Cicatricial pyloric stenosis. Symptoms of pyloric stenosis and its treatment

Pyloric stenosis is a narrowing of the pylorus, which leads to disruption of the normal process of food movement through the gastrointestinal tract. The pylorus is the part of the organ that connects the stomach and duodenum. Its purpose is to retain food in the stomach for a short time, during which the effect on it occurs digestive enzymes stomach.

If the pylorus is more narrowed physiological norm, this makes it difficult for food to enter the intestines, which in turn leads to severe disorders normal functioning of the body. The cause of stenosis is often.

Causes of the disease

Gastric pyloric stenosis is an acquired disease that most often develops in adults against the background of gastric pathologies, which primarily include ulcers. However, in some cases, pyloric insufficiency may be congenital. Congenital stenosis is caused by the fact that the baby’s connective tissue grows in the area of the pylorus, which blocks the lumen of the gastrointestinal tract. This disease is hereditary character and most often affects boys.

The most common cause of acquired stenosis is a stomach ulcer. When the ulcer heals, it forms scar tissue. This scar is made of rigid connective tissue that is unable to stretch. Thus, the elasticity of the stomach walls decreases. The same scar can block the pyloric lumen.

Another cause of stenosis is intramural. Malignant neoplasm grows into the tissue of the stomach walls, which leads to a narrowing of the pyloric lumen.

Symptoms of the disease

Congenital pyloric stenosis manifests itself already in the first month of a child’s life. Due to the fact that the pyloric lumen closes, food cannot enter the intestine. As a result, the baby vomits profusely some time after feeding.

If stenosis develops in an adult, the following symptoms appear:

nausea and vomiting;
belching with sour taste;
painful sensations in the stomach;
over time, exhaustion and dehydration increase.

It should be remembered that a stomach ulcer manifests itself with similar symptoms, so in people who suffer from this disease, stenosis may for a long time not to be diagnosed. Therefore, it is important for such patients to undergo regular examinations.

Stages of the disease

In its development, stenosis goes through three stages:

Stage I – full compensation. The pyloric lumen narrows slightly, food can pass into the intestine. The patient experiences the first symptoms of the disease: belching, which often has a sour attack, a feeling of heaviness in the stomach after eating, and sometimes vomiting. After vomiting, the patient feels better.
Stage II – partial compensation. The pyloric lumen narrows even more, the patient's symptoms worsen: a feeling of fullness in the stomach accompanies the person constantly and is accompanied by pain, and belching with a sour taste often occurs. Some time after eating, a person vomits, after which he feels better. Due to the fact that not enough food enters the intestines, the patient begins to develop anemia and loses weight.
Stage III – decompensation. The pylorus narrows or closes as much as possible. The patient's condition worsens, unpleasant symptoms increase. The stomach is distended, and fermentation of stagnant food occurs in it. Dehydration and exhaustion of the body occurs. The patient often vomits profusely. Vomit has a strong, unpleasant odor.

Treatment of the disease

If pyloric stenosis is congenital and develops in a newborn, traditional medicine recommends surgical treatment. The operation is often indicated for adult patients.

There are also non-surgical treatments for stenosis. In this condition, the patient is prescribed a strict diet. It is also important to reduce secretion gastric juice.

Treatment of pyloric stenosis should include therapy for peptic ulcer disease. The faster the ulcer is healed, the faster the normal elasticity of the stomach walls will be restored.

Diet for stenosis

For stenosis treatment to be effective, it is important to follow a diet and eat right. Gastric ulcers and stenosis require the same approach to proper nutrition.

If you have pyloric stenosis, you need to eat frequently 5–6 times a day. Portions should be small.
It's better to eat fresh food homemade. Food should be warm, since too hot and cold foods irritate the walls of the stomach.
You need to eat mostly liquid: liquid pureed vegetable soups and porridges.
It is better to avoid fresh vegetables and fruits, as they stimulate food fermentation in the stomach.
Fruits and vegetables can be baked or boiled and mashed.
It is necessary to exclude fatty meat and fish and broths made from them, and baked goods from the diet.
Food should be fresh; you should not eat spicy, salty or smoked foods, as they stimulate the secretion of gastric juice.
It is useful in this state to drink freshly squeezed vegetable juices, tea and herbal infusions. Coffee and cocoa must be excluded.

Traditional treatment

Treatment with traditional methods will alleviate the patient’s condition and reduce the manifestations of unpleasant symptoms diseases.

Forecast and prevention of the disease

Gastric ulcer is the most common cause of pyloric stenosis. The main prevention of the disease is timely detection and treatment of gastric ulcers. In this case, it is possible to minimize the formation of scar tissue and prevent stenosis.

The prognosis of the disease is favorable. If you have a stomach ulcer or other pathological conditions no longer bothers the patient, the disease can be effectively stopped, and the symptoms of stenosis disappear. The disease is rarely recurrent.

Write in the comments about your experience in treating diseases, help other readers of the site!
Share the material on social networks and help your friends and family!

Pyloric stenosis is stenosis of the pylorus. This disease is considered one of the acquired complications of peptic ulcer disease. It is expressed in a decrease in the lumen at the time of transition from the stomach to. This significantly complicates the movement of food through the digestive tract. This condition leads to changes in homeostasis. It occurs almost only in the adult population.

Pyloric stenosis is a pathological condition

The main cause is considered to be a scar that appears after the ulcerative surface has healed. Such scars consist of connective tissue; they greatly reduce the mobility of the stomach wall, as they tighten it. Stenosis also occurs as a result of growth inside the stomach wall.

As a result, food stagnates in the stomach. After all, it cannot fully move through the digestive tract. In order to somehow remove food from the stomach, the body provokes the growth of muscle tissue. This leads to compensation for the condition of stenosis.

But the hypertrophied layer of the stomach is also unable to cope with the existing loads. Therefore, the stomach gradually stretches due to the significant volume of stomach contents. The accumulated food still stagnates. Multiplying microbes provoke active fermentation and decomposition.

Main stages of the disease

The first stage is compensated pyloric stenosis. The passage is slightly narrowed. The patient feels a feeling of heaviness and fullness in the stomach after eating. A sour belch appears. Vomiting makes you feel better for a short period of time. The condition can be called satisfactory.

The second stage is the stage of subcompensation. An unpleasant feeling of fullness in the stomach is accompanied by pain, heaviness, and belching. Vomiting can even occur while eating. After vomiting, the person feels a little better. After some time, the person loses weight significantly.

If you palpate the abdomen, you can feel a splash in the navel area.

The third stage is the stage of decompensation. At this stage, the stomach stretches, and exhaustion only intensifies. Added to this is dehydration. does not provide adequate relief. The vomit contains remnants of food eaten many days ago. Therefore, the contents of the vomit emit a terrible smell.

Methods for diagnosing “pyloric stenosis”

Several methods are used for an accurate diagnosis:

X-ray image (they look to see if the stomach is enlarged, if the canal is narrowed, if peristaltic activity is reduced, how long it takes for food to be evacuated from the stomach);
(makes it possible to find out whether the stomach is narrowed or dilated, or whether there is deformation);
ultrasound (you can see an enlarged stomach only in the later stages);
electrogastroenterography- studying motor function(analyzes tone, stomach contractions, electrical activity).

This disease can only be treated surgically. Medicines should affect the body in two directions:

treat the disease by correcting the condition;
prepare the body for surgery.

To alleviate the condition, use antiulcer drugs. In treatment, drugs are used whose action is directed against metabolic disorders. They also restore body weight. Prevention of pyloric stenosis comes down to timely treatment of peptic ulcer under the supervision of a specialist.

Congenital pyloric stenosis

Symptoms of pyloric stenosis - characteristic

In children, this disease is exclusively congenital. Its hereditary nature is often determined. IN in this case connective tissue grows in the excretory region. Boys are susceptible to this pathology four times more often than girls.

This disorder is the main cause of gastric obstruction in infancy. The disease makes itself felt very early, literally in the second to fourth weeks. Attracts attention severe vomiting. Such fountain vomiting happens very often. If the operation is performed on time, everything ends well. Therefore, an accurate and correct diagnosis is of great importance.

Causes of development of esophageal stenosis

The cause of this disease is a developmental defect in the prenatal state. This pathology can be noticed already from the first days of a newborn’s life. The baby spits up milk quite persistently. If the stenosis is small, then it may not be noticed during the breastfeeding stage, but when solid food begins to be introduced, it makes itself felt.

If the stenosis is acquired, it is also characterized by a narrowing of the lumen. Obstruction of the esophagus is associated with one of the following reasons:

the presence of scars that appeared as a result of diseases such as peptic ulcer, gastroesophageal reflux disease, infectious and inflammatory lesions of the stomach;
traumatic lesions of the esophagus, burns;
neoplasms of the esophagus or adjacent tissues;
enlarged lymph nodes, aortic aneurysm, incorrect location vessels.

Signs of esophageal stenosis

There are several signs by which esophageal stenosis can be diagnosed, these traditionally include the following:

unpleasant pain when eating, and the pain is felt as the food moves in the esophagus;
salivation is constantly observed;
, often there is vomiting and belching.

There are several degrees of damage to esophageal stenosis:

First degree. Problems arise from time to time when swallowing solid foods. In general, the condition is satisfactory.
Second degree. Food can pass through the esophagus only in semi-liquid form.
Third degree. Only liquid food can pass through the esophagus.
Fourth degree. It is very difficult to swallow even saliva and water.

Diagnosis methods

To make a diagnosis, it is necessary to conduct some studies, these include the following:

X-ray examination (barium suspension is added);
esophagoscopy.

Treatment in the early stages is conservative and boils down to nutritional control. Patients also take prescribed medications. In later stages - only surgery. During the operation, the scars are cut, the esophagus is brought into the appropriate shape, and a gastrostomy tube is placed.

Reflection of the disease in the picture of laboratory data and ECG

In a general blood test, anemia (normochromic or hypochromic) may be observed. This is due to the depletion of the body’s intake of various nutrients and valuable substances, especially iron. The number of red blood cells increases when repeated vomiting occurs and the body becomes dehydrated. Dehydration also causes the blood to thicken. This increases hemoglobin and may increase ESR.

Stenosis in the duodenum is a disease in which the lumen in the initial part small intestine narrows due to the action of organic or functional factors.

The narrowing of the intestinal lumen develops in several stages with different symptoms.

Description

The disease develops in several stages, each of which is accompanied by its characteristic clinical picture. The symptoms of stenosis are pronounced and diagnosis is not difficult. The disease can be congenital or acquired. The first type occurs in approximately 1/3 of cases of pathologies of the digestive organs, and the disease is more typical for male children.

Acquired stenosis is also more common in males, but after the age of 30 years. It is a consequence of diseases of the gastrointestinal tract, especially ulcers duodenum. This is one of the most common complications of organ ulcers. This type of stenosis is also called functional, since as the peptic ulcer is treated, the intestinal lumen returns to normal size due to the fact that the inflammatory edema subsides. In this case, scar deformities can form in the organ, which do not affect the functionality of the organ in remission. With organic pylorobulbar stenosis, a persistent disruption of food transport by the digestive tract occurs.

Stages of stenosis and symptoms

Doctors distinguish 3 stages of stenosis. They differ in the symptoms of the disease.

Stages

Stage 1. Compensated

Intestinal stenosis develops in three stages

The lumen does not narrow much. Hypertrophy of the muscles of the organ occurs as a consequence of the need for evacuation food bolus from the stomach to the duodenum. At the same time, the stomach works more actively to compensate for problems with transporting food material. Symptoms:

heaviness and sensation full stomach after a meal;
belching with acid;
heartburn;
vomiting, and the vomit contains undigested food.

During diagnosis, the stenosis is almost invisible.

Stage 2. Subcompensated stenosis

It occurs when a problem is ignored for several months, sometimes years. Symptoms:

severe and frequent vomiting some time after eating food;
vomiting brings relief;
vomit contains food particles;
severe heaviness in the stomach after eating;
belching with a rotten aftertaste;
pain in the abdominal cavity;
decrease in body mass index.

The stage is easily diagnosed.

Stage 3. Decompensation

Persistent dysfunction of the stomach and duodenum occurs. The intestinal lumen narrows significantly. Symptoms:

frequent vomiting;
Rotten belching constantly bothers me;
the patient cannot quench his thirst;
convulsions;
bad breath;
the stomach hurts even from a small amount of food;
appetite suddenly disappears;
exhaustion occurs.

Causes

The causes of duodenal stenosis include the following groups of factors:

pathological processes in adjacent organs, for example, neoplasms or inflammation, which cause swelling, as a result of which they put pressure on the organ and the lumen narrows;
the walls of organs become denser due to pathology in the tissue, as fibrous fiber grows, causing the functions of contraction and expansion to be inhibited;
the occurrence of muscle spasms or elastic fibers. This leads to stress, causing blood vessels to constrict and blood pressure to rise.

More specific reasons can be determined by the presence of:

atherosclerotic plaques;
diabetes mellitus;
peptic ulcer;
arterial hypertension;
oncology;
fibromuscular dysplasia.

Diagnostics

During the initial examination, palpation is performed

If symptoms of stenosis are detected, you should contact a gastroenterologist. It is he who will be able to conduct high-quality diagnostics and prescribe adequate therapy. Diagnostic scheme:

taking anamnesis;
visual inspection;
palpation of the abdominal cavity;
blood chemistry;
Analysis of urine;
X-ray of the gastrointestinal tract using contrast: examine the intestinal lumen itself, the size of the stomach, its peristalsis, and determine the moment of complete elimination from the body contrast agent to determine the stage of the disease;
fibrogastroduodenoscopy (FGDS) - this way they check the size of the organ lumen and the condition of the mucous membranes;
ultrasound diagnostics;
computed tomography (rare);
MRI (rare);
differential diagnosis - to exclude the possibility of the presence of other pathological processes with similar symptoms.

Pyloric stenosis or pyloric stenosis- this is a narrowing of the lumen of the lower gastric sphincter ( pulp), which disrupts the movement of food from the stomach to the duodenum. In the presence of pyloric stenosis, the stomach loses its anatomical connection with the duodenum, which is why this condition is called “blocked stomach” ( blocked stomach).

The lower esophageal sphincter is a ring of muscle that has the ability to open when muscle fibers relax and close when muscles contract. The anatomical name of the lower gastric sphincter is the pylorus or pyloric sphincter ( "pylorus" means "gatekeeper" in Greek.). The pyloric sphincter or pylorus is located between the pyloric region of the stomach and primary department duodenum. The pyloric section of the stomach is its final part, which gradually narrows and passes into the pyloric sphincter.

The pyloric section of the stomach consists of the following layers:

Mucous membrane- this is the inner layer, which consists of glandular cells and has slit-like depressions ( deep gastric pits or folds). The pyloric region has much less acidity than the rest of the stomach. This is due to a special mission pyloric region, which consists of neutralizing the acidity of food after exposure to gastric juice, which is achieved with the help of substances secreted by the mucous membrane of this area. Reducing acidity is necessary because the environment in the duodenum is more alkaline.
Submucosal layer– contains elastic fibers that nourish blood vessels and nerve fibers regulating the function of the sphincter.
Muscularis– consists of three layers of muscles running in different directions. The muscle fibers of the upper and lower layers have a longitudinal direction, that is, they go in length, and the middle layer between them contains circular fibers ( orbicularis muscles).
Serosa– the outer layer, which consists of connective tissue.

The pyloric sphincter differs from other sphincters of the gastrointestinal tract in that it is not tightly closed; it can be opened even if there is no food to be evacuated ( moved) from the stomach to the duodenum. The movement of food is carried out thanks to peristalsis of the stomach - a wave-like contraction towards the sphincter. This ability of the stomach is called motor-evacuation function ( literally motor-moving function).

The thickness of the sphincter muscle wall is normally 1–2 cm ( in children 1 – 2 mm), and the length of the pyloric canal is 4–6 cm ( in children 10 – 13 mm). With pyloric stenosis, the pyloric section of the stomach sharply expands, and the muscle layer in some cases thickens. The opening and closing of the gatekeeper is carried out due to the ring ( circular) muscles.

The gatekeeper opens thanks to the following two mechanisms:

Nervous mechanism ( reflex) – This neural regulation which is carried out through the sympathetic and para sympathetic division s of the nervous system. When food moves out of the body of the stomach ( large, main part) into the pyloric region, it begins to irritate mechanical receptors ( sensory nerve endings that respond to stretching of the wall) that are in this zone. The impulse is transmitted to the brain, and from there, through the vagus nerve, impulses begin to flow to the pyloric region, causing the sphincter to relax, and the pylorus comes off. After food passes from the stomach into the duodenum, irritation of the nerve endings of the intestinal wall occurs, which reflexively causes the closure of the sphincter through the sympathetic part of the nervous system.
Humoral ( humor - liquid) is the regulation of function through biological active substances, which are contained in the liquid. In this case, either blood or gastric juice acts as a carrier of substances. The gastric mucosa produces hydrochloric acid ( HCl), gastrin and nitric oxide ( NO). The effect of gastric juice with acidic contents on the receptors of the pyloric region causes the opening of the sphincter. Gastrin ( gastric hormone) promotes the closure of the sphincter, and nitric oxide promotes the opening. Gastrin also stimulates the release of hydrochloric acid and other gastric enzymes.

Symptoms of pyloric stenosis are found in descriptions of doctors of the 17th century, but a full picture of the pathology was presented by the Danish pediatrician Hirschsprung in 1887. The first operation for pyloric stenosis was performed in 1912. Congenital pyloric stenosis is more often observed in children with the first or third blood group. If one of the parents had pyloric stenosis not associated with another disease ( independent), then children have a high chance of also inheriting this disease ( the odds are 15 times higher compared to children whose parents did not know pyloric stenosis in childhood). However, such a family predisposition is present only in 7% of cases. It was also found that pyloric stenosis is detected more often in those children whose parents are consanguineous. The first child has the greatest risk of developing pyloric stenosis as a hereditary disease. In subsequent children, the risk is almost 2 times less.

Causes of pyloric stenosis

Pyloric stenosis can have congenital and acquired causes. Congenital pyloric stenosis is a developmental defect and is an independent pathology. The causes of congenital pyloric stenosis have not yet been fully established; many hypotheses have been put forward. Acquired pyloric stenosis is a secondary pathology, that is, it develops as a consequence or complication of some other disease. In any case, all reasons lead to a narrowing of the pyloric lumen.

Pyloric stenosis can be:

organic– caused by structural changes in the organ ( obvious anatomical deformity);
functional– occurs due to a temporary cause, for example, sphincter spasm or swelling of the pyloric tissue.

Functional pyloric stenosis caused by pyloric spasm is called pylorospasm. It is a frequent companion to pyloric stenosis, aggravating its severity. However, the term “pyloric stenosis” should be understood specifically as anatomical ( organic) narrowing of the pylorus.

Doctors in Western countries refer to acquired pyloric stenosis as all pathologies that cause narrowing of the lumen of the pyloric region.

The following terms are synonyms for acquired pyloric stenosis:

gastroduodenal stenosis ( gaster - stomach, duodenum - duodenum);
pyloroduodenal stenosis ( emphasis on stenosis closer to the duodenum);
gastric outlet stenosis ( stenosis closer to the stomach);
pyloric obstruction ( obstruction).

These terms do not apply to congenital cases of pyloric stenosis, due to the peculiarities of the mechanism and causes of congenital pyloric stenosis.

The causes of pyloric stenosis can be:

congenital hypertrophy of the muscular membrane of the pylorus;
idiopathic pyloric hypertrophy in adults;
chronic gastritis;
pyloric polyps;
inflammatory and tumor processes of neighboring organs;
gastrinoma;
stomach tuberculosis;
stomach syphilis;
complications after gastric surgery;
bezoars ( foreign bodies in the stomach).

Congenital hypertrophic pyloric stenosis

This anomaly occurs with a frequency of 2–4 cases per 1000 healthy children. Among birth defects gastrointestinal tract pyloric stenosis takes first place. More often found in boys ( the ratio of boys to girls is 4:1). Pyloric stenosis occurs more often in premature infants than in full-term infants. The disease has a hereditary predisposition. Congenital pyloric stenosis does not appear immediately after birth, but in the first 3 to 8 weeks of life.

The cause of this pathology is concentric ( all around) hypertrophy ( thickening) pyloric muscles. Too thick a muscle layer causes an anatomical narrowing of the pyloric lumen. Later, sclerosis joins hypertrophy of the pyloric muscle ( seal) mucous and submucosal layer, which leads to more pronounced narrowing and obstruction ( blockage).

Concentric hypertrophy of the pylorus occurs in following cases:

immaturity or degeneration ( destruction) nerve endings of the sphincter;
high gastrin levels ( both mother and child), which causes spasm of the pylorus and thickening of its walls;
artificial feeding (is a risk factor for pyloric stenosis, but the mechanism of development has not yet been established);
low level enzyme that is needed to form nitric oxide ( in this case, the pylorus spasms and does not open reflexively);
taking antibiotics such as azithromycin ( during pregnancy) and erythromycin ( in newborns).

Idiopathic pyloric hypertrophy in adults

With this pathology, the pylorus undergoes the same changes as with congenital pyloric stenosis, however, this variant is observed in adults, and for no reason ( idiopathic – independent, without any cause). It is observed very rarely, usually between the ages of 30 and 60 years. Many authors believe that hypertrophic pyloric stenosis in adults is a form of congenital hypertrophic pyloric stenosis. In fact, these are all those cases of unexpressed congenital hypertrophic pyloric stenosis that previously did not cause any symptoms. With age and in the presence of other changes in the pyloric area, the stenosis becomes more pronounced and causes complaints.

Peptic ulcer of the stomach and duodenum

Peptic ulcer of the stomach and duodenum is a deep defect in the mucous membrane of these organs. The disease has chronic course, that is, the ulcer does not heal completely and periodically causes symptoms. Peptic ulcer disease has two main causes - increased acidity stomach and Helicobacter pylori infection ( infection caused by the bacterium Helicobacter pylori). Both factors weaken the protective layer of the stomach lining, which normally prevents self-digestion. A superficial defect of the mucous membrane gradually forms ( erosion), and later - a deep crater-shaped ulcer. If an ulcer forms in the pyloric cavity, it causes inflammatory swelling of the surrounding tissues and compaction, and upon healing, a deforming scar may form, narrowing the lumen of the pyloric sphincter.

With peptic ulcer disease, the pyloric region is affected quite often, which is due to certain features. On the one hand, it is in this section that the excessive acidity of the gastric juice is neutralized, thanks to the production of a more alkaline secretion by the glands of the mucous membrane. On the other hand, due to the fact that the pyloric sphincter is often open ( even if there is no food to pass from the stomach to the intestines), then reverse movement of contents from the duodenum to the stomach may occur. The environment in the duodenum is alkaline, so its secretion also has a damaging effect on the mucous membrane of the pylorus. Thus, the pyloric region experiences stress on both sides.

Suturing of gastric and duodenal ulcers

Pyloric stenosis can occur as a complication after surgery on the stomach and duodenum. If the ulcer has caused perforation ( perforation) the wall of the stomach or intestine, then it is sutured during the operation. Suturing a large ulcer can cause deformation of the pylorus and cause a narrowing of the sphincter lumen.

Pyloric tumors

Tumors of the pylorus can be benign or malignant. From benign tumors a polyp is often found - a soft formation on a stalk protruding into the pyloric cavity, which causes blockage of the lumen. A malignant tumor can also cause pyloric stenosis if it grows towards the pyloric cavity ( stenosing carcinoma of the pyloric region).

Chemical burns

In case of accidental or intentional ( suicide attempt) taking acidic or alkaline solutions destruction of the mucous membrane or chemical burn occurs. The pyloric region suffers the most. This is due to the fact that in the stomach there are so-called “tracks” - these are long longitudinal folds of the mucosa that begin from the mucosa of the lower part of the esophagus and stretch to the pylorus. Along these paths, any liquid you drink quickly passes directly to the pylorus. That is why chemical burns often observed in the pyloric area. A chemical burn is an open wound surface on the mucous membrane. After healing, a scar forms at the burn site. If the burn was deep, and the burn site was closer to the sphincter itself, then the resulting scar tightens the tissue, narrows the lumen of the sphincter, and pyloric stenosis develops.

Chronic gastritis

Gastritis is inflammation of the stomach. It can occur with increased or decreased acidity. In the first case, erosions and ulcers are often observed. With low acidity there is a risk of developing a malignant tumor. At chronic gastritis The patency of the pylorus may be impaired due to the formation of ulcers, inflammatory edema and thickening of the mucous membrane ( cicatricial ulcerative stenosis). All these pathological processes disrupt the coordinated activity of the neuromuscular apparatus of the stomach and the pylorus, causing persistent spasm of the pylorus ( functional stenosis). The main difference between chronic gastritis with the formation of erosions and peptic ulcers is pain. With a peptic ulcer, the pain is pronounced, and with chronic gastritis, the patient complains of nausea, vomiting and heaviness in the abdomen and rarely of abdominal pain.

Inflammatory and tumor processes of neighboring organs

Inflammatory and tumor lesions of organs located adjacent to the pylorus or the initial part of the duodenum ( pancreas, general bile duct ), can cause pyloric stenosis through several mechanisms. In most cases, a decrease in the lumen of the pylorus occurs due to its compression by an enlarged organ or a large tumor from the outside. This is a variant of intestinal obstruction ( pyloric obstruction).

In other cases, there is inflammation of any neighboring organ, which contributes to the narrowing of the pyloric lumen due to the development local edema tissues, since swelling of one organ causes congestion in this zone. The pylorus itself becomes inflamed with duodenitis ( inflammation of the duodenum), which is referred to as “pyloroduodenitis.”

The pylorus may narrow due to pathology of neighboring organs, when a focus of pain impulses appears ( formation of pain impulses). Painful stimulation causes a reflex reaction of the pylorus - it spasms. In the presence of inflammatory process and prolonged, chronic spasm, fibrosis and anatomical narrowing of the pylorus can develop.

In the above cases, the pylorus itself does not change anatomically, that is, functional pyloric stenosis occurs, and treatment of the pathology of the affected neighboring organ solves the problem of its patency.

Gastrinoma

Gastrin is secreted not only by the cells of the gastric mucosa, but also by a special group of pancreatic cells. Gastrinoma is a tumor of the pancreas that autonomously secretes gastrin ( its release cannot be controlled by the nervous system) into the blood. High level gastrin increases the acidity of the stomach and causes the formation of ulcers, which can lead to cicatricial ulcerative pyloric stenosis. Unlike peptic ulcers, conventional treatment for gastrinoma is ineffective. Treatment of pyloric stenosis itself is no different.

Crohn's disease

Crohn's disease is a lesion of the small and/or large intestine that is of autoimmune origin. Rarely does the disease affect the stomach. Deep ulcers form in the wall of the affected organ. When the duodenum or stomach is affected closer to the pylorus, compaction and thickening of the wall occurs. A long process causes the proliferation of connective tissue, development adhesive process and narrowing of the lumen of the pylorus.

Tuberculosis of the stomach

Tuberculous lesion stomach is observed against the background of tuberculosis respiratory tract, if sputum infected with Mycobacterium tuberculosis is constantly swallowed. In the stomach with tuberculosis, several types of changes can be detected. It may develop tubercles and ulcers typical of tuberculosis, and sclerosis may develop ( seal) or inflammatory swelling ( infiltrate, which causes thickening of the stomach wall). All these changes in the pyloric region can lead to its anatomical narrowing or functional pyloric stenosis. Tuberculosis can also contribute to the development of stomach cancer.

Syphilis of the stomach

Syphilis of the stomach is observed with tertiary syphilis ( late organ damage after infection). Ulcers form in the stomach, gastritis develops, dense inflammatory edema, gummas or syphilomas form ( dense nodules that cause irreversible destruction). These changes deform the stomach, promote the formation of adhesions between the stomach and neighboring organs, and cicatricial stenosis gradually develops.

Bezoars

Bezoars are foreign bodies that consist of hair or fibers of plant origin, tightly fused into one dense clump. Bezoars form in the stomach itself. Blockage of the pylorus by a bezoar can occur if the stomach pushes it out along with food. In fact, blockage of the pyloric sphincter by a bezoar is a variant of intestinal obstruction, and not an independent pathology ( pyloric obstruction).

Symptoms of pyloric stenosis

Symptoms of pyloric stenosis correspond to the symptoms of intestinal obstruction at the level of the duodenum. Obstruction includes two important points– the presence of an obstacle and increased load to the section of the digestive tract, which is located above ( before) places where there is an obstacle. The obstacle is the narrowed pylorus itself, and the load falls on the stomach. With congenital pyloric stenosis, symptoms usually do not appear immediately. In children characteristic features observed from 2 to 3 weeks of life. The fact is that in the first weeks the child eats very little, and, despite the presence of a narrowing, food still passes into the duodenum. Gradually, the amount of milk that the child receives increases, and the load on the stomach increases.

In adults, the symptoms of pyloric stenosis usually develop gradually, and often a person does not pay attention to the first signs, thinking that he simply “ate something wrong.” When complaints become pronounced, then when you consult a doctor, quite serious and profound changes in the sphincter and stomach are revealed. If you have stomach or duodenal disease and suspect pyloric stenosis, you should consult a physician or gastroenterologist ( a doctor who specializes in gastrointestinal pathology).

Symptoms of pyloric stenosis

Symptom	Development mechanism	How does it manifest?
*Impaired evacuation of food from the stomach*	The narrowing of the sphincter lumen makes it difficult to empty the stomach, slowing down the process and requiring the stomach to contract more strongly to push the contents into the duodenum. The wall of the stomach gradually becomes thicker, but up to a certain point the stomach retains its normal sizes. Gradually, the stomach expands, and the remaining food ceases to be removed from the stomach. If food does not go forward, it comes back - vomiting occurs.	feeling of bloating, heaviness and fullness in the stomach after eating; profuse “fountain” vomiting, which brings relief; in children, vomiting occurs 10–15 minutes after feeding; vomit contains remnants of food eaten the day before; the amount of vomit is greater than the amount of food recently taken; in the area of the upper abdomen contractions of the stomach are visible from left to right ( symptom " hourglass» ); splashing noise when beating the anterior abdominal wall.
*Dyspepsia*	Dyspepsia is a disorder of the digestion process in the stomach. If food stays in the stomach for too long, it disrupts the digestion process and the food itself becomes fermented. The peristaltic wave of contractions of the stomach can go not only towards the pylorus, but also towards the esophagus, which causes the reflux of food not only into the duodenum, but also back into the esophagus.	belching sour or rotten;
*Violation electrolyte balance body and dehydration*		If pyloric stenosis is due to a temporary cause ( swelling and inflammation), these drugs can be effective, although they usually only reduce the severity of the stenosis. In cases where pyloric stenosis is organic and permanent, drugs are used to prevent pyloric stenosis or eliminate complications of the disease.
*Antispasmodics*	no-shpa; ( drotaverine); atropine.	Antispasmodics are divided into 2 large groups– myotropic antispasmodics and neurotropic antispasmodics. Myotropic ( tropic – aimed at something) antispasmodics eliminate pyloric spasm by acting directly on the muscle, namely by blocking the flow of calcium into muscle cells (this is how no-spa works). Neurotropic antispasmodics block receptors of the parasympathetic nervous system in the pyloric area, thereby making it impossible to transmit impulses, causing spasm gatekeeper	Antispasmodics can reduce the severity of pyloric stenosis by eliminating sphincter spasm, but on the anatomical narrowing of the sphincter ( on pyloric stenosis itself) they have no effect.

Surgery

Surgery is the main, adequate and targeted treatment for pyloric stenosis, since no drug can widen the anatomical narrowing of the pylorus. If with acquired pyloric stenosis there is the possibility of drug correction of pyloric stenosis, then congenital pyloric stenosis is treated only surgically, and hospitalization is carried out for emergencies ( urgent) indications, that is, within 1 – 3 days after diagnosis. In case of compensated and subcompensated pyloric stenosis, hospitalization and surgery are carried out in in a planned manner (within 7 – 30 days). If the body is severely depleted, then 12 hours before the operation they begin to administer nutrients intravenously and carry out drug correction of disrupted processes in the body.

For pyloric stenosis, the following operations are performed:

Pyloromyotomy ( pylorus - pylorus, myo - muscle, tomia - dissection) according to the method of Frede and Ramstand. The operation is a plastic surgery ( shape change) pylorus, which is used for congenital pyloric stenosis in newborns. The essence of the method is to dissect the pylorus in the longitudinal direction ( in length) along a line where there is no blood vessels (avascular line). The outer serous membrane and muscle layer are dissected, and the edges of the muscle are separated with an instrument. The mucous membrane is not touched ( that's why the operation is called submucosal). After dilating the muscle, the mucous membrane is “pushed out” into the resulting defect, which helps eliminate pyloric stenosis and restore patency.
Pyloroplasty according to Weber. It differs from pyloroplasty for newborns in that after cutting the length of the muscle and serosa sutured in the transverse direction ( in width). This significantly increases the pyloric lumen. For use in adults.
Laparoscopic surgery. This operation allows you to perform the same techniques as the previous two operations, but without opening the abdominal cavity. The operation is carried out under the control of a video camera ( laparoscope). To perform the operation, the surgeon pierces the anterior abdominal wall and through a small hole ( the size of a navel) introduces the laparoscope itself and instruments. The advantage of this operation is a quick recovery. Laparoscopic pyloromyotomy is performed in the first stage of pyloric stenosis ( compensated), when the stomach is not yet dilated.
Endoscopic pyloromyotomy. The operation is performed using a gastroscope, which is inserted in exactly the same way as with diagnostic study. Using instruments inserted through a gastroscope, the surgeon cuts the orbicularis sphincter muscle from the inside. The operation is performed in children with congenital pyloric stenosis.
Balloon dilatation of the pylorus. With a gastroscope inserted into the stomach, the pylorus can be dilated using balloon dilators or dilators ( dilatation - expansion). The operation is performed under X-ray control. A balloon is inserted into the pyloric lumen, which is then inflated. The balloon mechanically expands the narrowed lumen. The operation is not always effective the first time, so repeated dilatation is often performed to expand the pylorus to the desired diameter.
Gastric resection. If pyloric stenosis develops in an adult, then, taking into account its causes, doctors in most cases perform removal ( resection) parts of the stomach ( outlet, pyloric and sphincter), followed by anastomosis ( anastomosis) between the remaining part of the body of the stomach and the intestinal loop. It is important to know that the extent of resection depends on the cause of pyloric stenosis and the degree of gastric dilation. At ulcerative lesion of the stomach, 2/3 of the stomach is removed, and in case of a malignant tumor, almost the entire stomach ( subtotal resection).
Gastroenterostomy. Literally, the name of the operation sounds like “stomach, intestines, hole,” that is, the essence of the operation is to connect the stomach and intestines, bypassing the pylorus, without resection of the stomach. This operation is performed only in cases where it is impossible to immediately remove the stomach or the patient has a malignant tumor ( this intervention is a forced or temporary measure).

The following pathologies may be indications for gastric resection for pyloric stenosis:

the presence of peptic ulcer of the stomach or duodenum;
chemical burns;
malignant tumor of the stomach or suspicion of malignant degeneration of a chronic ulcer;
pronounced dilation of the stomach caused by long-term pyloric stenosis ( stage of subcompensation and decompensation);
no effect from drug therapy;
progression of pyloric stenosis.

Mechanical decompression of the stomach is also a temporary or forced measure. This method does not cure, it only allows you to periodically remove food accumulated in the stomach through the nasogastric ( passed through the nose into the esophagus and stomach) probe.

Traditional methods of treating pyloric stenosis

It is impossible to cure pyloric stenosis with folk remedies, but you can mitigate the severity of some symptoms of the disease. Doctors call this treatment symptomatic, that is, aimed at the symptoms and not at the cause. For congenital forms of pyloric stenosis traditional treatment is not only ineffective, but also dangerous, because, despite vegetable origin, tinctures and decoctions of many herbs are contraindicated for newborn children. In adults, in most cases, pyloric stenosis develops as a result of peptic ulcer disease, so all recipes are aimed at accelerating the healing of ulcers and relieving symptoms of impaired digestion ( nausea, vomiting, heartburn, belching).

As concomitant treatment for pyloric stenosis the following can be used medicinal plants:

Coltsfoot. Take 1 tablespoon of herb and pour in 200 ml of boiling water. The mixture is infused for 30 minutes, after which the tincture is passed through a strainer and drunk half a glass at the time of heartburn.
Fresh Juice cabbage Cabbage juice promotes scarring of ulcers in the pyloric area. You should take half a glass of cabbage juice orally 3-4 times a day, half an hour before meals. Duration of treatment – 1 – 2 months.
Aloe. Aloe can reduce stomach acidity and inflammation, improve digestion. For the recipe you need indoor aloe 3 - 5 years old. The largest leaves of aloe are cut off and the juice is squeezed out of them. After this, take gauze and filter. Aloe juice is added in equal parts olive oil and honey ( Honey relieves pain and reduces stomach acidity). Take 1 tablespoon once a day before meals.
Calendula. Has an anti-inflammatory effect. It is used as follows. Take 2 tablespoons of calendula flowers, pour a glass of boiling water, place on water bath. After 15 minutes, remove and cool for 45 minutes. To restore the original volume of liquid after the water bath, add boiling water. The resulting infusion is taken orally, 1 tablespoon before meals, 2 – 3 times a day.

It is not recommended to use prescriptions that have an antiemetic effect, since vomiting with pyloric stenosis is sometimes the only way to alleviate the patient’s condition before treatment. medical care. If vomiting reflex suppress, then the food will remain in the stomach, fermentation will intensify, while poorly digested and fermented food entering the duodenum will only worsen the general condition of the body.

Diet for pyloric stenosis

A diet for pyloric stenosis is prescribed before surgery, after surgery, and in cases where the patient is temporarily not indicated for surgery ( the doctor monitors the pathology). The diet includes fractional meals, that is, eating in small portions ( 5 – 6 times a day, one serving – 250 – 300 grams). The intervals between meals need to be increased so that the food taken in has time to be removed ( given the slow movement of food from the stomach during pyloric stenosis). You cannot eat once and in large quantities, or at night. Drinking too much liquid is also not recommended ( you can drink 0.6 - 1 liter), because this leads to distension of the stomach, slows down the evacuation of food and promotes pyloric spasm. You should also not drink food with water.

The following products should be avoided:

alcohol;
coffee;
salted and smoked food;
spices ( mustard, pepper);
tomato and mushroom sauces;
kvass and carbonated drinks;
canned food;
nuts;
fried foods.

The above food products increase the acidity of the stomach, complicate the digestion process and contribute to the retention of food in the stomach.

The stomach should also be spared from any mechanical and chemical damage, so food should not be too hot or too cold. Food should be liquid or mushy, liquefied. The diet should contain a sufficient amount of protein, but less starchy carbohydrates. These include bread and bakery products, potato. A lot of starch helps to enhance fermentation processes. The amount of bread and potatoes per day should not be more than 250 mg.

Very fatty foods should not be taken for two reasons. Firstly, fatty foods require long-term processing in the stomach, so they linger longer, and secondly, fatty foods cause pyloric spasm and increase the severity of pyloric stenosis ( your doctor may prescribe antispasmodics to prevent this).

If you have pyloric stenosis, you can eat the following foods:

meat ( non-rough varieties are ok, but red meat is best avoided);
poultry meat, fish ( boiled);
cottage cheese, milk, yoghurts;
eggs ( omelettes);
cottage cheese;
fruits and vegetable purees ( can be used as a smoothie).

The above products contain proteins and fats in sufficient quantities, are a source of vitamins, provide caloric content of food, but do not burden the stomach. Protein in sufficient quantities reduces the activity of cells that produce hydrochloric acid, so the acidity of the stomach decreases.

Nutrition for severe pyloric stenosis

In severe forms of pyloric stenosis ( complete closure of the lumen and stage of decompensation) eating in the usual way for all people becomes impossible. Since the body needs to be prepared before surgery, the patient in the hospital is prescribed either tube feeding or parenteral nutrition.

Feeding through a tube is indicated if for some reason the operation cannot be performed ( severe pathology, which is a contraindication to surgical treatment ) or it is postponed ( temporarily). Probe ( tube through which food will flow) is inserted using a gastroscope through the narrowed opening of the pylorus into the duodenum. In fact, the stomach temporarily ceases to participate in digestion; the patient is fed nutritional mixtures that go directly into the duodenum.

Parenteral nutrition ( para – past, enteron – intestine) or nutrition, bypassing the intestines, implies the introduction necessary substances (amino acids, glucose, trace elements and vitamins) intravenously.

Feeding an infant after surgery for pyloric stenosis

After surgery for pyloric stenosis, the baby continues to receive intravenous fluids and nutrients until breastfeeding can be resumed. Feed the baby breast milk (expressed) is possible 4 – 8 hours after recovery from anesthesia. Before this, the child is given intravenous plasma and given a glucose solution to drink. Sometimes the baby is allowed to feed in the first 4 hours after surgery, but this is often associated with undesirable consequences– frequent and severe vomiting, which causes discomfort for both the baby and his parents. You can feed your baby like clockwork ( diet), and upon request.

The feeding regimen has following features:

on the first day, the baby is given 10 ml of milk every 2 hours; he needs to be fed 10 times a day, taking a break at night;
every day the amount of milk is increased by 100 ml per day or by 10 ml at each feeding;
after 5 days, the child should no longer be given 50 ml for each feeding, but 70 ml, and the interval between two feedings is also gradually increased;
then the child begins to eat in accordance with the norm for his age ( in weeks).

Why does pyloric stenosis occur in newborns?

Pyloric stenosis in newborns is congenital anomaly and is characterized by pronounced thickening and increase in volume of the annular muscle of the pylorus. The pathology has a hereditary predisposition. Children whose parents also had congenital pyloric stenosis are at risk of developing pyloric stenosis. Heredity is also supported by the fact that pyloric stenosis occurs in children whose parents are related by blood ( the pathological gene is more likely to manifest itself). The occurrence of pyloric stenosis in newborns may be facilitated by taking certain antibiotics during pregnancy ( azithromycin) or their administration to the baby himself after birth ( erythromycin).

Does pyloric stenosis occur in the elderly?

In the elderly, an acquired form of pyloric stenosis is observed. It, unlike congenital pyloric stenosis, is not associated with hypertrophy ( thickening) pyloric muscles. Acquired pyloric stenosis is a complication of diseases such as gastric and duodenal ulcers, benign ( polyps) and malignant ( cancer) stomach tumors, chemical burns of the pyloric region ( drunk acid, alkali and other aggressive substances). In addition, pyloric stenosis is observed when the stomach is damaged by tuberculosis or syphilis.

Tumors cause blockage of the pylorus. In all other cases, pyloric stenosis develops due to scarring and deformation of the sphincter. This type of stenosis is called cicatricial.

In people aged 30–60 years, an adult form of congenital pyloric stenosis, called idiopathic ( unknown origin) hypertrophic pyloric stenosis.

How is surgery performed for pyloric stenosis?

Surgery for congenital pyloric stenosis is somewhat different from operations that are performed if pyloric stenosis is caused by another disease. With congenital pyloric stenosis, the doctor must widen the opening of the pyloric sphincter, which is significantly hypertrophied ( thickened due to increased volume of the orbicularis muscle). The operation is called pyloromyotomy, which literally translates to “pylorus, muscle, cut.” Pyloromyotomy is performed either open method (the abdominal cavity is opened), or by laparoscopic surgery ( using instruments inserted into the abdominal cavity through a small hole). In both cases, the doctor dissects the muscular layer of the pylorus in the longitudinal direction ( in length) to the mucous membrane. After the dissection, an instrument is inserted into the incision, which pushes the muscle fibers apart, after which the mucous membrane, freed from muscle compression, bulges into the incision, and the patency of the pyloric sphincter is restored.

In case of acquired pyloric stenosis, which is caused by cicatricial narrowing, partial removal stomach, after which the stump of the stomach is connected to a loop of the small intestine, while the pylorus itself no longer takes part in moving food.

In some cases, the doctor decides to expand the narrowed pylorus with a balloon, which is inserted using a gastroscope ( a tube with a camera that is inserted through the mouth into the stomach). Cylinder ( deflated) is inserted through a gastroscope into the narrowed opening of the pylorus and inflated. This manipulation has to be repeated again, since it is not always possible to expand the sphincter to the desired diameter the first time.

How is the period after surgery for pyloric stenosis?

Flow postoperative period during surgery for pyloric stenosis depends on the state of the body before surgery. The operation itself to dissect the pyloric muscle is not complicated, it is standard and practically does not lead to death. Complications after surgery are not related to the complexity of the operation itself, but to the condition of the body. The risk of complications during or after surgery in children is 8–10%.

After surgery for pyloric stenosis, you may experience the following complications:

complications associated with surgery– bleeding, divergence of the edges of the surgical wound ( suture failure), impaired motor function of the gastrointestinal tract ( complete absence contractions of the stomach and intestines, that is, paresis), wound infection and development purulent inflammation;
complications not related to surgery– worsening of the underlying disease ( often seen in older patients), pneumonia, bleeding disorder.

More complex operations performed on the stomach ( removing part of the stomach and creating a bypass, connecting the stomach to the intestines) require a long recovery period. Closed surgery for the treatment of pyloric stenosis ( using instruments inserted through the mouth and esophagus into the stomach or through a small opening into the abdominal cavity) are less likely to cause complications.

For a month after the operation, the child or adult is under the supervision of the surgeon.

More than 80% of patients complain of regurgitation after surgery. If vomiting continues more than 5 days after surgery, a repeat examination of the stomach is necessary ( radiopaque). The patient is re-examined after surgery to exclude complications associated with the operation ( for example, incomplete dissection of the pyloric muscle, damage to the mucous membrane, bleeding). If there are no complications, the person is discharged after recovery. water balance body ( elimination of dehydration) and normalization of the motor function of the gastrointestinal tract. The child is discharged after the operation when the feeding process is restored.

Are pylorospasm and pyloric stenosis the same thing?

Pylorospasm and pyloric stenosis are two different states who may have the same symptoms. Pyloric stenosis is a permanent or prolonged narrowing of the pylorus. Stenosis ( from the Greek word stenosis - narrowing) is always associated with thickening of the mucous membrane, thickening of the muscle wall or tumor growth. Pylorospasm is a pathological, long-lasting contraction of the orbicularis pylorus muscle. Normally, the pylorus contracts when it is necessary to stop the movement of food from the stomach into the duodenum or to prevent its reflux back into the stomach. If the pylorus does not open when you need to let food pass, then this condition is considered a pathological spasm. That is why pylorospasm is often called functional stenosis, that is, stenosis associated with a violation of the function, and not the anatomy, of the pylorus.

It is important to know that in the presence of pyloric stenosis, the patient may also experience a spasm, which further narrows the pyloric lumen, up to complete closure of the lumen. At the same time, prolonged spasm of the pylorus in the presence of any disease in this area can stimulate the scarring process and cause gluing of the walls of the pylorus, that is, lead to anatomical narrowing.

The symptoms of pyloric stenosis and pylorospasm are similar in many ways, so it can be difficult to distinguish between the two conditions.

You can distinguish pyloric stenosis from pylorospasm by the following signs:

pyloric spasm in a newborn develops in the first days of life, and pyloric stenosis in the first weeks;
vomiting with pylorospasm is inconsistent ( may be absent for several days), in contrast to pyloric stenosis, which is characterized by constant vomiting;
with pyloric stenosis, vomiting occurs less frequently, with pyloric spasm - more often ( 3 – 4 times a day);
the child vomits more than he ate with pyloric stenosis, and with pyloric spasm, on the contrary, less;
with pyloric stenosis there is constant constipation, and with pyloric spasm, the stool is sometimes normal;
with pylorospasm, although the child’s development slows down, it proceeds normally, while with pyloric stenosis, progressive depletion of the body is observed.

What can be the consequences of pyloric stenosis?

If pyloric stenosis is not treated, the body ceases to receive nutrients in the required quantities, becomes dehydrated, the body's metabolism is disrupted, weight loss is observed and severe exhaustion develops. These consequences are due, on the one hand, to the fact that a very small amount of food passes into the intestines ( This is where most nutrients are absorbed into the blood), and on the other hand, excessive vomiting quickly causes dehydration and loss of salts from the body. If pyloric stenosis develops acutely, the child’s condition quickly deteriorates. When symptoms develop slowly, the child appears calm, but in fact, this is a sign of exhaustion ( lethargy, apathy).

In adults, the consequences of pyloric stenosis are the same, but develop gradually and slowly. It's easier to warn them. The gradual development of symptoms does not cause concern for a person until vomiting becomes the only option for getting rid of the feeling of fullness and heaviness after eating. These symptoms are associated with a pronounced expansion of the stomach, in which a lot of fermented and rotting food has accumulated. In addition to indigestion in severe cases a heart rhythm disorder develops.

In some cases, pyloric stenosis causes gastric bleeding, which is associated with tension and rupture of the mucous membrane during vomiting.

Can pyloric stenosis recur?

Pyloric stenosis can recur, although this is extremely rare. Recurrence of pyloric stenosis or relapse is associated mainly with technical errors during surgery. To completely eliminate pyloric stenosis caused by thickening of the pyloric muscle, the surgeon must cut the muscle all the way down to the mucosa. If the muscle is not completely cut, pyloric stenosis is partially preserved.

What is the most accurate diagnosis of pyloric stenosis?

To accurately diagnose pyloric stenosis, doctors order tests that can make visible the narrowing of the pylorus. For this, two main studies are used - gastroduodenography and gastroscopy. Gastroduodenography is an X-ray contrast examination of the stomach and duodenum. Radiocontrast, that is, a substance that colors the walls of an organ from the inside, is a suspension of barium sulfate. Barium is drunk before the examination, after which the patient stands in front of the X-ray tube, and the radiologist monitors the progress of the drunk contrast, taking pictures if necessary. In pyloric stenosis, contrast fills the stomach ( with pyloric stenosis it is dilated) and does not penetrate the duodenum or penetrates with difficulty. The contrast may penetrate into the pyloric cavity, but will not advance further, which may indicate damage to the duodenum. X-ray contrast examination of the stomach also allows us to identify some pathologies that led to pyloric stenosis, for example, peptic ulcer, stomach tumors.

Gastroscopy ( gastroduodenoscopy) is an examination of the stomach and duodenum using a long thin hose with a camera at the end ( endoscope or gastroscope). The endoscope is inserted through the mouth, passed into the esophagus and then into the stomach. The study can be carried out both after intravenous anesthesia and using local anesthesia (Irrigating the mouth with an anesthetic solution to reduce the gag reflex). A gastroscope inserted into the stomach cavity transmits an image of the gastric mucosa to the monitor screen, the doctor examines the area of the pylorus and tries to insert an instrument inserted through the same endoscope into it. In this way, the patency of the pylorus is determined. The instrument may not go into the sphincter at all ( complete obstruction) or pass, but with difficulty ( partial obstruction ).

Gastroscopy has the following advantages over x-ray examination:

using gastroscopy, you can determine the degree of narrowing of the pylorus in millimeters;
gastroscopy allows you to take a piece of changed tissue from the area of interest and find out the cause of pyloric stenosis ( malignant tumor, peptic ulcer, syphilis, tuberculosis);
if the pylorus is partially patent, then a nasogastric tube can be inserted there directly during the examination ( through the nose into the duodenum) tube to provide nutrition to the patient until the optimal operation is selected;
directly during the study, you can expand the pylorus with the help of balloons, which, when deflated, are inserted into the lumen of the pylorus and inflated, causing mechanical stretching and pyloric expansion.

Is ultrasound used to diagnose pyloric stenosis?

Ultrasound ( ultrasonography ) for the diagnosis of pyloric stenosis is prescribed to newborns, in whom a congenital form of narrowing of the pylorus can be easily detected. This form is caused by thickening of the muscular wall of the pylorus, which is clearly visible on ultrasound. The doctor evaluates not only the thickness of the muscle, but also the lengthening of the pyloric canal itself. In adults, ultrasound is not a particularly informative method for diagnosing pyloric stenosis, since the reasons that narrow the pyloric lumen in adults are different and difficult to distinguish during ultrasound of the stomach.

The criteria for congenital hypertrophic pyloric stenosis according to ultrasound are:

the thickness of the muscular wall of the pylorus is more than 3–4 mm;
the length of the pyloric canal is more than 15 mm;
presence of fluid in the stomach on an empty stomach;
"beak" symptom ( narrowed pyloric canal).

Pyloric and peripyloric gastric ulcers and duodenal ulcers easily lead to the formation of a scar ring, narrowing the lumen sometimes to the thickness of a goose feather.

Constriction of the stomach develops gradually as scarring occurs. Due to the narrowing of the lumen of the gastric outlet, the movement of gastric contents becomes difficult, which at first is compensated by the reflexive onset of gastric contents. enhanced peristalsis stomach and developing hypertrophy of the gastric muscles.

The increased activity of the stomach muscles becomes insufficient over time, and some of the food entering it is retained. A period of decompensation begins. The stomach begins to expand. At the beginning of the decompensation period, hypertrophy of the stomach muscles continues to increase, but then they become exhausted and atrophy. In the final stage, the stomach turns into a passive sac, unable to peristalt.

After eating, there is a feeling of fullness in the pit of the stomach, belching with a smell, and a few hours after eating, profuse vomiting. Remnants of food eaten long before are found in the vomit. Vomiting is relieved by patients, and they willingly induce it artificially. Peristalsis of the stomach becomes visible to the eye and is accompanied by severe pain.

Peristaltic waves invariably go from left to right to the pylorus and die there. The amount of contents in the stomach is often very large, up to 2 liters, which depends not only on the intake of food, but also on hypersecretion. On examination, one often notices the huge stomach, the greater curvature of which lies at the level of the symphysis.

The acidity of the gastric contents is increased, the content of free hydrochloric acid is insufficient, and lactic acid is often present. Probing in the morning on an empty stomach, remove from the stomach a large number of liquids with a smell and the remains of food eaten the day before.

The splashing of a full stomach is easily caused. The sick suffer strong thirst and constipation. Little urine is produced. Due to repeated vomiting and constant fasting, patients reach an extreme degree of thinness. The body becomes dehydrated. Demineralization and a state of alkalosis occurs. Sometimes tetany phenomena are observed. The X-ray picture depends on the stage of the disease.

In the period of muscle hypertrophy, deep spastic peristalsis is visible; in the period of attrition, peristalsis is not visible. The contrast mass falls directly to the bottom of the stomach and lies in the form of an accumulation with a horizontal level, above which there is a light layer of liquid. The stomach has the shape of a bowl. The contrast mass lingers in the stomach for a long time.

The diagnosis of narrowing of the gastric outlet is easy. It is more difficult to determine the cause of the narrowing. Organic narrowing can be caused by cancer, benign neoplasm, syphilis, tuberculosis, burn.

Characteristic of cancer elderly age, short, steadily progressive course, no history of ulcers, achylia, palpable tumor. Diseases of neighboring organs, for example, cholecystitis complicated by pericholecystitis spreading to the pylorus, cancer of the adjacent colon spreading to the pylorus, can also cause narrowing.

When the colon is narrowed, peristaltic movements occur from right to left. To distinguish organic narrowing from pylorospasm, 0.001 atropine is injected into the patient before fluoroscopy.

Treatment is exclusively surgical - gastroenteroanastomosis, excision of the scarred pylorus, or, best of all, gastric resection. Resection for an ulcer that has not completely healed and for suspected cancer is mandatory. Gastric lavage brings significant but temporary relief.