Bogi Pratomo
Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, University of Brawijaya/Dr. Saiful Anwar General Hospital, Malang

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Hubungan Pola Penggunaan OAINS dengan Gejala Klinis Gastropati pada Pasien Reumatik

Jurnal Kedokteran Brawijaya Vol 26, No 2 (2010)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

ABSTRAKKata Kunci : Obat Anti Inflamasi Non Steroid (OAINS) merupakan obat pilihan utama untuk osteoartritis. Penggunaan OAINS yang kurang  tepat  dapat  menyebabkan  gastropati.  Penelitian  ini  bertujuan  untuk  mengetahui  hubungan  pola  penggunaan OAINS dengan gejala klinis gastropati pada pasien reumatik Penelitian dilakukan dengan desain cross sectional pada 40 orang  pasien  dipilih  dengan  metode  consecutive  sampling.  Penelitian  ini  menilai  pola  pengguaan  OAINS  (jenis,  lama penggunaan,  cara  penggunaan,    pemakaian  obat  sitoproteksi  )  dan  gejala  klinis  gastropati  yang  timbul.  55%  pasien mengalami gejala klinis gastropati berupa sindrom dispepsia. Uji Kruskal Wallis gejala klinis gastropati antara penggunaan Na diclofenac, meloxicam, dengan ibuprofen menunjukkan p = 0,732. Uji regresi logistik lama penggunaan dengan gejala klinis  gastropati  menunjukkan  p  =  0,047.  Uji  Mann  Whitney  gejala  klinis  gastropati  pada  penggunaan  OAINS  secara periodik dengan berkelanjutan menunjukkan p > 0,05. Uji Mann Whitney gejala klinis gastropati pada penggunaan OAINS bersama  obat  sitoproteksi  dengan  penggunaan  OAINS  tanpa  obat  sitoproteksi  menunjukkan  p  =  0,000.  Penelitian  ini membuktikan  bahwa  jenis  OAINS  tidak  memberikan  perbedaan  gejala  klinis  gastropati,  demikian  juga  penggunaan periodik dan berkelanjutan. Dibuktikan juga bahwa lama penggunaan OAINS berhubungan dengan gejala klinis gastropati dan penggunaan obat sitoproteksi bersama dengan OAINS mengurangi gejala klinis gastropati.Gastropati, OAINS, reumatik

Hubungan Pola Penggunaan OAINS dengan Gejala Klinis Gastropati pada Pasien Reumatik

Jurnal Kedokteran Brawijaya Vol 26, No 2 (2010)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

ABSTRAKKata Kunci : Obat Anti Inflamasi Non Steroid (OAINS) merupakan obat pilihan utama untuk osteoartritis. Penggunaan OAINS yang kurang  tepat  dapat  menyebabkan  gastropati.  Penelitian  ini  bertujuan  untuk  mengetahui  hubungan  pola  penggunaan OAINS dengan gejala klinis gastropati pada pasien reumatik Penelitian dilakukan dengan desain cross sectional pada 40 orang  pasien  dipilih  dengan  metode  consecutive  sampling.  Penelitian  ini  menilai  pola  pengguaan  OAINS  (jenis,  lama penggunaan,  cara  penggunaan,    pemakaian  obat  sitoproteksi  )  dan  gejala  klinis  gastropati  yang  timbul.  55%  pasien mengalami gejala klinis gastropati berupa sindrom dispepsia. Uji Kruskal Wallis gejala klinis gastropati antara penggunaan Na diclofenac, meloxicam, dengan ibuprofen menunjukkan p = 0,732. Uji regresi logistik lama penggunaan dengan gejala klinis  gastropati  menunjukkan  p  =  0,047.  Uji  Mann  Whitney  gejala  klinis  gastropati  pada  penggunaan  OAINS  secara periodik dengan berkelanjutan menunjukkan p > 0,05. Uji Mann Whitney gejala klinis gastropati pada penggunaan OAINS bersama  obat  sitoproteksi  dengan  penggunaan  OAINS  tanpa  obat  sitoproteksi  menunjukkan  p  =  0,000.  Penelitian  ini membuktikan  bahwa  jenis  OAINS  tidak  memberikan  perbedaan  gejala  klinis  gastropati,  demikian  juga  penggunaan periodik dan berkelanjutan. Dibuktikan juga bahwa lama penggunaan OAINS berhubungan dengan gejala klinis gastropati dan penggunaan obat sitoproteksi bersama dengan OAINS mengurangi gejala klinis gastropati.Gastropati, OAINS, reumatik

Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicity

Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector 

Insiden dan Gambaran Klinis Hepatitis Akibat Obat Anti Tuberkulosis di Rumah Sakit Umum Daerah Dr. Saiful Anwar Malang

Jurnal Kedokteran Brawijaya Vol 28, No 3 (2015)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

 Hepatitis akibat obat anti tuberkulosis (OAT) merupakan ancaman yang serius terhadap pengendalian penyakit tuberkulosis. Namun belum ada data yang representatif mengenai hal tersebut dalam suatu populasi. Penelitian ini bertujuan untuk memahami gambaran klinis dan mengevaluasi efek dari terapi obat anti tuberkulosis di Rumah Sakit Umum Daerah Dr. Saiful Anwar Malang pada tahun 2013. Penelitian ini merupakan penelitian deskriptif potong-lintang (cross sectional) yang melibatkan sebanyak 460 pasien tuberkulosis (TB) yang menerima directly observed treatment strategy (DOTS). Dari hasil penelitian diperoleh 25 pasien yang mengalami hepatitis akibat OAT dengan nilai insiden sebesar 5,4%. Gejala-gejala yang paling sering timbul adalah rasa mual dan muntah (48%). Terjadi hepatitis ringan (20%), sedang (48%), berat (4%), dan sengat berat (4%). Sebanyak 60% tanpa penyakit penyerta. Efek Hepatitis yang menyebabkan pemberhentian OAT sementara sebesar 56% kasus dan yang tetap meneruskan OAT sebesar 44% kasus,  rata-rata durasi terapi hepatitis akibat Obat Anti Tuberkulosis adalah 18 hari. Hepatitis akibat OAT dapat mempengaruhi angka keberhasilan (outcome) terapi. Adanya insiden hepatitis akibat OAT dan besarnya populasi Hepatitis tersebut di Rumah Sakit Saiful Anwar menunjukkan bahwa mendeteksi efek negatif dari terapi OAT sangatlah penting.Kata Kunci: Anti-tuberculosis drug induced liver injury (ATLI), Obat Anti Tuberkulosis (OAT), tuberkulosis paru

Overview of Serum Interleukin-18 (IL-18) Levels in Liver Cirrhosis Patients and Their Correlation to Hepatic Encephalopathy

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

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Abstract

Background: The inflammatory process has an important role in the pathophysiology of hepatic encephalopathy (HE) in liver cirrhosis. IL-18 is a key mediator who plays a role in neuroinflamation processes that can lead to symptoms of HE. This study aimed to determine serum IL-18 levels in liver cirrhosis patients and to assess the association of serum IL-18 levels with HE.Method: A total of 52 subjects (32 patients with liver cirrhosis and 20 healthy controls) were enrolled in this study. 32 patients with liver cirrhosis will be assessed for HE based on West-Haven criteria. All subjects were examined for serum IL-18 levels which is measured by ELISA method. We performed a comparative analysis between serum IL-18 levels of liver cirrhosis patients and healthy controls, a correlation analysis between serum IL-18 levels and HE, and a comparative analysis of serum IL-18 levels among degrees of HE.Results: Mean serum IL-18 levels in the liver cirrhosis group were 688.5 ± 674.3 pg/ml, and in the healthy controls group were 163.9 ± 100 pg/mL with p value = 0.01 (p < 0.05). There was a significant correlation between IL-18 and HE (r = 0.85, p = 0.00). Serum IL-18 levels in covert and overt HE groups were significantly higher than those without HE (p < 0.05).Conclusion: Serum IL-18 levels were significantly higher in liver cirrhosis patients than in healthy controls. There was a positive correlation between IL-18 and HE. Serum IL-18 levels in liver cirrhosis patients with HE were significantly higher than those without HE.

Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicity

Effects of Curcumin against Matrix Metalloproteinase-2 (MMP-2) and Tissue Inhibitor Metalloproteinase-2 (TIMP-2) Serum Level on Rat Model of Liver Fibrosis Resolution Process

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 1 (2018): VOLUME 19, NUMBER 1, April 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Liver fibrosis is an effect from continuous fibrogenesis and fibrolysis process. During fibrogenesis, MMP-2 and TIMP-2 that produced by hepatic stellate cell (HSC) have a role to regulate extracellular matrix (ECM) homeostastic. Otherwise, curcumin inhibits both MMP-2 and TIMP-2 expression and enhances HSC apoptosis, thus inhibit fibrogenesis. Role of curcumin, MMP-2, and TIMP-2 in a fibrolysis process has not been widely studied. This study aimed to determine the correlation between curcumin administration and the decline of MMP-2 and TIMP-2 on rat model of liver fibrosis.Method: This is an experimental study done in male Wistar rats. There are 8 groups consist of 4 rats each. Both control and intervention group were exposed to CCl4 1 cc/kgBW intraperitoneally 2 times per week for 9 consecutive weeks to form F3 fibrosis. Negative control group was injected with normal saline. After CCl4 injection, control group was given curcumin solvent as placebo while intervention groups were given curcumin 200 mg/kgBW for 2, 5, and 9 weeks. Statistical analysis then conducted in the end of study. Results: MMP-2 and TIMP-2 were remarkably increased in positive control group, but found decreased in control group 5 and 9. There are remarkable decrease of MMP-2 and TIMP-2 serum level in intervention group 2, 5, and 9, but MMP-2 and TIMP-2 level was significantly lower in intervention group 2 compared to the control group.Conclusion: MMP-2 and TIMP-2 serum level were decreased after giving of curcumin for 2 weeks. The duration of curcumin administration correlated with decrease of TIMP-2 serum level but not correlated with MMP-2 serum level in rat model of liver fibrosis.

Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Original Source | Check in Google Scholar

Abstract

Background: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector 

Serial Case: Colorectal Malignancy in Young Age

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, August 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Colorectal cancer was the third most common cancer found worldwide. In 2002, colorectal cancer was the 2nd most common cancer in men, while it ranked third among women. Based on Indonesian Ministry of Health data, its prevalence was 1.8 per 100.000 population. We report four cases of colorectal cancer in this case series, and all cases was occured among person aged 28-32 years old. Age was the main relevant risk factors for colorectal cancer in most population. Only 3% of colorectal cancer found in individual aged less than 40 years old. This case series also aimed to show that risk factors was various and changing by the time, but its determinant factors could not be explained yet.