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In suspected cases of peptic ulcer, the primary investigation of choice is upper panendoscopy, which patients refer to as gastroscopy or gastroscopy. In fact, it involves observation not only of the stomach but also of the first third of the oesophagus and duodenum. With this examination, a trained examiner can detect 85-95 % of lesions in the esophagus, stomach and duodenum.
In addition to the presence of an ulcer, the test may reveal other upper gastrointestinal diseases. Targeted histopathological samples can be taken from the lesions to reveal: the degree of inflammation; signs of activity; and, in the case of gastric ulcers, possible malignancy. In a large number of studies, the malignant degeneration of gastric ulcers is not detectable on visual inspection in about 30 %, and therefore it is mandatory to take a sufficient number of histological samples from the gastric ulcer and its surroundings in all cases.
After the end of the medication (usually after 8-12 weeks), it is mandatory to monitor the healing of the gastric ulcer, precisely to make sure that no malignant tumours are present.
A gastroscope is a fibre-optic instrument with a diameter of 0.9-1.4 mm and a length of more than 100 cm, in which very thin - and therefore flexible - glass fibres with a diameter of 15-20 ľm guide the light to illuminate the inside of the oesophagus, stomach and duodenum and the image provided by the endoscope. Each point of the visible image is guided by a separate parallel glass fibre. The image can be observed by the examiner by looking into the device or, in the case of a video endoscope, by the assistant or even the patient himself, via a television monitor.
In addition to the image guide and the glass beams that illuminate the interior, the gastroplasty also includes a channel for the introduction of air and water, a channel for aspirating gastric juice or other secretions, and a channel for histological sampling or other procedures. A biopsy forceps for taking a tissue sample or a body-gripper for grasping a foreign body, a thin plastic tube (probe) for injecting a drug or fluid or for taking a gastric fluid sample may also be inserted.
The test is a little uncomfortable, but not painful. If you know what to expect, you can be sure you'll cope well with the ordeal. I am in the unique position of having experienced both sides of the examination (doctor and patient) on several occasions, and on one occasion I performed the gastroscopy on myself.
It is very important that you do not have an upper respiratory illness (cold, flu, sore throat) at the time of the examination, because in such cases - either when the gastroscope is passed through the pharynx or during the examination - the lack of unobstructed nasal breathing will make the examination much more unpleasant or it may not be possible to perform it because of a feeling of suffocation. In such cases, postpone the test, contact the laboratory that performed the test and request a new appointment.
Preparing for the test is simple. You can eat dinner the day before, but don't drink water after midnight and definitely don't smoke. The test is usually carried out in the morning, but if a later appointment is made, an 8-hour fasting state is usually required. Also, do not chew gum before the test, as this can also cause increased gastric juice production, which can interfere with a quick and successful test. If you feel very thirsty during the 8 hours before the test, rinsing your mouth can significantly reduce the sensation of thirst.
To avoid foaming in the stomach before the test, we recommend taking Ceolat tablets. The pleasant taste of these tablets gives you a little peace of mind before the test.
Before the test, it is important to read and complete the information leaflet and sign the consent form.
Outer clothing (sweatshirt, blazer, jacket, etc.) should usually be removed before the examination and if the patient is wearing a belt, tight skirt or trousers, these should be unbuttoned or loosened. This is necessary because the abdomen swells slightly when air is blown in, and the tightness caused by tight clothing can be uncomfortable and painful.
Under the assistant's guidance, the patient lies on the examination table, turns to his left side, with his legs bent at the knees and slightly drawn towards his abdomen. Before the examination, the assistant sprays Lidocaine on the posterior wall of the pharynx. Any allergy to lidocaine should be clarified beforehand, and if the patient is aware of this, it is important to mention it, although the assistant or doctor will always ask about it. Lidocaine spray causes a slightly bitter or burning sensation, but the sprayed mucous membrane quickly becomes numb and there may be a small burning sensation in the throat.
A plastic bite guard is then placed in the mouth and the patient bites down on it with their teeth or gums (removable dentures must be removed before the test due to the risk of accident). Finally, the head is lowered - as if looking at the buttons of a shirt or blouse - and the instrument is lowered. This is perhaps the most unpleasant part of the examination. The main thing to remember is that when the doctor says "Swallow", you really have to swallow, as this makes it easy for the device to enter the oesophagus. Once this is done, there is nothing more to do. Try to hold the inhaled air; if you can't, you can safely spit it out and the examiner will blow in another dose of air.
If phlegm builds up in the throat or saliva collects in the mouth near the chute, as if blowing out a candle, you can blow out the phlegm, which effectively relieves the feeling of choking. Try to relax as much as possible during the examination. This is important because it can shorten the examination time. In a spasmodic state, with constant gagging, the examiner needs considerably more time to fully explore the area to be examined.
The scan usually takes 5-10 minutes, depending on how many samples the doctor needs to take based on the image seen; whether there are areas that are difficult to see; whether targeted sampling may be needed.
The mucosal samples taken during the examination will be histologically examined. The histopathological examination will reveal the severity of the gastric mucosal inflammation, whether it is acute or chronic, the presence of any specific abnormalities (e.g. malignant degeneration, polyp, ulcer, or whether the abnormality is just a mucosal protrusion, etc.). This analysis takes approximately 2-6 days.
Quote from Dr.Alajos Takáts: Patient education book on ulcer disease
(Springer Publishers, 1998)
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