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==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The [[incidence]] of [[peptic ulcer]] disease (which is the most common benign cause of GOO) is approximately 10-19 per 100,000 individuals worldwide.<ref name="pmid19220208">{{cite journal |vauthors=Sung JJ, Kuipers EJ, El-Serag HB |title=Systematic review: the global incidence and prevalence of peptic ulcer disease |journal=Aliment. Pharmacol. Ther. |volume=29 |issue=9 |pages=938–46 |year=2009 |pmid=19220208 |doi=10.1111/j.1365-2036.2009.03960.x |url=}}</ref>
The epidemiology of GOO is as follows:<ref name="pmid21626606">{{cite journal |vauthors=Lin KJ, García Rodríguez LA, Hernández-Díaz S |title=Systematic review of peptic ulcer disease incidence rates: do studies without validation provide reliable estimates? |journal=Pharmacoepidemiol Drug Saf |volume=20 |issue=7 |pages=718–28 |year=2011 |pmid=21626606 |doi=10.1002/pds.2153 |url=}}</ref><ref name="pmid19220208">{{cite journal |vauthors=Sung JJ, Kuipers EJ, El-Serag HB |title=Systematic review: the global incidence and prevalence of peptic ulcer disease |journal=Aliment. Pharmacol. Ther. |volume=29 |issue=9 |pages=938–46 |year=2009 |pmid=19220208 |doi=10.1111/j.1365-2036.2009.03960.x |url=}}</ref>
* The [[incidence]] of [[peptic ulcer]] disease (which is the most common benign cause of GOO) is approximately 10-19 per 100,000 individuals worldwide.
* Five percent of all cases of [[Peptic ulcer|peptic ulcer disease]] worldwide, develop gastric outlet obstruction.
* Five percent of all cases of [[Peptic ulcer|peptic ulcer disease]] worldwide, develop gastric outlet obstruction.
* The [[incidence]] of gastric outlet obstruction is less than 5 per 100,000 [[Patient|patients]] worldwide.
* The [[incidence]] of gastric outlet obstruction is less than 5 per 100,000 [[Patient|patients]] worldwide.

Revision as of 21:18, 26 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Overview

GASTRIC OUTLET OBSTRUCTION: Pyloric obstruction

Historical Perspective

Classification

Pathophysiology

Gastric Outlet Obstruction (GOO) may be caused by intrinsic or extrinsic pathologies that involve the antrum and the pylorus.

Causes

Causes of GOO may be classified as benign and malignant.

Benign causes

Acquired causes of gastric outlet obstruction include:[1][2][3][4]

Congenital causes of gastric outlet obstruction include:[38][39]

Malignant causes

Differentiating Gastric outlet obstruction from Other Diseases

Differential Diagnosis
Disease Cause Symptoms Diagnosis Other findings
Pain Nausea & Vomiting Heartburn Belching or Bloating Weight loss Loss of Appetite Stools Endoscopy findings
Location Aggravating Factors Alleviating Factors
Gastric outlet obstruction (GOO) Epigastric pain Food - Black stools in case of Peptic Ulcer Disease(PUD)

Sodium chloride load test

Needle-guided biopsy

Acute gastritis Food Antacids - Black stools -
Chronic gastritis Food Antacids - H. pylori gastritis

Lymphocytic gastritis

  • Enlarged folds
  • Aphthoid erosions
-
Atrophic gastritis - - - - H. pylori

Autoimmune

Crohn's disease - - - - -
  • Mucosal nodularity with cobblestoning
  • Multiple aphthous ulcers
  • Linier or serpiginous ulcerations
  • Thickened antral folds
  • Antral narrowing
  • Hypoperistalsis
  • Duodenal strictures
GERD
  • Spicy food
  • Tight fitting clothing

(Suspect delayed gastric emptying)

- - - - Other symptoms:

Complications

Peptic ulcer disease

Duodenal ulcer

  • Pain aggravates with empty stomach

Gastric ulcer

  • Pain aggravates with food
  • Pain alleviates with food
- - - Gastric ulcers
  • Discrete mucosal lesions with a punched-out smooth ulcer base with whitish fibrinoid base
  • Most ulcers are at the junction of fundus and antrum
  • 0.5-2.5cm

Duodenal ulcers

Other diagnostic tests
Gastrinoma - -

(suspect gastric outlet obstruction)

- - - Useful in collecting the tissue for biopsy

Diagnostic tests

Gastric Adenocarcinoma - - Esophagogastroduodenoscopy
  • Multiple biopsies are taken to establish the diagnosis
Other symptoms
Primary gastric lymphoma - - - - - - - Useful in collecting the tissue for biopsy Other symptoms

Epidemiology and Demographics

The epidemiology of GOO is as follows:[58][59]

Risk Factors

Screening

There is no screening available for gastric outlet obstruction.

Diagnosis

History and Symptoms

The following history is relevant in patients with GOO:[60][61]

Clinical presentation:

Early stages:[5][41]

Late stages:[44][43][62][63]

Physical Examination

In the late stages of GOO, patients may develop signs of malnutrition and incomplete obstruction.

Laboratory Findings

Imaging Findings

Imaging studies such as plain radiographs, contrast upper gastrointestinal (GI) studies and Computed Tomography (CT) with oral contrast may be used for evaluating patients with symptoms of GOO.

Plain radiographs

Contrast upper gastrointestinal (GI) studies (Gastrografin or barium)

Computed tomography (CT) with oral contrast

Other Diagnostic Studies

Endoscopy

Sodium chloride load test

Needle-guided biopsy

Treatment

Medical Therapy

Surgery

Surgery is the primary modality of treatment for patients with GOO. It is required for more than 75 percent of patients, with scarring, fibrosis and tumors. The aims of surgery in case of GOO include:

  • Relief of obstruction
  • Relief in patients with failure to respond to medical therapy or failure to improve even after 72 hours of therapy
  • Correction of PUD symptoms

Preoperative evaluation

Guidelines for surgery

Types of surgical procedures

The types of surgical procedures performed in cases of GOO are as follows:[29][92][93][94][95][96][97]

Contraindications to surgery

Complications of surgery

Complications arising after surgery include:[119][120]

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