ORIGINAL ARTICLE

Upper  Gastrointestinal  Endoscopic  and  

Histopathological  Findings  in  Patients    
with  Dyspepsia
Suzanna Ndraha*, Marcellus Simadibrata**
*  Department  of  Internal  Medicine,  Koja  Hospital,  Jakarta
**  Department  of  Internal  Medicine,  Faculty  of  Medicine,  University  of  Indonesia  
Dr.  Cipto  Mangunkusumo  General  National  Hospital,  Jakarta

ABSTRACT

Background:  Dyspepsia  is  a  syndrome  located  in  the  epigastric  area.  Upper  gastrointestinal  (UGI)  tract  
endoscopy  and  histopathological  examination  are  important  diagnostic  tools  for  dyspepsia.  This  study  aimed  to  
evaluate  the  pattern  of  dyspepsia  in  patients  who  underwent  endoscopy  examination  at  Koja  Hospital,  Jakarta.  
Method:  All  patients  with  dyspepsia  who  visited  Koja  Hospital  from  January  until  December  2011  were  
evaluated   in   this   observational   study.   The   data   taken   were   age,   sex,   clinical   symptoms,   risk   factors,   alarm  
V\PSWRPVERG\PDVVLQGH[8*,WUDFWHQGRVFRSLFDQGKLVWRSDWKRORJLFDO¿QGLQJV'DWDZDVDQDO\]HGXVLQJ
descriptive  statistical  analysis.
Results:  Of  1,279  patients  with  dyspepsia  symptoms,  148  patients  underwent  UGI  tract  endoscopy.  The  main  
symptom  was  epigastric  pain  (91.2%).  The  most  common  risk  factor  was  female  (60.1%).  The  most  common  
¿QGLQJRIDODUPV\PSWRPVZDVKLVWRU\RI8*,EOHHGLQJ  7KHPRVWIUHTXHQWUHVXOWRI8*,WUDFWHQGRVFRS\
was  gastritis  (79.7%).  The  most  widely  found  of  gastritis  type  was  moderate  antral  gastritis  (56%).  The  most  
FRPPRQ JDVWULWLV KLVWRSDWKRORJLFDO ¿QGLQJ ZDV QRQDFWLYH QRQDWURSKLF QRQG\VSODVWLF FKURQLF PRGHUDWH
gastritis  (56%).  All  biopsy  results  included  those  with  gastritis  as  well  as  gastric  ulcer,  which  revealed  negative  
results  of  Helicobacter  pylori  (H.  pylori).
Conclusion:   The   pattern   of   dyspepsia   at   Koja   Hospital   includes   female   predominant,   most   patients   had  
DODUP V\PSWRP KLVWRU\ RI 8*, EOHHGLQJ JDVWULWLV RQ HQGRVFRSLF ¿QGLQJV EXW + S\ORUL ZDV QRW IRXQG LQ
histopathological  results.

Keywords:  dyspepsia,  symptoms,  risk  factors,  endoscopy,  histopathological

ABSTRAK
Latar   belakang:   Dispepsia   merupakan   sekumpulan   gejala   yang   berlokasi   di   epigastrium.   Pemeriksaan  
endoskopi  saluran  cerna  bagian  atas  (SCBA)  dan  histopatologi  merupakan  pemeriksaan  penunjang  yang  penting.  
3HQHOLWLDQLQLEHUWXMXDQXQWXNPHQJHYDOXDVLSUR¿OGLVSHSVLDSDGDSDVLHQ\DQJPHQMDODQLSURVHGXUHQGRVNRSL
di  Rumah  Sakit  (RS)  Koja,  Jakarta.
Metode:  Semua  pasien  dengan  keluhan  dispepsia  yang  tercatat  di  RS  Koja  pada  Januari  hingga  Desember  
2011  dievaluasi  dalam  penelitian  observasional  ini.  Data  yang  diambil  adalah  usia,  jenis  kelamin,  keluhan,  
faktor  risiko,  tanda  alarm,  indeks  massa  tubuh,  hasil  endoskopi  SCBA,  dan  hasil  histopatologi.  Data  diolah  
menggunakan  analisis  statistik  secara  deskriptif.  
Hasil:  Dari  1.279  pasien  dispepsia,  sejumlah  148  pasien  menjalani  endoskopi  SCBA.  Keluhan  terbanyak  
adalah  nyeri  ulu  hati  (91,2%).  Faktor  risiko  utama  yang  ditemukan  adalah  perempuan  (60,1%).  Tanda  alarm  
dispespia   yang   tersering   ditemukan   adalah   riwayat   hematemesis   melena   (21,6%).   Hasil   endoskopi   SCBA  
terbanyak   adalah   gastritis   (79,7%).   Jenis   gastritis   terbanyak   adalah   gastritis   antral   sedang   (56%).   Hasil  
SHPHULNVDDQKLVWRSDWRORJLJDVWULWLV\DQJWHUEDQ\DNDGDODKJDVWULWLVNURQLNVHGDQJQRQDNWLIQRQDWUR¿NGDQ

Volume 13, Number 1, April 2012 23

Suzanna Ndraha, Marcellus Simadibrata

QRQGLVSODVWLN  3DGDVHPXDNDVXV\DQJGLELRSVLEDLNJDVWULWLVPDXSXQXONXVWLGDNGLWHPXNDQDGDQ\D

Helicobacter  pylori  (H.  pylori).
Simpulan:   Pola   klinis   dyspepsia   di   RS   Koja   lebih   sering   terjadi   pada   perempuan   dengan   tanda   alarm  
terbanyak  adalah  riwayat  hematemesis  melena,  temuan  hasil  endoskopi  terbanyak  adalah  gastritis,  dan  dari  
hasil  histopatologi  tidak  ditemukan  adanya  H.  pylori.

Kata  kunci:  dispepsia,  keluhan,  faktor  risiko,  endoskopi  SCBA,  histopatologi

INTRODUCTION independently   associated   with   dyspepsia.   However,  

KLVWRORJLFDO VHYHULW\ RI LQÀDPPDWLRQ DQG JODQGXODU
Dyspepsia   is   a   syndrome   which   consists   of  
atrophy  were  not  associated  with  dyspeptic  symptoms.  
epigastric  pain  or  discomfort  sense  in  the  epigastric  
$OVRQRFRUUHODWLRQZDVIRXQGEHWZHHQHQGRVFRSLF
area,   including   nausea,   vomiting,   bloating,   early  
appearances   and   any   of   the   different   subgroups   of  
satiation,  postprandial  fullness,  burning,  regurgitation  
dyspeptic  symptoms.11
and   heartburn.1   Dyspepsia   can   be   caused   by   either  
$W.RMDKRVSLWDOG\VSHSVLDis  a  highly  prevalent.  
functional   disease   or   organic   lesion.1,2   Functional  
However,  VWXG\DERXWFOLQLFDOSUR¿OHRIG\VSHSVLDDQG
dyspepsia   (FD)   regarding   to   Rome   III   Criteria   is  
UGI   endoscopic   results   have   not   yet   been   explored  
divided   into   2   subgroup:   (1)   postprandial   distress  
previously.  The  aim  of  this  study  was  to  evaluate  the  
syndrome   (PDS),   characterized   by   postprandial  
pattern  of  dyspepsia  patients  who  underwent  endoscopy  
fullness   and   early   satiation,   and   (2)   epigastric   pain  
H[DPLQDWLRQDW.RMD+RVSLWDOVRWKDWSK\VLFLDQVZRXOG
syndrome  (EPS),  characterized  by  epigastric  pain  and  
provide  better  treatment  for  dyspeptic  patients.
burning.3,4  
Wallander   et   al,   found   that   smoking   and   obesity  
METHOD
increase   the   risk   of   dyspepsia;;   while   alcohol  
consumption  as  well  as  stress  condition  did  not  increase   This   observational   cross   sectional   study   was  
the   likelihood   of   receiving   a   dyspepsia   diagnosis.   FRQGXFWHG DW .RMD +RVSLWDO EHWZHHQ -DQXDU\ DQG
Consumption  of  pain  killer  drugs  was  also  a  risk  factor.5   December   2011.   The   diagnosis   of   dyspepsia   was  
Marwaha  et  al,  noted  that  the  prevalence  of  dyspepsia   established   based   on   the   presence   of   at   least   one   of  
VLJQL¿FDQWO\LQFUHDVHGLQIHPDOHVSDWLHQWVZKRZHUH the   followings,   i.e.   epigastric   pain,   early   satiation,  
Helicobacter  pylori  (H.  pylori)-­positive  and  individuals   postprandial   fullness   and   epigastric   burn.   Inclusion  
XVLQJQRQVWHURLGDQWLLQÀDPPDWRU\GUXJV 16$,'V 6   criteria   were   all   patients   with   dyspepsia   who   had  
7KHLQÀXHQFHRIGLHWDVWKHULVNIDFWRULVQRWDOZD\V agreed  to  undergo  UGI  tract  endoscopy  examination.  
consistent. 7   Prompt   endoscopy   is   recommended   Exclusion   criteria   were   patients   with   age   under   17  
in   patients   with   alarm   symptoms   or   patients   over   years   old,   who   refused   the   interview   or   could   not  
D WKUHVKROG DJH$JH VSHFL¿F WKUHVKROGV WR WULJJHU speak  Indonesian  language.  The  sex,  age,  symptoms,  
endoscopic  evaluation  may  differ  by  sex  and  locality   risk   factors,   alarm   symptoms,   body   mass   index,  
given   gender   and   regional   disease   specific   risks.   HQGRVFRSLFDQGKLVWRORJLFDO¿QGLQJVZHUHUHFRUGHG
7KH $PHULFDQ &ROOHJH RI 3K\VLFLDQV LQ  The  risk  factors  recorded  were  female,  consumption  
agreed   that   age   cut   off   for   referral   is   at   45   years.   RIKHUEDOPHGLFLQH16$,'VWUHVVREHVLW\VPRNLQJ
Upper   gastrointestinal   (UGI)   bleeding,   recurrent   osteoarthritis   and   the   presence   of   H.   pylori   from  
vomiting,   unexplained   weight   loss,   progressive   KLVWRSDWKRORJLFDO¿QGLQJV7KHDODUPV\PSWRPVZHUH
dysphagia   and   anemia   were   called   as   the   alarm   history  of  UGI  bleeding,  weight  loss  >  10  kg,  persistent  
symptoms   for   dyspeptic   patients.1,2   Without   alarm   vomiting  and  anemia.  The  age  >  45  years  was  noted  as  
symptoms,   the   patients   less   than   50   years   should   the  cut-­off  point  of  increased  cancer  risk.
receive   an   empiric   trial   of   PPIs.   Once   a   patient   has   6XEMHFWVZHUHFRQVLGHUHGDVWRKDYHDQHPLDZKHQ
failed  a  4  week  trial  of  PPI  therapy,  upper  endoscopy   their   hemoglobin   was   <   13   g/dL   for   male   and   <   12  
is   indicated.   Results   of   upper   endoscopy   is   not   g/dL   for   female.12 7KH VXEMHFWV ZHUH FODVVL¿HG DV
always   correspond   to   the   severity   of   the   symptom.   underweight   if   they   had   body   mass   index   (BMI)   <  
Tahara   et   al,   found   that   the   liner   redness   (friability)    NJP2 QRUPDO LI %0, ZDV ± NJP2;;  
in   the   antrum   and   duodenal   ulcer   scarring   were   RYHUZHLJKWREHVHIRU%0,•NJP2.13  Prior  to  the  

24 The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

 Upper Gastrointestinal Endoscopic and Histopathological Findings in Patients with Dyspepsia

endoscopy,  patients  were  divided  into  2  subgroups  based  

on  the  following  dominant  symptoms:  (1)  meal-­induced  
dyspeptic  symptoms  or  PDS;;  (2)  meal-­unrelated  FD  or   37%
(36WRGHVFULEHWKHSUR¿OHRIXQLQYHVWLJDWHGG\VSHSVLD 63%
8'  LQ WKLV VWXG\ VXEMHFW 'DWD ZDV DQDO\]HG XVLQJ
SPSS  15.0  with  a  descriptive  statistical  analysis,  and  
was  presented  as  n  (%)  or  mean  (SD).

RESULTS EPS  93  subject  (63%) PDS  55  subject  (37%)

'XULQJ -DQXDU\ XQWLO 'HFHPEHU   Figure   1.   Distribution   of   dyspeptic   patients   according   to  
dyspepsia  subgroup
dyspeptic   patients   visited   Internal   Medicine   Clinic  
LQ.RMD+RVSLWDO7KHUHZHUH  G\VSHSWLF
SDWLHQWVZKRXQGHUZHQWXSSHUHQGRVFRS\DQGIXO¿OOHG Table   2   shows   that   alarm   symptoms   were   found  
the   inclusion   criteria.   Eighty   nine   patients   (60.1%)   in  dyspeptic  patients  and  21.6%  patients  had  history  
ZHUHIHPDOHWKHPHDQDJHRISDWLHQWVZHUH“ of   UGI   bleeding.   Based   on   the   presence   of   alarm  
\HDUVZLWKDUDQJHEHWZHHQ\HDUVROG7KHDJH symptoms,   there   were   62.2%   patients   had   no   alarm  
group  of  40-­50  year  was  the  highest  among  the  patients   symptom,   23.65%   patients   had   1   alarm   symptom,  
(42%),  followed  by  50-­60  years  (37%).  The  age  >  45    SDWLHQWV KDG  DODUP V\PSWRPV  KDG 
years  was  found  in  52%.  The  most  frequent  symptom   alarm  symptoms.
IRXQG ZDV HSLJDVWULF SDLQ   ZLWK 
expressed  the  pain  as  “severe”  (very  disturbing),  and   Table  2.  Alarm  symptoms  in  dyspeptic  patients
%0,•NJP2ZDVIRXQGLQSDWLHQWV 7DEOH  Alarm  symptom n  (%)
History  of  upper  gastrointestinal  bleeding 32  (21.6)
$FFRUGLQJ WR G\VSHSVLD VXEJURXS the   study  
Persistence  of  vomiting 19  (12.8)
revealed   that   most   patients   (63%)   were   included   in   Unexplained  weight  loss 19  (12.8)
the  EPS  subgroup  (Figure  1).   Anemia 10  (6.8)

Table  1.  Characteristics  of  dyspeptic  patients

Characteristic  (n  =  148) n  (%) Table  3  shows  the  risk  factors  found  in  the  study  
Sex VXEMHFWVDQGEDVHGRQWKHSUHVHQFHRIULVNIDFWRUVWKHUH
Male   59  (39.9)
were  only  2%  patients  who  had  no  risk  factor,  1.4%  
Female   89  (60.1)
Age  (years) KDGULVNIDFWRUKDGULVNIDFWRUVKDG
<  20 5  (3.4) risk  factors,  41.1%  had  4  risk  factors,  11%  had  5  risk  
20-­30 11  (7.4) factors  and  5.4%  had  6  risk  factors.
30-­40 28  (19.0)
40-­50 42  (28.4)
Tabel  3.  Risk  factors  in  dyspeptic  patients
50-­60 37  (25)
60-­70 19  (12.8) Risk  factor n  (%)
>  70 6  (4.0) Female 89  (60.1)
mean  ±  SD   46.5  ±  13.8 Herbal  medicine  or  NSAID 52  (35.1)
Symptoms Stress 48  (32.4)
Epigastric  pain   135  (91.2) 2EHVLW\ %0,•NJP2) 27  (18.3)
Severe                                   76  (56.3) Smoking 19  (12.8)
Moderate                         36  (26.7) Osteoarthritis 16  (10.0)
Mild                                         23  (17.0) Helicobacter  pylori  infection 0  (0)
Early  satiation 130  (87.8) 16$,'QRQVWHURLGDODQWLLQÀDPPDWRU\GUXJ%0,ERG\PDVVLQGH[
Postprandial  fullness 75  (50.7)
Epigastric  burn 69  (46.6)
Indication  of  UGI  endoscopy Table  4  demonstrates  the  results  of  UGI  endoscopy  
Alarm  symptom   56  (37.8) RISDWLHQWVZKLOH7DEOHGLVSOD\VWKHUHVXOWVRI
NSAID  gastropathy 52  (35.1) KLVWRSDWKRORJLFDO ¿QGLQJV RI  JDVWULWLV SDWLHQWV
Dysphagia 4  (2.7) %DVHGRQWKHVWDWXVRIFKURQLFJDVWULWLVSDWLHQWV
GERD 2  (1.4)
Gastric  tumor 1  (0.7)
were   not   active,   36.4%   were   active,   and   1.7%   had  
SD:  standard  deviation;;  UGI:  upper  gastrointestinal;;  NSAID:  non-­steroidal no   data.   In   all   cases,   gastritis   as   well   as   the   ulcer  
DQWLLQÀDPPDWRU\GUXJV*(5'JDVWURHVRSKDJHDOUHÀX[GLVHDVH demonstrated  100%  negative  results  for  H.  pylori.

Volume 13, Number 1, April 2012 25

Suzanna Ndraha, Marcellus Simadibrata

7DEOH5HVXOWVRIXSSHUJDVWURLQWHVWLQDOHQGRVFRSLF¿QGLQJV be  due  to  the  ethnic  factor,  or  different  method  of  data  
Result n  (%) retrieval.14-­16
Gastritis 118  (79.7)
In  this  study,  the  biggest  risk  factor  for  dyspepsia  
Moderate  antral  gastritis 66  (56.0)
Erosive  gastritis 23  (20.0)
occurrence   was   female   (60.1%).   This   result   was   in  
Pangastritis 13  (11.0) DFFRUGDQFHZLWKWKH¿QGLQJVE\0DUZDKD6  The  role  
%LOHUHÀX[JDVWULWLV 12  (10.0) RI16$,'ZKLFKZDVWKHVHFRQGKLJKHVWULVNIDFWRU
Severe  antral  gastritis 4  (3.0) in   this   study   (35.1%),   is   also   expressed   by   many  
Gastric  ulcer 21  (14)
investigators.1,5,6,17  The  third  risk  factor  in  the  present  
Esophagitis 17  (11.5)
Duodenitis 16  (10.8) study  was  stress  (32.4%).  Some  studies  also  discussed  
Duodenal  ulcer 1  (0.7) about  the  role  of  stress  or  anxiety,   but  others  studies  
Gastric  cancer 1  (0.7) found  no  relationship  between  stress  and  the  increased  
risk  of  functional  dyspepsia.5,7,16  The  fourth  risk  factors  
7DEOH5HVXOWRIKLVWRSDWKRORJLFDO¿QGLQJVLQJDVWULWLVSDWLHQWV ZDVREHVLW\  DQGWKLVUHVXOWZDVLQDFFRUGDQFH
Result n  (%) ZLWK WKH ¿QGLQJV E\ :DOODQGHU HW DO5   In   this   study,  
Non-­active,   non-­atrophy,   non-­dysplastic   chronic     66  (56.0) VPRNLQJZDVRQO\IRXQGLQDQGZDVSODFHGDV
moderate  gastritis
Mild   activity,   non-­atrophy,   non-­dysplastic   chronic     34  (28.8)
WKH¿IWKULVNIDFWRUV7KHUROHRIFLJDUHWWHLQGHYHORSLQJ
moderate  gastritis   dyspepsia   is   not   always   consistent.   Some   studies  
Non-­active,   non-­atrophy,   non-­dysplastic   chronic     7  (5.9) showed   a   relationship,   some   did   not.7   Osteoarthritis  
mild  gastritis
Mild   activity,   non-­atrophy,   non-­dysplastic   chronic     7  (5.9)
has  become  one  of  the  risk  factors  because  of  the  use  
severe  gastritis   of   pain   killer   medicine.5   In   this   study,   osteoarthritis  
Severe  activity,  non-­atrophy,  non-­dysplastic  chronic     2  (1.7) ZDV IRXQG RQO\ LQ  RI VXEMHFWV ,W LV SRVVLEO\
moderate  gastritis  
EHFDXVHQRWDOO16$,'XVHUVXQGHUZHQWWKHUDGLRORJLF
No  data  (did  not  return) 2  (1.7)
examination  for  the  diagnosis.  
Many   studies   have   demonstrated   about   the   role  
DISCUSSION
of   H.   pylori   as   the   cause   of   dyspepsia,   especially  
7KLV VWXG\ KDV LQFOXGHG  G\VSHSWLF SDWLHQWV organic  dyspepsia  such  as  peptic  ulcer  and  gastritis.1,2,6,7    
RIZKLFK  ZHUHPDOHDQG  ZHUH In  this  study,  the  result  of  the  H.  pylori  examination  was  
female.   Mahadeva   et   al,   who   had   conducted   a   100%  negative.  This  is  likely  due  to  the  eradication  of  
population  based  study  to  evaluate  the  uninvestigated   H.  pylori  that  has  been  performed  extensively,  which  
dyspepsia   showed   that   the   male   :   female   ratio   was   results  in  no  more  positive  results.  However,  this  study  
generally  comparable.7  Wallander  et  al,  wrote  that  the   only  got  the  biopsy  from  antrum  area;;  whereas  H.  pylori  
incidence  was  greater  in  female  (16.0/1,000  person-­ could  be  found  in  other  parts  of  gastric  mucosa.
years)   than   male   (14.5/1,000   person-­years).5   Such   $QXSSHUHQGRVFRS\LVUHFRPPHQGHGLQSDWLHQWV
difference  is  possibly  due  to  the  different  ethnicity  and     with  alarm  symptoms  or  patients  over  a  threshold  age.  
a  different  sample  size. The   cut-­off   point   of   age   for   immediate   endoscopy  
$ VXUYH\ FRQGXFWHG LQ &DQDGD IRXQG WKDW peak   LV GLIIHUHQW LQ PDQ\ FHQWHUV7KH$PHULFDQ &ROOHJH
prevalence  of  UD  occurred  between  45-­54  years  of  age;;   RI3K\VLFLDQVLQDJUHHGWKDWWKHDJHFXWRIIIRU
ZKLOH)'DSSHDUHGWRKDYHSHDNLQ&KLQHVHVXEMHFWV referral  is  45  years.Talley  suggested  the  cut  off  at  45  
at  41-­50  years.  In  this  study  the  peak  was  obtained  at   \HDUVIRUWKH$VLD3DFL¿FUHJLRQDQGDW\HDUVIRU
WKHDJHRI\HDUV SDWLHQWV ZKLFKLV Western  countries.  This  is  because  in  Western  countries  
in  accordance  with  the  Canadian  and  Chinese  study.4 the  incidence  of  gastric  cancer  is  very  rare  below  this  
%DVHG RQ WKH SDWWHUQ RI V\PSWRPV  SDWLHQWV age  but  rises  rapidly  in  older  patients.  Furthermore,  
  ZHUH FODVVL¿HG DV (36 DQG WKH UHPDLQLQJ  Talley  suggested  an  age  cut  off  of  55  years  for  Western  
(37%)   patients   were   in   PDS   subgroup   (Figure   2).   countries,   and   a   lower   threshold   in   some   countries  
$ VWXG\ LQ ,WDO\ WKDW H[DPLQHG  SDWLHQWV ZLWK LQ WKH$VLD3DFLILF UHJLRQ10   In   the   present   study,  
dyspepsia   showed   contrary   results,   i.e.   77   (67.5%)   ZHXVHGWKHDJHFXWRIIDW\HDUVDW.RMD+RVSLWDO
SDWLHQWV ZHUH ¿W LQWR 3'6 DQG    SDWLHQWV VLQFH,QGRQHVLDLVDSDUWRIWKH$VLDQ3DFL¿FUHJLRQ
were  in  EPS  subgroups.  On  the  other  hand,  a  study  in   However,  in  this  study,  alarm  symptoms  were  present  
&DQDGDDOVRGHPRQVWUDWHGGRPLQDQW¿QGLQJVLQ3'6 RQO\LQSDWLHQWVDQGWKHPRVWFRPPRQDODUP
subgroup  (70.1%)  and  compared  to  the  EPS  subgroup,   symptom   found   was   the   history   of   UGI   bleeding  
ZKLFKZDVRQO\7KHVHGLIIHUHQWUHVXOWVFRXOG (21.6%).   The   patients   exceeding   the   threshold   age  

26 The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy

 Upper Gastrointestinal Endoscopic and Histopathological Findings in Patients with Dyspepsia

\HDUV ZHUHZKLFKPHDQVWKDWWKHPDMRULW\ 100%  patients  with  H.  pylori-­negative  results.  Most  of  
of   patients   underwent   upper   endoscopy   based   on   WKRVH VXEMHFWV KDG WKH QRQDFWLYH FKURQLF JDVWULWLV  
indication  of  threshold  age. Only  36.4%  showed  the  presence  activity,  which  was  
The  results  of  endoscopic  examination  demonstrated   LQDFFRUGDQFHZLWKWKH¿QGLQJVLQWKHVWXG\FRQGXFWHG
WKDWJDVWULWLVZDVWKHPRVWFRPPRQ¿QGLQJ   E\6KD¿LHWDO20  
Study  conducted  at  the  Cipto  Mangunkusumo  Hospital  
E\$QDPHWDOIRXQGWKDWWKHPRVWFRPPRQ¿QGLQJV CONCLUSION
were   gastritis   (44.5%)   and   erosive   gastritis   (40%),  
In   this   study,   we   found   the   dyspepsia   patterns  
followed   by   esophagitis   (31.4%)   and   peptic   ulcer  
DW .RMD +RVSLWDO LH WKHUH DUH PRUH IHPDOH WKDQ
(17.3%).  The  result  obtained  from  the  study  at  Cipto  
male   patients;;   the   peak   age   is   at   40-­50   years   old;;  
Mangunkusumo   Hospital   seems   in   accordance   with  
female   gender   is   the   most   common   risk   factor.  The  
.RMD +RVSLWDO VWXG\ WKDW WKH PRVW FRPPRQ ¿QGLQJ
most  common  alarm  symptom  is  the  history  of  UGI  
ZDVJDVWULWLV &LSWR0DQJXQNXVXPR+RVSLWDO
bleeding;;  most  patients  have  gastritis  on  endoscopic  
YV.RMD+RVSLWDO 2XWRIJDVWULWLV¿QGLQJV
¿QGLQJV DQG PRVW SDWLHQWV KDYH QRQDFWLYH QRQ
erosive  gastritis  was  found  in  as  many  as  23   (20%)  
atrophy,  non-­dysplastic,  moderate  chronic  gastritis  on  
SDWLHQWVZKLFKZDVORZHUWKDQWKH¿QGLQJVDW&LSWR
the  biopsy  result.
Mangunkusumo  Hospital  (40%).  
The   findings   of   esophagitis   was   found   more  
REFERENCES
common  at  Cipto  Mangunkusumo  Hospital  (31.4%);;  
while   this   study   only   found   7.4%.   However,   the   1.   'MRMRQLQJUDW'3HQGHNDWDQNOLQLVSHQ\DNLWJDVWURLQWHVWLQDO
,Q6XGR\R$:6HWL\RKDGL%$OZL,6LPDGLEUDWD06HWLDGL
JDVWULF XOFHU ¿QGLQJV ZDV DOPRVW VLPLODU EHWZHHQ 6HGV%XNX$MDU,OPX3HQ\DNLW'DODPthHG-DNDUWD,QWHUQD
&LSWR 0DQJXQNXVXPR +RVSLWDO   DQG .RMD 3XEOS
Hospital   (14%).   In   general,   the   results   of   this   study   2.   +DUGMRGLVDVWUR ' 6XPDQWUL 6 'DVDU SHQGHNDWDQ NOLQLN
were  not  much  different  with  the  study  conducted  at   SHQ\DNLWJDVWURLQWHVWLQDO,Q5DQL$$6LPDGLEUDWD06\DP
$)HGV%XNX$MDU*DVWURHQWHURORJL-DNDUWD,QWHUQD3XEO
Cipto  Mangunkusumo  Hospital.  However,  there  was   S
DOLWWOHELWGLIIHUHQFHLQWKH¿QGLQJVRIHVRSKDJLWLVDQG 3.   $QRQ\PRXV 5RPH ,,, GLDJQRVWLF FULWHULD IRU IXQFWLRQDO
erosive  gastritis.  It  may  occur  due  to  the  small  sample   JDVWURLQWHVWLQDOGLVRUGHUV>FLWHG$XJ@$YDLODEOHIURP
size  in  this  study.   85/ KWWSZZZ URPHFULWHULDRUJDVVHWVSGIB5RPH,,,B
DS$BSGI
Based   on   histopathological   examination   of   all  
4.   *HHUDHUWV%7DFN-)XQFWLRQDOG\VSHSVLDSDVWSUHVHQWDQG
gastritis   patients,   we   found   that   all   patients   had   IXWXUH-*DVWURHQWHURO±
non-­atrophy   chronic   gastritis.   Most   of   them   (56%)   5.   :DOODQGHU0$-RKDQVVRQ65XLJRPH]$5RGUՍJXH]/$
were   non-­active,   non-­atrophy,   non-­dysplastic,   -RQHV5'\VSHSVLDLQJHQHUDOSUDFWLFHLQFLGHQFHULVNIDFWRUV
PRGHUDWHFKURQLF JDVWULWLV$FFRUGLQJ WR 7DKDUD HW FRPRUELGLW\DQGPRUWDOLW\)DP3UDFW±
6.   0DUZDKD$ )RUG$ /LP$ 0RD\\HGL 3 5LVN IDFWRUV IRU
al,   the   histological   severity   of   inflammation   and  
dyspepsia:  systematic  review  and  meta-­analysis  [cited  2012  
glandular  atrophy  were  not  associated  with  dyspeptic   -DQ @$YDLODEOH IURP 85/ KWWSZZZSXOVXVFRP
symptoms.11  However,  in  this  study,  56.3%  of  patients   FGGZDEVKWP
with  epigastric  pain  had  expressed  the  pain  as  “severe”.   7.   0DKDGHYD6*RK./(SLGHPLRORJ\RIIXQFWLRQDOGLVSHSVLD
DJOREDOSHUVSHFWLYH:RUOG-*DVWURHQWHURO2006;;12:2661-­6.  
7KHHQGRVFRSLF¿QGLQJVUHYHDOHGWKDWSDWLHQWVKDG
 $QRQ\PRXV (QGRVFRS\ LQ WKH HYDOXDWLRQ RI G\VSHSVLD
moderate  antral  gastritis;;  while  the  histopathological   +HDOWKDQG3XEOLF3ROLF\&RPPLWWHH$PHULFDQ&ROOHJHRI
¿QGLQJV GHPRQVWUDWHG WKDW  SDWLHQWV KDG QRQ 3K\VLFLDQV$QQ,QWHUQ0HG±
active,  non-­atrophy,  non-­dysplastic  moderate  chronic    Manan   C.   Penatalaksanaan   sindroma   dispepsia.   In:   Rani  
gastritis.   It   seems   that   in   this   study,   the   severity   of   $$0DQDQ&'MRMRQLQJUDW'6LPDGLEUDWD00DNPXQ'
$EGXOODK0HGV'LVSHSVLD6DLQVGDQ$SOLNDVL.OLQLN2nd  ed.  
dyspeptic  symptoms  was  appropriate  with  endoscopic   -DNDUWD,QWHUQD3XEOS
DQGKLVWRSDWKRORJLFDO¿QGLQJV 10.   7DOOH\ 1- 9DNLO 1 *XLGHOLQHV IRU WKH PDQDJHPHQW RI
6KD¿L HW DO LQYHVWLJDWHG  ELRSV\ VDPSOHV RI G\VSHSVLD$P-*DVWURHQWHURO±
chronic  gastritis  in  order  to  determine  the  differences   11.   7DKDUD 7$ULVDZD 7 6KLEDWD 7 1DNDPXUD 0 2NXER 0
between   H.   pylori-­positive   and   H.   pylori-­negative   <RVKLRND '$VVRFLDWLRQ RI HQGRVFRSLF DSSHDUDQFHV ZLWK
G\VSHSWLFV\PSWRPV-*DVWURHQWHURO±
patients.  They   reported   that   the   presence   of   activity   12.   *XUDOQLN-0(UVKOHU:%6FKULHU6/3LFR]]L9-$QHPLD
RI FKURQLF JDVWULWLV ZDV VLJQL¿FDQWO\ KLJKHU LQ WKH   LQ WKH HOGHUO\ D SXEOLF KHDOWK FULVLV LQ KHPDWRORJ\$6+
H.  pylori  infected  patients  (56%)  comparing  to  non-­   special   symposium:   anemia   in   the   elderly   [cited   2012  
H.  pylori  infected  ones  (30.6%).20  In  this  study,  we  found   0DUFK @$YDLODEOH IURP 85/ KWWSDVKHGXFDWLRQERRN  
KHPDWRORJ\OLEUDU\RUJFRQWHQWIXOOSGIKWPO

Volume 13, Number 1, April 2012 27

Suzanna Ndraha, Marcellus Simadibrata

13.   :+2 H[SHUW FRQVXOWDWLRQ$SSURSULDWH ERG\PDVV LQGH[ 17.   Perkumpulan  Gastroenterologi  Indonesia  (PGI).  Penatalaksanaan  
IRU$VLDQ SRSXODWLRQV DQG LWV LPSOLFDWLRQV IRU SROLF\ DQG JDVWURHQWHURSDWL2$,16GL,QGRQHVLD-DNDUWD  Interna  Publ  
LQWHUYHQWLRQVWUDWHJLHV/DQFHW± S
14.   7DFN-0DVDRND7-DQVVHQ3)XQFWLRQDOG\VSHSVLDV\PSWRP  7DOOH\ 1- '\VSHSVLD PDQDJHPHQW JXLGHOLQHV IRU WKH
GH¿QLWLRQVDQGRYHUODS>FLWHG-DQ@$YDLODEOHIURP PLOOHQQLXP*XW 6XSSO,9 LY±
85/KWWSZZZPHGVFDSHFRPYLHZDUWLFOHB  $QDP,.XVQDQWR36XODLPDQ%61GUDKD6)DX]L$6\DP$)
15.   =DJDUL50/DZ*5)XFFLR/&HQQDPR9*LOWKRUSH06 HWDO3UR¿OSDVLHQ\DQJGLODNXNDQHVRIDJRJDVWURGXRGHQRVNRSL
Forman  D,  et  al.    Epidemiology  of  functional  dyspepsia  and   (EGD)  di  Departemen  Penyakit  Dalam  Rumah  Sakit  Cipto  
subgroups   in   the   Italian   general   population:   an   endoscopic   0DQJXQNXVXPR-DNDUWD6HSWHPEHU$JXVWXV,Q
VWXG\*DVWURHQWHURORJ\ 6LPDGLEUDWD0$EGXOODK0HGV(QGRVNRSL*DVWURLQWHVWLQDO
16.   $UR 3 7DOOH\ 1- 5RQNDLQHQ - 6WRUVNUXEE 7 9LHWK 0 7HUDSHXWLN7HUNLQL-DNDUWD,QWHUQD3XEOS
-RKDQVVRQ6(HWDO$Q[LHW\LVDVVRFLDWHGZLWKXQLQYHVWLJDWHG 20.   6KD¿L01LN]DG6(.DVLUL+1DJKLSRXU0+LVWRSDWKRORJLFDO
and   functional   dyspepsia   (Rome   III   criteria)   in   a   Swedish   evaluation  of  chronic  gastritis  with  and  without  Helicobacter  
SRSXODWLRQEDVHGVWXG\*DVWURHQWHURORJ\± pylori   FRORQL]DWLRQ D VWXG\ IURP ,UDQ 0DOD\VLDQ - 3DWKRO
±

Correspondence:  
6X]DQQD1GUDKD  
Department  of  Internal  Medicine  
 Koja  Hospital  
-O7HEHW7LPXU'DODP9OOO;1R-DNDUWD,QGRQHVLD  
3KRQH)DFV  
(PDLOVXVDQBQGUDKD#\DKRRFRLG

28 The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy