Diagnosis of duodenal ulcer

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Diagnosis of duodenal ulcer is a complex process. The first stage is the careful examination of subjective symptoms in the patient:

• Pain. When does it start with eating? What helps it to calm? How often does he show himself? Where does he give? Does it depend on seasonality?
• Dyspeptic disorders - a survey about the patient's gastrointestinal disorders, changes in appetite, heartburn, vomiting or nausea.

The doctor also conducts the examination of the patient, including abdominal palpation. In most cases, an experienced specialist, with a high probability based on the data obtained, will be able to deliver an accurate preliminary diagnosis and designate studies that need to be carried out further to develop treatment tactics.

However, with duodenal ulcers, diagnosis can not consist only of subjective data, since many GI diseases are similar in their symptoms. For an accurate differentiation of the disease, additional methods of examination are necessary.

So, how to determine duodenal ulcer? The patient with suspicion of YaB necessarily sends for examination:

1. instrumental;
2. histological;
3. biochemical, etc.

Of the instrumental ones, radiography and endoscopy are essential. For a long time it was believed that the X-ray can accurately diagnose duodenal ulcer, but after the beginning of a wide application of endoscopes it was found that the accuracy of this method varies between 50-80%, while in endoscopy, you can get the opposite result in 30% of cases.

However, even today the radiologic method of diagnosis has not lost its relevance, although it is significantly inferior to the reliability of esophagogastroduodenoscopy. The fact is that with a peptic ulcer with time, a rough deformation of the bulb of the duodenum often occurs, which makes the use of the endoscope impossible.

To accurately determine the diagnosis of duodenal ulcers, the following attributes are evaluated:

1. functional;
2. morphological;
3. associated.

Morphological attributes include: a peptic niche on the relief or contour, a defect in the area of ​​ulceration, deformation of the duodenum, "defect filling" of the intestine.

Functional features include changes in peristalsis, change in evacuation function, regional spasm.

Associated signs: a change in the gallbladder, spasticity of the colon, duodenitis, gastritis.

For the best results the doctor should refer the patient to both the radiograph and to the endoscopy, supplementing the obtained data with the results of cytology and histology.

Such complex diagnostics allows to establish the presence of a peptic ulcer in a patient, but does not allow to choose the optimal treatment tactics. To complete the picture, it is necessary to determine the deviations of the motor-evacuation and secretory functions of the duodenum and stomach. Let's see how it is possible to diagnose duodenal ulcer?

The investigation of the motor-evacuation function can be carried out using:

• Radiography .The advantage of the method is its physiological character, its disadvantages are the indirectness of the data obtained;
• Electrogastroscopy .The advantage of this method is the possibility for a long time without a probe to investigate the motor activity of the intestine. The disadvantage is that it is not possible to conduct a local study;
• phonographs or peristalsis noise recording is performed from the body surface, thereby not causing inconvenience to the patient. Disadvantages - the inability to localize recorded noise.
• Ballonography - evaluates the motor activity of the digestive system on the basis of pressure in the digestive tract. Allows to evaluate the state of motor activity of the intestine. The disadvantage is non-physiological( the cans used in the procedure irritate the intestinal wall, stimulating its motility).