What’s gastric outlet obstruction?

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Gastric outlet obstruction occurs when the outlet from the stomach to the small intestine is blocked, causing vomiting and malnutrition. Causes include benign and malignant conditions, with treatment depending on the underlying cause. Diagnosis is made through x-rays and fluid level checks, and treatment may include expanding devices, surgery, and antibiotics. Recurrent cases may require continued monitoring and surgery.

Gastric outlet obstruction refers to a condition in which the outlet to the stomach into the small intestine is blocked. This often causes someone to fill up quickly as there is nowhere to go for food. As a result, vomiting and, in severe cases, malnutrition can occur. There are various causes for gastric outlet obstruction, both benign and malignant, and treatment will depend on which underlying cause is to blame.

Benign gastric outlet obstruction can be caused by conditions such as peptic ulcer disease. This condition is usually treatable, although it can be very painful. Symptoms may include abdominal pain or burning related to the ulcer and a feeling of fullness, bloating, and vomiting due to the resulting blockage. Treatment may include the use of expanding devices that open the exit to the small intestine. Expansion can be accomplished using balloons or self-expanding stents. In many cases the only treatment needed will include aspiration of fluid from the stomach along with injections of electrolytes and other fluids that may be needed.

Malignant causes of gastric outlet obstruction are related to various types of stomach cancer. In this case a tumor often blocks the exit. Surgery will likely be needed to remove the tumor, and additional treatments for the remaining cancer will usually be done as well. This can include radiation and chemotherapy. While surgery can usually remove the blockage, the underlying cancer may not always be curable.

In some cases, an infection, such as tuberculosis, may cause gastric outlet obstruction. This can be treated with both expanding devices and antibiotics to kill the underlying infection. Some infectious diseases are more difficult to treat than others, so symptoms will likely be relieved before the infection clears to make the patient more comfortable.

Diagnosis is usually made by taking x-rays and checking fluid levels. More tests may be needed to determine the underlying cause. Once the diagnosis has been made and a cause has been discovered, treatment can begin to correct the condition and relieve symptoms. In some serious circumstances, treating the underlying cause may not be feasible before symptoms have been managed. Cancer, for example, needs to be treated over a long period of time. The blockage must be removed so that the current treatment can begin.

Some patients may have recurrent gastric outlet obstruction problems, mainly those with peptic ulcer disease. Continued monitoring and treatments may be needed to prevent the condition from causing weight loss, malnutrition, and damage to the esophagus from frequent vomiting. In some very severe cases, surgery may be required in a non-malignant case to open the passage to the intestine or create a new one.

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