What are the qualitative methods for examining the gastrointestinal tract? Can this be done with CT or MRI without having to deal with endoscopes? Long-term disorder.

What are the qualitative methods for examining the gastrointestinal tract? Can this be done with CT or MRI without having to deal with endoscopes? Long-term disorder.

Patients with Chronic Abdominal Pain - Douglas A. Drossman, MD | UCLA Digestive Diseases

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answers (3)

Answer 1
June, 2021

The fact is that any method can be carried out efficiently and informatively. Another question is that they differ in indications, that is, in clinical situations, when any method may be preferable. For example, a century-old X-ray of the stomach remains the leading method in diagnosing a hiatal hernia and manifestations of reflux disease to this day.

However, if you’re not smart, I believe that you and many patients are interested in the question: Is it possible to qualitatively examine organs abdomen, without resorting to painful and psychologically uncomfortable penetrating (invasive) methods? If the answer is no or yes, then no. And if not so categorically, then yes, in most cases it is possible. However, CT, MRI and other wonders of science cannot completely replace endoscopy. The paradox is that endoscopy is not always required for your specific diagnostic case.

And here there are two main scenarios: medical examination and illness.

As for medical examination, planned preventive examination for everyone case, it almost never includes endoscopic methods, unless you know for sure about hereditary familial polyposis or stomach cancer in both parents. In other cases, non-invasive methods are sufficient - determination of human hemoglobin in feces by the immunochemical method, etc. At the age of 50 or even 60 years, endoscopic methods of clinical examination are more likely to be justified, but have not yet entered official national recommendations, except for Japan and South Korea.

Imaging beam techniques, CT and MRI are focused primarily on incomplete organs (liver, pancreas, spleen, kidneys). Virtual colonoscopy or multislice computed tomography in colonoscopy mode could not replace endoscopic colonoscopy. But it can be used to control when, for example, the polyps have been removed and the patient is regularly examined for recurrence. Or in a situation where you need to track a possible relapse of Crohn's disease or swollen with growth outside the intestine. There are many indications, but they are all narrow. Moral: the method complements endoscopic colonoscopy, sometimes it is used instead of it for supervision.

When it comes to the disease, the indications are determined by the symptoms. Moreover, if a young man has a stomach ache for the first time, he probably does not need gastro and colonoscopy. If you follow the European protocols in this area, the number of these studies in young people will decrease many times, in the elderly, they will rather increase.

Now to the question of the possibilities of endoscopic methods and how they can be easily transferred. In European countries, 95-98% of these studies are performed in sleep. It is a little more expensive, but unimaginably more comfortable. Do not believe that this is unnecessary anesthesia, it is better to be patient, the doctor will know when you are in pain or when not, and will tear your intestines. All this is nonsense, obscurantism and medical folklore, because this tradition was passed on at the department from father to son to grandfather. These statements are not related to medicine andsweat. At the same time, since we have already entered the body, it would be nice to take out the maximum information from that. It is ugly rare for us to take biopsies, the answer "do not take it" is when there is no visible ulcer or tumor. A biopsy should always be, for example, in the stomach from at least 5 places in different departments, this is the only way to assess the predisposition to cancer by the presence of atrophy and metaplasia. In the intestine, some diseases are visible only with a histological examination of a biopsy, microscopic colitis is extremely rarely diagnosed in our country precisely because of the lack of the proper number of biopsies. Not to mention that endoscopes are also different, some have built-in laser and optical technologies that allow you to see the invisible. In Japan this is already a standard, in developed countries there is a rapid trend, we still have a rarity.

But what about the famous video capsule, which it swallowed and it reports from the inside in real time? A useful thing for examining the small intestine, but, in general, uninformative, not capable of replacing gastro and colonoscopy, only complementing it.

Is there at least one method that has completely replaced the invasive analogue? Perhaps this is an MRI cholangiography. A special MRI program allows for very accurate visualization of the bile tree, including inside the liver. And almost always allows you to do without invasive cholangiography. The latter is good diagnostic but in fact a mini operation with a high percentage of complications. Sometimes you still can't do without it, but you need it less and less. Especially with the advent of endoscopic ultrasound. This method is also invasive - a gastroscope with an ultrasound sensor is inserted, but the percentage of complications is negligible in comparison with classical cholangiography, and together with MRI it allows you to achieve amazing results.

Here a colleague wrote about the gastropanel. This is an accurate method for diagnosing atrophic gastritis, which allows you to assess the risk of cancer transformation. But again, gastroscopy cannot replace and not everyone needs it. Not a cheap but effective laboratory method for the differential diagnosis between inflammation and functional disorders of the intestine is calprotectin in the feces.

What is the result?

Non-invasive methods for examining the digestive system, completely replacing endoscopic analogues, have not yet been created. But the indications for invasive methods must be clearly formulated. They do not stand at the beginning of the diagnostic search; more often than not, they should be preceded by other examinations. Young people need them much less often and not for the purpose of medical examination. If you are confident in your doctor that he correctly identified the indications for research, it is better to do it in a place where there is a perfect technique, the rules for taking biopsies are followed and there is an anesthesiological service.

Answer 2
June, 2021

The Center for Molecular Diagnostics (CMD) carries out non-invasive diagnostics using the GastroPanel - a complex of laboratory blood tests. The GastroPanel includes the following tests: determination of the concentration of pepsinogen I, pepsinogen II, gastrin-17. In addition, antibodies to Helicobacter pylori (Helicobacter pylori) are determined. Helicobacter pylori is a pathogenic parasitic bacterium that infects the stomach and duodenum. It damages the mucous membrane, which leads to the development of atrophic gastritis, ulcers and stomach cancer.

The results obtained are processed by a special program GastroSoft®, after which a GastroCard is drawn up, including the most probable interpretation of the results obtained, a preliminary diagnosis, risk calculation and recommendations.

GastroPanel allows you to diagnose Helicobacter pylori infection and atrophic gastritis, to determine the risk of stomach cancer and peptic ulcer disease. Since the markers to be determined are produced by different parts of the stomach, GastroPanel allows you to determine the localization of the pathological process (antrum, body of the stomach or both), to assess the nature of changes.

The possibilities of using the GastroPanel are quite wide: it is both the primary method of diagnosis and screening in risk groups for preventive purposes, and monitoring the effectiveness of the treatment.

GastroPanel is absolutely safe for patients - you just need to donate blood from a vein. GastroPanel can be successfully used in the presence of contraindications to gastroscopy or in the absence of opportunities for its implementation.

Answer 3
June, 2021

CT and MRI can show neoplasms, narrowing or other anatomical abnormalities, but will not show the state of the mucous membrane.

Endoscopy allows not only to examine the gastrointestinal mucosa, but also to take secretions and biopsies, if necessary, which is also very useful .

In case of long-term disorder, functional tests, enzymes, coprogram, extended blood biochemistry and endoscopy. The mucous membrane should be examined for ulcers and erosion.

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