Although the prevalence of Helicobacter pylori infection in Indonesia is lower than that in other countries, H. pylori is still an essential pathogen associated with severe gastric mucosal damage and dyspeptic symptoms. Invasive diag-nostic methods are not ideal due to the lack of endoscopic centers and high costs without full coverage by social insur-ance. Among the noninvasive methods, the urea breath test is widely available in Indonesia and has been suggested as the primary option to ensure the successful eradication of H.pylori. There has been no local validation for the urea breath test utilizing 13 C or 14 C. The stool antigen test is inexpensive and suitable for use in active infections before and after eradication; however, customs and habits are obstacles to delivering fresh stool on time. Only polyclonal antibodies and qualitative stool antigen test kits with low sensitivity are available. Serology is a widely validated method and has good accuracy, but it cannot distinguish between active and inactive infections. According to our observations, serology is the main choice of experts and patients, as it is simple, inex-pensive and widely known. The urine test is an alternative for reducing costs and endoscopic workload, with high accuracy but low sensitivity. Further studies are necessary to prove the validity of the urine test to be used throughout Indonesia, especially in areas with a low prevalence of H. pylori infec-tion. In conclusion, the validated urea breath test and the stool antigen test are considered noninvasive practical ap-proaches for the detection of H. pylori infection in Indonesia, with serological and urine tests as alternatives.

Background/Aims: The management decisions regarding gastroesophageal reflux disease (GERD) may differ according to the presence of erosive esophagitis. On the other hand, the availability of upper endoscopy in Indonesia is relatively limited. This study compared the Reflux Disease Questionnaire (RDQ) and the GERD questionnaire (GERDQ) performance in predicting the presence of clinically significant erosive esophagitis and determined the validity and reliability of the Indonesian-translated version of RDQ. Methods: Ninety-two adults with GERD suspicion were recruited. All patients completed RDQ and GERDQ. Receiver operating curve analysis was conducted on RDQ and GERDQ to evaluate their performance in discriminating LA GERD B or higher esophagitis from others. The translated RDQ preserved its main structure and was culturally adapted. Results: The patients were 66.3% female and 73.9% Javanese. Only 22 (23.9%) patients presented with LA grade B or higher erosive esophagitis. The RDQ showed a higher AUC than the GERDQ (0.602 vs. 0.589). A cutoff point of 20 was selected for the RDQ with sensitivity and specificity of 73% and 50%, respectively, whereas the optimal cutoff point of GERDQ was 8, with a sensitivity and specificity of 77% and 43%, respectively. The r-value greater than the critical value table (r>0.205, p<0.01) confirmed the construct validity of our translated RDQ. The questionnaire also demonstrated excellent reliability (α=0.900) and moderate similarity with the Indonesian version of GERDQ (κ=0.459, p<0.01). Conclusions The RDQ is slightly superior to GERDQ in predicting the presence of clinically significant erosive esophagitis (LA grade B or higher). The Indonesian-translated RDQ is valid and reliable.

Background/Aims: The Reflux Symptom Index (RSI) is a questionnaire that evaluates the severity of extra-esophageal symptoms and is one of the most widely used measures to evaluate LPR. This study assessed the validity and reliability of the RSI questionnaire in Bahasa Indonesia and investigated the association between each extra-esophageal symptom reported in the questionnaire and the severity of erosive esophagitis as determined by endoscopic findings. Methods: 85 adult patients with GERD symptoms had an upper endoscopy examination and were asked to complete the translated RSI. The validity and reliability of the questionnaire were assessed. Results: The construct validity of the RSI translated into Bahasa Indonesia was verified with the r value of each question being higher than the crucial table value (r>0.213, p<0.05). Our questionnaire had a Cronbach alpha value of 0.81, which indicates an acceptable level of internal consistency. At least one extra-esophageal symptom was seen in 91.7% of patients with Los Angeles (LA) grade B or higher-grade esophagitis. In addition, the presence of extra-esophageal symptoms was associated with significant mucosal erosion (p=0.20). The symptoms of cough after eating or lying down and chronic cough were associated with the severity of esophageal mucosal erosion (p<0.05). Conclusions The version of RSI translated into Bahasa Indonesia is a valid and reliable tool for assessing extra-esophageal GERD symptoms. The occurrence of extra-esophageal symptoms in patients with typical GERD symptoms is associated with endoscopic findings of LA grade B or erosive esophagitis of higher severity.

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder associated with substantial impairment which considerably burdens healthcare systems worldwide. Research on IBS has largely been conducted in high-income countries posing barriers to the application of diagnostic strategies in low- and middle-income countries (LMICs) due to differences in disease characteristics, healthcare resources, and socioeconomic factors. This review discusses the diagnostic issues associated with LMICs. We present a concise overview of the relevant approaches and propose a diagnostic strategy based on the latest evidence. A positive diagnostic strategy that relies on appropriate symptom-based criteria is crucial within the diagnostic framework. A combination of complete blood count, fecal occult blood test, and complete stool test may reliably identify individuals with suspected IBS who are more likely to have organic diseases, thus justifying the necessity for a colonoscopy. Eventually, we developed a diagnostic algorithm based on a limited setting perspective that summarizes the available evidence and may be applied in LMICs.

BACKGROUND/AIMS: Differences in the Helicobacter pylori infection rate are not sufficient to clarify the dissimilarity of gastric cancer incidence between Myanmar and its neighboring countries. To better understand this trend, the H. pylori virulence gene cagA was characterized in Myanmar. METHODS: Glutamate-proline-isoleucine-tyrosine-alanine (EPIYA) patterns and CagA multimerization (CM) motifs of cagA genotypes were examined by performing polymerase chain reactions and DNA sequencing. RESULTS: Of 69 tested H. pylori strains, cagA-positive patients had significantly more severe histological scores in their antrum than cagA-negative patients. Sequence analysis revealed that 94.1% of strains had Western-type cagA containing an EPIYA motif (92.6%) or EPIYT motif (6.4%). The intestinal metaplasia scores in the antral of patients infected with the ABC and ABCC types of cagA were significantly higher than those of patients with AB-type cagA. Interestingly, in patients infected with H. pylori, 46.3% of strains with three EPIYA motifs contained two identical Western-typical CM motifs, and these patients showed significantly higher antrum inflammation scores than patients infected with two identical nontypical-CM motif strains (p=0.02). CONCLUSIONS: In Myanmarese strains, Western-type cagA was predominant. The presence of CM motifs and the proportion of multiple EPIYA-C segments might partially explain the intermediate gastric cancer risk found in Myanmar.
Genotype ; Helicobacter pylori ; Helicobacter ; Humans ; Incidence ; Inflammation ; Metaplasia ; Myanmar ; Polymerase Chain Reaction ; Sequence Analysis ; Sequence Analysis, DNA ; Stomach Neoplasms ; Virulence

Helicobacter pylori infects more than half the human population. However, the prevalence in Indonesia is low, as is the prevalence of gastric cancer. Hence, it could be instructive to compare these prevalence rates and their determining factors with those of countries that have high gastric cancer incidence. Ethnicity and genetic characteristics of H. pylori are important determinants of the H. pylori infection rate in Indonesia. The infection rate is higher in Bataknese, Papuans and Buginese than in Javanese, the predominant ethnic group. Ethnicity is also an important determinant of the genetic characteristics of H. pylori. Analysis of CagA in the EPIYA segment showed that the predominant genotypes in Papuans, Bataknese and Buginese are ABB-, ABDand ABC-type CagA, respectively. Meanwhile, in the countries with high gastric cancer incidence, almost all strains had East Asian type CagA. An antibiotic susceptibility evaluation showed that the standard triple therapy can still be used with caution in several cities. There is a very high rate of resistance to second-line regimens such as levofloxacin and metronidazole. Recent studies have shown that furazolidone, rifabutin and sitafloxacin are potential alternative treatments for antibiotic-resistant H. pylori infection in Indonesia. Rather than focusing on early detection and eradication as in countries with high gastric cancer prevalence, countries with low gastric cancer prevalence should focus on screening the several groups that have a high risk of gastric cancer.

Helicobacter pylori infects more than half the human population. However, the prevalence in Indonesia is low, as is the prevalence of gastric cancer. Hence, it could be instructive to compare these prevalence rates and their determining factors with those of countries that have high gastric cancer incidence. Ethnicity and genetic characteristics of H. pylori are important determinants of the H. pylori infection rate in Indonesia. The infection rate is higher in Bataknese, Papuans and Buginese than in Javanese, the predominant ethnic group. Ethnicity is also an important determinant of the genetic characteristics of H. pylori. Analysis of CagA in the EPIYA segment showed that the predominant genotypes in Papuans, Bataknese and Buginese are ABB-, ABDand ABC-type CagA, respectively. Meanwhile, in the countries with high gastric cancer incidence, almost all strains had East Asian type CagA. An antibiotic susceptibility evaluation showed that the standard triple therapy can still be used with caution in several cities. There is a very high rate of resistance to second-line regimens such as levofloxacin and metronidazole. Recent studies have shown that furazolidone, rifabutin and sitafloxacin are potential alternative treatments for antibiotic-resistant H. pylori infection in Indonesia. Rather than focusing on early detection and eradication as in countries with high gastric cancer prevalence, countries with low gastric cancer prevalence should focus on screening the several groups that have a high risk of gastric cancer.

Objective: To determine the proportion of HBV surface antigen (anti-HBs) antibody positive children under five years of age born to HBsAg-negative mothers and to analyze the possible related factors following implementation of a hepatitis B vaccination program for infants in Indonesia 22 years ago. Methods: Blood samples were taken from children under five years of age born to HBsAg-negative mothers who have completed primary vaccination series. Anti-HBs antibodies were determined by using rapid test. Data of age, gender, nutritional status, vaccination timing or vaccination compliance, and booster vaccination were collected from vaccination card. Results: Ninety children were enrolled, consisting of 47 females and 43 males with a mean age of 2.3 years. Twenty two (24.4%) children received booster vaccine between 18 and 24 months and 55 (61.1%) were anti-HBs positive. Among factors of age, gender, nutritional status, compliance to vaccination and booster vaccine, only administration of booster vaccine was significantly associated with anti-HBs status (OR 5.45, 95% CI 1.45, 20.52). Children who received booster vaccine at age of 18-24 months were 5.45 times more likely to be anti-HBs positive than that of children who did not receive booster vaccine. Conclusions: Booster vaccine rate is low among children under 5 years of age but is associated with anti-HBs positivity. Booster vaccination may be required to improve anti-HBs seropositivity.

Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).

Objective: To investigate the cardioprotective effect of Saffron (Crocus sativus L.) treatment as a potential supplement on patients with type 2 diabetes mellitus (T2DM). Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to analyze articles retrieved from PubMed, ScienceDirect, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and China Biology Medicine (CBM) with a publication time span from January 15, 2015 to March 20, 2023. The articles were published in English only, including randomized controlled trials (RCTs) on adult patients who were diagnosed with T2DM, and received either Saffron or placebo treatment. Meta-analysis was performed using Review Manager 5.4 software. The present study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number as CRD42023443180. Results: Seven RCTs with 455 patients were included in the study. The data revealed that Saffron treatment significantly reduced tumor necrosis factor (TNF)-α (P = 0.008) and fasting blood glucose (FBG) (P = 0.04) levels compared with what placebo did in T2DM patients. No significant differences were shown in the levels of interleukin (IL)-6, malondialdehyde (MDA), high serum C-reactive protein (hs-CRP), lipid profile, blood pressure, and body mass index (BMI) between Saffron and placebo ( P > 0.05) . Conclusion Saffron treatment has a cardioprotective effect in T2DM patients by reducing TNF-α and FBG levels. However, the potential anti-oxidant, anti-hypertensive, and anti-dyslipidaemia effects of the phytochemical need to be further investigated.