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"ABSTRAKLatar belakang: Sejak tahun 1980 Divisi Gastroenterologi Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Cipto Mangunkusumo (IPD FKUI/RSCM) membuat kriteria derajat gastritis kronik berdasarkan gambaran esofagogastroduodenoskopi (EGD) adanya hiperemis dan erosi. Kriteria derajat gastritis kronik ini banyak digunakan di seluruh Indonesia namun kriteria tersebut belum pernah dilakukan uji diagnostik.Tujuan: Mendapatkan akurasi diagnostik derajat gastritis kronik berdasarkan pemeriksaan EGD dibandingkan dengan pemeriksaan histopatologi.Metode: Penelitian ini merupakan uji diagnostik derajat gastritis kronik berdasarkan hasil pemeriksaan EGD pada pasien yang memiliki indikasi, dibandingkan dengan gambaran histopatologi sebagai pemeriksaan baku emas yang dilakukan di Pusat Endoskopi Saluran Cerna (PESC) Divisi Gastroenterologi Departemen IPD FKUI/RSCM dari Oktober 2014 hingga Februari 2015. Uji diagnostik yang dilakukan ada 2 yaitu uji diagnostik gastritis sedang - ringan dan berat - sedang. Masing-masing uji diagnostik di atas, ditampilkan parameter-parameter uji diagnostik berupa sensitivitas (Se), spesifisitas (Sp), nilai duga positif (NDP), nilai duga negatif (NDN), serta rasio kemungkinan (RK) positif dan negatif. Seluruh parameter di atas menyertakan interval kepercayaan 95% (IK 95%).Hasil Penelitian: Dari 230 subjek didapatkan karateristik penelitian perempuan lebih banyak dari laki - laki dengan perbandingan 3:2, terdapat merata pada semua kelompok usia, DM 23%, hipertensi 36,5% dan infeksi H.pylori 2,6%. Hasil uji diagnostik gastritis ringan - sedang: Se 0.95 (IK 95% 0.87-0.98), Sp 0.96 (IK 95% 0.86-0.99), NDP 0.97 (IK 95% 0.89-0.99), NDN 0.94 (IK 95% 0.84-0.98), RK Positif 23.39 (IK 95% 6.09- 89.74) dan RK Negatif 0.05 (CI 95% 0.02-0.14). Hasil uji diagnostik gastritis sedang - berat: Sensitivitas 0.93 (IK 95% 0.82-0.98), Spesifisitas 0.94 (IK 95% 0.86-0.98), Nilai Duga Positif 0.91 (IK 95% 0.79-0.96), Nilai Duga Negatif 0.96 (IK 95% 0.88-0.99), Rasio Kemungkinan Positif 16.54 (IK 95% 6.32-43.28) dan Rasio Kemungkinan Negatif 0.05 (CI 95% 0.02-0.21).Kesimpulan: Pemeriksaan EGD memiliki akurasi yang baik untuk menegakkan diagnosis derajat gastritis kronik.

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ABSTRACT

Background: Since 1980, Division of Gastroenterology Department of Internal Medicine FKUI/RSCM had made a criteria for chronic gastritis grading based on hyperemic and erosion that are found in gastric?s mucosa based on esophagogastroduodenoscopy (EGD) examination. This criteria is used nationwide all over Indonesia but until now there is no diagnostic study for chronic gastritis grading based on EGD examination compare to histopathology examination as the gold standard.

Purpose: To get diagnostic accuracy of chronic gastritis grading based on EGD compared to histopathology.

Methods: This research is a diagnostic study about chronic gastritis grading by EGD from patients that had indication for, compared to histophatology as a gold standard in gastrointestinal endoscopy room Division of Gastroenterology Department of Internal Medicine FKUI/RSCM from October 2014 to February 2015. There will be 2 diagnostic study, mild to moderate gastritis and severe to moderate gastritis diagnostic study. For every diagnostic study, the parameters that will be showed are Sensitivity (Se), Specificity (Sp), Possitive Predictive Value (PPV), Negative Predictive Value (NPV), Possitive Likelihood Ratio and Negative Likelihood Ratio (NLR). The 95% confidence interval will be included.

Results: Of 230 subjects, there were more women than men with ratio 3:2, age didn?t affect the grading of chronic gastritis, type 2 diabetes was found in 23% patients, hypertension was found in 36,5% patients and H.pylori infection in only 2.6% patients. The results for mild to moderate gastritis : Sensitivity 0.95 (CI 95% 0.87-0.98), Specificity 0.96 (CI 95% 0.86-0.99), Possitive Predictive Value 0.97 (CI 95% 0.89- 0.99), Negative Predictive Value 0.94 (CI 95% 0.84-0.98), Possitive Likelihood Ratio 23.39 (CI 95% 6.09-89.74), and Negative Likelihood Ratio 0.05 (CI 95% 0.02-0.14). The results for moderate to severe gastritis : Sensitivity 0.93 (CI 95% 0.82-0.98), Specificity 0.94 (CI 95% 0.86-0.98), Possitive Predictive Value 0.91 (CI 95% 0.79-0.96), Negative Predictive Value 0.96 (CI 95% 0.88-0.99), Possitive Likelihood Ratio 16.54 (CI 95% 6.32-43.28), and Negative Likelihood Ratio 0.05 (CI 95% 0.02-0.21).

Conclusion: Esophagogastroduodenoscopy feature has good accuracy to diagnose the grading of chronic gastritis."

"Inflamasi kronik adalah proses yang penting dalam patofisiologi adenokarsinoma duktal pankreas (PDAC). Beberapa studi telah meneliti potensi enzim siklooksigenase-2 (COX-2) sebagai faktor prognostik PDAC, dengan hasil yang kontradiktif. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), dan c−Jun adalah faktor transkripsi gen COX2. Penelitian ini adalah studi observasional eksploratori yang bertujuan untuk mengidentifikasi asosiasi ekspresi protein NF−?B (RelA/ p65), COX−2, Sp1, dan c−Jun dengan kesintasan pasien PDAC. Ekspresi protein tersebut dinilai di jaringan pasien PDAC menggunakan metode imunohistokimia. Diidentifikasi ekspresi keempat protein tersebut dengan overall survival (OS) dan karakteristik klinikopatologis pasien PDAC. Sebanyak 53 jaringan PDAC dari biopsi atau reseksi kanker diikutkan dalam penelitian. Hasilnya terdapat korelasi antara keempat protein di jaringan kanker. Ekspresi NF−?B sitoplasmik (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) atau nuklear (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) berhubungan secara independen dengan prognosis pasien yang lebih baik. Protein lainnya tidak berhubungan dengan kesintasan pasien. Hal ini menunjukkan bahwa peran inflamasi di PDAC lebih kompleks dari yang diperkirakan sebelumnya.

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Chronic inflammation is a crucial driver of carcinogenesis in pancreatic ductal adenocarcinoma (PDAC). Several studies have investigated the prognostic significance of cyclooxygenase−2 (COX−2) expression in PDAC patients, obtaining conflicting results. Nuclear factor kappa−B (NF−?B), specificity protein 1 (Sp1), and c−Jun are known as the transcription factors of the COX2 gene. This exploratory observational study investigated the association of the NF−?B, COX−2, Sp1, and c−Jun expressions with patient survival in PDAC. We used the immunohistochemical method to detect the PDAC tissue expressions of NF−?B (RelA/p65), COX−2, Sp1, and c−Jun. The expressions of these proteins were correlated with the overall survival (OS) and other clinicopathological characteristics of PDAC patients. We obtained 53 PDAC specimens from resections and biopsies. There were significant correlations between the four proteins’ expressions in the PDAC tissues. The expression of the cytoplasmic (aHR = 0.31; 95% CI 0.11–0.90; p = 0.032) or nuclear NF−?B (aHR = 0.22; 95% CI 0.07–0.66; p = 0.007) was independently associated with a better prognosis in the PDAC patients. COX−2, Sp1, and c−Jun showed no significant association with a prognosis in the PDAC patients. The PDAC patients who expressed NF−?B had a better prognosis than the other patients, which suggests that the role of inflammation in PDAC is more complex than previously thought."