Initial consultation

This consultation is carried on a first visit and includes:

• anamnesis (obtaining information through a survey of a patient);
• analysis of previous research;
• defining volume of forthcoming research (instrumental, biochemical).

HELIC-test – respiratory test for HP-infection (initial, additional, control)

The breath test is based on the method of high urease activity detection in the stomach, which occurs when infected with the Helicobacter pylori and can be determined by the gas entering the air of the oral cavity.

This method refers to the non-invasive diagnosis of Helicobacter pylori. Applicable in the practice of physicians-gastroenterologists, therapists, pediatricians and family doctors. The HELIK breath test is intended for the primary diagnosis of Helicobacter pylori, as well as for monitoring the course of anti-Helicobacter therapy and checking the effectiveness of the therapy already performed.

HELIK is the most common breath test for Helicobacter pylori infection. It has passed clinical trials and meets European quality standards (CE), which is confirmed by numerous awards for innovations in medical diagnostics. HELIK consists of a test tube (one-time use) with a mouthpiece, a connecting hose and a pump for air intake through the indicator tube.

How is the breath test performed?

1. The patient carefully rinses the mouth with still water.
2. A test tube with a mouthpiece is placed in the mouth of the patient. The mouthpiece with the indicator tube should be held with teeth, the mouth should be open, breathe evenly through the mouth for 6 minutes. If the mouth has accumulated saliva, you can take out the mouthpiece from the mouth, swallow saliva and put it back.
3. After 6 minutes of examination, the mouthpiece is removed from the mouth. The patient drinks a solution of carbamide through a straw, and then carefully rinses the mouth with still water and waits for 2 minutes. Meanwhile, a doctor fixes the parameters of the indicator tube.
4. After 2 minutes, the indicator tube with the mouthpiece is placed again in the mouth of the patient for 6 minutes.
5. After that, the mouthpiece is removed from the mouth. A doctor once again fixes the parameters of the indicator tube and concludes that there is a Helicobacter pylori infection.

Preparation

Attention!

To obtain reliable results, the patient must strictly comply with the requirements for preparation for testing!

1. The examination should be conducted in the morning on an empty stomach: before the examination, it is necessary to exclude the intake of food and water. The last meal should be at least 12 hours before the examination. The last meal should be "easy", you need to exclude products such as meat, fish and mushrooms.
2. You can not accept:
   • antibiotics for 4-6 weeks before the examination (does not apply to control tests during the treatment period, which may include taking antibiotics);
   • antacids (drugs neutralizing the acidity of gastric juice), anti-inflammatory drugs, antisecretory drugs (proton pump inhibitors or H2-histamine receptor's blockers), bismuth preparations and analgesics for 14 days before the examination.
3. Do not drink spirits for 3 days before the examination.
4. You can not eat legumes (beans, peas, lentils, soybeans) for 3 days before the examination.
5. On the day of the examination, it is necessary to discard the chewing gum.
6. You can not smoke 3 hours before the test; after smoking, you need to brush your teeth and rinse your mouth thoroughly.
7. The day before the examination, thoroughly (at least 1 minute) rinse the oral cavity and throat with a solution of furacilin (2 tablets of furacilin crush and dissolve in a 150-200 ml container of warm water).
8. In the morning before the examination, you need to brush your teeth and rinse the oral cavity and throat with a solution of furacilin.

Comprehensive survey

According to the order of Ministry of Health of Ukraine dated 10.08.2007. № 471, even in children for proper diagnosis, conduct a comprehensive survey is required, consisting of:

• determination of the level of acidity (pH-metry);
• conduct esophagogastroduodenoscopy (EGD);
• testing for Helicobacter pylori (HP) by two methods: urease test and microscopy stained smears, the material for which is taken during the inspection of 4 topographical stomach areas;
• testing for the presence of gastric mucosal lesions, including the presence of cancerous cells (histological investigations).

The period of the full range of surveys, including the necessary biochemical researches, is from 7 to 14 days.

According to the research a doctor makes an individual treatment regimen.

Adults must passing full comprehensive survey, as this is not only a requirement of the Ministry of Health, but also is the world standard.

pH-metry

Stepwise intragastric pH measurement by the method of prof. Chernobrov VN is the most advanced to date, and the most common in the pH research of the gastric juice.

Stepwise pH-metry is carried out using microprobes (d = 2 mm) with the first sensor on the end and a ИКЖ-2 (Stomach acidity indicator) device with the second sensor, which is attached to the inner surface of the forearm of the patient during the study. When microprobe is administered in the stomach cavity the first sensor touches with gastric mucosa, electrochemical circuit is closing, EMF current occurs which converts the data of the gastric pH in the form of ready digital data on the light board of the instrument. The information about the gastric pH is read from 40 places, is entered into the special table of measurements and easily calculated.

Preparation

The procedure is done in the morning on an empty stomach (the patient should not have eat, drink, take medicines and to smoke) and takes 2-4 minutes. The patient must bring a large thick towel.

Esophagogastroduodenoscopy (EGD)

Diagnostic research that allows to inspect the inside wall of the esophagus, stomach and duodenum. It is carried out to detect diseases of a listed organs. It is executed during the planned survey and emergency indications (gastrointestinal bleeding, foreign bodys).

Survey is carried out by a flexible fiber optic apparatus (endoscope) called gastroduodenoscope. There are many models of these devices designed for a variety of diagnostic and therapeutic purposes.

Since modern endoscopes flexible and small diameter, the survey does not involve painful sensations.

The endoscope is introduced first into the esophagus, the stomach, and then the duodenum. An inspection of the inner surface of these organs is made when an endoscope is passing forward and when is removing. To inspect the organs cavity wall, they inflates with air.

Preparation

The endoscopy is carried out in the morning on an empty stomach (the patient should not have eat, drink, take medicines and to smoke) and takes 2-5 minutes. However, if it becomes necessary to biopsy (in cases of stomach ulcers, cancers, polyps), procedure can take up to 15-20 minutes. The patient must bring a large thick towel.

Testing for HP (Helicobacter pylori)

Helicobacter pylori - spiral Gram-negative bacterium that infects various areas of the stomach and duodenum. Many cases of gastric and duodenal ulcers, gastritis, duodenitis, and possibly some cases gastric lymphomas and gastric cancer are etiologically associated with infection Helicobacter pylori. However, the majority (90%) infected with Helicobacter pylori carriers show no signs of disease.

The spiral form of the bacterium, from which the Helicobacter generic name is occurred, determines the ability of the microorganism to penetrate the gastric mucosa and duodenal ulcers and facilitates movement of the bacteria in the mucous gel covering the gastric mucosa.

The most reliable way to detect HP infection is a double test - a combination of urease test and microscopic examination by Giemsa stained smears, the material for which is taken at the time of endoscopy (EGD).

The comparative characteristic of the two methods determines not only the presence and shape of bacteria, but also their location in relation to the parietal cell - extracellular or intracellular.

For a maximum reliability, the testing on HP should be carried out in four topographical zones: the middle third of the antrum of the stomach and the middle third of the gastric body on the large and small curvature by own developed method (Patent for Utility Model 17723 Ukraine, UA МПК А61В1/00 Method of diagnosis of chronic gastritis type B, peptic ulcer disease and gastric cancer associated with H. Pylori infection / A.A. Avramenko. - № u200603422;. Declaring 29.03.06; Publ 16.10.06, Bulletin № 10.).

Preparation

The endoscopy is carried out in the morning on an empty stomach (the patient should not have eat, drink, take medicines and to smoke) and takes 2-5 minutes. However, if it becomes necessary to biopsy (in cases of stomach ulcers, cancers, polyps), procedure can take up to 15-20 minutes. The patient must bring a large thick towel.

Scheduled sampling for histological researches of the gastric mucosa with delivering of samples to the laboratory

According to the modern requirements the "chronic gastritis" is diagnosed only in accordance with the conclusion of histology, which requires material in the form of samples of the gastric mucosa. This manipulation is also held by a physician-endoscopist during endoscopy (EGD).

This expanded histological examination allows not only to determine the nature of inflammation (acute or chronic), but also to identify precancerous changes of the mucous: atrophy, colonic metaplasia and dysplasia and early forms of gastric cancer.

Preparation

The endoscopy is carried out in the morning on an empty stomach (the patient should not have eat, drink, take medicines and to smoke) and takes 2-5 minutes. However, if it becomes necessary to biopsy (in cases of stomach ulcers, cancers, polyps), procedure can take up to 15-20 minutes. The patient must bring a large thick towel.

Secondary (extended) consultation

This consultation is carried out at the second visit, after a survey results receiving and includes:

• more in-depth history taking;
• Individual selection of treatment regimens;
• the definition of the behavior of the subject during treatment;
• drawing up the diet that does not cause discomfort to the patient;
• determination of the date control studies acidity and a full-control comprehensive survey after treatment.