Diagnosis of duodenal reflux – Chemical study of stomach contents

Casting of duodenal contents into the stomach is observed in gastritis, gastric ulcer and duodenal ulcer, gastrectomy, vagotomy, applying irritating and draining factors.

Duodenogastral Reflux It may be accompanied by pain in the stomach, and in severe cases, vomiting bile, losing weight, symptom stomach hyposecretion. In cases of reflux after gastrectomy these symptoms align reduction of the secretory function, intestinal metaplasia, anemia.

Explicitly evidence of duodenal reflux are painted yellow vomit or gastric aspirates, as well as a visual statement of reflux at gastroendoscope. To determine the presence of hydrochloric acid in gastric juice, stained with bile pigments, inappropriate, as it is more or less neutralized duodenal contents alkaline. To establish the presence and intensity of duodenal reflux allows the definition of bile acids in gastric contents with bile by Reinhold-Wilson.

In normal gastric juice, bile acids are absent or stand their tracks (not higher 0,104 g / l). Higher scores indicate duodenal reflux. Depending on the amount of bile acids in gastric contents distinguish three degrees duodenogastric reflux:

• Grade I - the content of bile acids 0,11 to 0,25 g / l;
• II degree - from 0,25 to 0,5 g / l;
• Grade III - More 0,5 g / l.

Besides, it is also possible to determine the content of bile acids by thin layer chromatography sheets silufola.

When duodenal reflux duodenal contents into the stomach with the enzymes, exhibiting proteolytic activity at higher pH, than pepsin. Detection of high proteolytic activity at a pH above 3,5 It indicates the presence of gastric duodenal contents.

There are also other methods of laboratory diagnosis of duodenal reflux, in particular the identification of the stomach intraduodenal administration markers, such as polyethylene glycol or phenol red. In these cases, the gastric contents are aspirated photometry, determine the amount of the marker and the relative amounts administered in the duodenum and the stomach into the detected marker is a percentage value reflux. Such markers, how bromsulfalein, indocyanine green, injected, ekstretiruyutsya whereupon they fall into the liver and duodenum. In the presence of the marker is detected reflux of the gastric contents.

The presence duodenogastric reflux can be judged based on the detection of bilirubin in gastric contents.

At the heart of radionuclide methods of diagnosis of duodenal reflux is measurement of radioactivity above the stomach when administered radionuclide into the duodenum.

The most informative method of revealing duodenal reflux — внутрижелудочная pH-метрия. Identification on the pH-gram "alkaline bursts" refers to throw into the stomach duodenal contents.

The term "gastric secretory failure"Denote his gland dysfunction, are expressed in, that the physiological components of gastric secretion (acid, pepsins) do not provide the full (in healthy humans) initial stage of hydrolysis of food proteins.

Method of estimation of gastric secretory deficiency generally in the amount of produced HCl glands it has some significant drawbacks. In particular, it is impossible to pinpoint, what level of acid secretion should be considered a sign of failure, because the fluctuation limits of gastric secretory function in healthy people is very significant. Besides, uncommon, When significant changes of gastric secretory deficiency is clinically manifested nothing.

To identify the origin of reduced acidity definition recommended in gastric contents of alkaline phosphatase. The discovery of this enzyme, especially the thermally labile fractions, in patients with peptic ulcer and other diseases of the stomach, evidence of massive regurgitation of duodenal contents into the stomach, a lack of function of the pyloric sphincter.

The discovery of thermostable alkaline phosphatase It is proof of the presence in the gastric mucosa of intestinal metaplasia, which may be a consequence of prolonged duodenogastric reflux.

Thermostable fraction of alkaline phosphatase is absent in children and healthy adults. Finding her in adults indicates intestinal metaplasia of the gastric mucosa acquired character.