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 moving food through the gastrointestinal tract. The pylorus is the part of the organ that connects the stomach and the duodenum. Its purpose is to hold food in the stomach for a short time, during which it is affected. digestive enzymes stomach.

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

Causes of the disease

Pyloric stenosis is an acquired disease that most often develops in adults against the background of gastric pathologies, which primarily include an ulcer. However, in some cases, pyloric insufficiency may be congenital. Congenital stenosis is caused by the fact that in the infant, connective tissue grows in the pyloric region, which blocks the lumen of the gastrointestinal tract. Such a disease is hereditary character and more commonly 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 up of rigid connective tissue that cannot be stretched. Thus, the elasticity of the walls of the stomach decreases. The same scar can block the pyloric lumen.

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

Symptoms of the disease

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

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

nausea and vomiting;
belching with sour taste;
pain in the stomach;
over time, depletion and dehydration increase.

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

Stages of the disease

In its development, stenosis passes through three stages:

Stage I - full compensation. The pyloric lumen narrows slightly, food can pass into the intestine. The patient has the first symptoms of the disease: belching, which often has a sour attack, a feeling of heaviness in the stomach after eating, sometimes vomiting. After vomiting, the patient feels better.
Stage II - partial compensation. The pylorus 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, often there is an eructation with a sour taste. 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 weight decreases.
Stage III - decompensation. The gatekeeper narrows or closes as much as possible. The patient's condition worsens, unpleasant symptoms increase. The stomach is stretched, fermentation of stagnant food occurs in it. There is dehydration and exhaustion of the body. The patient often vomits profusely. Vomit has a sharp 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 is also non-surgical treatment for stenosis. In this condition, the patient is shown a strict diet. It is also important to reduce the secretion gastric juice.

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

Diet for stenosis

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

It is often necessary to eat with pyloric stenosis 5 to 6 times a day. Portions should be small.
Better to eat fresh food home cooking. Food should be warm, because too hot and cold foods irritate the walls of the stomach.
You need to eat mostly liquid: liquid mashed vegetable soups and cereals.
It is better to avoid fresh vegetables and fruits, as they stimulate the fermentation of food in the stomach.
Fruits and vegetables can be baked or boiled and ground.
It is necessary to exclude from the diet fatty meat and fish and broths from them, pastries.
Food should be insipid, spicy, salty, smoked foods should not be consumed, as they stimulate the secretion of gastric juice.
It is useful in this state to drink freshly squeezed vegetable juices, tea and herbal teas. Coffee and cocoa must be excluded.

Alternative treatment

Treatment with folk methods will alleviate the patient's condition and reduce the manifestation unpleasant symptoms illness.

Prognosis 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 ulcer. In this case, it is possible to minimize the formation of scar tissue and prevent stenosis.

The prognosis of the disease is favorable. If stomach ulcer and others pathological conditions no longer bothers the patient, the disease can be effectively stopped, the symptoms of stenosis disappear. The disease rarely recurs.

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

Pyloric stenosis - a pathological condition

The main cause is considered to be a scar that appears after the healing of the ulcerative surface. Such scars consist of connective tissue, they greatly reduce the mobility of the stomach wall, as they tighten it. Also, stenosis appears as a result of growth inside the wall of the stomach.

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 of the state in stenosis.

But the hypertrophied layer of the stomach is also unable to cope with the existing loads. Therefore, gradually the stomach is stretched due to the significant volume of the contents of the stomach. Accumulating food still stagnates. Reproducing microbes provoke active fermentation, decomposition.

The main stages of the disease

The first stage is compensated pyloric stenosis. The passage is a little narrow. The patient feels a feeling of heaviness and fullness of the stomach after eating. A sour eructation appears. Vomiting improves well-being 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 occur even directly during meals. After vomiting, the person feels a little better. After some time, the person significantly loses weight.

If you palpate the abdomen, then a splash can be felt in the navel.

The third stage is the stage of decompensation. At this stage, the stomach is stretched, 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, a terrible smell emanates from the contents of the vomit.

Methods for diagnosing "pyloric stenosis"

For an accurate diagnosis, several methods are used:

x-ray (they look at whether the stomach is enlarged, whether the channel is narrowed, whether 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 expanded, whether there is any deformation);
ultrasound (you can see an enlarged stomach only in the later stages);
electrogastroenterography- studying motor function(analyzes tone, contractions of the stomach, electrical activity).

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

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

To alleviate the condition, use antiulcer drugs. In the treatment, drugs are used, the action of which is directed against metabolic disorders. Also engaged in the restoration of body weight. Prevention of pyloric stenosis is reduced to the 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. Often determine its hereditary nature. IN this case there is a proliferation of connective tissue in the zone of the excretory section. Boys are four times more likely to suffer from this pathology than girls.

This violation is the main cause of gastric obstruction in infancy. The disease makes itself felt very early, literally in the second or fourth week. Attracts attention severe vomiting. This type of vomiting is very common. If the operation is done on time, everything ends well. Therefore, an accurate and correct diagnosis is of great importance.

Causes of stenosis of the esophagus

The cause of this disease is a malformation in utero. Already from the first days of a newborn's life, this pathology can be noticed. The baby is spitting up milk quite stubbornly. If the stenosis is small, then at the stage of breastfeeding it may not be noticed, and 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. The obstruction of the esophagus is associated with one of the following reasons:

the presence of scars that appeared as a result of the course of diseases such as peptic ulcer, gastroesophageal reflux disease, infectious and inflammatory lesions of the stomach;
damage to the esophagus of a traumatic nature, burns;
neoplasms of the esophagus or adjacent tissues;
swollen lymph nodes, aortic aneurysm, wrong 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 in the course of food movement in the esophagus;
salivation is constantly observed;
, often there is vomiting, belching.

There are several degrees of damage in esophageal stenosis:

First degree. Swallowing solid food occasionally causes problems. In general, the condition is satisfactory.
Second degree. Food can pass through the esophagus only in a semi-liquid form.
Third degree. Only liquid food can pass through the esophagus.
Fourth degree. It is very difficult to swallow even saliva, water.

Diagnosis Methods

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

x-ray examination (a suspension of barium is added);
esophagoscopy.

Treatment is carried out in the early stages conservative, it comes down to nutrition control. Patients also take prescribed medications. In the later stages - only operational. During the operation, the scars are dissected, the esophagus is brought into the appropriate shape, and a gastrostomy is applied.

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

Anemia (normochromic or hypochromic) may be observed in the general blood test. This is due to the depletion of the intake of various nutrients and valuable substances, especially iron. The number of red blood cells increases at the moment when repeated vomiting passes, the body is dehydrated. Dehydration also leads to thickening of the blood. From this, hemoglobin rises, ESR may increase.

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

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 the diagnosis is not difficult. The disease can be congenital or acquired. The first type occurs in about 1/3 of cases of pathologies of the digestive system, while the disease is more typical for male children.

Acquired stenosis is also more typical for 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, cicatricial deformities can form in the organ, which do not affect the functionality of the organ in remission. With organic pylorobulbar stenosis, there is a persistent violation of the transport of food by the organs of the digestive tract.

Stenosis stages and symptoms

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

Stages

Stage 1. Compensated

Bowel stenosis develops in three stages

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

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

During the diagnosis, stenosis is almost invisible.

Stage 2. Subcompensated stenosis

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

severe and frequent vomiting some time after eating;
vomiting brings relief;
vomit contains particles of food;
great 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

There is a persistent violation of the functions of the stomach and duodenum. The lumen of the intestine is significantly narrowed. Symptoms:

frequent vomiting;
constantly worried about rotten belching;
the patient cannot quench his thirst;
convulsions;
bad breath;
the stomach hurts even from a small amount of food;
appetite disappears sharply;
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 the organs become denser due to pathology in the tissue, as the fibrous fiber grows, which inhibits the functions of contraction and expansion;
the occurrence of spasms of muscles or elastic fibers. This leads to stress, causing blood vessels to constrict, and blood pressure rises.

As more specific reasons, you can determine the presence of:

atherosclerotic plaques;
diabetes;
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 a high-quality diagnosis and prescribe adequate therapy. Diagnosis scheme:

collection of anamnesis;
visual inspection;
palpation of the abdominal cavity;
blood chemistry;
Analysis of urine;
radiography 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) - in this way, the size of the lumen of the organ and the condition of the mucous membranes are checked;
ultrasound diagnostics;
computed tomography (rare);
MRI (rare);
differential diagnosis - to exclude the possibility of the presence of other pathological processes similar in symptoms.

Pyloric stenosis or pyloric stenosis is a narrowing of the lumen of the lower gastric sphincter ( pulp), which disrupts the movement of food from the stomach into the duodenum. In the presence of pyloric stenosis, the stomach loses its anatomical connection with the duodenum, therefore this condition is called "stomach in blockade" ( blocked stomach).

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

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

mucous membrane- this is the inner layer, which consists of glandular cells and has slit-like impressions ( deep stomach pits or folds). In the pyloric region, the acidity is much less than in the rest of the stomach. This is due to the special mission pyloric department, which consists in 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 zone. Reducing acidity is necessary because the environment in the duodenum is more alkaline.
Submucosal layer- contains elastic fibers that feed blood vessels and nerve fibers that regulate the function of the sphincter.
Muscular membrane- consists of three layers of muscles going 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 ( circular muscles).
Serous membrane- 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 due to the 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 muscle wall of the sphincter 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 part of the stomach expands sharply, and the muscle layer thickens in some cases. The opening and closing of the pylorus is carried out by ring ( circular) muscles.

The gatekeeper opens due to the following two mechanisms:

neural mechanism ( reflex) – This nervous regulation, which is carried out through the sympathetic and steam sympathetic department s nervous system. When food moves out of the body of the stomach ( large, main body) to the pyloric region, it begins to irritate the mechanical receptors ( sensory nerve endings that respond to wall stretch) located in this area. The impulse is transmitted to the brain, and from there, impulses begin to flow through the vagus nerve to the pyloric section, causing the sphincter to relax, and the pylorus comes off. After food passes from the stomach into the duodenum, the nerve endings of the intestinal wall are irritated, which reflexively causes the sphincter to close through the sympathetic division of the nervous system.
humoral ( humor - liquid) is the regulation of function through biological active substances 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 action of gastric juice with acidic contents on the pyloric receptors causes the opening of the sphincter. Gastrin ( gastric hormone) contributes to the closure of the sphincter, and nitric oxide - to the opening. Gastrin also stimulates the release of hydrochloric acid and other gastric enzymes.

Symptoms of pyloric stenosis are found in the descriptions of physicians of the 17th century, but the Danish pediatrician Hirschsprung presented a complete presentation of the pathology 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 unrelated to another disease ( independent), then children have a high chance of also inheriting this disease ( chances 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 or acquired causes. Congenital pyloric stenosis refers to malformations and is an independent pathology. The causes of congenital pyloric stenosis have not yet been fully established, and 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 causes lead to narrowing of the pyloric lumen.

Pyloric stenosis can be:

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

Functional pyloric stenosis caused by pyloric spasm is called pylorospasm. It is a frequent companion of pyloric stenosis, exacerbating its severity. However, the term "pyloric stenosis" should be understood precisely as anatomic ( organic) narrowing of the pylorus.

Western doctors include all pathologies that cause narrowing of the lumen of the pyloric region to acquired pyloric stenosis.

Acquired pyloric stenosis is synonymous with the following terms:

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

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;
pylorus polyps;
inflammatory and tumor processes of neighboring organs;
gastrinoma;
stomach tuberculosis;
syphilis of the stomach;
complications after stomach 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 ranked first. More commonly found in boys the ratio of boys and girls is 4:1). Pyloric stenosis is more common in premature babies than in full-term babies. 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) pylorus muscles. Too thick muscle layer causes anatomical narrowing of the pyloric lumen. Later, sclerosis joins hypertrophy of the pyloric muscle ( seal) of the mucosal and submucosal layer, which leads to a more pronounced narrowing and obstruction ( blockage).

Concentric pyloric hypertrophy occurs in the following cases:

immaturity or degeneration ( destruction) nerve endings of the sphincter;
high levels of gastrin 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 an enzyme 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 in 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 at the age of 30 - 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 region, 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 completely heal and periodically causes symptoms. Peptic ulcer has two main causes - hyperacidity stomach and Helicobacter pylori infection infection caused by the bacterium Helicobacter pylori). Both factors weaken the protective layer of the gastric mucosa that normally prevents self-digestion. Gradually, a superficial mucosal defect is formed ( erosion), and later a deep crater-like ulcer. If an ulcer forms in the pyloric cavity, it causes inflammatory edema of the surrounding tissues and thickening, and during healing, a deforming scar may form, narrowing the lumen of the pyloric sphincter.

With peptic ulcer, the pyloric region is affected quite often, due to some features. On the one hand, it is in this section that the excessive acidity of gastric juice is neutralized, due to the production of a more alkaline secret by the glands of the mucosa. 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 there may be a reverse movement of the contents from the duodenum into the stomach. In the duodenum, the environment is alkaline, so its secret also has a damaging effect on the mucous membrane of the pyloric region. Thus, the pyloric department is under load from two sides.

Suturing of gastric and duodenal ulcers

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

Tumors of the pylorus

Pyloric tumors can be benign or malignant. From benign tumors a polyp is often found - a soft pedunculated formation protruding into the pylorus 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 department suffers the most. This is due to the fact that there are so-called "paths" in the stomach - these are long longitudinal mucosal folds that start from the mucous membrane of the lower part of the esophagus and stretch to the pylorus. Along these paths, any liquid drunk quickly passes directly to the pyloric region. That is why chemical burns are often observed in the area of the pylorus. A chemical burn is an open wound surface on the mucous membrane. After healing, a scar forms at the site of the burn. If the burn was deep, and the burn site turned out to be closer to the sphincter itself, then the resulting scar tightens the tissues, narrows the sphincter lumen, and pyloric stenosis develops.

Chronic gastritis

Gastritis is an inflammation of the stomach. It can proceed with increased or decreased acidity. In the first case, erosions and ulcers are often observed. With low acidity, there is a risk of a malignant tumor. At chronic gastritis the pyloric patency may be impaired due to the formation of an ulcer, 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 erosion and peptic ulcer is pain. In peptic ulcer disease, the pain is severe, and in chronic gastritis, the patient complains of nausea, vomiting, and heaviness in the abdomen and, rarely, 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, common bile duct ), can cause pyloric stenosis by several mechanisms. In most cases, a decrease in the pyloric lumen 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 a neighboring organ, which contributes to the narrowing of the pylorus 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 can narrow in the pathology of neighboring organs, when a focus of pain impulses appears ( generation of pain impulses). Painful irritation causes a reflex reaction of the pylorus - it spasms. In the presence of inflammatory process and prolonged, chronic spasm, fibrosis and already anatomical narrowing of the pylorus may develop.

In the above cases, the pylorus itself does not change anatomically, that is, there is a functional pyloric stenosis, and the 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. A gastrinoma is a tumor of the pancreas that secretes gastrin offline ( its secretion is not 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 ulcer, gastrinoma does not respond to conventional peptic ulcer treatment. The 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, the disease affects the stomach. Deep ulcers form in the wall of the affected organ. When the duodenum or stomach is damaged closer to the pylorus, thickening and thickening of the wall occurs. A long process causes the proliferation of connective tissue, the 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 variants of changes can be found. Tubercles, ulcers typical of tuberculosis can form in it, sclerosis can develop ( seal) or inflammatory edema ( an infiltrate that 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 in 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, contribute to the formation of adhesions between the stomach and neighboring organs, gradually developing cicatricial stenosis.

bezoars

Bezoars are foreign bodies that consist of hair or plant fibers tightly soldered into one dense clot. Bezoars form in the stomach itself. Blockage of the pylorus with a bezoar can occur if the stomach pushes it out 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 moments- the presence of obstacles and increased load on the section of the digestive tract, which is located above ( before) places where there is an obstacle. The narrowed pylorus itself is an obstacle, and the load falls on the stomach. With congenital pyloric stenosis, symptoms usually do not appear immediately. In children characteristics observed from 2 to 3 weeks of age. 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, 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 the complaints become pronounced, then when you go to the doctor, quite serious and profound changes in the sphincter and stomach are already revealed. If you have a disease of the stomach or duodenum and suspected pyloric stenosis, you should consult a general practitioner or gastroenterologist ( doctor who deals with the pathology of the gastrointestinal tract).

Symptoms of pyloric stenosis

Symptom	Development mechanism	How is it manifested?
*Violation of the evacuation of food from the stomach*	The narrowing of the sphincter lumen makes it difficult to empty the stomach, slowing down this process and requiring the stomach to contract harder 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 the food does not go forward, then it comes back - vomiting occurs.	feeling of fullness, heaviness and fullness of the stomach after eating; profuse vomiting "fountain", which brings relief; in children, vomiting occurs 10 to 15 minutes after feeding; vomit contains remnants of food eaten the day before; the amount of vomit is greater than the amount of food taken recently; in the region of the upper abdomen, contractions of the stomach from left to right are visible to the eye ( symptom " hourglass» ); splashing noise when tapping the anterior abdominal wall.
*Dyspepsia*	Dyspepsia is a violation of the process of digestion in the stomach. If the food is in the stomach for too long, then this disrupts the process of digestion, and the food itself is 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 caused precisely by a temporary cause ( swelling and inflammation), these drugs may be effective, although they usually only improve the severity of the stenosis. In cases where pyloric stenosis is organic and permanent, drugs are used as a prophylaxis of pyloric stenosis or to eliminate complications of the disease.
*Antispasmodics*	no-shpa; ( drotaverine); atropine.	Antispasmodics are divided into 2 large groups- myotropic antispasmodics and neurotropic antispasmodics. Myotropic ( trope - aimed at something) antispasmodics eliminate pyloric spasm by acting directly on the muscle, namely by blocking the flow of calcium in muscle cells (this is how no-shpa works). Neurotropic antispasmodics block the receptors of the parasympathetic nervous system in the pyloric region, thereby making it impossible to transmit impulses, causing spasm gatekeeper.	Antispasmodics can reduce the severity of pyloric stenosis by eliminating spasm of the sphincter, but the anatomical narrowing of the sphincter ( for pyloric stenosis itself) they have no effect.

Surgery

Surgical intervention is the main, adequate and targeted treatment of pyloric stenosis, since no drug can expand the anatomical narrowing of the pylorus. If with acquired pyloric stenosis there is the possibility of medical correction of pyloric stenosis, then congenital pyloric stenosis is treated only by surgery, and hospitalization is carried out according to emergency ( urgent) indications, that is, within 1 to 3 days after diagnosis. With compensated and subcompensated pyloric stenosis, hospitalization and surgery are carried out in planned (within 7 - 30 days). If the body is severely depleted, then 12 hours before the operation, they begin to inject nutrients intravenously and carry out drug correction of disturbed processes in the body.

With pyloric stenosis, the following operations are performed:

Pyloromyotomy ( pylorus - pylorus, myo - muscle, tomiya - dissection) by the method of Frede and Ramstende. The operation is plastic shape change) pylorus, which is used for congenital pyloric stenosis in newborns. The essence of the method is the dissection of the pylorus in the longitudinal direction ( in length) along the line where there is no blood vessels (avascular line). Dissect the outer serous membrane, the muscle layer, spread the edges of the muscle with an instrument. The mucous membrane is not touched ( so the operation is called submucosal). After dilution of the muscle, the mucous membrane is “pushed out” into the formed defect, which contributes to the elimination of pyloric stenosis and the restoration of patency.
Pyloroplasty according to Weber. It differs from pyloroplasty for newborns in that after dissection in length, the muscle and serosa stitched in the transverse direction wide). This greatly increases the pylorus clearance. Used 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 opening ( belly button size) introduces the laparoscope itself and instruments. The advantage of such an operation is a quick recovery. Laparoscopic pyloromyotomy is performed, in the first stage of pyloric stenosis ( compensated), when the stomach is not yet expanded.
Endoscopic pyloromyotomy. The operation is performed using a gastroscope, which is inserted in the same way as with diagnostic study. With the help of instruments inserted through the gastroscope, the surgeon dissects the orbicular 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 expanded using balloon dilators or dilators ( dilatation - expansion). The operation is carried out under the control of X-ray examination. 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.
Resection of the stomach. If pyloric stenosis develops in an adult, then, given its causes, doctors in most cases perform removal ( resection) parts of the stomach ( exit section, pyloric section and sphincter), followed by anastomosis ( fistula) between the rest of the body of the stomach and the intestinal loop. It is important to know that the amount of resection depends on the cause of pyloric stenosis and on the degree of expansion of the stomach. At ulcerative lesion 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, orifice”, 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).

Indications for resection of the stomach with pyloric stenosis can serve the following pathologies:

the presence of peptic ulcer of the stomach or duodenum;
chemical burns;
a malignant tumor of the stomach or suspicion of malignant degeneration of a chronic ulcer;
pronounced dilatation 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 the food accumulated in the stomach through the nasogastric ( passed through the nose to the esophagus and stomach) probe.

Alternative methods of treatment of pyloric stenosis

It is impossible to cure pyloric stenosis with folk remedies, but it is possible to mitigate the severity of some symptoms of the disease. Doctors call such treatment symptomatic, that is, aimed at the symptoms, and not at the cause. With congenital forms of pyloric stenosis folk treatment not only inefficient, but also dangerous, because, despite vegetable origin, tinctures and decoctions of many herbs are contraindicated for newborns. In adults, in most cases, pyloric stenosis develops with peptic ulcer, so all recipes are aimed at accelerating the healing of the ulcer 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 herbs and pour 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 the ulcer in the pyloric region. Take cabbage juice inside should be half a glass 3-4 times a day half an hour before meals. Duration of admission - 1 - 2 months.
Aloe. Aloe can reduce stomach acidity and inflammation, improve digestion. For the recipe, you need indoor aloe 3 - 5 years of age. In aloe, the largest leaves are cut off, juice is squeezed out of them. After that, gauze is taken and filtered. Aloe juice is added in equal parts olive oil and honey ( honey relieves and reduces stomach acidity). Take 1 time per day, 1 tablespoon before meals.
Calendula. It has an anti-inflammatory effect. It is used in the following way. Take 2 tablespoons of calendula flowers, pour a glass of boiling water, put on water bath. Remove after 15 minutes and refrigerate for 45 minutes. Boiling water is added to restore the original volume of liquid after a water bath. 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 giving him medical care. If vomiting reflex suppress, then food will remain in the stomach, fermentation will intensify, while poorly digested and fermented food that has entered 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 nutrition, that is, eating in small portions ( 5 - 6 times a day, one serving - 250 - 300 grams). The intervals between meals should be increased so that the food taken has time to leave ( given the slow movement of food from the stomach in pyloric stenosis). You can not eat once and plentifully, as well as at night. Drinking too much liquid is also not recommended ( you can drink 0.6 - 1 liter), because it leads to distension of the stomach, slows down the evacuation of food and promotes pyloric spasm. It is also impossible to drink food with water.

The following foods should be avoided:

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

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

The stomach should also be spared from any mechanical and chemical damage, so the 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 contributes to the strengthening of 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 processing in the stomach, so it lingers longer, and secondly, fatty foods cause pyloric spasm and increase the severity of pyloric stenosis ( the doctor may prescribe antispasmodics to prevent this).

With pyloric stenosis, you can eat the following foods:

meat ( non-coarse varieties are allowed, but red meat is best avoided);
poultry meat, fish boiled);
cottage cheese, milk, yogurt;
eggs ( omelets);
cottage cheese;
fruits and vegetable purees can be in the form of 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) nutrition in the usual way for all people becomes impossible. Since the body must be prepared before the operation, 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 delayed ( temporarily). Probe ( a tube through which food will flow) is introduced 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 with nutrient mixtures that fall directly into the duodenum.

parenteral nutrition ( para - past, enteron - intestines) or nutrition, bypassing the intestines, implies the introduction essential substances (amino acids, glucose, trace elements and vitamins) intravenously.

Breastfeeding after surgery for pyloric stenosis

After surgery for pyloric stenosis, the baby continues to receive intravenous fluids and nutrients until breastfeeding is resumed. Feed the baby breast milk (expressed) can be done 4-8 hours after recovery from anesthesia. Prior to this, the child is injected with intravenous plasma and given a glucose solution to drink. Sometimes the child is allowed to feed for 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 the child like clockwork ( diet), as well as on request.

The feeding mode has the following features:

on the first day, the baby is given 10 ml of milk every 2 hours, you need to feed 10 times a day, taking a break for the 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 be given no longer 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 a pronounced thickening and increase in the volume of the annular pyloric muscle. Pathology has a hereditary predisposition. Children whose parents also had congenital pyloric stenosis are at risk of developing pyloric stenosis. The fact that pyloric stenosis occurs in babies whose parents are related by blood also speaks in favor of heredity ( the abnormal gene is more likely to be expressed). Pyloric stenosis in newborns may be promoted by the use of certain antibiotics during pregnancy ( azithromycin) or their appointment 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) pylorus muscles. Acquired pyloric stenosis is a complication of diseases such as peptic ulcer of the stomach and duodenum, benign ( polyps) and malignant ( cancer) tumors of the stomach, chemical burns of the pyloric region ( drunk acid, alkali and other aggressive substances). In addition, pyloric stenosis is observed when the stomach is affected 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. Such stenosis is called cicatricial.

People between the ages of 30 and 60 may have an adult form of congenital pyloric stenosis called idiopathic ( unknown origin) hypertrophic pyloric stenosis.

How is the operation for pyloric stenosis?

The operation for congenital pyloric stenosis is somewhat different from the operations that are performed if pyloric stenosis is caused by another disease. In congenital pyloric stenosis, the doctor must expand the opening of the pyloric sphincter, which is significantly hypertrophied ( thickened due to an increase in the volume of the circular muscle). The operation is called pyloromyotomy, which literally translates as "pylorus, muscle, dissection." Pyloromyotomy is performed either open way (the abdominal cavity is opened), or by laparoscopic surgery ( using instruments inserted into the abdominal cavity through a small opening). In both cases, the doctor dissects the muscle layer of the pylorus in the longitudinal direction ( in length) to the mucous membrane. After dissection, an instrument is inserted into the incision, which pushes the muscle fibers apart, after which the mucous membrane released from muscle compression swells into the incision, and the patency of the pyloric sphincter is restored.

With acquired pyloric stenosis, which is caused by cicatricial narrowing, partial removal stomach, after which the stump of the stomach is connected to the loop of the small intestine, while the pylorus itself no longer takes part in the promotion of 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). balloon ( deflated) is inserted through the 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 cut the pylorus 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 state of the body. The risk of complications during or after surgery in children is 8-10%.

After surgery for pyloric stenosis, there may be the following complications:

complications associated with surgery- bleeding, divergence of the edges of the surgical wound ( seam 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- aggravation of the course of the underlying disease ( often seen in older patients), pneumonia, bleeding disorders.

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 surgeries for the treatment of pyloric stenosis ( with instruments inserted through the mouth and esophagus into the stomach or through a small opening into the abdomen) are less likely to cause complications.

Within 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 persists for more than 5 days after surgery, a re-examination of the stomach is necessary ( radiopaque). The patient is re-examined postoperatively to rule out complications associated with the operation ( for example, defective dissection of the pyloric muscle, damage to the mucous membrane, bleeding). If there are no complications, then the person is discharged after recovery. water balance organism ( 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 which 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 mucosal thickening, muscle wall thickening, or tumor growth. Pylorospasm is an abnormal, long-lasting contraction of the pylorus orbicularis muscle. Normally, the pylorus contracts when it is necessary to stop the movement of food from the stomach into the duodenum or prevent it from being thrown back into the stomach. If the gatekeeper does not open when you need to skip food, then this condition is considered a pathological spasm. That is why pylorospasm is often called functional stenosis, that is, stenosis associated with impaired 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 spasm, which further narrows the pyloric lumen, up to complete closure of the lumen. At the same time, a prolonged spasm of the pylorus in the presence of any disease in this area can stimulate the scarring process and cause the walls of the pylorus to stick together, 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.

Pyloric stenosis can be distinguished from pylorospasm by the following features:

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

What are the consequences of pyloric stenosis?

If pyloric stenosis is not treated, then the body ceases to receive nutrients in the right amount, dehydrates, the body's metabolism is disturbed, weight loss is observed, and severe emaciation develops. These consequences are due, on the one hand, to the fact that a very small amount of food passes into the intestine ( This is where most of the nutrients are absorbed into the blood.), and on the other hand, profuse vomiting quickly causes dehydration and loss of salts in the body. If pyloric stenosis develops acutely, then the child's condition deteriorates rapidly. When symptoms develop slowly, the child looks 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. They are easier to prevent. The gradual development of symptoms does not cause concern in a person until vomiting becomes the only option to get 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, severe cases development of cardiac arrhythmias.

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. The recurrence of pyloric stenosis or recurrence is associated mainly with technical errors during the operation. To completely eliminate pyloric stenosis caused by thickening of the pyloric muscle, the surgeon must cut the muscle to the full depth to the mucous membrane. If the muscle is not completely cut, then pyloric stenosis is partially preserved.

What is the most accurate diagnosis of pyloric stenosis?

To accurately diagnose pyloric stenosis, doctors prescribe studies that can make the narrowing of the pylorus visible. For this, two main studies are used - gastroduodenography and gastroscopy. Gastroduodenography is an X-ray contrast study of the stomach and duodenum. Radiocontrast, that is, a substance that stains 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 can penetrate into the pyloric cavity, but not move further, which may indicate damage to the duodenum. X-ray contrast examination of the stomach also reveals 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 performed both after intravenous anesthesia, and using local anesthesia (irrigation of the mouth with an anesthetic solution to reduce the gag reflex). A gastroscope passed into the stomach cavity transmits an image of the gastric mucosa to the monitor screen, the doctor examines the pyloric area and tries to insert an instrument inserted through the same endoscope into it. Thus, the patency of the pylorus is determined. The instrument may not pass 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 altered 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 passable, then right during the study, you can enter the nasogastric ( through the nose into the duodenum) a probe to provide nutrition to the patient until the optimal operation is selected;
right during the study, it is possible to expand the pylorus with the help of balloons, which, when deflated, are introduced into the lumen of the pylorus and inflated, causing mechanical stretch and gatekeeper expansion.

Is ultrasound used to diagnose pyloric stenosis?

ultrasound ( ultrasonography ) for the diagnosis of pyloric stenosis is prescribed to newborns, in whom it is easy to detect a congenital form of narrowing of the pylorus. This form is due to the 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 causes 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 pylorus channel is more than 15 mm;
the presence of fluid in the stomach on an empty stomach;
beak symptom ( narrowed pyloric canal).

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

Narrowing of the stomach develops gradually, as scarring. Due to the narrowing of the lumen of the exit of the stomach, the promotion of gastric contents is difficult, which at first is compensated by a reflex advancing increased peristalsis stomach and developing hypertrophy of gastric muscles.

The increased activity of the muscles of the stomach becomes insufficient over time, and part of the food entering it is delayed. There comes a period of decompensation. The stomach begins to expand. At the beginning of the period of decompensation, 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, unable to peristaltize the bag.

After eating, there is a feeling of fullness in the lining, an eructation with a smell, and a few hours after eating, profuse vomiting. In the vomit, remnants of food eaten long before are found. Vomiting relieves patients, and they willingly cause 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 stop 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, a huge stomach is often striking, the large 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, removed from the stomach a large number of liquids with a smell and the remains of food eaten the day before.

The splash of a full stomach is easily caused. The sick suffer intense thirst and constipation. Little urine is excreted. Due to repeated vomiting and constant starvation, patients reach an extreme degree of thinness. The body is dehydrated. There comes demineralization and a state of alkalosis. Sometimes the phenomena of tetany are observed. The roentgenoscopic picture depends on the stage of the disease.

In the period of hypertrophy of the muscles, deep spastic peristalsis is visible, in the period of atrophy, peristalsis is not visible. The contrast mass falls directly to the bottom of the stomach and lies in the form of a cluster with a horizontal level, above which there is a light layer of liquid. The stomach is bowl-shaped. The contrast mass lingers in the stomach for a long time.

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

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

With narrowing of the colon, peristaltic movements occur from right to left. To distinguish organic narrowing from pylorospasm, the patient is injected with 0.001 atropine before fluoroscopy.

The treatment is exclusively surgical - the imposition of gastroenteroanastomosis, excision of the cicatricial pylorus, or, best of all, resection of the stomach. Resection with an incompletely healed ulcer and suspected cancer is mandatory. Significant, but temporary relief is brought by gastric lavage.