DISEASES OF THE DIGESTIVE TRACT. MODERN CAPABILITIES OF ENDOSCOPIC DIAGNOSTICS.

DISEASES OF THE DIGESTIVE TRACT. MODERN CAPABILITIES OF ENDOSCOPIC DIAGNOSTICS.

Therapist, Candidate of Medical Sciences Turakhodzhaeva Sabokhat Sultanovna and endoscopist of the highest category, Candidate of Medical Sciences of the VITAMED MEDICAL clinic Hamro Turaevich Sadykov, will share in this article their views on the issues of modern diagnosis and treatment of diseases of the digestive tract

In the work of a doctor, three universal questions always arise: what is happening, who is to blame and what to do? It is clinical diagnostics that can provide comprehensive answers to the first two questions and help the doctor find the correct answer to the main question - what to do?

In recent years, there has been an intensive increase in the number of patients whose symptoms are caused by pathological reflux of gastric contents into the esophagus. Reflux, according to some estimates, occurs in half of the adult population, which has given reason to call the 21st century the century of gastroesophageal reflux disease.

A real breakthrough in the study of gastric diseases was the isolation and identification of a new type of microorganism - Helicobacter pylori, which populates the mucous membrane of this human organ. The infection causes the development of chronic gastritis and is actively involved in the pathogenesis of duodenal ulcer (DU) and gastric ulcer (GUD). Destruction of the microorganism in most cases makes it possible to achieve a long relapse-free period for PUD and PUD. A large amount of evidence has been obtained in favor of a causal relationship between the chronic persistence of the microorganism and the development of gastric adenocarcinoma, which allowed the International Agency for Research on Cancer (WHO) to call H. pylori carcinogenic to humans.

As is known, there are currently three main strategies for the treatment of ulcers: anti-Helicobacter therapy, the use of proton pump inhibitors (PPIs) in cases of HP-negative ulcers or in the absence of effective bacterial eradication, and surgical treatment of complicated ulcers. It must be said that the ratio of surgical and therapeutic treatment has undergone significant changes over the past years. In the middle of the 20th century, the share of surgical treatment of ulcers accounted for approximately 30%, today – 0.2%. The achievements of modern gastroenterology include limiting the indications for surgical treatment of ulcerative disease, including ulcerative bleeding.

Gastric cancer (GC) is one of the most common localizations of the oncological process. In Europe, about 200 thousand cases of this dangerous disease are registered annually, of which 150 thousand end in death. Almost half of the patients die within a year from the moment of diagnosis, which is a consequence of untimely detection of GC, which requires improvement not only in treatment, but also in the diagnosis of GC, as well as its precancerous conditions.  One of the most common precancerous diseases that general practitioners and gastroenterologists encounter in their practice is chronic gastritis. The malignant potential of this disease is 10-20% in the presence of severe atrophy of the gastric mucosa.

Prevention involves the distribution of patients into risk groups and clinical monitoring of them. Patients who have atrophic gastritis with long-term non-epithelializing erosions, atrophic hyperplastic gastritis, ulcers and gastric polyps, or grade 3 dysplasia are classified as a group with a high degree of cancer risk. Such patients need to undergo gastroscopy with multiple biopsies once every 3 months, and after complete epithelization of the mucosa or polypectomy - at least 2 times a year.

The group of patients at average risk of developing gastric cancer includes patients with atrophic gastritis, gastritis of the gastric stump, and grade 1-2 dysplasia. They are indicated for gastroscopy once a year.

Patients with morphologically confirmed atrophic gastritis without elements of dysplasia are included in the low-risk group for gastric cancer and undergo gastroscopy once every 2-3 years.

Taking into account the quality of food, water, insufficient nutritional culture, abuse of alcohol, drugs, unfavorable economic and environmental situation, despite the successes achieved, the incidence of pathology of the digestive organs is not decreasing. One of the ways to improve the quality of medical care, develop preventive medicine, prevent the chronicization of diseases and ultimately improve the quality of life of people and reduce mortality is the early diagnosis of gastrointestinal diseases.

Is there a way out of this situation?   He is always there. First of all, the doctor must putcorresponding tasks for diagnostic services, and for this he must know the capabilities of modern diagnostic methods. When receiving diagnostic information, the doctor must demand that the diagnostic services decipher and explain it. And for this, diagnostic services must not just “rubber stamp” the results, but also engage in their comprehension and identification of clear and accurate diagnostic criteria for certain diseases.

We can confidently assert the significant place of clinical endoscopy in the provision of medical care to the population.

Throughout the entire period of development of endoscopy, the attitude of both doctors and patients towards endoscopic examinations has changed and continues to change. At the beginning of their introduction into clinical practice, standard gastroscopy and colonoscopy were perceived as a complex intervention comparable to surgery and were performed with premedication and sometimes under anesthesia. Today, the attitude towards this procedure often consists of the dismissive phrase “swallowing a light bulb,” which hardly requires any medical preparation.

You can ensure a sufficient level of comfort for the procedure and make it easier and less unpleasant for the patient through sedation. Sedation is a type of anesthesia that puts the patient into a sleep-like state, without fear or anxiety, with a dullness of all senses. Advantages of the method: short-term shutdown of the patient’s consciousness by immersing himself in deep sleep, preservation of spontaneous breathing and reflexes that prevent aspiration.

The degree of sedation can be divided into “light”, when contact with the patient is maintained, and “deep”, when the patient is in a state of medicated sleep. The need for sedation must be determined individually. Clinical experience shows that if, for example, you are going to perform a routine diagnostic EGD on an elderly man or woman who has previously tolerated this examination calmly, then you may need to limit yourself to local anesthesia of the oropharynx only.

But when a patient comes to you for examination and her hands are shaking at the very sight of the device itself, then sedation is necessary. Today, the drug propofol (Profol, Rokofol), a short-acting analgesic that provides rapid awakening and restoration of function after anesthesia, is used for sedation of adult patients. Switching off consciousness is achieved 30 seconds after administration. Recovery time does not exceed 10-20 minutes. There are no adverse reactions upon recovery from anesthesia (hallucinations, delusions, emotional disorders, confusion, agitation).

As many years of experience show, a separate section of clinical endoscopy is the examination of children. Often, parents, having their own endoscopic experience, may be wary of the pediatric endoscopy procedure. For painless implementation in children's clinics, local anesthesia or general anesthetic for medicated sleep are widely used. The choice of anesthetic depends on the child’s behavior and, of course, on medical indications. If the child is outwardly calm and does not have concomitant cardiovascular diseases, then an endoscopic examination is performed under local anesthesia.

For very young children or infants, gastroscopy is performed under general anesthesia. For this, the child is put into a state of light sedation for up to 10-12 minutes. Such medicinal sleep during endoscopy is indicated for hyperactive, sensitive and anxious children. This is due to the fact that their restless actions may prevent the doctor from conducting a quality endoscopic examination.

To put a child, like an adult patient, into a state of medicated sleep, the presence of an anesthesiologist is required, who must correctly select both the drug and calculate the dose.

Controlled sedation using these drugs is the best choice for a comfortable endoscopic examination.

Nowadays, medicine has advanced, and clinics that keep up with the times are equipped with unique digital equipment for HD-quality endovideoscopy. The VITAMED MEDICAL clinic uses innovative technology, this is equipment for endovideoscopy Fujifilm-4450HD (Fujifilm, Japan) and modern devices for endovideoscopy, such as Videogastroscope EC-600WR, Videoduodenoscope ED-530XT, Videocolonoscope EG-600WL (Fujinon, Japan).

Modern diagnostic endoscopic systems are equipped with a function for comparing conventional endoscopic images and images in FICE (Flexible spectral Imaging Color Enhancement) mode. The essence of this progressivedirection is that pathologically altered areas of the mucosa, including those affected by the oncological process, under different lighting conditions are noticeably distinguished from the surrounding healthy mucosa. The use of this method makes it possible to endoscopically diagnose any pathology in the early stages, incl. and oncological lesions limited only to the mucous membrane of the digestive tract.

To ensure absolute safety of patients in terms of preventing the transmission of blood transfusion infections through endoscopic devices, the VITAMED MEDICAL clinic uses an automatic washing machine, the Endowash model, which uses several types of effective disinfectants to achieve complete disinfection of endoscopic equipment after each diagnostic and therapeutic procedure.

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