Gastric Outlet Obstruction

What is gastric outlet obstruction?

Gastric outlet obstruction (GOO) is a condition where something blocks the passage between your stomach and small intestine (pylorus). This blockage prevents food from leaving your stomach and continuing the digestion process.

Your stomach is a muscular sac that breaks down food. Your pylorus acts like a valve at the bottom of your stomach. It controls the release of this mushy mixture into your small intestine for further processing. In GOO, something goes wrong with your pylorus or the surrounding area, causing a blockage and disrupting this flow.

What are the symptoms of gastric outlet obstruction?

Gastric outlet obstruction symptoms may include:

• Nausea
• Vomiting after eating
• Abdominal pain
• Early satiety (you get full before you finish a meal)
• Weight loss

What causes gastric outlet obstruction?

There are several different possible causes of gastric outlet obstruction. Healthcare providers call these “mechanical obstructions.” You can think of a mechanical obstruction like a clogged drain. There’s a physical blockage at the exit of your stomach, like a drain with a big wad of hair stuck in it. Obstructions can be benign (noncancerous) or malignant (cancerous).

Benign mechanical obstructions may include:

• Peptic ulcers. These are open sores that develop on the lining of your stomach or duodenum (the first part of your small intestine). Scarring from healed ulcers can also narrow your pylorus.
• Bezoars. These are hard, compacted masses of hair, food or other indigestible material that can form in your stomach and block your pylorus.
• Pyloric stenosis. This is a narrowing of the pylorus muscle that occurs in some infants, making it difficult for them to feed properly.
• Eosinophilic gastroenteritis. This is a rare inflammatory condition that affects your digestive tract, including your stomach and duodenum. It can cause thickening and narrowing of your pylorus.
• Crohn’s disease. This inflammatory bowel disease can involve your stomach and duodenum. It can cause inflammation and strictures (narrowed sections) that obstruct your pylorus.
• Hiatal hernia. In a large hiatal hernia, part of your stomach pushes up through your diaphragm into your chest cavity. This can sometimes cause kinking or twisting of your stomach, leading to GOO.
• Pancreatitis. Inflammation of your pancreas can cause swelling that compresses your duodenum. This can obstruct your gastric outlet.

Malignant mechanical obstructions may include:

• Stomach cancer. Tumors growing in your stomach can compress your pylorus or surrounding tissues. This can cause obstruction.
• Pancreatic cancer. Tumors in your pancreas can press on your duodenum, blocking the passage from your stomach.
• Gastrointestinal stromal tumors (GISTs). These are rare tumors that can develop in the wall of your stomach or intestines and sometimes cause obstruction.
• Lymphoma. This cancer of the lymphatic system can affect the lymph nodes around your stomach and duodenum, leading to compression and GOO.
• Metastatic cancer. Cancer that has spread from another part of your body to your stomach or surrounding tissues can also cause obstruction.

What are the risk factors for gastric outlet obstruction?

Risk factors for gastric outlet obstruction include:

• H. pylori infection. This bacteria weakens your stomach lining, making it more vulnerable to ulcers that can scar and narrow your pylorus.
• Long-term NSAID use. Using over-the-counter nonsteroidal anti-inflammatory medications can irritate your stomach lining and increase ulcer risk.
• Previous stomach surgery. Scarring from past stomach surgeries can cause narrowing of your pylorus.
• Gastroesophageal reflux disease (GERD). Chronic acid reflux can damage your stomach lining, potentially leading to scar tissue and obstruction.

What are the complications of gastric outlet obstruction?

Chronic gastric outlet obstruction can lead to several complications if left untreated. These include:

• Dehydration. Persistent vomiting can lead to a loss of fluids and electrolytes, causing dehydration.
• Electrolyte imbalance. Loss of electrolytes like sodium and potassium due to vomiting can disrupt muscle and nerve function.
• Malnutrition. If you can’t keep food down, your body won’t get the nutrients it needs, leading to malnutrition and muscle wasting.
• Aspiration pneumonia. You can inhale vomited material into your lungs, causing aspiration pneumonia.

How is gastric outlet obstruction diagnosed?

Diagnosing GOO involves a combination of techniques. Your healthcare provider will perform a physical exam and ask about your symptoms. They may order:

• X-rays. X-rays visualize your stomach and look for signs of obstruction.
• Endoscopy. Your provider inserts a thin, flexible tube with a camera into your stomach to examine your pylorus directly.
• Upper GI series. Your provider takes a series of X-rays after you drink a contrast solution that coats your digestive tract.
• Gastric emptying scan. This test measures how quickly food leaves your stomach.
• CT scan. This scan can provide detailed images of your stomach, duodenum and surrounding organs to identify potential causes of obstruction.

What is the treatment for gastric outlet obstruction?

Gastric outlet obstruction treatment options may include:

• Medications. For peptic ulcer-related GOO, medications that reduce stomach acid production (proton pump inhibitors) can promote healing and relieve obstruction.
• Endoscopic surgery. In some cases, your provider can perform a procedure called pyloroplasty endoscopically.
• Laparoscopic or open surgery. Depending on the cause and severity of GOO, surgery may be necessary. This could involve removing scar tissue, bezoars or a portion of your stomach or duodenum in severe cases.
• Balloon enteroscopy. This technique uses a special balloon catheter to widen your pylorus without open surgery.

Can gastric outlet obstruction be prevented?

Preventing gastric outlet obstruction entirely isn’t always possible, but there are steps you can take to help reduce your risk.

Lifestyle habits

• Quit smoking. Smoking can worsen peptic ulcers and increase the risk of complications like scarring. Quitting smoking is crucial for overall health and digestive well-being.
• Stress management. Chronic stress can worsen digestive issues, so finding healthy ways to manage stress, like exercise, relaxation techniques or meditation, can be beneficial.

Managing underlying conditions

• H. pylori treatment. If you test positive for H. pylori, the bacteria linked to peptic ulcers, getting rid of it with antibiotics can significantly reduce your risk of developing ulcers and potential GOO complications. After treatment, your healthcare provider will order a test to make sure the infection is gone.
• GERD management. People with gastroesophageal reflux disease (GERD) experience chronic acid reflux. This can irritate your stomach lining and contribute to ulcer formation. Following a treatment plan for GERD with medication or lifestyle changes can help prevent complications.

Being proactive

• Regular checkups. Maintaining regular visits with your healthcare provider allows for early detection and treatment of digestive issues that could potentially lead to GOO.
• Safe medication use. Certain medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate your stomach lining and increase your risk of ulcers. Using them carefully and discussing alternatives with your provider is important.

What is the life expectancy of someone with gastric outlet obstruction?

The prognosis for gastric outlet obstruction (GOO) depends on the underlying cause and the severity of the blockage. Early diagnosis and treatment typically lead to good outcomes. However, if left untreated, the condition can lead to serious complications and affect life expectancy.

How do I take care of myself?

Following treatment for gastric outlet obstruction, you might need to make some lifestyle changes, such as:

• Diet modifications. Eating smaller, more frequent meals can help ease the digestive burden on your stomach.
• Stress management. Stress can worsen symptoms of some digestive conditions. Relaxation techniques can be helpful.

What foods should you avoid with gastric outlet obstruction?

If you have gastric outlet obstruction, you should avoid raw fruits, vegetables and whole grains, as it’s harder to get them past the obstruction. Limiting spicy, greasy and acidic foods that can irritate your stomach lining might also be helpful.

When should I see my healthcare provider?

If you experience persistent symptoms like nausea, vomiting or abdominal pain, visiting a healthcare provider is important to determine the cause and prevent complications.

Remember, early diagnosis and treatment of underlying conditions can significantly reduce the risk of GOO and improve your overall digestive health.

What questions should I ask my healthcare provider?

If you have gastric outlet obstruction, there are many questions you may want to ask your healthcare provider, including:

• What’s the most likely cause of my GOO?
• How severe is the blockage?
• What treatment options are available?
• What are the benefits and risks of my treatment options?
• What’s the outlook for my condition?
• Will I need to make any dietary changes after treatment?

What is the difference between gastric outlet obstruction and gastroparesis?

Both gastric outlet obstruction (GOO) and gastroparesis can cause problems with emptying your stomach. But they have different underlying causes and mechanisms.

You can think of gastric outlet obstruction like a clogged drain. This blockage prevents food from leaving your stomach and continuing its digestive journey.

Unlike GOO, gastroparesis isn’t a physical blockage. Instead, the muscles in your stomach wall that normally help push food out become weak or paralyzed. This delays the emptying of food from your stomach.