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"Penyakit refluks gastroesofagus (GERD) merupakan kondisi kronik yang terjadi akibat asam lambung naik ke esofagus. COVID-19 dapat memperburuk gejala GERD dan berdampak pada fungsi pernapasan. Latihan diafragma mampu memperbaiki gejala GERD, namun efektivitasnya pada orang dewasa dengan GERD pasca COVID-19 belum pernah diteliti. Penelitian ini bertujuan untuk menguji efektivitas latihan diafragma modifikasi terhadap gejala GERD, tekanan inspirasi maksimal (TIM), ekskursi diafragma, dan fungsi paru. Penelitian ini merupakan uji klinis acak tersamar tunggal pada bulan September 2022 sampai April 2023 di Rumah Sakit Persahabatan. Dari data rekam medis terdapat 364 pasien yang mengalami gejala gastrointestinal persisten. Dari data pasien tersebut, 302 pasien mengalami gejala sebelum COVID-19 dan 62 pasien setelah COVID19. Sebanyak 55 pasien memenuhi kriteria inklusi dan lolos kriteria eksklusi. Selanjutnya dialokasikan secara random pada kelompok uji (n = 25) dan kontrol (n = 25), dan 5 pasien menjalani penelitian pendahuluan. Latihan diafragma selama empat minggu terdiri atas latihan diafragma modifikasi atau latihan diafragma standar. Evaluasi dilakukan 30 hari setelah latihan pertama. Dibandingkan dengan kelompok kontrol, kelompok uji menunjukkan peningkatan bermakna pada tekanan inspirasi maksimal (TIM; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 dan 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), ekskursi diafragma kanan (4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 dan 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), dan ekskursi diafragma kiri (4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 dan 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Selain itu, baik kelompok uji sebelum-dan-sesudah maupun kelompok kontrol mengalami penurunan bermakna pada skor GERDQ (10,44 ± 2,00 vs. 1,84 ± 2,17 dan 8,64 ± 0,57 vs. 3,32 ± 1,49), dengan nilai p < 0,001. Latihan diafragma meningkatkan nilai kapasitas vital paksa (KVP), tidak meningkatkan nilai volume ekspirasi paksa detik pertama (VEP1) maupun rasio antara volume ekspirasi paksa detik pertama dan kapasitas vital paksa (VEP1/KVP), tidak bermakna secara statistik (p > 0,05). Latihan diafragma modifikasi pada orang dewasa setelah COVID-19 dengan GERD meningkatkan TIM dan ekskursi diafragma, serta mengurangi gejala refluks gastroesofageal yang terlihat dari perbaikan skor GERDQ.

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Gastroesophageal reflux disease (GERD) is a common chronic condition characterized by stomach acid reflux into the esophagus. COVID-19 may worsen GERD symptoms and impact respiratory function. Diaphragmatic training has demonstrated potential effectiveness in managing GERD symptoms, but its effectiveness in adults with GERD after COVID-19 is unknown. This study aimed to examine the effectiveness of modified diaphragmatic training (MDT) on GERD symptoms, maximum inspiratory pressure (MIP), diaphragmatic excursion, and lung function in this population. This single-blinded randomized control trial was conducted from September 2022 to April 2023 at Persahabatan Hospital. The research team evaluated the medical records of 364 patients presenting persistent gastrointestinal symptoms; among these potential participants, 302 reported symptoms before COVID-19 infection, while 62 developed symptoms after being infected with COVID-19. After applying the study's inclusion and exclusion criteria, a total of 55 patients were selected and randomly assigned to either the intervention group (n = 25) or the control group (n = 25), and 5 patients were enrolled in the preliminary research. The intervention phase consisted of four weeks of diaphragmatic training, wherein participants received either modified diaphragmatic training (MDT) or standard diaphragmatic training. Following the training period, a follow-up assessment was conducted 30 days from the initiation of the intervention. In comparison to the control group, the intervention group demonstrated significant improvements in maximum inspiratory pressure (MIP; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 and 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), right diaphragmatic excursion (RDE; 4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 and 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), and left diaphragmatic excursion (LDE; 4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 and 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Additionally, both the pre–post-intervention group and the control group exhibited significant reductions in GERDQ scores (10.44 ± 2.00 vs. 1.84 ± 2.17 and 8.64 ± 0.57 vs. 3.32 ± 1.49, respectively), with a p-value < 0.001. Diaphragmatic training resulted in increased forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), these differences were not statistically significant in both groups (p > 0,05). MDT in adults post-COVID-19 with GERD enhanced MIP and diaphragmatic excursion, along with a reduction in symptoms of GERD as evidenced by improvements in GERDQ scores."

"ABSTRAK Latar belakang: Penyakit refluks gastroesofagus PRGE pada remaja sulit didiagnosis, karena gejala klinis tidak spesifik dan menyebabkan penurunan kualitas hidup. Gastroesofageal reflux disease questionnaire GERD-Q dan pediatric gastroesophageal symptom and quality of life questionnaire PGSQ telah divalidasi dan dikembangkan untuk mengidentifikasi PRGE dan kualitas hidup. Penggunaan GERD-Q dan PGSQ pada populasi remaja sebagian besar tidak diketahui.Tujuan: Untuk memperoleh prevalens dugaan PRGE pada remaja menggunakan GERD-Q dan penilaian kualitas hidup pada remaja yang memiliki GERD-Q positif skor ge; 7 dengan menggunakan PGSQ.Metode: Remaja usia 12-18 tahun di evaluasi menggunakan kuesioner GERD-Q. Remaja yang memiliki skor GERD-Q positif dievaluasi kualitas hidupnya menggunakan PGSQ. Analisis mengenai faktor risiko dugaan PRGE juga dilakukan.Hasil: Pada 520 subjek, rasio laki-laki dan perempuan 1:1,3 dan usia median 13 tahun. Prevalens dugaan PRGE pada remaja menggunakan kuesioner GERD-Q adalah 32,9 . Mengkonsumsi minuman soda memiliki risiko 1,7 kali mengalami dugaan PRGE Interval kepercayaan 95 1,3-2,2, ABSTRACT Background Gastroesophageal reflux disease in adolescent is difficult to diagnose due to nonspecific symptom and often lead to poor quality of life. Gastroesophageal reflux disease questionnaire GERD Q and pediatric gastroesophageal symptom and quality of life questionnaire PGSQ are validated questionnaire that was developed to help identify GERD patients and their quality of life respectively. The application of GERD Q and PGSQ in adolescent population is largely unknown.Aim To obtain suspected GERD prevalence in adolescent using GERD Q and quality of life score assessment in adolescent with GERD Q positive.Methods Adolescent age 12 18 years were evaluated using indonesian version of GERD Q. Adolescents with GERD Q positive were then evaluated their quality of life using Indonesian version of PGSQ. Suspected risk factors of having GERD, which would influence GERD Q result, were also analyzed.Result In 520 subjects, the male to female ratio was 1 1,3 and the median age was 13 years range 12 18 years . Prevalence of GERD in adolescent using GERD Q was 32,9 . Routine soda consumption was 1,7 times more likely to have GERD CI 95 1.3 2.2, p"

"Latar belakang. Refluks gastroesofagus (RGE) dengan gejala klinis regurgitasimerupakan manifestasi gastrointestinal yang sering dijumpai pada bayi. Penelitianmenunjukkan bahwa prevalens regurgitasi menurun setelah usia 6 bulan sedangkan gejalaklinis penyakit refluks gastroesofagus (PRGE) didapatkan pada anak di atas 1 tahun yangmemiliki riwayat regurgitasi sering pada usia di atas 6 bulan. Infant gastroesophagealreflux questionnaire (I-GERQ) merupakan sarana diagnosis PRGE yang tidak invasif danmemiliki nilai prediktif positif yang baik.Tujuan. Penelitian ini bertujuan untuk mengetahui insidens PRGE, karakteristik bayiyang mengalami regurgitasi, skor I-GERQ dan gejala yang berkaitan dengan PRGE,faktor-faktor risiko yang berkaitan dengan gejala regurgitasi yang menetap hingga akhirpemantauan, dampak regurgitasi terhadap peningkatan berat badan dan pola makanMetode. Penelitian longitudinal prospektif pada subjek dengan regurgitasi minimal1x/hari setidak-tidaknya 4x/minggu. Kriteria eksklusi adalah bayi atopi, mengi berulang,dicurigai alergi susu sapi, kelainan neurologis, terdiagnosis tuberkulosis, riwayat operasisaluran cerna sebelumnya, pernah mencapat terapi antogonis reseptor H2 ataupenghambat pompa proton. Subjek sesuai PRGE jika skor I-GERQ >7, dan dirujuk keRumah Sakit Cipto Mangunkusumo. Pemantauan dilakukan setiap bulan pada subjekdengan I-GERQ ≤ 7, dengan menilai skor I-GERQ dan pengukuran antropometris.Hasil. Sebanyak 131 dari 352 subjek yang memenuhi kriteria penelitian. Subjek sebagianbesar berusia 6 bulan (51,1%), status antropometris sesuai (85,5%), dan mendapat asupandengan median frekuensi 14 (5-15) x/hari. Median skor I-GERQ saat awal pemantauanadalah 4 (3-7). Sebanyak 81,9% subjek mencapai skor I-GERQ nol saat akhirpemantauan. PRGE didapatkan pada 1 subjek saat pemantauan pertama dengan gejalaberat badan sulit naik, regurgitasi 3-5x/hari, volume regurgitasi >15 mL. Variabelpemberian ASI eksklusif, paparan rokok, keluarga dengan alergi, keluarga dengan RGE,dan terapi non-farmakologis tidak berkaitan dengan gejala regurgitasi yang menetaphingga akhir pemantauan. Gejala regurgitasi hingga akhir pemantauan didapatkan pada13,7% subjek yang mengikuti saran terapi non-farmakologis dibandingkan dengan 86,4%yang tidak mendapat dan tidak mengikuti edukasi (p = 0,14). Perbedaan rerata z-scoreberat badan berdasarkan usia pada subjek yang masih mengalami gejala regurgitasihingga akhir pemantauan adalah -0,006 ± 0,357 (IK 95% -0,164; 0,152), p = 0,939.Kesulitan makan didapatkan pada 19 subjek dan 17 diantaranya tidak lagi mengalamiregurgitasi saat akhir pemantauan.Simpulan. Insidens PRGE adalah 0,7%. Sebagian besar subjek mencapai skor I-GERQsaat akhir pemantauan. Terapi non-farmakologis walaupun tidak bermakna secarastatistik dengan gejala regurgitasi yang menetap hingga akhir pemantauan namundidapatkan perbedaan proporsi. Gangguan peningkatan berat badan dan kesulitan makantidak berhubungan dengan gejala regurgitasi yang menetap hingga akhir pemantauan.Kata kunci: bayi, refluks gastroesofagus, penyakit refluks gastroeosfagus, infantgastroesophageal reflux questionnaire

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Background. Regurgitation as symptom of gastroesophageal reflux (GER) is a common

gastrointestinal manifestation in infant. Publications showed that regurgitation will

decrease after 6 month old; whereas symptoms of gastroesophageal reflux disease

(GERD) is more prevalent in children with history of frequent regurgitation after 6 month

old. Infant gastroesophageal reflux questionnaire (I-GERQ) is a non-invasive diagnostic

tool for GERD with high positive predictive value.

Aim. To investigate the incidence of GERD, characteristics of infants with regurgitation,

I-GERQ score and manifestation of GERD, risk factors that related with regurgitation

symptom that persists at the end of follow-up, correlation of regurgitation with weight

gain and feeding problems.

Method. A Longitudinal prospective study in subjects with regurgitation at least 1

time/day; 4 times/week. We excluded infants with atopy, recurrent wheezing, probable

cow milk allergy, diagnosed as tuberculosis, neurologic disorder, history of

gastrointestinal surgery, history of H2 receptor antagonist or proton pump inhibitor

treatment. I-GERQ score and anthropometric status were measured at enrollment.

Subjects with GERD (I-GERQ >7) were referred to Cipto Mangunkusumo Hospital.

Follow-up of I-GERQ, body weight, and body length in every month were performed in

subjects with I-GERQ ≤7.

Results. 131 of 352 subjects fulfilled the criteria. Subject mostly were 6 month old

(51.1%), normal anthropometric status (85.5%), and have frequent intake with median 14

(5 – 15) times/day. Median of I-GERQ at enrollment were 4 (3 – 7), and at the end of

follow-up 81.9% subjects reached I-GERQ score 0. GERD were found in 1 subject at first

month follow-up with poor weight gain, regurgitation 3-5 times/day, regurgitation>15

mL. Exclusively breastfeeding, smoke exposure, family history of allergy and GER, and

non-pharmacotherapy were not related with regurgitation that persists until 3 months

follow-up. Regurgitation at the end of follow-up were found in 13.7% subjects who

complied with non-pharmacotherapy; compared to 86.4% who have not complied nor had

educated (p = 0.14). Mean difference of weight for age z-score in subjects with

regurgitation at the end of follow-up were -0.006 ± 0.357 (95%CI -0.164; 0.152), p =

0.939. Feeding problems were found in 19 subjects while 17 of them no longer have

regurgitation symptom at the end of follow-up

Conclusion. Incidence of GERD is 0.7%. Most of subjects reached I-GERQ 0 at the end

of follow up. Non-pharmacotherapy showed no statistically significant with regurgitation

symptom at the end of follow up, but we found proportion difference. Weight gain and

feeding problems are not related with regurgitation symptom that persists at the end of

follow up"

"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."

"Latar Belakang: Resistensi insulin telah dilaporkan lebih tinggi pada populasi subjek dengan penyakit refluks gastroesofageal GERD dibandingkan subjek tanpa GERD serta berhubungan langsung terhadap adanya esofagitis erosif. Adanya perbedaan ras dan metode pengukuran pada penelitian sebelumnya, mendorong perlunya penelitian di Indonesia untuk dapat mengetahui resistensi insulin pada populasi GERD, khususnya pada erosi esofagus. Tujuan: Mempelajari perbedaan resistensi insulin pada penyakit refluks gastroesofageal dengan erosi dan tanpa erosi esofagus. Metode: Penelitian ini menggunakan metode potong lintang terhadap 84 pasien dewasa dengan gejala GERD yang berobat di poliklinik gastroenterologi RSCM pada bulan Januari hingga April 2017. Perekrutan subjek dilakukan secara konsekutif menggunakan kuesioner GERDQ. Nilai HOMA-IR digunakan untuk evaluasi resistensi insulin. Adanya erosi esofagus dinilai menggunakan pemeriksaan esofagogastroduodenoskopi EGD. Data diolah menggunakan analisis Mann Whitney untuk memperoleh beda median nilai HOMA-IR antara kelompok tanpa erosi dan kelompok dengan erosi esofagus. Hasil penelitian: Nilai median HOMA IR pada seluruh subjek dengan gejala GERD adalah 1,46 0,32-13,85 . Uji Mann Whitney menunjukkan adanya perbedaan nilai HOMA-IR yang signifikan p= 0,015 dengan nilai median HOMA IR yang lebih tinggi pada kelompok erosi esofagus, yaitu 1,74 0,35-13,85 dibandingkan dengan subjek tanpa erosi esofagus, yaitu 1,21 0,32-10,78. Kesimpulan: Resistensi insulin, yang dinilai dengan HOMA-IR, lebih tinggi secara bermakna pada pasien refluks gastroesofageal dengan erosi esofagus dibandingkan tanpa erosi esofagus.

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Background: Insulin resistance had been reported higher in GERD patients, particularly in patients with erosive esophagitis. Differences in subjects rsquo characteristics and measurement used in previous studies encourage the need to assign the study in Indonesia learn about insulin resistance among GERD patients especially in esophagitis erosive.

Aim: To learn the difference of insulin resistance between erosive and non erosive reflux disease in GERD patients.

Methods: A cross sectional study of 84 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between January 2017 and April 2017 at Cipto Mangunkusumo National Hospital in Jakarta. GERDQ questionnaire was used for subject recruitment. Homeostatic model assessment insulin resistance HOMA IR index was used to evaluate insulin resistance. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Mann whitney analysis was used to determine HOMA IR median difference between esophagitis and non esophagitis group.

Results: The median of HOMA IR in all subjects was 1.46 0.32 13.85 . Using Mann Whitney test, HOMA IR index was significantly higher in esophagitis patients p 0.015 than in non erosive patients, with the median of HOMA IR index were 1.74 0.35 13.85 and 1.21 0.32 10.78 respectively.

Conclusion Insulin resistance, using HOMA IR index, is significantly higher in gastroesophageal reflux disease patients with esophageal erosion. "

"Gastroesophageal reflux disease (GERD) adalah suatu kondisi kembalinya cairan lambung ke esofagus. Terapi akupunktur tanam benang telah menjadi salah satu terapi yang digunakan untuk alternatif terapi. Penelitian ini bertujuan untuk mengetahui perubahan kadar Nitrit Oksida (NO) serum setelah terapi akupunktur tanam benang dan medikamentosa. Uji acak tersamar tunggal dilakukan pada 50 responden dengan GERD yang di bagi kepada kelompok akupunktur tanam benang dan medikamentosa dibandingkan dengan kelompok akupunktur sham dan medikamentosa. Pemeriksaan kadar NO menjadi parameter yang dinilai pada saat sebelum perlakuan dan 30 hari setelah 2 kali terapi dengan durasi 15 hari sekali.Hasil penelitian menunjukkan terjadi kenaikan kadar NO pada kelompok perlakuan dibandingkan kelompok sham namun tidak ada perbedaan bermakna antara kedua kelompok. Kesimpulan penelitian ini akupunktur tanam benang belum terbukti secara statistik mempengaruhi kadar NO pada pasien GERD.

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OksidaGastroesophageal reflux disease (GERD ) is a condition that causes the return of gastric fluid into the esophagus. Catgut embedding acupuncture has become one of the therapies used for alternative therapies. This study aimed to determine changes in serum Nitric Oxide (NO) levels after catgut embedding acupuncture therapy and conventional medicine. Single -blind randomized trials is used on 50 respondents with GERD were divided to group catgut embedding acupuncture therapy and conventional medicine compared with sham acupuncture group and medicine. The level of NO into the parameters assessed at the time before treatment and 30 days after treatment with 2 times the duration of 15 days.

The results showed increased levels of NO in catgut embedding acupuncture therapy and conventional medicine group compared with sham acupuncture group and medicine but there was no significant difference between the two groups. The conclusion of this study catgut embedding acupuncture has not been proven statistically in influencing the levels of NO in patients with GERD."

"LATAR BELAKANG: Prevalensi GERD di Indonesia semakin meningkat.GERD dapat memengaruhi kualitas hidup penderitanya. Kuesioner GERD Qualityof Life GERD-QOL telah diuji keandalan dan kesahihannya di Cina. Penelitianini bertujuan untuk menterjemahkan kuesioner GERD-QOL ke dalam bahasaIndonesia dan menguji keandalan dan kesahihannya. METODE: Sebagai tahap awal, kuesioner GERD-QOL terlebih dahuluditerjemahkan dengan metode forward backward translation ke dalam bahasaIndonesia, dan dievaluasi oleh tim peneliti sehingga dihasilkan kuesioner GERDQOLversi bahasa Indonesia. Sembilan puluh satu orang pasien yang telahdidiagnosis GERD secara klinis sebelumnya berdasarkan kriteria Montreal,diwawancarai dengan menggunakan kuesioner GERD-QOL versi Indonesia dankuesioner SF-36. Keandalan dinilai melalui metode konsistensi internal dan tesulang dengan mewawancarai pasien pada hari pertama dan hari ke-14. Kesahihan dinilai menggunakan kesahihan konstruksi dan kesahihan eksternal melaluiperbandingan dengan SF-36. HASIL: GERD-QOL berbahasa Indonesia memiliki keandalan konsistensiinternal kuesioner yang baik Cronbach alpha: 0,687 ndash;0,842 dengan keandalantes ulang yang baik intra class correlation coefficient: 0,756-0,936, P

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BACKGROUND: GERD prevalence in Indonesia has been increasing. GERDcan affect quality of life. GERD Quality of Life GERD QOL questionnaire hasbeen translated and validated in China. This study is aimed to translate GERDQOLquestionnaire into Indonesian version and to assess its validity andreliability.

METHODS: GERD QOL is translated into bahasa Indonesia using forwardbackward translation and compared by experts to original version. Total of 91patients have been diagnosed clinically with GERD based on Montreal consensus,were recruited to complete the questionnaire and validated Indonesian SF 36.Reliability was conducted by using internal consistency and test retest methodwith 14 days interval. Validity was conducted by using construct validity andexternal validity with SF 36 comparison method.

RESULT Indonesian version of GERD QOL was internally reliable withCronbach Alpha 0.822 and had good test and retest reliability intra classcorrelation coefficient 0.756 0.936, P"

"Latar belakang: Refluks gastroesofagus merupakan hal yang normal pada bayi prematur karena fungsi sfingter esofagus bawah belum sempurna. Penegakkan diagnosis refluks seringkali didasarkan oleh gejala klinis berupa apnea, desaturasi, dan bradikardi. Gejala-gejala tersebut sering dijadikan dasar untuk pemberian terapi proton pump inhibitor. Kondisi overdiagnosis dan overtreatment  ini bukan hanya terjadi di Indonesia, tetapi secara global.

Tujuan: Mengetahui frekuensi kejadian refluks, apnea, desaturasi, dan bradikardi pada bayi prematur. Mengetahui faktor risiko refluks pada bayi prematur terkait dengan modalitas suplementasi oksigen dan strategi pemberian susu. Mengetahui hubungan refluks dengan apnea, desaturasi, dan bradikardi.

Metode: Penelitian analitik observasional dengan desain potong lintang. Subjek adalah bayi prematur dengan postmentrual age 32-36 minggu yang memiliki riwayat apnea, desaturasi, atau bradikardi dicurigai akibat refluks. Subjek sudah mendapat susu minimal 60 mL/kg/hari. Subjek dieksklusi jika sudah mendapat obat prokinetik, penekan asam lambung, menggunakan alat bantu pernapasan yang lanjut (terintubasi, noninvasive positive pressure ventilation, atau continuous positive airway pressure dengan positive and expiratory pressure >7 cmH₂O), terdapat kelainan intrakranial, kongenital mayor, atau dalam kondisi sepsis. Posisi semua bayi adalah terlentang dengan kepala lebih tinggi 45°. Diagnosis refluks ditegakkan dengan menggunakan pemeriksaan baku emas, yaitu multipel intraluminal impedance – pHmetri, yang merekam kejadian refluks selama 24 jam. Diagnosis apnea, desaturasi, dan bradikardi ditegakkan dengan perekaman monitor hemodinamik dan pencatatan oleh perawat selama 24 jam.

Hasil: Dari total 20 subjek, terdapat 3882 refluks selama 24 jam. Dari refluks tersebut, sebanyak 331 refluks (8,5%) mencapai batas sfingter esofagus atas. Sebanyak 17 subjek (85%) mempunyai nilai indeks refluks normal (<5). Dari 2 subjek yang mempunyai indeks refluks ≥ 10, tidak ada gejala klinis esofagitis refluks yang khas. Karakteristis refluks sebagian besar merupakan jenis refluks cair (79,9%) yang bersifat asam lemah (84,6%). Tidak ada hubungan yang signifikan antara refluks dengan jenis suplementasi oksigen, jenis susu, frekuensi pemberian susu, durasi pemberian susu, ataupun volume pemberian susu. Proporsi refluks tinggi yang disertai dengan apnea dan bradikardi sangat kecil (0,3%). Secara statistik, refluks tinggi tidak berhubungan dengan kejadian desaturasi. Namun, terdapat 2 subjek (10%) yang mempunyai refluks tinggi disertai dengan desaturasi. Pada kedua subjek tersebut, tidak ada alarm symptoms yang khas.

Kesimpulan: Semua bayi prematur mengalami refluks, tetapi hanya 15% yang mengalami refluks patologis. Refluks pada bayi prematur tidak dipengaruhi oleh modalitas suplementasi oksigen ataupun strategi pemberian susu. Tidak ada hubungan antara refluks dengan kejadian apnea, desaturasi, dan bradikardi.

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Background: Gastroesophageal reflux is common in premature baby due to immature lower esophageal sphincter function. The diagnosis of reflux is often based on clinical symptoms such as apnea, desaturation, and bradycardia. Furthermore, these symptoms are often used as the basis by clinicians to provide proton pump inhibitor therapy. This condition of overdiagnosis and overtreatment does not only occur in Indonesia but globally.

Objective: To determine the frequency of reflux, apnea, desaturation, and bradycardia in preterm infants. To determine the risk of reflux in preterm infants related to oxygen supplementation and milk feeding strategy. To determine the significance of the association between reflux with apnea, desaturation, and bradycardia.

Method: Observational analytic study with a cross-sectional design. Subjects were preterm infants with postmenstrual age of 32-36 weeks who have a history of apnea, desaturation, or bradycardia suspected of reflux and have received milk at least 60 mL/kg/day. Subjects were excluded if they have received prokinetic drugs, gastric acid suppressants, are still using advanced respiratory support (intubated, non-invasive positive pressure ventilation, or continuous positive airway pressure with positive and expiratory pressure >7 cmH2O), having intracranial abnormalities, major congenital abnormalities, or sepsis condition. The position of all subjects is lying with head elevated 45°. Diagnosis of reflux was done using the gold standard examination, namely multiple intraluminal impedance – pHmetry, which records for 24 hours. Diagnoses of apnea, desaturation, and bradycardia were made with 24-hour hemodynamic monitor recording and was recorded by the attending nurse.

Results: From a total of 20 subjects, there were 3,882 refluxes over 24 hours. Of these refluxes, 331 refluxes (8.5%) reached the upper esophageal sphincter. A total of 17 subjects (85%) had normal reflux index values (<5). Of the 2 subjects who had a reflux index ≥ 10, there were no typical clinical symptoms of reflux esophagitis. Reflux characteristics were mostly liquid reflux (79.9%) and weak acid reflux (84.6%). There is no significant relationship between reflux with modes of oxygen supplementation, types of milk, frequency of feeding, duration of feeding, and milk volume. The proportion of high reflux accompanied by apnea and bradycardia was very small (0.3%). Statistically, high reflux was not associated with the incidence of desaturation. However, there was two subjects (10%) with refluxes accompanied by desaturation. There was no specific alarm symptoms in both subjects.

Conclusion: Reflux occurs in all preterm infants, but only 15% of them have pathological reflux. Reflux in preterm infants is not affected by oxygen supplementation modes or milk feeding strategy. There is no association between reflux and the incidence of apnea, desaturation, and bradycardia."

"Gastroesophageal reflux disease (GERD) is a condi-tion of reflux of gastric content into the esophagus, whichcould create clinical symptoms. Reflux can occur under normal conditions, usually related to certain conditions, such as lying down after meals and during vomitting. If reflux occurs, the esophagus would immediately contract to cleanse the lumen from refluxate, preventing prolonged contact between the refluxate and the esophageal mucosa."

"Latar belakang: Pada saat puasa Ramadhan, terjadi penurunan rerata pH lambung dan memendeknya selisih waktu antara makan terakhir dan jam tidur sehingga memperberat keluhan Penyakit Refluks Gastroesofageal (Gastro-esophageal Reflux Disease, disingkat GERD). Sementara itu juga terjadi keteraturan jadwal makan, dan perubahan dalam kebiasaan merokok dan alkohol. Meski demikian, belum diketahui dengan pasti keluhan penyakit GERD selama berpuasa Ramadhan.Tujuan: Mengetahui pengaruh puasa Ramadhan terhadap keluhan GERD.Metode: Penelitian ini merupakan studi longitudinal yang mengevaluasi keluhan GERD pada pasien yang menjalani puasa Ramadhan. Penelitian dilakukan selama bulan Juli (Ramadhan) sampai bulan Oktober (tiga bulan setelah Ramadhan) 2015. Subjek penelitian yang didapatkan melalui metode consecutive sampling ini dikelompokkan menjadi kelompok berpuasa Ramadhan (n=66) dan kelompok tidak berpuasa Ramadhan (n=64). Evaluasi dilakukan antara kedua kelompok tesebut, dan antara bulan Ramadhan dengan di luar bulan Ramadhan pada kelompok berpuasa, dengan menggunakan kuesioner GERD (GERD-Q) yang telah diterjemahkan dalam bahasa Indonesia.Hasil: Pada kelompok yang berpuasa Ramadhan, terdapat perbedaan median nilai GERD-Q yang bermakna secara statistik (nilai p < 0,01) antara bulan Ramadhan dengan nilai median 0, dan di luar bulan Ramadhan dengan nilai median yang meningkat menjadi 4. Sementara itu, bila dilakukan analisis untuk membandingkan median nilai GERD-Q antara kelompok yang berpuasa Ramadhan dan tidak, juga didapatkan perbedaan yang bermakna (nilai p < 0,01).Simpulan: Pada subjek yang menjalani puasa Ramadhan, keluhan GERD dirasakan lebih ringan saat menjalani puasa Ramadhan dibandingkan di luar bulan Ramadhan. Di bulan Ramadhan, keluhan GERD lebih ringan dirasakan oleh subjek yang menjalani puasa Ramadhan dibandingkan subjek yang tidak menjalani puasa Ramadhan.

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Background: During Ramadan fasting, increasing gastric acid levels as a result of prolong fasting can precipitate symptoms of Gastroesophageal Reflux Disease (GERD). Meanwhile, lifestyle changes during Ramadan (such as smoking cessation) can relieve its symptoms. To the best of our knowledge, this is the first study to evaluate effect of Ramadan fasting on GERD.

Objective: The purpose of this study was to determine the effect of Ramadan fasting on GERD symptoms.

Method: This is a longitudinal study done in July (Ramadan) to October (three months after Ramadan) 2015. Using consecutive sampling method, a total of 130 GERD patients participated in this study. Patients were divided into two groups: patients who underwent Ramadan fasting (n=66), and patients who didn?t undergo fasting (n=64). The evaluation was done using Indonesian version of GERD questionnaire (GERD-Q) between the two groups, and between Ramadan month and non-Ramadan month of Ramadan fasting group.

Results: In Ramadan fasting group, there was a statistically significant difference (p < 0.01) in median of GERD-Q during Ramadan month and non-Ramadan month (median GERD-Q 0 and 4 respectively). Statistically significant difference (p < 0.01) was also found between Ramadan fasting group and non-fasting group.

Conclusion: In Ramadan fasting group, GERD symptoms were lighter during fasting month (Ramadan). During Ramadan month, GERD symptoms were also lighter in Ramadan fasting group than in non-fasting group."