Perkumpulan Gastroenterologi Indonesia (PGI) Kelompok Studi Helicobacter Helicobacter py pyllori Indonesia (KS HPI)
KONSENSUS NASI ONAL Penatalaksanaan Dispepsia dan Infeksi Helicobacter Helicobacter p py ylo ri Editor: Marcellus Simadibrata K Dadang Makmun Murdani bdulla! ri "a!rial S#am c!mad "au$i Kaka %enaldi Hasan Maula!ela manda P &tari
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Perkumpulan Gastroenterologi Indonesia (PGI) Kelompok Studi Helicobacter Helicobacter p pyl ylo ori Indonesia (KSHPI)
KONSENSUS NASI ONAL
Penatalaksanaan Dispepsia dan Infeksi Helicobacter p Helicobacter py ylori Editor: Marcellus Simadibrata K Dadang Makmun Murdani bdulla! rii "a!rial S#am r c!mad "au$i Kaka %enaldi Hasan Maula!ela manda P &tari
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Konsensus Penatalaksanaan Dispepsia da dan n Infeksi Helicobacter Helicobacter p pyl ylor ori i +
'* Perkumpulan Gastroenterologi Indonesia (PGI) da dan n Kelompok Studi Helicobacter Helicobacter py pylo lorri Indonesia (KSHPI)
xvii + 16 halaman xv 14,8 x 21 cm ISBN No No.. 978-602-17913-8-7
1.
Hak cipta Hak cipta ip!"an" ol!h ol!h pa#a pa#a p!n p!n$%&% $%&%n n a an n ilin%n"i %nan"%nan".
2.
'ila#an" m!mp!#(an$ak, m!nc!tak, a an n m!n!#(itkan &!(a"ian ata% &!l%#%h i& i&ii (%k% ini !n"an ca#a a an n alam alam (!n (!nt%k t%k apap%n )%"a tanpa &!i)in a#i a#i p!n p!n$%&%n $%&%n a an n p!n!#(it 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
Helicobacter py pylo lori ri $an" aa i m!n"!nai p!natala p!natalak&anaan k&anaan i&p!p&ia an in!k&i Helicobacter Inon!&ia. S!m%a hal t!ntan" !ini&i, !tiolo"i, ia"no&i& an p!natala p!natalak&aan k&aan i&p!p&ia ma%p%n in!k&i H.pylori &%ah &%ah p!# p!#nah nah i(aha& alam kon&!n&%& &!(!l%mn$a &!ca#a t!#pi&ah, nam%n kali ini i"a(%n"kan ka#!na ka#!na p!natala p!natalak&anaan k&anaan i&p!p&ia tiak tiak l!pa& l!pa& a#i p!natala p!natalak&aan k&aan in!k&i H.pylori, i&!#tai i&!#tai p! p!na nam(a m(aha han n p!n "!t "!tah ah%an %an (a#% t!#kait !ini&i, patoi& !ini&i, patoi&iolo"i, iolo"i, ia"no&i& a an n p!natala p!natalak&anaan k&anaan i&p!p&ia an in!k&i H.pylori. on&!n&%& na&ional na&ional p!natala p!natalak&anaan k&anaan i&p!p&ia a an n in!k&i H.pylori tah%n 2014 i Inon!&ia ini t!tap i(%at (!#a&a#ka (!#a&a#kan n evidence based medicine , &!hin""a c%k%p (!#(o (! #(o(ot (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#akti p#aktik k &!ha#i-ha#i. &!ha#i-ha#i. 'iha#apkan !n"an aan$a (%k%
kon&!n&%& ini, pa#a okt!# apat l!(ih m!nin"katkan
p!la$anann$a k!paa k!paa pa&i!n-pa&i!n pa&i!n-pa&i!n i&p!p&ia an in!k&i H.pylori. !paa &!l%#%h p!&! p!&!#ta #ta kon&!n&%& $an" t!lah m!l%an"kan akt%n$a alam p!n$%&%nan p!n $%&%nan kon&!n&%& na&ional p!natala p!natalak&anaan k&anaan i&p!p&ia a an n 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 a an n /. i&ai Inon!&ia $an" t!lah m!n)ai &pon&o# &pon&o# an an m!m(ant% hin""a t!#(itn$a kon&!n&%& ini. ami m!#a&a (aha (%k% kon&!n&%& na&ional p!natala p!natalak&anaan k&anaan i&p!p&ia a an n in!k&i H.pylori ini ma&ih )a%h a#i &!mp%#na, ol!h ka#!na it% k#itik a an n &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$a, N$ a, kami kami p!#&! p!#&!m(ahka m(ahkan n (%k% kon&!n&%& na&ional na&ional p!natala p!natalak&anaan k&anaan i&p!p&ia a an n in!k&i H.pylori ini. S!mo"a S!mo"a (%k% (%k% ini ini (!#man (!#manaat aat (a"i &!)aat i Inon!&ia. aka#ta, 1 p#il 2014
,im ,i m 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 (!#(a"ai "ai k!l%han %m%m $an" apat it!m%i ol!h okt!# okt!# i i (!#(a (!#(a"ai "ai (ian", (ian", tiak tiak t!#(ata& t!#(ata& han$a han$a pa paa a ahli &al%#an c!#na &a)a alam alam p#aktik p#aktik k!&!ha#iann$a. k!&!ha#iann$a. /!n"!#tian m!n"!nai m!n"!nai patoi&iolo"i patoi&iolo"i i&p!p&ia t!#%& (!#k!m( (!# k!m(an" an" &!)ak &!)ak im%lain$a im%lain$a inv!&ti"a&i &!ca#a ilmiah ilmiah pa paa a 1980-an &ai !n"an &aat ini $an" m!manan" in!k&i Helicobacter pylo pylori ri &!(a"ai &alah &at% akto# k%nci alam m!nan"ani i&p!p&ia, (aik t!#kait %lk%& ma%p%n non-%lk%&. /!m(aha&an i&p!p&ia p% i&p!p&ia p%n n ha#%& m!n"h%(%n"kan !n"an mana)!m!n a#i in!k&i H.pylori. /#!val!n&i in!k&i H.pylori i %nia c%k%p tin""i a an n (!#va#ia&i (!# (!#"ant "ant%n %n" " paa pa a a#!a, !tni&ita&, %&ia, an &tat%& &o&ial !konomi. In!k&i H.pylori it!m%kan l!(ih (an$ak pa a n!"a#a-n!"a#a $an" ma&ih (!# (!#k!m(a k!m(an" n" ala%p%n &!ca#a %m%m, paa pa a &aat ini t!#lihat k!c!n!#%n"an p!n p!n%#% %#%nan nan an"ka k!)aian. /!n"%#%& B!&a# /!#k%mp%lan a&t#o!nt!#olo"i Inon!&ia /B /I t!lah m!n$aa#i m!n$aa#i p!nti p!ntin"n$a n"n$a &%at% pan pa n%an %an alam m!nan""%lan"i hal ini $an" t!#c!#min t!#c!#min pa paa a p!n p!n$%&%nan $%&%nan on&!n&%&
pylori ri,, $an" i&%&%n ol!h !lompok Na&ional Na&io nal /!natalak&anaan In!k&i Helicobacter pylo Helicobacter py pylo lori ri Inon!&ia SH/I St%i Helicobacter SH/I pa pa a tah%n 1996 a an n ip!#(aha#%i tah%n 2003. on&!n&%& ini m!m(aha& &!ca#a komp#!h!n&i komp#!h!n&i m!n"!nai m!n"!nai ia"no&i& a an n tata
pylori ri, t!#%tama a#i &%%t lak&ana in!k&i Helicobacter pylo &%%t pa pana na n" okt!# okt!# i i p!la$an p!la$anan an p#im!#. p#im !#. In!k&i H.pylori &!#in" i)%mpai pa paa a pa&i!n-pa&i!n &ia, &!hin""a !k&kl%&i (akt!#i
ini
m!#%pakan (a"ia (a"ian n p!nt p!ntin" in"
a#i p!n p!n! !kata kata n
ia"no&i&
alam
p!na p! nan"a n"a na nan n i&p!p&ia pa paa a pop%la&i ini. #aika&i H.pylori t!lah t!#(%kti !!kti alam m!n"hilan"kan "!)ala i&p!p&ia t!#kait %lk%& p!ptik%m, nam%n !mikian %nt%k i&p!p&ia non-%lk%& h%(%n"ann$a ma&ih (!l%m m!$akinkan. Saat ini, t!#apat p!#k p!#k!m(a !m(an"an n"an t!#kini m!n"!nai in!k&i H.pylori, m%lai a#i pato"!n! pato"!n!&i&, &i&, akto# #i&iko, h%(%n"ann$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 p!m(ah (aha#% a#%an an pan % %an an ini, i&!&%aikan !n"an p!# p!#k!m(a k!m(an"a n"an n $an" aa an iha#apkan akan apat m!n)ai p! p!o oman man (a"i &!)aat alam p!natala p!natalak&anaan k&anaan pa&i!n-pa&i!n !n"an i&p!p&ia &!hin""a iapatkan p!natala p!natalak&anaan k&anaan $an" optimal.
Ketua Pengurus -esar Perkumpulan Gastroenterologi Indonesia (P- PGI) /#o. # #.. a#c!ll%& Simai(#ata, /h', Sp./'-H, INSI,:, 24S73
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Susunan Panitia Pelaksana Pen#usunan Konsensus Penatalaksanaan Dispepsia da dan n Infeksi Helicobacter Helicobacter py pylo lori ri /!na /! na&! &!ha hatt
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24:7
Daftar Is Isii ata /!n"anta# im ito# ............ ......................... ......................... ......................... .......................... ......................... ............... ... *II ata Sam(%tan !t%a /!n"%#%& B!&a# /!#k%mp%lan a&t#o!nt!#olo"i Inon!&ia /B /I ........... ........................ .......................... ......................... ...................... .......... I; S%&%nan /anitia /!lak&ana /!n$%&%nan on&!n&%& /!natalak&anaan 'i&p!p&ia a an n In!k&i Helicobacter pylo pylori ri (Hp) ........ I.
/!n /! nah ah%l %l%a %an n .... ........ ........ ........ ........ ........ ......... ......... ........ ........ ........ ......... ......... ........ ........ ........ ......... ......... ........ ........ ........ ......... ......... ......1 ..1
II.
'!ini&i ........... ........................ ......................... ......................... ......................... ......................... .......................... ......................... ...................... .......... 1
III.
pi p i!m !mio iolo lo"i "i............ ......................... ......................... ......................... ......................... ......................... .......................... ....................... .......... 2
I*.. I*
/ato /a toi i&i &iol olo"i o"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# akto# p&iko&o&ia p&iko&o&iall ............ ......................... ......................... ......................... .......................... ............. 3 I*.4. /!#anan a&am lam(%n" ............. ......................... ......................... ......................... ......................... ................. .... 3 I*.A. /!#anan in!k&i Hp ............ ......................... ......................... ......................... .......................... ......................... ............... ... 3
*.
'ia" 'i a"no no&i &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 'i&p!p&ia (!l% (!l%m m ii iinv! nv!&ti &ti"a& "a&i....... i............ ......... ........ ........ ........ ......... ......... ........ ........ ........ ......... ....... .. 8 *I.2. 'i&p!p&ia $an" t!lah iinv!&ti"a&i ............................................... 9 *I.2.1. 'i&p!p&ia o#"anik o#"anik ........... ........................ ......................... ......................... .......................... ................. .... 9 *I.2.2. 'i&p!p&ia %n"&ional ............ ........................ ......................... ......................... ....................... ........... 9 *I.3. ata lak&ana i&p!p&ia !n"an in!k&i Hp...............................
10
*II. ampi#an ............ ......................... ......................... ......................... .......................... ......................... ......................... ......................... ............... ...13 13 ampi#an 1. l"o#itm! ata ak&ana 'i&p!p&ia i B!#(a"ai in"kat a$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# /% /%&t &tak aka...................... a.................................. ......................... ......................... ......................... .......................... ......................... ................ .... 16
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;I
I.
Penda!uluan 'i&p!p&ia m!#%pakan k!l%han $an" %m%m it!m%i alam p#aktik p#aktik &!ha#i&!ha#i-
ha#i a an n t!lah ik!nal &!)ak lama !n"an !ini&i $an" t!#%& (!#k! (!#k!m(an m(an", ", m%lai a#i &!m%a "!)ala $an" (!#a&al a#i &al%#an c!#na (a"i (a"ian an ata&, &ai i!k&kl%&in$a "!)ala #!l%k& hin""a k! !ini&i t!#kini $an" m!n"ac% k!paa k#it!#ia ?oma III.
1
In!k&i Helicobacter Helicobacter py pylo lori ri Hp &aat ini ipanan" &!(a"ai &alah &at% akto# p!n akto# p!ntin tin" " alam m!nan"ani i&p!p&ia, i&p!p&ia, (aik (aik o#"anik o#"anik ma%p%n ma%p%n %n"&ional, &!hin""a p!m p!m(a (aha& ha& an m!n"!nai i&p!p&ia p!#l% ih%(%n"kan !n"an p!na p! nan"a n"ana nan n in!k&i Hp. B!#(a"ai &t%i m!ta-anali&i& m!n%n)%kkan aan$a h%(%n"an anta#a in!k&i Hp !n"an p!n$akit "a&t#o%o!nal $an" itanai k!l%hanC"!)ala i&p!p&ia.
2,3
/#!val!n&i in!k&i Hp i &ia c%k%p tin""i, &!hin""a p!#l% ip!#hatikan alam p! p!n! n!ka kata tan n ia"no&i& a an n p!nat p!natalak alak&ana &anaan an i&p!p&ia. #aika&i Hp t!lah t!#(%kti !!kti alam m!n"hilan"kan "!)ala i&p!p&ia o#"anik, t!tapi %nt%k i&p!p&ia %nt%k i&p!p&ia %n"&ional ma&ih ip!#l%kan p!n!l p!n!litian itian l!(ih lan)%t.
4
on&!n&%& ini i&%&%n %nt%k m!m(!#ikan pa pan n%a %an n pa paa a okt!# %m%m, &p!&iali& a an n kon&%ltan alam p!nat p!natalak& alak&anaa anaan n i&p!p&ia. on&!n&%& ini m!n""a(%n"kan p!nat p!natalak& alak&anaa anaan n i&p!p&ia a an n in!k&i Hp Hp,, &!hin""a akan icapai ha&il $an" l!(ih l!(ih (aik. (aik.
II.. De/nisi II 'i&p!p&ia m!#%pakan #a&a tiak n$aman $an" (!#a&al a#i a!#ah a(om!n (a"i (a"ian an ata&. ?a&a tiak n$aman t!#&!(%t apat (!# (!#%pa %pa &alah &at% ata% (! (!(!# (!#apa apa "!)ala (!#ik%t $ait%< n$!#i !pi"a&t#i%m, #a&a t!#(aka# i !pi"a&t#i%m, #a&a p! p!n% n%h h &!t!lah makan, c!pat k!n$an", #a&a k!m(%n" pa paa a A
&al%#an c!#na ata&, m%al, m%ntah, a an n &!naa. @nt%k i&p!p&ia %n"&ional, k!l%han t!#&!(%t i ata& ha#%& (!#l (!#lan"& an"&%n" %n" &!tiakn$a &!lama ti"a (%lan t!#akhi# !n"an t!#akhi# !n"an aitan "!)ala !nam (%la (%lan n &!(!l%m ia"no&i& it!"akkan.
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
III. Epidemiologi /#!val!n&i pa&i!n i&p!p&ia i p!la$an p!la$anan an k!&!hatan m!ncak%p 30 30D D a#i p!la p!la$anan $anan okt!# %m%m a an n A0 A0D D a#i p!la p!la$anan $anan okt!# &p!&iali& "a&t#o!nt!#olo"i. a$o#ita& pa&i!n &ia !n"an i&p!p&ia $an" (!l (!l%m %m iinv!&ti"a&i a an n
1
tanpa tana (aha (aha$a $a m!#%pakan i&p!p&ia %n"&ional. B!#a&a#kan ha&il p!n!litian p!n!lit ian i n!"a#a-n!"a#a &ia :ina, Hon" on", Inon!&ia, o#!a, ala$&ia, Sin"ap%#a, aian, hailan, a an n *i!tnam iapatkan 43-79,AD pa&i!n !n"an i&p!p&ia aalah i&p!p&ia %n"&ional.A 'a#i ha&il !no&kopi $an" ilak%kan pa paa a AA0 pa&i!n i&p!p&ia alam (!( !#a !#apa pa &!nt!# &!nt!# i i Inon!&ia Inon!&ia pa paa a an%a#i 2003 &ai p#il 2004, iapatkan 44,7 D ka&%& k!lainan minimal pa paa a "a&t#iti& a an n %o!niti&E 6,AD ka&%& !n"an %lk%& "a&t!#E a an n no#mal pa paa a 8,2D ka&%&. 6 'i Inon!&ia, ata p#!val!n&i in!k&i Hp pa paa a pa&i!n %lk%& p!pt p!ptik%m ik%m tanpa #ia$at p!mak p!makaian aian o(at-o(atan anti-inlama&i non-&t!#oiCINS (!#va#ia&i a#i 90-100D a an n %nt%k %nt%k pa&i!n pa&i!n i&p!p&ia %n"&ional &!(an$ak 2040D 40 D !n"an (!#(a (!#(a"ai "ai m!to! ia"no&tik p!m!#ik&aan &!#olo"i, k%lt%#, a an n hi&topatolo"i.7 /#!val!n&i in!k&i Hp Hp pa paa a pa&i!n i&p!p&ia $an" m!n)alani m!n)alani p!m!#ik p!m!#ik&aan &aan !no&kopik i (!#(a (!#(a"ai "ai #%mah &akit p!nii p!niikan kan k!okt!#an i Inon!&ia 2003-2004 it!m%kan &!(!&a# &!(!&a# 10.2D. 10.2D. /#!val!n&i $an" c%k%p tin""i it!m%i i aka&a# tah%n 2011 AAD, Solo tah%n 2008 A1,8D, Fo"$aka#ta 30.6D an a n S%#a(a$a tah%n 2013 23,AD, &!#ta p#!val!n&i t!#!nah i aka#ta 8D. 6,8-10
I0. Pato/siologi /atoi&iolo"i %lk%& p!pti p!ptik%m k%m $an" i&!(a(kan ol!h Hp a an n o(at-o(atan anti-inlama&i
non-&t!#oi
INS
t!lah (an$ak ik!tah%i.1
'i&p!p&ia
%n"&ional i&!(a(kan ol!h (!( !#a !#apa pa akto# %tama, anta#a lain "an""%an motilita& "a&t#o%o!nal, in!k&i Hp, a&am lam(%n", hip!#&!n&itivita& vi&!#al, an a n akto# p&iko p&ikolo"i&. lo"i&. akto#-akto# lainn$a $an" apat (!# (!#p! p!#an #an aalah "!n!tik, "a$a hi%p, lin"k%n"an, i!t a an n #ia$at in!k&i "a&t#oint!&tinal &!(!l%mn$a. 11,12
2
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
I0.. Peranan gangguan motilitas gastroduodenal an""%an motilita& "a&t#o%o!nal t!#i#i a#i p!n p!n%#% %#%na nan n kapa&ita& lam(%n"
alam m!n!#ima
inkoo#ina&i an""%an
ant#o%o!nal,
makanan
impaired gastric accommodation,
an a n p!#l p!#lam(a am(atan tan p! p!n"o n"o&o &on"a n"an n
lam(%n".
motilita& "a&t#o%o!nal m!#%pakan &alah &at% m!kani&m!
%tama alam patoi&iolo"i i&p!p&ia %n"&ional, (!#kait (!#kaitan an !n"an p!#a p!#a&aa &aan n (!"a (! "ah h &!t!lah makan, $an" apat (!# (!#%pa %pa i&t!n&i a(om!n, k!m(%n", a an n #a&a p!n% #a&a p!n%h. h. A,12
I0.'. Peranan !ipersensiti1itas 1iseral Hip!#&!n&itivita& vi&!#al (!# (!#p! p!#an #an p!n p!ntin tin" " alam patoi&iolo"i i&p!p&ia
%n"&ional, t!#%tama p!n p!nin"k in"kata atan n &!n&itivita& &a#a &a#a &!n&o#ik &!n&o#ik p!#i!# a p!#i!# an n &!nt#al t!#haap #an"&an"an #!&!pto# kimiai a an n #!&!pto# m!kanik int#al%minal lam(%n" (a"ia (a"ian n p#ok& p#ok&imal. imal. Ha Hall 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& an""%an p&iko&o&ial ial m!#%pakan &alah &at% akto# p!nc!t p!n c!t%& %& $an" $an" (!# (!#p! p!#an #an alam i&p!p&ia %n"&ional. '!#a)at (!#at (!#atn$a n$a "an""%an p&iko&o&ial &!)alan !n"an tin"kat k!pa#ahan i&p!p&ia. B!#(a"ai p!n!li p!n!litian tian m!n%n)%kkan (aha (ah a !p#!&i a an n an&i!ta& an&i!ta& (!# (!#p!# p!#an an pa paa a t!#)ain$a i&p!p&ia %n"&ional.A,12
I0.*. Peranan asam lambung &am lam(%n" apat (!# (!#p!# p!#an an alam tim(%ln$a k!l%han i&p!p&ia %n"&ional. Ha Hall ini ia&a#i pa paa a !!ktivita& t!#api anti-&!k#!to#ik a&am a#i (!(! (! (!#ap #ap a p!n!l p!n!litian itian pa&i!n i&p!p&ia %n"&ional. 'ata p!n!lit p!n!litian ian m!n"!nai &!k#!&i a&am lam(%n" ma&ih k%#an", a an n lapo#an i &ia ma&ih kont#ov!#&ial. A
I0.3. Peranan infeksi Hp /#!val!n&i in!k&i Hp Hp pa&i!n pa&i!n i&p!p&ia %n"&ional %n"&ional (!#va#ia&i (!#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.
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
3
/!nana (iolo"i& &!p!#ti "h#!lin a an n l!ptin , &!#ta p! p!#%( #%(aha ahan n !k&p#!&i
muscle-specifc
microRNAs
(!# !#h% h%(% (%n n"a "an n
i&p!p&ia %n"&ional, $an" ma&ih ma&ih p!#l% p!#l% it!liti l!(ih lan)%t.
!n" ! n"an an
p #o & ! &
A,13
0. Diagnosis 0.. Diagnosis Dispepsia 'i&p 'i &p!p !p&i &iaa
$an" $a n" t!lah iinv!&ti"a&i t!#i#i a#i i&p!p&ia o#"anik a an n
%n"&ional. 'i&p!p&ia o#"anik t!#i#i a#i %lk%& "a&t!#, %lk%& %o!n%m, "a&t#iti&
!#o&i,
"a&t#iti&,
%o!niti&
an a n p#o&!&
k!"ana&an.
'i&p!p&ia
%n"&ional m!n"ac% k!paa k#it!#ia ?oma III.#it!#ia ?oma III (!l% (!l%m m ivalia&i i Inon!&ia. on&!n&%& &ia-/a&iik 2012 m!m%t%&kan %nt%k m!n"ik%ti kon&!p a#i k#it!#ia ia"no&i& ?oma III !n"an p! p!na nam( m(ah ahan an "!)ala (!# (!#%pa %pa k!m(%n" pa paa a a(om!n (a"ia (a"ian n ata& $an" %m%m it!m%i &!(a"ai "!)ala i&p!p&ia %n"&ional.A 'i&p!p&ia m!n%#%t k#it!#ia ?oma III aalah &%at% p!n$akit !n"an &at% ata% l!(ih "!)ala $an" $an" (! (!#h% #h%(%n (%n"an "an !n"an "an""%an i "a&t#o%o!nal< •
N$!# N$ !#ii !pi"a&t#i%m
patoi&iolo"i pat
•
?a&a t!#(aka# t!#(aka# i i !pi"a&t#i%m
•
?a&a p! ?a&a p!n% n%h h ata% tiak tiak n$aman n$aman &!t!lah makan
•
?a&a c!pat k!n$an"
!)ala $an" i#a&akan ha#%& (!#l (!#lan"& an"&%n" %n" &!tiakn$a &!lama ti"a (%lan t!#akhi# !n"an t!#akhi# !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, $akni
epigastric pa epigastric pain in syndrome a post stpr pran andi dial al distress syndrome. kan t!tapi, an n po t!tapi, (%kti (%kti t!#kini m!n%n)%kkan (ah (aha a t!#apat t%mpan" tinih ia"no&i& alam % %aa p!#ti"a p!#t i"a pa&i!n i&p!p&ia.1
Sindroma &!t!lah makan
- ank!# lam(%n"
4
Sindroma
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
'i&p!p&ia (!l%m 'i&p!p&ia (!l%m iinv!&ti"a&i /!m!#ik&aan p!n%n)an" /!m!#ik&aan p!n%n)an " &!&%ai inika&i< - a(o#ato#i%m a#ah - no&kopi - Urea Breat !est - @S (om!n
'i&p!p&ia %n"&ional -
'i&p!p&ia o#"anik @lk%& p!ptik%m a&t#iti& !#o&i a&t#iti& &!an"-(!#at !pi"a&t#i%m
G /aa /aa p#aktik p#aktik &!ha#i-ha#i &!ha#i-ha#i apat it!m%kan t%mpan" tinih anta#a i&p!p&ia !n"an?'
Gambar .lur Diagnosis dispepsia belum diin1estigasi val%a&i tana (aha (aha$a $a ha#%& &!lal% m!n)ai (a"i (a"ian an a#i !val%a&i pa&i!n pa&i!n $an" atan" !n"an k!l%han i&p!p&ia. ana ana (aha (aha$a $a pa paa a i&p!p&ia $ait%< •
/!n%#%nan (!# (!#at at (a (aa an n unintended
•
'i&a"ia p#o"#!&i 'i&a"ia p#o"#!&i
•
%ntah #!k%#!n ata% ata% p!#&i&t p!#&i&t!n !n
•
/!#a#ahan &al%#an c!#na
•
n!mia
•
'!mam
•
a&&a a!#ah a(om!n (a"i (a"ian an ata&
•
?ia$at k!l%a#"a kank!# kank!# lam(%n" lam(%n"
•
'i&p!p&ia aitan (a# (a#% % pa paa a 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
!& Sn '!n"an !no&kopi ?api %#!a&! 98D t!&t
Hi&tolo"i
9AD
Sp
!t!#an"an
99D
•
9AD
%lt%#
:!pat a an n m%#ah S!n&itivita& pa&cat pa&cat!#api !#api • S!n&itivita& (!#k%#an" (!#k%# an" • Samp!l iam(il a#i ant#%m • '!t!k&i m!nin"kat !n"an p!a#naa p!a #naan n kh%&%& 5a#thinSta##$C h!maktok&ilin-!o&inC i!m&a an n • Samp!l iam(il a#i ant#%m a ko#p%& • San"at &p!&iik, &!n&itivita& (%#%k (ila (%#%k (ila m!ia t#an&po#ta&i tiak t!#&!ia tiak t!#&!ia p!n"al "alama aman n • 'i(%t%hkan p!n tiak t!#&!ia t!#&!ia • ahal, &!#in" tiak an n • Samp!l iam(il a#i ant#%m a ko#p%& • !ia $an" i"%nakan anta#a lain Spa##o
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
0.'. 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%# a an n /:? a an n &!ca#a tiak lan"&%n" tanpa !no&kopi urea breat test, stool test, urine test , a an n &!#olo"i. Urea breat test &aat ini &%ah m!n)ai gold standard %nt%k p!m!#ik&aan p!m!#ik &aan Hp Hp,, &alah &at% urea breat test $an" aa anta#a lain 13:2 %nt%k m!lak%kan m!lak%kan p!m!#ik& p!m!#ik&aan aan Hp Hp,, $ait% ha#%& ha#%& (!( (!( a& breat analy"er . S$a#at %nt%k anti(iotik a anti(iotik an n // //II prot a (!( (!( !#a !#apa pa proton on-p -pum ump p inibitor &!lama 2 min""%. a 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! p!#(! #(!a aan an alam p!#o#ma alam p!#o#ma t!&, a an n akto#-akto# $an" apat m!mp!n"a#%hi ha&il t!&, &!p!#ti p! p!n" n""%n "%n aa aan n t!#api anti&!k#!to#ik anti&!k#!to#ik a an n anti(iotik.
A
/:?
• • •
•
anpa !no&kopi S!#olo"i IS 8A 8A-9 -92D 2D
S!n&iti a an n &p!&iik iak t!#&tana#i&a&i Samp!l iam(il a#i ant#%m a an n ko#p%& !#hit%n" !k&p!#im!ntal
6
on&!n&%& Na&io Na&ional nal /!natalak&anaan 'i&p!p&i
pylori ri a an In!k&i Helicobacter pylo
79-8 79 -83D 3D
%#an" ak%#at a an n tiak m!n""am(a#kan in!k&i akti /#!ikto# in!k&i in!k&i $an" hanal • /#!ikto# i n!"a#a n!"a#a (! (!#k!m #k!m(an (an" " !n"an p#!val!n&i tin""i • iak i#!kom!na&ikan &!t!lah t!#api an n t!#&!ia • %#ah a 13 9AD 96D • 'i#!kom!na&ikan %nt%k : %#!a 14 breat test ia"no&i& Hp &!(!l%m t!#api @B mi&al< • !& t!#pilih %nt%k koni#ma&i 13 !#aika&i :2 breat (ol !h analy"er • /a&i!n tiak (ol!h m!n"kon&%m&i // //II a an n ,abel . Perbandingan berbagai metode tes te s diagnosis infe anti(iotik &!lama anti(iotik &!lama 2 min""% &!(!l%m p!m!#ik &!(!l%m p!m!#ik&aan &aan 1A,16 ilak%kan !t!#&!iaan (!#va#ia&i (!#va#ia&i • !t!#&!iaan nti"!n !&!& 9AD 94D iak &!#in" &!#in" i"%nakan m!&kip%n &!n&itivita& a an n &p!&ii&ita& tin""i, &!(!l%m a an n &!&%ah t!#api S!#olo"i San"at (%#%k San"at (%#%k a an n tiak tiak apat apat in"!#-&tick m!n$amai &!#olo"i IS nti(oi i Saat ini %#in! t!&t t!&t (!l (!l%m %m t!#&!ia %#in< i Inon!&ia 73,278,6• ?api @#in! 17-19 82D 90,7D !&t • @#in!-(a&! 18,19 74,468-81D IS 90D •
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
0I.. ,ata laksana 0I ata lak&ana i&p!p&ia im%lai !n"an %&aha %nt%k %nt%k i!ntiika&i i!ntiika&i patoi&iolo"i patoi&iolo"i 11 en"yme-lin#ed immunosorbent Sn
0I.. Dispepsia belum diin1estigasi St#at!"i tata lak&ana optimal pa paa a a&! ini aalah m!m(!#ikan t!#api !mpi#ik &!lama !mpi#ik &!lama 1-4 min""% &!(!l%m ha&il inv!&ti"a&i aal, $ait% $ait% p!m!#i p!m!#ik&aan k&aan aan$a Hp. Hp.11,13 @nt%k a!#ah a an n !tni& t!#t!nt% &!#ta pa&i!n !n"an akto# #i&iko tin""i, tin""i, p!m!#i p!m!#ik&aan k&aan Hp ha#%& ilak%kan l!(ih aal.
7
(at
$an"
ip!#"%nakan
apat (!# (!#%pa %pa
anta&ia, anti&!k#!&i
a&am
lam(%n" //I mi&aln$a om!p#a>ol!, #a(!p#a>ol! a an n lan&op#a>ol! anCata%
Anta tago goni nist st H2?J, p#okin!tik H2--Receptor An H2 p#okin!tik,, a an n
&itop#ot!kto# mi&aln$a
#!(amipi!, i mana pilihan it!nt%kan (!#a&a (!#a&a#kan #kan omina&i k!l%han a an n #ia$at p! p!n" n"o( o(at atan an pa&i!n &!(!l%mn$a. a&ih it%n""% p! p!n" n"!m !m(a (an" n"an an o(at (a#% $an" (!k!#)a m!lal%i do$n-regulation do$n-regulation pr prot oton on pu pum mp $an" iha#apkan m!miliki m!kani&m! k!#)a $an" l!(ih l!(ih (aik (aik a#i a#i //I, $ait% 'BS 2411.
and d treat !#kait !n"an p#!val!n&i in!k&i Hp $an" tin""i, &t#at!"i test an it!#apkan pa it!#apkan paa a pa&i!n !n"an k!l%han i&p!p&ia tanpa tana tana (aha$a. (aha$a.
!est an !est and d treat ilak%kan ilak%kan paa< paa< 20 •
/a&i!n !n"an
i&p!p&ia tanpa komplika&i $an" tiak (! (!#!&p #!&pon on
t!#haap p!# p!#%( %(ah ahan an "a$a hi%p, anta&ia, p!m( p!m(!#i !#ian an //I t%n""al &!lama 2-4 min""% a an n tanpa tana tana (aha$a. (aha$a. •
/a&i!n !n"an #ia$at %lk%& "a&t!# ata% %lk%& %o!n%m $an" $an" (!l (!l%m %m p!#nah p!# nah ip!#ik&a.
•
/a&i!n $an" akan min%m INS, t!#%tama !n"an #ia$at %lk%& "a&t#o%o!nal.
•
n!mia
!i&i!n&i
(!&i
$an"
tiak
apat
i)!la&kan, p%#p p%#p%#a %#a
t#om(o&itop!nik iiopatik t#om(o&itop!nik iiopatik a an n !i&i!n&i vitamin B12. tiak ilak%kan ilak%kan paa< paa< 20 !est an !est and d treat tiak
8
•
/!n$akit #!l%k& "a&t#o!&oa"!al ?'
•
nak-anak !n"an i&p!p&ia %n"&ional
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
0I.'. Dispepsia #ang tela! diin1estigasi /a&i!n-pa&i!n i&p!p&ia !n"an tana (aha (aha$a $a tiak i(!#ikan t!#api !mpi#ik, m!lainkan ha#%& ilak%kan inv!&ti"a&i t!#l!(ih ah%l% !n"an !no&kopi !n"an ata% tanpa tanpa p!m!#i p!m!#ik&aan k&aan hi&topatolo"i &!(!l%m itan"ani &!(a"ai i&p!p&ia %n"&ional. S!t!lah inv!&ti"a&i, tiak m!n$in"ki#kan k!m%n"kinan (ah (ahaa pa paa a (!(! (! (!#ap #ap a ka&%& i&p!p&ia it!m%kan ?' &!(a"ai k!lainann$a.
0I.'.. Dispepsia organik pa(ila it!m%kan l!&i m%ko&a mucosal damage &!&%ai ha&il !no&kopi, t!#api ilak%kan (!#a&a (!#a&a#kan #kan k!lainan $an" it!m%kan. !lainan $an" t!#ma&%k k! alam k!lompok i&p!p&ia o#"anik o#"anik anta#a anta#a lain "a&t#iti&, "a&t#iti& h!mo#a"ik, %o!niti&, %lk%& "a&t!#, %lk%& %o!n%m, ata% ata% p#o&!& p#o&!& k!"ana&an. /aa %lk%& p!pti p!ptik%m k%m %lk%& "a&t!# anC ata% %lk%& %o!n%m, o(at $an" i(!#ikan anta#a lain kom(ina&i //I, mi&al #a(!p#a>ol! 2x20 m" m"CC lan>op#a>ol! 2x30 m" !n"an m%kop#ot!kto#, mi&aln$a #!(amipi! 3x100 m".
0I.'.'. Dispepsia fungsional pa(ila &!t!lah inv!&ti"a&i ilak%kan tiak tiak it!m%kan it!m%kan k!#%&akan m%ko&a, t!#api apat i(!#ikan &!&%ai !n"an "an""%an %n"&ional $an" aa. /!n""%naan p#okin!tik &!p!#ti m!toklop#ami, omp!#ion, ci&ap#i, itop#ianla itop #ianlain& in&!(a"ai !(a"ain$aapatm!m(!#ikanp!#( n$aapatm!m(!#ikanp!#(aikan" aikan"!)a !)alapaa(!( lapaa(!( !#apa pa&i!n !n"an i&p!p&ia %n"&ional. Ha Hall ini t!#kait !n"an p!# p!#lam lam(at (atan an p!n"o p! n"o&on &on "an lam(%n" &!(a"ai &alah &at% &at% patoi&iolo"i patoi&iolo"i i&p!p&ia %n"&ional. !a&paaan ha#%& it!#apkan pa paa a p! p!n" n""%n "%n aa aan n ci&ap#i ol!h ka#!na pot!n&i pot! n&i komplika&i ka#iova&k%la#.11 'ata p! p!n" n""%n "%n aa aan n o(at-o(atan anti!p#!&an ata% an&iolitik an&iolitik pa paa a pa&i!n !n"an i&p!p&ia %n"&ional ma&ih t!#(ata&. 'alam &!(%ah &t%i i !pan" (a#%-(a#% (a#% -(a#% ini m!n%n)%kkan p!#(aik p!#(aikan an "!)ala $an" &i"niikan pa paa a 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, v!nlaaxin, p! p!n" n"ha ham( m(at at am(ilan &!#otonin a an n no#!pin!##in tiak m!n%n)%kkan ha&il $an" l!(ih l!(ih (aik (aik i(anin" i(anin" pla&!(o. A
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
an""%an p&iko p&ikolo"i&, lo"i&, "an""%an ti%#, a an n &!n&itivita& #!&!pto# &!#otonin &!nt#al m%n"kin m!#%pakan akto# akto# p!n p!ntin tin" " alam #!&pon t!#haap t!#api anti!p#!&an pa paa a pa&i!n i&p!p&ia %n"&ional.A
0I.2. ,ata laksana dispepsia dengan infeksi Hp' #aika&i Hp mamp% m!m(!#ikan k!&!m(%han )an"ka pan) pan)an" an" t!#haap "!)ala i&p!p&ia. 'alam &alah &at% &t%i cross-sectional pa paa a 21 pa&i!n i ?%mah Sakit :ipto an"%nk%&%mo, aka#ta 2010 iapatkan (ah (ahaa t!#api !#aika&i m!m(!#ikan p!#(aik p!#(aikan an "!)ala pa paa a ma$o#ita& pa&i!n i&p!p&ia !n"an p!# p!#&!nt &!nta&! a&! p!#(aik p!#(aikan an "!)ala &!(!&a# 76D a an n 81D p! p!n! n!m% m%an an Hp n!"ati $an" ip!#ik&a !n"an
21
@B.
/!n!litian p#o&p!kti /!n!litian p#o&p!kti ol!h ol!h S$am , kk kk tah%n tah%n 2010 m!n%n)%kkan (ah (ahaa t!#api !#aika&i Hp !n"an triple terapy #a(!p#a>ol!, amok&i&ilin, a an n kla#it#omi&in &!lama 7 ha#i l!(ih l!(ih (aik (aik a#i a#i t!#api &!lama A ha#i.
22
9
e
(at 'o&i& '%#a&i ini /!#tama< //IG 2x1 7-14 ha#i mok&i&ilin 1000 m" 2x1 la#it#omi&in A00 m" 2x1 'i a!#ah $an" ik!tah%i #!&i&t!n&i kla#it#omi&in 20D< //IG 2x1 7-14 ha#i Bi&m%t &%(&ali&ilat 2 x 2 ta(l!t !t#onia>ol! A00 m" 3x1 !t#a&iklin 2A0 m" 4x1 ika (i&m ika (i&m%t %t tiak tiak aa< aa< //IG 2x1 7-14 ha#i mok&i&ilin 1000 m" 2x1 la#it#omi&in A00 m" 2x1 !t#onia>ol! A00 m" 3x1 ini !%a< olon"an o(at ini ipakai (ila "a"al !n"an #!)im!n $an" m!n"an%n" kla#it#omi&in //IG 2x1 7-14 ha#i Bi&m%t &%(&ali&ilat 2 x 2 ta(l!t !t#onia>ol! A00 m" 3x1 !t#a&ikilin 2A0 m" 4x1 //IG 2x1 7-14 ha#i mok&i&ilin 1000 m" 2x1 !volok&a&in A00 m" 2x1 ini k!ti"a< ika "a"al !n"an #!)im!n lini k!%a. la m!m%n kinka kinkan, n, ilihan it!nt%kan (!#a&a (!#a&a#kan #kan % i #!&i&t!n&i anC //IG 2x1 7-14 ha#i mok&i&ilin 1000 m" 2x1 !volok&a&in A00 m" 2x1 ?ia(%tin
10 on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i H
licobacter py pylo lori ri
m",om!p#a>ol! 20 m", m", panto pantop#a> p#a>ol! ol! 40 m", !&om!p#a>ol! 40 m". :atatan < !#api &!k%!n&ial apat i(!#ikan &!(a"ai lini lini p!# p!#tam tamaa apa(ila tiak aaa ata #!&i&t!n&i kla#it#omi&in < //I + amoxicillin &!lama A ha#i iik%ti // a //II + kla#it#omi&in a an n nit#oimia>ol! ,abel tinia>ol! &!lama A ha#i. '. %egimen ,erapi Eradikasi Hp14 23
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
/aa a!#ah !n"an #!&i&t!n&i kla#it#omi&in tin""i, i&a#ankan %nt%k m!lak%kan k%lt%# a an n t!& #!&i&t!n&i m!lal%i &!l !no&kopi &!(!l%m m!m(!#ikan t!#api. !& mol!k%la# )%"a )%"a apat ilak%kan %nt%k %nt%k m!n!t!k&i m!n!t!k&i Hp an a n #!&i&t!n&i kla#it#omi&in anCata% l%o#ok%inolon &!ca#a lan"&%n" m!lal%i (iop&i lam(%n". S!t!lah p!m p!m(!#i (!#ian an t!#api !#aika&i, maka p!m!#ik& p!m!#ik&aan aan koni#ma&i ha#%& ilak%kan !n"an m!n""%nakan
@B
ata% H. py pylo lori ri stool antigen monoclonal
test . /!m!#ik&aan apat ilak%kan alam akt% palin" tiak tiak 4 4 min""% &!t!lah akhi# a#i t!#api $an" i(!#ikan. @nt%k HpS, a aaa k!m%n"kinan ha&il %alse
positive.
G//I $an" i"%nakan anta#a lain #a(!p#a>ol! 20 m", lan&op#a>ol! 30
11
12
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
0II. 4ampiran 4ampiran . lgoritme ,ata 4aksana Dispepsia di -erbagai ,ingkat 4a#anan Kese!atan3 'i&p!p&ia (!l%m 'i&p!p&ia (!l%m iinv!&ti"a&i &!lama 3 (%lan ata% l!(ih /, anamn!&i&, &in"ki#kan p!n$!(a( i&p!p&ia o#"anik, mi&. o(at-o(atan iak
ana (aha$a ana (aha$a
!#api !mpi#i&
Fa
?%)%k ?%)%k no&kopi S:B !pi"a&t#i%m
an)%tkan ?a&a p!n%h ?a&a p!n%h &!t!lah makan, t!#api
?!&pon& &!t!lah iak
2 min""%
Fa
!m%an m!n)!la&kan "!)ala pa(ila aa inika&i< inika&i< pa#a&it pa#a&it an a#ah &ama# tin)a, &ama# tin)a, kimia a#ah, anCata% p!ncit#aan a(om!n
Ha&il 'i&p!p&ia o#"anik
'i&p!p&ia %n"&ional
p!m!#ik&aan m!n)!la&kan "!)ala
//-1 //-2-3
Gana (aha$a< p!n p!n%#% %#%na nan n (!# (!#at at (a (aa an n unintended, i&a"ia p#o" p#o"#!&i #!&i,, m%ntah #!k%#!nCp!#&i&t!n, p!# p!#a#a a#ahan han &al%#an c!#na, an!mia, !mam, ma&&a a!#ah a(om!n (a"ia (a"ian n ata&, #ia$at k!l%a#"a kank!# lam(%n", i&p!p&ia aitan (a#% aitan (a#% pa paa a pa&i!n 4A tah%n. /< p!m!#ik& p!m!#ik&aan aan i&ik, S:B< &al%#an c!#na (a"ia (a"ian n ata&, //-1< /!m(!#i /!la$anan !&!hatan in"kat /!#tama, //-2-3< /!m(!#i /!la$anan !&!hatan in"kat !%a a an n !ti"a.
pylori ri on&!n&%& Na&io on&!n&%& Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
4ampiran '. lgoritme ,ata 4aksana Dispepsia "ungsional3
13
'i&p!p&ia %n"&ional
oi ka&i i!t
!)ala p#!ominan
N$!#iC#a&a N$!# iC#a&a t!#(aka# paa paa c!pat k!n$an", k!m(%n", m%al, m%ntah, (!#&!naa m%ntah, (!#&!naa //II !n"an ata% tanpa // p#okin!tik p#okin! tik Sitop#ot!kto# //I-do$n regulation
?!&pon& &!t!lah 4 ata% 8 min""%
/#okin!tik !n"an ata% /#okin!tik !n"an tanpa // //II
iak
iak K :o(a anti!p#!&an ata% an&iolitik K :o(a t!#api h!#(al
?!&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
prot oton on-p -pum ump p inibitor. //I< pr
14
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
4ampiran 2. lgoritme ,ata 4aksana Eradikasi Infeksi Hp3
/o&iti t!& /o&iti t!& H.pylori
ini p!#tama ini p!#tama
ini k!%a
ini k!ti"a
'a!#ah #!&i&t!n&i kla#it#omi&in #!nah
'a!#ah #!&i&t!n&i kla#it#omi&in tin""i
//I-kla#it#omi&in-
Bi&m%t &uadruple,
amok&i&ilinCm!t#onia>ol ata% (i&m%t ata% (i&m%t &uadruple
(ila tak tak t!#&!ia< t!#&!ia< &uadruple non-(i&m%t
Bi&m%t &uadruple ata% //Il!vo ok&a&in-amok&i&ilin
//Il!vo ok&a&in-amok&i&ilin
S!&%ai !n"an k%lt%# an t!& #!&i&#!n&i
pylori ri on&!n&%& Na&io Na&ional nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
Daftar Pustaka 1. 2. 3. 4. A. 6. 7. 8.
9. 10. 11. 11. 12. 13.
o# :, oa$$!i /. '$&p!p&ia. :%## pin a&t#o!nt!#ol. 2013E29<662-8. Saa , :ho%ha#$ , B!chtol . !ct o H!lico(act!# H!lico(act!# p$ p$lo#i lo#i t#!atm!nt on "a&t#o!&opha"!al #!l%x i&!a&! ?'< m!ta-anal$&i& o o #anomi>! #anomi>! cont#oll! t#ial&. Scan a&t#o!nt!#ol 2012E47<129-3A. an" :,F! , i%5, /an ;B, Lian , Mhan" ;. #aication o o H!lico(act!# H!lico(act!# p$l p$lo#i o#i in!ction #!%c!& th! inci!nc! o p!ptic p!ptic %lc!# i&!a&! in in pati!nt& pati!nt& %&in" non&t!#oial anti-inlammato#$ #%"&< a m!ta-anal$&i&. H!lico(act!# 2012E17<286-96. !!!FF, :h%a S. Inv!&ti"atin" %nctional $&p!p&ia in &ia. N!%#o"a&t#o ! N!%#o"a&t#o!nt!#ol !nt!#ol otil 2012E18<239-4A. ia H, ho&hal @:, onlachanvit S, !t al. &ian con&!n&%& #!po#t on %nctional $&p!p&ia. N!%#o"a&t#o!n N!%#o"a&t#o!nt!#ol t!#ol otil 2012E18<1A0-68. S$am 42, (%llah , ?ani , !t al. val%ation o o th! th! %&! o o #api #api %#!a&! t!&t< /#onto '# '#$ $ to !t!ct H p$l p$lo#i o#i in in pati!nt& pati!nt& ith $&p!p&ia in &!v!#al citi!& in Inon!&ia. 5o#l a&t#o!nt!#ol 2006E12<6216-8. ?ani , a%>i . In!k&i H!lico(act!# H!lico(act!# p$l p$lo#i o#i an p!n$akit "a&t#o-%o!nal. In In<< S%o$o 45, S!t$ohai B, li I, Simai(#ata , S!tiati S, !&. B%k% )a# Ilm% /!n$akit 'alam. aka#ta< /%&at /!n!#(itan Ilm% /!n$akit 'alam @IE 2006<331-6. Hia$ati /S /S,, I&an ((a& ((a& N%& N%&ii I, aim%nah @. H%(%n"an S!#opo&itivita& :a" H.p$lo#i !n"an '!#a)at !pa#ahan a&t#iti& paa /a&i!n 'i&p!p&ia. 'ivi&i a&t#o!nt!#oh!patolo"i '!pa#t!m!n Ilm% /!n$akit 'alam 2 @NI? ?S@ '# So!tomo S%#a(a$aE 2013. @np%(li&h! man%&c#ipt. %mlah ata H!lico(act!# H!lico(act!# p$lo p$lo#i #i po& po&iti iti.. ?S@' '# '# o!a#i o!a#i S%#aka#taE 2008. @np%(li&h! #a ata. /a#!an"i . %mlah ata H!lico(act!# p$l p$lo#i o#i po&iti i aka&&a#. aka&&a#< ?S@/ # #.. 5ahiin S%i#oh%&ooE 2011. @np%(li&h! #a ata. %ta"ami S, Shimp%k% ,FinF, !t al. /athoph$&iolo"$ o o %nctional %nctional $&p!p&ia. Nippon ! Sch 2011E78<280-A. :ho%n" ?S, all!$ all!$ N N. . Nov Nov!l !l m!chani&m& in %nctional $&p!p&ia. 5o#l a&t#o!nt!#ol 2006E12<673-7. Ha#mon ?: /!%#a ' val%ation an mana"!m!nt o o $&p!p&ia. $&p!p&ia. h!#ap v v a&t#o!nt!#ol 2010E3<87-98.
1A
14. H%nt ?H, ;iao S', !"#a% , !t al. H!lico(act!# H!lico(act!# p$l p$lo#i o#i in !v!lopin" co%nt#i!&. 5o#l a&t#o!nt!#olo"$ #"ani&ation lo(al %i!lin!. a&t#oint!&tin iv!# iv!# 'i 'i&& 2011E20<299-304. 1A. lt&ch%l!# S, /!%#a '. H!lico(act!# p$lo p$lo#i #i an p!ptic %lc!# i&!a&!. In In<< cNall$ /?, !. ICiv!# S!c#!t& /l%&. 4th !. /hila!lphia, /a /a<< l&!vi!# l&!vi!# o&($E o&($E 2010ol! an #anitiin! a!ct th! acc%#ac$ o o th! th! 14:-%#!a (#!ath t!&t t!&t ($ ($ a pH !p!n!nt m!chani&m. m a&t#o!nt!#ol. 1997E92<446-4A0. 17. N"%$ 17. N"%$!n !n B. o #api #api %#in! t!&t o# o# th! th! !t!ction o o H!lico(act!# H!lico(act!# p$lo p$lo#i #i in!ction in th! B.,, @chia , &%kamoto F, !t al. val%ation o *i!tnam!&! pop%lation. *i!tnam!&! pop%lation. 'i" 'i 'i&& Sc Scii 2010EAA<89-93. 18. !oolt!# , *ai#a ', Ba>>oli , !t al. %#op!an m%ltic!nt#! valiation t#ial o o to to n! non-inva&iv! t!&t& o# o# th! th! !t!ction o H!lico(act!# p$lo H!lico(act!# p$lo#i #i anti(oi!&< %#in!-(a&! 3BIS4 an #api %#in! t!&t. lim!nt /ha#macol h!# 2003E18<927-31. 19. '!mi#a$ %#(%> , on!n :, B!km!n N N,, !t al. h! ia"no&tic acc%#ac$ o %#in! I" I" anti(o$ t!&t& o# th! !t!ction o H!lico(act!# p$lo H!lico(act!# p$lo#i #i in!ction in %#ki&h $&p!ptic $&p!ptic pati!nt&. pati!nt&. %#k a&t#o!nt!#ol 2012E23<7A3-8. 20. al!#th!in!# /, !"#a% , Oo#ain :, !t al. ana"!m!nt o H!lico(act!# H!lico(act!# p$lo p$lo#i #i in!ction--th! aa&t#icht I*C lo#!nc! :on&!n&%& ?!po#t. %t 2012E61<646-64. 21. @tia , S$am 42, Simai(#ata , S!tiati S, anan :. :linical !val%ation o o $&p!p&ia $&p!p&ia in pati!nt& ith %nctional $&p!p&ia, ith th! hi&to#$ o H!lico(act!# H!lico(act!# p$ p$lo#i lo#i !#aication th!#ap$ in :ipto an"%nk%&%mo Ho&pital, aka#ta. cta ! Inon!& 2010E42<86-93. 22. S$am 42, (%llah , ?ani , !t al. 4 compa#i&on o o A A o# o# 7 7 a$& o o #a(!p#a>ol! #a(!p#a>ol! t#ipl! th!#ap$ o# o# !#aication !#aication o o H!lico(act!# H!lico(act!# p$lo#i. p$l o#i. ! Inon!& 2010<113-7. 23. :h!$ 5', 5on" B:, /#actic! /a#am!t!#& :ommitt!! o th! m!#ican :oll!"! o . m!#ican :oll!"! o a&t#o!nt!#olo"$ "%i!lin! on th! mana"!m!nt o o H!lico(act!# H!lico(act!# p$ p$lo#i lo#i in!ction. m a&t#o!nt!#ol 2007E102<1808-2A.
16
pylori ri on&!n&%& Na&ional on&!n&%& Na&io nal /!natalak&anaan 'i&p!p&ia an In!k&i Helicobacter pylo
Terima Kasih Kepada:
13
CO2 breath analyzer
