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Abstrak :
Tukak lambung adalah salah satu gastrointestinal kronis yang paling umum. Penggunaan obat konvensional banyak menimbulkan efek samping, sehingga perlu adanya pendekatan terapi herbal. Salah satunya dengan menggunakan dedak padi yang berasal dari penggilingan padi. Dedak padi mengandung ?-oryzanol yang mempunyai berbagai aktivitas farmakologis. Salah satunya adalah sebagai anti tukak lambung. Tujuan dari penelitian ini adalah untuk menggunakan metode IL-MAE untuk meningkatkan ?-oryzanol dalam dedak padi dan mengevaluasi efektivitas ekstrak dedak padi sebagai gastroprotektif pada model tukak lambung yang diinduksi etanol pada tikus. Ekstrak dedak padi diperoleh dengan IL-BMIM[BF4] 0,7 M dengan MAE pada kondisi ekstraksi rasio sampel/pelarut 15 g/mL, waktu ekstraksi 15 menit dan daya mikrowave 10 . Tikus diberi perlakuan dengan ekstrak dedak padi pada dosis yang berbeda 100, 200, 400 mg/kgBB selama tujuh hari dan kemudian terpapar lesi lambung akut yang diinduksi 80 etanol 0,5 ml/200 gBB . Omeprazol 36 mg/kgBB digunakan sebagai obat anti-ulkus standar. Indeks ulkus, keasaman lambung dan pembentukan mukus diukur untuk menilai tingkat gastroproteksi. Hasil penelitian ini menunjukkan bahwa metode IL[BMIM]BF4-MAE dapat meningkatkan kadar ?-oryzanol sebesar 0,421 mg/g dibandingkan dengan metode isopropanol-MAE dan pemberian oral ekstrak dedak padi pada dosis 400 mg/kgBB secara nilai signifikan menghambat pembentukan lesi lambung sebesar 66,75 dan penurunan keasaman lambung. Selain itu, ekstrak dedak padi dapat melindungi mukosa lambung dari lesi lambung akibat etanol dengan meningkatkan pembentukan mukus lambung. Aplikasi metode IL[BMIM]BF4-MAE lebih efektif meningkatkan kadar ?-oryzanol pada ekstrak dedak padi dan ekstrak dedak padi 400 mg/kgBB mempunyai efektivitas sebagai gastroprotektif.

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Peptic ulcer is one of the most common chronic gastrointestinal. The use of conventional medicine causes many side effects, so the need for an approach of herbal therapy. One of them by using rice bran derived from rice milling. Rice bran contains oryzanol which has various pharmacological activities. One of them is as an anti gastric ulcer. The aim of this study was to use the IL MAE method to increase oryzanol in rice bran and evaluate the effectiveness of rice bran extract as gastroprotective in the ethanol induced peptic ulcer model in rats. The rice bran extract was obtained with IL BMIM BF4 0.7 M with MAE at ratio sample liquid of 15 g mL, extraction time 15 min and microwave power 10. The rats were treated with rice bran extract at different doses 100, 200, 400 mg kgBW for seven days and then exposed to acute induced gastric lesions 80 ethanol 0.5 ml 200 gBW. Omeprazole 36 mg kgBW is used as a standard anti ulcer drug. The ulcer index, gastric acidity and mucus formation were measured to assess the level of gastroprotection. The results of this study indicate that the method of IL BMIM BF4 MAE can increase the oryzanol level by 0.421 mg g compared with isopropanol MAE method and oral administration of rice bran at dose 400 mg kgBW significantly decreases gastric lesion formation by 66.75 and decreased gastric acidity. In addition, rice bran extract can protect the gastric mucosa from gastric lesions due to ethanol by increasing gastric mucus formation. The application of the IL BMIM BF4 MAE method more effectively increases the oryzanol content of rice bran extract 400 mg kgBW has effectiveness as gastroprotective.

Abstrak :
Ulkus peptikum adalah hilangnya sel epitel yang mencapai atau menembus muskularis mukosa dengan diameter kedalaman < 5 mm. Ulkus dapat terjadi akibat produksi mukus yang terlalu sedikit atau produksi asam yang berlebihan. Lambung memiliki sistem pertahanan yang dimediasi oleh pelepasan CGRP dari serat saraf aferen dan pembentukan NO. Pada penelitian terdahulu, telah dibuktikan bahwa terdapat zat dalam capsaicin yang dapat membantu mempercepat proses penyembuhan ulkus peptikum. Capsaicin adalah suatu alkaloid yang larut dalam alkohol dan terdapat pada cabai. Capsaicin bekerja dengan merangsang pelepasan CGRP yang selanjutnya memicu pelepasan NO yang berfungsi untuk meningkatkan aliran darah ke lambung. Sedangkan dalam praktek dokter sehari-hari, terdapat beberapa obat yang dapat menimbulkan efek samping ulkus peptikum, salah satunya adalah indometasin. Indometasin mempengaruhi respon peradangan dengan menghambat enzim siklooksigenase sehingga berkurangnya sintesis prostaglandin dan leukotrien yang berfungsi sebagai suatu antiinflamasi. Namun, indometasin dalam dosis besar mempunyai efek samping merangsang produksi asam dan pepsin yang berlebihan di dalam lambung dan memudahkan timbulnya ulkus peptikum. Metode penelitian ini adalah eksperimental. Pada penelitian ini, dilakukan pemberian capsaicin bersamaan dengan suatu zat yang dapat menimbulkan ulkus seperti indometasin. Percobaan dilakukan dengan menginduksi ulkus pada lambung tikus kemudian tikus diberi capsaicin dan indometasin per oral pada hari yang sama. Hasil menunjukkan perbedaan luas ulkus pada tiap kelompok percobaan, rata-rata luas ulkus kelompok kontrol yaitu 5,3 mm2, kelompok capsaicin sebesar 2 mm2, kelompok indometasin sebesar 40,33 mm2, dan kelompok capsaicin dan indometasin sebesar 0 mm2. Hasil uji statistik: perbedaan bermakna (p = 0,034) terdapat antara kelompok yang diberi capsaicin dan kelompok yang diberi indometasin. Kesimpulan Capsaicin terbukti mampu mempercepat penyembuhan ulkus lambung pada tikus yang diberi paparan indometasin. ...... Peptic ulcer is loss of epithelial cell through muscularis mucosa with diameter of depth less than 5 mm.Peptic ulcer is caused by lack of mucous or excess of acid production. Gaster has own self-defence mechanism which mediated by CGRP release from afferent nerve and produce nitric oxide (NO). On the previous research, it has been proven that there is a substance in capsaicin which can accelerate ulcer healing process. Capsaicin is a alcohol solved material which is contained in chilli. Capsaicin stimulates the release of CGRP moreover stimulates release of nitric oxide (NO) that function to increase blood supply to the gaster. In daily clinical practice, there are some drugs which it will lead to peptic ulcer, one of them is indometachin. Indomethacin influence an inflammatory reaction by inhibit cyclooxigenase enzyme, so that decrease the synthesis of prostaglandin and leukotrien which functioned as an anti-inflammatory. However, large amount of indomethacin has side effect to increase acid and pepsin production then induce peptic ulcer. The method of this research is experimental. In this research, given capsaicin with substance that can induce peptic ulcer such as indometachin. The test was started with induction of ulcer on rat?s stomach moreover it?s given with capsaicin and indometachin per oral in the same day. The results shows the difference wide of ulcer between control which are 5,3 mm2, capsaicin 2 mm2, indomethacin 40,33 mm2, and indometchacin combine by capsaicin 0 mm2. Statistic result shows the difference is significant (p = 0,034) between capsaicin and indomethacin. This research shows capsaicin plays role in healing process of gastric ulcer in rats exposured by indomethacin.

Abstrak :
ABSTRAK Latar Belakang: Mortalitas pasien perforasi tukak peptik (PTP) masih stabil pada angka 20-50% dimana penyebab terbanyak adalah sepsis. Tantangan ini memicu para ahli bedah untuk meneliti faktor-faktor yang berhubungan dengan mortalitas dan morbiditas penyakit ini. Selain pembedahan untuk kontrol infeksi, antibiotika preoperatif diketahui menurunkan angka mortalitas. Penelitian ini bertujuan mengetahui hubungan kesesuaian antibiotika empiris dengan hasil kultur sensitifitas antibiotika terhadap ketahanan hidup 30 hari pasien perforasi tukak peptik di RSUPN Dr Cipto Mangunkusumo (RSCM) Jakarta. Metode: Studi kohort terhadap pasien PTP sejak Januari 2012 hingga Agustus 2015 di Departemen Bedah FKUI/RSCM Jakarta, dimana PTP akibat keganasan dan trauma tembus dieksklusikan. Pola kuman dan antibiotika pada pasien PTP disajikan sebagai studi pendahuluan. Hasil: dari 45 pasien yang didapat, angka mortalitas pasien PTP di RSCM sebesar 31,1% dan ketahanan hidup sebesar 68,9%. Pola kuman pada pasien PTP adalah Escherichia coli sebagai kuman Gram negatif terbanyak (35,85%) dan Streptococcus alfahemolytic sebagai kuman Gram positif terbanyak (15,09%). Antibiotika lini kedua yang sesuai untuk pasien PTP adalah Sulbactam/Ampicillin. Tidak terdapat hubungan antara skor Boey dan ketahan hidup, namun syok preoperatif memengaruhi ketahanan hidup (nilai OR 14,67). Begitu juga dengan komorbiditas memengaruhi ketahanan hidup sebesar 10,54 kali. Lama persiapan operasi tidak bermakna terhadap ketahanan hidup, sedangkan durasi operasi memengaruhi ketahanan hidup sebesar 7,5 kali. Antibiotika empiris yang sesuai dengan hasil kultur memengaruhi ketahanan hidup sebesar 12,57 kali. Kesimpulan: Pemberian antibiotika empiris yang tepat terbukti berhubungan dengan ketahanan hidup pasien perforasi tukak peptik.;

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ABSTRACT Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at 20-50%, which is the most common cause is sepsis. This challenge prompted the surgeon to examine the factors associated with mortality and morbidity of this disease. In addition to surgery to control infection, preoperative antibiotics are known to reduce mortality. This study aims to determine the suitability of empiric antibiotics relationship with antibiotic sensitivity culture results to the 30 days survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January 2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta, where PUP due to malignancy and penetrating trauma were excluded. Patterns of bacteria and antibiotics in PUP patients presented as a preliminary study. Results: 45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate for the PUP patients is sulbactam/ampicillin. There was no relationship between Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67). Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on survival was not significant, while the duration of surgery affecting the survival of 7.5 times. Empiric antibiotics in accordance with the culture results affects survival of 12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be associated with survival in patients with peptic ulcer perforation. ;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at 20-50%, which is the most common cause is sepsis. This challenge prompted the surgeon to examine the factors associated with mortality and morbidity of this disease. In addition to surgery to control infection, preoperative antibiotics are known to reduce mortality. This study aims to determine the suitability of empiric antibiotics relationship with antibiotic sensitivity culture results to the 30 days survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January 2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta, where PUP due to malignancy and penetrating trauma were excluded. Patterns of bacteria and antibiotics in PUP patients presented as a preliminary study. Results: 45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate for the PUP patients is sulbactam/ampicillin. There was no relationship between Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67). Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on survival was not significant, while the duration of surgery affecting the survival of 7.5 times. Empiric antibiotics in accordance with the culture results affects survival of 12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be associated with survival in patients with peptic ulcer perforation.;Background: Mortality of patients with peptic ulcer perforation (PUP) was stable at 20-50%, which is the most common cause is sepsis. This challenge prompted the surgeon to examine the factors associated with mortality and morbidity of this disease. In addition to surgery to control infection, preoperative antibiotics are known to reduce mortality. This study aims to determine the suitability of empiric antibiotics relationship with antibiotic sensitivity culture results to the 30 days survival of perforated peptic ulcer patients in Dr Cipto Mangunkusumo General Hospital (RSCM) in Jakarta. Methods: A cohort study of patients PUP since January 2012 to August 2015 at Department of Surgery Faculty of medicine/RSCM Jakarta, where PUP due to malignancy and penetrating trauma were excluded. Patterns of bacteria and antibiotics in PUP patients presented as a preliminary study. Results: 45 patients were obtained, the mortality rate of patients in RSCM PUP by 31.1% and amounted to 68.9% survival. Patterns of bacteria in a patient PUP is Escherichia coli as most Gram-negative bacteria (35.85%) and Streptococcus alfahemolytic as most Gram-positive bacteria (15.09%). The second line antibiotics are appropriate for the PUP patients is sulbactam/ampicillin. There was no relationship between Boey?s score and survivability, but the preoperative shock affect survival (OR 14.67). Likewise with comorbidities affecting the survival of 10.54 times. Time to surgery on survival was not significant, while the duration of surgery affecting the survival of 7.5 times. Empiric antibiotics in accordance with the culture results affects survival of 12.57 times. Conclusion: The provision of appropriate empiric antibiotic shown to be associated with survival in patients with peptic ulcer perforation.

Abstrak :
Latar belakang: Perforasi tukak peptik PTP merupakan komplikasi penyakit tukak peptik yang memiliki angka morbiditas dan mortalitas yang cukup tinggi. Luaran pasien yang maksimal dapat dicapai dengan perawatan optimal disertai alokasi sumber daya yang sesuai dengan statifikasi pasien berdasarkan kelompok risikonya. Skor peptic ulcer perforation PULP merupakan sistem penilaian terbaru untuk prediksi prognosis pasien PTP. Penelitian ini bertujuan untuk mengetahui penerapan skor PULP dalam prediksi mortalitas pasien PTP di Rumah Sakit dr. Cipto Mangunkusumo RSCM. Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 52 pasien PTP yang datang ke RSCM pada periode Januari 2011-Juni 2015. Pasien perforasi gaster/duodenum akibat trauma dan keganasan gaster/duodenum, pasien yang tidak menjalani pembedahan dan pasien yang sudah menjalani pembedahan di luar RSCM dieksklusi. Analisis statistik diolah dengan program SPSS 20 for windows, untuk menilai variabel apa yang secara independen memengaruhi mortalitas pasien PTP dan bagaimana akurasi skor PULP dalam prediksi mortalitas pasien PTP. Hasil penelitian: Variabel syok saat masuk rumah sakit dan awitan penyakit >24 jam merupakan prediktor independen mortalitas pasien PTP dengan nilai kemaknaan masing-masing 0,04 dan 0,03. Nilai area under the curve skor PULP dalam prediksi mortalitas pasien PTP mencapai 71,60 95 IK 53,80 -89,40. Kesimpulan: Penggunaan skor PULP dinilai cukup baik untuk prediksi mortalitas pasien PTP di RSCM. Kata kunci: Perforasi tukak peptik, skor peptic ulcer perforation PULP , mortalitas, syok, awitan penyakit. ...... Background: Perforated peptic ulcer PPU is a complication of peptic ulcer disease with high rates of morbidity and mortality. Maximum outcomes could be achieved by optimal care combined with allocation of resources in accordance with patient's risk stratification. Peptic ulcer perforation PULP score is the newest scoring systems for predicting the prognosis of PPU patients. This study aims to determine the application of PULP score in predicting mortality of PPU patient in Cipto Mangunkusumo Hospital. Method: A cross sectional analytical study carried out by taking the total sample of 52 patients who came with PPU to Cipto Mangunkusumo Hospital in the period of January 2011 June 2015. Those with perforation at stomach duodenum due to trauma and malignancy, those who did not undergo surgery and those who have undergone surgery outside Cipto Mangunkusumo Hospital were excluded. Statistical analysis is processed with SPSS 20 for windows, to determine which variables independently afffect the mortality of PPU patients and how is the accuracy of PULP score in predicting mortality of PPU patients. Results: Shock on admission and onset of disease 24 hours were independent predictors of mortality in PPU patients p value 0.04 and 0.03 respectively. The value of area under the curve of PULP score in predicting mortality in PPU patients was 71.60 95 CI 53.80 89.40. Conclusions: PULP score is considered good enough to predict mortality of PPU patients in Cipto Mangunkusumo Hospital. Keywords Perforated peptic ulcer, peptic ulcer perforation PULP score, mortality, shock, onset of disease.

Abstrak :
Evaluasi ilmiah terhadap aktifitas farmakologi obat herbal memerlukan model pengujian dengan metode induksi tukak yang sesuai pada hewan coba. Dalam kajian ini, metode antiulserogenik diinvestigasi menggunakan beberapa induktor. Tikus putih jantan galur Sprague-Dawley dibagi ke dalam 5 kelompok model yang masing-masing diberi air suling, indometasin (48 mg/kg bb), aspirin-HCl (150 mg/kg bb), 96% etanol (1 ml/200 g bb), dan 80% etanol (1 ml/200 g bb) secara oral. Hasil penelitian menunjukkan bahwa kelompok yang diinduksi dengan 80% etanol memberikan indeks ulkus tertinggi. Pengujian secara histologi menunjukkan adanya abnormalitas sel-sel mukosa lambung pada kelompok model tukak lambung yang diinduksi dengan aspirin-HCl, 96% dan 80% etanol.

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Abstract
Scientific evaluation on pharmacological activity of medicinal herbs required reproducible and valid method-induced ulcer models in animal. In this study, the method of antiulcerogenic effect was investigated using several inducers. The male white Sprague-Dawley rats divided into five groups which were orally administrated water, indomethacin (48 mg/kg bw), aspirin-HCl (150 mg/kg bw), 96% ethanol (1 ml/200 g bw), and 80% ethanol (1 ml/200 g bw), respectively. The result of this study showed that the group was induced with 80% ethanol demonstrated the highest ulcer index. Histological examination of the stomach showed abnormality of mucosa cells on the aspirin-HCl, 96% ethanol, and 80% ethanol-induced gastric ulcer model in rats.