GASTRIC OUTLET OBSTRUCTION

SYMPTOMS

The symptoms of gastric outlet obstruction may include:

• Nausea and Vomiting: Persistent nausea and vomiting, which may be projectile and occur shortly after eating.
• Abdominal Pain: Dull, aching abdominal pain, typically located in the upper abdomen, often worsened by eating and relieved by vomiting.
• Early Satiety: Feeling full quickly during meals (early satiety) due to impaired emptying of stomach contents.
• Weight Loss: Unintentional weight loss due to decreased food intake and impaired digestion.
• Dehydration and Malnutrition: Chronic vomiting and inadequate nutrient absorption can lead to dehydration, electrolyte imbalances, and malnutrition.

DIAGNOSIS

Diagnosing gastric outlet obstruction involves a combination of clinical evaluation, imaging studies, and sometimes endoscopic procedures. Diagnostic steps may include:

• Medical History and Physical Examination: A thorough history of symptoms, dietary habits, and medical conditions, along with a physical examination to assess for signs of obstruction.
• Imaging Studies: Imaging modalities such as abdominal ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) may be used to visualize the stomach and identify any structural abnormalities or signs of obstruction.
• Upper Endoscopy (Esophagogastroduodenoscopy, EGD): A flexible, lighted scope (endoscope) is passed through the mouth and into the stomach and duodenum to directly visualize the area of obstruction, obtain tissue samples for biopsy, and assess for underlying causes such as tumors or ulcers.
• Barium Swallow: In some cases, a barium swallow study may be performed to evaluate the anatomy and function of the upper gastrointestinal tract, including the stomach and duodenum.

TREATMENT

Treatment of gastric outlet obstruction aims to relieve the obstruction, alleviate symptoms, and address any underlying causes. Treatment options may include:

• Medical Management: In cases of acute obstruction or exacerbation of chronic obstruction, initial management may involve fasting, intravenous fluids, and antiemetic medications to control nausea and vomiting.
• Endoscopic Therapy: Endoscopic procedures such as balloon dilation or stent placement may be performed to mechanically widen the narrowed or obstructed area and restore patency of the gastric outlet.
• Surgery: Surgical intervention may be necessary for cases of severe or refractory obstruction, complications such as perforation or bleeding, or when endoscopic therapy is not feasible. Surgical options may include pyloroplasty (widening of the pyloric sphincter), partial gastrectomy, or tumor resection.
• Nutritional Support: In cases of chronic obstruction leading to malnutrition or weight loss, nutritional support with oral supplements, enteral feeding, or total parenteral nutrition (TPN) may be necessary to maintain adequate nutrition and hydration.