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Gastric outlet obstruction (GOO) is an uncommon but serious problem caused by benign causes. The incidence of GOO caused by peptic ulcer disease (PUD) is decreasing due to successful Helicobacter pylori treatment. Hence, these aggressive cases are rare. We present a case of a man who experienced intermittent abdominal pain and constipation for a week but acutely worsened in the last five days. He complained of intractable nausea and vomiting, leading to intolerable oral intake. Physical examination revealed abdominal distention, tenderness in epigastrium and right hypochondrium, and hypoactive bowel sounds. Laboratory results revealed leukocytosis with neutrophilia. Gastroscopy showed erosive esophagitis, pangastritis, and large duodenal ulcer causing stricture of duodenum pars I. An open distal gastrectomy, Roux-en-Y reconstruction, and fundoplication was then performed. The patient's general condition improved after ninth day of care and was discharge on the eleventh day of care. PUD is a major cause of GOO, but incidence has decreased to 5% with the use of proton pump inhibitors. If the distal stomach or duodenum is significantly obstructed, GOO should be considered. The gold standard for diagnosis is endoscopy. Initially, conservative and supportive therapy should be done followed by endoscopic treatment in appropriate cases. If there is no improvement, surgical interventions should be done. This case demonstrated the need for definitive invasive procedures in the intervention of GOO caused by PUD. When conservative measures fail, this case also adds support to the direct anatomic treatment of duodenal strictures. [ABSTRACT FROM AUTHOR]

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Background: Irritable bowel syndrome (IBS) is one of the health problems that bring great effects in education, productivity, and socioeconomic life in Indonesia. It accounts for approximately 10.5% of304 digestive problems in Jakarta, Indonesia. Particular characteristics are known to increase the risk of IBS in individuals, but the study of IBS in Indonesia is still limited in number. The objective of this study is to assess the prevalence and factors affectingIBS in medical students. Method: This study is a cross sectional study on medical students of Pelita Harapan University, Karawaci, Tangerang on January 2018 until March 2018. Data were obtained with the use of questionnaire of demographic data, ROME IV IBS Criteria, GAD DSM-IV, and PSQI as the instruments with random sampling technique, and statistically tested using Chi-square test. Results: A total of 210 samples consist of 54 subjects with IBS (25.7%) with 43 women (79.6%) and 11 men (20.4%). Findings ofbivariate analysis are sex (95% CI: 0.751 - 3.346), obesity (95% CI: 0.612 - 2.673), history of drug consumption (95% CI: 1.246 - 6.742), family history of IBS (95% CI: 1.246 - 6.742), anxiety (95% CI-.1.419 - 9.709), andsleep disorder (95% CI: 0.514 -1.785). Conclusion: The prevalence of IBS in medical students in our institution is 25.7% with history of drug consumptionffamily history ofIBS, and anxiety asfactors statistically significant in IBS. [ABSTRACT FROM AUTHOR]

Patients diagnosed with hematology malignancy and solid tumor who underwent chemotherapy, frequently encountered hepatitis B reactivation. Patients with blood cancer, including lymphoma, had higher risk of reactivation compared to those with solid tumor. Steroid and immunosuppressant drugs contained in chemotherapy regimens were responsible for those events. Hepatitis B reactivation during chemotherapy treatment could contribute to acute liver failure and increase mortality. Administration of analog nucleoside therapy in this group of patient prior to the initiation of chemotherapy could prevent reactivation of hepatitis B. A 43 year-old male patient were diagnosed with diffuse large B cell non-Hodgkin lymphoma stadium II BE (oropharynx) under chemotherapy and had hepatitis B. In this evidence based case report, we reported a critical appraisal of the role of lamivudine as preemptive therapy in blood cancer and solid tumor. [ABSTRACT FROM AUTHOR]