Recently, there has been a change in the understanding of the reasons that determine why an ulcer occurs, and the diagnosis in turn also changes the requirements for the methods of examination.
Since at the moment the main pathogen of the disease is considered to be the bacterium Helikobakter Pilori, the diagnosis of peptic ulcer occurs according to the principle of the aggregate of information. The complex of anamnestic data consists of complaints from the patient from the time of the onset of the first symptoms and the collection of information relating directly to the person's way of life. The medical history consists of the following items:
- work place;
- bad habits;
- long-term use of non-steroidal anti-inflammatory drugs;
- diet;
- hereditary predisposition;
- exclusion of such diseases and disorders as dyspepsia, irritable bowel syndrome, gastroesophageal reflux disease, gallstones, heart problems.
If the exacerbations are seasonal, the local mucosal defect is likely to have passed into a chronic process with cyclical development. In such a case, remission can be protracted and short-lived. Integral diagnostics of stomach ulcers helps to assign appropriate treatment and eliminate cause-effect relationships of pathogenesis, which became the precursor of erosive defects formation.;
Differential diagnosis of peptic ulcer
As practice shows, a significant number of patients with gastric ulcer in the past suffered from gastritis or suffered inflammation of the mucous membrane of the duodenum. The main phase in collecting information is to elucidate the evolution of the symptoms of the disease since its first signs. Detailed diagnosis of gastric ulcers makes it possible to recognize the defect at an early stage of development and to make a clinical picture of the causes that led to pathological organ disorders. Based on the history of the disease, a chart of further examination methods is drawn up to give a clear differential diagnosis of peptic ulcer, eliminating GI diseases with identical symptoms.
During the next phase of diagnosis, the doctor conducts a contact examination. Compares weight in relation to the constitution of the body, since in peptic ulcer a person can intentionally refuse food because of the discomfort that occurs after eating. Conducts a finger examination of the abdomen for pain or seizures in the epigastric region. Differential diagnosis of gastric ulcer makes it possible to account for the differences between such processes as chronic cholecystitis and pancreatitis. These diseases have a similar clinical picture: pain in the hypochondrium, flatulence, constipation or loose stool after eating fatty foods.
The main distinguishing feature of the disease are erosive foci, on which peptic ulcer is recognized. The diagnosis should also be distinguished from secondary erosive lesions of Zollinger-Ellison syndrome or as a result of the use of anti-inflammatory drugs. And before issuing the final conclusion - a stomach ulcer, it is important to exclude the symptoms of primary-ulcerated cancer of the digestive organ. The method of examination consists in the histological examination of the erosive material.
Methods for diagnosing gastric ulcer
Many patients are concerned with the question of how to diagnose a stomach ulcer for an accurate and objective conclusion about the nature of the disease? Experts trust only paraclinical methods of examination. To the collected anamnesis, which includes complaints of the patient, heredity, the nature of pain, the cyclicity of exacerbations and the touch of the condition of the tissues and organs of the abdominal wall, attach the results of instrumental diagnostic methods.
Currently, the following instrumental laboratory tests for gastric ulcer are used:
- Clinical blood test for the presence of the bacterium Helicobacter pylori. By the way, high levels of erythrocytes and hemoglobin are also often observed with peptic ulcer.
- Intragastric pH-metry is the measurement of the acidity of the stomach environment( first on an empty stomach, and then after a test meal).
- Roentgenoscopy of the stomach. X-ray examination is the most highly effective and allows you to detect the exact location of erosive foci, as well as to identify or exclude severe complications, such as perforation of the walls of the digestive organ and stenosis.
- Endoscopy. With the help of the study, the doctor assesses the condition of the mucosa and the lumen of the esophagus.
- Microscopic analysis of the material of the gastric mucosa obtained by sampling an intravital tissue sample.
On the obtained data on the etiology and pathogenesis of the disease, the formulation of the diagnosis of gastric ulcer is based. Diagnosis and treatment are interrelated concepts, and from the correctly established pathogenesis depends the further appointment of therapeutic actions and the prognosis of the cure of the defect.