Diagnosis of chronic gastritis and gastroduodenitis

To establish the diagnosis of chronic gastritis and gastroduodenitis, it is necessary to collect an anamnesis, including genetic and epidemiological, and to find out the patient's complaints. Particular attention should be paid to the nature of nutrition, the presence of bad habits, concomitant diseases and previous medication.

Physical examination is carried out according to the traditional method.

Obligatory laboratory tests - general blood and urine analysis, occult blood feces analysis, biochemical blood test (determination of the concentration of total protein, albumin, cholesterol, glucose, amylase, bilirubin, iron, transaminase activity).

To diagnose H. pylori infection, invasive or non-invasive methods of research are used according to the recommendations of the European Group for the study of this pathogen. Invasive methods require a fibrogastroscopy to obtain a biopsy, for non-invasive endoscopy is not required. Highly sensitive diagnostic tests are used for screening and primary diagnosis of infection, and highly specific for control of eradication treatment.

Non-invasive methods for diagnosing H. Pylori infection include:

• respiratory tests with registration of H. Pylori life products (carbon dioxide, ammonia);
• detection of specific anti-Helicobacter antibodies of classes A and M by enzyme immunoassay, rapid tests based on the precipitation reaction or immunocytochemical studies using capillary blood of the patient;
• PCR with stool samples.

Invasive methods for diagnosis of H. Pylori infection include:

• bacteriological method (determination of H. Pylori strain, establishment of its sensitivity to the drugs used);
• PCR in a biopsy specimen of the stomach and duodenal mucosa;
• urease test.

Invasive methods for primary diagnosis are used less and less.

Through multi-centered research, it was possible to develop a diagnostic algorithm that allows the detection and effective treatment of H. Pylori infection in a short time, achieving complete eradication of the pathogen and prolonged remission of the disease, significantly reducing the percentage of various complications.

Primary diagnosis (non-invasive methods) includes a respiratory test, enzyme immunoassay, and stool PCR. Control eradication administered 6 weeks after treatment conducted, provided that during this period the patient is not taking other drugs (antibiotics, proton pump inhibitors, blockers of H ₂ receptors of histamine, antacids, adsorbents, etc.), At least two methods, more often invasive. At present, H. Pylori genotyping methods are increasingly being used, including to determine the resistance to clarithromycin.

When determining eradication by invasive methods, it is necessary to investigate a fragment of the mucous membrane of the antral and fundal parts of the stomach.

From the laboratory studies for the diagnosis of autoimmune gastritis in children, the determination of specific autoantibodies to H +, K + -ATPase of parietal cells of the stomach and the factor of Castle, the vitamin B ₁₂ content in the blood serum is used.

The diagnosis of chronic gastritis and chronic gastroduodenitis is confirmed after endoscopic and histological studies, detection of H. Pylori infection, determination of gastric acidity and vegetative status, and consultation of a neurologist and a psychoneurologist.

EGDS is the most important method of confirming the diagnosis, allowing to assess the prevalence and nature of the lesion, to obtain biopsy samples for morphological investigation and determination of H. Pylori infection. In this case, it is possible to detect endoscopic signs indirectly indicative of H. Pylori infection: ulcers of the duodenal bulb, multiple different-sized bulging of the mucous membrane of the antral stomach in the form of a "cobblestone pavement" (nodular gastritis), turbid mucus in the lumen of the stomach, edema and thickening of the folds of the antral department of the stomach.

Diagnosing chronic gastritis, first of all, it is necessary to rely on the morphological structure of the gastric mucosa.

In addition to the main criteria in the visual analogue scale, other signs of the pathological process may be noted, for example, lymphoid follicles consisting of B lymphocytes and formed in response to antigenic stimulation (100% of cases confirm H. Pylori infection), microthromboses, hemorrhages, hypersecretion (consequences of microcirculation disorders).

Unlike adults, for whom the histological picture of an active, with a significant polymorphonuclear nuclear infiltration of Helicobacter pylori is characteristic, inflammatory cell infiltrate in children most often contains plasma cells and lymphocytes. Infiltration is usually superficial, very rarely there is inflammation of the mucosa throughout the thickness. A characteristic histological sign of Helicobacter pylori gastritis in children is the presence of lymphoid follicles with regenerative centers, localized in the own plate of the gastric mucosa.

For early diagnosis of autoimmune gastritis in children in biopsies of the body of the stomach, it is desirable to additionally assess the degree of focal destruction of the base glands.

Histological signs of chronic gastroduodenitis associated with taking NSAIDs are caused by collagen diseases, which are prescribed for NSAIDs (connective tissue disorganization, incomplete collagenosis, proliferative capillaritis and arteriolitis).

To evaluate gastric secretion, it is possible to use probe and probe-free methods. Most often, the following studies are used:

• fractional sounding, which allows to assess the secretory, acid and enzyme-forming functions of the stomach;
• intragastric pH-metry - an accurate study that allows continuous evaluation of secretory processes simultaneously in various parts of the stomach, in the esophagus or duodenum;
• conducting pH-metry or introducing into the stomach an indicator fluid during endoscopy.

[1], [2], [3], [4], [5]

Indications for consultation of other specialists

All patients are shown consultation of an otorhinolaryngologist and dentist, with concomitant anemia - a hematologist, with a pronounced pain syndrome - a surgeon. When detecting antibodies to the Epstein-Barr virus or the presence of antigens of the virus in the biopsy specimens, an infectious disease specialist is consulted. With expressed psychosomatic disorders, a consultation of a psychologist and / or psychotherapist is indicated.

Differential diagnostics

Chronic gastritis and gastroduodenitis differentiate from functional dyspepsia, peptic ulcer and duodenal ulcer, diseases of the esophagus, intestine, pancreas, hepatobiliary system and kidneys.

[6], [7], [8]