The only method treatment of carcinoids of the stomach is surgical. However, there is still no consequential opinion regarding the size of operational intervention. A. K. Ageev, Eklof, Hines and Savage, taking into account the multicenter genesis of carcinoids, insist on the need for resection of the entire stomach, while Martin and Atkins are considered possible to limit themselves with a wide excision of the affected area within healthy tissues. We consider the opinion of the first authors more justified, since when identifying a tumor solitarian node at the time of operation, smaller multiple tumors may remain unnoticed.

In addition, remaining after partial resection The macroscopically normal mucous membrane of the stomach, in accordance with the assumption of the multicenter occurrence of carcinoids, represents the potential hazard of the methachronous appearance of new foci of tumor growth.

In accessible to us literature We could not find a radiologically well-documented case of multiple carcinoids. Therefore, we consider it appropriate to lead the observations of V. L. Cakes, relating to the rare case of the solitary carcinoid of the stomach.

Patient, 33 years old, Received with complaints about stupid pain in the epigastric area, which appeared about a year ago. The general condition is satisfactory; Blank soreness during palpation of the epigastric area. X-ray: in the middle third of the body of the stomach in its lumen, an oval, clearly defined formation of 3x4 cm sizes; The folds of the mucosa over it are saved. Conclusion: Exofite gastric body tumor.

Operation detected exofithic The tumor on the front wall of the stomach is up to 4 cm in diameter, regarded as malignant; Metastasis was not. Receiver 2/3 of the stomach. The patient was discharged on the 18th day after surgery. Histologically: the gastric mucosa atrophic. In a limited area, the entire sublimited layer of the stomach is extended by tumor cells of small sizes with oval and round nuclei. Cells are arranged with massive complexes with the formation of f of lesist-like formations. All this is placed in the picture of the carcinoid (from the observation of V. L. Cakes).

Present observation illustrate A number of features of the stomach carcinoids: non-characteristic clinical manifestations, radiological data that were forced to limit themselves to the diagnosis of an exofic tumor of the stomach; The final establishment of the diagnosis of carcinoid is possible only with histological examination. The X-ray symptom marked in this monitoring symptom of the mucous membrane, discovered also PochaczeVsky and Sherman, seems to us in little happy and most likely represents the result of the projection overlay image of the folds of the opposite tumor of the normal wall of the stomach.

In this way, modern literature It has sufficiently convincing data, which is shown, which is primarily multiple stomach cancers are not uncommon and have a large practical value. Therefore, the oncological alertness in relation to the cancer damage of the stomach should not be limited to assumptions about the presence of only solitary cancer, it should be distributed and in search of possible primary multiple neoplasms. Such primary multiple crayfish can develop not only against the background of precancerous diseases of the stomach (polyps, gastritis, ulcers), but also in the macroscopically normal mucous membrane.

According to the international histological classification of the stomach tumors, the following types of tumors are distinguished.

Epithelial tumors

Benign

• Adenoma (papillary, or wool; tubular, papillary-tubular)

Malignant

• Adenocarcinoma (papillary, tubular, mucinosna, pistevenoid cell)
• Untifferentiated cancer
• Adenokancroid
• PlateLock carcalete cancer
• Unclassified cancer

Carcinoid

Nepphelial tumors

Tumors of smooth muscles

• Leiomiomoma
• Leioblastoma
• Leiomiosarcoma

Others

Hematopoietic and lymphoid tumors

• Lymphosarcoma
• Reticulosarcoma
• Hodgkin's disease
• Plasmocytoma
• Others

Mixed tumors

Secondary tumors

Tumor-like lesions of the stomach include polyps, lymphoid hyperplasia, heterotopy, gamartoms, etc.

Polyposis of the gastric mucosa - Collective concept. Any tumor on the leg, emanating from the mucous membrane and located in the lumen of the stomach, is regarded as a polyp. The histological polyp consists of a connective tissue base and a hypertrophied mucous membrane with the growth of glands and surface epithelium.

Polypa Malignization occurs without characteristic signs. Valuable data for diagnostics is obtained by gastrophibroscopy. The cytological study of the fingerprint of the tip of the gastrophibroscope and washing waters is obligatory.

Microscopically detect the layers of the epithelocytes of the stomach mucosa with proliferation drives and some atypics. Among the evenly located cells of the cylindrical epithelium there are two-, three-core enlarged cells, in which several nuclei nuclei are located. The same type of the structure of the kernel, chromatin and cell location indicates the absence of malignancy.

It allows it only to detect sharply modified cells with hyperchromic enlarged nuclei and hypertrophied nuclei.

Adenoma stomach - epithelial benign tumor, often turning into cancer; It is quite rare. Cytologically for the adenoma is characterized by the presence of high cylindrical cells of the epithelium, often with signs of intestinal metaplasia located with iron-like, tubular, papillary structures, clusters and formations. In cases of sharply pronounced proliferation and atiypics of cells, cellular and nuclear polymorphism are revealed, the kernel is enlarged, the chromatin pattern is uneven, possibly the presence of hyperchromy of nuclei, hypertrophied nucleol, nuclear structures, mitosis figures. With such a cytological picture, adenoma must be differentiated with highly differentiated adenocarcinoma.

Stomach cancer

Stomach cancer It ranks first among malignant neoplasms of another localization. Developed, as a rule, against the background of the altered mucosa as a result of various pathological processes (gastritis, polyposis, etc.). It is usually localized in the gatekeeper part on a small curvature, less often - in the cardiac part on a large curvature, on the front and rear walls, in the body of the gastric body. In connection with the collapse of the tumor, the functional disorders of the stomach motility, Ahlorohydria, Ahilia, the development of fermentation and grinding processes are characteristic.

The cytological picture depends on the histological form of cancer.

Differentiated adenocarcinoma

With differentiated adenocarcinoma Tumor cells in cytological fingerprint preparations are located small groups having a iron-like papillary structure, and are characterized by disorderly jams.

Cells do not differ in pronounced polymorphism, they may have a cubic, cylindrical, incorrect round or oval shape. The kernels are eccentric. In some cases, they are enlarged, bright, with uneven contours and a mesh chromatin pattern, not very large nuclei contain. In other sections of the kernel, hyperchromic, small or medium size, with a rude compact chromatin pattern and single, sharply hypertrophied nuclei. The cytoplasm of such cells is pale, basophilic, negrogenous, unclearly defined.

In some cases, malignantly modified cell epithelial cells with inhomogeneous, sharply vacuolated cytoplasm are found. In contrast to cells with intestinal metaplasia, intestinal tumor cells contain large hyperchromic nuclei and are characterized by severe nuclear and cellular polymorphism.

Low-differentiated adenocarcinoma

With low-differentiated adenocarcinoma Tumor cells have pronounced signs of malignancy, are located in cytological preparations most often with large clusters or solid fields in which the kernels of various magnitude and structure are chaotic. Chromatin their thin, soft-mesh, there are hypertrophied nuclei. The cytoplasm of individual cells with signs of secretion.

The cytoplasm of tumor cells can be filled with mucus - slim-forming cancer.

Sometimes tumor cells acquire a robust form - pisnoid cell cancer.

Untifferentiated gastric cancer

The presence of sharply analyzing large cells (30-40 μm) with a very large rounded or irregular shape of kernels containing chromatin of gentle-mesh pattern, and often hypertrophied nucleols. In some nuclei and cytoplasm, vacuolaization is found. The cytoplasm has the form of a narrow rim without clear boundaries. Frequently detected synchinatal education. Perhaps the presence of mitosis figures.

PlateLock Cancer Gastre

PlateLock cell (epidermoid) stomach cancer is observed very rarely. It may be buried and non-coordinating. The latter is cytologically characterized by clusters of cells with enlarged nuclei containing hypertrophied nuclei and fuzzly contigated basophilic cytoplasm of different widths. Less often revealed tumor cells with severe polymorphism and hyperchromic nuclei, characteristic of epi dermatoid cancer with moderate differentiation. In the mixed form of cancer, combining epidermoid cancer and adenocarcinoma (adenokancroid) in cytological preparations, tumor cells of both types are detected.

In cytological preparations from the washing water of the stomach, it is often possible to detect elastic fibers in the smallest tissues, testifying to the destruction of the fabric to be fabric. Sometimes in small necrotic blocks with elastic fibers and fibrous base coated with bacteria, a brown blood pigment is revealed - hemosiderine, sometimes with hematodine crystals and tumor cell groups. The presence of these elements indicates the decay of the malignant tumor. These elements are revealed mainly in native drugs.

Carcinoid

Carcinoid is rare, develops from the basal departments of the mucous membrane, is localized mainly in the area of \u200b\u200bthe infrared cave. Tumor cells of medium size, monomorphic, rounded, polygonal, sometimes cylindrical shape. Cores round, cytoplasm fuzzy. Cells are located with formations, heavy or glad structures.

Nepphelial tumors

Nepphelial tumors of the stomach are observed extremely rarely. These include Leiomioma, Leiomiosarcoma and other species, the cytological picture of which is similar to the same tumors of other localization.

From hemopoietic and lymphoid tumors in the stomach, the lymphosarcoma (prolimphocytic, lymphoplasmic, lymphoblastic, immunoblastic) is most often found. Prolimphocytic lymphosarcoma should be differentiated with hyperplasia of cell lymphoid formations of the stomach. Sometimes the stomach develops a lymphogranulomatous node; for cytological examination In such cases, Berezovsky-Sternberg cells are found.

RCRZ (Republican Center for Health Development MD RK)
Version: Archive - Clinical Protocols MOR RK - 2012 (Orders No. 883, №165)

Stomach of unspecified localization (C16.9)

general information

Short description

Clinical Protocol "Karcinoid stomach"

Stomach carcinoids - These are neuroendocrine tumors of the stomach.

Protocol code: PH-S-013 "Karcinoid of the stomach"

ICD code: C16.

Abbreviations used in the protocol:

NEO - neuroendocrine tumors.

Hell is blood pressure.

EchoCG - echocardiogram.

SE - Erythrocyte sedimentation rate.

Ultrasound - ultrasound examination.

CT - Computed tomography.

RW - Vasserman reaction.

HIV - human immunity virus.

ECG - electrocardiography.

MRI - magnetic resonance tomography.

GCT - gastrointestinal tract.

CT - Computer tomgraphia.

PET - positron emission tomography.

VSMP - highly specialized medical care.

SMP - specialized medical care.

Protocol users: Doctors of oncological institutions and the general medical network.

Indication for the absence of conflict of interest: There is no conflict of interest.

Classification

Clinical classification (The most common approaches, for example: in etiology, in stage, etc.).

International Histological Classification

G - histological degree of malignancy

Note:

10 PZBU: The field of view with a large increase of 2 mm², is estimated at least 40 fields (with 40 multiple microscope increases) in the area with the highest density of mitoses;

Ki -67 / MIB1 antibodies:% of 2000 tumor cells in areas with the largest number of painted nuclei.

Overall classification of endocrine WHO tumors:

1. High-differentiated endocrine tumors:

A benign current;

Indefinitely.

2. Highly differentiated endocrine carcinoma.

3. Low-differentiated endocrine carcinoma.

4. Mixed endocrine exocrine tumor.

5. Tumor-like education.

Highly differentiated tumors

The endocrine tumors of the stomach are most often highly differentiated, more than 90% are on the neoplasms of enterocromaffine-like cells. Tumors from these cells are located mainly in the acid-producing mucous membrane and highlight hystamine, histidydhecarboxylase and VMAT. On the basis of concomitant pathological conditions, 3 types of these neoplasms are distinguished.

Low-differentiated endocrine carcinomas

Low-differentiated stomach endocrine carcinomas are relatively rare, extremely aggressive large tumors (\u003e 4 cm). Men are more often sick. Usually, by the time of the diagnosis, there are extensive metastases and death occurs within a few months.

TNM (International Anti-Union Union, 2009)

T- primary tumor

TX - the primary tumor cannot be evaluated.

T0 - lack of data on primary tumor.

TIS - in situ / dysplasia carcinoma; A tumor is less than 0.5 mm, limited by the mucous membrane.

T1 is a tumor with dimensions of at least 0.5 mm and no more than 1 cm within the mucous membrane or dimensions of no more than 1 cm in the largest dimension and germinating into the sublimatural base.

T2 - the tumor germinates in the muscular shell and has a size more than 1 cm in the largest dimension.

T3 - the tumor germinates in the submern basis.

T4 - the tumor germinates to the visceral peritoneum (serous shell) or to other organs or neighboring structures.

Note: For any T add symbol (M) if multiple tumors are added.

N - Regional lymphatic

NX - regional lymph nodes cannot be evaluated.

N0 - no metastases in regional lymph nodes.

N1 - There are metastases in regional lymph nodes.

M - remote metastases

M0 - no remote metastases.

M1 - There are distant metastases.

Diagnostics

Diagnostic criteria

Complaints and anamnesis (nature of the occurrence and manifestation of pain syndrome).

As a rule, in initial stages The clinical picture is absent. As the tumor process grows, there is a pain in the epigastric area, weight loss, anemia.

Physical examination (eg: sharp pain in the epigastric area).

In the clinical picture of carcinoid syndrome, cardiovascular symptoms prevails. It is characteristic of pronounced tachycardia, pain in the field of the heart, an increase in hell. Metabolic disorders in patients with carcinoids lead to secondary changes in the heart (fibroelastosis of the right hearts of the heart - three-tier valve and valves pulmonary artery), which create an appropriate picture in physical research and ECCG.
Hyperemia of the face and tides is often the first, and sometimes the only symptom of carcinoid syndrome.
These manifestations may be provoked by emotional factors (excitement and excitement), meals and alcoholic beverages. Vasomotor reactions are manifested by hyperemia of the skin in the form of erythematous redness of the skin of the head and neck (blood tide area to face). With a vascular reaction, the skin color may vary from red to a pronounced pallor. Prolonged attacks of hyperemia may be accompanied by a tear and an echoing eye. The system effects of these reactions are diverse. In some patients, a teleangectasis on the skin of the face and neck appear in some patients as a result of frequent and continuous attacks of expansion of skin vessels.

Abdominal carcinoid syndrome due to the influence of serotonin on motility gastrointestinal tract and secretion. It is manifested by pain in the abdomen of a grapple-shaped character, dyspeptic and functional disorders (nausea, vomiting, diarrhea). Bronchospasm is associated with the release of serotonin, bradykinin, histamine and is manifested by the attacks of difficult breathing.

Carcinoid syndrome Causes disorders of the neuropsychic status of the patient. The critical and background flow of neuropsychiatric disorders during carcinoid syndrome is distinguished. The attacks are accompanied by headaches, nausea, vomiting, deep depression and abundant manifestations of vegetative dysfunction (severe sweating, chills, hyperthermia, face hyperemia). Sometimes Ikota arise, feeling of hunger, hypoglycemia. After the attack, patients are weakened, depressive, sonlis. With the background flow of carcinoid syndrome, the patients identify signs of astheno-depressive syndrome.

Laboratory research:

2. General analysis Urine - changes in the analysis may be absent.

3. Biochemical analysis blood (general protein, urea, creatinine, bilirubin, glucose)

4. Coagulogram - there may be disorders of blood clotting.
5. Determination of blood biomarkers:

3. CT organs abdominal cavity and retroperitoneal space.

Indications for consultation of specialists (eg: oncologist indicating the purpose of the competence).

Consultation of related specialists and other surveys are as necessary.

List of basic and additional diagnostic events

Main diagnostic events

Laboratory research:

1. Common blood test - the most characteristic of anemia, varying degrees of severity; ENGLISH ESP.

2. Total urine analysis - changes in the analysis may be absent.

3. Biochemical blood test (overall protein, urea, creatinine, bilirubin, glucose).

4. Blood on RW, blood for HIV, blood to the Australian antigen.

5. Blood type, blood rhesus.

6. Coagulogram.

7. Determination of blood biomarkers:

Tools:

1. Endoscopic study of the stomach. Taking biopsy and conducting immunohistochemical analysis - Chromograin A, KI-67.

2. Ultrasound of the abdominal cavity organs and retroperitoneal space.

3. CT / MRI of the abdominal organs and the retroperitoneal space.

4. X-ray study of the lungs.

Surveys that need to be held before planned hospitalization - Paragraphs 13.1.1. - 13.1.2.

Additional diagnostic measures:

According to the indications, the instrumental methods are based on the imaging of the neuroendocrine tumor and determining the stage of the disease.

1. X-ray methods. X-ray of the chest organs in two projections - a screening method for eliminating the coarse organic pathology of the mediastinal organs, lungs, the presence of hydro and pneumothorax, as well as to eliminate urradic metastasis and synchronous tumor diseases.

X-ray of the esophagus, stomach, irrigography - apply to the purpose of contrasting and visualizing the modified gastrointestinal departments in suspected of the presence of a tumor, as well as the secondary involvement of them into the tumor process.

Excretory urography is carried out to estimate the excretory function of the kidneys, visualization of ureters and bladder.

2. Endoscopic method - Direct visualization method, allowing to study in detail the condition of the mucous membrane of the hollow organ, in addition, to obtain a material for morphological research.

3. Esophagogastroduodenoscopy.
4. Bronchoscopy.
5. Colonoscopy.

6. The ultrasound method is the most common and convenient method of primary and clarifying diagnostics, with which you can reveal the fact of the presence of a tumor and clarify its localization, dimensions, tumor connection with the surrounding structures and the degree of its vascularization.

Ultrasonic Doppler Vessels;

Endosonography;

Intraoperative ultrasound;

Laparoscopic ultrasound.

7. Spiral CT with contrasting amplification and MRI are the most informative methods allowing to identify a tumor from 1.0 cm, find out the degree of its local prevalence, as well as the presence of regional and remote metastases. These methods are inferior in the efficiency of only angiography and scanning of sandostatin receptors.

8. Radioisotope methods.
9. Scintigraphy of the skeleton bones is carried out in order to exclude metastasis in the bone of the skeleton.
10. Scintigraphy with octreoscale.

11. Somatostatin receptor scintigraphy.

12. EchoCG.

Differential diagnosis

Differential diagnosis (in the form of a table, eg: duodenal ulcer)

Treatment abroad

Treat treatment in Korea, Israel, Germany, USA

Get advice on medical examination

Treatment

Treats of treatment: Removal of the tumor.

Tactics of treatment

Non-media treatment

Indication to the surgical treatment of stomach carcinoid is establishing the diagnosis of Operal gastric cancer in the absence of contraindications tooperations.

The main radical operations in the stomach cancer are subtotal distal, proximal resection of the stomach and gastrectomy.

Neuroendocrine stomach tumors It is basically operational.

Algorithm for the treatment of neuroendocrine stomach tumors without defeat lymph nodes or remote metastases (I and II stage)

The main condition of the radicality of the operation is to remove the single block affected by a tumor of the stomach or its corresponding part and regionallymph nodes with their fiber surrounding (lymphodissection).

Currently, on the basis of JRSGC (1998), 16 groups are described in detail. regional lymph nodes forming four consecutive (not intrue understanding of the sequence) stage of metastasis from variousstomach departments - N1 to N4.

First stage: Perigastral lymphocollectors located in a binder apparatus of the stomach (№1-6).

Second phase: lymph nodes in the course of arterial stems - common hepatic artery, creek, left gastric, at the gate of the spleen, along the wayspleen artery (№7-11).

Third stage: Lymph nodes of hepatoduodenal bundles, retropanRectoodenal, roots of the mesentery of the transverse colon (№12-14).

Fourth stage: lymph nodes along the top of the top mesenteric artery, paraolartal (№15-16).

It should be noted that various localizations of the primary tumor in the stomach match different stages of metastasis, which is confirmed by prospectivestudies on the survival of groups of patients under the defeat of various groupslymphatic nodes.

Based on the classification and taking into account research on the results survival (M. Sasako et al., 1995; T. Aiko et al., 1998) Invitation of lymphaticn1-2 collectors are considered as regional metastasis, whileinvolvement N3-4 - as remote metastasis (M1 LYM).

Various variants of lymphodissection were reflected in the classification operations: The lymphodissection variant is determined on the basis of the latterdeleted stage metastasis.

Type of surgical intervention based on the volume of lymphodissection

To determine the radicality and adequacy of the operation, is controlled by lack of tumor cells along the intersection of organs (esophagus, stomach,duodenal intestine), defined microscopically.

Subtotal proximal resection of the stomach is performed during cancer cardial stomach department I and II stages. For cancer proximal department Stomach IIIthe stage or infiltrative forms produced gastrectomy.

In all cases, the NEO of the stomach is shown by gastrectomy, which is associated with biological features of the propagation of cancer cells. When distributedtumors proximally on the esophageal operation must be performed fromcombined Toraco Laparotomic Access by Osawa-Garlok with Escapeindicious anastomosis by ru.

With an exofite tumor, a stomach resection line in the proximal direction should run in 3-5 cm from the visible border of the tumor, and with endophyte form in 8-10 cm. The distal border of resection should run at least 3 cm from the visibleor palpable tumor boundary. Distal subtotal resection of the stomach shouldto be carried out according to the method of bilot-II with advanced gastroenteroanastomosis withinterchepted Sustain in Brown.

Splenectomy is performed during proximal localization and \\ or in the body of the stomach;germination of the tumor of all layers of the stomach wall.

Diagnosed at the preoperative stage of the NEO stomach (stage tumor process II, IIIA, IIIB, IV surgical) - Indication for courses(2-3) preoperative polychimotherapy. Basic drugs medicinaltherapies are - Taxother, Irinotecan, Oxaliplatin, Ksenoda. Efficiency markpreoperative therapy is carried out by control endoscopic,ultrasonographic, computer-tomographic research methods, andalso, IGH methods.

The results of the treatment of patients with the IV stage remain extremely unsatisfactory. There are no clear treatment schemes.To eliminate complications caused by the common tumorthe process, perform operational interventions with a palliative purpose. INdepending on the specific situation is performed by palliative resection of the stomach,gastrectomy, bypass gastroenteroanastomosis on a long loop with intercircuitsustain, impose a gastro or euyutrosty. Endoscopic is possiblerecanabilization by diathermocoagulation tumor.

Standard chemotherapeutic treatment schemes for cancer patients IV there are no stages. There are many different schemes for using cytostaticsnao patients stomach, which differ from each other not only with a setchemotherapy products, but also time, by the number of courses, usemodifiers, as well as a way to introduce them to the body.

Partial effects of U. patients with disseminated stomach cancer can be achieved in 15-35% of cases fromapplications in monotherapy mode of such drugs like 5-fluorouracil, fluorofour,cisplatin, etoposide, CCNU, doxorubicin, epirubicin. Partial durationremisses are short, the effect does not affect survival.

In the nineties, a study of efficiency has begun and continues until of the present time with a generalized NEO of the stomach of new drugs -docetaxel, Paklitaxel, Kampto, S-1, UFF.

Currently, combinations based on 5- formuracila and Lukovorina. It is advisable to use for therapy of gastric cancer 5-formuracyl, Cisplatin, etoposide, doxorubicin and epirubicin.

Despite this, the effectiveness of the chemotherapeutic treatment of patients the common NEO of the stomach remains low, in most casesthere is a partial and short remission of the tumor process.

Treatment in stages

Recurd

1. Operation (individualized):

Different palliative surgery in terms of volume;

Endoscopic tumor destruction;

Staging stents.

2. Palliative chemotherapy (individualized).

Medicia treatment

Chemotherapy

Chemotherapy:

1. Monochemotherapy with cytostatics.

2. Polyhemotherapy with cytostatics.

Combined chemotherapy:

1. Biotherapy + chemotherapy.

2. Symptomatic therapy.

With neuroendocrine diseases of the stomach, it is possible to apply the following chemotherapy schemes:

1. With highly differentiated neuroendocrine carcinomas: somatostatin or Streptozocin / 5-Formuracyl or Doxorubicin:

Streptozocin - 1 g / m², drip, in the 1st, 2nd, 3rd, 4th days;

Fluoruracyl - 600 mg / m², drip, in 1st day or 325 mg / m², drip, in the 1st, 2nd, 3rd, 4th, 5th days.
Cycle repetition every 4 weeks.

Doxorubicin - 50 mg / m², drip, in the 1st day;

For patients previously not received octreotide, treatment starts with sandostatin in a dose 100 μg, 3 times a day, for 2 weeks.With good tolerability and clinical effect, go to octreotide.

The octreotide dose can be adjusted after 3 months of treatment:

With good control of symptoms and biological markers, the dose can be reduced to 10 mg every 4 weeks;

When returning symptoms, the dose increases to 20 mg;

If the symptoms are monitored only in part, then the dose can be increased up to 30 mg every 4 weeks.

Lanreotide - doses and modes are selected individually after the estimate of the response reactions. It is usually recommended 60-120 mg, per / m, every 4 weeks.

The octreotide depot, as well as octreotide, is applied at a dose of 20 mg, per / m, 1 time per month, if necessary, the dose can be increased.

Ultrasound of peripheral lymph nodes, finger research direct intestine, examination of the gynecologist (in women);

General blood analysis.

According to the testimony: fibrocolonoscopy, irrigoscopy, computed tomography, angiography, MRI, scintigraphy of skeleton bones, PET research.

Hospitalization

Indications for hospitalization indicating the type of hospitalization: Planned.

Information

Sources and literature

1. Periodic protocols of diagnosis and treatment of malignant neoplasms in adults of the Republic of Kazakhstan (Order No. 883 of 25.12.2012)
   1. 1. Neuroendocrine tumors. Guide for doctors. Edited by Martin Caplin, Larry Kvols / Moscow 2010 2. Minimum clinical recommendations European society Medical Oncology (ESMO) 3. Guidelines for chemotherapy of tumor diseases edited by N.I. Venevodchikova, Moscow 2011 4. The Chemotherapy Source Book, Fourth Edition, Michael C. Perry 2008 by Lippincot Williams 5. TNM Classification of malignant tumors. Sobin L.h., Gosportarovich M.K., Moscow 2011 6. Journalof Clinical Oncology Volume 2, No. 3, Page 235, "Carcinoid" 100 years later: Epidemiology and foredetteological factors of neuroendocrine tumors. 7. Ardill JE. Circulating Markers for Endocrine Tumors of the Gastroenteropancreatic Tract. Ann Clin Biochem. 2008; 539-59 8. ARNOLD R, WILKE A, RINKE A, ET AL. Plasma Chromogranin A As Marker for Survival In Patients with Metastatic Endocrine Gastroenteropancreatic Tumors. Clin Gastroenterol Hepatol. 2008, p. 820-7 9. Davydov M.I., Ter-Avanesov MD, "Clinical Oncology", p. 384, 2005 g 10. Shpotin I.B., "Stomach Cancer", 227 p. , 2000 11. Cherniusov A.F., Polycarpov S.A., "Extended lymphaderectomy in gastric cancer surgery", 159 p., 2000g. 12. Materials of ASCO conferences (42nd Congress, Atlanta, 2006) 13. ESMO (clinical recommendations, Bablin, 2002) 14. Russia (19th All-Russian Conference) 15. Materials of the 5th Congress of Oncologists and CIS radiologists (Tashkent, 2008) 16. Materials of the 6th Congress of Oncologists and Radiologists of the CIS (Dushanbe, 2010) 17. Materials of the 11th, 12th World ESMO Congress on Gastrointestinal Cancer (Barcelona , 2009, 2010) 18. Materials of the 9th International Congress on Stomach Cancer (Seoul, Korea, 2001) 172 19. Guidelines for chemotherapy of tumor diseases are ed. N.I. Venevodchikova (Moscow, 2010) 20. Bethesda Handbook of Clinical OnColology (James Abraham, James L.Gulley, Carmen J.allegrag, 2010) 21. Oxford Handbook of Oncology (Jim Cassidy, Donald Bisset, Roy Ajspence, Miranda Payne, 2010) 22. Pocket Guide to Chemotherapy Protocols (Edward Chu, 2008) 23. Principles and Practice of Gastrointestinal Oncology (D.Kelsen et al., 2009)

Information

Organizational aspects of the implementation of the Protocol

Evaluation criteria for monitoring and auditing efficiency implementation of the Protocol (a clear listing of criteria and the availability of binding withindicators of treatment and / or creating specific to thisindicators protocol):

1. Percentage of newly identified patients with malignant neoplasm diseases \u003d (number of patients, with a diagnosis of carcinoidstomach receiving initial treatment within two months after the startdiseases / All Patients with first-established carcinoid diagnosisstomach) x 100%.

2. The percentage of cancer patients receiving chemotherapy for two months after operational treatment \u003d (Number of oncological

1. D.M.N. Izhanov E.B. - doctor of the highest category, head. Departments of thoraco-abdominal oncosurgery.

2. Abzalbek E.Sh. - Doctor of the highest category, doctor of separating thoraco-abdominal oncosurgery.

3. Ph.D. Ahetov M.E. - doctor of the highest category, doctor of separation abdominal oncosurgery.

4. Ph.D. Smagulova KK - Doctor of chemotherapy.

5. D.M.N. Esentaeva S.E. - doctor of the highest category, deputy. Dir. Casniyir.

Note Protocol Review Conditions: Revision of the Protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods withthe level of evidence.

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Karcinoid tumors of the stomach are benign tumors from a group of neuroendocrine neoplasms, which are highly likely to be reborn in malignant.

The diagnosis is made on the basis of patient complaints according to inspection and clinical analyzes. The stomach carcinoid is characterized by pain, feeling of overflow, nausea and vomiting. For temporary relief symptoms, patients are conducted a course of drug therapy, treatment is surgical, with resection of the affected area.

The essence of the disease

The development of carcinoid tumor is the result of the cellular tissue mutation, when the endocrine system, which is responsible for the regulation of the activities of all body organs by means of hormones, gives a failure. The stomach carcinoid appears in the mucosa of its walls due to the allocation of biologically active prostaglandins, serotonin, kininov. The brightness of the symptoms of the disease depends on the activity of their synthesis.

The stomach carcinoid is infrequently, but in recent years there has been an increase in the number of cases, especially in women. For this, the alend is characterized by rebirth of a slowly growing benign tumor immediately into an aggressive malignant carcinoid. It is formed from ECL cells - endocrine mucosa cells - in the festive glands, which constitute the bulk of the glands of this organ in the bottom area.

Types of disease

The carcinoid of the stomach is three types - A, B and C.

Type A is a consequence of chronic gastritis for a long time. It is characteristic of:

• - reduced acidity;
• - Gastrene hormone indicator and the number of ECL cells above the norm;
• - Malokroviya;
• - multiple neoplasms up to 10 mm.

People under 60 years of age are most susceptible to the disease. For the treatment of the stomach, the prognosis for the type A is good, since metastases appear in total in 3-5% of the diseased, the likelihood of death is small, the manifestation of the disease is practically not disturbed by a person. Carcinoids of this species are found in 70% of patients with this pathology. Tumors type A are the formation of a minor size on the mucous membrane. Sometimes their germination occurs in lymph nodes and liver.

More on the topic: Intestinal metaplasia of the anthral stomach department

The type in develops due to the pancreatic adenoma, which occurs due to increased production of gastrin, so it is also called the gastric.

For carcinoid of this type, characteristic:

• - multi-grade damage to the mucous membrane;
• - Tumors of size not more than 10mm.

This type of neoplasms are found in 8% of the diseases of the gastric carcinoid.

Type C is an independent disease. For it, aggressive tumors are characterized by more than 10 mm, randing metastases.

With carcinoid type C:

• - the tumor is observed in the singular;
• - its size reaches 20-30 mm;
• - There is no pathological destruction of the gastric mucosa.

With this form of the disease, the fatal outcome occurs in 20% of cases, 80% of the sick - men.

Symptoms of the disease

For its course, this disease is very similar to the stomach ulcers, the same symptoms are noted - frequent heartburn, constipation, diarrhea, pain in the abdominal cavity.

In some patients there are gastric bleeding, externally, they are manifested by vomiting with blood and black - from the presence of blood in it - feces.

Sometimes the stomach carcinoid leads to gastrointestinal obstruction due to the violation of the function of the sphincter separating the stomach from the duodenum.

It happens that diseases accompany shortness of breath, redness of the skin after the use of certain products - for example, wine, yellow cheeses.

In the case of metastases, damage to the myocardial is the muscular layer of the walls of the ventricles of the heart.

Diagnosis of the disease

On time to identify the carcinoid of the stomach is usually difficult, since in most cases the disease proceeds asymptomatic, if symptoms are manifested, they are similar to other diseases of the gastrointestinal tract, and such pathology is rarely found.

According to medical statistics in 20-25%, carcinoid is diagnosed after the death of the patient - according to the results of the opening, or when the biopsytte fence on the histological analysis during the surgical operation, for example, for example, during the removal of appendix.

More on the topic: How to get rid of the mucus in the stomach?

The carcinoid tumor can be detected as a result of the ultrasound, CT or MRI of the abdominal cavity, also - according to the results of gastroscopy. Sometimes pathology is put on the basis of laboratory studies, when the content of metabolites is exceeded in the urine analysis.

At ultrasound examination, computer tomography of liver, x-ray and scintigraphy (when introduced into the organism of radioactive isotopes to obtain a special device of a two-dimensional image on the monitor due to the radiation, which it is emitted) bones - it is possible to detect carcinoid metastases.

Treatment of the disease

Treatment is prescribed based on the type of carcinoid neoplasms.

When type A, when low-size tumors are revealed in an amount of 3-5, it consists in removing them using the endoscopy technique. After the procedure, in order to control the postoperative state of the patient's health and for timely detection repeated pathology, once or two throughout the year, endoscopic surveys are carried out.

When a single (no more than five pieces) of the newly formed carcinoids, a similar operation is shown, but already with the use of laparoscopy, which is to remove the neoplasms together with damaged parts of the tissue mucosa. In case of identifying more than 5 neoplasms - resection of areas with pathology is produced.

When the type in and with the treatment consists in surgical removal of direct gastrices along with resection of affected tissues. If metastases in the liver are detected, then probably the purpose of alternative treatment:

• - embolization - the method lies in blockage blood vesselspowered by a tumor;
• - Radio frequency ablation - effects on malignant cells through tissue proteins for calling the rejection with healthy fabrics affected;
• - cryoablations - aqueous freezing of the tumor to call the necrosis of its fabrics and a piece of healthy fabrics around it.

Chemotherapy in the treatment of such tumors is considered ineffective.

The consequences of late detection of the disease

Non-detected carcinoids in the stomach can lead to significant complications:

• - fibrosis of the heart muscle and retroperitoneal fabrics;
• - pulmonary embolism;
• - pneumonia in chronic form;
• - damage to cancer of other bids due to metastases.

• 1 Description
• 2 How is it formed?
• 3 Prevalence
• 4 types of gastric carcinoid
  • 4.1 Type A.
  • 4.2 Type B.
  • 4.3 Type S.
• 5 Symptoms
• 6 Diagnostics
• 7 Treatment
  • 7.1 1 Type
  • 7.2 2 and 3 Type
• 8 Complications

The group is externally benign, but capable of metastasis, neuroendocrine tumors include a gastric carcinoid. Specific signs of pathology - pain, feelings of overcrowding in the stomach, pouring, vomiting, constipation, alternating with diarrhea. The disease is characterized by the development of carcinoid syndrome, manifested in the form of gastrointestinal obstruction and / or bleeding. Diagnosed disease based on the assessment of complaints, the history of the patient, inspection results, clinical studies and instrumental examination of the patient organ. The only correct method of treatment is an operation with excision of the affected area or hemicultomy. To relieve symptoms, a course of medication therapy is carried out.

The carcinoid tumor in the stomach refers to neuroendocrine formations. For its development requires mutated cells diffuse endocrine system. Carcinoid in the mucous membrane is growing and is characterized by the ability to secure biologically active substances, such as prostaglandins, kinines, serotonin, kallicrein. The higher the synthesis of these compounds, the brighter the symptoms of pathology is manifested.

The carcinoid tumor in the stomach is quite rare pathology, but the number of cases of its appearance increases every year. The disease is characterized by the variable potential of malignancy - from benign tumors to highly aggressive cancer carcinoids.

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How is it formed?

The carcinoid tumor in the stomach is formed from ECl cells (enterochromaphphphofodible) located at the bottom of the organ. When developing a gastric juice, ECL cells protrude with buffer between Gastrian G-particles, and by clad cells. When the synthesis of gastrin occurs, the level of histamine produced by ECL cells increases, which provokes the activation of the creation processes of hydrochloric acid In the fined fabrics. And the increased acidity of the gastric juice is inhibited by G-cells. As a result, disorders occur in the growth and reproduction of ECL cells.

Pretty rarely malignant carcinoids are formed regardless of gastrin products.

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Prevalence

Karcinoids in the stomach are quite rare, but over the past 5 years the number of cases has increased in the Wednesday of the Female Population.

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Types of carcinoid stomach

All carcinoid tumors in the stomach are classified by 3 types.

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Type A.

Develops on background chronic form Atrophic gastritis. Features of this type:

• low acidity;
• chronic inflammation of the gastric mucosa;
• increased amount of gastrine and ECL cells;
• anemia;
• carcinoids - multiple, no more than 10 mm;
• risk group - people from 60 years old.

Pathology is characterized by a favorable forecast, since remote metastases develop only in 3-5% of patients, mortality is minimal, the symptoms are practically disturbed by the patient. Tumors of this type are found in 70% of all cases of carcinoid damage to the stomach. Visually, under a microscope, tumors look like small formations attached to the gastric mucosa. Less frequently, their growth in the liver and regional lymph nodes are observed.

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Type B.

Developed against the background of Zolinger-Ellison syndrome, characterized by the development of a tumor in the pancreas against the background of the hypersecretion of gastrine in the stomach. Such pathology is also called the gastric. In addition to the pancreas, multiple endocrine neoplasia of the first type can affect the thyroid and adrenal glands. The total number of carnationides in the stomach type B is 8%. Visual features:

• polystagity;
• size - less than 10 mm.

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Type S.

It develops independently and is characterized by a large size (more than 10 mm). Such carcinoids are very aggressive, as they quickly give metastases, why the mortality is high. Their number is 20% of all cases. Men are more often found (80%). Visual features:

• single tumors;
• the value is 20-30 mm;
• the absence of pathological destruction of gastrointestinal mucosa.

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Symptoms

Carcinoids can be characterized by heartburn, diarrhea or constipation.

The stomach carcinoids are often similar to ulcers and can be characterized by heartburn, pain in epigastria, diarrhea or constipation. May open gastric bleedingwhich are manifested by the blackening of Cala, bloody vomit. Carcinoid syndrome in the form of gastrointestinal obstruction Against the background of the obstruction of the gatekeeper and / or with massive bleeding rarely develops. Even less often, the sword is developing, hyperemia of the skin (against the background of the use of some food products - wine, yellow cheese). Feature clinical picture Stomach carcinoids is the ability to develop diarrhea and myocardial damage.

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Diagnostics

In a timely manner, to determine the carcinoid in the stomach is difficult due to the asymptomaticity of the flow and rarity pathology. 20-25% of cases are diagnosed according to the results of a posthumous opening or histological analysis of a bioptate selected in a patient during surgery on another case, for example, when removing acute appendicitis.

To identify the carcinoid tumor is possible according to the results of the ultrasound, CT, MRI peritoneum, gastroscopy. Less often, pathology is diagnosed according to the results of laboratory tests on high content of 5-oucl and 5-nT in the urine. Metastases are detected by CT, ultrasound liver, radiography and bone scintigraphy.

Diffdiagnosis is carried out in order to exclude other oncoprocesses, chronic gastritis, acute and chronic appendicitis, stomach ulcers.

Table of preliminary results of clinical and hardware studies with a positive diagnosis:

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Treatment

The therapeutic scheme is selected depending on the type of carcinoid tumor.

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1 type

If it is detected from 3 to 5 small carcinoids, their removal is carried out by applying the endoscopic technique. Endoscopic examination is carried out to monitor the status and tracking of a possible relapse 1-2 times a year. If single low-size tumors are detected, assigned alternative therapy With the use of wedge-shaped laparoscopic equipment removal of carcinoid together with the affected plot of mucous membrane. When identifying more than 5 few pronounced tumors, a partial resection of the affected organ is carried out. As a new methodology, the use of the drug treatment regimen is possible. To date, effectiveness exhibit the analogues of somatostatin.

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2 and 3 Type

Chemotherapy at 2 and 3 types are ineffective.

Carcinoids are treated with resection of the gastric itself or a large-scale resection of affected stomach tissues. When detecting metastasis in the liver, the question of the use of alternative methods is solved:

• embolization;
• radiofrequency ablation;
• cryoablation.

Chemotherapy is ineffective.

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Complications

Frequent consequences of untreated carcinodia are such pathologies:

• fibrosis of the heart muscle and retroperitoneal space;
• recurrent impassability of light and chronic pneumonia;
• secondary malignant education in other gastrointestinal bodies.

The average forecast for the carcinoid tumor in the stomach: 5-year survival - 70-80%.

The first duodenal cancer symptoms

Many people think that such a duodenal cancer, the first symptoms and the reasons for his appearance? How and when to treat? How much do you live with this disease?

Duodenal cancer is a very serious, deadly oncological disease, a tumor is located in the initial department fine intestine. This ailment may affect the body of men and women over 55 years old. But as always there are exceptions, and cancer may arise in young people, but these are isolated cases.

The first neoplasms can appear from the epithelium and deepening of the mucous membranes, dense iron tissues. The second manifestation is when the tumor has already sprout into another body. If the carcinoma of the pancreas reaches large sizes and germinates in the epithelium of the 12-rosysome intestine, then it is very dangerous!

This disease is manifested in the late stage, thereby making it difficult to diagnose and treatment. In this regard, it is almost impossible to recognize the tumor at the beginning of its development.

In order to answer what reasons affect the development of this disease and how many people live with this disease, you need to analyze some facts.

Causes of development

Oncological diseases, unfortunately, remain a secret for science in terms of the reasons for their appearance.

It's believed that malignant tumor The 12-robes are able to cause many factors. These include excessive use:

• alcoholic beverages (alcoholism);
• narcotic substances;
• tobacco products (not detected, which component affects the development of the tumor);
• coffee (a separate component that affects the appearance of cancer is not detected;
• animal fat (increased panoposis emission);
• meat.

Diseases are influenced by the development of cancer of a 12-rosewoman:

• diabetes;
• stones in the urine;
• pancreatitis (chronic form).

And the hereditary factor is also not worth missing.

There is no reason for the unambiguous reason for this ailment, since they do not have scientific confirmation and require research. So if a person behaves the perfect lifestyle, it does not mean that he cannot develop such a cunning disease as cancer.

As for etiological factors, they are almost unknown.

Symptoms

Symptomatics plays a particular importance in diagnostics. The first symptoms can be easily confused with a simple stomach disorder. But in the future, when the tumor becomes more and starts to germinate in the walls of the stomach, then more weighty symptoms will appear. Tumor will let yourself know through painfulness. With some periodicity, pain will arise in the hypotherapy, also a person feels a feeling of gravity in his stomach.

Pain thresholds for each person are individual:

• it can be both acute and deaf pain;
• pain may be long or intermittent;
• sometimes pain is intensified to sleep;
• if you eat fatty food or drink alcohol, pain can increase.

Most often, pain signs are manifested in the period when the stomach is empty. But the decline in appetite is the main prime symptom of cancer.

Due to the fact that the duodenal cancer is manifested in the same way as other diseases associated with digestive system, It is necessary to consult a doctor and do not engage in self-medication!

At later stages, other symptoms begin to manifest.

Manifestation of symptoms of Cancer Disease 12 Pans is connected with:

• blockage of the gossip;
• pressure of the tumor for the nearest bodies;
• general intoxication of the body;
• anemia;
• weight loss;
• skin itch.

The temperature rise is the main symptom of the late stage.

When progressing cancer (increasing tumor) other features appear:

• nausea, turning into vomiting, diarrhea;
• sharp and frequent increase in temperature;
• mucous membranes dry;
• feeling of apathy;
• irritability;
• frequent belching, unworthy heartburn;
• migraine possible;
• the usual rhythm of life is disturbed;
• jaundice may appear;
• there is a flare in the language;
• the patient sweats greatly, especially during sleep;
• pains in the lower back may arise;
• feeling of a solid abdomen;
• the occurrence of bleeding;
• coal-black cal.

Based on the patient complaints, inspection and modern tool methods Diagnostics Doctor will be able to recognize the disease.

Treatment

The duodenal cancer is treated in several ways:

1. Resection (surgical tumor removal). Make an operation when spreading a tumor on a duodenal nipple and a common output duct. Patients are allowed not older than 75 years old, and if the tumor has not yet given metastases. The operation removes part 12-palace.
2. Partial duodenal removal together with developing cancer. But this procedure is done only if the tumor is less than 1 cm and age does not make it possible to remove everything.
3. Chemotherapy (destroys or slows down tumor growth). It is carried out after surgery as a fixing measure. At the same time, cancer cells are finally destroyed.
4. Radiation radiation. Applies only in a complex with chemotherapy and operation.
5. Radiation therapy. It is carried out at the early stage of the development of the tumor, if there is a chance to slow down the growth of cancer cells.

The possibility of carrying out the operation is determined by histological examination (account for about 70%).

Diagnostics

Most people think about the probability of cancer only when they begins to disturb something, when a man begins an unreasonable vomiting, when severe abdominal pain appear, obstruction of the stomach, etc.

It is worth noting that X-ray is carried out at any stage of the disease.

It scans the intestine, thereby helps to know where the tumor is located and what size it is. An ultrasound, which helps to determine the changes in the surface epithelium of the mucous membrane. Additionally, it is necessary to pass blood for analysis, feces, urine. And also recently popular computed tomography (MRI), ultrasound examination and biopsy - take a piece of tumor in order to determine its structure.

Conduct an instrumental examination of EGDS. EGDS is a procedure during which biochemical analysis is taken.

As a result, you can determine the state:

• stomach;
• esophagus;
• duodenal estate;
• bile duct.

On the basis of diagnostics, the doctor will be able to appoint proper treatment. And when passing the entire treatment, you can live a considerable number of years. The main thing is that there were no distribution of metastases.

As prevention, it is necessary to drastically change your lifestyle and not allow no reason to resume the disease.

To the question of how many people will live with such dangerous disease, The answer is simple: it all depends on him and attitudes towards their own health!

The first symptoms and signs of gastritis gastritis

Gastritis is inflammation of the gastric mucosa, the real Beach of the modern person. The reasons for its appearance are many: improper nutrition (irregular, hasty with swallowing is not enough facing food), the use of food and beverages irritating the mucous membrane, uncontrolled reception of medicines, also irritating mucous membrane, the presence of Helicobacter Pylori bacteria.

Early detection of gastritis simplifies the treatment of the disease.

Gastritis is sharp and chronic, and if the first form is practically not missing, since it is accompanied by strong pain in the abdomen, then with the second more and more difficult. The person sometimes has the unpleasant sensations that pass by themselves or are suppressed by any drug acquired at random. Unfortunately, such an attitude to his own health can affect him, because gastritis, unpleasant in itself, is often accompanied by dangerous complications and contributes to the development of the stomach and duodenal ulcers and even the stomach cancer. Therefore, it is very important to know and be able to recognize the first signs of gastritis and its symptoms, and with systematic pains to contact a gastroenterologist, even if the pains seem not strong.
Important! Remember - it is impossible to diagnose yourself.

• 1 first gastritis symptoms
  • 1.1 Specific
  • 1.2 Nonspecific
• 2 Complications for gastritis
• 3 Gastritis diagnostics

The first symptoms of gastritis

Specific

Nonspecific

These signs do not always indicate the appearance of gastritis, but they can accompany it. In any case, it is necessary to pay attention if such symptoms are manifested.

• problems with the work of the intestine, are manifested both in the form of diarrhea and in the form of constipation;
• minor, but regular increase in body temperature to subfebrile, i.e. up to 37 degrees;
• lowering appetite without visible reasons;
• weight loss without any actions for this man;
• increase nail fragments and hair loss;
• weakness, pallor, drowsiness, dizziness, sweating, irritability. Often these symptoms appear after feeding, a person has a feeling that he is "tired" during the meal;
• the appearance of snacks in the corners of the lips;
• problems with cardiovascular system - arrhythmia, heartbeat, changing blood pressure.

All this is manifestations of gastritis of the stomach. Agree, is extremely unpleasant?

Complications for gastritis

If you do not diagnose the disease on time, it will only be worse. First, gastritis itself, poorly treated or not durable, will regularly recur. Secondly, it brings with him a lot of complications. To understand the seriousness of the situation, familiarize yourself with their list.

1. Ulcer stomach. Damage to the stomach walls without the necessary treatment will only be progressing over time, which will naturally lead to an ulcer.
2. Stomach cancer. The launched gastritis or ulcer prone to the transition to the precancerous state, and then in cancer.
3. Pancreatitis (inflammation of the pancreas) very often appears on the background of gastric diseases, especially those who do not comply with the diet and does not receive treatment.
4. Anemia. Vitamins and trace elements are very poorly absorbed into the damaged walls, which leads to anemia and avitaminosis.
5. Anorexia. It leads to a decrease in appetite and metabolic disorders. Weight loss can be quite significant.
6. Internal bleeding. It may appear in erosive lesion.
7. Peritonitis and sepsis. Can appear with purulent gastritis.

Gastritis diagnosis

To put the correct diagnosis, the gastroenterologist prescribes various specific research. The main one is FGS, fibrogastroscopy. In addition, ultrasound studies of the abdominal cavity and blood tests and feces are prescribed.

1. FGS. The patient through the esophagus is introduced a probe equipped with a special chamber. The doctor on the monitor of the apparatus sees the walls of the stomach, duodenum and esophagus, based on what makes a diagnosis. Also using the probe take biomaterial for analysis: gastric juice and biopsy (scraping with damaged sites). The study is carried out on an empty stomach and requires pre-starvation about semi-sufficient.
2. Uzi pancreatic gland. Determines whether there are violations in the work of this body, which often accompany other gastrointestinal diseases.
3. Cala analysis on Helicobacter Pylori. Determines whether in the stomach data of bacteria.
4. Blood tests:

• general and biochemical - determine whether there is inflammatory process and changes in blood formula;
• igM, IgA and IgG antibodies to Helicobacter Pylori bacteria - determine the stage and intensity of gastritis;

• oncomarkers - define, benign or malignant are changes in the mucous membrane.

Many modern clinics offer comprehensive computer diagnostics of the gastrointestinal tract. The results of minimally traumatic studies are processed special programwhich determines the stage and type of disease, after which the gastroenterologist puts the most accurate diagnosis and prescribes the appropriate treatment.

In any case, you should not be lazy to go to the doctor and fear the research process. Many terrible stories about FGS transmitted from mouth to mouth, with the development of medicine became fairy tales. Modern apparatuses for studies in charge with anesthetizing drugs allow even fibrogastroscopy to spend almost painlessly.

If you notice the first signs of gastritis described in this article, please contact the doctor. Tightening with diagnosis and treatment is not worth it, because while you are waiting, destructive processes flow in the stomach. It is impossible to engage in self-treatment - it is impossible to choose a suitable diagnosis medicine. And remember - the earlier detect the symptoms of gastritis gastritis and start treatment, the faster and more efficient it will pass. Be healthy!