konsensus dispepsia dan helicobater pylori 2014

8/20/2019 Konsensus Dispepsia Dan Helicobater Pylori 2014

1/23

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


2/23

'*


3/23

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

'*


4/23

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.

-*-


5/23

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

- *II -


6/23

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 &ampai !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 &ampai 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

- I; -


7/23

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

- ;I -


8/23

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

- ;III -


9/23


10/23

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 &ampai 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


11/23

%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 &ampai

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


12/23

• ?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


13/23

• 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


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


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".


16/23

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


17/23

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


18/23

m",om!p#a>ol! 20 m", pantop#a>ol! 40 m", !&om!p#a>ol! 40 m".:atatan


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


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


21/23

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


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


23/23

konsensus dispepsia dan helicobater pylori 2014

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