Pyloric stenosis involves a narrowing of the pylorus, the muscular opening at the bottom of the stomach that connects to the small intestine. This narrowing obstructs the passage of food from the stomach. While frequently associated with infants, pyloric stenosis can also occur in adults, though it is a rare condition in this age group.
Pyloric Stenosis in Adults
Pyloric stenosis in adults differs significantly from its infantile counterpart. In infants, the condition is typically a developmental issue where the pyloric muscle thickens after birth, usually between 3 and 6 weeks of age, leading to symptoms like forceful vomiting. In adults, however, pyloric stenosis is almost always an acquired condition, developing later in life due to various underlying factors.
Unlike the infant form, where the muscle itself hypertrophies without a clear external cause, adult pyloric stenosis often results from other medical conditions that cause scarring, inflammation, or compression in the pyloric region. This distinction means the approach to diagnosis and treatment differs for adults compared to infants. The adult form can be categorized as primary (idiopathic) or secondary (attributable to an underlying condition). Secondary causes are more common, and the muscle thickening in these cases may be milder than in primary adult pyloric stenosis.
Causes and Risk Factors
Adult pyloric stenosis is primarily caused by conditions that lead to inflammation, scarring, or physical obstruction near the pylorus. One common cause is chronic peptic ulcer disease, where repeated ulceration and subsequent healing can result in scar tissue formation, narrowing the pyloric opening. Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a risk factor for peptic ulcers and, consequently, for developing pyloric stenosis, as NSAIDs can cause direct mucosal toxicity and lead to ulcer formation.
Chronic inflammatory conditions, such as Crohn’s disease, can also cause pyloric stenosis. While gastroduodenal involvement in Crohn’s disease is uncommon, it can lead to strictures and pyloric stenosis. Tumors, both benign and malignant, located in or near the pylorus can also cause obstruction. These can include stomach cancer, pancreatic cancer, gastrointestinal stromal tumors (GISTs), or lymphomas that compress the pylorus.
Recognizing Symptoms
The symptoms of pyloric stenosis in adults often develop gradually and can be less acute than in infants. Common symptoms include persistent nausea, which can worsen after meals. Recurrent vomiting is also typical, particularly after eating, and the vomited contents may contain undigested food from hours or even a day prior, rather than bile.
Individuals may experience early satiety, meaning they feel full quickly after consuming only a small amount of food. This reduced food intake often leads to significant unintentional weight loss over time. Upper abdominal pain or discomfort is also frequently reported. Other symptoms can include bloating and abdominal distension. These symptoms tend to be progressive, worsening as the pyloric opening becomes increasingly narrowed.
Diagnosis and Treatment
Diagnosing pyloric stenosis in adults involves a thorough medical history and physical examination to assess symptoms and overall health. Imaging studies are a primary tool for confirming the diagnosis and identifying the underlying cause. An upper gastrointestinal (GI) series, also known as a barium swallow, can show the narrowing of the pyloric channel and delayed gastric emptying. Computed tomography (CT) scans of the abdomen can also reveal thickening of the distal gastric wall and distension of the stomach.
Endoscopy allows for direct visualization of the pylorus, enabling doctors to assess the degree of narrowing and take biopsies to determine the cause, such as inflammation, ulcers, or tumors. Treatment approaches depend on the identified cause and the severity of the obstruction.
Initial management often focuses on correcting any dehydration or electrolyte imbalances resulting from persistent vomiting. Medical treatment for underlying conditions, such as anti-ulcer medications for peptic ulcer disease or anti-inflammatory drugs for Crohn’s disease, may be attempted. Endoscopic dilation, where a balloon is used to widen the narrowed pyloric opening, is a less invasive option.
For more severe or resistant cases, surgical intervention may be necessary. Common surgical procedures include pyloroplasty, which involves widening the pyloric opening, or a partial gastrectomy. Surgical exploration may also be necessary to differentiate between benign and malignant causes.