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"Bile reflux: gastropathy is a disease caused by reflux of duodenal fluid to the gaster: This fluid contains pancreatic juices and duodenal secretion. The manifestations that occur depend on the frequency amount, and duration of reflux. This disorder is quite rarely recognized in daily clinical practice. Endoscopy of the upper gastrointestinal tract is required to establish the diagnosis of this disorder: This paper will give a brief view ofthe pathogenesis and diagnostic method for this disorder."

"Even though there are still no epidemiological data on the prevalence of Gastro Esophageal Reflux Disease (GERD) in Indonesia, data from The Division of Gastroenterology Department of Internal Medicine Cipto Mangunkusumo Hospital demonstrate signs of esophagitis in 22.8% of all patients with dyspepsia who underwent endoscopic examination. Western countries report a higher rate of GERD than Asian and African countries, possibly due to dietary factors and increased obesity. Besides adequate history and physical examination, there are many other supporting examinations that could be performed to establish the diagnosis of GERD, especiaily endoscopy of the upper gastrointestinal tract and 24-hour esophageal pH monitoring. Even though this condition is rarely fatal, GERD patients should still receive adequate management. Most patients demonstrate a satisfactory response towards therapy which inciudes Iife-style modification as well as medication. Currently the drugs of choice for GERD are proton-pump inhibitors. A combination of proton-pump inhibitors and prokinetics produces a better effect. Patients resistant to medical treatment or those with recurrent esophageal stricture should be considered for anti-reflux surgery."

"Chronic hepatitis due to hepatitis B virus (HBV) or hepatitis C virus (HCP) is still a major problem in terms of progressive liver damage, prevention and therapy in most parts ofthe world. Unfortunately, to date, there is still no specific and effective therapy for HBV. No therapy can be given to carrier; non-replicative and asymptomatic patients of chronic HBV infection. Lamivudine or alpha-interferon can be used for treatment of compensated chronic hepatitis B infection with significant increase of aminotransferase. Approximately 40 % of patients can have seroconversion with this form of therapy. Chronic hepatitis D virus injection can be treat with alpha-interferon and in the final stage, may undergo liver transplantation. For chronic hepatitis C virus infection, alpha-interferon with ribavirin have been shown to have a better efficacy than afpha-interferon alone where the efficacy can reach 39-49 %."

"We report three rare cases of mucosal-associated lymphoid tissue (MALT) lymphoma. Two cases are of gastric MALT lymphoma and one is a case of transverse colon MALT lymphoma. The two cases of gastric MALT lymphoma were diagnosed by endoscopy which demonstrated an ulcer in the cardia and another in the corpus. The first case is in a 62-year-old male. The patients medical history revealed upper GI tract bleeding with melaena in 1993. At the time no diagnosis was made on endoscopy In August 2000, melaena recurred and endoscopy showed an ulcer in the cardio. Histology showed high-grade gastric MALT lymphoma. Based on Ann Arbor classification, the patient was classified as stage IE gastrointestinal lymphoma. H. pylori was negative. The patient received chemotherapy The second case is in a 53-year-old male. He suffered from gastric lymphoma for 3 years. He complained of annually recurring haematemesis before a definitive diagnosis was finally established. He suffered jiom stage IE low-grade well-differentiated lymphocytic MALT lymphoma. H. pylori was negative. Endoscopic procedure after H. pylori eradication showed ulcer regression though histology still showed low-grade MALT lymphoma and H. pylori as positive. The third case is in a 46-year-old male with a complaint of haematochezia. Colonoscopy showed intususception due to tumor in the transverse colon. Histologic examination showed chronic colitis and granulomatosa. lnvagination due to colon tumor was reported. Histologic examination of the biopsy specimen showed low-grade small cell lymphocyte-plasmocytoid lymphoma. "

"Benign recurrent intrahepatic cholestasis (BRIC) or idiopathic recurrent intrahepatic cholestasis is a rare case. It is familial and autosomal recessive. The etiology of BRIC is still unknown. We report the case of of patient with BRIC who suffered recurrent jaundice 7 times in 7 years that occurred for 1-3 months with spontaneous resolution. This patient received ursodeoxycholic acid, cholestiramine and prednisone. And within 2 months, the jaundice resolved together with other complaints."

"Background: The aim of the treatment for Helicobacter pylori (H. pylor) infection in any therapeutic context is the eradication of the organism from the fore gut. Triple or quadruple therapy has been widely accepted by many concensus as an eradication treatment in patients with ulcer or HC pylori positive dyspep- sia, but in our experience, especially in Malang successful eradication with a combination of amoxycillin, clarithromycin, metronidazole and PPI was only found in l5-20% of patients, showing an inadequacy in the use of a combination of triple or quadruple drugs. This failure may be due to multi resistant H. pylori. Thus, we must look for another agent for successful eradication. Ascorbic acid is known to play a role in inhibiting H. pylori activities. Objective: To evaluate the eject of the fleroxacine and ascorbic acid combination on H. pylori dyspeptic patients. Design: Single blind randomized clinical trial. Setting: Out-patients from The Gastro-Hepatologic Clinic, Internal Department Medical Faculty Unibraw/Dr: Sahhil Anwar Hospital, Malang, East Java, Indonesia. Patient: 30 patients were enrolled with a history of more than 3 months of ayspeptic symptoms with prior treatment using amoxycillin 500 t. id, metronidazole 500 :ng t. i.d, and landsoprazole 30 mg and persistent H. pylori after therapy. Method: We administered a combination ofjleroxacine 400 mg, ascorbic acid 1000 mg and lansoprazole to patients who had formerly taken amoxicillin, rnetronidazole and lansoprazole. These drugs were given for I4 days. Evaluation was performed 8 weeks after therapy The pre-elementary study showed that H. pylori strains in Malang, East Java, Indonesia were multi-resistant to many antibiotics. Result: After 2 weeks of treatment and 8 weeks after termination' of therapy 96, 6% of patients treated with fleroxacine, ascorbic acid and PPI demonstrated an absence of ayspeptic symptoms. The culture turned out negative and the treatment was found effective in eradicating H pylori in 28 patients (93,3%). Conclusion: Fleroxacine in combination with hexoxaene, ascorbic acid and lansoprazole was efficacious in the treatment of H. pylori dyspeptic patients in Malang East Java, Indonesia."

"Recurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAR Typically the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H.pylori infection in Indonesian children with RAR The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAR Mztcosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27. 7%. Histologic evidence of gastritis was present in 94.1 % children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegatives children were found to be H pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be perforated for a longer time of period to clarify this issue."

"Background: The prevalence of Helicobacter pylori (H. pylori) infection in the world is quite high, especially in developing countries. Usually the patient shows no specific symptoms and chronic gastritis therefore becomes chronically infected The complication of the injéction is the development of peptic ulcer; which is a predisposing factor for gastric carcinoma. Early diagnosis is an important step to avoid these complications by providing immediate accurate therapy. Methods: In this study the CLO, MIU (Motility Indole Urease) tests and culture were conducted on 131 biopsy samples of the stomach antrum mucous tissue taken from chronic dyspepsia patients from several hospitals in Jakarta. In the CLO test, biopsy tissue was put in a small well agar to be incubated at room temperature. In the MIU test the biopsy tissue sample was submerged in the small MlU tube agar with a depth of approximately 2/3 rds from the surface, and then incubated at room temperature. Another piece of biopsy tissue was cultured micro-aerophylicalty The CLO and MlU tests are considered positive if the color changes from yellow to red and are considered negative if there is no color change within 24 hours. Results: Compared to culture, the CLO test demonstrated 38% sensitivity; 96% specificity, 94% positive predictive value and 52% negative predictive value, whereas the results of the MIU test against culture method showed 76% sensitivity 89% specificity 88% positive predictive value, and 78% negative predictive value. Conclusion: The MIU test that showed high sensitivity and specyficity and thus could be further developed as an alternative diagnostic method for H. pylori infection."

"Pembedahan masih menjadi standar emas terapi kuratif untuk obstruksi saluran empedu maligna, namun hanya 10-20% kasus yang dianggap dapat dioperasi. Oleh karena itu, terapi paliatif untuk menghilangkan rasa sakit, kolestasis, dan obstruksi saluran empedu, merupakan pengobatan utama bagi sebagian besar pasien. Perkembangan drainase bilier transhepatik perkutan dan drainase bilier endoskopi telah menghasilkan pengobatan invasif minimal untuk obstruksi bilier ganas, yang memiliki morbiditas dan mortalitas lebih rendah dibandingkan drainase bedah. Pilihan teknik drainase tergantung pada jenis tumor, lokasi obstruksi, serta ketersediaan tenaga ahli dan instrumentasi.

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Surgery is still the golden standard of curative therapy for malignant biliary obstruction, but only 10-20% of cases considered resectable. Therefore, palliative therapy to relieve pain, cholestasis, and biliary obstruction, is the main treatment for most patients. The development of percutaneous transhepatic biliary drainage and endoscopic biliary drainage had brought about minimally invasive treatment for malignant biliary obstruction, which had lower morbidity and mortality than surgical drainage. The choice of drainage technique depends on type of tumor , site of obstruction, also the available expert and instrumentation."

"Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding."