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Diagnosis of chronic gastritis and gastroduodenitis
Last reviewed: 03.07.2025
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To establish a diagnosis of chronic gastritis and gastroduodenitis, it is necessary to collect anamnesis, including genetic and epidemiological, and also to find out the patient's complaints. Particular attention should be paid to the nature of nutrition, the presence of bad habits, concomitant diseases and previous drug treatment.
Physical examination is carried out using traditional methods.
Mandatory laboratory tests include a complete blood count and urine test, stool occult blood test, and a biochemical blood test (determination of the concentration of total protein, albumin, cholesterol, glucose, amylase, bilirubin, iron, and transaminase activity).
To diagnose H. pylori infection, invasive or non-invasive research methods are used according to the recommendations of the European Group for the Study of this Pathogen. Invasive methods require fibrogastroscopy to obtain a biopsy, while non-invasive methods do not require endoscopic examination. Highly sensitive diagnostic tests are used for screening and primary diagnosis of infection, and highly specific tests are used to monitor eradication treatment.
Non-invasive methods for diagnosing H. pylori infection include:
- breath tests with registration of H. pylori waste products (carbon dioxide, ammonia);
- detection of specific anti-Helicobacter antibodies of classes A and M by enzyme immunoassay, rapid tests based on the precipitation reaction or immunocytochemical studies using the patient's capillary blood;
- PCR with stool samples.
Invasive methods for diagnosing H. pylori infection include:
- bacteriological method (determination of the H. pylori strain, determination of its sensitivity to the drugs used);
- PCR in biopsy of the gastric and duodenal mucosa;
- urease test.
Invasive methods for primary diagnostics are used less and less.
Through many years of multicenter research, it was possible to develop a diagnostic algorithm that allows for the rapid detection and effective treatment of H. pylori infection, achieving complete eradication of the pathogen and long-term remission of the disease, significantly reducing the percentage of various complications.
Primary diagnostics (non-invasive methods) include a breath test, enzyme immunoassay, and PCR in feces. Eradication control is prescribed 6 weeks after the treatment, provided that during this period the patient does not take other drugs (antibiotics, proton pump inhibitors, H2-histamine receptor blockers , antacids, adsorbents, etc.), by at least 2 methods, most often invasive. Currently, H. pylori genotyping methods are increasingly used, including to determine resistance to clarithromycin.
When determining eradication using invasive methods, it is necessary to examine a fragment of the mucous membrane of the antral and fundal sections of the stomach.
Laboratory tests for diagnosing autoimmune gastritis in children include determination of specific autoantibodies to H+, K+-ATPase of gastric parietal cells and Castle factor, and the content of vitamin B12 in the blood serum.
The diagnosis of chronic gastritis and chronic gastroduodenitis is confirmed after endoscopic and histological examinations, detection of H. pylori infection, determination of gastric acidity and vegetative status, as well as consultation with a neurologist and psychoneurologist.
EGDS is the most important method of confirming the diagnosis, allowing to assess the prevalence and nature of the lesion, obtain biopsies for morphological examination and determination of H. pylori infection. In this case, it is possible to detect endoscopic signs that indirectly indicate H. pylori infection: ulcers of the duodenal bulb, multiple different-sized protrusions of the mucous membrane of the antral part of the stomach in the form of a "cobblestone pavement" (nodular gastritis), cloudy mucus in the lumen of the stomach, edema and thickening of the folds of the antral part of the stomach.
When diagnosing chronic gastritis, it is first necessary to rely on the morphological structure of the gastric mucosa.
In addition to the main criteria, other signs of a pathological process may be noted on the visual analogue scale, such as lymphoid follicles consisting of B-lymphocytes and formed in response to antigen stimulation (in 100% of cases confirms H. pylori infection), microthrombosis, hemorrhage, hypersecretion (consequences of microcirculation disorders).
Unlike adults, who are characterized by a histological picture of active Helicobacter gastritis with significant polymorphonuclear infiltration, in children the inflammatory cell infiltrate most often contains plasma cells and lymphocytes. Infiltration is usually superficial, and inflammation of the mucous membrane throughout its entire thickness is very rare. A characteristic histological sign of Helicobacter gastritis in children is the presence of lymphoid follicles with regenerative centers localized in the proper plate of the gastric mucosa.
For early diagnosis of autoimmune gastritis in children, it is advisable to additionally assess the degree of focal destruction of the fundic glands in biopsies of the body of the stomach.
The histological features of chronic gastroduodenitis associated with NSAID use are caused by the collagen diseases for which NSAIDs are prescribed (connective tissue disorganization, defective collagenosis, proliferative capillaritis, and arteriolitis).
To assess gastric secretion, it is possible to use probe and non-probe methods. The following studies are most often used:
- fractional sounding, which allows to evaluate the secretory, acid- and enzyme-forming functions of the stomach;
- intragastric pH-metry - an accurate study that makes it possible to continuously evaluate secretory processes simultaneously in different parts of the stomach, in the esophagus or duodenum;
- performing pH-metry or introducing an indicator liquid into the stomach during an endoscopic examination.
[ Indications for consultation with other specialists
All patients are recommended to consult an otolaryngologist and a dentist, in case of concomitant anemia - a hematologist, in case of severe pain syndrome - a surgeon. If antibodies to the Epstein-Barr virus are detected in the blood serum or if antigens of the virus are present in biopsy specimens, a consultation with an infectious disease specialist is recommended. In case of severe psychosomatic disorders, a consultation with a psychologist and/or psychotherapist is recommended.