Background: Intestinal ultrasound (IUS) is a non-invasive tool for monitoring inflammatory bowel disease (IBD), offering high diagnostic accuracy and greater patient convenience than gastrointestinal endoscopy. The present study evaluated the feasibility of a mastery learning approach in Indonesia’s inaugural IUS workshop to enhance skill acquisition among physicians. Methods: A retrospective study was conducted on 37 physicians who participated in a two-day IUS workshop employing a mastery learning approach that included flipped learning, lectures, a pre-test, hands-on sessions with real-time feedback, and a post-test. Skill acquisition was assessed using standardized checklists for scanning the sigmoid colon and terminal ileum, with pre- and post-test performance evaluated against a minimum passing standard (MPS) established by expert faculties. Data was analyzed using SPSS with appropriate statistical tests to determine learning outcomes and effect sizes. Results: 34 out of 37 participants completed the workshop and skill assessment. Significant improvements were observed in both sigmoid colon and terminal ileum ultrasound scores after training (P < 0.001), with effect sizes of r = 0.89 and r = 0.86, respectively. The MPS was achieved by 67.65% of participants for the sigmoid colon and 50% for the terminal ileum. Conclusion: A mastery learning–based workshop significantly enhanced IUS skill acquisition among internists and gastroenterologists. Based on the MPS criteria, approximately one-third of participants would require additional training for sigmoid colon scanning, while about half would benefit from further training in terminal ileum scanning.

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

Ulcerative colitis (UC) and Crohn's disease (CD) are increasingly prevalent in the Asia Pacific region, necessitating updated, region-specific guidance on advanced therapies. Targeted small molecule agents, such as filgotinib, tofacitinib, upadacitinib, etrasimod, and ozanimod; and the IL-23 p19 inhibitors (guselkumab, mirikizumab, risankizumab) are the newest advanced therapies in our armamentarium for the treatment of IBD. The aim of the Asia-Pacific consensus statements is to provide context-specific recommendations integrating real-world evidence specific to our region. The Asian-Pacific Association of Gastroenterology (APAGE) Committee on Inflammatory Bowel Disease, with the participation of Asian Education Network in Inflammatory Bowel Disease (AEN-IBD), convened a forum of 34 IBD experts from 12 countries to develop consensus guidelines on the best practices on the use of these new advanced therapies using the modified Delphi method. IL-23 p19 inhibitors have shown good efficacy in biologic-naïve and experienced patients in both UC and CD, with clinical and endoscopic superiority over ustekinumab and an excellent safety profile. JAK inhibitors (tofacitinib and filgotinib) are efficacious in UC, and upadacitinib is efficacious in both UC and CD. They have a rapid time to response, and emerging data on acute severe UC appears promising. However, careful screening and monitoring is needed for known side effects, and prophylactic vaccination for herpes zoster should be considered. S1P modulators (ozanimod, etrasimod) are efficacious in UC with a favorable side effect profile.

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.

Backgrounds Tuberculosis (TB) remains a significant health issue in Indonesia, ranking second globally in TB incidence in 2021. Diagnosing intestinal tuberculosis (ITB) is challenging due to its symptoms, which mimic other diseases, limited laboratory tests, and the need for invasive procedures like colonoscopy. This study aimed to develop a non-invasive laboratory panel for ITB using various biomarkers. Methods A cross-sectional study from November 2020 to December 2022 was carried out at Dr. Cipto Mangunkusumo National Central General Hospital. Laboratory parameters from 143 subjects were identified by Chi-square test and multiple regression analysis. The scoring system was developed based on the identified independent diagnostic parameters scored by regression coefficient β value and standard errors, with the cut-off value determined by the ROC curve. The sensitivity and specificity of the scoring system were determined using the ROC curve. Results Among 143 subjects, 22 were diagnosed with ITB and 121 Non-ITB (prevalence of 15.38%). This study was dominated by females (65.03%), with a ratio of 1.86: 1. The median age in this study was 41 years. The scoring system to differentiate ITB and Non-ITB consisted of 6 diagnostic parameters (referred to as the HEALTH scoring system) as follows: stool HBD-2 (1 and 0 points), ESR (1 and 0 points), blood ADA activity (1 and 0 points), Lymphocyte (0 and 1 point), stool TB PCR (2 and 0 points), and NLR (1 and 0 points). Subjects with scores ≥ 4 could be diagnosed as ITB. The sensitivity and specificity of the HEALTH scoring system were 68.18% and 95.04%, respectively. Conclusion This study developed and validated a laboratory panel called the HEALTH scoring system based on clinical biomarkers of stool HBD-2 level, ESR, blood ADA activity, lymphocytes, stool TB PCR, and NLR, which could be used to differentiate ITB from other gastrointestinal diseases.

Background:Pancreatic cancer is among the leading causes of cancer-related deaths worldwide. Resectable pancreatic cancer is typically treated with curative resection, often followed by adjuvant therapy. Despite this, recurrence rates remain high after resection. Additionally, micro-metastases may develop during the immediate postoperative period. To address this issue, neoadjuvant therapy has been proposed. This review aimed to assess the effectiveness of neoadjuvant treatment compared to surgery as first approach in resectable pancreatic cancer. Methods:A comprehensive literature search was conducted up to October 2, 2024, in CENTRAL, PubMed, ProQuest, SAGE and JSTOR. Randomized controlled trials (RCTs) evaluating the effects of neoadjuvant treatment in patients with resectable pancreatic cancer were included. Results:A total of 5422 articles were identified after duplicate removal. Following the screening process, 8 RCTs were included. No significant difference was observed in the overall survival (OS) among those who received neoadjuvant therapy and those who underwent upfront surgery (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.72-1.18; P=0.51). Additionally, the groups' disease-free survival (DFS) was comparable (HR 0.98, 95%CI 0.80-1.20; P=0.83). Patients who received neoadjuvant treatment had noticeably higher R0 resection rates compared to the upfront surgery group (risk ratio 1.31, 95%CI 1.11-1.55; P=0.002). Conclusions:When compared to upfront surgery, neoadjuvant therapy significantly improved the R0 resection rates, but had no significant effect on OS or DFS. More research is required to confirm the potential benefits of neoadjuvant therapy in treating resectable pancreatic cancer.

During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania1. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily2-4. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920-2024), we show spatiotemporal transitions across stages 1-3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.

Background Assessment of malnutrition is important in cancer patients, especially in gastrointestinal cancer in Indonesia. The Scored Patient-Generated Subjective Global Assessment (PG-SGA), an instrument that allows interdisciplinary assessment of malnutrition and its risk factors, has yet to be available in the Indonesian version. Object To produce a valid and reliable PG-SGA questionnaire in Indonesian while maintaining the English version's form, purpose, and meaning. Methods The PG-SGA questionnaire was translated, culturally and linguistically adapted, following the International Society for Pharmacoeconomics (ISPOR) principles. Each question item in the questionnaire will be assessed based on content validity, comprehensibility, and difficulty, operationalized by calculating item and scale indices. A scaled score of 0.80 - 0.90 is considered acceptable, while a score of more than 0.90 is considered excellent. Results The content validity of the entire PG-SGA questionnaire obtained an S-CVI of 0.92. The content validity score of the PG-SGA questionnaire on professional participants was S-CVI 0.91. The comprehensibility score of professional and general public participants was S-CI 0.89. The score for the difficulty of question items on the PG-SGA questionnaire with professional and general public participants obtained the results of S-DI 0.86 and 0.88. Conclusion The translation and cultural adaptation of the PG-SGA questionnaire according to the ISPOR principles of successfully maintaining the format, purpose, and meaning of the Indonesian version of the PG-SGA questionnaire. The PG-SGA questionnaire's Indonesian version is now comprehensible and relevant for patients, the general public, and professionals. However, there are components of the professional questions that are considered difficult, so additional descriptions or brief explanations and training are needed, especially for physical examinations.

Background: The current hypothesis regarding the mechanism of Non-Alcoholic Fatty Liver Disease (NAFLD) is the multiple hit theory, where one of the factors involved is gut microbiota. Short-chain fatty acid (SCFA) is the main metabolite of gut microbiota and is suspected to play a role in the development of NAFLD. This study aims to determine the correlation between SCFA levels (acetate, propionate, butyrate) and the degree of fibrosis and steatosis in patients with NAFLD assessed by controlled attenuation parameter (CAP) and transient elastography (TE). Methods: A cross-sectional study that included 33 consecutively selected patients at Cipto Mangunkusumo Hospital was conducted from January to August 2023. Fecal sample collection was performed for SCFA examination using GC-MS (Gas Chromatography-Mass Spectrometry). Absolute fecal SCFAs were analyzed for correlation with steatosis and fibrosis based on controlled attenuation parameter (CAP) and transient elastography (TE) values. Results: Subjects were predominantly female (51.5%), with an average age of 49 years, an average CAP value of 296 dB/m, and a median transient elastography value of 6.1 kPa. The ratio of acetate, propionate, and butyrate values in the subjects was 59:24:17. A moderate negative correlation was observed between the absolute butyrate and CAP values (r=-0.522; p=0.002). Conclusion: There is no correlation was identified between short-chain fatty acid levels and transient elastography values.

The emergence of Mpox as a significant zoonotic viral threat presents new challenges in gastrointestinal endoscopy. This article outlines the risk of Mpox transmission during gastrointestinal endoscopy, particularly through respiratory droplets and contact with the mucosal surfaces. Gastrointestinal endoscopy may also facilitate transmission by fomites, as the Mpox virus can persist on medical instruments and surfaces for long periods. Nosocomial Mpox transmission is a significant concern in both endemic and non-endemic regions. This highlights the necessity for enhanced infection control measures in gastrointestinal endoscopy, including pre-endoscopic assessment, proper use of personal protective equipment, and rigorous post-procedural disinfection. Additionally, vaccination of healthcare workers frequently exposed to high-risk situations is emphasized. Ongoing surveillance and monitoring of healthcare workers are key components in minimizing the transmission risk. Although no direct cases of Mpox transmission via gastrointestinal endoscopy have been reported, these recommendations mitigate the potential risks associated with such procedures and necessitate strict adherence to infection control protocols. By adhering to these protocols and adapting to current practices, gastrointestinal endoscopy can be safely performed during the Mpox upsurge, ensuring the protection of both patients and healthcare workers.

Background: DLBS2411, A bioactive fraction derived from the bark of Cinnamomum burmanii has been developed to address acid-related gastrointestinal disorders. This study evaluated the pharmacodynamic effect of DLBS2411 on the 24-hour intragastric acidity in healthy adults. Methods: In a 3-arm, parallel, double-blind, randomized, placebo-controlled clinical trial, healthy subjects received a single dose of DLBS2411 (250 mg or 500 mg) or placebo. Gastric pH was monitored, analyzed and profiled over 24 hours. Results: Of a total of 54 enrolled male subjects, 47 subjects (87.04%) were eligible for the analysis. The mean 24-hour intragastric pH for DLBS2411 250 mg and 500 mg was 2.29 ± 0.42 and 2.13 ± 0.50, respectively, both higher than placebo (1.93 ± 0.70). Differences were more pronounced during the first 12 hours (daytime). DLBS2411 250 mg and 500 mg reached a gastric pH 4 significantly faster (129.9 ± 128.2 and 92.9 ± 106.8 minutes) compared to placebo (196.9 ± 99.7 minutes). No serious adverse events occurred. All adverse events were mild and had been resolved by the end of study, confirming the safety and tolerability of DLBS2411 at the dose of 250 and 500 mg. Conclusion: DLBS2411 effectively suppressed the intragastric acidity and demonstrated a good safety profile in healthy adults. These findings warrant further studies of DLBS2411 in patients with gastric acid-related disorders. Keywords: Alternative medicine, DLBS2411 cinnamomum burmanii, healthy volunteers, intragastric-acidity, proton pump inhibitors

Esophageal squamous cell papilloma (ESP) is a benign tumor that is rarely found in the esophagus. Human papillomavirus (HPV) has been known to play a role in the development of ESP. In most cases, ESP is asymptomatic but may also manifest with dysphagia, heartburn, and epigastric pain. Although rare, ESP has the potential to become malignant; thus, early detection and removal of the tumor is essential. Here, we report a rare case of ESP in a 29-year-old woman.

Background: Inflammatory Bowel Disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), is an inflammatory digestive tract condition with unknown causes. Its unpredictable symptoms affect quality of life. In Indonesia, the quality of life of IBD patients remains unreported. Factors such as advanced age, long disease duration, active disease, corticosteroid use, comorbidities, unemployment, and poor sleep quality may reduce quality of life. This study aims to assess the quality of life profile of IBD patients and its associated factors. Methods: This cross-sectional study collected data from October to November 2024 through interviews at the outpatient unit of Dr. Cipto Mangunkusumo Hospital (RSCM). Quality of life was measured using the Inflammatory Bowel Disease Questionnaire 9 (IBDQ-9), and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Both tools were validated in Indonesian. Eligible participants met inclusion and exclusion criteria. Bivariate and multivariate logistic regression analyses identified factors associated with quality of life. Results: Among 201 participants, 95% reported a good quality of life. Multivariate analysis identified active disease (PR 4.072 [1.133–14.633], p = 0.031) and combination therapy (PR 12.803 [1.423–115.147], p = 0.023) as factors associated with poor quality of life. Age, disease duration, comorbidities, employment status, and sleep quality showed no significant associations. Conclusion: Most IBD patients (95%) in the RSCM outpatient unit reported a good quality of life. Active disease and combination therapy were linked to poorer quality of life.

Gastrointestinal toxicities of radiation might develop after exposure, thus leading to conditions such as abdominal pain, rectal bleeding, diarrhea, anemia, and weight loss. The development of drugs to reduce mucosal damage progression has been a focus on managing radiation proctitis. Radiation proctitis resulting from exposure to pelvic radiotherapies is effectively managed with topical administration on the anal mucosa. The clinical use of hyaluronic acid offers an innovative approach to managing radiation injury. Hyaluronic acid has multiple beneficial properties, such as regulating immune process to reduce inflammation and oxidative stress, supporting natural protective mechanism, promoting mucosa healing, and improving tissue hydration. Therefore, this case series introduces the idea that application of hyaluronic acid could potentially improve patients' clinical conditions.

Background:The impairment of gastrointestinal mucosa visibility during esophagogastroduodenoscopy (EGD), due to the presence of foam and bubbles, may lead to reduced quality in the EGD results. The combination of simethicone, a defoaming agent, along with N-acetylcysteine (NAC), which has mucolytic properties, has been proposed to improve the visibility of the mucosa. This study aimed to evaluate the effectiveness of pre-procedural administration of simethicone and N-acetylcysteine in improving mucosal visibility, procedure time and mucosal cleansing volume needed during EGD. Methods:We conducted a comprehensive literature search from inception to November 23, 2023, in PubMed, CENTRAL, ProQuest, SAGE, and JSTOR. We included randomized clinical trials that investigated the effects of simethicone with or without NAC as premedication in EGD. For the quantitative analysis, standardized mean difference (SMD) was used to assess continuous outcomes and risk ratio for dichotomous outcomes. The Cochrane risk of bias 2 tool was used to evaluate the risk of bias. Results:This meta-analysis comprised a total of 20 studies and found that simethicone with or without NAC improved mucosal visibility compared with control (SMD -1.27, 95% confidence interval [CI] -1.74 to -0.81, P<0.001). The combination of simethicone and NAC was significantly better than simethicone alone (SMD -0.68, 95%CI -1.08 to -0.28, P=0.001). Simethicone with or without NAC also shortened the procedure time compared to control (MD -1.40, 95%CI -2.67 to -0.12, P=0.03). The risk of bias was low with a moderate grade of certainty. Conclusion:The administration of simethicone with or without NAC may improve EGD quality.

Abstract BACKGROUND Epidemiologic stages of inflammatory bowel disease (IBD) have been proposed: 1. Emergence (low incidence and prevalence); 2. Acceleration in Incidence (rapidly rising incidence, low prevalence); and 3. Compounding Prevalence (stabilizing incidence, rapidly rising prevalence). To date, these stages have been theoretical without quantified definitions of incidence and prevalence. AIM To use machine learning to determine incidence and prevalence ranges corresponding to the epidemiologic stages and provide stage classifications across time for global regions. METHODS We built a supervised random forest classifier in R to determine epidemiologic stages of IBD from population-based studies (n=340), a subset derived from a systematic review on the incidence and prevalence of IBD. A labelled training data set comprising rates of incidence and prevalence of Crohn’s disease (CD) and ulcerative colitis (UC) extracted from the systematic review was used to predict classifications of stage 1, stage 2, or stage 3 for each region, stratified by decade (1960–2019). Model accuracy was measured using a blind validation data set. The validated model was then used to predict stage classifications for regions in the data set. Interquartile ranges for incidence and prevalence of CD and UC were calculated on the random forest output, and the distributions were compared using negative binomial regression. RESULTS The random forest’s classification accuracy on the blinded validation data was 93.7% (95%CI: 90.6, 96.1) indicating an appropriate model fit and performance. Significant differences between all stages for the incidence and prevalence of CD and UC (p<0.001) were found. The clear distinction across stages defines the incidence and prevalence ranges (25th–75th, per 100,000) for IBD as: CD incidence 0.0–0.3, UC incidence 0.2–0.7, CD prevalence 0.3–2.2, and UC prevalence 1.7–8.1 for stage 1; CD incidence 1.0–4.4, UC incidence 2.3–6.3, CD prevalence 9.0–33.9, and UC prevalence 22.8–73.3 for stage 2; and CD incidence 6.6–14.0, UC incidence 10.1–18.1, CD prevalence 163.2–274.7, and UC prevalence 189.1–323.2 for stage 3 (Figure 1). A decade-by-decade analysis shows global regions transitioning across the epidemiologic stages (Figure 2). By the 2010s, North America, Scandinavia, Western Europe, Australia, and New Zealand were in stage 3. Most regions in Asia and Latin America were in stage 1 in the last half of the 20th century, with many transitioning to stage 2 in the 2010s. DISCUSSION Temporal incidence and prevalence data show that regions transition across epidemiologic stages. Numerical definitions of the epidemiologic stages can be used to establish the anticipated burden growth of IBD by providing estimated rates of the number of incident and prevalent IBD cases a region can expect as it transitions between IBD epidemiologic stages in the future. Figure 1 Coalescing ranges for incidence (panel A) and prevalence (panel B) by Crohn’s disease and ulcerative colitis at epidemiologic stage 1, stage 2, and stage 3. Data were categorized by data type (incidence or prevalence), disease type (Crohn’s disease or ulcerative colitis), and epidemiologic stage, as per results from the random forest classifier. The 25th and 75th percentiles were calculated using the rates across all regions included in the analysis for all available time points for each box group. Figure 2 Global maps depicting epidemiologic stages of IBD evolution from 1960 to 2019 broken down by decade, as predicted by the random forest model. Panel A contains stage classifications from 1960 to 1969; panel B contains stage classifications from 1970 to 1979; panel C contains stage classifications from 1980 to 1989; panel D contains stage classifications from 1990 to 1999; panel E contains stage classifications from 2000 to 2009; and panel F contains stage classifications from 2010 to 2019.

Introduction. Esophageal variceal bleeding is one of the complications caused by an increase in pressure within the portal vein blood vessels. The gold standard examination for portal pressure is the hepatic venous pressure gradient (HVPG), but HVPG examination is invasive, involving transjugular catheterization of the hepatic vein. Currently, non-invasive methods for measuring portal hypertension are being developed to predict esophageal varices and esophageal variceal bleeding using spleen stiffness measurements. This study aimed to evaluate the accuracy of spleen stiffness measurement in predicting recurrent esophageal variceal bleeding in patients with liver cirrhosis.