Gastroenterology

Gastroenterology

Gastroenterology is a branch of medicine dealing with the structure and functions of the human digestive system under normal and pathological conditions. Gastroenterology studies the causes of diseases of the digestive system, the mechanisms of their development, methods of treatment and prevention of gastroenterological diseases.

Today, diseases of the digestive system are the most common of all diseases of the internal organs. These include diseases of the oesophagus, stomach, pancreas, gallbladder, liver, and intestines.

Strong indications for contacting a gastroenterologist are symptoms such as:

  • Heaviness in the right hypochondrium
  • Chronic belching and bloating
  • Black stool
  • Stomach pain on an empty stomach
  • Bitterness in the mouth.

The most frequent complaints with which a patient turns to a gastroenterologist are abdominal pain, heartburn, belching, nausea, vomiting, stool disorders (constipation, diarrhoea), flatulence, and bloating.

Features of the work of a gastroenterologist

A gastroenterologist investigates the systems of regulation of the function of the digestive organs, ways of their damage, the features of the course of diseases of the gastrointestinal tract in combination with pathologies of other organs.

Groups of diseases treated by a gastroenterologist:

  • Diseases of the stomach and duodenum (chronic and acute gastritis, gastric and duodenal ulcers)
  • Diseases of the oesophagus (gastro-oesophageal reflux disease (GERD) of an erosive and non-erosive nature, esophagitis, achalasia of the diverticulum, cardia, hiatal hernia)
  • Diseases of the pancreas (acute and chronic pancreatitis, dysfunction of the sphincter of Oddi, cystic fibrosis)
  • Diseases of the gallbladder and liver (hepatitis, biliary dyskinesia, cholecystitis, liver cirrhosis, Gilbert’s disease, cholelithiasis)
  • Intestinal pathology (malabsorption syndrome, Crohn’s disease, irritable bowel syndrome, ulcerative colitis, intestinal infection).

Risk factors for the occurrence of pathologies of the gastrointestinal tract:

  • Poor diet (eating a lot of fast food, preservatives, spices, eating too cold or too hot food)
  • Chronic stress
  • Alcoholism
  • Physical inactivity

 

Gastrointestinal endoscopy

Endoscopic examinations are performed using special endoscope devices that are inserted into the patient through the mouth or anus and transmit an image in the organ under study or on the endoscope eyepiece or on the monitor. In modern practice, two types of flexible endoscopes are used: optic-fibre endoscopes and video endoscopes, which digitize the image seen through the lens and transmit it in this form to a monitor or eyepiece. Esophago-, gastro-, duodeno are indicated for suspected inflammation or ulcers, as well as other diseases of the oesophagus, stomach, small intestine, and papilla of Vater. Colonoscopy is an endoscopic examination of the colon, indicated in the presence of clinical signs indicating damage to the colon, monitoring the patient during treatment, during examinations aimed at detecting cancer and other diseases at an early stage.

Study of the acidity of the upper sections

Intragastric pH-metry plays an important role in the diagnosis and treatment of acid-dependent diseases, in the study of gastroesophageal, duodenogastric, and pharyngolaryngeal refluxes. In clinical practice, several methods of intragastric pH-metry have found an application:

  • endoscopic (measurement duration 5 minutes)
  • express pH-metry (about 30 minutes)
  • short-term stimulated (up to 2-3 hours)
  • long-term (24 hours or more) pH-metry.

PH-metry is also used to assess the effect of acid-suppressing medication.

Measurements are performed using special pH-metric probes that are administered to the patient orally (for short-term pH-metry), transnasally (for daily pH-metry), through the instrumental channel of the endoscope (for endoscopic pH-metry) or using pH-metric capsules attached to the wall of the esophagus. The study of non-acidic refluxes is performed using impedance-pH-metry of the esophagus. For differential diagnosis of retrosternal pain of unclear aetiology, gastrocardiac monitoring is used – a simultaneous study of the acidity of the gastrointestinal tract and an electrocardiogram.

Gastrointestinal manometry

For direct registration of the motor activity of the organs of the gastrointestinal tract, manometry, performed using a multichannel water-perfusion catheter, is most widely used.

There are the following types of manometry: 

  • esophageal manometry
  • antroduodenal manometry
  • sphincter of Oddi manometry
  • colonic and anorectal manometry.

Esophageal manometry is indicated before surgical interventions in the area of the gastroesophageal junction, with anomalies of the upper esophageal sphincter (UAS) and pharynx, examination of the pressure of the lower esophageal sphincter (LES), primary esophageal motor disorders esophageal symptoms (cardiospasm, achalasia of the cardia, esophageal dyskinesia, diffuse esophageal spasm, LES hypertonicity), assessment of peristalsis defects [15].

Indications for manometry of the sphincter of Oddi: postcholecystectomy syndrome, cholangitis, spasm of the sphincter of Oddi, obstruction of the bile duct, etc.

Anorectal and/or colonic manometry is performed according to the following indications: constipation resistant to therapy, differential diagnosis of chronic intestinal pseudo-obstruction, unexplained causes of dysmotility colon, lack of relaxation of the internal sphincter of the anus, before and after surgery, in the process of biofeedback therapy for faecal incontinence and functional constipation.

Radiation diagnostics

In the study of the liver, pancreas and bile ducts, the leading role is played by ultrasound (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI). When diagnosing the condition of the oesophagus, an x-ray study with barium is common, in which the passage of sips of barium suspension is recorded fluoroscopically in real time. X-ray of the esophagus is used to detect hiatal hernias, tumours, diverticula, strictures, varicose veins, foreign bodies. Radiography or fluoroscopy with or without double contrast is used in the study of the stomach and duodenum in order to detect ulcers, tumours, strictures, obstructions, and monitor the results of surgical interventions. For the diagnosis of intestinal tumours, inflammatory diseases, causes of intestinal obstruction, strictures, obstruction, contrast radiography, computed or magnetic resonance imaging are used.

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