Analyzes and methods of survey for diagnosing gastritis. Instrumental methods for study of chronic gastritis Beneficial methods for studying the secretory function of the stomach

- an unpleasant disease that requires careful diagnosis. The diagnosis of chronic gastritis makes it possible to identify the disease and correctly determine the degree of the disease. There are several different diagnostic methods.

Fisical - The easiest method of examination, which can be held in the doctor's office. It consists in obtaining information from a patient about the history of his life and disease, visual inspection of the skin, language, eye, feeling, climbing and listening to the whole abdomen.

Clinical laboratory research (determining the main indicators) of blood, urine, feces:

Additional research methods

Immunological examination of blood:

Receives chronic type A gastritis (autoimmune). In the blood, they are found characteristic of the autoantile age characteristics for this disease, parietal cells, sometimes to vitamin B12.
At the beginning of inflammatory processes in the stomach, a significant amount of pepsinogen appears - proferred pepsin in the blood. In atrophic processes in the gastric mucosa (), these indicators decrease sharply.

Histological and cytological examination of the gastrobioptate.

The chronic gastritis is confirmed and its cause is the chelicobacter pylori, the degree of its severity is determined.

Tool methods

Diagnostics of Bacteria Helicobacterpylori in the stomach

Helicobacterpylori is the main cause of chronic gastritis

Cytological storing mucous meal stomach. Determines the presence of Helicobacter.
Histological study of biopsy material. The presence of specific antibodies in serum confirms Helicobacter.
Ureazy respiratory standard test. In exhaled air, the patient is determined by ureaz bacteria, which confirms their presence. It is directed not only to the diagnosis of the disease, but also to the correction of treatment.
Urease express test. A special substance applied to the bioptat of the gastric mucosa changes its painting under the action of urease Helicobacter.
Bacteriological research method. On the crops of the bopotate of the stomach, bacteria isolated.
The immunohistochemical method is based on the effects of special antibodies on the Helicobacter when applied to the biopsy material. At the same time, the color changes only by bacteria. Perform in case of resumption of the disease after treatment.
Molecular biological method. Finding DNA bacteria in a bioptach of the stomach with the help of a special enzyme.

Specific types of surveys are appointed by a gastroenterologist to determine the exact diagnosis and purpose of proper treatment.

Currently, in world medicine, chronic gastritis "chronic gastritis" practically abandoned the clinical diagnosis. Under this name, only structural changes in the gastric mucosa, observed under the microscope and in patients, and in healthy people, usually caused by the effect of helicobacter infection, are now understood. And although in the ICD-10, chronic gastritis is still highlighted into a separate disease and has code K29, its diagnosis does not give the basis of the doctor to prescribe to any patient with external signs of illness, but without complaints.

Currently, in the presence of the patient, they are appropriate to say about the presence of a functional dyspepsia; If there is a gastric ulcer, pancreatitis, bile reflux and other diseases, is already talking about organic dyspepsia. Modern drug reception schemes are oriented primarily on the removal of heartburn, pain, nausea, and not to eliminate microscopic signs of inflammation of the stomach.

It would seem why to diagnose "chronic gastritis", since it is only morphological and does not affect the treatment of pain in the stomach? It turned out that the diagnosis of the disease is very important for identifying precancerous states.

Changes in the stomach wall

The cascade of morphological changes in the mucous membrane of the stomach begins with the population of the bacterium Helicobacter pylori or with the action of another, the surface pathological process is developing, which gradually progresses. In 1 - 3% of patients during the year, atrophy processes begins, that is, the elimination of the cells of the stomach mucosa. They are replaced by cells resembling intestinal epithelium - intestinal metaplasia develops, and then epithelium dysplasia. This state is already predrate.

Of the hundreds of patients with an infectious disease of the disease, the epithelium dysplasia will arise in 10, and 1 - 2 people will develop a gastric cancer. Up to 90% of all cases of this malignant tumor are associated with changes in the gastric mucosa, which have arisen under the infection. Eradication (destruction) Helicobacter makes it possible to stop or even reverse the processes of atrophy and dysplasia and thereby prevent cancer. That is why morphological confirmation of the diagnosis of "chronic gastritis" is so important.

At the same time, we note that the severity of symptoms of the disease does not depend on the state of the stomach wall. Therefore, it is the diagnosis of "functional dyspepsia" with an indication of the complaint option helps to correctly choose the necessary medicines. Quite often, one person has both of these states, different in nature and methods of treatment.

Stages of gastritis diagnostics

First of all, the diagnosis is specified by the type of disease (neatrophic, atrophic autoimmune, atrophic multifocal or special forms of the disease - chemical, radiation, lymphocytic, granulomatous, eosinophilic, other infectious or giant hypertrophic). The type of disease mainly depends on its cause.

The second stage in diagnosis is determining the endoscopic characteristics of the disease. Distinguish such types of pathological process:

surface;
with flat or raised erosions (superficial damage to the mucous membrane);
hemorrhagic (with bleeding);
hyperplastic (with the thickening of the plots of mucous);
reflux-gastritis with the cast of the contents of the 12-rosewoman in the stomach.

The diagnosis of the atrophic option is complemented by the definition of the atrophy of the OLGA system. This classification is based on histological assessment, that is, the study of the tissues obtained during FGDS under the microscope.

Laboratory diagnostics of chronic gastritis

After evaluating the patient's complaints and anamnesis, some laboratory tests are appointed. Mandatory of them is only one - a rapid urease test of the biopsy material of the gastric mucosa. When FGDS take a piece of fabric, then it is placed in a special solution of reagents and determine the color change, whether in the material Helicobacter pylori or not.

A similar diagnosis of gastritis without gastroscopy is possible - the analysis in the exhaled air products of the activity of Helicobacter (respiratory urease test).

Respiratory Urease Test

Additional methods of diagnosing chronic gastritis, depending on its shape and related diseases:

Gastritis diagnostic instrumental methods

The main method of diagnosing chronic gastritis - fibrogastroduodenoscopy (FGDS) with biopsy and subsequent histological and cytological studies of the material obtained under the microscope.

With an external examination, the doctor can distinguish the main signs that allow the differential diagnosis of infectious and atrophically autoimmune gastritis, as well as a peptic disease:

redness and hemorrhage in the mucous membrane - a sign of surface anthral inflammation;
pallor, thinning, translucent vessels - the diagnostic sign of the atrophic process.

In a microscopic study for anthral surface gastritis, inflammatory infiltration is characterized by inflammatory infiltration (impregnation of blood cells), and for atrophic - intestinal metaplasia with gastric iron atrophy.

Additionally, it can be assigned:

study of the acidity of gastric juice, or intragastric PH-metry with severe atrophic lesion;
x-ray study of the stomach with barium - with refusal or contraindications to FGDS, as well as during stenosis (narrowing) of the gatekeeper (pylorostenosis).

In a multifocal atrophic version of the disease, a counseling of an oncologist is needed, with anemia - hematologist, with neurological symptoms of vitamin B12 deficiency (paresthesia, sensitivity impairment and others) - inspection of the neurologist.

Differential diagnosis of different forms of gastritis

To accurately determine the form of the disease, the patient's complaints are used, external signs and additional diagnostics data.

Chronic anthral gastritis associated with Helicobacter Pylori infection

Symptoms:

heartburn;
pain on an empty stomach;
stool violations.

For patients, food is characterized by eating food, inserts, the predominance of acute, fried, smoked food, carbonated drinks, as well as the presence of gastritis or ulcers in the family. There is a slight bloating of the abdomen and weak soreness in its upper part. Blood tests normally.

At FGDS, signs of inflammation are determined with the defeat mainly the anthral department, the urease test is positive.

Chronic Atrophic Multifocal Gastritis

The symptoms associated with dismisions of food are dominated: diarrhea, weight loss, nausea, sometimes vomiting. It is characteristic of irritability, the tendency to consider itself very sick, fear of cancer, sweating, weakness, heartbeat. When the abdomen is tested in his upper part, moderate, but rather large soreness in the area is determined. The type of language is changing: it is either covered with a thick white bloom, or becomes shiny and smooth, as if lacquered.

General and biochemical blood tests remain unchanged. The amount of pepsinogen I is reduced in the blood.

With FGDS, a common pathological process is detected, affecting not only the antral part, but also the body of the stomach. With intragastric acidity measurement, a reduced amount of hydrochloric acid (hypo-or ahlorohydria, the fact that earlier was called "reduced acidity") was found. Urease test is usually positive. With a microscopic study of the bioptate, signs of intestinal metaplasia, atrophy, colonization of the Helicobacter are visible.

Chronic autoimmune atrophic gastritis

The main part of the complaints is associated with the disease that arises in this form of a deficiency of the Castle factor - substance that ensures the absorption of vitamin B12. As a result, signs of appropriate hypovitaminosis appear:

weakness, shortness of breath, heartbeat;
burning language;
loss of appetite, weight loss;
constant diarrhea;
numbness and weakness in the limbs;
irritability and heavier psyche disorders, right up to dementia.

The patient often enlarged the liver. In the analyzes are noted:

macrocytic hyperchromic anemia;
increasing indirect bilirubin;
antibodies to parietal cells;
reducing the level of pepsinogen I;
increase the level of gastrin.

At FGDS, the atrophy of the wall of the stomach is determined, its polyps. With microscopy, the combination of inflammation, intestinal metaplasia, lack of parietal cells is noticeable. The acidity of the gastric juice is reduced. Urease test is usually negative. When ultrasound, there is an increase in liver, less often spleen.

Differential diagnosis of antral gastritis

The diagnosis of hyperacid, erosive and other forms of surface gastritis should be carried out taking into account the fact that similar symptoms are observed with some common diseases of the gastrointestinal tract. We present the main differential diagnostic signs of these diseases in the table.

Antral gastritis

Functional dyspepsia

Prank ulcer

Chronic pancreatitis

Characteristics of pain

Brief pain, usually on an empty stomach, after eating often heartburn

Symptoms are similar to the signs of antral gastritis, less often peptic ulcer

Pain above navel, night, "hungry"

Walking pains, mainly on the left and in the area of \u200b\u200bthe belt

Additional diagnostics

FGDS - signs of inflammation

Positive Urease Test in Most Patients

FGDS without pathological changes

On FGDS - ulcerative defect on the wall of the stomach

FGDS without pathology, the main changes are noted under the ultrasound of the pancreas.

Differential diagnosis of atrophic gastritis

The diagnosis of hypoacid gastritis is also carried out taking into account other possible diseases, but their list of the other than with antral destruction.

	Multifocal option	An autoimmune version	Prank ulcer	Stomach cancer
Basic symptoms	Nausea, belching, gravity in the stomach, pain are uncharacteristic	There are signs of anemia (weakness, dizziness, shortness of breath) and a sensitivity disturbance ("crawling of goosebumps" in the field of lower extremities	Nausea, vomiting, heartburn, pour on an empty stomach and an hour after eating, weight loss, lack of appetite	Nausea, vomiting, weakness; pain noncharacterne; disgust for food, especially for meat, sharp weight loss to exhaustion
Additional diagnostics	FGDS: Signs of atrophy of the mucous membrane, urease test negative, increased levels of gastroin in the blood, reduced the level of pepsinogen - I	Signs of blood anemia (decrease in the amount of hemoglobin and erythrocytes, macrocytosis), a decrease in the number of platelets and leukocytes, an increase in the indirect bilirubin, alkaline phosphatase and LDH in blood biochemistry; In the study of acidity - its pronounced decline	FGDS: signs of a peptic defect. Positive reaction to hidden blood in feces. In the blood - signs of iron deficiency anemia. In the study of acidity, it is normal or moderately reduced	In the blood signs of hypochromic anemia, the ESP increases. A tumor is found on FGDS. Positive reaction to hidden blood in feces. Acidity is significantly reduced.

Video "Independent diagnosis of chronic gastritis"

Acute or chronic inflammation of the gastric mucosa, called gastritis, is found more than half of the entire population: men, women, children and the elderly. Approximately 80-85% of all diseases of the gastrointestinal tract are accounted for by this disease.

At the same time, only 12-15% of those who have gastritis moved into a chronic shape to the doctor. Interestingly, one of the factors that strengthen the patient's fears before medical intervention in its body is the long and sufficiently unpleasant diagnosis of gastritis, in particular, frightening all the procedure of fibrogastodenoscopy.

Patient survey plan

The patient's examination program with suspicion of gastritis includes the following procedures:

visual inspection;
collection of anamnesis;
cala and verification tests for blood;
common urine and blood tests;
Tank: study on bilirubin, protein and protein fractions, alkaline phosphatase, transaminase, aldolase;
checking the secretory gastrointestinal function: basal and artificially stimulated by the preparations of a row of gastrin, or histamine;
FEGDS (fibrogastroduodenoscopy) with the selection of the biopultic of the gastric sheath;
cytological and histological examination of biopsy
x-ray (if the medical prescriptions need to do without gastroscopy);
check for Helicobacter.

Subjective symptoms of gastritis

Symptoms of the disease varies depending on the stage. In the light stage, the disease is most often localized in the antral stomach department. Symptoms are similar to ulcers:

morning headaches;
pain in the epigastric department after a half - two hours after meals;
sour belching;
normal appetite;
periodic constipation.

In the late stage of helicobacteria, it is harder to identify: they are not so pronounced, and not in such a number as at an early stage of the disease. Symptomatics is mainly associated with secretory failure:

nausea and bad appetite;
the taste of metal and dryness in the oral cavity;
frequent janctures by air or food with a shade of rotten smell;
non-intensive stomach pain after meals;
bloating;
frequent and liquid diarrhea;
the feeling of the overflow of the stomach even after moderate absorption of food.

In the launched stage of gastritis, inflammation is distributed from the anthral stomach department to all other departments, atrophic processes in the mucous membrane begin.

Objective patient survey data

Diagnosis and treatment of gastritis at an early stage depends on the thoroughness of the initial examination of the patient. The doctor can identify the following symptoms in the patient:

language is a bit covered by the root;
epigastric pain (most often on the left);
the normal location of the lower boundary of the stomach: above the navel by 4 cm (determined by the methods of palpation).

Late stage is characteristic of the following symptoms:

language is very covered;
cracks in the corners of the mouth;
a small pain "under the spoon";
abnormal location of the lower border of the stomach: below or at the level with navel;
flatulence;
rATION in palpation of colon;
a slight weight loss (than the launched stage of the disease, the more intensely reset the weight).

Instrumental examination

Instrumental examination involves the use of special medical equipment, most often it applies to chronic patients.

The most effective methods of diagnosing chronic gastritis:

FGDS and subsequent cytological, histological and microbiological study of biopsyat;
ureazu test (text on the pH of the gastric medium);
non-invasive methods: an immunoferment blood test, the determination of the acidity of the gastric medium with the help of "acidotest";
respiratory test.

FGDS is carried out using a flexible small diameter probe equipped with a video camera from the opposite end. The probe is introduced through the oral cavity and the esophagus directly in the stomach. To illuminate the internal cavities, there is a backlight next to the camcorder. All data on inflammation foci, places of lesion of mucous membranes are transmitted to the monitor, where the doctor is observed for them.

The main plus FGD method - it helps cut off the version of the ulcer of the stomach immediately and put the correct diagnosis.

Bioptate research obtained at FGDS

The most important laboratory studies of the bioptate:

cytology,
diagnostic Test on Uraase,
microbiological research
histological method.

For cytological research, the bio-optics of the bioptate of the mucous membrane of the anthral department, seized from the most empty areas (strokes are not taken from erosive sites). After the smears are dried, they are painted, after which helicobacteria is visible under the microscope.

A test on the pH of the gastric medium (ureazu test) will also be negotiated using local bioptate staining. Helicobacter Pilori highlights ureaz - enzyme, under the influence of which the urea, which was in the stomach, decomposes and distinguishes ammonium. Ammonium greatly increases the pH of the stomach environment, which is visible to change the color.

Microbiological research takes longer. Sowing for analysis is taken from the bioptate of the mucous membrane, then placed in the nutrient for the reproduction of the Helicobacteria medium, and is left for 3-4 days. After this time, there are whole colonies of bacteria Helicobacter on the crop, and the doctor remains to identify them.

Histological analysis of the biopsy is made approximately the same as cytology. From biopsytte, thin layers are cut into the foci of inflammation, thin layers are painted with eosin and hematoxylin. After staining on the samples of the bioptate, helicobacteria appear.

Respiratory test

The respiratory urease test is carried out in order to identify Helicobacteria. It quickly multiplies, it takes good in the acidic stomach acid, and eats its walls. Once upon a time in the body, it for many years can provoke gastritis, ulcers and gastroduodenitis.

The respiratory test is a non-invasive alternative to biopsy analyzes, made up during FGDS.

The main object of the study is air blowable by the patient.

The method is based on the ability of Helicobacteria to produce enzymes that decompose urea to ammonia and carbon dioxide. To reveal their presence, the doctor offers the patient to make two air samples (the air blows into special tubes, the patient must breathe in them at least 2 minutes). After that, another sample is taken, this time the patient permits the urea solution over passing the test. The resulting samples are numbered and sent to the laboratory for further analysis.

The sensitivity of the respiratory test is up to 95%. Its use is justified for the primary diagnosis of helicobacter gastritis.

However, not to lubricate the results of the study, the patient must adhere to such rules:

2 weeks before the test, stop the reception of any antisecretory and antibacterial drugs;
testing exclusively on an empty stomach, preferably in the morning;
to the test thoroughly clean and rinse the oral cavity, paying special attention to the language;
on the eve of excluding legume products from diet, in no case to smoke and do not apply chewing gum;
1-2 days before the test, exclude the reception of analgesics.

Blood analysis

Blood research is one of the mandatory patient's procedures. Common biochemical analysis is made on the blood taken from the finger. This determines the quantitative ratio of different types of blood cells, changes in the ratio of leukocyte varieties, hemoglobin and EE levels.

In patients with gastritis, special changes are revealed both in common and immunological and biochemical analysis of blood tests.

Patient Fitting Analyzes: Cala and Urine

The laboratory analysis of the feces and urine of the patient is necessary in order to detect the violation of the fermentation responsible for digesting food, acid balance, and presence of foreign substances: starch, fatty acids, etc. In addition, samples of detergents are necessarily checked for blood.

The study of samples of feces helps to determine atrophic gastritis. In this case, a large amount of intracellular starch, digested fiber and muscle fibers is found in the sample.

The urine test is carried out primarily in order to eliminate renal diseases.

Chronic gastritis, which finally confirmed the diagnosis - an easily healing disease. The "ominous" procedures of FGDS and biopsy are not at all so painful as most patients represent them.

The main thing is to diagnose the disease as soon as possible in order to avoid the development of malignant processes and the transition of gastritis in a more dangerous disease - the stomach ulcer.