WO2016000756A1 - Dispositif de mesure pour la détection d'ammoniac dans le suc gastrique - Google Patents

Dispositif de mesure pour la détection d'ammoniac dans le suc gastrique Download PDF

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Publication number
WO2016000756A1
WO2016000756A1 PCT/EP2014/063923 EP2014063923W WO2016000756A1 WO 2016000756 A1 WO2016000756 A1 WO 2016000756A1 EP 2014063923 W EP2014063923 W EP 2014063923W WO 2016000756 A1 WO2016000756 A1 WO 2016000756A1
Authority
WO
WIPO (PCT)
Prior art keywords
electrode
measuring
silver chloride
chloride layer
measuring electrode
Prior art date
Application number
PCT/EP2014/063923
Other languages
German (de)
English (en)
Inventor
Patrick Fröse
Erhard Magori
Roland Pohle
Angelika Tawil
Oliver von Sicard
Original Assignee
Siemens Aktiengesellschaft
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Siemens Aktiengesellschaft filed Critical Siemens Aktiengesellschaft
Priority to PCT/EP2014/063923 priority Critical patent/WO2016000756A1/fr
Publication of WO2016000756A1 publication Critical patent/WO2016000756A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00097—Sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/273—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the upper alimentary canal, e.g. oesophagoscopes, gastroscopes
    • A61B1/2736—Gastroscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/1486—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using enzyme electrodes, e.g. with immobilised oxidase
    • A61B5/14865—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using enzyme electrodes, e.g. with immobilised oxidase invasive, e.g. introduced into the body by a catheter or needle or using implanted sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/42—Detecting, measuring or recording for evaluating the gastrointestinal, the endocrine or the exocrine systems
    • A61B5/4222—Evaluating particular parts, e.g. particular organs
    • A61B5/4238—Evaluating particular parts, e.g. particular organs stomach
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/041—Capsule endoscopes for imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/02—Details of sensors specially adapted for in-vivo measurements
    • A61B2562/0209—Special features of electrodes classified in A61B5/24, A61B5/25, A61B5/283, A61B5/291, A61B5/296, A61B5/053
    • A61B2562/0215—Silver or silver chloride containing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/6852—Catheters

Definitions

  • the invention relates to a measuring device for ammonia detection in gastric juice.
  • a common cause of discomfort in the upper gastrointestinal tract is a bacterial infestation of its organs.
  • Helicobacter pylori infestation is believed to be responsible for a whole range of gastric disorders associated with increased gastric acid secretion. These include, for example, type B gastritis, about 75% of gastric ulcers, and almost all twelve-finger gut ulcers.
  • the investigation of the hollow organs of the gastrointestinal tract on colonization with bacteria, in particular on colonization with Helicobacter pylori, is therefore an important part of the diagnosis of gastric diseases.
  • stomach for colonization with Helicobacter pylori One possibility for examining the stomach for colonization with Helicobacter pylori is the so-called gastroscopy ("gastroscopy”)
  • WO 2010/094650 Al described, a gastroscope used at the end of which are two electrodes with which a measurement for the detection of Helicobacter pylori is made possible.
  • Endoscopy capsule as shown in more detail in WO 2009/127528, for example.
  • the endoscopy capsule is guided to a point to be examined in the gastrointestinal tract and a determination for Helicobacter pylori is carried out "on site.”
  • WO 2010/094649 describes another method for the determination of Helicobacter pylori.
  • a disadvantage of the known in-vivo measuring devices is that the intensity and timing of the characteristic signal which arises when the AgCl layer is detached by ammonia can be unfavorable at very low ammonia concentrations or very high ammonia concentrations. For example, with thinly selected AgCl layers, a signal may unfavorably occur immediately when contact with the gastric juice is made. The actual signal is disadvantageously superimposed by the other effects of immersion on the sensor. If the AgCl layer is made thicker, at low ammonia concentrations the signal may be delayed significantly.
  • the measuring device is in particular a gastric capsule, a catheter, a gastroscope or a biopsy forceps and comprises a sensor which has a reference electrode, a first measuring electrode and at least one second measuring electrode.
  • the reference electrode comprises a noble metal which is not attackable by gastric acid.
  • the first measuring electrode comprises a silver chloride layer.
  • the second measuring electrode likewise comprises a silver chloride layer.
  • the silver chloride layer of the second measuring electrode has one and the silver chloride layer of the first measuring electrode mutually different thicknesses and / or
  • the sensor comprises means for determining a first electrical variable between the first measuring electrode and the reference electrode and a second electrical variable between the second measuring element Electrode and the reference electrode, wherein the electrical quantities are influenced by the presence of ammonia in the region of the electrodes.
  • the method according to the invention for ammonia detection in gastric juice comprises the following steps:
  • a measuring device in particular capsule, catheter, gastroscope or biopsy forceps, with a sensor, the sensor comprising:
  • a first measuring electrode with a silver chloride layer at least one second measuring electrode with a
  • the invention is based on the finding that an improvement of the detection with respect to greatly varying ammonia concentrations can be achieved by using at the location of only one measuring electrode a plurality of measuring electrodes in which a different functionalization is present.
  • the functionalization i. the silver chloride layer is different so that the time until dissolution of the entire layer by the ammonia is different. This can be achieved by different thicknesses of AgCl layers, but also by a different microstructure.
  • the measuring device allows in a simple manner, during the examination directly in Gastrointestinal tract of a patient and without taking a tissue sample to detect ammonia (NH3).
  • the measuring device thus makes it possible to examine the gastric acid and the tissue of the gastric mucosa for Helicobacter pylori only to a low degree.
  • the measuring device can be designed to apply a voltage before a measurement which is suitable for preventing the formation of a silver chloride layer on the measuring electrodes in the gastric juice. As a result, it is achieved particularly advantageously that even in gastric juice the measuring electrodes remain largely unchanged and a well-defined initial state of the sensor is maintained for the measurement.
  • precious metals that are not attacked by hydrochloric acid and thus are suitable for the reference electrode, for example, platinum (Pt) and gold (Au) come into question.
  • the measuring device may be configured to apply no voltage during a measurement. Thus no current flows between the measuring electrodes and the reference electrode. Between the measuring electrodes and the reference electrode, the potential, that is to say without current, is thus advantageously measured. This hardly causes ion migration in the stomach acid.
  • the measuring device may be configured to apply a DC electrical voltage during a measurement for a predeterminable time.
  • the predeterminable time for which a voltage can be applied by the user between the first electrode and the second electrode can be between zero seconds and continuously, wherein the user-selected electrical voltage can be zero volts or higher.
  • Time of zero seconds or a voltage of zero volts is a passive measurement.
  • an active measurement is available.
  • potentials, electrical currents or electrical resistances or their changes or quantities derived from the electrical variables (for example electrical conductivity or impedance) or changes thereof can be measured as the electrical variable.
  • the measuring device may have a single reference electrode, so that pairs of electrodes are formed with this reference electrode.
  • the measuring device may comprise a plurality of, preferably exactly two, reference electrodes, so that a separate reference electrode is available for each measuring electrode.
  • FIG. 1 shows a gastroscope 1, which is a flexible endoscope and is used to examine the upper gastrointestinal tract.
  • the gastroscope 1 comprises an insertion tube, in which a working channel 2 is arranged, and a sensor 4, which is guided over a guide wire 3 in the working channel 2.
  • the sensor 4 comprises a first electrode 5 (reference electrode) made of gold.
  • the sensor 4 comprises a first measuring electrode 6 and a second measuring electrode 7.
  • the first measuring electrode 6 is a silver electrode with an overlying silver chloride layer 61.
  • the second measuring electrode 7 is also a silver electrode with an overlying silver chloride layer 71.
  • the measuring electrodes 6, 7 have the same and constant distance from the reference electrode 5.
  • FIG. 2 shows the measuring electrodes 6, 7 and the reference electrode in a highly schematic and not to scale side view for clarification The different structure of the silver chloride layers 61, 71.
  • a separate electrical voltage can be applied to the pairs of the first measuring electrode 6 and reference electrode 5 and the second measuring electrode 7 and reference electrode 5 , whereby in the presence of ammonia in the region of the first Electrode 6 and the second electrode 7, a change in electrical size, such as potential, electrical current or electrical resistance, can be measured.
  • Abwinkelungsus (running in the flexible outer casing of the gastroscope) may be arranged.
  • the other elements the arrangement of which is known per se, are not shown in the drawing for reasons of clarity.
  • the gastroscope 1 can have a supply line for urea.
  • Urea is converted from Helicobacter pylori to ammonia.
  • urea By targeted addition of urea, therefore, an amplification of the measured effect can be achieved.
  • the sensor 4 detects ammonia (NH3) present in the stomach acid and in the tissue of the gastric mucosa on the stomach inner wall. This results in an infection of the tissue (gastric mucous membrane) with Helicobacter pylori by the detection of ammonia (NH3). knows. This is done without biopsy and is thus much less stressful for the patient.
  • NH3 ammonia
  • the detection of ammonia is a very strong indication of the presence of Helicobacter pylori, since ammonia is produced by the Helicobacter pylori bacteria by a cleavage of urea by urease to the acidic environment of the gastrointestinal tract, in particular the high acid concentration in the stomach , to protect.
  • the salt AgCl silver chloride
  • the salt AgCl is split by ammonia into the silver-diamine complex [Ag (NH3) 2] + and chlorine Cl-.
  • [Ag (NH3) 2] + is highly soluble in water as a cation and is absorbed by the stomach acid.
  • two electrical variables are measured and logged.
  • These electrical variables relate to the first measuring electrode 6 and the reference electrode 5 as well as the second measuring electrode 7 and the reference electrode 5.
  • the electrical voltage between the first measuring electrode 6 and the reference electrode 5 are recorded and stored as a first electrical quantity.
  • the electrical voltage between the second measuring electrode 7 and the reference electrode 5 is used.
  • the two measured electrical variables can reflect the different structure of the two measuring electrodes 6, 7.
  • the immersion in the stomach acid can influence the structure of the measuring electrodes.
  • a countervoltage can be applied to the second measuring electrode in the gastroscope 1 shown, which prevents further buildup of an AgCl layer together with the stomach acid.
  • the initial state of the measuring electrodes 6, 7 is obtained and the accuracy of the measurement is improved.
  • the advantages of the sensor show.
  • the thick silver chloride layer 61 which generates a signal only delayed, allows a much more accurate measurement that is unaffected by the immersion process.
  • An analogous effect can be achieved if the silver chloride layers 61, 71 also have a different microstructure instead of or in addition to the different thickness. For example, a higher porosity can lead to an increased reaction with the ammonia and thus to an accelerated degradation of the silver chloride layer 61, 71.
  • a third or fourth or further measuring electrodes are used in which there are further different thicknesses and / or morphologies.
  • further ranges of ammonia concentration can be tapped for accurate measurement.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Pathology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biophysics (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Optics & Photonics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Endocrinology (AREA)
  • Physiology (AREA)
  • Investigating Or Analyzing Materials By The Use Of Fluid Adsorption Or Reactions (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Investigating Or Analysing Biological Materials (AREA)

Abstract

L'invention concerne un dispositif de mesure pour la détection d'ammoniac dans le suc gastrique, notamment une capsule, un cathéter, un gastroscope ou une pince à biopsie, comprenant un capteur. Le capteur comprend : - une électrode de référence munie d'un métal précieux qui ne peut pas être attaqué par l'acide présent dans le suc gastrique, - une première électrode de mesure munie d'une couche de chlorure d'argent, - au moins une deuxième électrode de mesure munie d'une couche de chlorure d'argent, la couche de chlorure d'argent de la deuxième électrode de mesure et la couche de chlorure d'argent la première électrode de mesure possédant des épaisseurs et/ou des morphologies en couches mutuellement différentes, - des moyens pour déterminer une première grandeur électrique entre la première électrode de mesure et l'électrode de référence ainsi qu'une deuxième grandeur électrique entre la deuxième électrode de mesure et l'électrode de référence, les grandeurs électriques étant influencées par la présence d'ammoniac dans la zone des électrodes.
PCT/EP2014/063923 2014-07-01 2014-07-01 Dispositif de mesure pour la détection d'ammoniac dans le suc gastrique WO2016000756A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/EP2014/063923 WO2016000756A1 (fr) 2014-07-01 2014-07-01 Dispositif de mesure pour la détection d'ammoniac dans le suc gastrique

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2014/063923 WO2016000756A1 (fr) 2014-07-01 2014-07-01 Dispositif de mesure pour la détection d'ammoniac dans le suc gastrique

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007120442A2 (fr) * 2003-07-25 2007-10-25 Dexcom, Inc. Système d'électrode double pour capteur d'analyte continu
WO2009127528A1 (fr) 2008-04-18 2009-10-22 Siemens Aktiengesellschaft Capsule endoscopique
WO2010094649A1 (fr) 2009-02-17 2010-08-26 Siemens Aktiengesellschaft Appareil diagnostique
WO2010094650A1 (fr) 2009-02-17 2010-08-26 Siemens Aktiengesellschaft Gastroscope

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2007120442A2 (fr) * 2003-07-25 2007-10-25 Dexcom, Inc. Système d'électrode double pour capteur d'analyte continu
WO2009127528A1 (fr) 2008-04-18 2009-10-22 Siemens Aktiengesellschaft Capsule endoscopique
WO2010094649A1 (fr) 2009-02-17 2010-08-26 Siemens Aktiengesellschaft Appareil diagnostique
WO2010094650A1 (fr) 2009-02-17 2010-08-26 Siemens Aktiengesellschaft Gastroscope

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