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The number of children attending the Pediatric Outpatient Clinic of Pirngadi Hospital, Medan, during 1982 was 15.375. Out of these, 1246 (8.1%) had gastroenteritis. Most of the patients (1046 or 83.94%) were under two years old. The male to female ratio was 1.6: I. The peak incidence for allendance was in January, April, and May. Of 1057 patients under five years old, 383 (36.2%) also had malnutrition. The highest percentage (70. 75%) of those who had malnutrition was found in the I to 2 years age group. Of 370 patients whose Hb level was examined, 185 (50%) had anemia. The highest percentage (67.02%) was in the below 1 year group. Only 360 (28.8%) of gastroenteritis cases received oral rehydration solution. There were 23 (1.85%) cases in which diarrhea lasted longer than 7 days. The number of patients admitted to the ward was 213 (17.07%), and the highest percentage was in the above 3 years age group. The largest number of hospitalized patients was in January (43), February (21), and April (28); while the highest percentage was in April (20.40%), June (21.42%) and August (31.42%). Peak rainfall in Medan during 1982 was in October, November, and December, i.e. much 322.2 mmm, 366.4 and 382 mm, respectively.

In 1989, oj2350 patients hospitalized in the paediatric ward of Dr. Pirngadi Hospital, Medan, 829 (35.3%) were gastroenteritis cases, with male more than female. Most of the patients with gastroenteritis were found in the age group of under 1 years (521 cases = 62.8%). The highest prevalence was found in january, February and March. Mild, moderate and severe dehydration were encountered in 2. 7%, 83.1% and 14.2% cases respectively. Eighty for (10.1%) cases had been treated with oralit before admission. Only 49. 1% of those patients with gastroenteritis under two years of age were breastfed. The patients of under five year old were 791 (95. 4%) cases; 259 (32. 7%) cases were malnourished. The overall mortality rate of these patients with gastroenteritis was 5.9% ( 49 cases). The age specific mortality rate was highest in the age group of 6- 12 months. Usually patients died with gastroenteritis had complications or associated diseases.

The parents' knowledge on diarrhea was evaluated by a cross sectional study in Balirnbingan plantation PTP Vlll Kabupaten Simalungunon December 18-19, 1992. The study was conducted by providing questionnaires to 216 parents of infants and children with diarrhea. Most parents (97.2%) knew that diarrhea was a disease, wbile six of them (2.SOA>) thought that diarrhea was not a disease but was associated with the increase level of intelligence or teeth eruption. Seventy-five percent of parents thought that fluid and electrolyte ought to be given to children with diarrhea, and 16.5 % thought to give anti-diarrheal drugs or traditional medicaments. Fluid and electrolytes were given as an initial treatment for diarrhea by most of the parents (69%). Eight per cent of parents gave diarrheal drugs and 12% used traditional medicaments. They got oral electrolyte solution (OES) from the health workers (63.3%) or from the dispensaries or drug stores (36.7%). Most of the parents (53.7%) thought that OES was useful to stop diarrhea. Only 30.3% knew that OES was used as the substitute of fluid loss, 16% thought it was to cure for stomach ache. As many as 57.4% parents knew diarrhea as an infectious disease and 57.4 % knew how to prevent it. Most of them knew that environmental sanitation could prevent the disease (23.3%). Food and beverages were known as vehicle of infections by 37.5% parents.

A prospective study on steatocrit value in full-term or preterm newborn babies of~ 2 days of age in Dr. Pimgadi Hospital, Medan is reported. This study was conducted from December 7, 1992, to February 7, 1993; there were 72 newborn babies (37 males and 35 females). The body weight was> 2500 gin 60 babies and s. 2500 gin 12 babies. The median steatocrit value in babies with body weight of> 2500 g was 9%, and it was 32% in babies less than 2500 g of body weight. The proportion of babies with > 25% steatocrit value was larger in babies less than 2500 g than that in 2500 g by the diet patterns of breast milk, breast milk and milk formula, milk formula. The proportion of babies with < 25% steatocrit value was higher in babies with body weight of< 2500 g than that in babies > 2500 g for those who had either breast milk, breast milk and milk formula or milk formula. There was significant difference (p 2500 g and those who had body weight of ≤ 2500 g.

Background Functional constipation is a common pediatric problem in both developed and developing countries. In the past two decades, the prevalence of obesity has increased worldwide. Obesity itself leads to many health problems, including functional constipation. Studies correlating obesity to functional constipation have thus far mostly originated from developed countries. Objective To assess for a possible correlation between obesity and functional constipation in children in a developing country. Methods This cross-sectional study was conducted in Al-Mukhlisin Islamic Boarding School, Batu Bara District, North Sumatera Province, Indonesia, between July and August 2015. The subjects were 150 students aged 12 to 17 years. Questionnaires were used to determine functional constipation and filled by direct interview. Obesity was determined by body mass index. Data were analyzed using Chi-square test. Results Of 150 children, 49 had functional constipation; and 18 of the 49 were obese. The mean age of children with constipation was 14.7 (SD 1.07) years (95%CI 14.1 to 14.7) and their mean body weight was 53.8 (SD 15.10) kg (95%CI 49.4 to 58.1). The prevalence for functional constipation in obese children was 58% There was a statistically significant correlation between obesity and functional constipation (prevalence ratio=4; 95%CI 1.72 to 8.94; P=0.001), indicating that obese children had 4 times higher risk of having functional constipation. Conclusion There is a significant correlation between obesity and functional constipation in children.

Background Functional dyspepsia is common among adolescents. Pain reduces children’s quality of life, psychosocial functioning, and school attendance. Amitriptyline is assumed to be one of the alternative treatments in functional dyspepsia. Objective To investigate the effectiveness of amytriptyline as a treatment for functional dyspepsia in adolescents. Methods We conducted a randomized, single-blind, controlled trial from January to March 2011 in junior and senior high school students in Dobo City, Aru Island District, Maluku Province. Adolescents suffering from functional dyspepsia and who fulfilled the inclusion criteria were eligible for the study. Subjects were randomized into two groups. Each group received 10 mg (for body weight < 35 kg) or 20 mg (for body weight ≥ 35 kg) amitriptyline or placebo once per day for 28 days. Pain frequency was measured in terms of abdominal pain episodes per month, and duration was measured in minutes. Data were analyzed using t-test. Results Eighty-eight students participated in this study: the amitriptyline group (43 subjects) and the placebo group (45 subjects). There were no statistically significant differences between the amitriptyline and placebo groups in frequency (P=0.777; 95%CI -0.846 to 1.129) or duration (P=0.728) of abdominal pain after treatment. Conclusion Amitriptyline is not more effective than placebo for treating functional dyspepsia in adolescents.

Objective To compare the efficacy of fructooligosaccharide (FOS) versus placebo in pediatric patients with acute diarrhea with re- gard to duration and frequency of diarrhea and the volume and consistency of the stools. Methods This double-blind randomized clinical trial was carried out from July to November 2003 in the pediatric intensive care unit, outpatient clinic, and pediatric ward of Adam Malik Hospital and Pirngadi Hospital, Medan. Subjects were children and infants aged 4 to 24 months suffering from acute diarrhea without dehy- dration or with mild to moderate dehydration whose parents gave consent. Children included in this trial received tablets of either 600 mg FOS or 761 mg fructulin as placebo. Patients with mild to moderate dehydration were initially rehydrated according to the WHO protocol. Afterwards, 10 tablets of FOS or placebo were given to each subject to be taken twice daily. In subjects without dehy- dration, the tablets were given by their parents. Daily follow-up was performed, in which body weight, temperature, duration and frequency of diarrhea, and the volume and consistency of stools were recorded. For outpatients, home visits were made. Results Out of 142 children who met inclusion criteria, 135 com- pleted the study. These consisted of 68 children in the FOS group and 67 in the placebo group. Subjects were mostly 0.05). Conclusion There is no effect of the administration of FOS as supplemental therapy on the duration and frequency of diarrhea and on the volume and consistency of stools in children with acute diarrhea

Background Constipation is a common problem in children, with approximately 90 to 95% of constipation cases having functional constipation. Oxidative stress may be a causative factor in gastrointestinal diseases, alleved by intervention with antioxidants. Selenium is an essential trace element and acts as a cofactor of gluthathione peroxidase, which protects membranes from oxidative damage. Objective To determine the effect of selenium on functional constipation in children. Methods We conducted a single-blind, randomized clinical trial from November to December 2012 at the Al-Kautsar Al-Akbar Islamic Boarding School in Medan, North Sumatra. Subjects were children aged 12 to 17 years with functional constipation, diagnosed according to the ROME III criteria. Patients were randomly allocated into either the selenium group (n=57) or the placebo group (n=57). Subjects were clinically evaluated for frequency of defecation, stool consistency, severity of abdominal pain, and side effects during the 2 weeks of treatment (days 7 and 14) and 1 week after treatment had stopped (day 21). Results A total of 114 subjects were eligible to participate. The average frequency of defecation observed on day 14 was 1.5 (SD 0.75) days per defecation (P=0.0001) in the selenium group and 2.4 (0.84) days per defecation in the placebo group, a statistically significant difference (P=0.0001). There was no significant difference in frequency of defecation on the 7th day of treatment. But after day 7, there were significant differences between the groups at days 14 and 21. Normal stool consistency was found in 45 subjects (78.9%) on day 7 and in 57 subjects (100%) on day 14 of treatment in the selenium group, significantly more than those in the placebo group (P

Background Acute watery diarrhea remains a major health problem affecting infants and children in developing countries. Selenium deficiency may be a risk factor for diarrhea and vice versa. Few studies have been conducted on the effectiveness of selenium for the treatment of diarrhea in children. Objective To determine the effectiveness of selenium in reducing the severity of acute watery diarrhea in children. Methods A single-blind, randomized clinical trial was done in children with acute watery diarrhea, aged six months to two years, and who visited the community health center in Simalungun from May to August 2012. Children were randomized into either the selenium or placebo (maltodextrin) group. We monitored diarrheal frequency, stool consistency, and duration of diarrhea. Mann-Whitney, Fisher’s, and Kolmogorov-Smirnov tests were used to compare the two groups. Results Sixty-five children were recruited into the study, of whom 36 children received selenium and 29 children received a placebo. The selenium group had significantly lower frequency of diarrhea (bouts per day) than the placebo group on days 2, 3, and 4 after treatment onset [day 2: 3.5 vs. 4.1, respectively (P=0.016); day 3: 2.7 vs. 3.4, respectively (P=0.002); day 4: 2.1 vs. 2.8, respectively (P

Background Functional constipation is a common childhood condition. Benefits of oral and rectal laxatives in terms of recovery and recurrence in children with functional constipation are still controversial. Objective To compare the effectiveness of oral and rectal laxatives in terms of recovery and recurrence in children with functional constipation. Methods Children aged 8 to 17 years who met the Rome III criteria for functional constipation were enrolled in this open randomised trial. Data was collected through questionnaires, interviews, and physical examinations. The participants were randomly assigned to receive stimulant laxatives (5 mg bisacodyl) either orally for three consecutive days or rectally in a single dose. Subjects kept daily defecation records for 7 days, and were followed up on days 14, 21, 28, 35, and 42. Comparisons of defecation patterns and recurrence of constipation between groups were assessed using Chi-square test. Results Of 99 subjects, 46 children (5 boys, 41 girls) received oral laxatives (group I) and 45 children (8 boys, 37 girls) received rectal laxatives (group II). Four children in each group dropped out. Baseline characteristics are comparable between the groups. Rate of recovery in the first 7 days was higher in the oral compared to rectal groups [84.8% versus 73.3%, respectively, but this was not statistically sininficant (P=0.278)]. In the second week, the recurrence of constipation was significantly higher in the rectal (57.5%) than in the oral laxative group (42.5%) (P=0.026). Conclusion Although recovery tends to occur more with oral compared to rectal laxative agents, the difference was not statistically significant. Higher recurrence in the second week after treatment occurred with rectal laxative agent. [Paediatr Indones. 2016;56:162-6.].

its most common type is functional constipation. The dietary fiber may be useful in childhood functional constipation management, but unfortunately the role of fiber in functional constipation is still less developed. Objective To determine the role of glucomannan in treatment of childhood functional constipation. Methods A crossover randomized controlled trial (RCT) was done from May until July 2012 in a boarding school in Medan, North Sumatera. The subjects were children with functional constipation aged 7 to 12 years. Subjects were randomised into two group receiving glucomannan fiber as polysaccharide gel (group A) and maltodextrin as placebo (group B) with each dose of 100 mg/kg/day (maximum of 5 g/day) diluted in 50 ml water/500 mg for 4 weeks, then after a wash out period we did the crossover of the two groups. Frequency and consistency of stools were recorded into diary sheet for 4 and 8 weeks of treatment. Functional constipation has been diagnosed based on Rome III criteria. Data was analyzed using independent T-test and Chi-square test. Results A total of 36 subjects were eligible with each group consisting of 18 subjects and mean of weight of 25 kg. We found significant difference in stool frequency, treated on glucomannan with P= 0.002 before and P = 0.0001 after the wash out period. For stool consistency, we found difference while treated on glucomannan 9/18 (P= 0.034) in 4 weeks before and 11/18 (P = 0.008) in 4 weeks after the wash out period. Conclusion Glucomannan has significant effect to improve functional constipation especially in 4 weeks treatment.

Background Functional dyspepsia is a common gastrointestinal disorder in school-aged children, though, there is no reliable treatment. Probiotics are live microorganisms administered in adequate amounts to confer beneficial health effects on the host. Although definitive evidence is lacking, several studies have found probiotics to be effective for relieving symptoms of dyspepsia, particularly abdominal pain and bloating. Objective To determine the efficacy of lactobacillus probiotics for treating functional dyspepsia in children. Method A double-blind, randomized controlled trial was done from April to June 2012 in five schools in the Pakpak Bharat Regency, North Sumatera. A total of 116 children who fulfilled the Rome III criteria for functional dyspepsia were randomized into 2 groups to receive either lactobacillus probiotics or placebo for 2 weeks. All patients received a diary to record symptoms and frequency of pain daily. The primary outcome for treatment was defined to be no pain at the end of the intervention. Results The probiotics and placebo groups were not significantly different in recovery from functional dyspepsia (29.3% vs. 13.8%, respectively; P=0.432). However, compared to the placebo group, the probiotics group had significantly reduced frequency of pain (P=0.0001), but no significant differences in pain severity (P=0.08) or pain duration (P 0.091). Conclusion There are no significant differences in recovery from functional dyspepsia, pain severity, or pain duration between the probiotics and placebo groups. However, the probiotics group has significantly reduced frequency of pain compared to that of the placebo group.

Background Diarrhea has been a health problem in children under five year old. Although the mortality caused by acute diarrhea has fallen worldwide, the mortality has increased in developing countries, such as Indonesia. Objective To assess the effect of folic acid in reducing the severity of acute diarrhea in children. Methods This study was a single-blind, randomized control trial in children with diarrhea aged six months to five years at a local goverrnent clinic in the Secanggang District, Langkat Regency, North Sumatera Province from August 2009 until January 20 10. Subjects were recruited by con secutive sampling then randomized into two groups. Of the 112 children who participated, 56 children received oral fo lic acid and 56 children received placebo, 1 capsule per day for five days. The statistical analyses used were the independent T-test and Chi square test with 95% confidence intervals (95% CI) and P values < 0.05 considered to be statistically significant. Results There were significant differences between the fo lic acid and placebo groups with regards to stool consistency (P=0.02), diarrheal volume on the second day [ 14 7 .52 vs. 303 .21 mL, respectively, (P=0.001)], frequency of diarrhea on the third day [1.9 vs 2.8 episodes, respectively, (P= 0.001)], duration of initial treatment to recovery [91.3 vs. 117 .9 hours, respectively, (P = 0.001) and the total duration between initial symptoms and recovery (123.6 vs . 147.4 hours, respectively, (P = 0.001)]. Conclusion Oral folic acid is clinically beneficial for reducing the severity of acute diarrh ea in children under five year old.

Background The incidence of diarrhea in Indonesia has declined in the past five years. In spite of the increasing number of studies on the treatment for acute diarrhea, especially the use of zinc, it is not known if bacterial vs. non-bacterial etiology makes a difference in the reduction of severity of acute diarrhea in children on zinc therapy. Objective To assess the effect of zinc therapy in reducing the severity of acute bacterial and non-bacterial diarrhea. Methods We performed a cross-sectional study in the Secanggang District, Lan gkat Regen cy of North Sumat era, from August to November 2009 in children aged 2 months to 14 years . Microscopic stool examination s were undertaken to separate subjects into the acute bacterial or non-bacterial diarrhea groups. Both groups received 10 mg/day ofzinc sulphate for subjects aged

Background Vitamin A deficiency may increase the risk or be a cause of diarrhea. Many studies have been conducted on the efficacy of vitamin A in the management of acute diarrhea, but the outcomes remain inconclusive. Objective To determine the effectiveness of vitamin A in reducing the severity of acute diarrhea in children. Methods We performed a single􀁈blind􀁈randomized controlled trial in the Secanggang District, Langkat Regency, North of Sumatera, from August 2009 to January 2010 in children aged 6 months to 5 years, who had diarrheas. Subjects were divided into two groups. Group 1 received a single dose of vitamin A (100,000 IU for subjects aged 6 to 11 month old or with body weights :s 10 kg, or 200,000 IU for subjects aged 2: 12 month old or with body weights> 10 kg). Group 2 received a single dose of placebo. The establishment of severity was based on changes in diarrheal frequency, stool consistency, volume and duration of diarrhea after treatment. We performed independent T􀁈test and Chi square tests for statistical analyses. The study was an intention􀁈to􀁈treat analysis. Results We enrolled 120 children who were randomized into two groups of 60 subjects each. Group 1, received vitamin A and group 2 received a placebo. The results showed significant differences between the two groups in stool volume starting on the first day (95%CI 192.30 to 3237.51; P􀁉O.OOI), as well as diarrheal frequency (P=O.OOl) and stool consistency (P=O.OOl) on the second day observation and duration of diarrhea following treatment (95%CI - 40.60 to - 25.79; P􀁉O.OOI;). Conclusions Vitamin A supplementation is effective in reducing the severity of acute diarrhea in children under five years of age. [Paediatr lndones. 2013;53:125-31.]

Background Recurrent abdominal pain (RAP) is one of the most common complaints in adolescents. Treatment for RAP depends on the etiology. Lansoprazole has been shown to be effective on gastroesophageal reflux disease (GERD), but further study is needed to assess the effects of lansoprazole on RAP. Objective To assess quality of life (QoL) of RAP patients who received lansoprazole compared to placebo treatment. Methods This randomized, clinical trial was conducted in the Secanggang District, Lan gkat Regency, North Sumatera, from August to October 2009. Patients who met the Apley criteria for RAP diagnosis were enrolled in the study. Subj ects were divided into two groups: those who received 30 mg lansoprazole daily and those who received placebo, for 14 days. Quality oflife was assessed using the Pediatrics Quality of Life (PedsQL) version 4.0 before administration oflansoprazole/placebo and reassessed 30 days after treatment. Efficacy of treatment was assessed by comparing the QoL before and after treatment in the two groups. Results A total of 98 adolescents, aged 12 - 18 years, were enrolled in the study and divided into two groups: lansoprazole and placebo. There was no significant difference QoL in physical health (mean differences 95%CI -109.19 to 1.02; P=0.054), emotional health (mean differences 95%CI -29.26 to 45.48; P=0.666), social functioning (mean differences 95%CI -42.91 to 31.69; P=0.766), and sch ool functioning (mean differences 95%CI -56.97 to 24.32; P= 0.430), before and after treatment in the two groups. Conclusion There is no significant difference in QoL between the two groups of adolescents with RAP before and after lansoprazole treatment.

Background Functional constipation is often a consequence of habitual bowel elimination while sitting on common toilet seats. A considerable proportion of the population with n ormal bowel movement frequency has difficulty emptying their bowels. The principal cause of this problem may be the obstructive nature of the rectoanal angle and its relationship to the posture normally used in defecation. Objective To assess the relationship between functional constipation with the posture (sitting vs squatting) during defecation in children. Methods We conducted a cross-sectional study in November 2010. Participants aged 12- 15 years were selected consecutively from a junior high school in Medan . Parents and children filled questionnaires and were interviewed. Functional constipation was assessed based on the Rome III criteria. Results Sixty-five students enrolled in the study. There was no statistically significant diffe rences in subjects' characteristics. T here was a significant correlation between functional constipation with posture during defecation in children (RR= 0.06, 95%CI 0.02 to 0.25; P=0.0001). Functional constipation was more likely occured in children with sitting (12/20) th an squatting posture (4/45) during defecation. Conclusion We found th at posture in defecation is correlated to functional con stipation in children.

Background Recurrent abdominal pain is common among adolescents. School absenteeism and lower quality of life are associated with severity of symptoms. Lansoprazole has been used to treat recurrent abdominal pain. Objective To investigate the effectiveness of lansoprazole as a treatment for recurrent abdominal pain in adolescents. Methods We conducted a randomized, double-blind, controlled trial from August 2009 to October 2009. Adolescents suffering recurrent abdominal pain were eligible for the study. Simple randomization was done to divide subjects into two groups. Groups received 30 mg of lansoprazole or placebo, once a day for 14 days. Before treatment, we performed laboratory and physical examinations. Pain frequency was measured in number of abdominal pain episodes per month. Duration was measured in minutes and pain intensity was measured by a pain rating scale. Drug efficacy was measured before, during and after intervention. Data was analyzed using Mann-Whitney U-test and t-test. Results One hundred sixteen recurrent abdominal pain patients were randomized into two groups of 58 patients. There were no statistically significant differences in pain frequency before and after treatment for either the lansoprazole group or the placebo group (P=0.083, 95%CI, -0.033 to 0.021 and P=0.096, 95%CI -0.376 to 0.031, respectively). In addition, there were no significant differences in frequency, duration, and degree of abdominal pain at baseline and after 1, 2 and 3 months of treatment between the two groups. Conclusion Lansoprazole was not more effective than the placebo for treatment of recurrent abdominal pain among adolescents.

Background Although the incidence of diarrhea in Indonesia has declined in the last five years, the mortality rate in children under five years old is still high. Therefore, appropriate and comprehensive management of diarrhea is essential. There have been many studies on the role of zinc therapy and probiotic therapy in reducing the severity of acute diarrhea, but not many studies have compared the use of a combination of the two therapies to zinc therapy alone. Objective To compare the efficacy of zinc-probiotic combination therapy to zinc alone in reducing the severity of acute diarrhea. Methods We conducted a randomized, open-label, controlled trial from July 2009 to January 2010 in Adam Malik Hospital and Pirngadi Hospital, Medan. Children aged between 1 month and 5 years who met the criteria were divided into two groups. Group I received zinc sulphate (aged

Background Functional immaturity of gastrointestinal (GI) motility predisposes preterm infants to feeding intolerance. Erythromycin as a prokinetic agent has been given to preterm infants for the management of non-obstructive GI dysmotility. Objective To evaluate the efficacy of oral erythromycin for the treatment of GI dysmotility in preterm infants. Methods A randomized controlled clinical trial was done at Adam Malik Hospital and Pirngadi Hospital, Medan, between October 2004 – March 2005. Fifty preterm infants with feeding intolerance were randomly assigned to either receive oral erythromycin (12.5 mg/kg, every 6 hours) or placebo for 7 days. Improved tolerance for enteral feedings was evaluated by the amount of gastric residue before feeding. Results On the sixth day, there was a significant difference in the amount of residue from gastric residue between the oral erythromycin group and placebo group (mean 21.7 and 29.4; P

Hati merupakan organ parenkim terbesar yang sering terlibat akibat penyakit sistemik. Pada beberapa penyakit sistemik, hati dapat lebih bertahan dibanding organ tubuh lainnya. Dalam mengevaluasi pasien dengan disfungsi dan penyakit sistemik, klinisi harus dapat membedakan apakah gangguan hati yang terjadi akibat penyakit sistemik, akibat obat yang digunakan dalam terapi penyakit sistemik tersebut ataupun bersamaan dengan penyakit hati primer