Where to check the gastrointestinal tract. Methods for examining the gastrointestinal tract. Possible complications after procedures

State budget educational institution

higher professional education

"Omsk State medical Academy»

Ministry of Health of the Russian Federation

Department of Propaedeutics of Internal Diseases

Laboratory and instrumental methods for diagnosing diseases of the gastrointestinal tract

S.S. Bunova, L.B. Rybkina, E.V. Usacheva

Study guide for students

UDC 616.34-07(075.8)
BBK 54.13-4ya73

Present textbook Laboratory and instrumental methods for diagnosing diseases of the gastrointestinal tract are presented, and their diagnostic capabilities are outlined. The material is presented in a simple accessible form. The textbook contains 39 figures, 3 tables, which will facilitate the assimilation of the material when independent work. The proposed textbook complements the textbook on propaedeutics of internal diseases. The presented test tasks are intended to consolidate the assimilation of the presented material.

This manual is intended for students studying in the following specialties: 060101 – General Medicine, 060103 – Pediatrics, 060105 – Medical and preventive medicine.

Preface
List of abbreviations

Chapter 2. Data instrumental methods research for gastrointestinal diseases
1. Endoscopic methods research
1.1. Fibroesophagogastroduodenoscopy
1.2. Sigmoidoscopy
1.3. Colonoscopy
1.4. Enteroscopy
1.5. Capsule endoscopy
1.6. Chromoscopy (chromoendoscopy)
1.7. Diagnostic laparoscopy
2. X-ray research methods
2.1. Fluoroscopy (x-ray) of the esophagus and stomach
2.2. Computed tomography and multislice computed tomography of organs abdominal cavity
2.3. Survey radiography of the abdominal organs and study of the passage of barium through the intestines
2.4. Irrigoscopy
3. Ultrasound methods research
3.1. Ultrasound of the stomach
3.2. Ultrasound of the intestines (endorectal ultrasonography)
4. Functional diagnostic methods

4.2. Study of gastric secretion - aspiration-titration method (fractional study of gastric secretion using a thin probe)

Test tasks for self-study
Bibliography

Preface

Diseases of the gastrointestinal tract occupy one of the first places in the structure of morbidity, especially among young people of working age; the number of patients with pathologies of the digestive organs continues to increase. This is due to many factors: the prevalence of Helicobacter pylori infection in Russia, smoking, alcohol consumption, stress factors, the use of non-steroidal anti-inflammatory drugs, antibacterial and hormonal drugs, cytostatics, etc. Laboratory and instrumental research methods are extremely important point in the diagnosis of diseases of the gastrointestinal tract, since they often occur latently, without obvious clinical signs. In addition, laboratory and instrumental methods for diseases of the esophagus, stomach and intestines are the main methods for monitoring the dynamics of the disease, monitoring the effectiveness of treatment and prognosis.

This textbook presents the diagnostic capabilities of laboratory and instrumental methods for diagnosing diseases of the esophagus, stomach and intestines, including general clinical and special laboratory research methods, endoscopic, radiological, ultrasound methods and methods of functional diagnostics.

Along with traditional, well-established research, new ones were considered modern methods diagnostics of diseases of the gastrointestinal tract: quantitative determination of transferrin and hemoglobin in feces, determination of a marker of inflammation of the intestinal mucosa - fecal calprotectin, examination of blood serum using the "GastroPanel", a method for diagnosing stomach cancer using a tumor marker in blood serum, modern methods for diagnosing Helicobacter pylori infection , capsule endoscopy, CT scan and multislice computed tomography of the abdominal organs, ultrasonography stomach and intestines (endorectal ultrasonography) and many others.

Currently, the potential of laboratory services has significantly increased as a result of the introduction of new laboratory technologies: polymerase chain reaction, immunochemical and enzyme immunoassays, which have taken a strong place on the diagnostic platform and allow screening, monitoring of certain pathologies and solving complex clinical problems.

Coprological research has not yet lost its importance in assessing the digestive capacity of the digestive system organs, for the selection of adequate enzyme replacement therapy. This method is easy to perform and does not require large material costs and special laboratory equipment, available in every medical institution. In addition, this manual describes in detail the main scatological syndromes.

For better understanding diagnostic capabilities of laboratory and instrumental research methods and interpretation of the results obtained, the textbook presents 39 figures and 3 tables. The final part of the manual provides test tasks for self-study.

List of abbreviations

TANK	- blood chemistry
BDS	– major duodenal papilla
DPK	- duodenum
ZhVP	– bile ducts
ZhKB	- cholelithiasis
Gastrointestinal tract	– gastrointestinal tract
ELISA	- linked immunosorbent assay
CT	- CT scan
MSCT	– multislice computed tomography
OAK	- general blood analysis
OAM	- general urine analysis
OBP	– abdominal organs
p/z	- line of sight
PCR	– polymerase chain reaction
sozh	– gastric mucosa
soe	- erythrocyte sedimentation rate
Tf	– transferrin in feces
Ultrasound	- ultrasonography
FEGDS	- fibroesophagogastroduodenoscopy
HP	– Helicobacter pylori
Hb	– hemoglobin in stool
NS1	– hydrochloric acid

Chapter 1. Data laboratory methods research for diseases

1. Screening research methods

1.1. General analysis blood

1.2. General urine analysis

1.3. Biochemical analysis blood

1.4. Examination of stool for worm eggs and protozoan cysts:

2. Special research methods

2.1. Stool research methods

2.1.1. Coprological research (coprogram)

Coprogram indicators	Coprogram indicators are normal	Changes in coprogram indicators in gastrointestinal diseases
Macroscopic examination
Amount of feces	100-200 g per day. When protein foods predominate in the diet, the amount of feces decreases, while vegetable feces increase. At vegetarian diet the amount of feces can reach 400-500 g.	- Excretion of feces in a large volume (more than 300 g per day - polyfecal matter) is characteristic of diarrhea. - A small volume of feces (less than 100 g per day) is characteristic of constipation.
Stool consistency	Moderately dense (dense)	- Thick consistency - with constant constipation due to excess water absorption - Liquid or mushy consistency of stool - with increased peristalsis (due to insufficient absorption of water) or with abundant secretion of inflammatory exudate and mucus by the intestinal wall - Ointment-like consistency - in the presence of a large amount of neutral fat (for example, when chronic pancreatitis with exocrine insufficiency) - Foamy consistency - with enhanced fermentation processes in the colon and the formation of large amounts of carbon dioxide
Shape of feces	Cylindrical	- The form of feces in the form of “large lumps” - with prolonged stay of feces in the colon (hypomotor dysfunction of the colon in people with in a sedentary manner life or not eating rough food, as well as in case of colon cancer, diverticular disease) - Form in the form of small lumps - " sheep feces" indicates spastic state intestines, during fasting, gastric and duodenal ulcers, reflexive in nature after appendectomy, with hemorrhoids, fissure anus - Ribbon or “pencil” shape - for diseases accompanied by stenosis or severe and prolonged spasm of the rectum, for rectal tumors - Unformed feces- maldigestion and malabsorption syndrome Bristol scale forms of feces (Fig. 1) - medical classification forms of human feces, developed by Meyers Hayton at the University of Bristol, published in 1997. Types 1 and 2 characterize constipation Types 3 and 4 - normal stool Type 5, 6 and 7 - diarrhea
Smell	Fecal (regular)	- Long delay feces in the colon (constipation) leads to the absorption of aromatic substances and the odor almost completely disappears - During fermentation processes, the smell of feces is sour due to volatile fatty acids(oil, vinegar, valerian) - Intensified decay processes (putrefactive dyspepsia, decay of intestinal tumors) cause the appearance of foul odor as a result of the formation of hydrogen sulfide and methyl mercaptan
Color	Brown (when eating dairy foods - yellowish-brown, meat - dark brown). Ingestion of plant foods and some medications can change the color of stool (beets - reddish; blueberries, blackcurrants, blackberries, coffee, cocoa - dark brown; bismuth, iron color stool black)	- With obstruction of the biliary tract (stone, tumor, spasm or stenosis of the sphincter of Oddi) or with liver failure(acute hepatitis, cirrhosis of the liver), leading to a violation of the secretion of bilirubin, the flow of bile into the intestines stops or decreases, which leads to discoloration of stool, it becomes grayish-white, clayey (acholic feces) - In case of exocrine pancreatic insufficiency - gray, since stercobilinogen is not oxidized to stercobilin - Bleeding from the stomach, esophagus and small intestine accompanied by the appearance of black stool - “tarry” (Melena) - When bleeding from the distal parts of the colon and rectum (tumor, ulcers, hemorrhoids), depending on the degree of bleeding, the stool has a more or less pronounced red color - In cholera, intestinal discharge is an inflammatory exudate gray with fibrin flakes and pieces of the colon mucosa (“ congee») - Dysentery is accompanied by the secretion of mucus, pus and scarlet blood - Intestinal discharge with amoebiasis may have a jelly-like character, deep pink or red.
Slime	Absent (or in scant quantities)	- When the distal colon (especially the rectum) is affected, mucus occurs in the form of lumps, strands, ribbons or a glassy mass - With enteritis, the mucus is soft, viscous, mixing with feces, giving it a jelly-like appearance - Mucus covering the outside of formed stool in the form of thin lumps, occurs with constipation and inflammation of the large intestine
Blood	Absent	- When bleeding from the distal parts of the colon, the blood is located in the form of streaks, shreds and clots on formed stool - Scarlet blood occurs when bleeding from the lower parts of the sigmoid and rectum (hemorrhoids, fissures, ulcers, tumors) - Changed blood from the upper digestive system (esophagus, stomach, duodenum), mixing with feces, colors it black (“tarry” feces, melena) - Blood in stool can be detected when infectious diseases(dysentery), ulcerative colitis, Crohn's disease, disintegrating colon tumors in the form of streaks, clots, up to profuse bleeding
Pus	Absent	- Pus on the surface of the stool is determined by severe inflammation and ulceration of the mucous membrane of the colon ( ulcerative colitis, dysentery, intestinal tumor decay, intestinal tuberculosis) often along with blood and mucus - Large amounts of pus without mucus are observed when opening paraintestinal abscesses
Leftover undigested food (lientorrhea)	None	Severe insufficiency of gastric and pancreatic digestion is accompanied by the release of undigested food residues
Chemical research
Reaction	Neutral, less often slightly alkaline or slightly acidic	- Acid reaction(pH 5.0-6.5) is noted with the activation of iodophilic flora, forming carbon dioxide and organic acids (fermentative dyspepsia) - Alkaline reaction (pH 8.0-10.0) occurs with increased processes of protein putrefaction in the large intestine, activation of putrefactive flora that produces ammonia (putrefactive dyspepsia)
Reaction to blood (Gregersen reaction)	Negative	A positive reaction to blood indicates bleeding in any part of the gastrointestinal tract (bleeding from the gums, rupture of varicose veins of the esophagus, erosive and ulcerative lesions Gastrointestinal tract, tumors of any part of the gastrointestinal tract in the stage of decay)
Reaction to stercobilin	Positive	- The absence or sharp decrease in the amount of stercobilin in the feces (the reaction to stercobilin is negative) indicates obstruction of the common bile duct with a stone, compression by a tumor, stricture, stenosis of the common bile duct or a sharp decline liver function (for example, in acute viral hepatitis) - An increase in the amount of stercobilin in feces occurs with massive hemolysis of red blood cells (hemolytic jaundice) or increased bile secretion
Reaction to bilirubin	Negative, because the vital activity of the normal bacterial flora of the colon ensures the process of restoration of bilirubin into stercobilinogen, and then into stercobilin	The detection of unchanged bilirubin in the stool of an adult indicates a disruption in the process of bilirubin recovery in the intestine under the influence of microbial flora. Bilirubin may appear during rapid evacuation of food (sharp increase in intestinal motility), severe dysbiosis (syndrome of bacterial overgrowth in the colon) after ingestion antibacterial drugs
Vishnyakov-Triboulet reaction (for soluble protein)	Negative	The Vishnyakov-Triboulet reaction is used to identify a hidden inflammatory process. Detection of soluble protein in stool indicates inflammation of the intestinal mucosa (ulcerative colitis, Crohn's disease)
Microscopic examination
Muscle fibers: With striations (unchanged, undigested) - without striations (altered, overcooked)	None Absent (or only a few in sight)	A large number of changed and unchanged muscle fibers in feces ( Torheatorrhea) indicates a violation of proteolysis (digestion of proteins): - in conditions accompanied by achlorhydria (lack of free HCl in gastric juice) and achylia ( complete absence secretion of HCl, pepsin and other components gastric juice): atrophic pangastritis, condition after gastrectomy - with accelerated evacuation of food chyme from the intestines - in case of violation exocrine function pancreas - for putrefactive dyspepsia
Connective tissue (remnants of undigested vessels, ligaments, fascia, cartilage)	Absent	Presence in feces connective tissue indicates a deficiency of proteolytic enzymes of the stomach and is observed with hypo- and achlorhydria, achylia
Fat neutral Fatty acid Salts of fatty acids (soaps)	None or meager quantity fatty salts acids	Impaired digestion of fats and the appearance in the stool of large amounts of neutral fat, fatty acids and soaps is called Steatorrhea. - with a decrease in lipase activity (exocrine pancreatic insufficiency, a mechanical obstruction to the outflow of pancreatic juice), steatorrhea is represented by neutral fat. - if there is a violation of the flow of bile into the duodenum (a violation of the process of emulsification of fat in the small intestine) and if the absorption of fatty acids in the small intestine is impaired, fatty acids or salts of fatty acids (soaps) are found in the feces
Plant fiber (digestible) is found in the pulp of vegetables, fruits, legumes and grains. Indigestible fiber (skin of fruits and vegetables, plant hairs, epidermis of cereals) has no diagnostic value, since in digestive system humans do not have enzymes that break it down	Single cells in p/z	It occurs in large quantities during rapid evacuation of food from the stomach, achlorhydria, achylia, and with the syndrome of bacterial overgrowth in the colon (pronounced decrease in normal microflora and an increase in pathogenic microflora in the colon)
Starch	Absent (or single starch cells)	The presence of large amounts of starch in feces is called amilorrhea and is observed more often with increased peristalsis intestines, fermentative dyspepsia, less often – with exocrine insufficiency of pancreatic digestion
Iodophilic microflora (clostridia)	Single in rare p/z (normally iodophilic flora lives in the ileocecal region of the colon)	With a large amount of carbohydrates, clostridia multiply intensively. A large number of clostridia is regarded as fermentative dysbiosis
Epithelium	Absent or single cells of columnar epithelium in the p/z	A large amount of columnar epithelium in the feces is observed in acute and chronic colitis of various etiologies
Leukocytes	Absent or single neutrophils in the p/z	A large number of leukocytes (usually neutrophils) are observed in acute and chronic enteritis and colitis of various etiologies, ulcerative necrotic lesions of the intestinal mucosa, intestinal tuberculosis, dysentery
Red blood cells	None	- the appearance of slightly changed red blood cells in the feces indicates the presence of bleeding from the colon, mainly from its distal parts (ulceration of the mucous membrane, disintegrating tumor of the rectum and sigmoid colon, anal fissures, hemorrhoids) - during bleeding from the proximal colon, red blood cells are destroyed and are not detected by microscopy - a large number of erythrocytes in combination with leukocytes and cylindrical epithelium is characteristic of ulcerative-necrotic lesions of the colon mucosa (ulcerative colitis, Crohn's disease with damage to the colon), polyposis and malignant neoplasms colon
Worm eggs	None	Eggs of roundworms, tapeworms, etc. indicate a corresponding helminthic infestation
Pathogenic protozoa	None	Cysts of dysenteric amoeba, lamblia, etc. indicate corresponding invasion by protozoa
Yeast cells	None	Found in feces during treatment with antibiotics and corticosteroids. Identification of the fungus Candida albicans is carried out by culturing on special media (Sabouraud's medium, Microstix Candida) and indicates a fungal infection of the intestine
Calcium oxalate (oxalic lime crystals)	Absent	They enter the gastrointestinal system with plant foods and normally dissolve in the HCl of gastric juice to form calcium chloride. Detection of crystals is a sign of achlorhydria
Triple phosphate crystals (ammonium phosphate magnesium)	None	It is formed in the large intestine during the breakdown of lecithin, nuclein and other products of protein decay. Triple phosphate crystals found in feces (pH 8.5-10.0) immediately after defecation indicate increased putrefaction in the colon

Scatological syndromes

Chewing deficiency syndrome

Mastication deficiency syndrome reveals insufficiency in the act of chewing food (detection of food particles in the stool, visible to the naked eye).

Causes of chewing deficiency syndrome:

• missing molars
• multiple dental caries with their destruction

The normal enzymatic activity of digestive secretions in the oral cavity is drowned out by waste products of pathogenic microflora. Appearance in the oral cavity abundant pathogenic flora reduces the enzymatic activity of the stomach and intestines, so insufficient chewing can stimulate the development of gastrogenic and enteral scatological syndromes.

Digestive insufficiency syndrome in the stomach (gastrogenic scatological syndrome)

Gastrogenic coprological syndrome develops as a result of impaired formation of hydrochloric acid and pepsinogen in the coolant.

Causes of gastrogenic scatological syndrome:

• atrophic gastritis
• stomach cancer
• conditions after gastrectomy
• erosions in the stomach
• stomach ulcer
• Zollinger-Ellison syndrome

Gastrogenic coprological syndrome is characterized by the detection in the feces of a large number of undigested muscle fibers (creatorrhoea), connective tissue in the form of elastic fibers, layers of digestible fiber and calcium oxalate crystals.

The presence of digestible fiber in feces is an indicator of a decrease in the amount of free HCl and a violation gastric digestion. During normal gastric digestion, digestible fiber is macerated (softened) by free HCl of gastric juice and becomes accessible to pancreatic and intestinal enzymes and is not found in feces.

Pancreatic digestive insufficiency syndrome (pancreatogenic scatological syndrome)

A true indicator of pancreatic digestive insufficiency is the appearance of neutral fat in the stool (steatorrhea), since lipases do not hydrolyze fats.

There are muscle fibers without striations (creatorrea), the presence of starch is possible, and polyfecal matter is characteristic; soft, ointment-like consistency; unformed feces; color gray; pungent, fetid odor, the reaction to stercobilin is positive.

Causes of pancreatogenic scatological syndrome:

• chronic pancreatitis with exocrine insufficiency
• pancreas cancer
• conditions after pancreatectomy
• cystic fibrosis with exocrine pancreatic insufficiency

Bile deficiency syndrome (hypo- or acholia) or hepatogenic scatological syndrome

Hepatogenic coprological syndrome develops due to the lack of bile ( acholia) or its insufficient supply ( hypocholia) in the KDP. As a result, they do not enter the intestines bile acids, participating in the emulsification of fats and activating lipase, which is accompanied by impaired absorption of fatty acids in the small intestine. At the same time, intestinal motility, stimulated by bile, and its bactericidal effect are also reduced.

The surface of the stool becomes matte, granular due to the increased content of fat droplets, the consistency is ointment-like, grayish-white in color, the reaction to stercobilin is negative.

At microscopic examination: a large number of fatty acids and their salts (soaps) - products of incomplete breakdown.

Causes of hepatogenic scatological syndrome:

• diseases of the gallbladder (gallstones, obstruction of the common bile duct with a stone (choledocholithiasis), compression of the common bile duct and bile duct by a tumor of the head of the pancreas, severe strictures, stenosis of the common bile duct)
• liver diseases (acute and chronic hepatitis, liver cirrhosis, liver cancer)

Syndrome of indigestion in the small intestine (enteral scatological syndrome)

Enteral coprological syndrome develops under the influence of two factors:

• insufficiency of enzymatic activity of small intestinal secretions
• decreased absorption of end products of hydrolysis of nutrients

Causes of enteral scatological syndrome:

• mastication insufficiency syndrome gastric digestion insufficiency
• insufficiency of separation or entry of bile into the duodenum
• helminthic infestations of the small intestine and gallbladder
• inflammatory diseases of the small intestine (enteritis of various etiologies), ulcerative lesions of the small intestine
• endocrine diseases that cause increased intestinal motility (thyrotoxicosis)
• diseases of the mesenteric glands (tuberculosis, lymphogranulomatosis, syphilis, lymphosarcoma)
• Crohn's disease affecting the small intestine
• disaccharidase deficiency, gluten enteropathy (celiac disease)

Scatological signs will vary depending on the cause of digestive disorders in the small intestine.

Colon indigestion syndrome

Causes of indigestion syndrome in the colon:

• violation of the evacuation function of the colon - constipation, spastic dyskinesia of the colon
• inflammatory bowel diseases (ulcerative colitis, Crohn's disease)
• insufficiency of digestion in the large intestine, such as fermentative and putrefactive dyspepsia
• massive intestinal damage by helminths, protozoa

With spastic dyskinesia of the colon and irritable bowel syndrome with constipation, the amount of feces is reduced, the consistency is dense, the feces are fragmented, in the form of small lumps, mucus envelops the feces in the form of ribbons and lumps, moderate amount columnar epithelium, single leukocytes.

A sign of colitis will be the appearance of mucus with leukocytes and columnar epithelium. With inflammation of the distal colon (ulcerative colitis), a decrease in the amount of feces is observed, the consistency is liquid, the feces are unformed, pathological impurities are present: mucus, pus, blood; sharply positive reaction to blood and Vishnyakov-Triboulet reaction; a large number of columnar epithelium, leukocytes and erythrocytes.

Insufficiency of digestion in the large intestine according to the type of fermentative and putrefactive dyspepsia:

• Fermentative dyspepsia(dysbiosis, bacterial overgrowth syndrome in the colon) occurs due to impaired digestion of carbohydrates and is accompanied by an increase in the amount of iodophilic flora. Fermentation processes occur with an acidic pH environment (4.5-6.0). The stool is copious, liquid, foamy with sour smell. Mucus mixed with feces. In addition, fermentative dyspepsia is characterized by the presence of large amounts of digestible fiber and starch in the feces.
• Putrid dyspepsia more common in people suffering from gastritis with secretory insufficiency (due to the lack of free hydrochloric acid, food is not properly processed in the stomach). The digestion of proteins is disrupted, their decomposition occurs, and the resulting products irritate the intestinal mucosa and increase the secretion of fluid and mucus. Mucus is a good breeding ground for microbial flora. During putrefactive processes, feces have a liquid consistency, dark brown, alkaline reaction with sharp, putrid smell and a large number of muscle fibers under microscopy.

2.1.2. Bacteriological research feces

Bacteriological examination of stool- sowing feces on nutrient media with the aim of qualitative analysis And quantification normal intestinal microflora, as well as opportunistic and pathogenic forms of microorganisms.
Bacteriological culture of stool is used to diagnose intestinal bacterial overgrowth syndrome (intestinal dysbiosis), intestinal infections and monitoring the effectiveness of their treatment:

• quantitative assessment of microflora (bifido- and lactic acid bacteria, clostridia, opportunistic and pathogenic microflora, fungi) with determination of sensitivity to antibiotics and phages
• identification of pathogens of intestinal infections (Shigella, Salmonella, Proteus, Pseudomonas, Yersinia enterocolitica, Campylobacter jejuni, E.coli, Candida, rotaviruses, adenoviruses)

2.1.3. Markers of damage to the intestinal mucosa:

A. stool examination occult blood(Gregersen reaction)
B. determination of transferrin (Tf) and hemoglobin (Hb) in feces

A. Examination of feces for occult blood (Gregersen reaction):

Hidden blood is blood that does not change the color of stool and is not detectable macroscopically or microscopically. The Gregersen reaction for detecting occult blood is based on the property of blood pigment to accelerate oxidative processes (chemical study).

A positive fecal occult blood reaction can occur when:

• erosive and ulcerative lesions of the gastrointestinal tract
• tumors of the stomach and intestines in the decay stage
• infestations by helminths that injure the intestinal wall
• rupture of varicose veins of the esophagus, cardia of the stomach, rectum (liver cirrhosis)
• getting into digestive tract blood from the mouth and larynx
• impurities in stool blood from hemorrhoids and anal fissures

The test allows you to determine hemoglobin in a minimum concentration of 0.05 mg/g of stool; positive result within 2-3 minutes.

B. Determination of transferrin (Tf) and hemoglobin (Hb) in feces(quantitative method (iFOB)) - identification of lesions of the intestinal mucosa. This test is much more sensitive than the fecal occult blood test. Transferrin persists for a longer time than hemoglobin in feces. An increase in transferrin levels indicates damage upper sections intestines, and hemoglobin - in the lower intestines. If both indicators are high, then this indicates the extent of the damage: the higher the indicator, the greater the depth or affected area.

These tests are of great importance in the diagnosis of colorectal cancer, as they can detect cancer as early stages(I and II), and more late stages(III and IV).

Indications for the determination of transferrin (Tf) and hemoglobin (Hb) in feces:

• bowel cancer and suspicion of it
• screening for colorectal cancer - as a preventive examination for people over 40 years of age (once a year)
• monitoring the condition of the intestine after surgery (especially in the presence of a tumor process)
• intestinal polyps and suspicion of their presence
• chronic colitis, including ulcerative colitis
• Crohn's disease and suspicion of it
• examination of first- and second-degree family members who have been diagnosed with cancer or intestinal polyposis

2.1.4. Determination of a marker of inflammation of the intestinal mucosa - fecal calprotectin

Calprotectin is a calcium-binding protein secreted by neutrophils and monocytes. Calprotectin is a marker of leukocyte activity and inflammation in the intestine.

Indications for the determination of calprotectin in feces:

• identification of acute inflammatory processes in the intestines
• monitoring of inflammation activity during treatment for inflammatory bowel diseases (Crohn's disease, ulcerative colitis)
• differential diagnosis of organic intestinal diseases from functionally caused ones (for example, irritable bowel syndrome)

2.1.5. Determination of Clostridium difficile antigen (toxin A and B) in stool- used to identify pseudomembranous colitis (against the background of long-term use of antibacterial drugs), in which the causative agent is this microorganism.

2.2. Blood serum examination using GastroPanel

"GastroPanel" is a set of specific laboratory tests that allow you to identify the presence of coolant atrophy, assess the risk of developing stomach cancer and peptic ulcer, determine HP infection. This panel includes:

• gastrin-17 (G-17)
• pepsinogen-I (PGI)
• pepsinogen-II (PGII)
• specific antibodies - immunoglobulins class G (IgG) to Helicobacter pylori

These indicators are determined using enzyme-linked immunosorbent assay (ELISA) technology.

Intragastric pH measurements are presented in Table 2.

Table 2. Intragastric pH-metry indicators

Gastric body pH	hyperacid state	normoacid state	hypoacid state	anacid state
basal period	<1,5	1,6-2,0	2,1-6,0	>6,0
after stimulation	<1,2	1,2-2,0	2,1-3,0 3,1-5,0 (very weak reaction)	>5,1
pH of the antrum of the stomach	alkalization compensation	decreased alkalizing function	subcompensation for alkalization	decompensation of alkalization
basal period	>5,0	-	2,0-4,9	<2,0
after stimulation	>6,0	4,0-5,9	2,0-3,9	<2,0

4.2. Study of gastric secretion– aspiration-titration method (fractional study of gastric secretion using a thin probe).

The technique includes two stages:

1. Study of basal secretion
2. Stimulated secretion assay

Study of basal secretion: the day before the study, medications that inhibit gastric secretion are discontinued, and after a 12-14-hour fast in the morning, a thin gastric tube (Fig. 39) is inserted into the antrum of the stomach. The first portion, consisting of completely removed stomach contents, is placed in a test tube - this is the fasting portion. This portion is not taken into account when studying basal secretion. Then every 15 minutes the gastric juice is removed. The study is continued for an hour - thus, 4 portions are obtained, reflecting the level of basal secretion.

Study of stimulated secretion: parenteral stimulants of gastric secretion (histamine or pentagastrin - a synthetic analogue of gastrin) are currently used. So, after studying secretion in the basal phase, the patient is injected subcutaneously with histamine (0.01 mg/kg of the patient’s body weight - submaximal stimulation of the parietal cells of the coolant fluid or 0.04 mg/kg of the patient’s body weight - maximum stimulation of the parietal cells of the coolant fluid) or pentagastrin (6 mg /kg of patient's body weight). Gastric juice is then collected every 15 minutes. The resulting 4 servings within an hour constitute the volume of juice in the second phase of secretion - the phase of stimulated secretion.

Physical properties of gastric juice: normal gastric juice is almost colorless and odorless. Its yellowish or greenish color usually indicates an admixture of bile (duodenogastric reflux), and a reddish or brownish color indicates an admixture of blood (bleeding). The appearance of an unpleasant putrefactive odor indicates a significant disruption of gastric evacuation (pyloric stenosis) and the resulting putrefactive breakdown of proteins. Normal gastric juice contains only a small amount of mucus. An increase in mucus impurities indicates inflammation of the coolant, and the appearance of food residues in the resulting portions indicates serious disturbances in gastric evacuation (pyloric stenosis).

Normal gastric secretion indicators are presented in Table 3.

Table 3. Indicators of gastric secretion are normal

Indicators	Normal values
Determination of clock voltage – amount of gastric juice produced by the stomach within an hour	Basal secretion phase: 50-100 ml per hour - 100-150 ml per hour (submaximal histamine stimulation) - 180-220 ml per hour (maximum histamine stimulation)
Determination of flow rate HCl free. – amount of HCl, released into the lumen of the stomach per hour and expressed in milligram equivalents	Basal secretion phase: 1-4.5 mEq/l/hour Stimulated secretion phase: - 6.5-12 meq/l/hour (submaximal histamine stimulation) - 16-24 meq/l/hour (maximum histamine stimulation)
Microscopic examination of gastric juice	Leukocytes (neutrophils) single in the field of view Single cylindrical epithelium in the field of view Slime +

Interpretation of research results

1. Clock voltage change:

• an increase in the amount of gastric juice indicates hypersecretion (erosive antral gastritis, ulcer of the antrum or duodenum, Zollinger-Ellison syndrome) or a violation of the evacuation of food from the stomach (pyloric stenosis)
• a decrease in the amount of gastric juice indicates hyposecretion (atrophic pangastritis, stomach cancer) or accelerated evacuation of food from the stomach (motor diarrhea)

2. Change in flow-hour of free HCl:

• normoacid state (normoaciditas)
• hyperacidity (hyperaciditas) - ulcer of the antrum or duodenum, Zollinger-Ellison syndrome
• hypoacid condition (hypoaciditas) - atrophic pangastritis, stomach cancer
• anacid state (anaciditas), or complete absence of free HCl after maximum stimulation with pentagastrin or histamine.

3. Microscopic examination. Detection of leukocytes, columnar epithelium and mucus in large quantities during microscopy indicates inflammation of the coolant. With achlorhydria (lack of free hydrochloric acid in the phase of basal secretion), in addition to mucus, columnar epithelial cells can also be found.

Disadvantages of the aspiration-titration method that limit its use in practice:

• removal of gastric juice disrupts the normal working conditions of the stomach; it is of little physiological value
• Some of the stomach contents are inevitably removed through the pylorus
• secretion and acidity indicators do not correspond to actual ones (as a rule, they are underestimated)
• the secretory function of the stomach increases, since the probe itself is an irritant of the gastric glands
• the aspiration method provokes the occurrence of duodenogastric reflux
• it is impossible to determine night secretion and the circadian rhythm of secretion
• it is impossible to assess acid formation after eating

In addition, there are a number of diseases and conditions for which the insertion of a probe is contraindicated:

• varicose veins of the esophagus and stomach
• burns, diverticula, strictures, stenosis of the esophagus
• bleeding from the upper gastrointestinal tract (esophagus, stomach, duodenum)
• aortic aneurysm
• heart defects, cardiac arrhythmias, arterial hypertension, severe forms of coronary insufficiency

Test tasks for self-study

Select one or more correct answers.

1. Special laboratory tests for gastrointestinal diseases

1. scatological research
2. general blood analysis
3. blood serum examination using GastroPanel
4. bacteriological examination of stool
5. general urine analysis

2. Changes in the general blood test, characteristic of inflammatory bowel diseases (ulcerative colitis, Crohn's disease)

1. neutrophilic leukocytosis
2. thrombocytosis
3. anemia
4. erythrocytosis
5. acceleration of ESR

3. Anemia in a general blood test can be observed with:

1. gastric ulcer complicated by bleeding
2. condition after gastric resection
3. chronic duodenitis
4. cancer of the cecum in the decay stage
5. opisthorchiasis

4. Changes in the biochemical blood test due to malabsorption in the small intestine:

1. hypoproteinemia
2. hyperproteinemia
3. hyperlipidemia
4. hypolipidemia
5. hypokalemia

5. Normal coprogram is characterized by:

1. positive reaction to stercobilin
2. positive reaction to bilirubin
3. positive Vishnyakov-Triboulet reaction (for soluble protein)
4. microscopy shows a small amount of neutral fat
5. microscopy shows a small amount of digested muscle fibers

6. Signs of bleeding from a duodenal ulcer:

1. acholic feces
2. "tarry" stool
3. Gregersen's strongly positive reaction
4. anemia
5. polyfecal

7. In a coprogram, macroscopic indicators are

1. muscle fibers
2. stool color
3. reaction to stercobilin
4. stool consistency
5. reaction to bilirubin

8. In a coprogram, the chemical indicators are

1. reaction to stercobilin
2. connective tissue
3. shape of stool
4. reaction to bilirubin
5. Gregersen reaction

9. In a coprogram, macroscopic indicators are

1. amount of stool
2. neutral fat
3. vegetable fiber (digestible)
4. leukocytes
5. red blood cells

10. Steatorrhea is a sign

1. ahilia
2. appendectomy
3. hyperchlorhydria
4. exocrine pancreatic insufficiency
5. normal coprogram

11. Causes of hepatogenic scatological syndrome

1. cholidocolithiasis
2. stomach tumor
3. tumor of the head of the pancreas
4. cirrhosis of the liver
5. atrophic gastritis

12. Markers of damage to the intestinal mucosa

1. Gregersen reaction
2. transferrin in feces
3. reaction to bilirubin
4. hemoglobin in stool
5. reaction to stercobilin

13. Methods for diagnosing Helicobacter pylori infection

1. morphological study of biopsy samples of the gastric mucosa
2. X-ray
3. urease breath test with 13C-urea
4. rapid urease test
5. bacteriological

14. Endoscopic methods for diagnosing gastrointestinal diseases are

1. fibroesophagogastroduodenoscopy
2. irrigoscopy
3. colonoscopy
4. fluoroscopy of the stomach
5. sigmoidoscopy

15. X-ray methods for diagnosing gastrointestinal diseases are

1. irrigoscopy
2. sigmoidoscopy
3. enteroscopy
4. computed tomography of the abdominal organs
5. fluoroscopy of the stomach

16. Options for intragastric pH-metry

1. short-term
2. aspiration
3. endoscopic
4. X-ray
5. daily allowance

17. Indicators of gastric secretion determined by aspiration-titration method

1. gastrin-17
2. hourly voltage
3. determination of IgG antibodies to Helicobacter pylori
4. flow-hour of free HCl
5. pepsinogen-I

18. A large amount of broken down and undigested fat in the stool is called _____________

19. A large number of changed and unchanged muscle fibers in feces is called___________

20 A large amount of starch in feces is called ____________

Answers to test tasks

1.	1, 3, 4	6.	2, 3, 4	11.	1, 3, 4	16.	1, 3, 5
2.	1, 3, 5	7.	2, 4	12.	1, 2, 4	17.	2, 4
3.	1, 2, 4	8.	1, 4, 5	13.	1, 3, 4, 5	18.	steatorrhea
4.	1, 4, 5	9.	2, 3, 4, 5	14.	1, 3, 5	19.	creatororrhea
5.	1, 5	10.	4	15.	1, 4, 5	20.	amilorrhea

Bibliography

1. Vasilenko V.Kh., Grebenev A.L., Golochevskaya V.S., Pletneva N.G., Sheptulin A.A. Propaedeutics of internal diseases / Ed. A.L. Grebeneva. Textbook. – 5th edition, revised and expanded. - M.: Medicine, 2001 – 592 p.
2. Molostova V.V., Denisova I.A., Yurgel V.V. Scatological research in health and pathology: educational and methodological manual / Ed. Z.Sh. Golevtsova. – Omsk: Publishing House Omsk State Medical Academy, 2008. – 56 p.
3. Molostova V.V., Golevtsova Z.Sh. Methods for studying the acid-forming function of the stomach: educational manual. Supplemented and revised. – Omsk: Publishing House Om-GMA, 2009. – 37 p.
4. Aruin L.I., Kononov A.V., Mozgovoy S.I. International classification of chronic gastritis: what should be accepted and what is in doubt // Pathology Archives. – 2009. – Volume 71 – No. 4 – P. 11–18.
5. Roytberg G.E., Strutynsky A.V. Internal illnesses. Laboratory and instrumental diagnostics: textbook. – Moscow: Publishing house MEDpress-inform, 2013. – 816 p.
6. Electronic library of Omsk State Medical Academy. Access mode: weblib.omsk-osma.ru/.
7. Electronic library system "KnigaFond". Access mode: htwww. knigafund.ru
8. Electronic library system of the 1st Moscow State Medical University named after. I.M. Sechenov. Access mode: www. scsml.rssi.ru
9. Scientific electronic library (eLibrary). Access mode: http://elibrary.ru
10. Journal of Consilium Medicum. Access mode: www. consilium-medicum.com

Colonoscopy or MRI of the intestine? This question is asked by every patient who has had to undergo examination in perhaps the most inconvenient place. As sad as it is to realize, colonoscopy is one of the most effective methods. However, MRI also has its indications. We will talk about which is better - MRI or colonoscopy - in this article.

The simplest methods for examining a patient’s gastrointestinal tract

There are many different methods for examining the stomach and intestines, the results of which can make a diagnosis or refute it.

The simplest methods can be carried out by a specialist during the patient’s first complaint. More complex are those that require additional equipment or a more qualified doctor.

In order for the diagnosis to be accurate, it will be necessary to undergo some of the most important and significant tests, which will be prescribed by the doctor after the initial examination.

Palpation

Palpation is a procedure during which an experienced doctor can, using conventional examination and palpation, without the use of additional medical instruments, make an accurate diagnosis. What is the patient doing at this time? The patient will have to stand or lie down as required by the doctor. The room should be warm, the doctor will feel the body with warm hands, this procedure is completely painless and does not pose any danger, there are no contraindications for its implementation.

Auscultation

Unlike palpation, to carry out this procedure the specialist will need an additional medical instrument - a stethoscope. This procedure is also very simple and painless. The specialist will simply listen to how the patient’s internal organs work. Noise distorts the picture. There are also no contraindications for this procedure. It will only take a few minutes and will allow you to talk about pathologies in the gastrointestinal tract, which will greatly help in making a final diagnosis.

Percussion

This is an additional method of initial research, which is often carried out during palpation. This procedure will help determine the boundaries of the location of the patient’s internal organs.

Probing

The doctor can obtain more information using additional equipment or other tools. Thus, very useful information can be obtained using a diagnostic method such as probing. The procedure is not very pleasant, but very important and significant. It consists of the following: the doctor uses a probe to gain access to the digestive system from the inside. He will definitely take a sample of gastric juice for examination. The entire procedure takes several hours. There are no contraindications for its implementation, but there are some recommendations that make sense to use before probing.

For two or three days before the test, it is recommended to eat food that does not lead to increased gas formation. You cannot eat fresh fruits and vegetables, or drink sparkling water. Before the procedure, you should not eat food for 12 hours.

Using probing, it is possible to examine the stomach, or rather gastric juice, to check the acidity level.

Instrumental methods for studying the gastrointestinal tract

There are also known methods for examining the stomach, with which you can obtain more detailed and accurate information about the general condition of the patient’s digestive system. These include ultrasound, X-ray, examination with an endoscope, sigmoidoscopy, laparoscopic examination and MRI and CT. All of these are instrumental methods for examining the gastrointestinal tract, which will allow a more thorough examination of the patient’s gastrointestinal tract organ of interest to the doctor.

X-ray

This is a very important and simple procedure that has contraindications. It should not be performed on pregnant women or nursing mothers only on the recommendation of a doctor. An X-ray examination of the stomach can identify some defects in the internal organs of the digestive system. There are various x-ray methods for examining the gastrointestinal tract and diagnosing it.

Examination using a special tube

Endoscopic methods for examining the gastrointestinal tract come in different types. It all depends on which organ of the digestive system is being examined. In order to conduct an examination of the intestines, a tube is inserted into the anus.

An endoscope is a tube that has a camera. In real time, it is quite possible to look inside a person and look at the walls of internal organs and determine whether there are defects or other pathologies there or not.

Or they are at risk, very often they ask the question: how to check the stomach and intestines? There are a large number of diagnostic methods that are highly effective and allow you to accurately determine the disease.

Doctors quite often prescribe a colonoscopy.

If a patient experiences pathological changes in the intestines or stomach, then he must undergo an instrumental examination. Doctors in most cases recommend:

1. Magnetic resonance imaging;
2. PET scan;
3. Computed tomography;
4. Capsule endoscopy;

These methods provide the opportunity to explore gastrointestinal tract and also determine the presence of diseases. Some research methods require the use of anesthesia, since the person will not be able to tolerate the intervention. The choice of a particular research method directly depends on the characteristics of the development of the disease and the preliminary diagnosis.

Features of PET scanning and computed tomography

PET scanning as an effective diagnosis.

Computed tomography and PET scans are often used to examine the large and small intestines.

Using these research methods, the affected organs are visualized.

During the diagnosis, the doctor receives an image on an x-ray or computer monitor.

Equipment used for diagnostics visualizes the condition of internal organs using methods such as magnetic fields, ultraviolet waves, and X-rays.

Thanks to the use of computer imaging, it is possible to obtain several multilayer images of the stomach and intestines, which greatly simplifies the process of studying the condition of these organs for the doctor.

Using this research method, not only the internal, but also the external contour is assessed. Before the scan, the patient receives a contrast agent. The drug can also be administered intravenously during a computed tomography scan.

During the diagnostic period, images are taken in a special camera. That is why, if a patient has claustrophobia, testing is not recommended. Also, diagnosis is not carried out if the patient is excessively obese. Virtual colonoscopy is one of the types of computed tomography.

When using this method, it is possible to obtain images that have a three-dimensional image. This diagnosis is quite informative in the presence of growths on the intestinal walls, the size of which is more than one centimeter.

PET diagnostics involves the use of radioactive sugar, which produces images of the large and small intestines. It is infused into the patient intravenously before the study.

To carry out diagnostics, positron emission equipment is used, which is equipped with a special table for positioning the patient. The duration of the study is on average half an hour.

If the doctor has previously diagnosed the patient with early oncology, then this method is not used to confirm the diagnosis. But, with its help, the level of abnormalities in the inflamed intestinal wall, which was previously identified by a tomogram, is checked.

In case of intestinal cancer, using this research method, the presence of metastases in the lymphatic system and nearby organs is checked. Thanks to the possibility of simultaneous use of computed tomography and a PET scanner, the doctor can compare the images and make the diagnosis as accurately as possible.

To get a more complete picture, the doctor very often prescribes a test.

This video will tell you what capsule endoscopy is:

Carrying out ultrasound and MRI

Ultrasound is one of the diagnostic methods.

To check the intestines and stomach for the development of cancer, ultrasound is used.

It is used for fairly large tumors. If the patient has early or polyps in the gastrointestinal tract, then this method is not used for diagnosis.

In some cases, ultrasound is used to determine metastases of intestinal cancer in other organs.

If a patient is preliminarily diagnosed with rectal cancer, then endorectal ultrasound is used to confirm this diagnosis. For this purpose, a special device is used, which is inserted into the patient through the rectum.

Endorectal ultrasound makes it possible to determine the extent of pathological foci and the presence of pathological processes in the rectum and neighboring organs.
Magnetic resonance imaging can be used to diagnose diseases of the stomach and intestines.

When it is carried out, images are obtained on the computer screen that display sections of the patient’s body. This research method uses radio waves and strong magnets. During the examination, the human body absorbs the energy that the image displays. Thanks to the presence of a special program in the tomograph, the template is converted into an image.

Before the test, a person is given a drug that contains gadolinium. The distribution of the substance throughout the patient’s body occurs in different ways, depending on the location of the disease.

This makes it possible to distinguish between healthy and diseased tissues of the stomach and intestines. Compared to computed tomography, magnetic resonance imaging provides clearer images. If the patient has renal failure, this diagnostic method is not used. To determine this, capsule endoscopy is most often used.

This research method is based on the use of a capsule that has a built-in wireless camera of the smallest possible size. Thanks to this device, it is possible to obtain photographs of the stomach and intestines. The video tablet makes it possible to examine hard-to-reach areas. Unlike endoscopy, this method examines the small intestine.

Ultrasound, magnetic resonance imaging and capsule endoscopy are highly effective diagnostic methods that are characterized by a minimum number of contraindications.

Features of laparoscopy and endoscopy

Laparoscope is a tool for performing laparoscopy.

If the diagnostic case is unclear, then laparoscopy is used.

Using this research method, the depth of damage to the stomach is determined. This method can be used for not only diagnostics, but also surgical interventions. Using laparoscopy, gastric cancer is determined, as well as the extent of spread to neighboring organs.

During the examination, a special instrument is used - a laparoscope. Initially, the patient is given anesthesia. After this, an incision is made, the dimensions of which range from 0.5 to 1 centimeter.

Through it, a device is inserted, with the help of which carbon dioxide is pumped into the stomach. Thanks to this, the organ is enlarged, which allows you to get the most detailed picture. Next, a laparoscope is inserted into the resulting space.

Standard laparoscopy does not make it possible to determine the presence of metastases in. For this purpose, laparoscopic ultrasonography is used, which makes it possible to examine the abdominal organs. For this purpose, special laparoscopic sensors are used. With their help, hard-to-reach areas are explored.

Laparoscopy is practically the only diagnostic method that can be used to determine metastases before surgery. Endoscopy is performed using a special device - an endoscope.

It has a small camera that connects to a computer screen. Using this method, the upper parts of the digestive tract are examined. The endoscope tube must be swallowed by the patient during the examination.

Before this, the throat is irrigated using anesthetics. This makes the coping process easier. During the study, the walls of the stomach are examined using a camera. The doctor views the captured images with a camera in the endocope eye.

This research method allows you to take a biopsy. In some cases, using an endoscope, a catheter is inserted and all ducts are filled with radiopaque contrast. This makes it possible to take an X-ray of the gastrointestinal tract.

A variety of research methods can be used to determine the condition of the stomach and intestines. They should only be selected by a doctor in accordance with the indications and individual characteristics of the patient.

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According to medical statistics, 95% of the world's inhabitants need regular monitoring. Of these, more than half (from 53% to 60%) are familiar firsthand with chronic and acute forms (inflammatory changes in the gastric mucosa), and about 7-14% suffer.

Symptoms of gastric pathology

The following manifestations may indicate problems in this area:

• pain in the stomach, feeling of fullness, heaviness after eating;
• pain behind the sternum, in the epigastric region;
• difficulty swallowing food;
• feeling of a foreign body in the esophagus;
• belching with a sour taste;
• heartburn;
• nausea, vomiting of undigested food;
• vomiting with blood;
• increased gas formation;
• black stool, bleeding during bowel movements;
• bouts of ravenous hunger/lack of appetite.

Of course, previously identified pathologies of the digestive system are serious indications for gastroenterological examination:

• inflammatory processes;
• oncological diseases, etc.

Diagnosis of stomach diseases

Diagnosis of stomach diseases is a whole complex of studies, including physical, instrumental, and laboratory methods.

Diagnosis begins with interviewing and examining the patient. Next, based on the collected data, the doctor prescribes the necessary studies.

Instrumental diagnosis of stomach diseases involves the use of such informative methods as:

• CT scan;

The complex of laboratory methods for diagnosing stomach diseases usually includes:

• general blood analysis;
• blood chemistry;
• general analysis of urine, feces;
• gastropanel;
• pH-metry;
• analysis for tumor markers;
• breath test for .

General blood analysis . This study is indispensable for assessing the state of health in general. When diagnosing gastrointestinal diseases by changes in indicators (ESR, red blood cells, leukocytes, lymphocytes, hemoglobin, eosinophils, etc.), one can ascertain the presence of inflammatory processes, various infections, bleeding, and neoplasms.

Blood chemistry . The study helps to identify dysfunctions of the gastrointestinal tract, to suspect an acute infection, bleeding or growth of a tumor in the subject.

General urine analysis . Based on characteristics such as color, transparency, specific gravity, acidity, etc., as well as the presence of inclusions (glucose, blood or mucous inclusions, protein, etc.), one can judge the development of an inflammatory or infectious process or neoplasms.

General stool analysis . The study is indispensable in diagnosing bleeding and digestive dysfunction.

Tumor markers . To identify malignant tumors of the gastrointestinal tract, specific markers are used (REA, CA-19-9, CA-242, CA-72-4, M2-RK).

PH-metry . This method allows you to obtain data on the level of acidity in the stomach using flexible probes equipped with special measuring electrodes, which are inserted into the stomach cavity through the nose or mouth.

It is carried out in cases where the doctor needs this indicator to make a diagnosis, to monitor the patient’s condition after gastrectomy, as well as to assess the effectiveness of drugs designed to reduce or increase the acidity of gastric juice.

RN-metry is carried out in a medical facility, under the constant supervision of a doctor.

Gastropanel . A special set of blood tests that helps assess the functional and anatomical state of the gastric mucosa.

The gastroenterological panel includes the most important indicators for diagnosing gastric pathologies:

• antibodies to Helicobacter pylori (these antibodies are detected in patients suffering from gastritis, duodenitis, peptic ulcer);
• gastrin 17 (a hormone that affects the regenerative function of the stomach);
• pepsinogens I and II (the level of these proteins indicates the condition of the mucous membrane of the body of the stomach and the organ as a whole).

How to prepare for tests

Urine and stool tests . The biomaterial is collected in a special sterile container (purchased at the pharmacy). The day before, it is not recommended to take multivitamins and eat foods that can change the color of the biomaterial, as well as laxatives and diuretics.

Urine is collected in the morning, after careful hygiene of the external genitalia. It is necessary to drain the first dose of urine into the toilet, and collect the middle portion (100-150 ml) in a container.

Feces are collected in the morning or no later than 8 hours before the test.

Gastropanel . A week before the study, you should stop taking medications that can affect gastric secretion. The day before, avoid taking medications that neutralize hydrochloric acid. On the morning of the test, do not drink, eat, or smoke.

The study involves donating blood from a vein in two doses: immediately upon arrival at the treatment room and 20 minutes after taking a special cocktail designed to stimulate the hormone gastrin 17.

Blood tests (general, biochemical) . Blood for testing is donated in the morning on an empty stomach. On the eve of the analysis, you should avoid stress, refrain from eating heavy food and alcohol. You should not eat or smoke on the morning of the test. Drinking clean water is allowed.

PH-metry. The probe is installed in the morning on an empty stomach. At least 12 hours must pass since the last meal, and you can drink water no later than four hours before the procedure. Before the planned study, be sure to notify your doctor about the medications you are taking; their use may have to be discontinued several hours (and some medications several days) before the procedure.

Diseases of the stomach and intestines - the organs that make up the gastrointestinal tract - occupy 1st place among all diseases occurring in people of different ages. These pathologies bring patients many unpleasant moments - from an uncomfortable state to excruciating pain. But the most dangerous thing is that it is gastrointestinal diseases that cause a huge number of complications - perforated ulcers, severe inflammation and cancerous tumors, leading to disability and even death. That is why it is recommended for every person to undergo a gastrointestinal ultrasound periodically, even if nothing hurts yet.

And your gastrointestinal tract is healthy: stomach health is a matter of time

Let's look at medical statistics on diseases of the stomach and intestines. Alas, it is frightening, even without taking into account hidden patients who have not been examined and residents of the poorest countries where there is no access to medical services.

According to statistics:

• Almost 90% of the population of developed countries suffers from gastritis of varying degrees of neglect.
• 60% of the world's inhabitants are infected with Helicobacter pylori, a bacterium that causes inflammation of the mucous membrane of the stomach and intestines, and is the cause of gastritis and stomach ulcers.
• In Western countries, up to 81% of citizens, according to statistics, periodically experience heartburn, which is a symptom of gastroesophageal reflux disease - a disease of the esophagus that leads to disruption of the gastrointestinal tract.
• About 14% of people have stomach ulcers.

At the age of over 60 years, the quality and length of life depends on the condition of the stomach and intestines, but it is possible to get rid of existing pathology only in the initial stages of the disease. This is why it is so important to be attentive to your health and not bring the problem to a chronic stage.

How to check the stomach and intestines quickly, cheaply and informatively?

There are several types of examination of the intestines and stomach, but only one has a full range of advantages, which doctors consider invaluable and very effective in making a diagnosis.

• An ultrasound can be done urgently for any patient’s condition. The examination will take a maximum of 15-30 minutes.
• Ultrasound diagnostics are carried out painlessly, without causing psychological discomfort. Unfortunately, other methods of examining the gastrointestinal tract require very unpleasant procedures - swallowing tubes, inserting sharp instruments into the anus, sometimes to a considerable depth, ingesting liquids that cause vomiting, etc.
• Ultrasound is completely safe. The method is based on echolocation and does not require the use of X-ray and MRI equipment.
• This is one of the cheapest examinations. An examination of the gastrointestinal tract along with the rest of the abdominal organs will cost around 1 thousand rubles.

With all this, this technique is sometimes even more informative than other methods of examining the stomach and intestines. For example, unlike the endoscopic diagnostic method (using probes that are inserted inside), ultrasound reveals intestinal inflammation, thickening and protrusion of the walls, stenosis (expansion of the lumen), abscesses, fistulas, congenital anomalies (Crohn's disease), neoplasms in the early stages of development diseases.

Specifics of the gastrointestinal tract examination: why the stomach and intestines need to be examined in detail

Despite the close relationship between the stomach and intestines, the doctor examines both organs in detail, since they not only have similar diseases. For example, ulcers can be localized in any part of the gastrointestinal tract or form in all parts at once. The same applies to oncological tumors, inflammation and other processes.

Depending on the patient’s complaints, the specialist examines the intestines and stomach separately. Having received data indicating dangerous processes, the doctor refers the patient for additional diagnostics.

Along with an ultrasound, it is recommended to simultaneously take a breath test for Helicobacter pylori. This analysis is also not traumatic - the patient will only need to exhale air a few times. The ultrasound plus complex will allow you to literally identify in 15-20 minutes the cause of heartburn, abdominal pain and cramps, diarrhea or constipation, bloating and other symptoms, determine the extent of the processes and prescribe treatment without resorting to unpleasant diagnostic methods.

How to examine the intestines: Ultrasound plus additional techniques

The intestine has three sections: the large, small intestine and rectum, and the study of each of them has its own characteristics and nuances.

• Ultrasound of the large intestineHelps detect cancer at the earliest stage. To make sure, the patient is prescribed a contrast X-ray and colonoscopy. Irrigoscopy, an X-ray examination using contrast liquid, will also be very effective. The method allows you to “see” areas that are invisible to colonoscopy and difficult to distinguish with ultrasound, for example, areas of bends or accumulations of mucus.
• Ultrasound of the small intestinemakes it difficult to tortuosity and deep burial, as well as the accumulation of gases that distort the image on the monitor. A special curved sensor and the latest high-precision equipment help to examine the small intestine. Ultrasound evaluates wall thickness, visualization of layers, patency, wall expansion, and peristalsis.
• Ultrasound of the duodenumcarried out together with a stomach examination. Allows you to 100% diagnose stomach ulcers, cancer, gastroduodenitis.

Depending on the area being examined, the doctor uses a sensor with certain characteristics.

Ultrasound machines for intestinal examination

The intestines are examined using two types of sensors: transabdominal (through the abdominal wall) and endorectal. To study the colon, a 2D device is sufficient, which produces a flat two-dimensional image. Such an examination already provides reliable information about the patient’s health status. The endorectal method is more informative because the sensor is inserted into the anus and examines the organ from the inside.

The doctor decides which sensor to choose depending on the patient’s complaints. In special cases, both methods are used.

• In 15% of cases, the transabdominal sensor “does not see” the rectum, as well as the anal canal area. The endorectal method is not possible with stenosis of the terminal gastrointestinal tract (abnormal narrowing).
• The endorectal probe usually examines the distal parts of the rectum. A rectal examination requires preparation.

Preparation and performance of intestinal ultrasound

Preparation for the procedure begins 3 days in advance, the patient refuses food that causes constipation or flatulence (legumes, sweets, flour products, smoked and spicy foods).

The day before, from 18.00, the patient completely refuses any food, having first taken a laxative (Guttalax, Regulax, Duphalac, Bisacodyl). If there are problems with peristalsis, the patient is given an enema, and in special cases, a special cleansing enema is performed using a Bobrov apparatus (a glass vessel for introducing a large amount of liquid inside).

In the morning, the patient goes for an ultrasound examination until 11.00 am. This is due to the fact that the procedure is carried out only on a well-cleansed intestine and a completely empty stomach, while long breaks in food intake are contraindicated.

In the ultrasound diagnostic room, the patient lies on the couch on his side with his back to the machine, having first removed his clothes below the waist and lowered his underwear. The legs are tucked with the knees to the chest. Ultrasound begins in the direction from the lower parts to the higher ones. In parallel with this, the doctor moves the probe in such a way as to examine the intestine in the transverse, longitudinal and oblique planes. When the echogenic picture is not entirely clear, the doctor asks the patient to change position (lean on his knees and elbows, stand up).

It is carried out using a transabdominal sensor. A contrast liquid (barium sulfate solution) is first injected into the empty intestine. Thanks to this, a clear picture is obtained on the monitor screen.

To examine the rectum, 3.5-5 MHz sensors are used. Ultrasound of a given length passes through the soft tissue of the intestine, being reflected back. The built-in receiving sensor picks up the signal and transmits it in processed form to the monitor screen. Various compactions, neoplasms and erosions are expressed in the form of white, black or mixed areas of varying echogenicity. An experienced doctor does not make a diagnosis immediately, but correlates the data obtained with the results of tests and other studies.

Interpretation of intestinal ultrasound results

A healthy intestine has two membranes. The outer one is muscle tissue with low echogenicity, the inner mucous membrane is in contact with gas, and therefore is visualized as a hyperechoic layer.

During an ultrasound examination, the following parameters are assessed:

• Dimensions and shape. The wall thickness is 3-5 mm. The picture is distorted in the event of the formation of gases that deform the ultrasound, and insufficient filling of the intestines with liquid.
• Bowel locationrelative to other organs.
• Wall structure (echogenicity). The outer layer is hypoechoic, while the inner wall is characterized by hyperechogenicity. The contours are smooth, the intestinal lumen should not have expansions or contractions. Peristalsis is noticeable.
• Length and shape of various sections.The thermal section is 5 cm, the middle section is 6-10 cm, the middle ampullary section is 11-15 cm.
• Lymph nodes.Should not be visualized.

Deviations from the norm indicate various pathologies:

• Enteritis (inflammation of the small intestine): dilation of the intestine, increased peristalsis, accumulation of contents of varying echogenicity;
• Hirschsprung's disease (congenital pathology of an increase in certain sizes of the intestine): significant expansion of the lumen, uneven contours, heterogeneous wall thickness, noticeable places of thinning, lack of peristalsis;
• If it is impossible to determine the layers of the intestine, we can talk about acute mesenteric thrombosis - a consequence of myocardial infarction, expressed in thrombosis of the mesenteric artery;
• Uneven internal contours (which causes ulcerative lesions of the mucous surface), weak echogenicity, thickening of the wall - all this indicates nonspecific ulcerative colitis;
• Chronic spastic colitis: areas of high echogenicity against the background of a hypoechoic surface, thickening of the walls;
• Ischemic colitis: inability to visualize layers, uneven thickening, reduced echogenicity;
• Acute appendicitis: the monitor screen shows a vermiform appendix 7 mm in diameter, the layers of the appendix do not differ from each other, the walls of the appendix are thickened asymmetrically, free fluid is visualized, increased echogenicity indicates an abscess;
• Diverticulitis (protrusion of the intestinal walls): at the site of the diverticulum, ultrasound “sees” a thickening of the wall more than 5 mm above normal, echogenicity indicates an abscess, the contours are uneven;
• Mechanical damage to the intestine: in addition to severe tension in the abdominal muscles, the patient’s echogenicity at the site of the hematoma is reduced, the walls at the site of damage are thickened;
• Oncology (cancerous or precancerous tumor): the external contours are uneven, the lumen is narrowed, peristalsis is impaired at the site of the tumor, lymph nodes of reduced echogenicity are visualized.

What are the advantages and disadvantages of ultrasound of the intestinal gastrointestinal tract?

Ultrasound diagnostics of the intestine is used for initial examination in case of suspected pathology, as well as in cases where the endoscopic method is contraindicated due to health conditionspatient (intestinal perforation (damage), inflammatory process).

Ultrasound examination of the intestines has a number of advantages:

• The patient does not experience psychological discomfort.
• The doctor receives information about the size of the organ, its structure, thickness, number of layers, without penetrating inside the organs.
• Ultrasound allows you to examine the inflamed intestines and clearly sees the upper gastrointestinal tract.
• Peristalsis is visualized in real time and intestinal obstruction is determined.
• On an ultrasound of the intestines, the specialist will see even small compactions or changes in the echostructure of tissues.
• Ultrasound allows you to do screening (endorectal method), completely confirm or refute oncology.

Despite the large number of advantages, diagnosing this organ with ultrasound has some disadvantages, the main one of which is the impossibility of making an accurate diagnosis without additional examination.

Also, the disadvantages of the method include the following:

• Only functional disorders in the functioning of the organ are detected.
• Structural changes are determined without defining the parameters of the changes.
• It is not possible to assess the condition of the internal mucous surface; if structural changes are detected, colonoscopy is prescribed - an endoscopic method

Tests and studies that complement intestinal ultrasound

As mentioned above, intestinal ultrasound is not 100% confirmation of a particular diagnosis, although in many ways the method is informative and accurate. Depending on the preliminary diagnosis, in addition to ultrasound, the patient is prescribed:

• Capsule examination. The patient swallows a capsule with a sensor inside, which conducts video surveillance and transmits the image to the monitor screen. The method allows you to see areas inaccessible to the endoscope. Significant advantages also include the absence of trauma (the intestinal walls are not scratched) and radiation (unlike X-rays).

The disadvantages of the capsule technique include the low prevalence of capsule examination, because the method was first tested in the USA in 2001, and today it is still not widespread. Its cost is very high, and this limits the circle of clients. Other disadvantages include the inability to conduct a capsule study in case of intestinal obstruction, infections, and peritonitis. The method has age restrictions associated with the peculiarities of peristalsis.

• Colonoscopy. This is an endoscopic method that allows you to examine the internal mucous membrane for polyps, colitis, tumors, Crohn's disease, inflammation and other pathologies. The disadvantage of this method is the risk of intestinal trauma and perforation (punctures of the walls). Colonoscopy also does not see tumors between the intestinal walls.
• Irrigoscopy. This is a special method aimed at identifying hidden tumors located between the inner and outer lining of the intestine. In addition, the method, unlike colonoscopy, sees areas on the folds of the intestine and its remote areas.

Irrigoscopy involves the introduction of a liquid solution of barium sulfate through the anus, which allows a clear contrast image to be obtained upon contact with air. The advantages of irrigoscopy are the ability to examine structural changes in tissue (scars, diverticula, fistulas). The method is used for diarrhea or constipation, mucus in the intestines, pain in the anus.

Ultrasound of the stomach is an important part of the gastrointestinal tract examination using ultrasound.

For a long time, ultrasound diagnostics was not used in the study of the stomach. This is due to the fact that the stomach is a hollow organ, and the air does not allow the normal ultrasound sensor to be fully used - special sensors are needed to examine the back walls. In addition, accumulated gases distort the displayed results. However, medicine does not stand still, and modern techniques already provide sufficient information to make an accurate diagnosis.

Sensors for studying the stomach appeared relatively recently, in the late 2000s. However, the speed and safety of scanning makes ultrasound examination of the stomach increasingly popular.

During an ultrasound examination, the doctor evaluates the organ according to the main indicators:

• Stomach volume.It is a hollow muscular organ that resembles a pouch. The volume of an empty stomach is 0.5 liters, and when full it stretches to 2.5 liters. The stomach reaches 18-20 cm in height and 7-8 cm in width. When filled, the stomach stretches up to 26 cm in length and up to 12 cm in width.
• Structure.Near the heart is the cardiac region, in which the esophagus passes into the stomach. On the left you can see the bottom of the organ, where air entering with food accumulates. The body of the stomach is the largest part, rich in glands that produce hydrochloric acid. The pyloric zone is the transition from the stomach to the intestine. There, partial absorption of substances received from food occurs.
• Structure.The walls of the stomach have a muscular layer that is responsible for contracting and promoting the food coma. The serosa is intermediate between the muscular and mucous layers. Lymph nodes and blood vessels accumulate in it. The mucous layer is covered with the finest villi, which secrete gastric juice produced by the glands.
• Blood supply.The circulatory system covers the entire organ. The organ is supplied with venous blood by three main vessels: the left, hepatic and splenic. The venous network runs parallel to the arterial network. Various bleeding occurs when the gastric mucosa is damaged (ulcers, tumors).

How is an ultrasound of the stomach performed?

Preparation for an intestinal ultrasound is similar: the patient adheres to a strict diet for 3 days, and the night before, from 18.00, does not eat any food. If there is a tendency to form gas, the patient drinks 2 capsules of Espumisan before bed. In the morning, half an hour before the procedure, you should drink a liter of water so that the walls of the stomach straighten.

There is also a method of ultrasound examination with contrast. Water is an excellent conductor of ultrasound, and without it, scanning an organ is somewhat difficult.

The procedure is carried out on an empty stomach. The doctor assesses the condition and thickness of the walls on an empty stomach, looking for the presence of free fluid. Then he asks the patient to drink 0.5-1 liter of liquid, and uses an ultrasound machine to evaluate changes in the expanded stomach. A third ultrasound scan is performed 20 minutes later when the stomach begins to empty. The doctor evaluates the motility of the organ and the rate of fluid loss. Normally, a glass of water (250 ml) comes out of the stomach in 3 minutes.

The patient lies on the couch on his side, the specialist applies gel to the peritoneal area and moves the sensor over the surface. Periodically, he tells the patient to change position or change his posture slightly. The doctor pays attention to the following indicators:

• position of the stomach and its size
• Has the mucous surface of the stomach expanded?
• is there thickening or thinning of the walls
• what is the state of the circulatory system of the stomach?
• contractility of the stomach
• are there inflammations and neoplasms?

The entire examination takes a maximum of 30 minutes and does not cause discomfort or pain. Ultrasound, unlike FGDS, is much easier to tolerate for children and the elderly.

Advantages and disadvantages of ultrasound of the stomach when examining the gastrointestinal tract

The doctor prescribes an ultrasound examination of the stomach to the patient as a primary auxiliary diagnostic method.

The advantages of ultrasound are as follows:

• the exit section most susceptible to diseases is examined;
• ultrasound “sees” any foreign bodies in the cavity;
• Ultrasound accurately assesses the thickness of the walls of the organ;
• thanks to the method, venous blood flow is clearly visible;
• using diagnostics, benign and malignant tumors of minimal size are identified;
• stomach ulcers are well assessed;
• the degree of inflammation of the gastric mucosa varies;
• the method allows you to see reflux disease - the reflux of the contents of the lower sections back into the stomach;
• the organ is examined from different points and in different sections, which is impossible with x-rays;
• Ultrasound sees what is happening in the thickness of the stomach wall;
• thanks to the echo structure, ultrasound can easily distinguish a polyp from an oncological neoplasm;
• in addition to diagnosing the stomach, ultrasound diagnostics reveals concomitant pathologies of other organs (usually with gastritis, diseases of the biliary tract and pancreas develop);
• Ultrasound is performed on newborns and small children for whom it is impossible to undergo an FGDS or x-ray.

The main advantage of ultrasound over FGDS is the ability to detect forms of cancer developing in the thickness of the organ wall (infiltration forms), which cannot be detected using fibrogastroscopy.

Despite all the advantages, ultrasound has some disadvantages that do not allow the method to become widespread as an independent examination of the stomach.

The disadvantages include the following:

• Unlike endoscopic examination, ultrasound does not allow tissue samples to be taken for further study (for example, gastric juice;
• scraping of the mucous membrane, tissue biopsy);
• Ultrasound cannot assess the degree of changes in the mucous membrane;
• limitation of the areas studied (it is possible to examine only the outlet zone of the stomach).

What does ultrasound of the stomach reveal when examining the gastrointestinal tract?

The ultrasound method is not the most popular when examining the gastrointestinal tract, but it makes it possible to obtain very important information.

The stomach is an extension of the digestive canal in the form of a bag. It is a hollow organ whose walls have an outer muscular layer and an inner mucous layer. The mucous membrane is rich in glands that produce gastric juice and hydrochloric acid, as well as enzymes. With their help, incoming food is softened and treated with a natural antiseptic. The stomach is separated from the esophagus by the sphincter, and from the duodenum by the pylorus.

The organ is examined by ultrasound in two ways:

• Transabdominal (through the walls of the peritoneum). It is carried out with different sensors, but the results always require additional confirmation.
• Probe (sees the stomach from the inside). Used extremely rarely.

When conducting a study using a sensor, the specialist pays attention to the following:

• thickness, folding, structure of the mucous membrane (are there any neoplasms, bulges, or irregularities on it);
• thickness of the muscle layer (expansion or thinning indicates pathology);
• the integrity of the gastric wall (are there any perforations, ulcers or neoplasms);
• amount of free fluid (indicates inflammation);
• peristalsis, motility and contractility of the stomach;
• transitional sections of the stomach (sphincter and pylorus, their features
• functioning).

It is worth noting that ultrasound of the stomach and duodenum is significantly inferior in its informative value to the more popular method known as FGDS. But in some cases, other research methods are unacceptable for the patient due to health conditions or fear of a traumatic procedure.

Transabdominal examination identifies three layers of the gastric wall: hyperechoic mucosal layer (1.5 mm), hypoechoic submucosal layer (3 mm) and hyperechoic muscular layer (1 mm). With the probe research method, 5 layers up to 20 mm thick are determined.

Ultrasound diagnostics of the stomach allows us to identify the following pathologies

Symptoms	Possible disease
Swelling of the antral mucosa	Acute pancreatitis, nephrotic syndrome (kidney damage)
Thickening of the stomach wall, uneven rounded neoplasm, rich in blood vessels, no boundaries between layers, no peristalsis	Carcinoma (malignant tumor) with distant metastases
Lack of boundaries between layers, narrowing of the pyloric lumen	Pyloric stenosis (narrowing of the pylorus due to scarring caused by an ulcer)
Changes in the echostructure of the stomach walls, the walls are expanded, the contours are uneven	Neuroma (tumor developing from the tissues of the peripheral nervous system), leiomyoma (benign tumor of the smooth muscles of the stomach), adenomatous polyp
Expansion of the abdominal region (compared to the norm) after filling the stomach with water, splitting of the echo signal, the presence of hypoechoic inclusions, stagnation of fluid in the cardiac region	Gastroesophageal reflux (reflux of intestinal contents back into the esophagus)
Small amount of fluid, rapid release of fluid from the stomach, changes in the contour of the stomach	Diaphragmatic hernia
Dense hyperechoic formations with a clear structure, the boundaries between the layers are clearly visible, the echogenicity of the mucous and muscle layers is not changed	Cystic formations
Uncertain changes recorded by ultrasound	Affected hollow organ syndrome. This diagnosis requires mandatory confirmation by other types of research (CT, MRI, FGDS, X-ray).
Anechoic crater-like areas on the inner wall of the stomach	Stomach ulcer

Ultrasound scanning of different parts of the stomach

Thanks to ultrasound, the doctor assesses the condition of the following areas of the organ:

Bulbar or duodenal bulb. This part of the organ is located in the area where the stomach exits, and controls the flow of contents processed by gastric juice into the intestinal lumen. With intestinal diseases, ulcers and sites of inflammation form on the bulb. The main reasons for duodenal ulcers are increased acidity and the bacterium Helicobacter pylori, which begins to actively multiply under such conditions.

The study is carried out in real time with a linear or convex sensor with a frequency of 3.5-5 MHz. To detail the condition of the walls, sensors with a frequency of 7.5 MHz are used, but they are ineffective for obese patients with developed subcutaneous fat.

If a patient is diagnosed with a gastric and duodenal ulcer, then in most cases the walls of the bulb are affected. On ultrasound, this is reflected by anechoic areas, because, unlike healthy walls, the ulcer does not reflect ultrasound.

The diagnosis of “stomach and duodenal ulcer”, if zones of anechoicity are identified on ultrasound, is made conditionally. Additionally, the condition of the walls of the bulb is assessed (they have a mucous structure with longitudinal folds). The normal thickness should be no more than 5 mm, and in the antrum (the transition of the stomach into the duodenum) - up to 8 mm. With thickening, we are not talking about an ulcer, but about an oncological neoplasm. The patient will need additional research: endoscopic with sampling of material for biopsy.

Due to the fact that ultrasound is not able to establish an accurate diagnosis, the patient is given a preliminary diagnosis of “anechoic areas”, and then he is sent for fibrogastroduodenoscopy. It is this method that makes it possible to take tissue from the wall of the bulb to determine the nature of the pathology. FGDS also allows you to assess the condition of the organ’s vessels.

Pyloric canal or pylorus of the stomach.This is a slight narrowing at the junction of the bulb and the duodenum. It consists of smooth muscle walls 1-2 cm long, located both in the annular and transverse directions. Normally, there is some curvature of the canal. Ultrasound can detect diseases such as polyps, stenosis (narrowing), ulcers, and pyloric spasm.

Sphincter (cardia)- This is the border between the peritoneum and the esophagus. Normally, the sphincter opens only after eating, and remains closed the rest of the time. Due to its functional significance, the sphincter has a stronger muscular layer than the stomach, which allows it to open and close like a valve. When eating, the sphincter closes the exit from the stomach, allowing food to be digested. But as a result of increased acidity and other pathologies, the organ ceases to function normally, and the contents of the stomach enter the esophagus.

Pathology detected: should it be rechecked?

Ultrasound of the stomach and intestines is very informative, but it is impossible to make a diagnosis based on the data obtained. If problems are detected, the patient undergoes additional examination. The most popular methods for examining the gastrointestinal tract include:

• FGDS. This is an endoscopic method that allows you to see bleeding, tumors in the stomach and intestines.
• Probing. It involves taking the contents of the stomach for further laboratory testing.
• Gastropanel. This is an innovative method, according to which the patient is drawn from a vein, and a possible ulcer, atrophy, or cancer is detected using certain markers.
• CT scan. They take cross-sectional images in different projections and identify the location of tumors, hematomas, hemangiomas, etc.
• MRI. This is the most expensive and effective research method. Allows you to visualize not only the organ itself, but also nearby lymph nodes and blood vessels.
• Endoscopy. Used when collecting material for biopsy.
• X-ray. Reveals incorrect location of the stomach and intestines relative to other organs, pathology of shape, and various neoplasms.
• Parietography. Translucent the walls of the stomach and intestines thanks to the injected gas.
• Laboratory tests (blood, urine, stool tests).

After undergoing additional diagnostics, the doctor decides on treatment methods. It is important to understand that treatment of the gastrointestinal tract cannot be done in a “mono” mode - it is always a set of measures associated with restoring health and preventing relapses and complications. You can also monitor the quality of treatment using ultrasound, comparing previous results of a gastrointestinal tract examination with new ones.