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

Doctors quite often prescribe a colonoscopy.

If a patient has pathological changes in the intestines or stomach, then he must undergo an instrumental examination without fail. Doctors in most cases recommend:

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

With the help of these methods, it is possible to examine the gastrointestinal tract, as well as to determine the presence of diseases. Some research methods require the use of anesthesia, as a person will not be able to endure 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 diagnostics.

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

With the help of these research methods, visualization of the affected organs is carried out.

During the diagnosis, the doctor receives an image on a radiograph or computer monitor.

The equipment that is used for diagnostics visualizes the state of internal organs through the use of methods such as a magnetic field, ultraviolet waves, x-rays.

Thanks to the use of a computer, it is possible to obtain several multi-layered images of the stomach and intestines, which greatly simplifies the process of studying the state of these organs for the doctor.

With the help of this research method, an assessment is given not only to the internal, but also to the external contour. Before the scan, the patient is given a contrast agent. Intravenous administration of the drug can also be carried out during the period of computed tomography.

During the diagnostic period, images are taken in a special camera. That is why if the patient has claustrophobia, he is not recommended to conduct a study. Also, diagnosis is not carried out with excessive obesity of the patient. Virtual colonoscopy is one of the types of computed tomography.

During the period of 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 walls of the intestine, the size of which is more than one centimeter.

PET diagnostics is the use of radioactive sugar, which is used to obtain images of the large and small intestines. It is injected into the patient intravenously before the study.

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

If the doctor previously diagnosed or early oncology in a patient, then this method is not used to confirm the diagnosis. But, with its help, the level of anomalies of the inflamed intestinal wall, which was previously revealed by the 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 establish the diagnosis as accurately as possible.

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

What is capsule endoscopy, the video will tell:

Performing ultrasound and MRI

Ultrasound is one of the diagnostic methods.

In order to check the intestines and stomach for the development of oncological diseases, ultrasound is used.

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

In some cases, ultrasound is used to detect metastases of bowel cancer in other organs.

If the patient is previously 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 prevalence 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 on a computer screen, images are obtained that display sections of the patient's body. This research method uses radio waves and strong magnets. During the period of examination, the human body absorbs energy, which is displayed by the picture. Thanks to the presence of a special program in the tomograph, the template is converted into an image.

Before the study, a drug is administered to a person, which includes gadolinium. The distribution of the substance throughout the patient's body is carried out 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 transmits clearer images. If the patient has renal insufficiency, this diagnostic method is not used. Capsule endoscopy is most commonly used to determine.

This research method is based on the use of a capsule that has a built-in wireless camera of the smallest possible dimensions. 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

A laparoscope is an instrument for performing laparoscopy.

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

With the help of this method of research, the depth of the lesion of the stomach is determined. This method can be used not only for diagnostics, but also for surgical interventions. With the help of laparoscopy, the determination of stomach cancer is carried out, as well as the degree of spread to neighboring organs.

During the study, a special instrument is used - a laparoscope. Initially, anesthesia is administered to the patient. After that, an incision is made, the dimensions of which reach from 0.5 to 1 centimeter.

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

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

Laparoscopy is practically the only diagnostic method by which metastases are determined before surgery. Endoscopy is performed using a special device - an endoscope.

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

Before this, the throat is irrigated with the use of anesthetics. This provides a simplification of the overcoming process. With the help of the camera during the study period, the walls of the stomach are examined. The doctor looks through the pictures taken by the camera in the eye of the endoscope.

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

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

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The appointment of examinations of the gastrointestinal tract is based on the symptoms that the patient presents, and in order to control and prevent diagnosed chronic diseases of the gastrointestinal tract. Indications for diagnostic procedures can be: difficult and painful digestion (dyspepsia), regular nausea, vomiting, heartburn, stomach pain, suspicion of oncopathology.

To date, the most accurate examination of the gastrointestinal tract is fibrogastroduodenoscopy. During FGDS, the gastroenterologist has the opportunity to assess in detail the condition of the gastric mucosa and duodenum, and make the only correct diagnosis. The complexity of the examination lies in the inability of some patients to swallow a flexible hose equipped with a video camera.

Many people ignore the procedure precisely because of the discomfort. Therefore, it would be useful to find out how to check the stomach without gastroscopy in order to timely diagnose one or another pathology. In addition to the vegetative prejudice to FGDS, there are a number of contraindications to its implementation: a history of hemostasis (blood clotting) disorders, bronchial asthma, emetic hyperreflex.

In such cases, other methods of examining the stomach are prescribed. Diagnosis of diseases and abnormalities in the work of the stomach is carried out in three main areas: a physical set of measures, a laboratory study of the patient's tests, an examination using medical diagnostic equipment, and alternative endoscopy.

Easy Diagnosis

Simple diagnostic methods are mandatory for use when a patient complains of an acute abdomen, nausea, and other symptoms of gastric diseases.

Physical examination

Physical activities are carried out at the doctor's appointment, the results depend on the qualifications of the medical specialist. The complex includes:

• study of anamnesis, evaluation of symptoms according to the patient;
• visual examination of the mucous membranes;
• feeling painful areas of the body (palpation);
• palpation in a specific position of the body (percussion).

Based on the results obtained during such an examination, it is extremely difficult to diagnose the disease. The doctor may suspect the presence of a pathology, but deeper research methods are needed to confirm it.

Microscopic laboratory diagnostics

Laboratory methods consist in taking samples from the patient for further study and evaluation of the results. Most often, the following physical and chemical studies are prescribed:

• general urine analysis;
• coprogram (fecal analysis);
• clinical blood test. The number of all types of blood cells (erythrocytes, leukocytes, platelets) is counted, the level of hemoglobin is determined;
• gastropanel. This blood test is aimed at studying the condition of the gastric mucosa. Based on its results, the following are established: the presence of antibodies to Helicobacter pylori bacteria, the level of pepsinogen proteins produced, the level of the polypeptide hormone - gastrin, which regulates the acidic environment in the stomach;
• blood biochemistry. Quantitative indicators of bilirubin, liver enzymes, cholesterol and other blood cells are established.

Blood sampling for clinical analysis is carried out from a finger

Analyzes help to identify inflammatory processes and other disorders of the organs and systems. If the results differ significantly from the normative indicators, the patient is assigned an instrumental or hardware examination.

Application of hardware techniques

Examination of the stomach without gastroscopy is carried out with the participation of special medical devices. They record the state of the mucosa, density, size and other parameters of the organ, and transmit information that is subject to subsequent decoding by a specialist.

• x-ray examination (with the use of contrast);
• CT and MRI (computed and magnetic resonance imaging);
• EGG (electrogastrography) and EGEG (electrogastroenterography);
• Ultrasound (ultrasound examination).

During gastric examination by hardware, all manipulations are performed without direct intervention in the body, without damaging the external tissues of the body (non-invasively). The procedures do not cause pain in the patient.

Significant disadvantages of the method include low information content in the initial period of the disease, X-ray irradiation unsafe for health, side effects from taking a barium solution.

X-ray with contrast

The method is based on the use of x-rays. To improve visualization of the stomach, the patient drinks a barium solution before the examination. This substance plays the role of a contrast, under the influence of which soft tissues acquire the ability to absorb x-rays. Barium darkens the organs of the digestive system in the picture, which allows you to detect possible pathologies.

X-ray helps in determining the following changes:

• improper arrangement of organs (displacement);
• condition of the lumen of the esophagus and stomach (enlargement or narrowing);
• non-compliance of organs with standard sizes;
• hypo- or hypertonicity of the muscles of organs;
• a niche in the filling defect (most often, this is a symptom of peptic ulcer disease).

CT scan

In fact, this is the same x-ray, only modified, with advanced diagnostic capabilities. The examination is carried out after the preliminary filling of the stomach with liquid for a clearer view.

In addition, an iodine-based contrast agent is injected intravenously to highlight blood vessels on a tomogram. CT, as a rule, is used for suspected tumor processes of oncological etiology. The method allows you to find out not only the presence of stomach cancer in a patient and its stage, but also the degree of involvement of adjacent organs in the oncological process.

The imperfection of diagnostics consists in the exposure of the patient to X-rays, possible allergic reactions to contrast, as well as the inability of CT to fully and detailed study of the digestive tract, since its hollow tissues are difficult to diagnose using CT. The procedure is not performed for women in the perinatal period.

MR imaging

The prerogative aspects of MRI are the use of magnetic waves that are safe for the patient, the ability to determine the initial stage of gastric cancer. In addition, this diagnosis is prescribed for suspected ulcers, intestinal obstruction and gastritis, to assess the adjacent lymphatic system, and to detect foreign objects in the gastrointestinal tract. The disadvantages include contraindications:

• body weight 130+;
• the presence in the body of metal medical items (vascular clips, pacemaker, Ilizarov apparatus, inner ear prostheses);
• rather high cost and inaccessibility for peripheral hospitals.

Examination of the gastrointestinal tract on magnetic resonance imaging is often performed with contrast

EGG and EGEG

Using these methods, the stomach and intestines are evaluated during the period of peristaltic contractions. A special device reads the impulses of electrical signals that come from the organs during their contraction during the digestion of food. As an independent study, it is practically not used. They are used only as an auxiliary diagnostics. The disadvantages are the long time period of the procedure (about three hours) and the inability of the appliance to establish other diseases of the gastrointestinal tract.

ultrasound

Diagnosis of the stomach by ultrasound, most often, is carried out as part of a comprehensive examination of the abdominal organs. However, unlike the indicators of other organs (liver, pancreas, gallbladder, kidneys), it is not possible to examine the stomach completely. There is no complete picture of the organ.

In this regard, the list of diagnosed diseases is limited:

• abnormal change in the size of the organ, swelling of the walls;
• purulent inflammation and the presence of fluid in the stomach;
• limited accumulation of blood in case of damage to the organ with rupture of blood vessels (hematomas);
• narrowing (stenosis) of the lumen;
• tumor formations;
• protrusion of the walls (diverticulosis) of the esophagus;
• intestinal obstruction.

Ultrasound examination of the abdominal organs is preferably carried out annually

The main disadvantage of all hardware diagnostic procedures is that the medical specialist examines only external changes in the stomach and adjacent organs. In this case, it is impossible to determine the acidity of the stomach, to take tissues for further laboratory analysis (biopsy).

Addition to hardware diagnostics

An additional method is Acidotest (taking a combined medical preparation to establish approximate indicators of the pH of the gastric environment). The first dose of medication is taken after emptying the bladder. After 60 minutes, the patient gives a urine test and takes a second dose. After an hour and a half, urine is taken again.

Before testing, it is forbidden to eat food for eight hours. Urine analysis reveals the presence of a dye in it. This allows you to roughly determine the acidity of the stomach without gastroscopy. Acidotest does not give 100% effectiveness, but only indirectly indicates a reduced (increased) level of acidity.

Alternative Endoscopy

Closest to EGD in terms of information content is capsule endoscopy. The examination is carried out without swallowing the probe, and at the same time it reveals a number of pathologies that are inaccessible to hardware procedures:

• chronic ulcerative and erosive lesions;
• gastritis, gastroduodenitis, reflux;
• neoplasms of any etiology;
• helminth infestations;
• inflammatory processes in the small intestine (enteritis);
• cause of systematic indigestion;
• Crohn's disease.

The diagnostic method is carried out by introducing a capsule with a tiny video camera into the patient's body. There is no need for an instrumental introduction. The weight of the microdevice does not exceed six grams, the shell is made of polymer. This makes it easy to swallow the capsule with a sufficient amount of water. The video camera data is transmitted to the device installed on the patient's waist, the indications from which are taken by the doctor after 8-10 hours. At the same time, the rhythm of a person's habitual life does not change.

Capsule for endoscopic examination of the stomach

Removal of the capsule occurs naturally during bowel movements. Significant disadvantages of the technique include: the inability to conduct a biopsy, the extremely high cost of the examination. All methods for diagnosing the gastrointestinal tract provide for preliminary preparation of the body. First of all, it concerns the correction of nutrition.

The diet should be lightened a few days before the examination. Carrying out hardware procedures is possible only on an empty stomach. The stomach can be checked using any method that is convenient and not contraindicated for the patient. However, the palm in terms of information content, and hence the maximum accuracy of diagnosis, remains with FGDS.

In general, they can be divided into the study of the structure, functions of the gastrointestinal tract, the detection of infections.

Structure Study: Visualization

Standard radiography

Standard abdominal x-ray shows the distribution of gas in the small and large intestines, it is used in the diagnosis of intestinal obstruction or paralytic ileus, when dilated intestinal loops and (when taken in a standing position) fluid level are detected. You can see the contours of parenchymal organs, such as the liver, spleen and kidneys (visualization of calcifications and stones in these organs is possible), the pancreas, blood vessels, and lymph nodes. Abdominal x-rays are not helpful in diagnosing gastrointestinal bleeding. The diaphragm can be seen on a chest x-ray, and on x-rays taken in the standing position, free gas can be found under the diaphragm when a hollow organ is perforated. It is also possible to accidentally detect pulmonary pathology, for example, pleural effusion.

Contrasting Studies

Barium sulfate, used in contrast studies, and nerthen, well envelops the mucous membrane and provides the necessary contrast of structures of interest. However, it may thicken and stop proximal to the obstruction. Water-soluble radiopaque is used to contrast the bowel before abdominal CT and when perforation is suspected, but it absorbs x-rays to a lesser extent and is also irritating in case of aspiration. Studies with contrast are carried out under fluoroscopic control, which allows you to assess the movement of organs and correct the position of the patient. The double contrast technique, using gas to inflate barium-coated inner walls of hollow organs, improves visualization of the mucosa.

Barium studies are used to detect filling defects. A distinction is made between intraluminal (eg, food or feces), intramural (eg, carcinoma), or extramural (eg, lymph nodes) filling defects. Strictures, erosions, ulcers, and organ motility disorders can also be identified.

X-ray studies with contrast in the diagnosis of diseases of the gastrointestinal tract

	barium intake	barium breakfast	Passage of barium suspension	barium enema
Indications	Dysphagia Chest pain Possible dysmotility	Dyspepsia epigastric pain Possible perforation (non-ionic contrast)	Diarrhea and abdominal pain of small bowel origin Possible obstruction due to strictures	Discomfort in the abdomen rectal bleeding
Main use	Strictures hiatal hernia Gastroesophageal reflux and dysmotility such as achalasia	Gastric or duodenal ulcers Stomach cancer Obstruction of the pyloric region Disorders of gastric emptying	Malabsorption Crohn's disease	Neoplasia Diverticulosis Strictures, such as ischemic Megacolon
Restrictions	Aspiration risk Poor mucosal detail Inability to take a biopsy	Low sensitivity in detecting early cancer Inability to take a biopsy or detect Helicobacter pylori	Labor intensive method Exposure to radiation	Difficulties in debilitated elderly or incontinent patients Causes inconvenience The need for sigmoidoscopy to assess the condition of the rectum Possibility of skipping polyps< 1 см Менее пригодно при воспалительных заболеваниях кишечника

Ultrasound, computed and magnetic resonance imaging

The use of these methods in the diagnosis of diseases of the abdominal cavity has become widespread. They are non-invasive and provide a detailed image of the contents of the abdominal cavity.

Ultrasound scanning, computed tomography and magnetic resonance imaging in gastroenterology

Study	ultrasonic	CT	MPT
Main indications	Masses in the abdomen, such as cysts, tumors, abscesses Organ enlargement Expansion of the biliary tract gallstones Controlled fine needle aspiration biopsy from the lesion	Assessment of pancreatic diseases Location of liver tumors Assessment of vascularization of lesions	Assessment of the stage of liver tumors Diseases of the pelvic/perianal region Swishes in Crohn's disease
Flaws	Low sensitivity for small lesions Little informative about the function Depends on the researcher Gases and the thickness of the fatty layer of the examined can obscure the picture	Expensive research High dose of radiation Some tumors may be underestimated, such as esophagogastric	Role in the diagnosis of gastrointestinal disease has not been fully established. Limited availability Labor intensive research Claustrophobia (in some patients) Contraindicated in the presence of metal prostheses, cardiac pacemakers

Endoscopy

Videoendoscopy has replaced endoscopic examination using fiberoptic endoscopes. The image is displayed on a color monitor. Endoscopes are equipped with handpiece controls, and they also have channels for suctioning air and water. Additional instruments are passed through the endoscope to perform diagnostic and therapeutic procedures.

Endoscopy of the upper gastrointestinal tract

Indications

• Dyspepsia in patients over 55 years of age or with warning symptoms
• Atypical chest pain
• Dysphagia
• Vomit
• Weight loss
• Acute or chronic gastrointestinal bleeding
• Suspicious Results of the Barium Breakfast Study
• Biopsy of the duodenal mucosa to identify the causes of malabsorption

Contraindications

• Severe degree of shock
• Recent myocardial infarction, unstable angina, cardiac arrhythmia
• Severe respiratory disease
• Atlas subluxation
• Possible perforation of internal organs
• These are relative contraindications: it is possible to perform an endoscopic examination by an experienced specialist

Complications

• Aspiration pneumonia
• Perforation
• Bleeding
• Infective endocarditis

Endoscopy in the elderly

• Tolerability: endoscopic procedures are generally well tolerated by people even at very old age Side effects of sedation: older people are more sensitive to sedation; respiratory depression, hypotension, and prolonged recovery time are more common.
• Bowel preparation for colonoscopy can be difficult in malnourished, immobilized people. Sodium phosphate preparations may cause dehydration or hypotension If it is necessary to use an antiperistaltic substance, the drug of choice is glucagon.

Fibroesophagogastroduodenoscopy

The study is carried out under intravenous benzodiazepine premedication to a state of mild sedation or using only a local anesthetic sprayed onto the patient's pharyngeal mucosa (the procedure is carried out on an empty stomach for at least 4 hours). When the patient lies on the left side, the entire esophagus, stomach and the first 2 parts of the duodenum can be seen.

Enteroscopy and capsule endoscopy

Using a long endoscope (enteroscope), a large part of the small intestine can be visualized. Enteroscopy is of particular importance in the assessment of obstruction, recurrent gastrointestinal bleeding. Capsule endoscopes contain a light source and lenses. After swallowing, the endoscope transmits the picture from the small intestine to a data recording device. The images are then processed using software to localize the detected deviations. Capsule endoscopy is used for suspected upper GI bleeding, a tumor, or an ulcer in the small intestine.

Sigmoidoscopy and colonoscopy

Sigmoidoscopy can be performed on an outpatient basis using a 20 cm rigid plastic sigmoidoscope or in an endoscopy unit using a 60 cm flexible colonoscope after bowel preparation. When combining sigmoidoscopy with rectoscopy, hemorrhoids, ulcerative colitis and distal colorectal neoplasia can be detected. After complete bowel cleansing, the entire colon and often the terminal ileum can be examined using a longer colonoscope.

Colonoscopy

Indications

• Suspicion of inflammatory bowel disease
• chronic diarrhea
• Discomfort in the abdomen
• Rectal bleeding or anemia
• Evaluation of abnormalities identified in the study with a "barium enema"
• Screening for colorectal cancer
• Surveillance for colorectal adenoma
• Therapeutic procedures
• Colonoscopy is unsuitable for establishing causes of constipation

Contraindications

• severe acute ulcerative colitis
• Same as for upper gastrointestinal endoscopy

Complications

• Depression of cardiac and respiratory function due to sedation
• Perforation
• Bleeding
• Infective endocarditis (in patients with a history of endocarditis or with a prosthetic heart valve, prophylactic antibiotics are indicated)

ERCP

ERCP allows you to visualize the ampulla of Vater and obtain x-rays of the bile duct system and pancreas. Diagnostic ERCP has largely been replaced by magnetic resonance cholangiopancreatography (MRCP), which provides comparable images of the bile duct system and pancreas. MRCP complements CT and endoscopic ultrasonography in evaluating obstructive jaundice, identifying the cause of pain in the gallbladder area, and suspected pancreatic disease. ERCP is then used to treat a number of biliary tract and pancreatic diseases identified by these non-invasive methods. ERCP includes removal of common bile duct stones, stenting of bile duct strictures, and treatment of pancreatic duct ruptures. Performing therapeutic ERCP is associated with technical difficulties and a significant risk of pancreatitis (3-5%), bleeding (4% after sphincterotomy) and perforation (1%).

Histological examination

Biopsy material obtained by endoscopy or percutaneously can provide important information.

Indications for biopsy and cytology

• Suspicion of malignancy
• Evaluation of deviations in the structure of the mucous membrane
• Diagnosis of infections (eg, Candida, H. pylori, Giardia lamblia)
• Determination of enzyme composition (for example, disaccharidases)
• Analysis of genetic mutations (eg, oncogenes, tumor suppressor genes)

Tests for infections

Bacteriological research

Detection of bacterial cultures in the stool is necessary to determine the causes of diarrhea, especially acute or bloody, and to identify pathogens.

Serological study

The detection of antibodies is of limited value in the diagnosis of gastrointestinal infections caused by microorganisms such as H. pylori, some Salmonella species, and Entamoeba histolytica.

Urease test

Non-invasive breath tests for H. pylori infection and for suspected small intestinal bacterial overgrowth are discussed below.

Functional Research

Several functional tests are used to investigate various aspects of intestinal activity (digestion, absorption), inflammation and epithelial permeability.

Functional tests in the study of the gastrointestinal tract

Process	Test	Principle	Comments
Suction
Fats	14 C-trioley-new test	Measurement of 14 CO 2 concentration in exhaled air after ingestion of fat labeled with C	Fast and non-invasive, but not quantitative
	3 day fecal test	Quantitative assessment of fat content in feces when the patient consumes fat 100 g/day Normal<20 ммоль/сут	Non-invasive, but slow and unpleasant for everyone, research method
Lactose	Lactulose-hydrogen breath test	Measurement of exhaled H 2 after ingestion of 50 g of lactose. Undigested sugar is metabolized by colonic bacteria in hypolactosemia, and hydrogen is detected in exhaled air.	Non-invasive and precise. May cause pain and diarrhea in subjects
bile acids	75 SeHCAT test	Determination of the amount of the isotope retained in the body for 7 days after ingestion of labeled 75 Se homocholithaurin (> 15% - norm,<5% - патология)	Accurate and specific method, but requires 2 visits to the doctor, radioactive. The results can be interpreted in two ways. The 7α-hydroxycholestenone test is also sensitive and specific
Exocrine function of the pancreas
	Pancreolauril test	Pancreatic esterases bind fluorescent dilaurate after ingestion. Fluorescin is absorbed in the intestine and is measured in the urine.	Accurate and does not require duodenal probing. Takes 2 days. Accurate urine collection required
	Fecal chymotrypsin or elastase	Immunological analysis of pancreatic enzymes in stool	Simple, fast and does not require urine collection. Does not detect mild forms of the disease
Inflammation / mucosal permeability
	51 Cr-EDTA	Determination of the concentration of the label in the urine after ingestion. With increased mucosal permeability, more is absorbed	Relatively non-invasive and accurate, but radioactive. Limited availability
	Sugar tests (lactulose, rhamnose)	In the non-inflamed small intestine, mono-but not disaccharides are absorbed. Urinary excretion of ingested 2 sugars is estimated as a ratio (normally<0,04)	A non-invasive test that determines the integrity of the lining of the small intestine (eg, colitis, Crohn's disease). Accurate urine collection required
	Calprotectin	A non-specific protein secreted by neutrophils in the colon in response to inflammation or neoplasia	Useful screening test for colon diseases

If malabsorption is suspected, it is necessary to conduct blood tests [with counting of formed elements, erythrocyte sedimentation rate (ESR), determination of the concentration of folates, vitamin B 12, iron, albumin, calcium and phosphates], determine the condition of the gastrointestinal mucosa in the biopsy material obtained during endoscopy .

Peristalsis of the gastrointestinal tract

There are a number of different X-ray, manometric, and radioisotope tests to study intestinal motility, but most of them have very limited use in clinical practice.

Peristalsis of the esophagus

A study after careful ingestion of barium sulfate suspension may provide information on esophageal motility. In difficult cases, videofluoroscopy may be helpful. Esophageal manometry, usually in combination with a 24-hour pH measurement, is of value in the diagnosis of gastroesophageal reflux, achalasia of the cardia, and non-cardiac chest pain.

Gastric emptying

Delayed emptying of the stomach (gastroparesis) causes persistent nausea, vomiting, bloating, or early satiety. The results of endoscopy and studies with barium sulfate are usually within the normal range. Indicators for the emptying of solids are very variable, but approximately 50% of the contents leave the stomach in 90 minutes (T1 / 2). Calculation of the amount of radioisotope remaining in the stomach after ingestion of food containing solid and liquid labeled components can reveal pathology.

Passage through the small intestine

This parameter is much more difficult to quantify and is rarely required in clinical practice. The study of the passage of barium sulfate can give an approximate idea of ​​the functional state of the intestine when determining the time required to achieve contrast enhancement of the terminal ileum (normally 90 minutes or less). Orocecal transit can be assessed using the lactulose-hydrogen breath test. Lactulose is a disaccharide that normally enters the colon unchanged; here, the breakdown of lactulose by colon bacteria leads to the release of hydrogen. The time of appearance of hydrogen in exhaled air is a measure of orocecal transit.

Peristalsis of the colon and rectum

Direct abdominal radiography, performed on the 5th day after ingestion of inert plastic pills of various shapes, in the first 3 days from the start of the test gives an idea of ​​the duration of complete intestinal transit. The test is used to identify the causes of chronic constipation, since the location of any of the delayed pills can be seen; it helps to differentiate cases of delayed transit from the presence of an obstruction to the movement of feces. The mechanism of defecation and the functional state of the anorectal region can be assessed using anorectal manometry, electrophysiological tests and proctography.

Radioisotope tests

Many different radioisotope tests are used. Some give information about the structure, such as the location of Meckel's diverticulum, or the activity of the inflammatory process in the intestine. In other tests, radioisotopes are used to obtain information about functional status, such as the degree of bowel movement or the ability to reabsorb bile acids. There are tests for infection, they are based on the ability of bacteria to hydrolyze radioactively labeled substances, followed by the determination of the isotope in exhaled air (for example, the respiratory urease test for H. pylori).

Radioisotope tests commonly used in gastroenterology

Test	Isotope	Main indications and test principle
Study of gastric emptying		Used to assess gastric emptying, especially if gastroparesis is suspected
Urease breath test	13 C- or 14 C-urea	Used for non-invasive diagnosis of N. pylori infection. The bacterial enzyme urease breaks down urea into CO2 and ammonia, which is found in exhaled air.
Scan for diverticulum	99m Tc-pertech	Diagnosis of Meckel's diverticulum in cases of latent gastrointestinal bleeding. The isotope is administered intravenously and is determined in the ectopic parietal mucosa inside the diverticulum
Radionuclide study for labeled erythrocytes	51 Cr-labeled erythrocytes	Diagnosis of latent and recurrent gastrointestinal bleeding. Labeled erythrocytes that have left the bleeding vessel into the intestine are determined
Radionuclide study for labeled leukocytes	111 In- or 99m Tc-HMPAO-labeled leukocytes	Accumulations of leukocytes in the area of ​​the abscess and the extent of inflammatory bowel disease are revealed. The patient's leukocytes are labeled in vitro, returned to the bloodstream, after which the leukocytes migrate to sites of inflammation or infection
Radionuclide testing for somatostatin receptors	111 In-DTPA-DPhe-octreotide	Labeled analogue of somatostatin binds to specific receptors located on the cell surface of pancreatic neuroendocrine tumors

In gastroenterological practice, there are a considerable number of different diseases, some of which can be very dangerous and lead to the development of severe complications. According to statistics, every second person on earth suffers from one or another pathology of the digestive system. That is why it is extremely important to conduct a timely examination of the gastrointestinal tract (GIT), which will allow the specialist to develop an effective treatment strategy.

Today, there are quite a few modern diagnostic methods that allow for a comprehensive study of all organs and departments of the gastrointestinal tract, to identify the disease as soon as possible and with maximum reliability, to clarify its stage, prevalence and other features. Research methods used in gastroenterology can be divided into three groups:

• physical;
• laboratory;
• instrumental.

Instrumental methods, in turn, can be divided into secretion studies, endoscopic and radiation studies. The expediency of prescribing a particular examination will be determined by the doctor in the process of working with the patient.

Physical research

The first stage of a gastroenterological examination is a consultation with a gastroenterologist or therapist, who must collect an anamnesis of the patient's complaints and compile an overall clinical picture. The doctor conducts a more detailed examination using special methods: palpation, percussion, auscultation.

Palpation is a procedure in which the patient's abdomen is felt without the use of any additional instruments. This method allows you to detect certain signs characteristic of some diseases of the gastrointestinal tract, in particular, to identify the degree of tension of the peritoneal wall and painful areas. Palpation can be performed while the patient is standing or lying on the couch. In a standing position, palpation is performed in cases where it is necessary to examine the organs located on the sides of the abdominal cavity.

Usually, along with palpation, percussion is performed - a study that allows you to determine the boundaries of the location of the organs of the gastrointestinal tract by tapping. In gastroenterological practice, this technique is mainly used to study the spleen and liver.

Diagnosis using auscultation involves listening to the sounds that the organs of the gastrointestinal tract emit. To do this, the doctor uses a special tool - a stethophonendoscope. During the procedure, symmetrical parts of the body are listened to, and the results are then compared.

The above diagnostic studies are only primary and do not allow a specialist to accurately diagnose a particular gastrointestinal disease. So, for example, physical methods practically do not allow a specialist to identify organic pathologies of the organs of the gastrointestinal tract with a predominant lesion of their mucous membrane. This requires a more complete examination, the plan of which is drawn up individually for each patient and may include a number of different clinical, laboratory and instrumental methods.

Laboratory tests

Laboratory diagnostics plays an important role in the detection of many diseases of the gastrointestinal tract. At the discretion of the doctor, the patient may be assigned blood tests to determine the following substances and enzymes:

bilirubin is a special substance formed after the breakdown of hemoglobin in red blood cells and is part of bile. The detection of direct bilirubin in the blood may indicate a number of pathologies of the gastrointestinal tract associated with a violation of the outflow of bile, for example, obstructive or parenchymal jaundice;

transaminases: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) - these enzymes function in almost all organs of the human body, especially in the liver and muscle tissues. An increased concentration of AST and ALT is observed in various hepatic diseases, including chronic ones;

gamma-glutamyl transpeptidase (gamma-GT) - another enzyme, an elevated level of which indicates inflammation of the bile ducts, hepatitis or obstructive jaundice;

amylase - this enzyme is produced by the pancreas, and as part of its juice, amylase enters the intestines, where it contributes to the accelerated digestion of carbohydrates. If the level of amylase in the blood is elevated, most likely the patient has some kind of pancreatic disease;

lipase is another enzyme produced by the pancreas, the level of which increases with pancreatitis and other pathologies of the digestive system.

In addition, a general analysis of feces is mandatory, which will allow the specialist to assess the overall functioning of the digestive system, detect signs of disorders and inflammation of various parts of the intestine. In addition, the study of feces can detect microorganisms that are the causative agents of infectious diseases.

A more detailed study of feces is called a coprogram. With its help, the digestive and enzymatic activity of the stomach is assessed, signs of inflammation are revealed, microbial activity is also analyzed, fungal mycelium can be detected.

If necessary, a bacteriological study can be prescribed, that is, the determination of the microbial composition. This will detect intestinal dysbacteriosis, infections. There are also special tests for the detection of antigens of microbial pathogens, making it possible to identify viral infectious diseases.

Another common laboratory test widely used in gastroenterology is the occult bleeding test. This analysis is based on the detection of latent hemoglobin in the feces.

If the patient is taking iron supplements or other medications, the attending physician must be informed about this, as medications can significantly distort the results of the tests. Before donating blood, you must follow a special diet for several days, excluding fatty foods, meat, green vegetables and tomatoes from the diet.

If necessary, laboratory diagnostics of the gastrointestinal tract can be supplemented by such studies as enzyme-linked immunosorbent assay (ELISA) of feces and blood plasma.

Instrumental techniques

The most important section of a comprehensive examination of patients with gastrointestinal pathologies is instrumental diagnostics. It includes endoscopic, radiological, ultrasound, electrometric and other diagnostic techniques.

The appointment of a particular study in order to obtain the most common information occurs at the discretion of the attending physician, depending on the existing clinical picture. Each of the instrumental methods makes it possible to evaluate the structural and morphological features of the organ under study, as well as its function. Most of these studies require special preparation from the patient, since their information content and reliability will depend on it.

Assessment of gastric acid secretion

Since most inflammatory diseases of the digestive system are characterized by a change in the acidity of the stomach. That is why, during a diagnostic examination, an assessment of the secretion of gastric acid necessary for adequate digestion of food, using a special technique called pH-metry, can be shown. Indications for its implementation are peptic ulcer of the duodenum and stomach, chronic duodenitis, gastritis and other pathologies of the gastrointestinal tract.

There are several types of pH-metry in gastroenterology: short-term (intragastric), long-term (daily), endoscopic. Each of these methods involves the introduction of a pH-metric probe through the mouth or nasal opening into the corresponding section of the digestive system for a certain period. The level of acidity is measured at a specific point using built-in electrodes. In endoscopic pH-metry, the probe is inserted through a special instrumental channel of the endoscope.

Any type of pH measurement requires some preparation. First, the patient should not smoke or eat at least twelve hours before the procedure. Secondly, a few hours before the study, the use of any liquids is prohibited, in order to avoid the occurrence of vomiting and aspiration. Additionally, you should consult with your doctor about the medications you are taking.

Another common procedure used in gastroenterological practice for suspected gastritis, peptic ulcer and many other pathologies is duodenal sounding of the stomach. When conducting a study of the secretory function of the stomach in this way, all contents are first pumped out of the stomach, and then the basal secret. After that, the patient is stimulated with secretion with the help of special preparations or is given a trial breakfast in the form of broth, after half an hour a fifteen-minute secretion is taken, which is then studied in the laboratory. The procedure is performed under local anesthesia on an empty stomach.

Gastric probing is a procedure that has a number of contraindications. It cannot be carried out in case of severe pathologies of the cardiovascular system, gastric bleeding, as well as during pregnancy.

If the patient has contraindications to duodenal sounding of the stomach, secretion is assessed by a tubeless method using the Acidotest preparation. The test is also carried out in the morning on an empty stomach. Analysis of the secretory function of the stomach is carried out by examining portions of urine after taking the drug.

Endoscopic techniques

Endoscopic examination of the organs of the gastrointestinal tract involves the introduction of special optical instruments into its lumen. To date, this is the most technologically advanced procedure that allows you to get a complete picture of the condition and functioning of the large and small intestines, as well as to conduct a biopsy - to obtain a sample of material for further histological examination.

The endoscopic methods for examining the gastrointestinal tract include the following diagnostic procedures:

As a rule, endoscopic methods for examining the gastrointestinal tract are not used if the patient has an allergy to anesthetic drugs, as well as pathologies associated with impaired blood clotting. In addition, they all require special training, which will be discussed in detail by the attending physician.

Radiation techniques

As the name implies, it is customary to refer to radiation methods for examining the gastrointestinal tract those that involve the use of radiation. The most widely used in gastroenterology are the following methods:

fluoroscopy or x-ray examination of the abdominal organs by taking x-rays. Usually, before the procedure, the patient needs to consume barium porridge, which is opaque to x-rays and makes it possible to visualize almost all pathological changes well; ultrasound examination of the abdominal cavity examination of the organs of the gastrointestinal tract using ultrasound radiation. A variety of ultrasound is the so-called dopplerometry, which allows you to assess the speed of blood flow and movement of the walls of organs; scintigraphy study of the activity of the gastrointestinal tract using radioactive isotopes that the patient consumes with food. The process of its progress is fixed with the help of special equipment; computer and magnetic resonance imaging, these studies are prescribed only when absolutely necessary, if you suspect tumor neoplasms, cholelithiasis and other pathological conditions.

Possibilities of modern gastroenterology

Today, many modern clinics offer their patients such a service as a comprehensive examination of the gastrointestinal tract, which can be done, both if you suspect a disease of any organ of the digestive system, or for preventive purposes. Comprehensive diagnostics involves the use of a combination of various methods that allow you to assess the state of the organs of the gastrointestinal tract, to get the most complete picture of the existing violations.

Such an extended diagnosis may be necessary for those patients who suffer from a complex disease of unknown etiology, accompanied by metabolic disorders and other serious symptoms. The capabilities of modern gastroenterological clinics allow for a comprehensive examination of patients using the latest generation of medical equipment, with which you can get the most accurate research results in a short time. The list of analyzes and studies carried out may vary depending on the specific diagnostic program.

The presence of symptoms such as:

• smell from the mouth
• stomach ache
• heartburn
• diarrhea
• constipation
• nausea, vomiting
• belching
• increased gas production (flatulence)

If you have at least 2 of these symptoms, then this indicates a developing

gastritis or ulcer.

These diseases are dangerous for the development of serious complications (penetration, gastric bleeding, etc.), many of which can lead to

exodus. Treatment needs to start now.

Read an article about how a woman got rid of these symptoms by defeating their root cause. Read the material ...

Every sane person who is not indifferent to his health and the general condition of the body should, from time to time, periodically check the digestive organs.

How to get a complete examination of the digestive system?

It is known that the digestive system begins with the mouth strip, pharynx, which passes into the esophagus. From the esophagus, food enters the stomach. The continuation of the stomach is the small and large intestine. In addition, the digestive system includes the glands of the stomach and small intestine, the presence of the pancreas, liver and gallbladder.

A complete examination of the digestive organs includes:

reception of a specialist;

Ultrasound of the digestive organs;

taking liver function samples;

blood test for total and direct bilirubin;

blood tests for AST and ALT;

analysis for the level of alkaline phosphatase.

The reliability and informativeness of the results of X-ray, endoscopic and ultrasound methods of studying the organs of the digestive system to a large extent depend on the quality of the preparation of patients for these studies.

X-ray examination of the digestive organs

X-ray examination of the digestive organs. Patients with normal bowel function do not require any special preparation. With pronounced flatulence and persistent constipation, a cleansing enema is recommended 1.5–2 hours before the study. As a contrast agent for fluoroscopy, a suspension of barium sulfate is used, which is prepared at the rate of 100 g of powder per 80 ml of water.

For X-ray examination of the gallbladder and biliary tract, such methods of studying the organs of the digestive system are used, such as

• cholecystography
• and cholegraphy (examination of the bile ducts).

Before cholecystography and cholegraphy, the patient must follow a diet for 3 days to prevent flatulence (raw cabbage, black bread, milk are excluded). A cleansing enema is given only with severe flatulence. With cholecystography, the patient on the eve of the study takes a radiopaque iodine-containing preparation (cholevis, iodagnost, etc.) at the rate of 1 g per 20 kg of the patient's body weight, drinking it with sweet tea for half an hour. The maximum concentration of the drug in the gallbladder is observed 15-17 hours after ingestion, after which x-rays of the gallbladder are taken. During cholegraphy, a contrast agent (Bilignoy, Bilitrast, etc.) is administered intravenously.

Cholecystography is not performed in severe liver damage, hypersensitivity to iodine, and cholegraphy is not performed in acute inflammatory diseases of the bile ducts that occur with fever (cholangitis), severe hyperfunction of the thyroid gland. X-ray examination of the colon (irrigoscopy) is performed using a contrast enema.

In preparation for irrigoscopy on the eve of the study, the patient is given 30 g of castor oil before dinner, in the evening and in the morning they put a cleansing enema. As a contrast agent, a suspension of barium sulfate is used, heated to body temperature, the suspension is administered with an enema.

Endoscopic examination of the digestive system

Endoscopic examination of the digestive organs allows using a special optical device (endoscope) to examine the mucous membrane of the esophagus, stomach, duodenum, rectum and sigmoid colon (sigmoid colonoscopy), colon (colonoscopy), abdominal organs (laparoscopy).

When esophagogastroduodenoscopy special preparation of patients is not required. Planned gastroscopy is carried out in the morning on an empty stomach, emergency - at any time of the day, 30 minutes before the study, the patient is injected subcutaneously in ml of a 1% solution of atropine; immediately before the study, local anesthesia of the pharyngeal mucosa is performed with a solution of Dipanin. Preparation for sigmoidoscopy includes the setting of a cleansing enema in the evening and in the morning. Preparation for colonoscopy is similar to that for barium enema.

For the diagnosis of diseases of the digestive system, ultrasound (sonography) is widely used. Preparation for it usually comes down to fighting flatulence (diet, taking activated charcoal 2-3 days before the study, taking enzyme preparations, such as Festal).

Stages of a complete examination of the digestive system

If you do not know where to start and how to undergo a complete examination of the digestive system, first of all, he recommends that you visit a doctor who checks and diagnoses the digestive system. The survey includes the following processes:

sounding;

fluoroscopy;

scanning tomography;

ultrasonic localization.

With the help of the above methods, it became possible to carry out a comprehensive examination of all organs of the digestive system, using modern and new computer equipment.

In case you have teeth damaged by caries, it is recommended to consult a doctor at a dental clinic and undergo a sanitation of the oral cavity. To some extent, caries is also considered the cause of the development of diseases of the gastrointestinal tract, since various microorganisms of unknown origin enter the body with food intake.

The method of esophagogastroscopy is prescribed in cases where there is heaviness in the stomach after eating food, sour taste in the mouth, nausea, plaque on the tongue, and hunger pains. The essence of this method is to keep a tube with a monitor, with which it is possible to examine the gastric mucosa and, if necessary, take tissue tests or stop bleeding, which can also be diagnosed by this method.

For examination of the digestive organs, the most commonly used method is ultrasound. With it, you can examine the stomach and the entire abdominal cavity of a person, while obtaining accurate results. Diagnosis using ultrasound helps to identify disorders in the work of such digestive organs as

• liver,
• stomach,
• check for diseases of the pancreas,
• and to check whether there is or is not feces in the gallbladder.

Full liver examination method

Laboratory diagnosis of diseases of the gastrointestinal tract will help to timely identify the pathology, clarify its stage and prescribe the necessary treatment.

More about research...

Timely detection of stomach diseases is an opportunity to reduce the risk of developing pathologies such as ulcers, oncology and others.

Find out more…

Laboratory diagnosis of diseases of the gastrointestinal tract requires special preparation for the procedures - the information content and reliability of the study depend on this.

Learn about research preparation

You can receive test results in person, by phone, by e-mail or by courier.

Find out more…

The stomach is the organ of the gastrointestinal tract where food is digested. In gastroenterological practice, a large number of various diseases of the stomach are distinguished. Some of them can be dangerous and lead to the development of complications. That is why it is so important to conduct instrumental and laboratory examinations of the stomach, prescribed by a specialist. They will allow timely detection of the disease, clarifying its stage with maximum reliability and prescribing effective treatment.

When to get a stomach exam

If any abnormalities in the work of the gastrointestinal tract are found, it is necessary to contact a gastroenterologist. It is this specialist who can recommend undergoing an examination of the stomach both to establish or clarify the diagnosis, and for preventive purposes. It is usually prescribed if the patient has the following symptoms:

• pain behind the sternum or in the epigastric region;
• increased gas formation;
• bleeding from the colon;
• pain, feeling of fullness or heaviness that appears in the stomach after eating;
• frequent heartburn;
• vomiting, in which there is an admixture of blood;
• belching with a sour taste;
• frequent nausea or vomiting of food consumed the day before;
• violation of the digestive function or the act of swallowing;
• feeling of a foreign body in the esophagus;
• changes in appetite (when the desire to eat is reduced or absent for a long time, as well as in cases where a person is constantly tormented by the feeling of hunger).

Indications for the appointment of a medical examination of the stomach can be various diseases. Hardware diagnostic tools help to identify the cause of the disease and find out how effective the treatment is. Various procedures for examining the stomach are carried out with:

• the presence of polyps and other neoplasms on the gastric mucosa;
• gastritis;
• hernia;
• peptic ulcer;
• reflux disease;
• oncological diseases;
• inflammatory processes of any etiology in the pancreas, in the duodenum and stomach;
• portal hypertensive gastropathy;
• achalasia of the esophagus;
• cholelithiasis.

In order to clarify the diagnosis or control the treatment, the gastroenterologist prescribes various types of instrumental and laboratory studies.

Methods for diagnosing pathologies of the stomach

Statistics say that approximately 95% of the population in one way or another needs regular monitoring by a gastroenterologist. But you should not be afraid of this. The current level of diagnosis of stomach diseases in Russia is high. Many clinics have high-tech equipment that allows for high-precision diagnostics, and qualified gastroenterologists who will explain what kind of gastric examination you need and how to start preparing for it.

Instrumental methods for examining the stomach

Hardware methods of examining the stomach are the main link in diagnosing diseases of the digestive system. They cannot replace each other. Each of these methods of examining the stomach is prescribed on the basis of the existing clinical picture and makes it possible to assess the morphological and structural features of the digestive organ.

Modern instrumental methods for examining the stomach include:

Gastroscopy, or esophagogastroduodenoscopy (EGDS),- this is an examination of the stomach with a special flexible instrument, with a fiber optic thread inside and a micro-lens at the end of the device - an endoscope. EGDS is prescribed before a planned operation, with significant weight loss and any symptoms of diseases of the stomach or intestines (nausea, severe heartburn, pain, belching, feeling of heaviness in the stomach, etc.). Contraindications to its implementation are:

• severe respiratory failure;
• heart rhythm disturbances;
• hypertensive crisis;
• stroke;
• hypertensive crisis;
• mental disorders.

The doctor always tells all patients how to prepare for such an examination of the stomach, since the reliability and informativeness of the results depend on this. The patient should:

• refuse to eat 10 hours before the study;
• do not smoke or take medicines in capsules or tablets before the procedure;
• remove tie, glasses and dentures during the procedure.

Gastroscopy takes 5 to 10 minutes. The patient is asked to lie on the left side. A mouthpiece is inserted into the mouth, and an endoscope is inserted into the throat. The doctor asks to make a swallowing movement and, controlling the endoscope, makes an examination.

Note!
Do not be afraid of pain in the process of gastroscopy. When using new equipment and special anesthetics, discomfort is minimized.

No other types of gastric diagnostics will provide so much information for making a diagnosis and choosing a treatment method. Only EGDS allows you to examine in detail the inner surface of the organ, make a digital video recording of the process and conduct the necessary additional studies (biopsy and determination of the acidity of gastric juice). The results of a gastroscopic examination with a detailed description of age-related or pathological changes seen during the examination are issued to the patient on the same day. Often, EGDS is prescribed in conjunction with colonoscopy, or fibrocolonoscopy (FCS), - a similar procedure, but intended for examining the intestines.

Fluoroscopy of the stomach- this is a visualization of an organ on the screen of X-ray equipment, used to study the state of the mucous membranes and diagnose disorders in their functioning. Indications for its implementation are:

• weight loss;
• belching;
• blood in the stool;
• heartburn;
• swallowing disorder.

Attention!
Do not confuse fluoroscopy with radiography! Radiography involves the creation of x-ray images for their subsequent study. Digital fluoroscopy is the most informative method for examining an organ in real time and in motion. The procedure is fast and does not require taking multiple pictures. In addition, the radiation exposure itself in fluoroscopic devices is hundreds of times lower.

Radioscopy of the stomach has contraindications. It is not recommended to carry it out with intestinal obstruction, a through violation of the stomach wall, pregnancy and the patient is allergic to drugs that contain barium.

Preparation for such an examination of the stomach is very simple. The patient needs to exclude legumes, milk, pastries, fruits, vegetables from the diet for several days and refrain from eating on the evening before the procedure.

Before starting fluoroscopy, the patient takes a contrast agent - a suspension with barium sulfate (approximately 0.250 ml). This substance envelops the gastric mucosa, delays x-rays, providing a clear image of the organ on the screen. After this, the patient is asked to take different poses and pictures are taken. The procedure does not cause any discomfort.

It's important to know!
After completion of the examination, mild nausea may occur and within 2-3 days the feces will be white. Do not worry! So the body removes barium sulfate.

The results of fluoroscopy allow you to quickly and accurately diagnose various diseases of the stomach - gastritis, hernia, malignant tumors, stomach and duodenal ulcers.

Sonography, or ultrasound examination of the stomach, - a method based on the ability of tissues to reflect sound waves with a frequency of more than 20 kHz. Such a study is prescribed extremely rarely and mainly for children. Why? Ultrasound of the stomach (namely the stomach) is an uninformative procedure in comparison, for example, with gastroscopy. With echography, it is impossible to see the pathology as a whole, it is impossible to simultaneously perform a biopsy, to track the nature of the changes. But in view of the fact that other types of hardware studies can cause discomfort to children, they begin with an ultrasound of the stomach - solely to confirm the suspicions of a gastroenterologist. A definitive diagnosis cannot be made after this examination. As a primary diagnosis, it is sometimes prescribed for adults who are timid about other types of research.

Ultrasound of the stomach is recommended if there is increased gas formation, pain in the stomach, there are problems with digestion of food, or suspicions of gastritis, ulcers, polyps or oncological neoplasms.

When prescribing an ultrasound of the stomach, the doctor always specifies what kind of preparation is required during the examination, because the accuracy of the results depends on it. Approximately 3 days in advance, patients should exclude fiber (fruits, vegetables), dairy products, legumes, sodas and pickles, bread from the menu. Do not eat, drink or smoke in the morning before the procedure. Usually, this study is performed (not always) as part of an ultrasound of all abdominal organs.

In terms of time, ultrasound takes 7-15 minutes. The patient lies on the couch and a special gel is applied to his stomach. The doctor moves the sensor over the skin and receives an image on the monitor. In some cases, after the examination on an empty stomach, the patient needs to drink 0.5 liters of water and undergo the procedure again. Ultrasound does not cause any discomfort.

The results of the ultrasound are known immediately after the completion of the examination. They suggest what causes discomfort, since many factors are assessed:

• the position and size of the organ in sections - normally they are “oval or rounded ring-shaped formations with an echo-negative rim and an echo-positive center”;
• the outer serous membrane is normally "hyperechoic";
• the size of the muscular membrane - "20-25 mm, hypoechoic character";
• the size of the submucosa - "up to 3 mm, medium echogenicity";
• muscular plate of the mucosa - "up to 1 mm, low hypoechogenicity";
• the state of the mucosa - "up to 1.5 mm in size, hyperechoic";
• wall thickness - in the norm "5 layers of the wall, different in echogenicity, wall thickness - from 4–6 to 6–8 mm in the proximal sections";
• layers of the gastric wall - "uniform";
• peristalsis - "primary evacuation of a glass of water - 3 minutes, complete - 20 minutes";
• the presence of inflammation - "absent".

It is interesting!
Ultrasound is a method for diagnosing the stomach, which does not have any harmful effects on the body. It is used even for newborns.

Laboratory diagnostics of stomach pathologies

These are studies of body fluids: gastric juice, blood, feces and urine. Without instrumental methods, they will not help to make an accurate diagnosis. But they must be carried out with a full examination of the stomach, otherwise it is impossible to determine the secretory activity, the bacterial composition of the intestine, the activity of liver enzymes and other important indicators.

Examination of gastric juice prescribed for chronic gastritis and stomach ulcers. This examination is also carried out in conditions such as functional achlorhydria and an irritable stomach.

You need to prepare for the study - no later than 8 pm the day before, eat a light dinner, and in the morning on the day of the procedure do not smoke, do not drink liquids, do not take medication and do not eat. Gastric juice is taken using a special probe, which is gently inserted through the mouth and esophagus. After that, the probe is removed, the patient is given breakfast, and then another portion of gastric juice is taken. There is also a probeless method. It is based on the patient taking reagents, after which saliva and urine are examined for color changes.

The results of sounding imply a description of color, volume, smell, determination of the acidity of gastric juice. They allow assessing the functional and morphological state of the gastric mucosa and are the main ones for determining the secretory function of the stomach. But the results of tubeless methods provide only indicative information without quantitative characteristics of gastric secretion.

Blood study. Not a single comprehensive examination can do without it when diagnosing or checking any diseases of the stomach. Blood is taken for analysis in the morning on an empty stomach. The day before the procedure, you should not drink alcohol and fatty high-calorie foods, you must refrain from smoking. If the study requires sampling, for example, a stimulation test involving the use of a protein mixture, it is necessary to make sure that the patient has not had a history of allergies to certain plant and animal proteins. If a gastroenterological patient takes medications, it is necessary to find out whether they can be abandoned. If not, then at least 1 day before the study, it is necessary to reduce the dosage. It is also possible that the drugs will not distort the test results. Blood is taken in compliance with all the rules of asepsis and antisepsis.

Based on the results of the analysis, it is possible to assess the general condition of the body, morphological tissue damage, determine the functional characteristics of the organ, determine the stage of the inflammatory process and the effectiveness of therapy.

Today, special gastroenterological panels have been developed, which include a set of tests with blood sampling from a vein. The panel may include, for example, tests for the level and proportions of pepsinogens I and II, stimulated or basal gastrin-17, for the presence of antigens (IgG) to the bacterium Helicobacter pylori, which can lead to H. pylori-associated chronic gastritis. In addition, indications for such a study are usually the risk of peptic ulcer and various dyspeptic disorders.

It is known that during inflammation of the pancreas, the enzyme lipase (triacylglycerolacylhydrolase) enters the blood, so if lipase can be detected in the blood in a volume of more than 78 U / l, we can talk about acute or chronic pancreatitis or a perforated stomach ulcer.

To confirm or refute autoimmune pathologies of the stomach (chronic atrophic gastritis, pernicious anemia, etc.), blood serum is taken for antibodies (IgG, IgA, IgM) to the parietal cells of the stomach, as well as for antibodies (IgG) to the internal factor of the Castle and for antibodies ( IgG) to saccharomycetes - baker's yeast Saccharomyces cerevisiae (ASCA).

Although perfect specific tumor markers for gastric cancer have not yet been found, it is known that the level of some antigens correlates with the stage of oncology. Such antigens include in particular the oncofetal carbohydrate antigens CA 72-4 and Ca 19-9. The latter is used to monitor pancreatic carcinoma together with carcinoembryonic antigen (CEA).

Urine study. A general urine test is prescribed for diarrhea, vomiting, ascites (fluid accumulation in the abdominal cavity) and malignant neoplasms. It should be noted that in uncomplicated peptic ulcer, urinalysis results do not show any significant changes. On the eve of the procedure, you should not take diuretics and eat any foods that change the color of urine (carrots, beets, etc.). Only morning urine on an empty stomach is taken for analysis. Before this, hygiene procedures of the external genital organs should be carried out. A small amount of urine (the first 1-2 seconds) is released into the toilet, and the next portion in a volume of 50 ml is collected in a sterile container.

The results of the analysis indicate the physico-chemical characteristics of urine (specific gravity, acidity, color, transparency) and check the urinary sediment for the presence of some inclusions (protein, blood cells, glucose, hemoglobin, etc.).

Study of feces. It is prescribed for the appearance of any symptoms of diseases of the digestive system. In order for the results to be informative, the patient must exclude fish and meat foods from the diet for 3 days before the procedure, as well as not take medications containing iodine, iron and bromine. For analysis, take a small amount of feces immediately after sleep. Send it for research in a sterile container.

The results always indicate the presence of blood and mucus in the feces, evaluate its color, smell, consistency and other physicochemical characteristics. Explicit and especially latent bleeding are observed in peptic ulcer disease in 10-15% of cases. But most often bleeding is fixed with a duodenal ulcer. In acute blood loss, the feces are tarry.

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)
BBC 54.13-4ya73

This textbook presents laboratory and instrumental methods for diagnosing diseases of the gastrointestinal tract, and outlines their diagnostic capabilities. The material is presented in a simple accessible form. The manual contains 39 figures, 3 tables, which will facilitate the assimilation of the material during 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 material presented.

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

Foreword
List of abbreviations

Chapter 2. Data of instrumental research methods in diseases of the gastrointestinal tract
1. Endoscopic research methods
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. Radiological research methods
2.1. Fluoroscopy (radiography) of the esophagus and stomach
2.2. Computed tomography and multislice computed tomography of the abdominal organs
2.3. Plain radiography of the abdominal organs and the study of the passage of barium through the intestines
2.4. Irrigoscopy
3. Ultrasonic research methods
3.1. Ultrasound of the stomach
3.2. Intestinal ultrasound (endorectal ultrasonography)
4. Methods of functional diagnostics

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

Test tasks for self-study
Bibliography

Foreword

Diseases of the gastrointestinal tract occupy one of the first places in the structure of morbidity, especially among people of young, working age, the number of patients with pathology of the digestive system 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 an extremely important point in the diagnosis of gastrointestinal diseases. a path as quite often they proceed 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 course 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 the traditional, well-established studies, new modern methods for diagnosing diseases of the gastrointestinal tract were considered: quantitative determination of transferrin and hemoglobin in feces, determination of the marker of inflammation of the intestinal mucosa - fecal calprotectin, examination of blood serum using the "GastroPanel", method diagnosis of gastric cancer using a blood serum tumor marker, modern methods for diagnosing Helicobacter pylori infection, capsule endoscopy, computed tomography and multislice computed tomography of the abdominal organs, ultrasound examination of the stomach and intestines (endorectal ultrasonography) and many others.

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

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

For a better understanding of the diagnostic capabilities of laboratory and instrumental methods of research and interpretation of the results obtained, the textbook contains 39 figures and 3 tables. In the final part of the manual, test tasks for self-study are given.

List of abbreviations

TANK	- blood chemistry
obd	- major duodenal papilla
DPK	- duodenum
ZhVP	- bile ducts
cholelithiasis	- 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	- sedimentation rate of erythrocytes
Tf	- transferrin in feces
ultrasound	- ultrasound procedure
FEGDS	- fibroesophagogastroduodenoscopy
HP	– Helicobacter pylori
Hb	- hemoglobin in feces
HC1	– hydrochloric acid

Chapter 1

1. Screening research methods

1.1. General blood analysis

1.2. General urine analysis

1.3. Blood chemistry

1.4. Examination of feces for eggs of worms and cysts of protozoa:

2. Special research methods

2.1. Methods for the study of feces

2.1.1. Coprological examination (coprogram)

Coprogram indicators	Coprogram indicators are normal	Changes in coprogram parameters in gastrointestinal diseases
Macroscopic examination
Amount of feces	100-200 g per day. With the predominance of protein in the diet, write the amount of feces decreases, vegetable - increases. With a vegetarian diet, the amount of feces can reach 400-500 g.	- Isolation of fecal masses in a large volume (more than 300 g per day - polyfecal matter) is characteristic of diarrhea. - A small amount of feces (less than 100 g per day) is characteristic of constipation.
Consistency of feces	Moderately dense (dense)	- Dense consistency - with constant constipation due to excessive absorption of water - Liquid or mushy consistency of feces - 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, in chronic pancreatitis with exocrine insufficiency) - Foamy consistency - with enhanced fermentation processes in the colon and the formation of a large amount of carbon dioxide
The shape of the feces	Cylindrical	- The form of feces in the form of "large lumps" - with a long stay of feces in the colon (hypomotor dysfunction of the colon in people with a sedentary lifestyle or who do not eat coarse food, as well as with colon cancer, diverticular disease) - The form in the form of small lumps - "sheep feces" indicates a spastic state of the intestine, during starvation, a stomach ulcer and duodenal ulcer, a reflex character after appendectomy, with hemorrhoids, an anal fissure - Ribbon-like or "pencil" shape - in diseases accompanied by stenosis or severe and prolonged spasm of the rectum, with tumors of the rectum - Unformed feces - a syndrome of maldigestion and malabsorption The Bristol scale of fecal forms (Fig. 1) is a medical classification of human feces forms developed by Meyers Hayton at the University of Bristol, published in 1997. Type 1 and 2 characterize constipation Type 3 and 4 - normal stool Type 5, 6 and 7 - diarrhea
Smell	Fecal (regular)	- Prolonged retention of stool in the colon (constipation) leads to the absorption of aromatic substances and the smell almost completely disappears - During fermentation processes, the smell of feces is sour due to volatile fatty acids (butyric, acetic, valeric) - Enhanced putrefaction processes (putrefactive dyspepsia, decay of the intestinal tumor) cause the appearance of a fetid odor as a result of the formation of hydrogen sulfide and methyl mercaptan
Color	Brown (when eating dairy food - yellowish-brown, meat - dark brown). The intake of plant foods and certain medications can change the color of feces (beets - reddish; blueberries, blackcurrants, blackberries, coffee, cocoa - dark brown; bismuth, iron color feces black)	- In case of obstruction of the biliary tract (stone, tumor, spasm or stenosis of the sphincter of Oddi) or liver failure (acute hepatitis, cirrhosis of the liver), leading to a violation of the release of bilirubin, the flow of bile into the intestine stops or decreases, which leads to discoloration of the feces, it becomes greyish white, clayey (acholic feces) - With exocrine pancreatic insufficiency - gray, since stercobilinogen is not oxidized to stercobilin - Bleeding from the stomach, esophagus and small intestine is accompanied by the appearance of black stool - "tarry" (Melena) - With bleeding from the distal colon and rectum (tumor, ulcers, hemorrhoids), depending on the degree of bleeding, the stool has a more or less pronounced red color - In cholera, the intestinal discharge is an inflammatory gray exudate with fibrin flakes and pieces of the colon mucosa ("rice water") - Dysentery is accompanied by the release of mucus, pus and scarlet blood - Intestinal discharge in amoebiasis may have a jelly-like character of rich pink or red color
Slime	Absent (or scarce)	- When the distal colon (especially the rectum) is affected, the mucus is in the form of lumps, strands, ribbons or vitreous mass - With enteritis, mucus is soft, viscous, mixing with feces, giving it a jelly-like appearance - Mucus covering the formed feces from the outside in the form of thin lumps, occurs with constipation and inflammation of the large intestine
Blood	Missing	- When bleeding from the distal colon, the blood is located in the form of veins, shreds and clots on the formed feces - Scarlet blood occurs when bleeding from the lower parts of the sigmoid and rectum (hemorrhoids, fissures, ulcers, tumors) - Altered blood from the upper part of the digestive system (esophagus, stomach, duodenum), mixing with feces, stains it black ("tarry" feces, melena) - Blood in the feces can be detected in infectious diseases (dysentery), ulcerative colitis, Crohn's disease, decaying tumors of the colon in the form of veins, clots up to profuse bleeding
Pus	Missing	- Pus on the surface of the feces is determined with severe inflammation and ulceration of the mucous membrane of the colon (ulcerative colitis, dysentery, decay of the intestinal tumor, intestinal tuberculosis) often together with blood and mucus - Pus in large quantities without admixture of mucus is observed at the opening of paraintestinal abscesses
Leftover undigested food (lientorrhoea)	Missing	Severe insufficiency of gastric and pancreatic digestion is accompanied by the release of undigested food residues.
Chemical research
Reaction	Neutral, rarely slightly alkaline or slightly acidic	- An acidic reaction (pH 5.0-6.5) is noted when the iodophilic flora is activated, which forms carbon dioxide and organic acids (fermentative dyspepsia) - Alkaline reaction (pH 8.0-10.0) occurs with enhanced processes of protein decay in the colon, activation of the putrefactive flora that forms ammonia (putrefactive dyspepsia)
Reaction to blood (Gregersen's 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 of the gastrointestinal tract, tumors of any part of the gastrointestinal tract in the stage of decay)
Reaction to stercobilin	Positive	- The absence or a sharp decrease in the amount of stercobilin in the feces (the reaction to stercobilin is negative) indicates obstruction of the common bile duct by a stone, compression of it by a tumor, strictures, choledochal stenosis, or a sharp decrease in liver function (for example, in acute viral hepatitis) - An increase in the amount of stercobilin in the 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 large intestine ensures the process of reduction of bilirubin to stercobilinogen, and then to stercobilin	The detection of unchanged bilirubin in the feces of an adult indicates a violation of the process of restoring bilirubin in the intestine under the influence of microbial flora. Bilirubin can appear with rapid evacuation of food (a sharp increase in intestinal motility), severe dysbacteriosis (a syndrome of excessive bacterial growth in the colon) after taking antibacterial drugs
Vishnyakov-Tribulet reaction (for soluble protein)	negative	The Vishnyakov-Tribulet reaction is used to detect a latent inflammatory process. The detection of soluble protein in feces indicates inflammation of the intestinal mucosa (ulcerative colitis, Crohn's disease)
microscopic examination
Muscle fibers: With striation (unchanged, undigested) - without striation (altered, digested)	Missing None (or single in sight)	A large number of altered and unchanged muscle fibers in feces ( toreatorrhea) indicates a violation of proteolysis (digestion of proteins): - in conditions accompanied by achlorhydria (lack of free HCl in gastric juice) and achilia (complete absence of secretion of HCl, pepsin and other components of gastric juice): atrophic pangastritis, condition after gastric resection - with accelerated evacuation of food chyme from the intestines - in violation of the exocrine function of the pancreas - with putrefactive dyspepsia
Connective tissue (remains of undigested vessels, ligaments, fascia, cartilage)	Missing	The presence of connective tissue in the feces indicates a deficiency of proteolytic enzymes of the stomach and is observed with hypo- and achlorhydria, achilia
Fat neutral Fatty acid Salts of fatty acids (soaps)	Missing or meager amount fatty salts acids	Violation of the digestion of fats and the appearance in the feces of a large amount 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. - in violation of the flow of bile into the duodenum (violation of the process of emulsification of fat in the small intestine) and in violation of the absorption of fatty acids in the small intestine, fatty acids or salts of fatty acids (soaps) are found in the feces
Vegetable fiber (digestible) is found in the pulp of vegetables, fruits, legumes and cereals. Indigestible fiber (skin of fruits and vegetables, plant hairs, epidermis of cereals) has no diagnostic value, since there are no enzymes that break it down in the human digestive system	Single cells in p / s	It occurs in large numbers with rapid evacuation of food from the stomach, achlorhydria, akhiliya, with the syndrome of excessive bacterial growth in the colon (a 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 the stool is called amylorrhea and is observed more often with increased intestinal motility, fermentative dyspepsia, less often with exocrine insufficiency of pancreatic digestion
Iodophilic microflora (clostridia)	Single in rare cases (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 / o	A large amount of columnar epithelium in the feces is observed in acute and chronic colitis of various etiologies.
Leukocytes	Absent or solitary neutrophils in the s / c	A large number of leukocytes (usually neutrophils) is observed in acute and chronic enteritis and colitis of various etiologies, ulcerative-necrotic lesions of the intestinal mucosa, intestinal tuberculosis, dysentery
red blood cells	Missing	- the appearance of slightly altered erythrocytes in the feces indicates the presence of bleeding from the colon, mainly from its distal sections (ulceration of the mucous membrane, a decaying tumor of the rectum and sigmoid colon, anal fissures, hemorrhoids) - with bleeding from the proximal colon, erythrocytes are destroyed and are not detected by microscopy - a large number of erythrocytes in combination with leukocytes and columnar epithelium is characteristic of ulcerative-necrotic lesions of the colon mucosa (ulcerative colitis, Crohn's disease with lesions of the colon), polyposis and malignant neoplasms of the colon
worm eggs	Missing	Eggs of roundworm, broad tapeworm, etc. indicate the corresponding helminthic invasion
Pathogenic protozoa	Missing	Cysts of dysenteric amoeba, Giardia, etc. indicate the corresponding invasion by protozoa
yeast cells	Missing	They are found in feces during treatment with antibiotics and corticosteroids. Identification of the fungus Candida albicans is carried out by inoculation on special media (Saburo's medium, Microstix Candida) and indicates a fungal infection of the intestine
Calcium oxalate (lime oxalate crystals)	Missing	They enter the gastrointestinal system with plant foods, normally HCl of gastric juice dissolves with the formation of calcium chloride. Detection of crystals is a sign of achlorhydria
Tripelphosphate crystals (ammonia-magnesium phosphate)	Missing	It is formed in the large intestine during the breakdown of lecithin, nuclein and other decay products of proteins. Trippelphosphate crystals found in faeces (pH 8.5-10.0) immediately after defecation indicate increased putrefaction in the colon

Scatological syndromes

Chewing failure syndrome

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

Causes of chewing deficiency syndrome:

• absence of molars
• multiple dental caries with their destruction

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

Syndrome of insufficiency of digestion in the stomach (gastrogenic scatological syndrome)

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

Causes of gastrogenous scatological syndrome:

• atrophic gastritis
• stomach cancer
• conditions after resection of the stomach
• erosion in the stomach
• stomach ulcer
• Zollinger-Ellison syndrome

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

Syndrome of insufficiency of pancreatic digestion (pancreatogenic scatological syndrome)

The true indicator of insufficiency of pancreatic digestion is the appearance of neutral fat in the feces (steatorrhea), since lipases do not hydrolyze fats.

There are muscle fibers without striation (creatorrhoea), the presence of starch is possible, polyfecalia is characteristic; soft, ointment-like consistency; unformed feces; gray color; sharp, fetid odor, positive reaction to stercobilin.

Causes of pancreatogenic scatological syndrome:

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

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

Hepatogenic scatological syndrome develops due to the absence of bile ( acholia) or its insufficient supply ( hypocholia) in the DPC. As a result, bile acids involved in the emulsification of fats and activating lipase do not enter the intestine, which is accompanied by a violation of the absorption of fatty acids in the small intestine. This also reduces peristalsis of the intestines, stimulated by bile and its bactericidal action.

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

Microscopic examination: a large amount of fatty acids and their salts (soaps) - products of incomplete cleavage.

Causes of hepatogenic scatological syndrome:

• diseases of the biliary tract (GSD, obstruction of the common bile duct with a stone (choledocholithiasis), compression of the common bile duct and BDS by a tumor of the pancreatic head, pronounced strictures, stenoses 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 scatological syndrome develops under the influence of two factors:

• insufficiency of the enzymatic activity of the secretion of the small intestine
• reduced absorption of end products of hydrolysis of nutrients

Causes of enteral scatological syndrome:

• chewing insufficiency syndrome gastric digestion insufficiency
• insufficiency of separation or flow of bile into the duodenum
• helminthic invasions 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, celiac disease (celiac disease)

Coprological signs will be different depending on the cause of indigestion in the small intestine.

Syndrome of indigestion in the colon

Causes of the syndrome of indigestion in the colon:

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

With spastic colon dyskinesia 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, a moderate amount of cylindrical epithelium, single leukocytes.

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

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

• Fermentative dyspepsia(dysbiosis, syndrome of excessive bacterial growth in the colon) occurs due to a violation of the digestion of carbohydrates and is accompanied by an increase in the amount of iodophilic flora. Fermentation processes proceed with an acidic pH (4.5-6.0). Stools are copious, thin, frothy, with a sour smell. Mucus mixed with feces. In addition, fermentative dyspepsia is characterized by the presence in the feces of large amounts of digestible fiber and starch.
• 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 disturbed, their decomposition occurs, the resulting products irritate the intestinal mucosa, increase the release of the amount of fluid and mucus. Mucus is a good breeding ground for microbial flora. In putrefactive processes, the feces are of a liquid consistency, dark brown in color, alkaline with a sharp, putrid odor and a large number of muscle fibers under microscopy.

2.1.2. Bacteriological examination of feces

Bacteriological examination of feces- inoculation of feces on nutrient media for the purpose of qualitative analysis and quantitative determination of normal intestinal microflora, as well as opportunistic and pathogenic forms of microorganisms.
Bacteriological culture of feces is used to diagnose the syndrome of excessive bacterial growth in the intestine (intestinal dysbacteriosis), intestinal infections and monitor the effectiveness of their treatment:

• quantitative assessment of microflora (bifidus and lactic acid bacteria, clostridia, opportunistic and pathogenic microflora, fungi) with the determination of sensitivity to antibiotics and phages
• identification of causative agents 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. examination of feces for occult blood (Gregersen's reaction)
B. determination of transferrin (Tf) and hemoglobin (Hb) in feces

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

Latent blood is called, which does not change the color of feces and is not determined macro- and microscopically. The Gregersen reaction for the detection of occult blood is based on the property of the blood pigment to accelerate oxidative processes (chemical study).

A positive stool reaction to occult blood can be observed when:

• erosive and ulcerative lesions of the gastrointestinal tract
• tumors of the stomach, intestines in the stage of decay
• helminth invasions that injure the intestinal wall
• rupture of varicose veins of the esophagus, cardia of the stomach, rectum (liver cirrhosis)
• ingestion of blood from the oral cavity and larynx into the digestive tract
• impurities in the feces of blood from hemorrhoids and anal fissures

The test allows you to determine hemoglobin at 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)) - detection of lesions of the intestinal mucosa. This test is far superior in sensitivity to the fecal occult blood test. Transferrin persists for a longer time than hemoglobin in feces. An increase in the content of transferrin indicates damage to the upper intestine, and hemoglobin - the lower intestine. If both indicators are high, then this indicates the extent of the lesion: the higher the indicator, the greater the depth, or the affected area.

These tests are of great importance in the diagnosis of colorectal cancer, as they can detect cancer both at early stages (I and II) and at later 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 of people over 40 years old (1 time per year)
• monitoring of the state 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 its suspicion
• examination of family members of the first and second degree of kinship who have been diagnosed with cancer or intestinal polyposis

2.1.4. Determination of the 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:

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

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

2.2. The study of blood serum using the "GastroPanel"

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

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

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

Indicators of intragastric pH-metry are presented in table 2.

Table 2. Indicators of intragastric pH-metry

pH of the body of the stomach	hyperacid state	normoacid condition	hypoacid condition	anacid condition
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 response)	>5,1
pH of the antrum	alkalization compensation	decrease in alkalizing function	alkalization subcompensation	alkalization decompensation
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. Examination 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 study

The study of basal secretion: the day before the study, drugs that inhibit gastric secretion are canceled, and after 12-14 hours of fasting 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 a fasting portion. This portion is not taken into account in the study of basal secretion. Then every 15 minutes remove the gastric juice. The study is continued for an hour - thus, 4 servings are obtained, reflecting the level of basal secretion.

Stimulated secretion study: Parenteral gastric secretion stimulants (histamine or pentagastrin, a synthetic analogue of gastrin) are currently used. So, after the study of 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 gastric parietal cells or 0.04 mg/kg of the patient's body weight - maximum stimulation of the parietal cells of the gastric mucosa) or pentagastrin (6 mg /kg of body weight of the patient). Then, every 15 minutes, gastric juice is collected. Received 4 portions within an hour make up 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 putrid odor indicates a significant violation of the evacuation from the stomach (pyloric stenosis) and the resulting putrefactive breakdown of proteins. Normal gastric juice contains only a small amount of mucus. An increase in mucus impurity indicates inflammation of the gastric mucosa, and the appearance of food mass residues in the received portions also indicates serious violations of evacuation from the stomach (pyloric stenosis).

Indicators of gastric secretion are normally 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 debit-hour of HCl free. is the 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 Phase of stimulated secretion: - 6.5-12 meq / l / h (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 columnar epithelium in the field of view Slime +

Interpretation of study results

1. Clock voltage change:

• an increase in the amount of gastric juice indicates hypersecretion (erosive antral gastritis, an ulcer of the antrum of the stomach 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, gastric cancer) or an accelerated evacuation of food from the stomach (motor diarrhea)

2. Change in debit-hour of free HCl:

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

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

Disadvantages of the aspiration-titration method, which limit its practical application:

• removal of gastric juice violates the normal conditions of the stomach, it is unphysiological
• part of the contents of the stomach is inevitably removed through the pylorus
• secretion and acidity indicators do not correspond to the actual ones (usually underestimated)
• the secretory function of the stomach increases, since the probe itself is an irritant of the gastric glands
• aspiration method provokes the occurrence of duodenogastric refluxes
• it is impossible to determine nocturnal secretion and the daily rhythm of secretion
• it is impossible to assess acid production after a meal

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

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

Test tasks for self-study

Choose one or more correct answers.

1. Special laboratory studies for diseases of the gastrointestinal tract

1. scatological examination
2. general blood analysis
3. blood serum analysis using "GastroPanel"
4. bacteriological examination of feces
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. ESR acceleration

3. Anemia in the general blood test can be observed when:

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

4. Changes in the biochemical analysis of blood in case of malabsorption in the small intestine:

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

5. A normal coprogram is characterized by:

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

6. Signs of bleeding from a duodenal ulcer:

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

7. In the coprogram, macroscopic indicators are

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

8. In the coprogram, chemical indicators are

1. reaction to stercobilin
2. connective tissue
3. form of feces
4. response to bilirubin
5. Gregersen reaction

9. In the coprogram, macroscopic indicators are

1. amount of feces
2. neutral fat
3. vegetable fiber (digestible)
4. leukocytes
5. erythrocytes

10. Steatorrhea is a sign

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

11. Causes of hepatogenic scatological syndrome

1. cholidocholithiasis
2. stomach tumor
3. pancreatic head tumor
4. cirrhosis of the liver
5. atrophic gastritis

12. Markers of damage to the intestinal mucosa

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

13. Methods for diagnosing Helicobacter pylori infection

1. morphological study of biopsy specimens of the gastric mucosa
2. radiological
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 diseases of the gastrointestinal tract are

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

16. Variants of intragastric pH-metry

1. short-term
2. aspiration
3. endoscopic
4. radiological
5. daily

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

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

18. A large amount of digested and undigested fat in feces is called _____________

19. A large number of altered and unchanged muscle fibers in the stool 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.	creatorrhoea
5.	1, 5	10.	4	15.	1, 4, 5	20.	amylorrhea

Bibliography

1. Vasilenko V.Kh., Grebenev A.L., Golochevskaya V.S., Pletneva N.G., Sheptulin A.A. Propaedeutics of internal diseases / Ed. A.L. Grebenev. Textbook. – 5th edition, revised and enlarged. - M.: Medicine, 2001 - 592 p.
2. Molostova V.V., Denisova I.A., Yurgel V.V. Coprological research in norm and pathology: teaching aid / Ed. Z.Sh. Golevtsova. - Omsk: OmGMA Publishing House, 2008. - 56 p.
3. Molostova V.V., Golevtsova Z.Sh. Methods for studying the acid-forming function of the stomach: a teaching aid. Supplemented and revised. - Omsk: Publishing House of 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 // Archives of Pathology. - 2009. - Volume 71 - No. 4 - S. 11-18.
5. Roitberg G.E., Strutynsky A.V. Internal illnesses. Laboratory and instrumental diagnostics: textbook. - Moscow: Publishing house MEDpress-inform, 2013. - 816 p.
6. Electronic library of OmGMA. Access mode: weblib.omsk-osma.ru/.
7. Electronic library system "KnigaFond". Access mode: htwww . bookfund.ru
8. Electronic library system of the 1st Moscow State Medical University. I.M. Sechenov. Access mode: www . scsml.rssi.ru
9. Scientific electronic library (eLibrary). Access mode: http: // elibrary.ru
10. Journal Consilium Medicum. Access mode: www . consilium-medicum.com