A woman in her 60s often felt upper abdominal pain while eating, but because she was afraid of having a gastroscopy, she did not seek further medical attention, but bought painkillers by herself. However, in addition to abdominal pain, she also often suffers from back pain and knee pain. She takes painkillers to relieve the pain. However, she does not know that improper use of painkillers will also hurt her stomach. It was not until she discharged black asphalt-like feces that she was urgently sent to the doctor by her family for a gastroscopy examination. She found that the bleeding in the stomach was quite serious and must be stopped immediately; at the same time, the doctor also found that she had a Helicobacter pylori infection. After active treatment by specialists, the aging disease of the stomach can be gradually improved.

We talked about endoscopy last time. Generally, there are two main methods of endoscopy, gastroscope and colonoscopy. Today we mainly talk about gastroscope. Gastroscopy can see not only the stomach, but also the esophagus and the first half of the duodenum. It can check whether these organs have problems such as inflammation, ulcers, polyps or tumors. It is a very effective way of diagnosis and treatment.

A gastroscope is a common inspection item. It is a slender tube with a diameter of about 1 cm wrapped in black plastic and wrapped with a light guide fiber. The front end is equipped with an endoscope, which enters the throat through the mouth and extends through the esophagus. The light passes through the optical fiber, allowing the doctor to clearly observe the situation in the upper digestive tract from the other end.

Gastroscopy to examine the esophagus, stomach, and anterior duodenum

Gastroscopy is our common name. In fact, the full name of this examination is “esophagogastric and duodenal endoscopy” (EGD). Generally speaking, the common causes of gastroscopy are arranged clinically, including abdominal pain and gastric acid reflux. , ulcers, polyps, dysphagia, vomiting blood or melena, unexplained anemia, stuck by foreign bodies such as fish bones, etc. When the patient has the above conditions, the doctor will arrange the examination after evaluating the need for gastroscopy to clearly identify the lesions. But some diseases may not have symptoms, so gastroscopy is also one of the items of health check.

Painless anesthesia avoids discomfort during gastroscopy

Many people feel scared when they hear gastroscopy. The common discomfort is that the gag reflex is induced when the gastroscope is passed through the throat, and there will be obvious foreign body sensation within 5-10 minutes of the examination. The gastroscope does little damage to the gastrointestinal tract, and there is little chance of an accident. For discomfort, there is now a painless gastroscopy, that is, before the examination, the anesthesiologist will give sedative and anesthetic drugs by intravenous injection. The patient usually falls asleep in about 1 minute, but when the effect of the anesthetic wears off, the patient is prone to Dizziness, so painless gastroscopy must be accompanied by relatives and friends to ensure safety.

However, not everyone can use painless anesthesia, such as older people, people over 70 years old, and patients who have just had a heart stent or have a specific medical history such as arrhythmia, must have an anesthesiologist assess the risk before deciding Is it feasible. For those who are not suitable for general anesthesia, there are other options, such as transnasal gastroscope. The diameter of the endoscope used is only about 0.3-0.5 cm, which is not easy to cause the throat reflex, but because the equipment is smaller, the brightness and resolution of the image are improved. , The visual field will be worse than the general gastroscope, and the diagnostic accuracy will decrease to a certain extent.

An 8-hour fasting time is required before the examination. Patients who take the medicine regularly should ask the doctor whether to stop the medicine first.

Before gastroscopy, the stomach must be emptied first, and there should be no food residue, so fasting should be at least 8 hours. If painless gastroscopy is performed, the longer the fasting time, the better.

Patients on regular medication may have to pause or adjust certain medications based on safety at the time of examination. For example, diabetic patients fasting for such a long time, because blood sugar is already low, it is not recommended to continue taking hypoglycemic drugs or insulin; patients taking anticoagulants will affect blood coagulation function, because they are worried about bleeding if there is a wound during gastroscopy Therefore, you should inform the specialist first, and the doctor will assess the risk and decide whether to stop the drug first; for example, if you have a heart stent, you need to use the drug for a long time, and you should stop the drug for a few days before the examination. If you are taking aspirin, you may stop the drug. Time will be longer.

However, whether to suspend or adjust the medication should be judged by the doctor and cannot be stopped or adjusted by itself. In addition, on the day of the examination, the patient’s body temperature, blood pressure, heart rate and blood oxygen will also be measured. If there are problems such as insufficient oxygen, too high or too low blood pressure, arrhythmia, etc., the examination may be temporarily suspended on the day, and these must be dealt with first. question.

Patients with glaucoma and enlarged prostate are not suitable for antispasmodic drugs

Since saliva is prone to foam, the subjects will be asked to take antifoaming agents to increase the visibility of the mucosa during gastroscopy, and parasympathetic inhibitors to reduce gastric motility and saliva secretion according to the situation, especially for subjects without anesthesia , If you drool too much during gastroscopy, it will be easy to choke, so you must rely on drugs to reduce saliva secretion and reduce gastric motility to facilitate the examination. However, patients with atresia glaucoma are worried that the regulation of parasympathetic nerves will be inhibited and cause high intraocular pressure, so these drugs are not suitable for use; in addition, patients with benign prostatic hypertrophy are also not suitable, because prostatic hypertrophy will compress the urethra and cause difficulty in urination, which requires more Powerful bladder contractions, but inhibited parasympathetic nerves can cause weak bladder contractions, and side effects can make it difficult to urinate smoothly throughout the day.

During the examination, a mouth guard will be placed between the teeth of the examinee to avoid biting the endoscope when nervous, resulting in damage to the teeth and the endoscope; the posture is to lie on the left side, so that the stomach sags, far from the cardia, and it is less prone to aspiration pneumonia ; Bend your knees toward your chest to avoid belly strain.

Gastroscopy can detect Helicobacter pylori simultaneously

Helicobacter pylori is usually tested at the same time as gastroscopy, because Helicobacter pylori is a bacterium that can cause a variety of stomach diseases. Early detection and early medication can be cured. This test will have results in as little as half an hour. .

Most gastroscopy is safe, but because it is an invasive test, there is still a risk of potential complications, such as a sore throat. This is because the gastroscope will pass through the throat, and some people have a narrow or sensitive throat. The discomfort will improve in about 2-3 days, rarely more than a week; if there is too much gastric acid in the stomach, when the cardia relaxes, the gastric acid will flow out and cause choking injury, which may lead to aspiration pneumonia, and the elderly are at higher risk. Follow-up May cause infection problems. The more serious complications are gastric perforation or upper gastrointestinal bleeding. However, the equipment and technology are very advanced now, and the probability of aspiration pneumonia, perforation, and bleeding is very low.

In fact, in addition to inspection, gastroscopy can also do tissue sections, polyp removal, ulcer hemostasis, and bacterial culture for patients with pylori who have failed treatment, which is powerful.

Gastroscopy can diagnose gastroesophageal reflux and identify different types of gastritis

Gastroesophageal reflux is a common reason for clinical gastroscopy. Such patients may have typical symptoms such as heartburn and hyperacidity, or they may seek medical treatment due to symptoms such as chest pain, difficulty swallowing, unexplained cough, and throat discomfort. Diagnosed with gastroesophageal reflux.

Gastritis refers to the phenomenon of inflammation or erosion and bleeding of the gastric mucosa, and endoscopy can also identify different types of gastritis, such as: superficial gastritis is some uneven erythema in the stomach; erosive gastritis is a little bit of broken skin bleeding. As for nodular gastritis, it is granular and covered with lymph nodes; hemorrhagic gastritis will see many red spots of subcutaneous hemorrhage, and the latter two are related to Helicobacter pylori infection.

Helicobacter pylori can easily lead to a variety of gastric diseases, three-in-one therapy can be cured

When it comes to stomach health, we cannot fail to mention Helicobacter pylori, which is one of the few bacteria that can survive in the stomach. Infected people have more than 50% chance of causing chronic gastritis in their lifetime, 20% will develop gastric ulcer, 2% will get gastric cancer and 0.1% will develop gastric lymphoma.

There are many ways to check for the presence of H. pylori. Non-invasive tests include blood serum antibody assays or stool antigen assays, but the most accurate is the urea breath test. The invasive examination method is to take some gastric mucosal tissue (sections) through a gastroscope, and then perform a rapid urease test, histopathological examination, and bacterial culture.

If you find that you have Helicobacter pylori infection, you must treat it symptomatically, preferably before the age of 40, to avoid chronic gastritis or irreversible atrophic gastritis.

Treating Helicobacter pylori infection can also prevent gastric cancer, because once atrophic gastritis occurs, the stomach wall will become thinner and thinner, causing some memory blocks in the stomach to become mucus-secreting intestinal mucosal goblet cells, which is the intestinal tract The mucosal cells of intestinal metaplasia appear in the stomach wall, which is called intestinal metaplasia. One of them will become gastric cancer. Therefore, if a patient with intestinal metaplasia occurs, a gastroscopy must be done once a year for early detection and early treatment.

There is also a type of hypertrophic gastritis, which is related to the liver. The stomach of patients with liver cirrhosis will be congested and look swollen; and atrophic gastritis is due to the thinning of the stomach wall and the blood vessels become clear.

It is recommended that patients with liver cirrhosis do regular gastroscopy tracking, and pay attention to whether there is esophageal venous aneurysm, because when liver cirrhosis causes portal hypertension, blood will flow back to the gastroesophageal vein, making the veins from the stomach up through the esophagus swell and varicose, like a tumor; esophageal veins When the tumor pressure reaches a certain level, it is likely to rupture and cause bleeding. The mortality rate during bleeding is as high as 30%, and the probability of rebleeding within a year is as high as 70%. Embolizes, shrinks, reduces risk of rupture.

Other upper gastrointestinal diseases may also be detected by gastroscopy

In upper gastrointestinal diseases, early-stage esophageal cancer has almost no symptoms, and endoscopy can detect early changes through narrow-band imaging technology, allowing the resection of local lesions. The risk factors of esophageal cancer are those who have the habit of smoking, drinking and betel nut, so those who have these habits should do gastroscopy as soon as possible.

Gastric submucosal lesions are often found accidentally through gastroscopy. Most patients have no symptoms. Such lesions may be benign or potentially malignant. Generally, the size of 2 cm will be used as the benchmark. A gastroscopy should be performed once a year if the size is less than 2 cm. If it exceeds 2 cm, it is recommended Do further examination by endoscopic ultrasonography. If malignant or high malignant potential lesions are identified, they should undergo endoscopic treatment or surgical resection.