Titong Sugihartono

Background/Objectives: Despite increasing GERD prevalence worldwide, the role of gastroduodenal microbiota in GERD phenotypes and symptom severity remains poorly understood. This study profiled mucosa-associated microbiota from the gastric antrum and duodenum across phenotypes and examined site-specific associations with symptom severity. Methods: In this cross-sectional study, forty individuals, including 26 with erosive reflux disease (ERD), 10 with non-erosive reflux disease (NERD), and 4 participants in the endoscopically normal comparator group, underwent 16S rRNA gene sequencing. Community differences were assessed using Bray–Curtis dissimilarity, differential taxa were explored by linear discriminant analysis effect size (LEfSe), and correlations with validated symptom questionnaires were evaluated. Results: Microbial community structure differed significantly between the antrum and duodenum, with Proteobacteria and Firmicutes predominating at both sites. LEfSe suggested enrichment of Streptococcus, Haemophilus, and Enterobacter in the duodenum, whereas Sphingobium, Acinetobacter, and Aquabacterium were more abundant in the antrum. The genus Helicobacter was relatively enriched in the antrum of ERD samples, whereas Streptococcus-dominant signatures were more prominent in the duodenum. Symptom severity showed stronger associations with duodenal taxa, including Fusobacterium with odynophagia, early satiety, and globus; Aquabacterium with postnatal drip and dyspnea, whereas gastric associations were fewer. Conclusions: In this small exploratory cross-sectional cohort, gastroduodenal microbiota exhibited both site-specific and phenotype-associated differences, with phenotype-related microbial variation being more evident in the duodenum than in the antrum. These hypothesis-generating findings highlight the importance of considering both anatomical context and GERD phenotype in upper gastrointestinal host–microbe interactions, and require confirmation in larger, phenotypically well-characterized cohorts.

Strongyloides stercoralis is an intestinal parasitic nematode classified as a Soil-Transmitted Helminth (STH) and estimated to infect up to 100 million people worldwide. The prevalence of STH is higher in tropical developing countries, such as Indonesia. This disease can manifest as a digestive tract infection, and in a few cases, also as colitis. Strongyloides colitis frequently exhibits clinical and endoscopic features that closely resemble those of Inflammatory Bowel Disease (IBD), particularly Ulcerative Colitis (UC). Their resemblance could lead to diagnostic errors and also mistreatment. Here we present a case of helminthiasis manifested as Strongyloides colitis in an at-risk elderly person from an endemic area. This study aims to highlight the complex diagnostic and treatment challenges to achieve a better prognostic outcome. A 61-year-old female was referred with a history of prolonged diarrhea accompanied by worsening abdominal pain. The colonoscopy demonstrated features of helminth colitis. A single dose of an anthelmintic was administered, after which the patient showed progressive improvement within two weeks. Six months of follow-up after treatment showed satisfactory results. In typical symptoms of colitis, detection of the underlying cause is very important. This uncommon case report is intended as an alert to avoid further misdiagnosis of helminth colitis from UC, since the cure rate is relatively high with appropriate medication. Further discussions on initial diagnostic tools and comprehensive treatment are needed, along with integration into global helminth control strategies.

The management of Crohn’s disease (CD) using anti-tumour necrosis factor therapy in tuberculosis (TB)-endemic regions poses major clinical challenges due to the risk of latent TB infection reactivation. This bibliometric–systematic literature review synthesised evidence from 17 peer-reviewed studies (2020–2025) evaluating adalimumab administered with concurrent prophylactic antitubercular therapy. Thematic synthesis and bibliometric mapping using VOSviewer demonstrated that adalimumab achieved 60–85% clinical remission in moderate-to-severe CD and axial spondyloarthritis while enhancing mucosal healing. However, 1–3% of patients developed active TB despite appropriate screening and isoniazid prophylaxis, revealing false-negative diagnostics and partial chemoprophylaxis protection. These findings highlight the need for region-specific frameworks integrating multimodal screening, targeted prophylaxis and ongoing clinical surveillance. Adalimumab remains a cornerstone biologic in TB-endemic settings, but its safe use requires adaptive, context-driven protocols emphasising vigilant risk mitigation.

The emergence of Mpox as a significant zoonotic viral threat presents new challenges in gastrointestinal endoscopy. This article outlines the risk of Mpox transmission during gastrointestinal endoscopy, particularly through respiratory droplets and contact with the mucosal surfaces. Gastrointestinal endoscopy may also facilitate transmission by fomites, as the Mpox virus can persist on medical instruments and surfaces for long periods. Nosocomial Mpox transmission is a significant concern in both endemic and non-endemic regions. This highlights the necessity for enhanced infection control measures in gastrointestinal endoscopy, including pre-endoscopic assessment, proper use of personal protective equipment, and rigorous post-procedural disinfection. Additionally, vaccination of healthcare workers frequently exposed to high-risk situations is emphasized. Ongoing surveillance and monitoring of healthcare workers are key components in minimizing the transmission risk. Although no direct cases of Mpox transmission via gastrointestinal endoscopy have been reported, these recommendations mitigate the potential risks associated with such procedures and necessitate strict adherence to infection control protocols. By adhering to these protocols and adapting to current practices, gastrointestinal endoscopy can be safely performed during the Mpox upsurge, ensuring the protection of both patients and healthcare workers.

Background: The diverse clinical characteristics of erosive esophagitis (EE) and symptom perception in patients with gastroesophageal reflux disease (GERD) remain a major challenge in understanding their underlying pathogenesis. This study aimed to investigate the association between the levels of IL-8, TNF-α, and IL-17 in serum and the presence of erosive esophagitis and symptoms related to GERD. Method: We enrolled 65 subjects presenting with GERD symptoms. Based on the findings of upper endoscopy, the subjects were categorized into two groups: (1) erosive esophagitis (EE LA grades B-D) and (2) non-erosive esophagitis (normal-EE LA grade A). Symptom perception was assessed via GERD questionnaire (GERD-Q) and the frequency scale for the symptoms of GERD (FSSG). The enzyme-linked immunosorbent assay (ELISA) method was used to analyze serum levels of IL-8, TNF-α, and IL-17. Analysis of cytokine levels between different symptoms severity was performed using the Kruskal-Wallis H test. Results: Median serum IL-8 levels were significantly higher in the erosive esophagitis group compared to those with non-erosive esophagitis (20.2 (IQR 16.9–32.2) vs. 17.7 (IQR 15.2–19.6), p < 0.05). The study found a significant association between IL-8 levels and the presence of globus symptoms (median IL8 level 46.961 (38.622–92.644) in subjects with globus vs. 18.06 (16.68–20.49) in those without globus; p < 0.05). Similarly, TNF-α levels were associated with the frequency of regurgitation symptoms (H index = 10.748; dr = 3; p < 0.05). We observed a significant correlation between IL-17 levels and the frequency of heartburn and early satiety symptoms. Conclusions: IL-8 may play a role in the development of mucosal erosion in GERD. IL-8, TNF- α, and IL-17 might be involved in the development of globus symptoms, the frequency of regurgitation, and the frequency of heartburn and early satiety, respectively. The diverse symptom phenotypes observed in patients with GERD symptoms may be mediated by distinct profiles of proinflammatory cytokines.

Type 2 diabetes mellitus (T2DM) and non-alcoholic liver disease (NAFLD) shared a common feature, insulin resistance (IR), which is marked by a change in the lipoprotein fraction, namely increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels. Blood lipids are routinely examined in T2DM patients; thus, our study aimed to investigate the performance of TG/HDL-C ratio values to identify hepatic steatosis, the earliest manifestation of nonalcoholic fatty liver disease (NAFLD), in T2DM patients. One hundred adult T2DM patients over 30 years old were recruited from the diabetes outpatient clinic at the Dr. Soetomo General Academic Hospital from August to October 2023. Data regarding sociodemographics, medication, glycosylated hemoglobin (HbA1c), lipid profiles, and FibroScan with controlled attenuation parameter (CAP) were collected from all participants. The group with hepatic steatosis (CAP≥237 dB/m) had a higher body mass index (BMI), higher TG levels, and TG/HDL-C ratio values. The TG/HDL-C ratio was significantly correlated with CAP values. Hepatic steatosis can be identified using the TG/HDL-C ratio with a cut-off value of 2.83 (sensitivity:72.4%; specificity:71.4%). An elevated TG/HDL-C ratio is associated with a higher risk (OR:6.562; p<0.05) of having hepatic steatosis. The TG/HDL-C ratio is a potential marker to predict NAFLD in T2DM patients.

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder associated with substantial impairment which considerably burdens healthcare systems worldwide. Research on IBS has largely been conducted in high-income countries posing barriers to the application of diagnostic strategies in low- and middle-income countries (LMICs) due to differences in disease characteristics, healthcare resources, and socioeconomic factors. This review discusses the diagnostic issues associated with LMICs. We present a concise overview of the relevant approaches and propose a diagnostic strategy based on the latest evidence. A positive diagnostic strategy that relies on appropriate symptom-based criteria is crucial within the diagnostic framework. A combination of complete blood count, fecal occult blood test, and complete stool test may reliably identify individuals with suspected IBS who are more likely to have organic diseases, thus justifying the necessity for a colonoscopy. Eventually, we developed a diagnostic algorithm based on a limited setting perspective that summarizes the available evidence and may be applied in LMICs.

Titong Sugihartono, Amal Arifi Hidayat, Michael Austin Pradipta Lusida, Kuntaman, Hafeza Aftab and Muhammad Miftahussurur. Korean J Gastroenterol 2023;82:84-90. https://doi.org/10.4166/kjg.2023.027

Titong Sugihartono, Amal Arifi Hidayat, Michael Austin Pradipta Lusida, Kuntaman, Hafeza Aftab and Muhammad Miftahussurur. Korean J Gastroenterol 2023;82:18-24. https://doi.org/10.4166/kjg.2023.029

Dyspepsia still becomes a major challenge in upper gastrointestinal disease in Indonesia. This disease often correlated with Helicobacter pylori infection. However, the prevalence of this bacterium is generally low in Indonesia. Therefore, several considerations should be taken into consideration during the management of dyspepsia and H. pylori infection. “Management of dyspepsia and H. pylori infection in Indonesia: The Indonesian consensus report” comprises information gathered from 22 gastroenterology centers across Indonesia. The experts gathered to evolve a consensus, that consists of the statements, grades of recommendations, evidence levels, and rationales for the dyspepsia and H. pylori infection management for daily clinical practice. The report explains several aspects from the updated epidemiology information to comprehensive management therapy. After the experts worked together on all statements in the recommendations, the results are presented with the final agreement as a consensus to help clinicians in understanding, diagnosing, and treating dyspepsia and H. pylori infection patients in daily clinical practice in Indonesia.