SU1399677A1 - Method of evaluating the acid-generating function of stomach - Google Patents

Abstract

 Acquisition relates to medicine, intended for the diagnosis of diseases of the stomach and the choice of treatment. The purpose of the invention is to improve the accuracy of the method and reduce the research time. For this purpose, the pH of the stomach is measured by a pH probe through the channel of the fibroscope by means of a terminal antimony pH sensor. To suppress the gag reflex, 1% rdir dikain is administered to the patient. The distal head of the gastrofibroscope is advanced sequentially from the cardiac sphincter along the lesser curvature of the stomach to the pyloric sphincter, registering the pH value every 1 cm. At pH 7.0, anacidism is diagnosed throughout the length of the stomach, i.e. no release of HC1 The acid-forming function of the stomach is assessed by the dominant pH range, at values of which 0.9-1.5 establish hyperacidity, 1.6-2.6 norm, 2.3-6.9 - hypoacidness, 1 tab. with $ (L

Description

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The invention relates to medicine and can be used to diagnose diseases of the stomach, as well as the choice of treatment.

The aim of the invention is to increase the accuracy of the method and reduce the research time.

The method is as follows. in a way.

Before the examination, a terminal antimony pH sensor of a small-diameter pH probe (2.0 mm or less) is inserted into the hole of the instrumental canal of the gastrofibroscopic and promoted until the pH sensor comes to the outer surface of the distancion head. In order to suppress the gag reflex, the patient is inhaled with a 1% solution of dikain. The patient is placed on the table I in position on the left side. On the skin: the forearm of the right hand is fixed; I auxiliary mercury-calomel: electrode. The plug of the active antimony legs of the I electrode, located at the distal HEAD of the gastrofibroscope, and the plug of the auxiliary mercury calomel electrode, through a switch, are connected to a measuring device, pH meter APM 10-01. Gastrofibro- iCKorr was introduced into the patient through the mouthpiece. Starting from the bottom 1/3 of the esophagus | fixed by the pH meter readings of intracavitary pH. After the passage of the cardiac sphincter (the length of the occupied part of the gastrofibroscope | from the distal head with the pH sensor (to the front edge of the incisors, simultaneously Md is measured at this pH level. the curvature of the stomach to the pyloric sphincter, registering a pH value every 1 cm. When measuring, the pH sensor is placed in the cavity of the stomach near the wall. The distribution of pH values is fixed according to the length of the stomach from cardiac to pilo. sphincter on each centimeter, focusing on the digitization of the external obstruction of the kidney gastrofibroscope. stomach pH is measured. at pH 7.0 throughout

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the length of the stomach is diagnosed anacid, i.e. absence of HC1. When the stomach secretes HC1, the distribution of pH values is recorded sequentially along the length of the stomach every 1 cm. The length of the length of the stomach on which the values of the following pH intervals are recorded is indicated: 0.9-1.2 .; 1, 3-1, 5; 1.6-2.2; 2.3-3.5; 3.6-6.9. The interval that corresponds to the greatest extent in cm along the longitudinal stomach is considered to dominate among the indicated pH ranges. With an equal distribution over the pH ranges, the interval with the lowest absolute pH values (highest acidity) is considered to be dominant. Evaluation of the acid-forming function of the stomach is performed by the dominant pH range, at values of which 0.9-1.2 establish a pronounced hyperacidity, 1.3-1.5 - hyperacidity, 1.6-2.2 - normacidity, 2.3 -3.5 - hypoacidism, 3.6–6.9 - extended hypoacid nos.

Example 1. Patient 0., 33 years. Clinical and endoscopic diagnosis: a disease with a link with cicatricial and duodenal deformity of the duodenal bulb, a pronounced recurrent gastroduodenitis, a phase of pronounced exacerbation. With gastrofibroscopy, the following pH values are fixed every 1 cm along the length of the stomach: 5.0; 2.5; 2.4; 1.7; -1.8; 1.9; 1.7; 1.6; 1.5; 1.3; 1.2; 1.2; 1.2; 1.1; 1.1; 1.2; 1.3; 1.2 1.1; 1.2; .1,4; 1.3; 1.4; 1.2.

Thus, the distribution of pH intervals over the length of the long stomach was as follows: 0.9-1.2 (10 cm) / 1.3-1.5 (5 cm); 1.6-2.2 (5 cm); 2.3-3.5 (3 cm), 3.6-6.9 (1 cm). The length of the stomach is 24 cm. The dominant pH range is the interval 0.9-1.2. Diagnosed with pronounced hyperacidity of the stomach. Gastrobiopsi (body of the stomach): hypertrophy of the gastric mucosa. Study time 17 min.

PRI mme R 2. Patient M., 30 years old. Clinical and endoscopic diagnosis: chronic primary gastroduodenitis, phase of damped exacerbation. When ga-i strofibroscopy every 1 cm along the length of the stomach, the stomach recorded the following pH: 4.5; 4.3; 5.1; 2.4; 1.8; 1.5, 1.7; 1.9; 1.8; 3.2; 3.5;

1.7; 1.9, - 2.1; 3.4; 1.9; 2.3, - 2.9; 4.0; 4.4; 4.5. Distribution of pH ranges along the longitudinal part of the stomach: 0.9-1.2 (O cm); 1.3-1.5 (1 cm); 1.6-2.2 (8 cm) - 2.3-3.5 (6 cm), 3.6-6.9 (6 cm). The length of the stomach is 21 cm. The dominant pH range is 1.6-2.2. Diagnosed with the normality of the stomach. Gastrobiopsi (body of the stomach): mild superficial gastritis. Study time 20 min.

PRI me R 3. Patient G., 37 years old. Clinical and endoscopic diagnosis: a link disease with a large (2x3 cm) ulcer of the lesser curvature of the stomach, a phase of marked exacerbation. Diffuse gastritis. When gastrofibroscopy every 1 cm along the length of the stomach recorded the following pH values: 7.1; 6.9; 7.0; 6.5; 6.1; 5.1; 3.5; 2.4; 2.2; 5.3; 5.1; 6.7; 6.1; 5.7; 5.4; 6.7; 7.2; 6.4; 6.9: Distribution of pH ranges along the longitudinal side of the stomach: 0.9-1.2 (O cm); 1.3-1.5 (O cm); 1.6-2.2 (1 cm) / 2.3-3.5 (2 cm); 3.6-6.9 (13 cm). The length of the stomach is 19 cm. The dominant pH range is 3.6-6.9. Diagnosed with pronounced hypoacidity of the stomach. Gastrobiopsi (body of the stomach), pronounced atrophic gastritis adjustment. Study time 21 min.

The proposed method makes it possible to more accurately assess the acid-forming function of the stomach with the pronounced hyperacid, normacid, hypoacid, pronounced hypoacid and anacid states, which is important in the selection and control of treatment. In addition, a one-time combination of gastrofibroscopy with intragastric pH-meter allows for a comprehensive functional-morphological study of the stomach, speeding up the diagnosis and initiating treatment, reducing the time for examining patients, and eliminating the unsafe X-ray method for monitoring the pH sensor localization.

The proposed method was applied in 173 patients with gastroduodenal pathology; in 49 patients, comparative studies with the prototype were carried out. For this, 1-3 days before the eudoscopic examination of the pH, the indicated patients underwent the usual intraglobal pH-meter (in accordance with the prototype of the examination) following the procedure. A serial dual-tip infrared probe of standard diameter (3.0 mm) was introduced in the morning on an empty stomach through the mouth to a depth of 55-60 cm from the front edge of the incisors and under fluoroscopic control was positioned so that the end olive was in the antrum of the stomach, and the intermediate olive was at the level the body of the stomach, i.e. the zone of the seser nitrating HC1. According to fluoroscopy data, out of 49 patients, the initial position of the probe in the stomach in 21 patients was correct, and in 28 patients a correction was required. The use of the fluoroscopic method lengthened the test procedure: up to 5 minutes without adjusting the position of the probe and up to 15 minutes with adjusting the position of the probe. The basal (initial) pH of the prototype was recorded every 15 min for one hour. The prototypical acid-forming function of the stomach was assessed according to the indications of intermediate olive, located at the level of the stomach, where acidification occurs due to the function of the covering cells. The end of the olive of the prototype was in the anthralais section of the stomach. Her readings testified mainly to the course of acid neutralization, for hydrochloric acid in this section of the stomach is not excreted.

Comparative data from the study of the acid-forming function of the stomach by the proposed method and the prototype are given in the table.

The data indicate a greater sensitivity-accuracy of the proposed method in assessing gastric acid production. This is evidenced by the fact that, of the 49 patients with the prototype, 3 G was diagnosed with a hypoanacid state, while The proposed method of taxing the state of the stomach was only in 17 patients.

The proposed method makes it possible to more accurately detect the effect of HC1 and evaluate the acid-forming function of the stomach. This is due to the fact that according to the proposed method, the pH is measured under vision control by direct contact of the pH sensor with the gastric mucosa throughout its length every 1 cm.

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from the cardiac sphincter and along the lesser curvature to the pyloric sphincter. At the same time, according to the prototype, pH is measured in the cavity of the stomach, in principle, at one point without constant monitoring of the localization of the sensor, which may vary during peristalsis.

The use of the prototype stimulus showed that, out of 31 patients with an initial hypoanthidal state after histamine, a preserved response to histamine (pHi2.0) was found in 6 patients, decreased (pH 2.1-6.9) 15 in 21 and no (, 0 ) in 4. In the group of patients with a preserved reaction to histamine, atrophic gastritis is usually not observed (5 patients). Less commonly, this is in the group of 20 CD patients with a reduced reaction to histamine (i4 of 21 patients).

Thus, according to the prototype, the registration of the initial hypo-anacid state of the stomach in some patients 25 (1/3) does not correspond to atrophic gastritis. In connection with this, a stimulus, histamine, is really required, which makes it possible to clarify the true function 13996776

15 minutes), a four-time measurement of the basal (initial) pH every 15 minutes for one hour (60 minutes), a four-time measurement of the pH after the irritant (histamine) every 15 minutes for one hour (60 minutes). Total up to 135 min. At the same time, the proposed method is carried out over a period of time endoscopic examination, i.e. does not exceed 20 minutes, and makes it possible to judge not only the acid-forming function of the stomach, but also its morphological changes. It takes 2 days to get such complex information from the prototype, because these studies are carried out separately.

Claims (1)

Invention Formula The method for determining the acid-forming function of the stomach by measuring the pH of the stomach with a pH probe is different in that, in order to improve the accuracy of the method and reduce the time of the study, the measurement is carried out through the fibroscope channel at every centimeter of the longitudinal stomach Invention Formula The method for determining the acid-forming function of the stomach by measuring the pH of the stomach with a pH probe is different in that, in order to improve the accuracy of the method and reduce the time of the study, the measurement is carried out through the fibroscope channel at every centimeter of the longitudinal stomach the on-morphological state of the cardiac sphincter in the small cry Ludka. At the same time, according to the proposed method, out of 17 patients with the initial hypoanaltic state of the stomach, atrophic gastritis was diagnosed in 1: 6, and gastritis with a diseased H: Ice gland without noticeable atrophy was diagnosed in one. Thus, the greater accuracy of the proposed method makes it possible to avoid additional irritant (histamine), because the initial background of the formation of bacteria is more reliable than in the prototype, it characterizes the morphological state of the gastric mucosa. In actual practice, the research on the proposed method. She also has a factor in irritation of the gastric glands. It is a mechanical irritation of acid formation, which inevitably occurs when an endoscope is introduced into the stomach and air is suffused. The prototype study is lengthy and consists of: the time of X-ray monitoring of the probe position (5 VNIIPI Order 2661/45 Random polygons pr-tie, Uzhgorod, st. Project, 4 hyperacidity, 1.6–2.2 - normality, 2.3–6.9 - hypoacid, and during registration, determine the viscosity of the pyloric sphincter and with a pH of 0.9–1.5. pH equal to 7 or more throughout the longitudinal cavity of the stomach is anacid. Circulation 847 Subscription