Diagnosis
Gastric outlet obstruction
A clinical syndrome caused by any condition that obstruct the passage of gastric contents through the pylorus into the duodenum.
Also known as: Pyloric obstruction
Etiology
Cause [tsm]
Benign conditions (39%):
Chronic inflammation: Gastritis, ulcer disease (NSAIDs, H. pylori), pancreatitis, Crohn disease, eosinophilic gastroenteritis
Chronic infection: Gastric tuberculosis
Mechanical obstruction: Gastric polyps, gallstone obstruction (Bouveret syndrome), anastomotic stricture, annular pancreas, pancreatic pseudocysts, ,
Pediatric conditions: Pyloric stenosis, congenital duodenal webs, duodenal atresia, bezoar, ingestion of corrosive substances (stricture), gastric volvulus
Motility disorders/gastroparesis: Diabetes mellitus, virus, opiates, anticholinergics, vagus nerve damage due to fundoplication/bariatric procedures, amyloidosis, paraneoplastic/infiltrative process
Malignant conditions (61%):
Disital gastric cancer (35%), pancreatic cancer (20%), gastric lymphoma, ampullary cancer, duodenal cancer, cholangiocarcinoma, GIST, locally advanced gallbladder carcinoma and metastases to the gastric outlet
Pathophysiology [tsm]
Mechanical obstruction: benign or malignant conditions.
Motility disorders
Anatomic classification
Distal stomach
Pyloric channel
Duodenum
Intrinsic vs. Extrinsic
Complications
Malnutrition
Perforation
Epidemiology
Incidence per 100.000 [yfs][h9n][9zw][eb3]
Symptoms & findings
Symptoms
Anorexia, Dehydration, Dry mucous membranes, Flat neck veins, Nausea, Poor skin turgor, Postprandial fullness, Regurgitation, Vomiting, Weight loss
Clinical findings
Alkalosis, Gastrointestinal obstruction, Hypochloremia, Hypokalemia, Metabolic alkalosis
Anamneses
None listed.
Localized findings
Approach
Blood gas
Barium enema
Chest x-ray
Abdominal x-ray
CT abdomen
Gastroscopy
Biopsy
Treatment
Gastric decompression (nasogastric tube) --> reduce symptoms and the risk of aspiration
Treatment of the cause:
Medicine: Treatment of ulcer disease, Crohns disease,
Surgery: [ic3]
Endoscopic resection of polyps
Endoscopic ballon dilatation (and stent placement)
ERCP (stone extraction)
Heineke-Mikulicz pyloroplasty
Decompressive gastrostomy
Antrectomy/distal gastrectomy (Billroth I or II)
Bypass surgery: Gastroduodenostomy, gastrojejunostomy
Endoscopic ultrasound-guided gastroenterostomy
Differential diagnoses
Ampullary carcinoma, Bezoar, Cholangiocarcinoma, Diabetic gastroparesis, Drug side effects, Eosinophilic gastroenteritis, Esophageal hiatal hernia, Gallstone Ileus, Gastric cancer, Gastroesophageal reflux disease, Gastrointestinal obstruction, Intestinal atresia, Ogilvie syndrome, Pancreatic cancer, Pancreatic pseudocyst, Pyloric stenosis, Small bowel cancer, Superior mesenteric artery syndrome, Ulcer disease
References
[1] Goosenberg E, Annamaraju P. Gastric Outlet Obstruction. [Updated 2025 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557826/
[2] Sukumar V, Ravindran C, Prasad RV. Demographic and Etiological Patterns of Gastric Outlet Obstruction in Kerala, South India. N Am J Med Sci. 2015 Sep;7(9):403-6.
[3] Jaka H, Mchembe MD, Rambau PF, Chalya PL. Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases. BMC Surg. 2013 Sep 25;13:41.
[4] Sachin V, S RR, Sunil Kumar V. Spectrum and outcome of gastric outlet obstruction in a tertiary care hospital. International surgery journal. 2018 Oct 26;5(11):3467–7.
[5] Negash S, Jembere T, Abera G, Kedir E, Eshetu B. Gastric outlet obstruction due to peptic ulcer disease in a 5 years-old female child. Case report. June 23, 2022. Int J Surg Case Rep. 2023 Apr;105:108086.
[6] Papanikolaou IS, Siersema PD. Gastric Outlet Obstruction: Current Status and Future Directions. Gut Liver. 2022 Sep 15;16(5):667-675.
[7] http://emedicine.medscape.com/article/190621 (2014-01-02); [Medscape]
[8] Yen JB, Kong MS. Gastric outlet obstruction in pediatric patients. Chang Gung Med J. 2006 Jul-Aug;29(4):401-5.