Chronic gastritis. Methods for diagnosing gastritis

Diagnosis of gastritis є a complex of different methods for the development of shlunks, which do not only appear to become ill, but first form, form and stage of development.

The standard scheme for the diagnosis of ailments includes:

• anamnesis;
• physical coverage;
• instrumental laboratory methods doslіdzhennya.

Anamnesis and physical condition

Diagnosis of gastritis, as a rule, is repaired from taking an anamnesis with further physical conditions.

Anamnesis of the information about:

• key manifestations of illness;
• minds of the life of the patient;
• yo recession;
• the manifestation of any kind of allergic reactions;
• transferred in the last operations and important ailments;
• injuries.

Physical security - the goal of looking at a patient from a patient:

• palpation (washing of the abdomen);
• percussion (vistukuvannya singing dilyanok black wastes);
• auscultation (hearing sounds appear in the pre-listening area).

instrumental methods

The managers of the young instrumental preliminaries will take away the most accurate and detailed information about the ignition process that has been introduced into the slurry. Prior to them, it should be mentioned:

• fіbrogastroduodenoskopіyu (Je visokoіnformativnim i Bezpieczne method dіagnostiki whether yakih zahvoryuvan shlunkovo-kishkovogo path; daє mozhlivіst detail rozglyanuti, vivchiti mill slizovoї Ilya Obolonkov i otrimati fotografіyu neobhіdnih dіlyanok doslіdzhuvanogo body; dopomagaє zdіysniti bіopsіyu vnutrіshnіh tkanin and takozh zabіr materіalu for viyavlennya in nyoma prisutnostі bakterії Helicobacter Pylori);
• Ultrasound scans of the shlunk (vvazhaєtsya to finish with a simple, informative and unhealthy way to diagnose small ailments, pathologies of internal organs);
• X-ray with contrasting speech (with diagnostics of gastritis, additional help to diagnose motor-evacuation disorders, and also to diagnose the presence of large serious sickness Shlunkovo-intestinal tract);
• intragastric pH-measurement (є the main diagnostic procedure at the indicated level of acidity in the slurry);
• probing (the whole method allows not only to accurately estimate the stan- dard of the mucous, but the last to see the shlunk secretion);
• thermography (highly informative lucky method diagnostics, which allow for additional restoration of the informational vipprominuvannya of specific preliminarily organs to evolve be-like destructions in their robots).

Analyzes for gastritis

Diagnostics of laboratory analyzes and preliminaries in diagnosing gastritis allow the most accurate type, form, characteristic features, And also the reason for the incriminating disease.

Laboratory methods include:

• zagalny analiz blood (with gastritis gastritis - leukocytosis and increased SHOE; with chronic - decreased level of erythrocytes and hemoglobin);
• zagalny analysis of the sech (detection of amilazi to indicate about pancreatitis);
• coprogram (for indirect assessment of acidity shlunk juiceі manifestation of burning in the herbal tract);
• analysis feces on the appearance of adherent blood in them (for the prevention of bleeding from the herbal tract);
• biochemical analysis of blood (an increase in the level of gastrin and a decrease in comparison with pepsinogen may indicate atrophic gastritis; a decrease in the level of blood and gamma globules from we will advise bilirubin is characteristic of autoimmune gastritis);
• immunologic level of blood count (value of antibodies to H. pylori in blood);
• histological and cytological preliminaries of the biopsy material taken at FGDS (preliminaries under the microscope of smears-edits, barbed using a special technique);
• tests for H. pylori (dichny test, detecting antigen in feces, PLR in biopsy, bacteriological dosage, serological method);
• viznennya acidity of the slurry juice (intraventricular ph-measurement, probe, or for an additional special capsule).

Features of the diagnosis of Helicobacter pylori

At the same time, type B gastritis is most often observed, with all the symptoms igniter get sick to diagnose Helicobacter pylori, it is violated in a general order. In the Danish hour of victorious work:

• invasive procedures;
• non-invasive methods of dosage.

The most sensitive, specific and reliable volodya invasive diagnostics. Vaughn is recommended for the first time on the presence of H. pylori. Vinyatki to become vagіtnі women, children and those, to whom the contraindications of the Danish method.

The most informative volodya of testing a combination of 2-3 methods of invasive and non-invasive diagnostics.

Invasive methods of performing fibrogastroduodenoscopy from biopsies. As a result, 5 gastrointestinal specimens were obtained from the older types of shlunks. Tsei material can be used for one of the following methods:

• histological dosage (vivchennia of barbed smears-preparations);
• quick ureazny test;
• bacteriological dosage (seeding on a special medium for detecting the growth of H. pylori and determining the sensitivity to antibiotics);
• molecular genetic predictions (carrying out PLR diagnostics for the detection of H. pylori in biopsy).

For the control of vilikuvannya, as well as in vipads, if fibrogastroduodenoscopy is not indicated or recommended, non-invasive methods should be used. To them are admitted:

• dichny test (urease dichny test of scaffolds on the basis of the value in carbon dioxide with a marked atom in carbon);
• detection of H. pylori antigen in feces;
• serological method (detection of antibodies to H. pylori in blood, detection of pepsinogen l, ll and gastrin-17).

Differential diagnosis

With gastritis, symptoms may appear that are characteristic of those who are sick of organs of the black empty, as well as for children Infectious diseases.

In order to detect the manifestation of this pathology, spiral on clever show and skargi for a particular patient, as well as to carry out a number of additional donations. Differential diagnosis of gastritis gastritis is violated with such ailments shlunkovo-intestinal tract:

• Hostry cholecystitis specific signs for ultrasonic inspection of organs of the worms);
• Gostry pancreatitis characteristic signs at ultrasonic inspection of a carriage empty);
• virazkov ailment of the slunk or 12-palate intestine (diagnosis is confirmed during fibrogastroscopy);
• abdominal form of myocardial infarction (ischemic changes in the electrocardiogram, adjustment of enzymes (lactate dehydrogenase, creatine phosphokinase and CF-fraction) in the blood analysis

Chronic gastritis differentiation from wiry ailmentі shlunk cancer, as well as shlunkovaya dyspepsia. The main method of preliminaries here is fibrogastroduodenoscopy with histological preliminaries of biopsy.

For the inclusion of infectious diseases, against dyspeptic syndrome (typhoid fever, yersiniosis), conduct blood and fecal analyzes on the basis of infectious diseases.

- inadvertently becoming ill, as the need for diagnostics. Diagnosis of chronic gastritis gives the possibility of detecting ailments and the correctness of the steps of ailment. A little bit of other diagnostic methods.

physical- the simplest method of conditioning, which can be carried out in the cabinet of the doctor. Win polyagu in the disclaimed information about the history of your life and sickness, the visual inspection of shkirny curvatures, moving, eyes, obmazuvanny, prostrated and heard in the ear.

Clinical laboratory reports(The value of the main indicators) blood, slaughter, feces:

Advanced methods

Immunologic blood count:

1. Viyavlyak chronic type A gastritis (autoimmune). In the blood, they are characteristic for this disease of autoantityl to astromucoprotein, parietal cells, inodi to vitamin B12.
2. On the cob of ignition processes in the shlunk, there is a quantity of pepsinogen - the proenzyme pepsin in the blood. With atrophic processes in the slime of the slurry (), the indicators change rapidly.

Gistologic and cytologic dosage of gastrointestinal specimens.

Chronic gastritis is suspected and the reason for this is Helicobacter pylori, and the steps of this turn begin.

instrumental methods

Diagnostics of Helicobacterpylori bacterium in the slunk

Helicobacterpylori є the main cause of chronic gastritis

• Cytological dosage of a smear of mucus slunk. The appearance of the helikobakter.
• Histological information about biopsies. The presence of specific antibodies in the blood of the Helicobacter is confirmed.
• Urease dichny standard test. In the case of a sick person, a urease bacterium begins to grow, so it is obvious. Directly not only on diagnostics of illnesses, but on the correction of illnesses.
• Ureazny express - test. Special speech, applied to the biopsy specimen of the mucous slurry, changes its storage for the preparation of Helicobacter urease.
• Bacteriological method of preschool education. Bacteria are seen on the biopsy sample of the slunk.
• Immunohistochemical method of inoculation on the injection of special antibodies on Helicobacter when applied to the biopsy material. At the same time, there is only one color in bacteria. Victory in case of renewal of ill health after the carried out treatment.
• Molecular biological method. Know the DNA of bacteria in the biopsy of the slunk for an additional special enzyme.

Concrete vidi of obsozhennya sign of a lykar - a gastroenterologist with the sign of an accurate diagnosis and sign of correct lykuvannya.

In this day, in modern medicine, it was practically considered as a clinical diagnosis of "chronic gastritis". At the same time, there are only structural changes in the mucous membrane of the slurry that can be tested with a microscope in ailments, and in healthy people, Call Wiklican for Helicobacter Infections. I would like in the ICD-10 chronic gastritis all the visions in the vicinity of the disease and the code K29, this diagnosis is not given to the doctor to recognize the liking, whether it’s like a patient with a sign of ailment, ale without scarg.

In the given hour, when the patient is evident, it is accepted to talk about the manifestation of a new functional dyspepsia; as well є slurry swelling, pancreatitis, gum reflux and indigestion, see also about organic dyspepsia. modern schemes receive drugs orintovani in front of the heat of the stove, pain, boredom, and not on the weakening of microscopic signs of burning the slunk.

Well, would you ever put the diagnosis "chronic gastritis", since it is only morphological and not infused into the treatment of pain in the slunk? Viyavilosya, so the diagnosis of ailments is even more important for the emergence of pre-malignant diseases.

Changes in the slurry station

cascade morphological changes in the mucous membrane of the slunk, it is necessary to repair for the colonization of the bacterium Helicobacter pylori, or because of the development of a superficial pathological process, which progressively progresses. In 1 - 3% of ailments, the processes of atrophy are repaired by the end of the disease, so that the clot of the mucous membrane of the shlunk is reduced. The stench is replaced by clitines, and if the intestinal food is fouled up - intestinal metaplasia develops, and then dysplasia of the food. Tsey stan is already є overcrowded.

Out of hundreds of ailments with an infectious form of ailment, dysplasia of epithelium in 10, and in 1 - 2 individuals, cancer of the slunk has developed. Up to 90% of all types of malignant poop are tied with the wines of a slime slurry, so that they are free from infection. Eradication (reduction) of the bacterium gives the possibility of zupiniti or to turn back the processes of atrophy and dysplasia and in this way to prevent cancer. It is so important for the morphological diagnosis of chronic gastritis.

It is immediately significant that the swelling of the symptoms of ailments does not linger in the form of the slunk. To that same diagnosis of "functional dyspepsia" due to the meaning of the scarg option, it is necessary to correctly adapt the requirements. Often, in the same people in the presence of the same people, I’ll get offended, because of my nature and ways of drinking.

Etapi diagnostics of gastritis

In the first place, when setting up a diagnosis, specify the type of ailment (non-atrophic, atrophic autoimmune, atrophic multifocal, or especially the form of ailments - chemically, radioactive, lymphocytic, granulomatous, eosynthetic) The type of disease is mainly due to the cause.

Another stage in the production of diagnostics is the determination of the endoscopic characteristics of the disease. The development of such a pathological process:

• superficial;
• with flat or raised erosions (superficial mucous membranes);
• hemorrhagic (with bleeding);
• hyperplastic (from slime doughs);
• reflux gastritis with a zakid in place of a 12-palate intestine into a slurry.

Diagnostics of an atrophic variant is complemented by the stage of atrophy according to the OLGA system. This classification is based on the histological assessment, which is to be taken into account in patients with FGDS of small tissue under a microscope.

Laboratory diagnostics of chronic gastritis

The assessment of the scarg and the patient's anamnesis is recognized as a laboratory analysis. Obov'yazkovoyu from them є only one - a quick urease test of the biopsy of the mucus slunk. With FGDS, take a piece of tissue, then help it in a special range of reagents and start according to the color, which is in the material of Helicobacter pylori.

It is possible to diagnose gastritis without gastroscopy - an analysis of a vidyhuvanny povіtri productsіvіdіyalnostі bacterії (dichal urease test).

Dichny urease test

Additional methods for diagnosing chronic gastritis in the presence of both form and subset of illness:

Instrumental methods of diagnostics of gastritis

The main method for diagnosing chronic gastritis is fibrogastroduodenoscopy (FGDS) with biopsies and advancing histological and cytological preliminaries of the rendered material under a microscope.

When you look around the car, you can develop basic signs that allow you to carry out differential diagnostics infectious and atrophic autoimmune gastritis, as well as acute ailments:

• pockery and hemorrhage in mucus - a sign of superficial antral inflamed;
• blіdіst, vitonchennya, how to enlighten the judgment - diagnostic signs of an atrophic process.

With microscopic dosage, for antral superficial gastritis, an inflammation of the inflammation is characteristic immune cells blood), and for the atrophic - intestinal metaplasia with atrophic shlunkovy zaloz.

Dodatkovo can be used for:

• dosage of acidity of slurry juice, or intragastric pH-measurement in case of important atrophic lesions;
• roentgenologic dosage of the shlunka z barієm - with an indication or a contraindication to FGDS, as well as with stenosis (stenosis) of the collar (pylorostenosis).

In case of multifocal atrophic variant of ailment, consultation of an oncologist is required, in case of anemia - a hematologist, in case of neurological symptoms, Vitamin B12 deficiency (paresthesia, impaired sensitivity and inspiration) - a neurologist's examination.

Differential diagnosis of different forms of gastritis

For an accurate visualization of the form of ailments, vicoristovuyt of ailments, signs and data of pre-diagnostic diagnostics.

Chronic antral gastritis, association with infection with Helicobacter pylori

symptoms:

• oven;
• b_l on the heart;
• ruinous style.

For ailments, it is characteristic to vzhivanya dry, quick, food, smoked, smoked, gassy drinks, as well as the appearance in a number of cases of gastritis, for example. It is notable that there is little abdominal pain and slight ailment in the upper part of the body. Analysis of blood in the norm.

With FGDS, signs of inflammation of the lesions in the main antrum, the urease test are positive.

Chronic atrophic multifocal gastritis

Overwhelm the symptoms associated with the destructiveness of the ear: carry, decreased vagi, nudota, inodi bloating. Characterized by gratitude, smartness to respect ourselves even worse, fear of cancer, pithiness, weakness, heartache. At the same time, it’s a good stomach in its upper form, but it’s okay, but it’s a lot of sickness. Zmіnyutsya viglyad movi: win or curl up with thick bilim nalot, or become bland and smooth, like bi varnished.

Zagalny and biochemical analysis of blood is lost without change. In the blood, the number of pepsinogen I decreases.

With FGDS, a pathological process appears, which is not only the antral part, but only the slunk. With internal sludge acidity, the amount of hydrochloric acid appears to be reduced (hypo- or achlorhydria, then, earlier it was called "reduced acidity"). The urease test is positive. With microscopic pre-diagnosed biopsy, signs of intestinal metaplasia, atrophy, bacterial colonization are visible.

Chronic autoimmune atrophic gastritis

The main part of the scarg is associated with a deficiency of the Castle factor, which is caused by the deficiency of the Castle factor, which will prevent the acquisition of vitamin B12. As a result, there are signs of a hypovitaminosis:

• weakness, zadishka, sertsebittya;
• pechinnya movi;
• loss of appetite, reduction of vagi;
• carry it post-it;
• onimіnnya that weakness in pictures;
• drastic and important psyche, right up to bewilderment.

The patient has a bad stove. The analyzes mean:

• macrocytic hyperchromic anemia;
• build-up of indirect bilirubin;
• antibodies to parietal cells;
• lowering the level of pepsinogen I;
• zbіlshennya rіvnya gastrin.

With FGDS, atrophy of the shlunk wall, yogo polypy occurs. When microscopic microscopic appearance of heat, intestinal metaplasia, appearance of parietal cells. The acidity of the slurry juice is reduced. The urease test is negative. With ultrasound, an increase in the liver appears, before the spleen.

Differential diagnosis of antral gastritis

Diagnosis of hyperacid, erosive and other forms of superficial gastritis is to blame for urahuvannya of the fact that similar symptoms are spared in cases of widespread congestion of the intestinal tract. Guided by the main differential and diagnostic signs of cych ailments in the table.

Differential diagnosis of atrophic gastritis

Diagnosis of hypoacid gastritis can also be carried out with the help of you get sick, However, there is no change in antral lesions.

Video "Self-diagnosis of chronic gastritis"

The initial efficiency and correctness of the reverse scheme of treatment. Alleviated ailments are complicated by the similarity with other pathologies of the intestinal tract and the body as a whole. Therefore, in diagnostic purposes, a comprehensive approach is used to fix the patient's scarg and assessments right up to minimally invasive operations. Diagnostics zdіysnyuє behind the plan, hover below. Zastosovuvani methods of vikoristovytsya for the identification of pathology in children.

look around

The supportive gastroenterologist started collecting a family history of the sick and the history of the sickness. Tse allows you to find the reason for the sharpening or attack. Palpation of the slunk projection area should also be carried out. In case of gastritis, there will be zbіlshuvatisya in case of onslaught.

Physical insight is relevant in case of high quality corrosive flammability, as well as wine on the other side of chemistry. Through the great accounts of the company, the stravohode, when the acids are poured out, will cause erosion and necrosis near the company and empty. Bili scabs come out in the presence of hydrochloric acid, zhovtoy koloru- nitrogenous, black - sirchanoi, brown-gray - meadow. At the end of the stage it is necessary to take the following signs:

• zagalnaya weakening;
• stress m'yazovoy fabric abdomen;
• vividness of blues i zovnishniy viglyad blues wt.

Laboratory methods for the treatment of chronic gastritis

Dorosly patient for a child in the general order of the building of the headquarters and specific analyzes:

1. Test for blood counts. Gastritis can be diagnosed by the appearance of low hemoglobin, platelets, erythrocytes, leukocytes with advanced SHE.
2. Laboratory assessment of feces for the presence of adherent blood and helicobacteria. In a whole test, the value of acidity begins, as it can be the cause of filthy etching.
3. Zagalny test slash. Struggling for prevention and allowing for background ailments, the appearance of other infections.
4. Analysis for biochemistry. The method allows the differentiation of gastritis from the ailments of the pancreatic disease, and the presence of helikobacteria. In case of heliobacteriopathic infarction, the shelter will show the norm in terms of preliminaries. Iakshcho є autoimmune chronic gastritis, hypertension occurs, as a result of anemia on the presence of vitamin B12 deficiency, low blood pressure, gammaglobulin streak.
5. Specific tests. It is carried out with the help of the detection of other microbes, such as salmonella, staphylococcus, shigella. Tests are carried out on the concentration of the protein and th fraction in the plasma, the amount of pepsinogen in the blood and herbal juice, the activity of the pool phosphatases, transaminases, the concentration of electrolytes, such as calcium, sodium, calcium.
6. Bacteriological analysis.
7. Immunological dosage.

instrumental methods

For cich purposes, the size of the equipment and tools is stagnant. A wider complex becomes stagnant when chronically ignited, Nіzh at the hostel. In the last resort, the head method є look around, so how to show more yaskravі in children and grown-ups.

FGDS

Fibrogastroduodenoscopy is carried out before the main diagnostic methods, which should be included in the group of endoscopic ones. Tools:

• a probe at the viglyadі of a thin rocking tube;
• mini-camera on probes;
• the monitor, on how to visualize information, is captured by the camera.

In order to improve the need for the introduction of the probe into herbal organ through the mouth and stravohid. FGDS viznacha:

• roztashuvannya ignited vognisch in shlunkovyh stinka;
• type, character, stage of urazhennya shell;
• viclyuchaє virazkovu ailment.

One hour, with a slurry, you can see a 12-palate intestine, yak often also develop gastritis. Endoscopic examination results:

1. With a blistering mucous with fibrinous nalot, yak hyperemic and swollen with blood cells, non-atrophic or superficial gastritis is diagnosed.
2. With a strong thinning of the shell, we smoothen it with a relief, gray colorі translucent judgmental gossips indicate atrophic gastritis. Illness will be taken care of, as the vitonishing of the dilyanka is scattered with small areas of atrophy of the white color in a bright form... As the atrophy has moved on to the last stage, it appears to grow thinning of the mucous cyanotic appearance, if it is easy to hurt, we will forgive the dot. The folds do not appear in the first place.
3. When the collar is enlarged, hyperemic and mucous bulge, the amount of gallbladder in the slunk is diagnosed as reactive gastritis, drainage when chipped with chemotherapy.
4. Multiple or one-by-one erosive dilens are formed on mucous membranes in case of lykarsky gastritis.
5. When great folds appear in the slunk, similar to the brain, overworldly mucus, hypertrophic gastritis is diagnosed. The shell can be easily injured. Erosion often bleed.

biopsia

To be held pid hour FGDS. A special probe is used to pick up a piece of damaged tissue from a piece of a baby's baby, or an older one for laboratory dosage... The pick-up is carried out from the shlunks. It allows for a greater accuracy due to the increase in the appearance of heliobacteria, the activity of those in the old dishes to the organ of development. For a total of 2 biopsies from the antrum and from the herbal organ should be taken. Helicobacter test is carried out by 4 methods:

• bacteriological;
• morphological, which includes the value of cytology, histology of tissue;
• urizanim biochimichnym;
• immuno-stochastic.

Seemingly, gastritis is an acid-dependent pathology, so it is necessary to carry out an analysis with the measurement of acid in the slunk juice. For qih purposes, the pH-measurement is stagnated, yak is classified as yak:

1. Express-test is a probe method for vimiruvannya acid into the slurry with special electrodes.
2. 24-year pH measurement, which allows assessing the dynamics of acidity in two ways:
   • probe, zd_ysnyuvanim way introduced into the herbal organ of the probe;
   • probe-free, transferring the capsule prokovtuvannya, how to creep to the wall of the slunk for transferring the objects to the adogastrometer, and then vivoditsya from the body in a natural way;
   • endoscopic pH-measurement, allowance for parkan and analysis of biopsy at FGDS

Assessment of shlunk juice

Intake of the slunk is carried out during gastroscopy. In front of a grown-up child, it is necessary to take special food with components that stimulate the secretion of herbal juice. The method allows the body to see the cause of the burning of the stinks. For example, the amendments instead of gastrin indicate the presence of helicobacteria in the organism. Vognischevic gastritis with atrophic tissue is characterized by a decrease in acidity, changes in the activity of pepsin and gastric acid. Stronger change in the number of parameters to indicate about the prevailing atrophy. Antral gastritis is manifested by three types of secretion:

• hyperreactivity;
• hyperparametally;
• pangіperkhlorgіdricheskoy.

The alterations of the components in the shlunk juice are not overturned, as in case of duodenal inflections.

X-ray

X-ray examination is carried out from a special contrasting speech, as the patient is guilty of vipity in front of the patient. The method allows for the visibility of the steps of the changes in the shape, relief, tone and form of the organ, and for the development of inflammation and differentiation of gastritis as a result. Children younger than three rocks are not recommended.

We will show the є method of subway contrasting, which can be used for children and adults. In contrast, the bar and the fortune are victorious. In the world of zapovnenya shlunkovo-intestinal tract, the slime of the shlunk is reliably distributed, so that it allows pathology to emerge, roztashovanu in education. Dodatkovo estimate a shlunkovy mischief of a child and an older one.