Diagnosis of chronic gastritis: what is the patient's examination plan. What tests are taken for gastritis, and how is gastritis diagnosed? Phlegmonous gastritis anamnesis clinic laboratory tests

Currently, the world medicine has practically abandoned the clinical diagnosis of chronic gastritis. This name is now understood only as structural changes in the gastric mucosa, observed under a microscope in both sick and healthy people, usually caused by the action of Helicobacter pylori infection. And although in the ICD-10 chronic gastritis is nevertheless isolated as a separate disease and has the K29 code, its diagnosis does not give a doctor a reason to prescribe treatment to any patient with external signs of the disease, but without complaints.

Currently, if the patient has the appropriate, it is customary to talk about the presence of functional dyspepsia; if there is a stomach ulcer, pancreatitis, bile reflux and other diseases, we are already talking about organic dyspepsia. Modern drug regimens are focused primarily on relieving heartburn, pain, nausea, and not on eliminating microscopic signs of stomach inflammation.

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

Changes in the stomach wall

A cascade of morphological changes in the gastric mucosa begins with the colonization of the Helicobacter pylori bacterium or with the action of another. A superficial pathological process develops, which gradually progresses. In 1 - 3% of patients, during the year, the processes of atrophy begin, that is, the death of cells of the gastric mucosa. They are replaced by cells resembling intestinal epithelium - intestinal metaplasia develops, and then epithelial dysplasia. This condition is already precancerous.

Out of hundreds of patients with an infectious form of the disease, epithelial dysplasia will occur in 10, and in 1 - 2 people will develop stomach cancer. Up to 90% of all cases of this malignant tumor are associated with changes in the gastric mucosa caused by infection. Eradication (destruction) of Helicobacter makes it possible to stop or even reverse the processes of atrophy and dysplasia and thereby prevent cancer. That is why the morphological confirmation of the diagnosis of chronic gastritis is so important.

At the same time, we note that the severity of the symptoms of the disease does not depend on the state of the stomach wall. Therefore, it is the diagnosis of "functional dyspepsia" with an indication of the type of complaints that helps to choose the right medication. Quite often, the same person has both of these conditions, different in nature and methods of treatment.

Stages of gastritis diagnosis

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

The second stage in the diagnosis is the determination of the endoscopic characteristics of the disease. There are such types of pathological process:

surface;
with flat or raised erosions (superficial damage to the mucous membrane);
hemorrhagic (with bleeding);
hyperplastic (with thickening of the mucous membrane);
reflux gastritis with the reflux of the contents of the duodenum into the stomach.

Diagnostics of the atrophic variant is complemented by the determination of the stage of atrophy according to the OLGA system. This classification is based on a histological assessment, that is, the study of tissue pieces obtained with EGD under a microscope.

Laboratory diagnosis of chronic gastritis

After evaluating the complaints and anamnesis of the patient, he is assigned some laboratory tests. Mandatory of them is only one - a rapid urease test of biopsy material of the gastric mucosa. With FGDS, a piece of tissue is taken, then it is placed in a special solution of reagents and it is determined by the color change, whether the material contains Helicobacter pylori or not.

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

Respiratory urease test

Additional methods for diagnosing chronic gastritis, depending on its form and concomitant diseases:

Instrumental methods for the diagnosis of gastritis

The main method for diagnosing chronic gastritis is fibrogastroduodenoscopy (FGDS) with biopsy and subsequent histological and cytological examination of the material obtained under a microscope.

During an external examination, the doctor can distinguish between the main signs that allow the differential diagnosis of infectious and atrophic autoimmune gastritis, as well as peptic ulcer:

redness and hemorrhage in the mucous membrane is a sign of superficial antral inflammation;
pallor, thinning, translucent vessels are a diagnostic sign of an atrophic process.

Microscopic examination for antral superficial gastritis is characterized by inflammatory infiltration (saturation of immune blood cells), and for atrophic - intestinal metaplasia with atrophy of the gastric glands.

Additionally, the following can be assigned:

study of gastric acidity, or intragastric pH-metry in severe atrophic lesions;
X-ray examination of the stomach with barium - in case of refusal or contraindications to FGDS, as well as in case of pyloric stenosis (narrowing) (pyloric stenosis).

With a multifocal atrophic variant of the disease, consultation with an oncologist is necessary, with anemia - with a hematologist, with neurological symptoms of vitamin B12 deficiency (paresthesia, sensitivity disorders, and others) - examination by a neurologist.

Differential diagnosis of different forms of gastritis

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

Chronic antral gastritis associated with Helicobacter pylori infection

Symptoms:

heartburn;
pain on an empty stomach;
stool disorders.

Patients are characterized by eating dry food, in a hurry, the predominance of spicy, fried, smoked food, carbonated drinks, as well as the presence in the family of cases of gastritis or ulcers. There is slight bloating and mild soreness in the upper abdomen. Blood tests are normal.

With EGD, signs of inflammation with damage mainly to the antrum are determined, the urease test is positive.

Chronic atrophic multifocal gastritis

Symptoms associated with impaired absorption of food predominate: diarrhea, weight loss, nausea, and sometimes vomiting. Characterized by irritability, a tendency to consider oneself very sick, fear of cancer, sweating, weakness, palpitations. When palpating the abdomen in its upper section, moderate, but rather large soreness is determined. The appearance of the tongue changes: it either becomes covered with a thick white bloom, or becomes shiny and smooth, as if varnished.

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

With EGD, a common pathological process is revealed that affects not only the antrum, but also the body of the stomach. An intragastric acidity measurement reveals a reduced amount of hydrochloric acid (hypo- or achlorhydria, what was previously called "low acidity"). The urease test is usually positive. Microscopic examination of the biopsy specimen shows signs of intestinal metaplasia, atrophy, colonization by Helicobacter.

Chronic autoimmune atrophic gastritis

The main part of complaints is associated with the deficiency of the Castle factor, which occurs in this form of the disease, a substance that ensures the absorption of vitamin B12. As a result, there are signs of the corresponding hypovitaminosis:

weakness, shortness of breath, palpitations;
burning of the tongue;
loss of appetite, weight loss;
persistent diarrhea;
numbness and weakness in the limbs;
irritability and more severe mental disorders, up to dementia.

The patient often has an enlarged liver. The analyzes note:

macrocytic hyperchromic anemia;
an increase in indirect bilirubin;
antibodies to parietal cells;
a decrease in the level of pepsinogen I;
increased gastrin levels.

When FGDS is determined by atrophy of the stomach wall, its polyps. Microscopy shows a combination of inflammation, intestinal metaplasia, and the absence of parietal cells. The acidity of the gastric juice is reduced. The urease test is usually negative. An ultrasound scan reveals an enlargement of the liver, less often the spleen.

Differential diagnosis of antral gastritis

Diagnosis of hyperacid, erosive and other forms of superficial gastritis should be carried out taking into account the fact that similar symptoms are observed in some common diseases of the gastrointestinal tract. Here are the main differential diagnostic signs of these diseases in the table.

Antral gastritis

Functional dyspepsia

Stomach ulcer

Chronic pancreatitis

Pain characteristic

Short-term pain, usually on an empty stomach, often heartburn after eating

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

Pain above the navel, at night, "hungry"

Girdle pain, mainly on the left and in the lumbar region

Additional diagnostics

EGD - signs of inflammation

Positive urease test in most patients

EGD without pathological changes

On FGDS - ulcerative defect on the wall of the stomach

EGD without pathology, the main changes are noted with ultrasound of the pancreas.

Differential diagnosis of atrophic gastritis

Diagnosis of hypoacid gastritis is also carried out taking into account other possible diseases, but their list is different than with antral lesions.

	Multifocal option	Autoimmune variant	Stomach ulcer	Stomach cancer
The main symptoms	Nausea, belching, heaviness in the abdomen, uncommon pain	There are signs of anemia (weakness, dizziness, shortness of breath) and impaired sensitivity ("creeping" in the lower extremities	Nausea, vomiting, heartburn, pain on an empty stomach and an hour after eating, weight loss, lack of appetite	Nausea, vomiting, weakness; pain is uncommon; aversion to food, especially meat, drastic weight loss to exhaustion
Additional diagnostics	EGD: signs of mucosal atrophy, urease test is negative, the level of gastrin in the blood is increased, the level of pepsinogen is reduced - I	Signs of anemia in the blood (a decrease in the amount of hemoglobin and erythrocytes, macrocytosis), a decrease in the number of platelets and leukocytes, an increase in indirect bilirubin, alkaline phosphatase and LDH in blood biochemistry; in the study of acidity - its pronounced decrease	EGD: signs of a peptic ulcer. A positive reaction to occult blood in the stool. In the blood - signs of iron deficiency anemia. In the study of acidity, it is normal or moderately reduced	In the blood there are signs of hypochromic anemia, ESR increases. FGDS shows a tumor. A positive reaction to occult blood in the stool. The acidity is significantly reduced.

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Ministry of Health of the Republic of Buryatia

GAOU SPO "Republican basic medical college

them. E.R. Radnaev "

Course work

Theme:Diagnosticschronic gastritis

Ulan - Ude, 2015

Introduction

Gastritis is an inflammation of the gastric mucosa, in which there is a violation of the restoration of the mucous membrane, the secretion of gastric juice changes and the contractile activity of the stomach is disturbed.

Over the past 20 years in the Russian Federation, there has been an increase in the proportion of stomach diseases in the structure of diseases of the digestive system, among which chronic gastritis dominates.

Chronic gastritis is a polyetiological disease, characterized by an inflammatory process in the gastric mucosa, accompanied by morphological changes in the latter (atrophy, impaired regeneration), impaired motor, secretory and endocrine functions of the stomach and a specific clinical picture. Simultaneously with inflammation of the stomach in chronic gastritis, other internal organs are also affected, that is, the disease is not local, but general, systemic.

Chronic gastritis is one of the most common human diseases. It affects from 30 to 85% of the working-age population of industrially developed countries, and the incidence is high in childhood. It is believed that the prevalence of chronic gastritis depends on race, place of residence and age. Chronic type A gastritis is quite rare (about 10% of all atrophic gastritis), mainly in two age groups: the elderly and children. Chronic type B gastritis accounts for about 90% of all chronic gastritis, and young and middle-aged men suffer from it much more often than women, but after 60-65 years, these differences disappear.

The urgency of the problem is not limited to the widespread prevalence of chronic gastritis. The disease is dangerous due to its etiological relationship with stomach cancer and ulcers. And although the prognosis for chronic hepatitis is generally favorable, the disease negatively affects the QOL indicators of patients, their ability to work and socio-psychological adaptation. In addition, the long course of the disease is accompanied by dysfunction of other digestive organs, as well as the formation of actual psychogenias, persistent inadequate reactions of the psyche to the disease and personality disharmony.

To study the diagnosis of chronic gastritis according to literary sources.

1. Study the prevalence

2. To study the etiology and pathogenesis

3. Study the classification according to ICD 10

4. Find out the symptoms, diagnosis, complications

DISTRIBUTION

Chronic gastritis - chronic inflammation of the gastric mucosa - is one of the most "popular" stomach diseases in our country. Almost all patients and a significant part of doctors put an equal sign between the symptoms of gastric dyspepsia (belching, heartburn, nausea, vomiting, stomach overflow after eating and pain in the epigastric region) and the diagnosis of gastritis. Therefore, to the question of the patient: "What diseases do you have or have been sick before?", In 8 cases out of 10 they note "chronic gastritis". This is partly due to the fact that the diagnosis of the disease in most cases is carried out clinically, i.e. on the basis of complaints, without the use of instrumental research methods.

About 50% or even more of the working-age population of developed countries suffers from this disease, and with age, the incidence increases markedly.

ETIOLOGY

By etiology, chronic gastritis is divided into three main forms:

Type B (bacterial) - antral gastritis associated with seeding of the gastric mucosa with Helicobacter pylori bacteria

Type C (chemical) - develops as a result of the throwing of bile into the stomach with duodenogastric reflux

Type A (autoimmune) - fundic gastritis; the inflammation is caused by antibodies against the lining cells of the stomach.

In addition, there are also mixed - AB, AC and additional (medicinal, alcoholic, etc.) types of chronic gastritis.

Topographically distinguish:

Gastritis of the body of the stomach

Gastritis of the antrum

Gastritis of the fundic stomach

Pangastritis

In 1990, at the World Congress of Gastroenterology in Sydney (Australia), the following main characteristics of the "Sydney system" of classification of gastritis were adopted:

Etiological characteristics:

Autoimmune gastritis type A;

HP-associated - bacterial gastritis - type B;

Reactive gastritis - type C.

Topographic characteristics:

Antral gastritis;

Fundal gastritis;

Pangastritis.

Chronic gastritis very often occurs in patients with gastroenterological pathology. In this case, it will be expressed by inflammation of the gastric mucosa; accompanying factors - impairment of motor, secretory and some other functions. Very often, chronic gastritis develops against the background of appendicitis, chronic cholecystitis or colitis.

If gastritis proceeded in an acute form and was not completely cured, then as a result of further development, it can turn into a chronic form. But in most cases, chronic gastritis is caused by such external factors as prolonged malnutrition (deficiency of vitamins, protein, iron, etc.), the use of spicy, too hot or rough food, a violation of the diet, etc.

Chronic gastritis can be caused by certain factors present inside the human body. Some diseases of internal organs (kidney disease, gout, etc.) lead to the fact that the gastric mucosa begins to secrete uric acid, urea, indole, skatole, etc. Metabolic disorders, which also lead to the development of chronic gastritis, are provoked by such diseases like diabetes and obesity. Diseases of the gallbladder, pancreas and thyroid glands also lead to all sorts of disorders and changes in the state of the gastric mucosa.

Prolonged exposure to irritating factors leads to functional secretory and motor disorders of the stomach, which, in turn, leads to inflammation, dystrophy, disruption of the regeneration process in the epithelium of the surface of the layers of the gastric mucosa. These areas in the future can atrophy or completely rebuild.

PATHOGENESIS

Chronic gastritis most often develops as a result of constantly existing violations of a balanced diet (both quantitatively and qualitatively): non-observance of the food intake, constant consumption of dry, poorly chewed, too hot or cold, fried, spicy foods, etc. Chronic gastritis can develop with prolonged use of certain drugs (for example, glucocorticoids, NSAIDs, antibiotics, sulfonamides). In recent years, they attach importance to hereditary predisposition, since chronic gastritis is more often detected in children with a family history of gastrointestinal diseases. Helicobacter pylori plays a significant role in the development of chronic gastritis. This microorganism is often detected in other family members of a sick child. Helicobacter pylori is able to break down urea (with the help of the urease enzyme), the resulting ammonia affects the surface epithelium of the stomach and destroys the protective barrier, opening the gastric juice access to the tissue, which contributes to the development of gastritis and ulcerative defect of the stomach wall.

CLASSIFICATION ICD 10

K29.0 Acute hemorrhagic gastritis

Acute (erosive) gastritis with bleeding Excludes: erosion (acute) of the stomach (K25.-)

K29.1 Other acute gastritis

K29.2 Alcoholic gastritis

K29.3 Chronic superficial gastritis

K29.4 Chronic atrophic gastritis

Mucosal atrophy

K29.5 Chronic gastritis, unspecified

Chronic gastritis: antral. fundamental

K29.6 Other gastritis

Gastritis hypertrophic giant Granulomatous gastritis Menetrie's disease

K29.7 Gastritis, unspecified

K29.8 Duodenitis

K29.9 Gastroduodenitis, unspecified

The most widespread in our country is the classification of chronic gastritis, proposed by S.M. Ryss (1966). According to this classification, chronic gastritis is divided into:

1. On the etiological basis:

a) primary (exogenous):

b) secondary (endogenous);

2. By morphological characteristics:

a) superficial gastritis;

b) gastritis with damage to the glands without atrophy;

c) atrophic gastritis (moderate and severe, with intestinal restructuring):

d) hypertrophic gastritis;

3. By localization:

a) widespread (pangastritis);

b) limited (antral or fundal);

4. On a functional basis:

a) with normal (or increased) secretion;

b) with secretory insufficiency (moderate or severe);

5. According to clinical signs:

a) exacerbation phase;

b) the phase of remission.

Special forms of chronic gastritis: rigid, giant hypertrophic (Menetrie's disease), polyposis, erosive (hemorrhagic), eosinophilic (allergic).

The development of chronic gastritis is based on a genetically determined defect in the restoration of the gastric mucosa, damaged by the action of stimuli.

There are two main forms of the chronic course of the disease: superficial and atrophic gastritis. For the first time, these terms, based on the results of endoscopic studies of the gastric mucosa, were proposed in 1948 by the German surgeon R. Schindler. These terms have received universal recognition and are reflected in the ICD-10 classification of gastritis. The division is based on the factor of preservation or loss of normal glands, which has obvious functional and prognostic significance.

CLINICAL PICTURE

Many gastroenterologists believe that chronic gastritis is not accompanied by a typical clinical picture. However, a carefully collected anamnesis (medical history, its manifestations) in many cases makes it possible to distinguish, perhaps, not very bright, but characteristic signs of this disease (for all forms). The clinic of chronic gastritis is often manifested by pain syndrome, gastric dyspepsia, but it can be asymptomatic. The general condition of the patient with chronic gastritis in most cases does not suffer.

This is a fairly characteristic symptom of chronic gastritis. Pains are observed after eating, and are associated with a certain type of food, less often they appear on an empty stomach, at night or regardless of food, they are dull, aching in nature, do not radiate, intensify when walking and in a standing position. Acute paroxysmal pain is not characteristic of chronic gastritis, their appearance should be alarming regarding the development of any complications (peptic ulcer, etc.). Sometimes in patients, even after taking a small amount of food, there is a feeling of pressure in the stomach, a feeling of fullness in the stomach. In rare cases, the pain may be more intense (with erosive gastritis). In a few cases, the pain syndrome in children is mild. Sometimes the pains have the character of a crisis - sharp and severe pain in the epigastric region, which is preceded by profuse indomitable vomiting. In a number of patients, the pain syndrome resembles a peptic ulcer (pain occurs 1 1/2 to 2 hours after eating, on an empty stomach and at night). Half of patients with chronic gastritis have no pain syndrome. The asymptomatic course is especially characteristic of the secondary forms of the disease.

Gastric dyspepsia

It includes decreased appetite, unpleasant taste in the mouth, belching, nausea, bloating, rumbling and transfusion in the abdomen. This syndrome is caused by impaired gastric digestion and absorption due to insufficient secretion of gastric juice, enzymes and hormones formed in the gastric mucosa. Constipation and a tendency to them are more often observed in patients with Helicobacter pylori gastritis and with high or normal gastric secretion, and flatulence, rumbling and a tendency to loose stools, periodic diarrhea after taking milk or fats - in patients with reduced secretion. Often, the tongue in patients with chronic gastritis is coated with a white or yellow-white bloom with imprints of teeth on its lateral surface.

HYPOVITAMINOSIS SYNDROME

It is a consequence of insufficient digestion and absorption and is manifested by signs of a deficiency of various vitamins, more often group B (cracks and seizures in the corners of the mouth, increased flaking of the skin, premature hair loss, brittle nails).

ASTENO-NEUROTIC SYNDROME

It is often determined in patients with chronic gastritis. It is characterized by increased irritability, suspiciousness, sweating, paresthesias (disorders of skin sensitivity, "creeping"), chilliness of the extremities, neurogenic pain in the heart, etc.

ELECTROLYTIC BALANCE DISORDER SYNDROME

It is observed mainly in atrophic gastritis with reduced gastric secretory function. Depending on the specific features, there may be a deficiency of potassium (accompanied by malnutrition of the heart muscle and changes in the ECG), calcium (characterized by osteoporosis, fragility of bones), iron (iron deficiency anemia).

ENDOCRINE INSUFFICIENCY SYNDROME

It occurs with gastritis not so often, very variable, often mild. Sometimes it manifests itself as a violation of sexual function, especially in men.

FEATURES OF SOME FORMS OF GASTRIT

Chronic superficial gastritis with normal or increased gastric secretion

It is more often found in young and middle age, mainly in men. It is characterized by intense pain in the epigastric region that occurs on an empty stomach, heartburn, sometimes sour belching, a feeling of heaviness in the epigastric region after eating. Constipation is often observed in patients with this form of gastritis.

CHRONIC EROSIVE GASTRITIS

It is characterized by the presence of numerous superficial ulcerations of the gastric mucosa with frequent latent gastric bleeding, which leads to moderate anemia. Epigastric pain, heartburn, belching may be present, but sometimes absent. The main importance in the diagnosis of this form of gastritis is endoscopic examination of the stomach (gastroscopy) and a clinical blood test (decrease in hemoglobin and the number of erythrocytes).

CHRONIC ATROPHIC GASTRITIS WITH LOWERED ACIDITY

This is the most common form of gastritis. It usually diffusely affects the entire gastric mucosa. The main clinical symptoms: unpleasant taste in the mouth, decreased appetite, nausea, especially in the morning, belching with air, a feeling of rumbling and transfusion in the stomach after eating, stool disturbances, more often diarrhea, sometimes constipation. With a long course in severe cases of the disease, weight loss, polyhypovitaminosis (insufficient absorption of various vitamins), dysfunction of the endocrine glands (general weakness, hypotension, impaired sexual function), hypochromic anemia, etc.

Chronic atrophic gastritis with secretory insufficiency is often accompanied by enteritis, colitis (inflammation of the small and large intestines), pancreatitis, cholecystitis and other chronic inflammatory diseases of the digestive system. The occurrence of these concomitant intestinal dyskinesias and inflammatory lesions of other organs of the digestive system is explained, on the one hand, by upset gastric digestion, accelerated intake of insufficiently digested food masses into the intestine and pathological reflexes of its mucous membrane, and on the other hand, by a violation of the production of special hormones (which are synthesized in mucous membrane of the stomach and intestines), regulating the functions of the digestive system.

CHRONIC HYPERTROPHIC GASTRITIS

Complaints in this form of gastritis are not of any specific nature and may coincide with complaints in other forms of gastritis (pain, belching, nausea, etc.). The main criterion for making such a diagnosis is gastroscopic examination, which reveals a sharp thickening and increase in the folds of the gastric mucosa and hypertrophy of the glands.

CHRONIC HELICOBACTERIC GASTRITIS

This form of gastritis, as we have already noted, is caused by the microbial pathogen Helicobacter pylori. The clinical picture of this form is dominated by the following complaints: general weakness, feeling of heaviness, overcrowding in the stomach, dull pain in the epigastric region, unpleasant taste in the mouth, loss of appetite, belching with air, unstable stools. The onset of Helicobacter pylori gastritis can sometimes manifest itself as ulcerative symptoms: moderate hunger pains, night pains, nausea and even vomiting after eating, sour belching and heartburn. These symptoms are caused by increased gastric secretion and motor-evacuation disorders that occur immediately after infection with this type of bacteria.

COMPLICATIONS

The complications that can arise as a result of the development of chronic gastritis are worth mentioning separately, since they can be quite serious and lead to death. Although with timely, systematic and correct treatment, many undesirable and destructive consequences can be avoided and even achieved complete recovery.

There are the following possible complications caused by the development of the disease:

1. Increased atrophy and achilia.

2. Transformation into a peptic ulcer.

3. Transformation into cancer.

Among the possible complications, five most likely groups are noted:

1. Anemia. It develops with erosive and atrophic gastritis.

2. Bleeding. Occurs with erosive gastritis.

3. Pancreatitis, cholecystitis, hepatitis, enterocolitis. These diseases can occur in connection with the exacerbation or development of some forms of chronic gastritis.

4. Pre-ulceration and ulcer. Especially likely with pyluroduodenitis.

5. stomach cancer. Any form of advanced chronic gastritis can lead to this disease. It has already been proven that cancerous tumors first of all appear in patients with primary lesions of the antrum and anthrocardial expansion (on the border between healthy and diseased cardiac expansion, as well as on the border between healthy and diseased tissue). In addition, if there have already been cases of cancer in the family, then the risk of this complication increases by 4 times. The first signs of the development of a cancerous tumor are the following: causeless weakness, fast food saturation, impaired appetite, a change in the nature of a pre-existing symptom, the appearance of a syndrome of small signs. The absence of an immunological reaction and the II blood group Rh + can also serve as signs of early cancer.

DIAGNOSTIC METHODS

There are several main types of examination for gastritis:

1. Objective.

2. Non-invasive diagnostics (clinical analysis of blood, feces for the Gregersen reaction, etc.).

3. Invasive diagnosis (histological method, rapid urease and enzyme immunoassay tests, phase contrast microscopy and bacteriological method).

4. X-ray.

5. Probe diagnostics (histamine test).

6. Fibrogastroscopy (FGS) and fibroesophagogastroduodenoscopy (FEGDS).

7. Thermography.

Objective diagnosis

Objective diagnosis gives little information, since it relies only on the external symptoms of gastritis - such as severe weight loss, pale skin, etc. In chronic autoimmune gastritis with a syndrome of poor digestion and absorption, bleeding of the gums, premature baldness, brittle nails, dry skin are observed especially in the corners of the mouth), hyperkeratosis, white or yellow coating on the tongue. With Helicobacter pylori gastritis, painful sensations arise during palpation.

Increased sleepiness and fatigue are observed with autoimmune gastritis. In this case, the patient quickly loses weight, appetite sharply decreases, symmetrical paresthesias appear in the extremities. In addition, pallor of the skin, plaque on the tongue and palate, and some symptoms of a neurological nature are observed. In some cases, there are problems with vision, often there is a burning sensation of the tongue and mouth.

A more accurate diagnosis can be made only after a deep examination using additional diagnostic methods.

Non-invasive diagnosis.

This method is based on the study of analyzes of feces, blood, exhaled air serum. This type of examination includes a breath urease test using labeled urea and an enzyme-linked immunosorbent assay (Read-Fast Test).

The enzyme immunoassay is indirect and refers to rapid tests. This method of examination allows detecting antibodies to the bacteria Helicobacter pylory (Hp) in the patient's blood. The results of analyzes are established very quickly, this does not require laboratory conditions and complex apparatus for special processing. However, the presence of antibodies in the body cannot serve as absolute proof of the development of infection in the human stomach. In addition, in the early stages of infection, tests do not give any results. These tests are usually used during mass research (during an outbreak of epidemics, etc.).

Invasive diagnosis.

The histological method, as bacteriological and rapid urease, as well as phase contrast microscopy, refers to an invasive diagnostic method. These tests are based on the study of the mucous membrane and gastroduodenal zone of the stomach with the detection of Hp bacteria in the human stomach. A biopsy of the gastric mucosa is examined.

The histological method is considered the most effective in diagnosing Helicobaccidal infection and at the same time, simple in terms of implementation. The test does not deteriorate during transportation and storage, and the study of the results obtained can be carried out under normal conditions without any special laboratory apparatus.

The method of rapid urease test is that a substance is injected into the stomach, which leads to an increase in the pH of the medium, certain results affect the color change. The test can take several minutes, and sometimes a day. Effective results are obtained only if the patient is infected and the bacteria are actively spreading. The test is very easy to perform and has a high guarantee of Hp bacteria detection.

In practice, several types of rapid urease test are used: CLOtest (Delta West Ltd, Bentley, Australia); Denol-test (Yamanauchi); Pyloritek (Serin Research Corporation, Elkhart, India); Hpfast (GI Supply, Philadelphia, USA).

In case of severe infection of the gastric mucosa, the test results are ready after 1 hour (+++). With moderate infection after 2 hours (++). With a minor infection, the test will give results after 2 hours or after a day (+). To be sure of a negative test result (-), it is necessary to wait for the color change to appear for more than 24 hours.

Phase contrast microscopy can detect the presence of the Hp bacteria in the human body in a matter of minutes. This test has high accuracy, since the study of the results is carried out in laboratory conditions in an endoscopic room using a phase contrast microscope. The fresh biopsy obtained during the study is placed on a special glass, and covered with another glass moistened with immersion oil. Further studies are carried out using the phase contrast method. Hundred-fold magnification reveals the presence or absence of Hp bacteria, which are helical, curved microorganisms. If there are any, then an indisputable diagnosis of gastritis can be made. The processing of test results can be carried out only in laboratory conditions and using special equipment, which excludes the possibility of using this method under normal conditions.

The method of bacteriological research is considered one of the most difficult and therefore quite expensive. It consists in determining the sensitivity of the human body in relation to various drugs for the presence of infection.

This examination method is necessary for differentiation with peptic ulcer and cancer, but it is impossible to detect the development of gastritis in this way. If peptic ulcer disease or tumors are not detected by X-ray results, then other methods are used to further diagnose gastritis.

Probe diagnostics.

Probing has been practiced in our country for a long time in the diagnosis of gastritis, although recently this method has become a little outdated. However, with its help, you can study the state of the stomach in sufficient detail. The probe is a thin tube equipped with a micro-camera and sensors. The patient swallows this tube, thus the probe enters the stomach and the doctor is able to examine his condition.

Sounding includes three phases. The first phase is carried out on an empty stomach, when the patient does not eat for 6-8 hours before the start of the session. The second phase begins an hour after the introduction of the probe: basal secretion is established, that is, the reaction of the intestinal organs to mechanical stress. The third phase takes place after artificial stimulation. Parenteral secretion agents are used to stimulate the stomach, although in the recent past different doses of food were given to the patient as stimulants. Parenteral causative agents of secretion are special drugs (pentagastrin, histamine, in some cases aminophylline or insulin).

Histamine is administered in an amount of 0.008 mg per kilogram of the patient's weight; with an average weight, the amount of the drug administered is approximately 0.4-0.5 mg. Taking histamine allows the doctor to determine the state of the stomach according to the following parameters:

Total acidity;

The total amount of gastric juice secreted in 2 hours (the norm is 150-200 ml);

An increase in the content of pepsin in the gastric juice produced in 1 hour, or, in scientific terms, the debit-hour of pepsin;

The amount of acid produced in 1 hour, or debit-hour of hydrochloric acid.

The method using histamine for gastric intubation is called the submaximal histamine test. This method will make it possible to accurately establish the diagnosis in 97 cases out of 100.

There is also a method using daily monitoring. Its essence lies in the fact that several probes are placed in the patient's abdominal cavity at once, which are much smaller than those used when conducting a histamine test. Daily monitoring lasts much longer than a histamine test, and allows you to thoroughly examine the state of the internal organs of the abdominal cavity.

Probe diagnostics allows you to make a very accurate diagnosis, therefore it is widely used in most clinics in our country.

FGS and FEGDS

Fibrogastroscopy with biopsy is one of the main methods in the diagnosis of gastritis, as well as in the examination of the stomach for the possible development of a malignant tumor. Using this method, it is possible to thoroughly examine 45 parts of the stomach with a full guarantee of establishing possible precancerous signs.

Fibroesophagogastro-duodenoscopy is one of the most effective methods for examining the condition of the stomach, esophagus, and duodenum. It is used in many clinics, although it is believed that this method is somewhat outdated. Examination of the internal organs of the abdominal cavity is carried out using flexible liquid crystal endoscopes with fiber optics, which is a kind of camera. FEGDS is used mainly as a starting test at the initial stages of the development of the disease and at the first complaints of the patient. The indications of this method can be emergency and planned.

conclusions

Chronic gastritis is sometimes the result of the further development of acute gastritis, but more often it develops under the influence of various factors (repeated and prolonged malnutrition, the use of spicy and rough food, an addiction to hot food, poor chewing, eating dry food, drinking spirits). The cause of chronic gastritis can be qualitatively malnutrition (especially a deficiency of protein, iron and vitamins); long-term uncontrolled intake of medicines that have an irritating effect on the gastric mucosa (salicylates, butadion, prednisolone, some antibiotics, sulfonamides, etc.); industrial hazards (lead compounds, coal, metal dust, etc.); diseases that cause oxygen starvation of tissues (chronic circulatory failure, anemia); intoxication with kidney disease, gout (in which the mucous membrane of the stomach secretes urea, uric acid, indole, skatole, etc.); the action of toxins in infectious diseases. In 75% of cases, chronic gastritis is combined with chronic cholecystitis, appendicitis, colitis and other diseases of the digestive system.

The most common symptoms of chronic gastritis are a feeling of pressure and distention in the epigastric region after eating, heartburn, nausea, sometimes dull pain, decreased appetite, and an unpleasant taste in the mouth. Most often, the acidity of the gastric juice decreases. At a young age, predominantly in men, the acidity of gastric juice can be normal and even increased. Characterized by pain, often heartburn, sour eructation, a feeling of heaviness in the epigastric region after eating, and sometimes constipation.

Collecting theoretical material, studying all the subtleties of the topic of chronic gastritis, I gained knowledge that will no doubt be useful to me in my profession.

In doing all the work, I relied on my knowledge gained in the course of my studies. I experienced slight difficulties when working with the information of the course work, and yet I managed to present the material, as it seems to me, in full.

Finishing my coursework, I can say that I have mastered all the skills and abilities I need when working with patients.

Bibliography

1. Aruin L.I., Kapuller L.L., Isakov V.A. Morphological diagnosis of diseases of the stomach and intestines. - M .: "Triada-X", 1998. - 483 p.

2. Aruin L.I. New international classification of dysplasias of the gastric mucosa // Ross, journal of gastroenterol., Hepatol., Coloproctology. - 2002, No. 3. - S. 15-17.

3. Encyclopedic Dictionary of Medical Terms. - ed. B.V. Petrovsky. - M .: Soviet encyclopedia, 1982 .-- T. 1. - 464 p.

4. . Aruin L.I., Grigoriev P.L., Isakov V.A., Yakovenko E.P. Chronic gastritis. Amsterdam, 1493.362 p.

5. Minushkin O. N., Zverkov I. V. Chronic gastritis. / Therapist. - 2003, No. 5, p. 24-31.

6. Ivashkin V.T. Lapina T.L. Chronic gastritis, principles of diagnosis and treatment. // R. M. J. - 2001; 2; 54-61.

7. Osadchuk M.A., Pakhomov A.L. Kvetnoi I.M. Chronic gastritis with functional dyspepsia: pathological features of clinical manifestations. // Ros. J. G.G. K. - 2002; 5; 35-39.

8. Pajares-Garcia H. Helicobacter pylori gastritis with and without dyspepsia: morphological or clinical unit. // Ros. J. G.G. K. - 2002; 6; 76-80.

9. Livzan M.A., Kononov A.V., Mozgovoy S.N. EKS-Helicobacterus gastritis: neologism or clinical reality. / Experimental and clinical gastroenterology. - 2004; 5; 55-59.

10. Clinical lectures on gastroenterology and heptology / edited by A.V. Kalinin, A.I. Khazanov, in 3 volumes. Volume

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The main symptoms

At the initial stage, the inflammatory process proceeds without pronounced symptoms. The first signs of the disease include:

heaviness in the stomach;
pain;
nausea;
sometimes or.

Patients complain of decreased appetite, weight loss. If such symptoms occur, you should immediately consult a doctor who will give directions for tests. You can consult a therapist or gastroenterologist.

There are many analyzes to be done: it is necessary to accurately establish the form of gastritis and differentiate it from other diseases. For example, the most dangerous - with it, a cancerous degeneration of the tissues of the stomach occurs. However, it is also necessary to distinguish gastritis from other pathologies: from infectious diseases, appendicitis. In some cases, myocardial infarction is accompanied by symptoms of gastritis.

What tests are taken for gastritis?

To make a diagnosis, it is necessary to conduct examinations and laboratory tests.

What compulsory laboratory tests are passed:

general blood analysis;
blood biochemistry;
Analysis of urine;
stool analysis;
analysis of gastric juice.

A complete blood count allows you to determine the level of blood components.

Gastritis is characterized by iron deficiency, a decreased level of hemoglobin, erythrocytes, and an increased erythrocyte sedimentation rate.

In the biochemical analysis of blood with gastritis, there is a low level of pepsinogens I, II. For autoimmune gastritis, elevated bilirubin, gamma globulin, and low blood protein levels are characteristic. Pepsinogen level is one of the most important indicators.

Bacterial gastritis is indicated by its symptoms: presence of antibodies to Helicobacter Pylori.
With pancreatitis, the level of digestive enzymes rises, the level of acid phosphatase rises.
Urinalysis can rule out kidney disease.

Expert opinion

Irina Vasilievna

Practicing gastroenterologist

Stool analysis is also important: an occult blood test is performed. It allows you to identify signs of atrophic gastritis, in which a large amount of connective tissue and muscle fibers are found in the test material.

Identification of Helicobacter Pylori

To detect gastritis caused by HP bacteria, study:

blood test - the presence of specific immunoglobulins indicates the bacterial nature of the disease;
biopsy material;
plaque.

Breathing tests can be used to obtain the necessary information.... A urease test is required to determine HP. This bacterium is active, it can exist in an acidic environment, and produces ammonia during its life.

The bacteria can also be identified by biopsy data, however breath test is a safe and non-invasive procedure so it is preferred.

The research is carried out in 2 stages:

sampling of 2 background samples of exhaled air;
repetition of the procedure after ingestion of a special test solution.

For the reliability of the results, it is necessary to adhere to the following rules before conducting the study.:

the analysis is carried out in the morning, on an empty stomach;
quit smoking in the morning, do not chew gum;
do not consume legumes the day before the test;
within 2 weeks before analysis do not use antibiotics, antisecretory drugs;
during the same period of time, it is forbidden to use spicy, fatty foods, alcohol;
before the study, do not use antacids, analgesics.

This test is characterized by high sensitivity rates - up to 95%.

What examinations are carried out

Most often, EGD is used for instrumental diagnostics. During the procedure, a flexible probe with a video camera is introduced to the patient, which allows you to see foci of inflammation in the stomach and lesions of the mucous membrane... Through a video camera, the image is transmitted to the monitor, where the specialist sees all the violations.

Expert opinion

Irina Vasilievna

Practicing gastroenterologist

When conducting FGDS, it is possible to collect material for research. This is a very unpleasant procedure, but it allows you to get maximum information, so you shouldn't give it up. The material is taken from several areas of the mucous membrane.

Acidity PH

Measurement of acidity can be used to diagnose gastritis. You can determine the Ph indicator using several methods.:

Express analysis is carried out using a thin probe equipped with an electrode.
Daily measurement. The change in acidity is monitored over 24 hours. It can be carried out in various ways:
the probe is inserted through the nasal sinuses, and the patient carries a special measuring device (acidogastrometer) around his waist;
the patient is given a special capsule to swallow, which allows obtaining the necessary data on the acidogastrometer;
sampling of materials during the gastroscopy process.
In cases where the use of the probe is not possible, an acid test can be performed. In the process of this type of diagnosis, special drugs are used that react with hydrochloric acid in the stomach, as a result of which the color of urine changes.
Study of gastric juice.

X-ray

The presence of inflammation can also be determined using fluoroscopy. The patient takes a special substance that allows him to obtain information about the tone, relief of the stomach, to differentiate gastritis from ulcers. If we compare the effectiveness of the procedure with EGD, then using the latter is more efficient.

Prevention of stomach diseases

People who have a hereditary predisposition to, as well as those who do not eat properly, smoke, often, it is recommended to undergo diagnostics 2 times a year. This will allow you to identify the disease at an early stage.

You should not take this condition lightly, it is not only unpleasant in itself, but can also cause the development of other, even more serious diseases.

To prevent exacerbation, you should pay attention to your diet and lifestyle in general. In addition to excessive consumption of fatty, spicy foods, it is necessary to avoid stressful situations and not to self-medicate. Any medications used must be agreed with your doctor.

Acute or chronic inflammation of the gastric mucosa, called gastritis, occurs in more than half of the entire population: men, women, children and the elderly. Approximately 80–85% of all gastrointestinal diseases are attributable to this disease.

At the same time, only 12-15% of people who have chronic gastritis go to the doctor. It is interesting that one of the factors that increase the patient's fears of medical intervention in his body is a long and rather unpleasant diagnosis of gastritis, in particular, the frightening procedure of fibrogastroduodenoscopy for everyone.

Patient examination plan

The examination program for a patient with suspected gastritis includes the following procedures:

visual inspection;
collection of anamnesis;
stool tests and checking for the presence of blood in them;
general urine and blood tests;
LHC: test for bilirubin, protein and protein fractions, alkaline phosphatase, transaminase, aldolase;
checking the secretory gastric function: basal and artificially stimulated by drugs of a number of gastrin, or histamine;
FEGDS (fibrogastroduodenoscopy) with biopsy of the gastric mucosa;
cytological and histological examination of biopsy;
fluoroscopy (if, according to medical prescriptions, you need to do without gastroscopy);
check for the presence of Helicobacter.

Subjective symptoms of gastritis

Symptoms of the disease vary depending on the stage. In the mild stage, the disease is most often localized in the antrum of the stomach. Symptoms are similar to an ulcer:

morning headaches;
pain in the epigastric region one and a half to two hours after eating;
sour belching;
normal appetite;
periodic constipation.

At the late stage, Helicobacter pylori is more difficult to identify: they are not as pronounced, and not in such abundance as at the early stage of the disease. Symptoms are mainly associated with secretory insufficiency:

nausea and poor appetite;
metal taste and dry mouth;
frequent belching of air or food with a tinge of rotten smell;
non-intense aching pain in the stomach after eating;
bloating;
frequent and runny diarrhea;
a feeling of fullness in the stomach even after a moderate intake of food.

In the advanced stage of gastritis, inflammation spreads from the antrum of the stomach to all other sections, atrophic processes begin in the mucous membrane.

Objective data of patient examination

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

the tongue is slightly coated at the root;
epigastric pain (most often on the left);
the normal location of the lower border of the stomach: 4 cm above the navel (determined by palpation methods).

The late stage is characterized by the following symptoms:

the tongue is heavily coated;
cracks in the corners of the mouth;
slight pain in the stomach;
abnormal location of the lower border of the stomach: below or at the level with the navel;
flatulence;
rumbling on palpation of the colon;
slight weight loss (the more advanced the stage of the disease, the more intensively weight is lost).

Instrumental examination

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

The most effective methods for diagnosing chronic gastritis:

EGD and subsequent cytological, histological and microbiological examination of the biopsy specimen;
urease test (text on the pH of the gastric environment);
non-invasive methods: enzyme-linked immunosorbent assay, determination of the acidity of the gastric environment using "acidotest";
breath test.

FGDS is performed using a flexible small-diameter probe equipped with a video camera from the opposite end. The probe is inserted through the mouth and esophagus directly into the stomach. To illuminate the internal cavities, there is a backlight next to the video camera. All data on the foci of inflammation, places of lesion of the mucous membranes are transmitted to the monitor, where they are monitored by the doctor.

The main advantage of the EGD method is that it helps to cut off the variant of gastric ulcer immediately and make the correct diagnosis.

Studies of a biopsy obtained with EGD

The most important laboratory tests for biopsy:

cytology,
diagnostic test for urease,
microbiological research,
histological method.

For a cytological examination, biopsy smears of the mucous membrane of the antrum will be required, taken from the most edematous areas (smears are not taken from erosive areas). After the smears are dried, they are stained, after which Helicobacteria become visible under the microscope.

A gastric pH test (urease test) is also performed using local staining of the biopsy specimen. Helicobacter pylori secretes urease, an enzyme that decomposes the urea in the stomach and releases ammonium. Ammonium greatly increases the pH of the stomach environment, which is evident from the color change.

Microbiological examination takes longer. The culture for analysis is taken from a biopsy specimen of the mucous membrane, then placed in a nutrient medium for the reproduction of Helicobacteria, and left for 3-4 days. After this time, whole colonies of Helicobacter bacteria are formed on the inoculum, and the doctor only needs to identify them.

Histological analysis of a biopsy is performed in much the same way as cytology. Thin layers are cut off from a biopsy taken from the foci of inflammation, stained with eosin and hematoxylin. After staining, Helicobacteria appear on biopsy specimens.

Breath test

A breath urease test is performed in order to detect Helicobacter pylori. It multiplies quickly, takes root well in the acidic environment of the stomach, and eats its walls. Once in the body, it can provoke gastritis, ulcers and gastroduodenitis for many years.

The breath test is a non-invasive alternative to biopsy samples taken during EGD.

The main object of the study is the air blown out by the patient.

The method is based on the ability of Helicobacteria to produce enzymes that decompose urea into ammonia and carbon dioxide. To detect their presence, the doctor suggests that the patient make two air samples (air is blown out into special tubes, the patient must breathe in them for at least 2 minutes). After that, another sample is taken, this time before passing the test, the patient takes an oral solution of urea. The received samples are numbered and sent to the laboratory for further analysis.

The sensitivity of the breath test is up to 95%. Its use is justified for the primary diagnosis of Helicobacter pylori gastritis.

At the same time, in order not to smear the results of the study, the patient must adhere to the following rules:

2 weeks before the test, stop taking any antisecretory and antibacterial drugs;
the test should be performed exclusively on an empty stomach, preferably in the morning;
thoroughly clean and rinse the mouth before the test, paying special attention to the tongue;
on the eve, exclude legumes from the diet, in no case smoke or use chewing gum;
1-2 days before the test, exclude the use of analgesics.

Blood test

A blood test is one of the mandatory procedures for a patient. A general biochemical analysis is performed on a blood sample taken from a finger. This is how the quantitative ratio of different types of blood cells, changes in the ratio of types of leukocytes, the level of hemoglobin and ESR are determined.

In patients with gastritis, there are no specific changes in both general and immunological and biochemical analysis of blood tests.

Analysis of the patient's stool: feces and urine

A laboratory analysis of the patient's feces and urine is necessary in order to detect disturbances in fermentation, which is responsible for the digestion of food, acid balance, and the presence of foreign substances: starch, fatty acids, etc. In addition, stool samples must be checked for blood.

Examination of stool samples can help determine atrophic gastritis. At the same time, a large amount of intracellular starch, digested fiber and muscle fibers is found in the sample.

Urinalysis is done primarily to rule out kidney disease.

Chronic gastritis, which was finally confirmed by the diagnosis, is an easily curable disease. The "sinister" procedures of EGD and biopsy are not at all as painful as most patients imagine them.

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

Features of acute gastritis

Acute gastritis occurs as a result of inflammation of the glandular apparatus of the gastric mucosa. Inflammation can occur both in the thickness and on the surface of the epithelium. It can be diagnosed on the basis of an initial examination, as well as collecting anamnesis from the patient's words.

In acute gastritis, the initial examination reveals pain in the stomach with pressure, dryness, pallor of the skin. An unpleasant odor appears from the mouth, a gray coating is visible on the tongue. In the future, the doctor prescribes directions for the delivery of general blood and urine tests.

It is also necessary to pass a detailed biochemical blood test to determine the state of the liver, kidneys, pancreas; analysis of feces for occult blood; bacteriological analysis of feces. It is imperative to pass a respiratory test to determine the presence of Helicobacter pylori. In some cases, the possibility of passing additional tests is possible.

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Methods for diagnosing gastritis

Gastroscopy or fibrogastroduodenoendoscopy (FGDS) is one of the most important methods of examining the gastrointestinal tract. This method of examination is carried out with a special flexible thin instrument - an endoscope. At its tip there is a camera, thanks to which the specialist sees the state of the mucous membrane of the organs on a special screen. The endoscope is inserted through the mouth, the pharynx, the esophagus, and the patient's stomach. Before the introduction of the endoscope, the tongue is treated with an anesthetic spray to relax the oral muscles. With the help of FGDS, the location, type of gastritis, and differentiation are determined. Video recording and photographs of FGDS are made as necessary.

Stomach biopsy

Biopsy is another effective method for diagnosing gastritis. The essence of a biopsy is to take individual fragments of the contents of the stomach for the purpose of further research in laboratory conditions. This procedure is performed with an endoscope. At its tip, special tweezers or a thick needle are installed. The endoscope is inserted through the mouth into the gastric cavity, the doctor, as needed, with the help of tips, pinch off small pieces of tissue from certain parts of the stomach. The taken fragments are sent for histological examination.

Electrogastroenterography

With the help of this type of analysis, the ability to push food through contractions or the motor-evacuation function of the stomach is determined. Special capsules inserted inside the stomach measure the pressure in the gastrointestinal tract. The stomach begins to contract involuntarily due to irritation from the contact of the capsule with the mucous membrane. All data is displayed on the sensor screen.

Electrogastroenterography examines the biological potential of the stomach walls by a method similar to a cardiogram. The electrodes are connected near the stomach - this is a direct method; on the limbs - peripheral. The results are written on the tape of the apparatus.

pH-metry of the stomach

This type of analysis is prescribed to determine the state of acidity of the stomach and the presence of the degree of inflammation. The PH metric method is divided into several subspecies:

Express analysis is carried out by introducing a thin probe with electrodes through the mouth, with which the acidity is measured in different parts of the stomach.
Daily pH metering - this type of analysis uses an improved method. A special mini-capsule is swallowed by the patient; in the esophagus, the capsule is attached to its walls. An apparatus is attached to the patient's belt - an acidogastrometer. The capsule outputs information to the device. After 3 days, the capsule leaves the body on its own.
Endoscopic pH metry is performed in conjunction with EGD.

Stomach probing

This analysis examines the secretory activity of the stomach, its ability to produce gastric juice. A special thin probe with a diameter of 5 mm is inserted into the patient's stomach through the oral cavity. One end of the probe is attached to the pump. Then from the stomach in portions, within an hour, the liquid present there is pumped out - the basal secret. After that, the patient is given a test breakfast - broth or a secretion stimulant, for example, histamine. After half an hour, the fluid formed as a result of taking stimulants is pumped out. The whole procedure takes about 2.5 hours. The collected analyzes are examined in the laboratory; data are compiled on the state of levels of acidity, hydrochloric acid, peptides and other impurities, conclusions are drawn on the type, quantity, consistency of liquid samples.

X-ray of the stomach

X-ray examination of the stomach for diagnosing gastritis is not widely used. The essence of the X-ray is that the patient drinks a special contrast agent that fills the gastric cavity. The contrast agent helps to determine the presence of gastritis by surface relief changes in the mucous membrane, the walls of the stomach. X-ray data is visible on the screen of specialized equipment.

Analysis for the determination of Helicobacter pylori

There is a possibility of gastritis from the presence of Helicobacter pylori in the gastric section. This bacterium is capable of causing other diseases of the gastrointestinal tract, up to the formation of tumor cells. Therefore, it is very important to conduct an analysis to determine this microorganism in the stomach.

To identify these bacteria, a laboratory analysis of feces, samples of the gastric mucosa, a blood test for the presence of antibodies to Helicobacteria are prescribed. They also carry out a respiratory test. Its essence lies in the fact that the patient drinks juice where carbamide with a marked carbon atom is dissolved. The fact is that Helicobacter very quickly knows how to break down carbamide. At this moment, it emits a large amount of carbon dioxide. At this level, Helicobacter is determined. In addition to the above, it is mandatory to pass general blood tests, urine feces.