonesian version of SF-36. There are limited data from Indonesia comparing HRQoL across different stages of chronic liver disease, particularly including patients with chronic hepatitis. Methods: A cross-sectional study was conducted at Gastroenterohepatology Clinic of Saiful Anwar General Hospital, Malang, using 273 patients including 156 with chronic hepatitis, 88 with liver cirrhosis, and 29 with HCC. HRQoL was assessed using SF-36 questionnaire, which evaluated eight domains. Data were analyzed through Kruskal–Wallis test followed by Mann–Whitney post hoc analysis. Results: The results showed that HRQoL differed significantly across all SF-36 domains among the three groups (p 0.001), with the lowest scores observed in patients with HCC. Post hoc analysis showed a progressive decline in quality of life with increasing disease severity. However, no significant difference was found between cirrhosis and HCC groups in role limitations due to emotional problems (p 0.05). Conclusion: Advanced stages of chronic liver disease are associated with poorer HRQoL. Emotional role limitations appear less dependent on disease severity, signifying the need for psychological support across all stages.
Background: The severity of dyspepsia symptoms is often overlooked despite established definitions and diagnostic criteria. The Short Form-Leeds Dyspepsia Questionnaire (SF-LDQ) is a validated English-language tool designed to evaluate these symptoms. This research focuses on creating and validating an Indonesian version of the SF-LDQ. Methods: The SF-LDQ was translated into Indonesian following standard procedures, including forward-backward translation, cross-checking, and pilot testing. Unselected patients from Dabo Regional Hospital and Dabo Lama Community Health Center (Pusat Kesehatan Masyarakat, or Puskesmas) completed a questionnaire upon enrollment and again after three days via direct follow-up or blinded phone interviews. Reliability was measured through internal consistency (Cronbach’s α) and test-retest analysis (Spearman’s correlation). Meanwhile, validity was evaluated by comparing SF-LDQ scores with Rome IV Criteria-based diagnoses from blinded physicians and analyzing diagnostic performance with ROC curves. Results: A total of 204 participants were included. The Indonesian SF-LDQ exhibited excellent reliability, with Cronbach’s α of 0.875 and Spearman’s correlation of 0.984 (p 0.001). Validity analysis demonstrated an AUC of 0.946 (p 0.001, 95% CI = 0.913–0.978). A cut-off score of 6.5 yielded 87.0% sensitivity and 93.3% specificity. Conclusion: The Indonesian SF-LDQ is a dependable and valid tool for evaluating the frequency and severity of dyspeptic symptoms.
Cirrhosis is the advanced stage of liver disease, marked by the presence of liver fibrosis. Cirrhosis serves as a risk factor for various metabolic conditions, including hypoglycemia and hyperglycemia. Although the pathophysiology remains unclear, hyperglycemia can occur due to the interaction of various factors, such as insulin resistance. The prevalence of both diabetes mellitus and cirrhosis is increasing, and their interaction influences each other’s outcomes. Hepatogenous diabetes (HD) refers to diabetes mellitus that develops in patients with cirrhosis. HD is diagnosed using an oral glucose tolerance test, which typically reveals elevated postprandial blood glucose levels. The management of HD follows the same principles as diabetes mellitus treatment; however, pharmacological therapy should be individualized based on the patient’s liver function to ensure optimal outcome. The objective of this review is to provide a comprehensive discussion of HD, encompassing its pathophysiology, clinical implications, diagnostic approaches, and management strategies.
