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Inflammatory Bowel Disease (IBD) is a chronic condition characterized by persistent inflammation of the gastrointestinal tract, comprising ulcerative colitis (UC) and Crohn's disease (CD). While the current global incidence of IBD exceeds 0.3% in Western nations, Indonesia reports a comparatively lower prevalence however projections indicate a potential rise in incidence from 2020 to 2050. Hepatobiliary manifestation is one of the most common extraintestinal manifestations of IBD. Some of the liver diseases associated with IBD had similar background immune responses, inflammatory reactions, similar risk factors, or due to the treatment of IBD. Primary sclerosing cholangitis (PSC) has a close association with IBD and both affect the prognostic and disease progression of each other. Non-alcoholic fatty liver disease (NAFLD) shares common metabolic risk factors. Several drugs used as the treatment of IBD might cause hepatic injury especially due to the long treatment duration of IBD. Hepatitis B reactivation is another concerning event found after prolonged use of immunosuppressive drugs for IBD. Therefore, close monitoring of liver function tests periodically is a mandatory test to screen for liver disease in IBD patients. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis in Indonesia still become a burden disease, and the etiology is mostly from the hepatitis B virus. Esophageal varices (EV) is the most common complication of portal hypertension in liver cirrhosis. Due to many reasons, esophagogastroduodenoscopy is still not fully suitable for routine surveillance in daily practice. Hence, studies that work in the search for the best non-invasive test are still important for predicting EV. Method: A total of 71 patients with liver cirrhosis due to hepatitis B who had undergone endoscopy, spleen stiffness measurement (SSM), and liver stiffness measurement (LSM), between January-April 2023 were enrolled. Diagnostic applicability was assessed by the area under the receiver-operator curve (AUC) to measure and compare the performance of each measurement and combination for predicting EV and to obtain the corresponding optimal prediction value. Results: This study was participated by 71 subjects with liver cirrhosis. The prevalence of Child-Pugh A was 74.6% (53 patients), Child-Pugh B 22.5% (16 patients), and 2.8% (2 patients) with Child-Pugh C. Among these patients, the proportion of EV was 71.8%. This study showed that SSM with a cut-off of 38.8 kPa had AUC 0.867 (95% CI: 0.774-0.960) (sensitivity 78.4%, specificity 80%) and LSM with a cut-off of 10.55 kPa had AUC 0.822 (95% CI: 0.701-0.943) (sensitivity 88.2%, specificity 65%). Conclusion: Spleen stiffness and liver stiffness measurements have a good performance for predicting EV in patients with liver cirrhosis caused by hepatitis B. [ABSTRACT FROM AUTHOR]

Aim: This evidence-based case report aims to assess the accuracy of EUS-PPG measurement in patients with portal hypertension. Method: A literature search was performed using PubMed, Cochrane, ProQuest, and EBSCO. A total of 2 articles were selected after meeting the inclusion and exclusion criteria. Critical study assessment was conducted to assess the validity, importance, and applicability of the study. Results: As a result, the first study found higher EUS-PPG measurement values in patients with clinical parameters of portal hypertension and the second study found a good correlation between EUS-PPG measurement values with hepatic vein pressure gradient (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS) portal pressure gradient (PPG). Conclusion: From these two studies, it can be concluded that EUS-PPG measurement is a safe, effective, and feasible method to be performed on patients. [ABSTRACT FROM AUTHOR]

By late December 2019, a novel beta-coronavirus, named as COVID-19 (2019-nCoV), was discovered in Wuhan, Hubei Province, China which epidemiologically linked to a Huanan seafood market in Wuhan. Coronavirus Disease 2019 or COVID-19 cases are growing rapidly from Wuhan to many countries, finding the health care system unprepared to face this threat. No effective drugs are clinically approved to manage the disease and strategies to protect the most vulnerable from developing severe illness and infection is still unclear. Information on how COVID-19 virus infection may affects many organs, especially the liver and the relevance of pre-existing liver disease in patients as a risk factor for the infection or disease severity are still scarce and inconclusive. Besides, the recommendation and consideration in liver transplant patients, hepatocellular carcinoma, or patient on immunosuppressive therapy still need further analysis Therefore, the information on the mechanism and treatment of COVID-19 related liver injury in patients with or without pre-existing liver disease should be considered. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the fifth most prevalent and the second highest cause of death among cancer. The treatment of large solitary nodule HCC is still challenging. Transarterial chemoembolization (TACE) and liver resection are two modalities of therapy in HCC management. However, recurrence rate from each therapy is relatively high. We report a case of 46-year-old man diagnosed with large solitary nodule HCC, who was treated with drug eluting bead TACE (DEB-TACE) prior to liver resection. Studies about this combination are still limited and showed various results. [ABSTRACT FROM AUTHOR]

Incidence of percutaneous exposure to hepatitis C virus (HCV) is still quite high, particularly in medical staffs. Though not all will cause infection, but if acute HCV infection occurs, it usually develops into chronic hepatitis which finally causes cirrhosis and hepatocellular carcinoma. Untill now, there is no standard method either in regiments, administration time, or duration of administration to prevent HCV infection after exposure occurs, as well as the use of antiviral therapy in acute HCV. HCV therapy target is viral eradication, thus the therapy response is defined using virological parameter than clinical parameter. Different from hepatitis B virus (HBV), immunoglobulin administration after exposure to HCV is not recommended as it is not proven to prevent transmission, similarly with pegylated interferon (PEG-IFN) or interferon (IFN) administration. In addition, several studies concluded that risk of HCV transmission after percutaneous exposure is low, therefore regular strict monitoring (monthly in the first 16 weeks after exposure) to clinical and laboratory results (HCV-RNA, alanine aminotransferase) is more required, so that detection and early treatment to acute HCV can be performed, considering that several studies showed that early monotherapy using IFN/PEG-IFN in acute HCV could reach quite high sustained virological response (SVR). [ABSTRACT FROM AUTHOR]

Background: The mortality rate in patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) is still very high. Currently, liver support systems are an alternative therapy in bridging liver transplantation. However, its effectiveness in reducing mortality is still controversial when compared to standard medical therapy (SMT). Our study aims to review the efficacy of liver support system compared to standard medical therapy (SMT) among acute liver failure patients without liver transplantation. Method: We conducted systematic literature searching using PubMed/MEDLINE, EBSCO-CINAHL, ProQuest, and Cochrane databases. Selected articles were examined for duplicates and were screened by abstract and title. Then, we appraised the articles based on the critical appraisal tools from Centre for Evidence-Based Medicine (CEBM) University of Oxford Results: One systematic review and meta-analysis of randomized control trials study was extracted after thorough research. Alhamshi et al showed that extracorporeal liver support has significantly reduced mortality in both ALF and ACLF patients as the primary outcome. Other main findings about adverse events including hepatic encephalopathy, thrombocytopenia, bleeding, and infection were still unclear. Conclusion: The use of liver support system demonstrated better outcome in reducing mortality to standard medical therapy in transplant free patients with liver failure, but best modality recommendation was inconclusive. [ABSTRACT FROM AUTHOR]

This study aimed to describe risk factors of severe hypoglycemia in type 2 diabetes mellitus (T2DM) patients in a tertiary care hospital in Indonesia. This study was a retrospective cohort study in the Endocrinology Outpatient Clinic of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. All subjects more than 18 years old who had been visiting the clinic for at least a year were included. Subjects were interviewed whether they had any severe hypoglycemia events within the past year, while data on risk factor variables of severe hypoglycemia was taken from medical records one year before data collection. We recruited 291 subjects, among whom 25.4% suffered at least one episode of severe hypoglycemia within one year. History of severe hypoglycemia (OR 5.864, p ≤ 0.001), eGFR less than 60 mL/min/1.73m2 (OR 1.976, p = 0.028), and insulin use (OR 2.257, p = 0.021) were associated with increased risk of severe hypoglycemia. In conclusion, history of previous severe hypoglycemia, eGFR less than 60 mL/min/1.73m2, and insulin use were associated with severe hypoglycemia. [ABSTRACT FROM AUTHOR]

This study aimed to describe risk factors of severe hypoglycemia in type 2 diabetes mellitus (T2DM) patients in a tertiary care hospital in Indonesia. This study was a retrospective cohort study in the Endocrinology Outpatient Clinic of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. All subjects more than 18 years old who had been visiting the clinic for at least a year were included. Subjects were interviewed whether they had any severe hypoglycemia events within the past year, while data on risk factor variables of severe hypoglycemia was taken from medical records one year before data collection. We recruited 291 subjects, among whom 25.4% suffered at least one episode of severe hypoglycemia within one year. History of severe hypoglycemia (OR 5.864, p ≤ 0.001), eGFR less than 60 mL/min/1.73m2 (OR 1.976, p = 0.028), and insulin use (OR 2.257, p = 0.021) were associated with increased risk of severe hypoglycemia. In conclusion, history of previous severe hypoglycemia, eGFR less than 60 mL/min/1.73m2, and insulin use were associated with severe hypoglycemia. [ABSTRACT FROM AUTHOR]

Background: The minimal number of hepatocellular carcinoma (HCC) patients diagnosed through surveillance is proposed as the cause of persistently low number of survival. It is important to identify the proportion of surveillance for early detection of HCC in patients with liver cirrhosis and related factors. This study aimed to determine the proportion of surveillance for early detection of HCC in patients with liver cirrhosis and related factors. Method: A cross-sectional study of patients with liver cirrhosis at Cipto Mangunkusumo Hospital from January to December 2013. The data was obtained from medical records and confirmed by telephone. Surveillance was required for abdominal ultrasound with or without AFP at least once a year within 3 years after that period. Factors studied were gender, ethnicity, education level, income level, availability of medical insurance, location of residence, surveillance education, cirrhosis aetiology, and severity of cirrhosis. Then, logistic regression test was used in the multivariate analysis. Results: From 200 patients, 50 patients (25,0%) underwent surveillance, 150 patients (75,0%) did not. Bivariate analysis revealed 4 variables with p < 0.25, gender (p = 0,056), ethnicity (p = 0, 231), surveillance education (p = 0,005), and severity of cirrhosis (p = 0, 005). Multivariate analysis showed that the risk factors for surveillance were surveillance education (OR = 2,598; CI 95% (1,325 - 5,094), p = 0,005) and severity of cirrhosis (OR = 1.815; CI95% = 1,210-2,724;p = 0,004). Conclusion: Surveillance education and severity of cirrhosis were the factors associated with surveillance for early detection of HCC in liver cirrhosis patients. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. There are several treatment modalities according to Barcelona treatment algorithm. Liver transplant is one of the curative option treatments, with its indication and prognostic factors. Carefully selected patients for liver transplant in HCC case will result in the same or slightly inferior survival rate compare with liver transplant in non-malignancy case. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease-2019 (COVID-19) is a disease caused by infection of SARS-CoV-2 virus which leads to mortality due to respiratory failure. The progression of COVID-19 is more severe in patients with pre-existence morbidities, including liver disease. Recently, a few studie showed that liver cirrhosis patients with COVID-19 had a higher risk of mortality rather than liver cirrhosis patients without COVID-19 infection. Nevertheless, the study of survival COVID-19 in a patient with underlying liver cirrhosis is still limited. The aim of this study is to evaluate the survival of COVID-19 in adult patients with liver cirrhosis Method: An observational study in Cipto Mangunkusumo Hospital was conducted. Patients with underlying liver cirrhosis between March 2020-January 2021 with positive confirmation of COVID-19 were enrolled in this study. Liver cirrhosis patients without COVID-19 were enrolled as a comparison. Both liver cirrhosis patients with and without COVID-19 were follow up at the time of hospital admission until 30 days outcome. Kaplan Meier and a log-rank test were conducted to evaluate the comparison of survival rate in liver cirrhosis patients with and without COVID-19. Multivariate Cox Proportional Hazard was conducted to identify the independent risk factors related to survival. Results: There were 22 liver cirrhosis patients with COVID-19 and 116 liver cirrhosis patients included in this study. Presentation of gender and age similar both of them. Predominantly males with average age were 57 years ± 13,60 for cirrhosis with COVID-19 patients and 53 years ± 12,75 for without COVID-19. The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19 (35.8% vs. 67.2%, p-value 0.001). Median survival of liver cirrhosis patients with COVID-19 was 4 days (95% CI: 1-8 days), while median survival of liver cirrhosis patients without COVID-19 couldn't be reached since the survival rate of this group above 50%. Final model Cox PH showed that liver cirrhosis with COVID-19 (HR: 8.99; CI 95%: 4.55 - 17.80, p-value 0.001) and Child-Pugh class C (HR: 5.61; 95% CI: 2.76 - 11.40, p value 0.001) were the independent risk factors associated with poor survival. Conclusion: The survival rate of liver cirrhosis patients with COVID-19 lower than liver cirrhosis patients without COVID-19. Liver cirrhosis with COVID-19 and Child-Pugh class C were associated with poor survival. [ABSTRACT FROM AUTHOR]

Background: After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.Method: This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves.Results: 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.Conclusion: APRI score ≥ 1 and FIB-4 score ≥ 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available. [ABSTRACT FROM AUTHOR]

Aim: To assess mac-2-binding protein glycosylation isomer (M2BPGi) serum performance compared to liver biopsy in diagnosisng liver fibrosis. Method: Literature search using Pubmed ®, Ebsco®, ProQuest®, Scopus®, Clinical Key databases, and the Cochrane Library® yield four relevant and full-text articles. The four articles were critically appraised for its validity, importance, and applicability. Results: Sensitivity and specificity in all four studies showed that M2BPGi serum was inadequate to ruling in and ruling out the diagnosis of liver fibrosis in chronic hepatitis B patients. The difference in M2BPGi cut-off value to determine the stage of fibrosis in each study makes this value cannot be used as an accurate standard to determine the advanced stage (F=3) of liver fibrosis. On the other hand, M2BPGi serum combined with other tests are known to improve the diagnostic accuracy. Conclusion: MBP2Gi serum cannot be used as a diagnostic modality for detecting liver fibrosis in chronic hepatitis B patients. [ABSTRACT FROM AUTHOR]

Aim: To identify whether probiotics have the same effectiveness as lactulose in improving the results of psychometric testing in patients with hepatic encephalopathy. Method: Literature Searching were performed on Pubmed, EBSCOhost, Scopus, and Cochrane databases to obtain an randomized controlled trial (RCT) or a systematic review. Searches were made with the keywords "hepatic encephalopathy", "probiotic", "lactulose" and number connection test ("NCT"). Search is continued by excluding the literature through abstract and full text. Results: Two studies were found to be relevant according to the criteria. The study by Mittal showed that probiotics were better than lactulose in improving NCT-B with a risk ratio (RR) = 0.88 (95% CI: 0.54-1.44; p = 0.62) but not better for improving NCT- A with RR = 1.43 (95% CI: 0.62-3.24; p = 0.40). In the Sharma study, lactulose was better in improving NCT score with the mean difference (MD) 6.7 (95% CI: 0.58-12.82) and in the Li study, there was no significant significance betweenMD 3.93 (95% CI: -0,72-8,58). Conclusion: In conclusion, Probiotics cannot replace lactulose as a standard therapy for hepatic encephalopathy. There is not enough evidence that proves probiotics are better than lactulose. [ABSTRACT FROM AUTHOR]

Background: The presence of direct-acting antiviral (DAA) has improved the treatment of hepatitis C virus (HCV) infection and making it more preferable than Pegylated-interferon (PegIFN) and Ribavirin (RBV) based treatment. However, treatment with all DAA combination regimen is limited and expensive in low health care affordability country including Indonesia. The appearance of generic sofosbuvir (SOF) facilitate the utilization of SOF plus PegINF with or without RBV combination. Therefore, in this study we assessed the efficacy of SOF+RBV and SOF+RBV+PegINF combination for treatment of chronic hepatitis C infections patient with genotype 1 in Indonesia. Method: We performed retrospective study comprising 128 patients in Cipto Mangunkusumo Hospital with chronic hepatitis C, genotype 1, infection. Thirty six (36) patients was treated with PegINF+SOF+RBV and 92 patients was treated with SOF+RBV with the duration of therapy was 12 and 24 weeks in both arms. The primary endpoint was sustained virologic response after treatment completion (SVR12). Results: In the end of treatment, 99.2% patients achieved undetected HCV RNA in 12 weeks and 24 weeks duration of therapy (100% in PegINF+SOF+RBV group and 98.9% in SOF+RBV group). The SVR12 of PegINF+SOF+RBV reach 100% meanwhile The SVR12 of SOF+RBV reach 88%. No different in SVR12 between cirrhotic and non-cirrhotic patient in PegINF+SOF+RBV group while in SOF+RBV group, the SVR12 was lower in cirrhotic patients (82.9%) compared to non-cirrhotic patients (92.2%). In multivariate analysis, HIV co-infection is associated with lower SVR12 in SOF+RBV group. Conclusion: Twelve (12) weeks and 24 weeks of PegINF+SOF+RBV and SOF+RBV is effective in the treatment of genotype 1 chronic hepatitis C infection. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is an emerging disease, where it can progress to non-alcoholic steatohepatitis (NASH) and lead to liver cirrhosis or liver cancer. Small intestinal bacterial overgrowth (SIBO) has been hypothesized to play an important role in NAFLD development and progression, however, there is still conflicting data about this phenomenon. Transient Elastography (TE) examination using controlled attenuation parameter (CAP) has been validated for liver disease progression assessment in NAFLD. It is non-invasive method and easy to perform in clinical practice. Therefore, we would like to know the role of SIBO in NAFLD and its possible impact on disease progression.Methods: A cross-sectional design study performed at outpatient's Hepatobiliary clinic at tertiary referral university hospital in Jakarta. All recruited study subjects based on inclusions criteria underwent laboratory examination, transabdominal ultrasound examination, CAP-TE 502 (by Echosens, France), and glucose hydrogen breath test (GHBT) using portable hydrogen breath test apparatus (Gastro+™ Gastrolyzer by Bedfont Scientific Ltd). Stool sample examination was performed using RT-PCR.Results: This study recruited 160 subjects with median age of 58 (22-78) years and 108 (67.5%) of them are female. SIBO (65,5%), DM (70.8%), dyslipidemia (75.2%), obesity (76.6%), and metabolic syndrome (73%) were more prevalent in NAFLD than non-NAFLD population. Bivariate analysis showed no significant association between SIBO and NAFLD development (p = 0.191; PR 0.871; CI 95% [0.306-1.269]). SIBO was also not associated with significant hepatic steatosis (p = 0.951; PR = 0.951; CI 95% [0.452-2.239]) and fibrosis (p = 0.371; PR = 1.369; CI 95% [0.608-3.772]). However, the presence of central obesity has significantly associated with the presence of SIBO (p = 0.001; PR = 0.378; CI 95% [0.021-0.478]). Based on stool sample analysis from 60 NAFLD patients, there is a significant correlation using Spearmen test between the presence of Bacteroides and the stage of fibrosis (p .037). Further analysis between obese NAFLD patients and non-obese NAFLD patients showing that there is a significant decrease of Bifidobacteria (p .047) and Lactobacillus (p .038) in obese NAFLD patients and a tendency of increase Bacteroides in obese NAFLD patients (p .572).Conclusions: SIBO is not associated with NAFLD development and progression. [ABSTRACT FROM AUTHOR]