Gastric pyloric stenosis or pyloric stenosis is a thickening of the passageway from the stomach to the duodenum. It prevents the passage of food and causes gushing vomiting. Pyloric stenosis must be treated or it can cause a life-threatening condition.
What is pyloric stenosis?
Gastric pyloric stenosis (medical term: pyloric stenosis) is a thickening at the exit of the stomach. The gastric portal (pylorus) is a muscle that can close and open by contracting and relaxing like a ring, due to fibers that are arranged in a circular pattern. The pylorus separates the stomach from the duodenum. If the pylorus is thickened, it can no longer be opened wide enough to allow the food pulp to pass into the intestine. This causes the digested food to remain in the stomach, where it begins to ferment and putrefaction processes begin. Gastric pylorus stenosis is common in infants from two to eight weeks of age, with boys affected more often than girls. Adults can also develop gastric pylorus stenosis, usually as a result of scarring after healed stomach or intestinal ulcers.
Causes
The exact cause of gastric portal stenosis is not known. The condition is thought to be genetic in infants because it runs in families. This means that in a family in which one parent already had gastric portal stenosis, the offspring are often affected as well. If gastric pyloric stenosis occurs in adults, the cause is often scarring of the pylorus. These sometimes develop after ulcers in the stomach or duodenum. If they have been near the gastric portal, scars may form on the pylorus during the healing phase. They thicken the sphincter muscle and gastric pyloric stenosis develops. Another possible cause of gastric portal stricture is the development of tissue overgrowth directly at the stomach outlet.
Symptoms, complaints, and signs
A typical symptom of pyloric stenosis is gushing vomiting shortly after eating a meal. This may involve repeated vomiting that occurs at short intervals. Usually, the odor of the stomach contents is strongly acidic. If the stomach is already irritated, isolated traces of blood may be present in the vomit. Because the stomach outlet is often thickened in pyloric stenosis, it can be clearly palpated through the abdominal wall. Also, the stomach muscles can occasionally be seen to contract, which can be observed as a wave-like movement of the abdomen. Since fluids are excreted with the vomit in addition to food, the children quickly suffer from deficiency symptoms. They lose weight and are very thirsty, which manifests itself in downright greedy drinking. However, since they do not retain the fluid, over time they develop the typical signs of dehydration, such as dark circles under the eyes, dry mucous membranes and so-called standing skin folds. The latter are wrinkles of the skin pulled with the fingers, which remain standing when they are released. Furthermore, there is severe pain in the upper abdomen. Sometimes jaundice may occur, which is accompanied by yellowing of the skin and the originally white sclera of the eyes. All symptoms lead to total exhaustion over time and require urgent medical attention.
Diagnosis and course
Infographic of the anatomy and structure of the stomach with gastric ulcer. Click to enlarge. The typical symptom of gastric portal obstruction in infants is gushing vomiting about 30 minutes after eating. The odor of the vomit is strongly acidic and sometimes thin threads of blood are visible. Occasionally, the undulating movements of the stomach can be seen through the abdominal wall as it tries to empty itself through muscle contractions. The children feel uncomfortable and have abdominal pain. Because vomiting interferes with food and fluid intake, the child loses weight and, as it progresses, shows signs of dehydration (desiccosis), such as dry mucous membranes, a sunken fontanel (soft spot on the top of the head), and dark circles under the eyes. Adults with gastric portal obstruction feel thirsty and suffer from a feeling of fullness, they have to burp sourly and, as in children, gushing vomiting occurs. The doctor makes the diagnosis based on the symptoms and medical history.With the aid of an ultrasound examination, he can detect whether there is a gastric orifice stenosis, as the thickened sphincter muscle is visible in the ultrasound. A blood test will clarify whether a deficiency of vital electrolytes and minerals has already occurred due to the lack of fluid.
Complications
In the worst case, pyloric stenosis can lead to the death of the affected person. However, this case usually occurs when treatment is not initiated. Patients suffer from permanent vomiting due to the thickening. Not infrequently, depression or irritability of the affected person also occurs. Pain in the abdomen and stomach area can also occur and significantly reduce the patient’s quality of life. Vomiting occurs mainly after the ingestion of food. Persistent vomiting inevitably leads to severe weight loss of the affected person. In young children, crying often occurs due to the pain, so that the child’s parents and relatives are also usually stressed and irritated. Increased thirst and a strong feeling of fullness can also occur due to pyloric stenosis. Weight loss also causes various deficiency symptoms, which have a very negative impact on the patient’s health. The disease is usually treated without complications by surgical intervention. The symptoms disappear completely and do not reappear. The patient’s life expectancy is also not limited.
Treatment and therapy
Gastric portal stenosis is usually treated surgically. Conservative therapy, that is, non-surgical treatment, can be used only for very mild stenosis. It consists of feeding the patient food only in very small portions and administering medications that cause relaxation of the muscles. This therapy is very long and usually does not bring the desired success. In most cases, surgery is performed, but this is possible only after the patient has been stabilized by the administration of electrolytes and liquid nutrition. In a surgical procedure called pyloromyotomy (myo= muscle, tomie= incision), the ring-shaped muscle of the gastric portal is divided with an incision and pulled open. This increases the diameter of the passage. The operation can be performed with an abdominal incision (laparotomy) or by laparoscopy. In laparotomy, the abdominal wall is opened to get to the gastric portal. In laparoscopy, only three small incisions are made in the abdomen through which a camera and the surgical instruments are inserted to the gastric portal. After the gastric portal stenosis surgery is performed, it is possible to resume solid food after only a few days.
Prevention
Gastric portal stenosis cannot be prevented because it is either congenital or results from scarring. It is important to seek medical attention immediately if gastric portal stenosis is suspected, as the condition can lead to a life-threatening condition if not treated.
Follow-up
Follow-up treatments and any follow-up examinations depend on the treatment method used. Most cases involve infants who are treated surgically-for example, in a laparoscopic procedure. Infants usually recover very quickly from the procedure, so that a gradual build-up of feeding can soon take place postoperatively. The symptoms observed before surgery disappear quickly and there is no risk of recurrence, i.e. recurrence of pyloric stenosis. Therefore, there are no pronounced recommendations for aftercare. If the typical symptoms recur, these should be taken as an opportunity to have more detailed examinations performed. In less severe cases where surgical treatment is not indicated, the present symptoms suggestive of pyloric stenosis should be followed closely. In the very rare cases where surgical treatment is urgently indicated but not possible due to other conditions, the only remaining option is a jejunal feeding tube. It opens directly into the small intestine, bypassing the gastric portal (pylorus). In these cases, follow-up care expands to permanent care as long as the treatment of the secondary disease lasts, which prevents the primary surgical intervention.
