Diagnosis
To diagnose inflammation of the stomach lining, the doctor will first start with a detailed medical history and physical examination to get an overview of the symptoms. One way of clarification is endoscopic gastroscopy (gastroscopy), where the doctor can assess the stomach mucosa under visual inspection and there is the possibility of taking a mucosa biopsy. In acute gastritis, the gastroscopy reveals a reddened mucous membrane and minor bleeding, but in most cases the gastroscopy is not necessary to diagnose acute gastritis.
If alarming symptoms such as weight loss, performance slump, difficulty swallowing, blood in the vomit or stool, fever or anemia are noticed during consultation with the doctor or during the physical examination, a gastroscopy with biopsy taking and an examination for Helicobacter pylori should be performed in any case. In gastroscopy, the location and type of mucous membrane damage provides an indication of the type of inflammation present. There are several ways to detect Helicobacter pylori: The 13C-urea breath test is used both for non-invasive screening and for monitoring the success of antibiotic therapy.
It has a high sensitivity (over 95%). In this test the patient is given 13C-labelled urea in a drinking solution. If the stomach of the patient is colonized with Helicobacter pylori, the urease of the bacterium splits this urea into ammonia and into 13C-labelled carbon dioxide.
The amount of 13C-labelled carbon dioxide in the exhaled air is measured. If the stomach of the patient is not colonized with Helicobacter pylori, the test is negative and no 13C-labelled carbon dioxide is found in the exhaled air.To test tissue samples from a biopsy for Helicobacter pylori, the CLO rapid test (Campylobacter line organism test) is performed. The tissue sample is placed in a pH-sensitive solution, which changes color when the pH value changes.
Since Helicobacter pylori produces alkaline ammonia, infected tissue will show a change in pH and thus a color change, which indicates Helicobacter infection with high sensitivity. Further possibilities are the detection of the bacterium in stool or the detection of antibodies in blood. The diagnostic gold standard of Helicobacter detection is microscopic examination after special staining to make the bacterium visible. In order to avoid false negative test results in the detection of Helicobacter pylori, it is important to discontinue therapy with proton pump inhibitors several days before the diagnosis is made. If type A gastritis is suspected, autoantibodies against supporting cells and/or the intrinsic factor and a low vitamin B-12 concentration in the blood can be detected.
