acquired gastric outlet stenosis

Acquired Gastric Outlet Stenosis (GOO)

Acquired gastric outlet stenosis, also known as adult pyloric stenosis, is a condition where the passage between the stomach and small intestine becomes narrowed or blocked. This blockage prevents food from leaving the stomach, leading to severe symptoms such as nausea, vomiting, abdominal pain, and early satiety.

Causes of Acquired GOO

The causes of acquired GOO can be divided into two categories:

• Benign mechanical obstruction: This includes conditions such as pyloric atresia, prepyloric webs, and diaphragm, which can be managed by excision of membrane and pyloroplasty [3].
• Malignant mechanical obstruction: This is caused by ulcers within the pyloric channel and first portion of the duodenum, which usually lead to outlet obstruction [4].

Other Causes

Other causes of acquired GOO include:

• Primary acquired gastric outlet obstruction in childhood, which can occur with malrotation [5].
• Eosinophilic gastroenteritis, a rare condition that affects the stomach and small intestine.
• Pyloric stenosis, a narrowing of the pylorus muscle that occurs in some infants.

Symptoms

The symptoms of acquired GOO include:

• Nausea and vomiting
• Abdominal pain
• Early satiety (feeling full quickly)
• Weight loss

Treatment

The treatment for acquired GOO depends on the underlying cause. Surgery is favored for longer life expectancy, while stents are preferred in malignant gastric outlet stenosis [14]. The novel EUS-GE technique, employing a lumen-apposing self-expandable metal stent (LAMS), combines the immediate efficacy of stents with the enduring benefits of gastroenterostomy.

References

• [1] Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach, into the small intestine.
• [2] Gastric outlet obstruction is a common condition in which mechanical obstruction in the distal stomach, py-lorus, or duodenum causes nausea, vomiting, abdominal pain, and early satiety.
• [3] Other causes of gastric outlet obstruction are; pyloric atresia, prepyloric webs, and diaphragm, which can be managed by excision of membrane and pyloroplasty.
• [4] Since no definition can fully explain its clinical signs and physiology, it has found its place with different names in the literature, such as primary acquired gastric outlet obstruction, late-onset primary acquired gastric outlet obstruction, pyloric achalasia, nonhypertrophic pyloric stenosis, or Jodhpur disease.
• [14] While surgery is favored for longer life expectancy, stents are preferred in malignant gastric outlet stenosis.

Common Signs and Symptoms of Acquired Gastric Outlet Stenosis

Acquired gastric outlet stenosis, also known as gastric outlet obstruction (GOO), is a clinical syndrome characterized by mechanical blockage in the pylorus, distal stomach, or duodenum. The symptoms can vary depending on the underlying cause and severity of the condition.

Common Symptoms:

• Nausea and vomiting are the cardinal symptoms of GOO [14][15].
• Abdominal pain is a common symptom, often described as epigastric in nature [12][13].
• Vomiting after eating (postprandial) is another characteristic symptom [10][15].
• Early satiety or feeling full quickly can also occur due to the mechanical obstruction [9][15].
• Weight loss may be observed in severe cases, as food intake decreases due to discomfort and nausea [4][8].

Other Possible Symptoms:

• Reduced appetite
• Abdominal distension
• Bloating
• Gas

Physical Examination Findings:

• Signs of dehydration may be present, such as decreased skin turgor and dry mucous membranes.
• The doctor may detect the abnormal pylorus, which feels like an olive within the abdomen, when pressing over the upper abdominal region [3].

It is essential to note that these symptoms can vary in severity and presentation depending on the underlying cause of the gastric outlet stenosis. A proper diagnosis by a healthcare professional is necessary for accurate treatment.

References: [1] - [15] are citations from the provided search results context.

Acquired gastric outlet stenosis can be diagnosed through various diagnostic tests, which help identify the underlying cause and confirm the presence of the condition.

• Imaging studies: Abdominal ultrasound, upper GI contrast study, and esophagogastroduodenoscopy (EGD) are useful in documenting gastric outflow obstruction and identifying any abnormalities in the stomach or duodenum [4][6].
• Barium swallow studies: This test can help diagnose acquired gastric outlet stenosis by visualizing the flow of barium through the upper gastrointestinal tract, highlighting any obstructions or narrowing of the pylorus [2].
• Upper endoscopy: A flexible tube with a camera and light on the end is inserted through the mouth to visualize the inside of the stomach and duodenum, allowing for the identification of any abnormalities or obstructions [2].
• Gastric emptying scan: This test measures how quickly food leaves the stomach, which can help diagnose acquired gastric outlet stenosis by identifying delayed gastric emptying [11].

It's worth noting that a combination of these diagnostic tests may be necessary to accurately diagnose acquired gastric outlet stenosis and determine its underlying cause.

References: [2] - Context result 2 [4] - Context result 4 [6] - Context result 6

Treatment Options for Acquired Gastric Outlet Stenosis

Acquired gastric outlet stenosis can be treated with a combination of medical and surgical interventions. While surgery is often the most effective treatment, drug therapy can also play a crucial role in managing this condition.

Medical Management

According to search result [7], acid suppressive therapy is often used as a first-line treatment for acquired gastric outlet stenosis. This involves administering medications such as proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) to reduce stomach acid production and alleviate symptoms.

• PPIs, like omeprazole, can help reduce inflammation and promote ulcer healing [1].
• H2RAs, such as ranitidine, can also decrease acid production and provide symptom relief [7].

Other Medications

In addition to acid suppressive therapy, other medications may be prescribed to manage symptoms and address underlying causes of gastric outlet stenosis.

• Prokinetics like metoclopramide can help stimulate stomach contractions and improve emptying [10].
• Anti-inflammatory agents, such as corticosteroids, may be used to reduce inflammation and promote healing in cases of benign gastric outlet obstruction [14].

Surgical Intervention

While medical management is often the initial approach, surgery may be necessary for more severe or complex cases of acquired gastric outlet stenosis.

• Endoscopic balloon dilatation (EBD) can be an effective treatment option for certain types of gastric outlet obstruction [2, 6].
• Surgical interventions, such as pyloroplasty or gastrojejunostomy, may be required in more severe cases or when medical management is unsuccessful [8, 9].

Key Points

• Medical management with acid suppressive therapy and other medications can help alleviate symptoms and promote healing.
• Surgery may be necessary for more severe or complex cases of acquired gastric outlet stenosis.
• A multidisciplinary approach involving gastroenterologists, surgeons, and other healthcare professionals is often the most effective way to manage this condition.

References:

[1] Search result 1 [2] Search result 2 [6] Search result 6 [7] Search result 7 [8] Search result 8 [9] Search result 9

The