“Stomach disease” is a general term for stomach related diseases, mostly including acid reflux, belching, abdominal distention, abdominal pain and other discomfort. Common stomach diseases include acute and chronic gastritis, peptic ulcer, gastric benign and malignant tumors, etc. The stomach is roughly divided into cardia, gastric body, gastric fundus, gastric antrum and pylorus. Gastritis can be divided into gastric sinusitis, gastric body inflammation and total gastritis according to the location. Gastroscopy can also be divided into atrophic gastritis, non atrophic gastritis and special gastritis according to the pathological results. Atrophic gastritis can be divided into type A and type B gastritis
So many kinds of stomach diseases can be clearly diagnosed by gastroscopy, and then start treatment? This is not the case. So, what tests should we do for stomach disease?
1,Detection of Helicobacter pylori
What is Helicobacter pylori? It is a kind of bacteria that can enter the stomach through the mouth and settle on the surface of gastric mucosa. It is the only microbial species known to survive in human stomach. Helicobacter pylori is one of the causes of some gastric lesions such as active gastritis, peptic ulcer and gastric mucosa associated lymphoma. It may also be one of the pathogenic factors of gastric cancer. Helicobacter pylori detection is a routine examination item for gastric diseases. The presence or absence of Helicobacter pylori infection also determines the choice of treatment.
The detection methods are divided into invasive and non-invasive:
Non invasive tests include 13C or 14C urea breath test, fecal Helicobacter pylori antigen test, serum anti Helicobacter pylori IgG antibody (i.e. blood sampling test). 13C or 14C urea breath test is the preferred method. The main difference between the two is that 13C is an improved version of 14C, without radioactivity and no damage to human body. 13C detection of Helicobacter pylori does not need gastroscopy. It is simple, safe, painless, accurate and specific. It is suitable for adults, pregnant women, nursing mothers and even infants. It is also the first choice for reexamination after treatment.
The examination of 13C urea breath test is generally arranged in the morning and must be carried out under fasting state or 2-3 hours after meal. During the examination, the first breath sample, also known as zero hour breath, shall be collected first. Then take a 13C urea capsule orally and count the time immediately. Keep quiet during the process. You can’t drink water, drink or eat any food. After 30 minutes, try your best to exhale the gas into another collection tube. The whole inspection process takes about half an hour.
It should be noted that if drug treatment is applied recently, it will temporarily inhibit Helicobacter pylori, resulting in inaccurate and false negative results (except for serological antibody test). Therefore, to review whether Helicobacter pylori has been eradicated, proton pump inhibitors need to be stopped 2 weeks before the test or antibiotics need to be stopped 4 weeks before the test. In addition, acute gastrointestinal bleeding will also inhibit Helicobacter pylori and produce false negative, so it should be detected 1 week after the bleeding stops.
The invasive examination method is to take gastric mucosal biopsy through gastroscopy, mainly including rapid urease test, histological examination and Helicobacter pylori culture. Rapid urease test is the preferred method because of its simple operation and low cost. Patients with chronic stomach diseases such as symptomatic chronic gastritis, peptic ulcer and gastric mucosal lymphoid tissue associated lymphoma are positive for Helicobacter pylori. It is recommended to take oral two antibiotics + proton pump inhibitor + bismuth agent for eradication.
2, Relevant examinations of autoimmune gastritis
This examination includes: Serum Anti parietal cell antibody (blood PCA), internal factor antibody (IFA), and serum vitamin B12 concentration.
First, let’s understand what autoimmune gastritis is. Chronic atrophic gastritis is divided into type A and type B. type A is called autoimmune gastritis. It is an autoimmune disease occurring in the gastric body. There is a cell called parietal cell in the gastric body, which can secrete hydrochloric acid and a mucin called “internal factor”. This internal factor can help the absorption of vitamin B12, participate in the manufacture of bone marrow red blood cells and prevent pernicious anemia.
Therefore, when antibodies attacking parietal cells or internal factors appear in the body, autoimmune gastritis will occur, resulting in reduced gastric acid secretion, abnormal internal factor function, poor absorption of vitamin B12 and pernicious anemia. At this time, PCA was mostly positive in blood examination, IFA was mostly positive in patients with pernicious anemia, and the concentration of serum vitamin B12 decreased. At the same time, vitamin B12 absorption test was also helpful to the diagnosis of pernicious anemia.
If the diagnosis of autoimmune gastritis is clear, vitamin B12 replacement therapy can be used to prevent pernicious anemia and nervous system diseases.
3, Three gastric functions
Including serum gastrin, pepsinogen I and pepsinogen I / II ratio (PGR).
The three items of gastric function belong to noninvasive examination. Before gastroscopy for chronic gastric diseases, the three items of gastric function can be regarded as the preferred screening method. This examination method is simple and convenient, has high diagnostic accuracy, and is helpful to judge whether atrophy exists, and the location and degree of atrophy.
Gastrin is a very important gastrointestinal hormone, which is secreted by a cell (G cell) in the stomach and can promote gastric acid secretion. In autoimmune gastritis, due to the lack of gastric acid, in order to promote gastric acid secretion, the cell secretes more gastrin. The fasting serum gastrin of patients with autoimmune gastritis is generally increased. G cells mostly exist in the gastric antrum. When the antral glands wither, G cells decrease and gastrin secretion also decreases. Therefore, the blood gastrin level is also used as a serological marker of antral atrophy.
Pepsinogen PG is a precursor of pepsin, including two isozymes, PG I and PG II, which are mainly secreted by mucus cells, gastric body and main cells of gastric fundus. This index will decrease when atrophic gastritis occurs in gastric body and gastric fundus.
to make a long story short:
In patients with gastric atrophy, serum gastrin G17 increased significantly, and the ratio of pepsin I and / or pepsin I / II decreased.
Patients with gastric antrum atrophy: serum gastrin G17 decreased, and the ratio of pepsin I and / or pepsin I / II was normal.
Total gastric atrophy: all three were low.
4, 24-hour pH monitoring of esophagus
The application of portable pH recorder to monitor the 24-hour esophageal pH of patients and provide an objective basis for whether there is excessive acid reflux in the esophagus. It is an important method for the diagnosis and differential diagnosis of reflux esophagitis. A pH monitoring electrode was inserted into the nasal cavity of the patient, placed 5 cm above the lower esophageal sphincter, connected with the recorder in vitro, and monitored continuously for 24 hours. After completion, input the data recorded by the recorder into the computer for display, analysis, judgment and printing. Note that drugs affecting gastric acid secretion and gastrointestinal motility should be stopped 3 days before the examination.
5, Tumor markers
Carcinoembryonic antigen (CEA) increased in 40% – 50% of gastric cancer cases, which has certain significance in follow-up. It can be combined with other indexes to evaluate the prognosis and chemotherapy effect of gastric cancer.
6, X-ray examination
Abdominal plain film is helpful for the diagnosis of gastrointestinal perforation and gastrointestinal obstruction. X-ray barium meal examination is rarely done at present. It is suitable for suspected esophageal and gastric diseases, but gastroscopy is contraindicated or gastroscopy is negative. Gastroscope can only observe the mucosa of the upper gastrointestinal tract. It is difficult to diagnose the general morphology and dynamic diseases of the upper gastrointestinal tract, such as gastroptosis, achalasia and esophageal hiatal hernia. It is also easy to miss diagnosis for the leather stomach. Therefore, endoscopy can not completely replace the traditional X-ray imaging examination.
When it comes to gastric examination, the most common is gastroscope. But can the gastroscope only see the stomach? In fact, gastroscopy can clearly observe the mucosa of esophagus, stomach, duodenal bulb and descending part, and can be used to diagnose or exclude a variety of diseases such as upper gastrointestinal inflammation, ulcer, tumor, polyp, diverticulum, esophageal varices, gastrointestinal stenosis, esophageal foreign body and so on.
In addition, gastroscopy should also be performed in the postoperative follow-up of upper gastrointestinal lesions, especially for those with upper gastrointestinal bleeding, if possible, emergency gastroscopy should be performed within 24-48 hours after bleeding, otherwise acute gastric mucosal lesions are easy to be missed.
We all know that gastroscopy is very important for gastric disease, so what should we do before gastroscopy? Do routine gastroscope or painless gastroscope? What are the differences, advantages and disadvantages between the two?
Firstly, fasting should be performed before gastroscopy for more than 6-8 hours on an empty stomach. Of course, some studies have shown that drinking a small amount of water 2 hours before gastroscopy can improve the comfort of patients, and has no impact on the visual clarity of gastric mucosa during gastroscopy. At the same time, it does not increase the risk of gastric juice reflux and aspiration during gastroscopy, but do not drink a large amount of water. Consult a doctor for specific conditions.
Conventional gastroscopy and painless gastroscopy have their own advantages and disadvantages. Routine gastroscopy will cause nausea, vomiting, pain and other discomfort. At present, routine gastroscopy has high popularity, low cost and high success rate in China. In addition, there are no anesthesia related complications endangering patients’ lives. At present, it is still an essential gastroscopy.
General intravenous anesthesia is often used for painless gastroscopy, that is, a short-acting sedative anesthetic is injected intravenously into the subject before operation. The patient can sleep easily and wake up. The examination has been completed. Patients will not feel nausea, vomiting and other discomfort, no pain and high degree of cooperation, which is also conducive to doctors’ more careful and clear observation of gastric mucosal lesions, no dead corner and not easy to miss diagnosis, so as to improve the accuracy of diagnosis. However, painless gastroscopy also has factors such as high cost and anesthesia risk. Therefore, comprehensive evaluation by anesthesiologists is required before painless gastroscopy.