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Perkumpulan
Gastroenterologi
Indonesia
(PGI)
Kelompok Studi Helicobacter pylori Indonesia (KSHPI)
KONSENSUS NASIONALPenatalaksanaanDispepsia dan Infeksi Helicobacter pylo
ri
Editor:Marcellus Simadibrata K
Dadang
MakmunMurdani bdulla!ri "a!rial S#amc!mad "au$iKaka %enaldiHasan Maula!elamanda P &tari
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Perkumpulan Gastroenterologi Indonesia (PGI)
Kelompok
Studi
Helicobacter
pylori
Indonesia
(KSHPI)
KONSENSUS NASIONAL
Penatalaksanaan
Dispepsia
dan
Infeksi
Helicobacter pylori
Editor:Marcellus Simadibrata K Dadang MakmunMurdani bdulla!ri "a!rial S#amc!mad "au$iKaka %enaldiHasan Maula!ela
manda
P
&tari
'*
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onsensus Penatalaksanaan Dispepsia dan Infeksi Helicobacter pylori
+ '* Perkumpulan Gastroenterologi Indonesia (PGI) dan Kelompok
Studi Helicobacter pylori Indonesia (KSHPI)
vi + 16 halaman
4,8 x 21 cm
BN No. 978-602-17913-8-7
1. Hak cipta ip!"an" ol!h pa#a p!n$%&%n an ilin%n"i %nan"-%nan".
2.
'ila#an" m!mp!#(an$ak, m!nc!tak, an m!n!#(itkan &!(a"ian
ata% &!l%#%h i&i (%k% ini !n"an ca#a an alam (!nt%k apap%n )%"a tanpa &!i)in a#i p!n$%&%n an p!n!#(it.
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Kata Pengantar ,im Editor
B%k% ini m!#%pakan ha&il kon&!n&%& pa#a paka# "a&t#o!nt!#olo"i i Inon!&ia
m!n"!nai p!natalak&anaan i&p!p&ia an in!k&i Helicobacter pylori $an" aa i
Inon!&ia.
S!m%a hal t!ntan" !ini&i, !tiolo"i, ia"no&i& an p!natalak&aan i&p!p&ia
ma%p%n in!k&i H.pylori &%ah p!#nah i(aha& alam
kon&!n&%& &!(!l%mn$a &!ca#a
t!#pi&ah, nam%n kali ini i"a(%n"kan ka#!na p!natalak&anaan i&p!p&ia tiak l!pa&
a#i p!natalak&aan in!k&i H.pylori, i&!#tai p!nam(ahan p!n"!tah%an (a#% t!#kait
!ini&i, patoi&iolo"i, ia"no&i& an p!natalak&anaan i&p!p&ia an in!k&i H.pylori.
on&!n&%& na&ional p!natalak&anaan i&p!p&ia an in!k&i H.pylori tah%n 2014
i Inon!&ia ini t!tap i(%at (!#a&a#kan evidence based medicine, &!hin""a c%k%p
(!#(o(ot i"%nakan &!(a"ai #%)%kan pa#a okt!# i Inon!&ia alam m!nan"ani
ka&%&-ka&%& i&p!p&ia an in!k&i H.pylori i t!mpat p#aktik &!ha#i-ha#i. 'iha#apkan
!n"an
aan$a
(%k% kon&!n&%&
ini,
pa#a
okt!#
apat
l!(ih
m!nin"katkanp!la$anann$a k!paa pa&i!n-pa&i!n i&p!p&ia an in!k&i H.pylori.
!paa &!l%#%h p!&!#ta kon&!n&%& $an" t!lah m!l%an"kan akt%n$a alam
p!n$%&%nan kon&!n&%& na&ional p!natalak&anaan i&p!p&ia an in!k&i H.pylori
tah%n 2014 ini, kami m!n"%capkan t!#ima ka&ih $an" &!(!&a#-(!&a#n$a. iak l%pa
)%"a t!#ima ka&ih kami k!paa /. t&%ka Inon!&ia, /. '!xa !ica, /. al(!
a#ma an /. i&ai Inon!&ia $an" t!lah m!n)ai &pon&o# an m!m(ant% hin""a
t!#(itn$a kon&!n&%& ini.
ami m!#a&a (aha (%k% kon&!n&%& na&ional p!natalak&anaan i&p!p&ia an
in!k&i H.pylori ini ma&ih )a%h a#i &!mp%#na, ol!h ka#!na it% k#itik an &a#an a#i
t!man-t!man &!)aat akan &an"at kami ha#"ai.
khi#n$a !n"an m!man)atkan p%)i &$%k%# k! hai#at llah S5 ata& ka#%nia-
N$a, kami p!#&!m(ahkan (%k% kon&!n&%& na&ional p!natalak&anaan i&p!p&ia an
in!k&i H.pylori ini. S!mo"a (%k% ini (!#manaat (a"i &!)aat i Inon!&ia.
aka#ta, 1 p#il 2014
,im Editor
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Kata Sambutan Ketua Pengurus -esar Perkumpulan
Gastroenterologi
Indonesia
(P-
PGI)
'i&p!p&ia m!#%pakan &alah &at% a#i (!#(a"ai k!l%han %m%m $an" apat
it!m%i ol!h okt!# i (!#(a"ai (ian", tiak t!#(ata& han$a paa ahli &al%#an c!#na
&a)a alam p#aktik k!&!ha#iann$a. /!n"!#tian m!n"!nai patoi&iolo"i i&p!p&ia t!#%&
(!#k!m(an" &!)ak im%lain$a inv!&ti"a&i &!ca#a ilmiah paa 1980-an &ai !n"an
&aat ini $an" m!manan" in!k&i Helicobacter pylori &!(a"ai &alah &at% akto# k%nci
alam m!nan"ani i&p!p&ia, (aik t!#kait %lk%& ma%p%n non-%lk%&. /!m(aha&an
i&p!p&ia p%n ha#%& m!n"h%(%n"kan !n"an mana)!m!n a#i in!k&i H.pylori.
/#!val!n&i in!k&i H.pylori i %nia c%k%p tin""i an (!#va#ia&i (!#"ant%n"
paa a#!a, !tni&ita&, %&ia, an &tat%& &o&ial !konomi. In!k&i H.pylori it!m%kan l!(ih
(an$ak paa n!"a#a-n!"a#a $an" ma&ih (!#k!m(an" ala%p%n &!ca#a %m%m,
paa &aat ini t!#lihat k!c!n!#%n"an p!n%#%nan an"ka k!)aian. /!n"%#%& B!&a#
/!#k%mp%lan a&t#o!nt!#olo"i Inon!&ia /B /I t!lah m!n$aa#i p!ntin"n$a &%at%
pan%an alam m!nan""%lan"i hal ini $an" t!#c!#min paa p!n$%&%nan on&!n&%&
Na&ional /!natalak&anaan In!k&i Helicobacter pylori, $an" i&%&%n ol!h !lompok
St%i Helicobacter pylori Inon!&ia SH/I paa tah%n 1996 an ip!#(aha#%i tah%n
2003. on&!n&%& ini m!m(aha& &!ca#a komp#!h!n&i m!n"!nai ia"no&i& an tata
lak&ana in!k&i Helicobacter pylori, t!#%tama a#i &%%t panan" okt!# i p!la$anan
p#im!#.
In!k&i H.pylori &!#in" i)%mpai paa pa&i!n-pa&i!n &ia, &!hin""a !k&kl%&i
(akt!#i
ini
m!#%pakan
(a"ian
p!ntin"
a#i
p!n!katan
ia"no&i&
alamp!nan"anan i&p!p&ia paa pop%la&i ini. #aika&i H.pylori t!lah t!#(%kti !!kti
alam m!n"hilan"kan "!)ala i&p!p&ia t!#kait %lk%& p!ptik%m, nam%n !mikian
%nt%k i&p!p&ia non-%lk%& h%(%n"ann$a ma&ih (!l%m m!$akinkan. Saat ini,
t!#apat p!#k!m(an"an t!#kini m!n"!nai in!k&i H.pylori, m%lai a#i pato"!n!&i&,
akto# #i&iko, h%(%n"ann$a !n"an mani!&ta&i klini& p!n$akit lain &ai k!paa
#!&i&t!n&i t!#haap anti(iotik.
l!h ka#!na it%, /!n"%#%& B!&a# /!#k%mp%lan a&t#o!nt!#olo"i Inon!&ia
/B /I m!manan" p!#l%n$a ilak%kan p!m(aha#%an pan%an ini, i&!&%aikan
!n"an
p!#k!m(an"an
$an"
aa
an
iha#apkan
akan
apat
m!n)ai
p!oman
(a"i &!)aat alam p!natalak&anaan pa&i!n-pa&i!n !n"an i&p!p&ia &!hin""a
iapatkan p!natalak&anaan $an" optimal.
Ketua Pengurus -esar Perkumpulan Gastroenterologi Indonesia (P- PGI)
/#o. #. a#c!ll%& Simai(#ata, /h', Sp./'-H, INSI,:, 24S73
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sunan Panitia Pelaksana Pen#usunan Konsensus
natalaksanaan Dispepsia dan Infeksi Helicobacter pylori
a&!hat < /#o. '#. #.'ali$ono, INSI, Sp./'-H
/#o. #. H. 4 >i> ?ani, INSI, Sp./'-H'#. #. H. :h%ahman anan, INSI,
Sp./'-H /#o. #. a#c!ll%& Simai(#ata, /h', Sp./'-H, INSI,:, S
%a < '#. #. #i ah#ial S$am, B, Sp./'-H,INSI,:/
#!ta#i& < #. aka ?!nali,Sp./'
ah < /#o. #. a#c!ll%& Simai(#ata, /h', Sp./'-
H, INSI,:, S '#. #. H. 'aan" akm%n, Sp./'-H,
INSI,:
'#. #. %#ani (%llah, Sp./'-H, INSI, 24:7#. Ha&an a%lah!la, Sp./'#. mana / @ta#i, Sp./'
aha#a < #. chma a%>i, Sp./'-H, INSI
< :!nt#a :omm%nication&
#!ta#iat < 'a#i
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Daftar Isiata /!n"anta# im ito# .............................................................................. *II
ata Sam(%tan !t%a /!n"%#%& B!&a# /!#k%mp%lan
a&t#o!nt!#olo"i Inon!&ia /B /I ........................................................... I;
S%&%nan /anitia /!lak&ana /!n$%&%nan on&!n&%&
/!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylori (Hp) ........ ;I
I. /!nah%l%an..................................................................................................1
II.
'!ini&i ............................................................................................................. 1
III. pi!miolo"i.................................................................................................. 2
I*. /atoi&iolo"i.................................................................................................... 2
I*.1. /!#anan "an""%an motilita& "a&t#o%o!nal ......................... 3
I*.2. /!#anan hip!#&!n&itivita& vi&!#al
.................................................. 3
I*.3. /!#anan akto# p&iko&o&ial ............................................................... 3I*.4. /!#anan a&am lam(%n" ................................................................... 3
I*.A. /!#anan in!k&i Hp .............................................................................. 3
*. 'ia"no&i&......................................................................................................... 4
*.1. 'ia"no&i& 'i&p!p&ia ............................................................................ 4
*.2. 'ia"no&i& in!k&i Hp ............................................................................ 6
*I.
ata lak&ana .................................................................................................... 8
*I.1. 'i&p!p&ia (!l%m iinv!&ti"a&i........................................................ 8
*I.2. 'i&p!p&ia $an" t!lah iinv!&ti"a&i ............................................... 9
*I.2.1. 'i&p!p&ia o#"anik .................................................................. 9
*I.2.2. 'i&p!p&ia %n"&ional ............................................................ 9
*I.3. ata lak&ana i&p!p&ia !n"an in!k&i Hp............................... 10
*II. ampi#an ....................................................................................................... 13
ampi#an 1. l"o#itm! ata ak&ana 'i&p!p&ia i B!#(a"ai
in"kat a$anan !&!hatan ........................................... 13
ampi#an 2. l"o#itm! ata ak&ana 'i&p!p&ia %n"&ional........ 14
ampi#an 3. l"o#itm! ata ak&ana #aika&i In!k&i Hp........... 1A
'ata# /%&taka..................................................................................................... 16
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pa
tana
(aha$a
m!#%pakan
i&p!p&ia
%n"&ional.
B!#a&a#kan
ha&il
!litian i n!"a#a-n!"a#a &ia :ina, Hon" on", Inon!&ia, o#!a, ala$&ia,
"ap%#a, aian, hailan, an *i!tnam iapatkan 43-79,AD pa&i!n
"an i&p!p&ia aalah i&p!p&ia %n"&ional.A
'a#i ha&il !no&kopi $an" ilak%kan paa AA0 pa&i!n i&p!p&ia alam
!#apa &!nt!# i Inon!&ia paa an%a#i 2003 &ai p#il 2004, iapatkan
7
D
ka&%&
k!lainan
minimal
paa
"a&t#iti&
an
%o!niti&E
6,AD
ka&%&
"an %lk%& "a&t!#E an no#mal paa 8,2D ka&%&.6
'i
Inon!&ia,
ata
p#!val!n&i
in!k&i
Hp
paa
pa&i!n
%lk%&
p!ptik%m
npa #ia$at p!makaian o(at-o(atan anti-inlama&i non-&t!#oiCINS
va#ia&i a#i 90-100D an %nt%k pa&i!n i&p!p&ia %n"&ional &!(an$ak 20-
D !n"an (!#(a"ai m!to! ia"no&tik p!m!#ik&aan &!#olo"i, k%lt%#, an
opatolo"i.7
/#!val!n&i in!k&i Hp paa pa&i!n i&p!p&ia $an" m!n)alani p!m!#ik&aan
o&kopik i (!#(a"ai #%mah &akit p!niikan k!okt!#an i Inon!&ia
03-2004 it!m%kan &!(!&a# 10.2D. /#!val!n&i $an" c%k%p tin""i it!m%i
aka&a# tah%n 2011 AAD, Solo tah%n 2008 A1,8D, Fo"$aka#ta 30.6D
S%#a(a$a tah%n 2013 23,AD, &!#ta p#!val!n&i t!#!nah i aka#ta 8D.
Pato/siologi
/atoi&iolo"i %lk%& p!ptik%m $an" i&!(a(kan ol!h Hp an o(at-o(atan
-inlama&i
non-&t!#oi
INS
t!lah
(an$ak
ik!tah%i.1
'i&p!p&ia
"&ional
i&!(a(kan
ol!h
(!(!#apa
akto#
%tama,
anta#a
lain
"an""%an
ilita& "a&t#o%o!nal, in!k&i Hp, a&am lam(%n", hip!#&!n&itivita& vi&!#al,
akto# p&ikolo"i&. akto#-akto# lainn$a $an" apat (!#p!#an aalah
!tik, "a$a hi%p, lin"k%n"an, i!t an #ia$at in!k&i "a&t#oint!&tinal
!l%mn$a.11,12
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&ia
an
In!k&i
Helicobacter
pylori
I0.. Peranan gangguan motilitas gastroduodenal
an""%an motilita& "a&t#o%o!nal t!#i#i a#i p!n%#%nan kapa&ita&
lam(%n"
alam
m!n!#ima
makanan
impaired
gastric
accommodation,
inkoo#ina&i
ant#o%o!nal,
an
p!#lam(atan
p!n"o&on"an
lam(%n".
an""%an
motilita&
"a&t#o%o!nal
m!#%pakan
&alah
&at%
m!kani&m!
%tama alam patoi&iolo"i i&p!p&ia %n"&ional, (!#kaitan !n"an p!#a&aan
(!"ah &!t!lah makan, $an" apat (!#%pa i&t!n&i a(om!n, k!m(%n", an
#a&a p!n%h.A,12
I0.'. Peranan !ipersensiti1itas 1iseral
Hip!#&!n&itivita& vi&!#al (!#p!#an p!ntin" alam patoi&iolo"i i&p!p&ia
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%n"&ional, t!#%tama p!nin"katan &!n&itivita& &a#a &!n&o#ik p!#i!# an &!nt#al
t!#haap #an"&an"an #!&!pto# kimiai an #!&!pto# m!kanik int#al%minal
lam(%n" (a"ian p#ok&imal. Hal ini apat m!nim(%lkan ata% m!mp!#(!#at
"!)ala i&p!p&ia.A
I0.2. Peranan faktor psikososial
an""%an
p&iko&o&ial
m!#%pakan
&alah
&at%
akto#
p!nc!t%&
$an"
(!#p!#an
alam i&p!p&ia %n"&ional. '!#a)at (!#atn$a "an""%an p&iko&o&ial &!)alan!n"an
tin"kat
k!pa#ahan
i&p!p&ia.
B!#(a"ai
p!n!litian
m!n%n)%kkan
(aha !p#!&i an an&i!ta& (!#p!#an paa t!#)ain$a i&p!p&ia %n"&ional.A,12
I0.*. Peranan asam lambung
&am lam(%n" apat (!#p!#an alam tim(%ln$a k!l%han i&p!p&ia
%n"&ional. Hal ini ia&a#i paa !!ktivita& t!#api anti-&!k#!to#ik a&am a#i
(!(!#apa p!n!litian pa&i!n i&p!p&ia %n"&ional. 'ata p!n!litian m!n"!nai
&!k#!&i a&am lam(%n" ma&ih k%#an", an lapo#an i &ia ma&ih kont#ov!#&ial.A
I0.3. Peranan infeksi Hp
/#!val!n&i in!k&i Hp pa&i!n i&p!p&ia %n"&ional (!#va#ia&i a#i 39D &ai
87D. H%(%n"an in!k&i Hp !n"an "an"""%an motilita& tiak kon&i&t!n
nam%n !#aika&i Hp m!mp!#(aiki "!)ala-"!)ala i&p!p&ia %n"&ional.
on&!n&%& Na&ional /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylori 3
/!nana (iolo"i& &!p!#ti "h#!lin an l!ptin , &!#ta p!#%(ahan !k&p#!&i
scle-specifc
microRNAs (!#h%(%n"an !n"an p#o&!& patoi&iolo"i
p!p&ia %n"&ional, $an" ma&ih p!#l% it!liti l!(ih lan)%t.A,13
Diagnosis
.
Diagnosis
Dispepsia'i&p!p&ia $an" t!lah iinv!&ti"a&i t!#i#i a#i i&p!p&ia
o#"anik an
"&ional. 'i&p!p&ia o#"anik t!#i#i a#i %lk%& "a&t!#, %lk%& %o!n%m,
t#iti&
!#o&i,
"a&t#iti&,
%o!niti&
an
p#o&!&
k!"ana&an.
'i&p!p&ia
"&ional m!n"ac% k!paa k#it!#ia ?oma III.#it!#ia ?oma III (!l%m ivalia&i
Inon!&ia.
on&!n&%&
&ia-/a&iik
2012
m!m%t%&kan
%nt%k
m!n"ik%ti
&!p a#i k#it!#ia ia"no&i& ?oma III !n"an p!nam(ahan "!)ala (!#%pa
m(%n" paa a(om!n (a"ian ata& $an" %m%m it!m%i &!(a"ai "!)ala
p!p&ia %n"&ional.A
'i&p!p&ia m!n%#%t k#it!#ia ?oma III aalah &%at% p!n$akit !n"an &at%
% l!(ih "!)ala $an" (!#h%(%n"an !n"an "an""%an i "a&t#o%o!nal<
• N$!#i !pi"a&t#i%m
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• ?a&a t!#(aka# i !pi"a&t#i%m
• ?a&a p!n%h ata% tiak n$aman &!t!lah makan
• ?a&a c!pat k!n$an"
!)ala
$an" i#a&akan ha#%&
(!#lan"&%n"
&!tiakn$a
&!lama ti"a
(%lan
khi# !n"an aitan "!)ala !nam (%lan &!(!l%m ia"no&i& it!"akkan.
#it!#ia ?oma III m!m(a"i i&p!p&ia %n"&ional m!n)ai 2 &%("#%p, $akni
gastric pain syndrome an postprandial distress syndrome. kan t!tapi, (%kti
ini m!n%n)%kkan (aha t!#apat t%mpan" tinih ia"no&i& alam %ai"a pa&i!n i&p!p&ia.1
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&ia
an
In!k&i
Helicobacter
pylori
'i&p!p&ia (!l%m iinv!&ti"a&i
/!m!#ik&aan p!n%n)an"&!&%ai inika&i<
- a(o#ato#i%m a#ah- no&kopi- Urea Breat !est - @S (om!n
'i&p!p&ia %n"&ional- 'i&p!p&ia o#"anik - @lk%& p!ptik%m- a&t#iti& !#o&i - a&t#iti& &!an"-(!#at
!pi"a&t#i%m
G /aa p#aktik &!ha#i-ha#i apat it!m%kan t%mpan" tinih anta#a i&p!p&ia
!n"an?'
Gambar .lur Diagnosis dispepsia belum diin1estigasi
val%a&i tana (aha$a ha#%& &!lal% m!n)ai (a"ian a#i !val%a&i pa&i!n-
pa&i!n $an" atan" !n"an k!l%han i&p!p&ia. ana (aha$a paa i&p!p&ia
$ait%<
• /!n%#%nan (!#at (aan unintended
• 'i&a"ia p#o"#!&i
• %ntah #!k%#!n ata% p!#&i&t!n
• /!#a#ahan &al%#an c!#na
- ank!# lam(%n" Sindroma &!t!lah makan Sindroma
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• n!mia
• '!mam
• a&&a a!#ah a(om!n (a"ian ata&
• ?ia$at k!l%a#"a kank!# lam(%n"
• 'i&p!p&ia aitan (a#% paa pa&i!n i ata& 4A tah%n
/a&i!n-pa&i!n !n"an k!l%han &!p!#ti i ata& ha#%& ilak%kan inv!&ti"a&i
t!#l!(ih ah%l% !n"an !no&kopi.A
on&!n&%& Na&ional /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylori
A
Diagnosis infeksi Hp14
!& ia"no&i& in!k&i Hp apat ilak%kan &!ca#a lan"&%n" m!lal%i
!no&kopi rapid urease test , hi&tolo"i, k%lt%# an /:? an &!ca#a tiak
lan"&%n"
tanpa
!no&kopi
urea
breat
test,
stool
test,
urine
test ,
an&!#olo"i.
Urea breat test
&aat
ini
&%ah
m!n)ai
gold standard
%nt%k
p!m!#ik&aan
Hp,
&alah
&at%
urea breat test $an" aa anta#a lain 13:2
breat analy"er . S$a#at %nt%k m!lak%kan p!m!#ik&aan Hp, $ait% ha#%& (!(a&
anti(iotik an //I proton-pump inibitor &!lama 2 min""%. a (!(!#apa
akto#
$an"
p!#l%
ip!#tim(an"kan<
&it%a&i
klini&,
p#!val!n&i
in!k&i,
p#!val!n&i in!k&i alam pop%la&i, p#o(a(ilita& in!k&i p#at!&, p!#(!aan
alam p!#o#ma t!&, an akto#-akto# $an" apat m!mp!n"a#%hi ha&il t!&,
&!p!#ti p!n""%naan t!#api anti&!k#!to#ik an anti(iotik.
Sn Sp !t!#an"an
n"an !no&kopi
pi %#!a&!
t
98D 99D • :!pat an m%#ah
• S!n&itivita& pa&cat!#api (!#k%#an"
• Samp!l iam(il a#i ant#%m
&tolo"i 9AD 9AD • '!t!k&i m!nin"kat !n"an p!a#naan kh%&%& 5a#thin-
Sta##$C h!maktok&ilin-!o&inCi!m&a
• Samp!l iam(il a#i ant#%m anko#p%&
lt%# • San"at &p!&iik, &!n&itivita& (%#%k (ila m!ia t#an&po#ta&itiak t!#&!ia
• 'i(%t%hkan p!n"alaman• ahal, &!#in" tiak t!#&!ia•
Samp!l iam(il a#i ant#%m anko#p%&
• !ia $an" i"%nakan anta#alain Spa##o
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14/23
6
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&i
a an
In!k&i
Helicobacter
pylori
on&!n&%& Na&ional /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylori
7
,ata laksana
ata lak&ana i&p!p&ia im%lai !n"an %&aha %nt%k i!ntiika&i patoi&iolo"i
akto#
p!n$!(a(
&!(an$ak
m%n"kin.11
!#api
i&p!p&ia
&%ah
apat
%lai (!#a&a#kan &in#oma klini& $an" ominan (!l%m iinv!&ti"a&i an
n)%tkan &!&%ai ha&il inv!&ti"a&i.
. Dispepsia belum diin1estigasi
St#at!"i
tata
lak&ana
optimal
paa
a&!
ini
aalah
m!m(!#ikan
t!#api
pi#ik &!lama 1-4 min""% &!(!l%m ha&il inv!&ti"a&i aal, $ait% p!m!#ik&aan
n$a Hp.11,13 @nt%k a!#ah an !tni& t!#t!nt% &!#ta pa&i!n !n"an akto#
ko tin""i, p!m!#ik&aan Hp ha#%& ilak%kan l!(ih aal.
,abel . Perbandingan berbagai metode tes diagnosis infe
:? • S!n&iti an &p!&iik
• iak t!#&tana#i&a&i• Samp!l iam(il a#i ant#%m an
ko#p%&
• !#hit%n" !k&p!#im!ntal
anpa !no&kopi
!#olo"i IS 8A-92D 79-83D • %#an" ak%#at an tiak m!n""am(a#kan in!k&i akti
• /#!ikto# in!k&i $an" hanali n!"a#a (!#k!m(an" !n"an p#!val!n&i tin""i
• iak i#!kom!na&ikan &!t!laht!#api
• %#ah an t!#&!ia
: %#!areat test
@B mi&al<
:2 breatnaly"er
9AD 96D • 'i#!kom!na&ikan %nt%k 14
ia"no&i& Hp &!(!l%m t!#api• !& t!#pilih %nt%k koni#ma&i
!#aika&i• /a&i!n tiak (ol!h
m!n"kon&%m&i //I ananti(iotik &!lama 2 min""%&!(!l%m p!m!#ik&aan
1A,16ilak%kan
• !t!#&!iaan (!#va#ia&i
nti"!n !&!& 9AD 94D iak &!#in" i"%nakan m!&kip%n
&!n&itivita& an &p!&ii&ita& tin""i,&!(!l%m an &!&%ah t!#api
!#olo"in"!#-&tick
San"at (%#%k an tiak apatm!n$amai &!#olo"i IS
nti(oi i
in<
?api @#in!17-19
!&t@#in!-(a&!
18,19IS
73,2-
82D
74,4-
90D
78,6-
90,7D
68-81D
Saat ini %#in! t!&t (!l%m t!#&!ia
i Inon!&ia
Sn
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
15/23
(at
$an"
ip!#"%nakan
apat
(!#%pa
anta&ia,
anti&!k#!&i
a&am
(%n" //I mi&aln$a om!p#a>ol!, #a(!p#a>ol! an lan&op#a>ol! anCata%
Receptor
Antagonist H2?J, p#okin!tik, an &itop#ot!kto# mi&aln$a
amipi!, i mana pilihan it!nt%kan (!#a&a#kan omina&i k!l%han an
a$at p!n"o(atan pa&i!n &!(!l%mn$a. a&ih it%n""% p!n"!m(an"an
t (a#% $an" (!k!#)a m!lal%i do$n-regulation proton pump $an" iha#apkan
miliki m!kani&m! k!#)a $an" l!(ih (aik a#i //I, $ait% 'BS 2411.
!#kait
!n"an
p#!val!n&i
in!k&i
Hp
$an"
tin""i,
&t#at!"i
test and treat #apkan paa pa&i!n !n"an k!l%han i&p!p&ia tanpa tana (aha$a.
!est and treat ilak%kan paaop#a>ol!
2x30 m" !n"an m%kop#ot!kto#, mi&aln$a #!(amipi! 3x100 m".
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
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0I.'.'. Dispepsia fungsional
pa(ila &!t!lah inv!&ti"a&i ilak%kan tiak it!m%kan k!#%&akan m%ko&a,
t!#api apat i(!#ikan &!&%ai !n"an "an""%an %n"&ional $an" aa.
/!n""%naan
p#okin!tik
&!p!#ti
m!toklop#ami,
omp!#ion,
ci&ap#i,
itop#ianlain&!(a"ain$aapatm!m(!#ikanp!#(aikan"!)alapaa(!(!#apa
pa&i!n
!n"an
i&p!p&ia
%n"&ional.
Hal
ini
t!#kait
!n"an
p!#lam(atan
p!n"o&on"an lam(%n" &!(a"ai &alah &at% patoi&iolo"i i&p!p&ia %n"&ional.
!a&paaan
ha#%&
it!#apkan
paa
p!n""%naan
ci&ap#i
ol!h
ka#!na
pot!n&i komplika&i ka#iova&k%la#.11
'ata p!n""%naan o(at-o(atan anti!p#!&an ata% an&iolitik paa pa&i!n
!n"an i&p!p&ia %n"&ional ma&ih t!#(ata&. 'alam &!(%ah &t%i i !pan"
(a#%-(a#% ini m!n%n)%kkan p!#(aikan "!)ala $an" &i"niikan paa pa&i!n
i&p!p&ia %n"&ional $an" m!napatkan a"oni& A-H1 i(anin"kan pla&!(o.
'i &i&i lain v!nlaaxin, p!n"ham(at am(ilan &!#otonin an no#!pin!##in tiak
m!n%n)%kkan ha&il $an" l!(ih (aik i(anin" pla&!(o.A
on&!n&%& Na&ional /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylori 9
an""%an p&ikolo"i&, "an""%an ti%#, an &!n&itivita& #!&!pto# &!#otonin
t#al
m%n"kin
m!#%pakan
akto#
p!ntin"
alam
#!&pon
t!#haap
t!#api
!p#!&an paa pa&i!n i&p!p&ia %n"&ional.A
2. ,ata laksana dispepsia dengan infeksi Hp'
#aika&i Hp mamp% m!m(!#ikan k!&!m(%han )an"ka pan)an" t!#haap
ala i&p!p&ia. 'alam &alah &at% &t%i
cross-sectional paa 21 pa&i!n i
mah Sakit :ipto an"%nk%&%mo, aka#ta 2010 iapatkan (aha t!#api
ika&i
m!m(!#ikan
p!#(aikan
"!)ala
paa
ma$o#ita&
pa&i!n
i&p!p&ia
"an
p!#&!nta&!
p!#(aikan
"!)ala
&!(!&a#
76D
an
81D
p!n!m%an
Hp
ati $an" ip!#ik&a !n"an @B.21
/!n!litian p#o&p!kti ol!h S$am , kk tah%n 2010 m!n%n)%kkan (aha
pi !#aika&i Hp !n"an triple terapy #a(!p#a>ol!, amok&i&ilin, an
it#omi&in &!lama 7 ha#i l!(ih (aik a#i t!#api &!lama A ha#i.22
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
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10
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&ia
an
In!k&i
H
licobacter pylori
(at 'o&i& '%#a&i
ini /!#tama<
//IG
mok&i&ilin
la#it#omi&in
2x1
1000 m" 2x1A00 m" 2x1
7-14 ha#i
'i a!#ah $an" ik!tah%i #!&i&t!n&i kla#it#omi&in 20D<
//IG
Bi&m%t &%(&ali&ilat!t#onia>ol!
!t#a&iklin
2x1
2 x 2 ta(l!tA00 m" 3x12A0 m" 4x1
7-14 ha#i
ika (i&m%t tiak aa<
//IG
mok&i&ilin
la#it#omi&in
!t#onia>ol!
2x1
1000 m" 2x1A00 m" 2x1A00 m" 3x1
7-14 ha#i
ini !%a
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
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m",om!p#a>ol! 20 m", pantop#a>ol! 40 m", !&om!p#a>ol! 40 m".:atatan
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
19/23
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&ia
an
In!k&i
Helicobacter
pylori
0II. 4ampiran
4ampiran
.
lgoritme ,ata
4aksana
Dispepsia
di
-erbagai ,ingkat
4a#anan Kese!atan3
'i&p!p&ia (!l%m iinv!&ti"a&i &!lama 3 (%lan
ata% l!(ih
/, anamn!&i&, &in"ki#kan p!n$!(a(
i&p!p&ia o#"anik, mi&. o(at-o(atan
ana (aha$a
Fa
?%)%k
iak !#api
!mpi#i&
no&kopi S:B
!m%an
m!n)!la&kan
"!)ala
?%)%k
&!t!lah
2 min""%
an)%tkan
t!#api
'i&p!p&ia o#"anik
pa(ila aa inika&i
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
20/23
'i&p!p&ia %n"&ional
oi
ka&i i!t
!)ala
p#!ominan
N$!#iC#a&a t!#(aka# paa
c!pat k!n$an",
k!m(%n", m%al,m%ntah, (!#&!naa
//I !n"an ata% tanpa p#okin!tik
Sitop#ot!kto#
//I-do$n regulation
/#okin!tik !n"an ata%
tanpa //I
?!&pon&
&!t!lah 4 ata%8 min""%
iak
K
:o(a anti!p#!&an ata%
an&iolitik
K
:o(a t!#api h!#(al
iak ?!&pon&
&!t!lah 4 ata%8 min""%
iak aa #!&pon&
Fa Fa
?%)%k k! &p!&iali&
:o(a h!ntikan ata% t!#api
&!&%ai k!(%t%han
proton-pump inibitor.
on&!n&%& Na&ional
/!natalak&anaan
'i&p!p&ia
an
In!k&i
Helicobacter
pylori
4ampiran 2. lgoritme ,ata 4aksana Eradikasi Infeksi Hp3
/o&iti t!& H.pylori
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
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ini p!#tama
ini k!%a
'a!#ah #!&i&t!n&ikla#it#omi&in #!nah
//I-kla#it#omi&in-
amok&i&ilinCm!t#onia>ol
ata% (i&m%t &uadruple
Bi&m%t &uadruple ata% //I-
l!vo ok&a&in-amok&i&ilin
'a!#ah #!&i&t!n&i
kla#it#omi&in tin""i
Bi&m%t &uadruple,
(ila tak t!#&!ia
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
22/23
H%nt ?H, ;iao S', !"#a% , !t al. H!lico(act!# p$lo#i in !v!lopin" co%nt#i!&. 5o#l a&t#o!nt!#olo"$ #"ani&ation lo(al%i!lin!. a&t#oint!&tin iv!# 'i& 2011E20
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8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014
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