Gastric Outlet Obstruction: Causes, Symptoms, Treatment and Cost

Gastric outlet obstruction (GOO) is a condition in which the stomach's outlet is blocked, preventing food and fluids from passing into the small intestine. The blockage can be caused by either a physical obstruction, such as a tumour or scar tissue, or by pressure from enlarged lymph nodes.

Depending on the underlying cause of the obstruction, there are three main types of gastric outlet obstruction: mechanical obstruction, pyloric stenosis and gastroparesis.

• Mechanical Obstruction:Mechanical obstruction occurs when something physically blocks the flow of food through the stomach's outlet. This type of blockage is usually caused by a tumour or an enlarged lymph node pressing against the stomach's opening. Other common causes include scar tissue from previous surgery or trauma to the stomach wall, hiatal hernias, and peptic ulcers.
• Pyloric Stenosis: Pyloric stenosis is a rare condition in which a person’s pylorus (the muscular valve at the bottom of their stomach) becomes narrowed or thickened due to inflammation or overgrowth of muscle tissue. Pyloric stenosis is most commonly seen in infants between one and three months old but can occur in adults as well.
• Gastroparesis:Gastroparesis is a disorder in which normal movement of food through your digestive system slows down or stops due to nerve damage. The nerves that control movement in your digestive system may be affected by diabetes or other conditions such as scleroderma or Parkinson’s disease.

Gastric Outlet Obstruction (GOO) can be caused by a variety of conditions, including:

• Gastric tumours: Tumours that form in or around the stomach can cause GOO. These tumours may be benign, in which case they are not cancerous, or they may be cancerous (cancerous).
• Adhesions: Scar tissue from previous abdominal surgery can form adhesions that block the outlet of the stomach, causing GOO.
• Swelling of the pylorus: The pylorus is a muscular valve at the lower end of the stomach that controls food movement from the stomach to small intestine. Swelling of this valve due to inflammation or infection can lead to GOO.
• Peptic ulcer disease: Inflammation caused by peptic ulcers can cause narrowing and blockage in some cases, leading to GOO.
• Gallstones: Stones that form in your gallbladder may become stuck in your bile ducts, which can lead to obstruction of your stomach outlet and consequent GOO.

• Nausea and or vomiting
• Abdominal pain or cramping
• First signs of fullness (feeling full after eating a small amount of food)
• Bloating
• Poor appetite
• Weight loss

• Consume a number of smaller meals throughout the day rather than three large ones.
• Exercise regularly to help promote regular bowel movements and digestion.
• Quit smoking, if you smoke, as it can worsen symptoms of gastric outlet obstruction and increase risk of complications from the condition.
• Talk to your doctor about medications that may help reduce symptoms and prevent complications from gastric outlet obstruction.

Initial diagnosis of gastric outlet obstruction (GOO) is based on physical examination and the patient's symptoms.

• X-ray: X-rays are often used to diagnose gastric outlet obstruction. During a X-ray, a radiologist will take images of the abdomen. These images can show if there is any blockage in the stomach or intestines that could be causing the gastric outlet obstruction. The X-ray can also help to identify any potential causes, such as tumors or other growths in the digestive tract.
• CT scan: A Computed Tomography (CT) scan is a diagnostic imaging test used to create detailed images of the body. It is often used to diagnose and evaluate gastric outlet obstruction, as it can provide detailed images of the stomach, small intestine, and other organs in the abdomen. The exam typically involves an injection of contrast dye that helps highlight any abnormalities.
• Upper gastrointestinal (GI) series: it can help diagnose GOO by looking at how food moves through your stomach and upper intestine.
• Endoscopy: Endoscopy is a procedure that uses a thin, flexible tube with a camera on one end to look inside your stomach and upper intestine to help diagnose GOO and its cause.
• Laparoscopy: It is another procedure used to diagnose GOO by looking directly at the internal organs in your abdomen with special tools inserted through tiny incisions in your skin.

• Dehydration: Gastric outlet obstruction can lead to dehydration due to an inability to properly absorb nutrients and fluids.
• Malnutrition: Inadequate nutrient absorption can lead to malnutrition, particularly if the obstruction is long-term or chronic.
• Vomiting: Vomiting can occur due to blockage in the stomach and duodenum, as well as a buildup of pressure in the stomach that leads to expulsion of food and fluid through the mouth.
• Infection: A build-up of fluid in the stomach can lead to bacterial overgrowth, which may cause infections such as sepsis or peritonitis.
• Bowel Perforation: In severe cases, gastric outlet obstruction can cause a rupture in the bowel wall, leading to internal bleeding or infection of the abdominal cavity (peritonitis).
• Bleeding: Blockage of small veins near the site of obstruction may cause bleeding from these vessels that could be severe enough to require hospitalization and/or surgery for treatment.

• Ayurvedic herbs such as Triphala, Licorice root, Amalaki and Bael are known to be beneficial in treating gastric outlet obstruction.
• Regular intake of the juice of a lemon mixed with honey is also known to help improve digestion and reduce gastric outlet obstruction.
• Herbal teas such as ginger tea, chamomile tea or peppermint tea can help relieve symptoms associated with gastric outlet obstruction.
• Consuming hot milk with a pinch of turmeric powder before bed may help reduce symptoms of gastric outlet obstruction.
• Eating small meals throughout the day can help prevent further obstruction by allowing food to digest more easily and avoid feeling bloated or full after eating larger amounts of food at once.
• Drinking plenty of water helps keep your system hydrated and prevents bloating or constipation that can lead to blockages in the digestive tract due to digestive waste build-up or indigestible material like fibre or seeds getting stuck in the intestines or stomach lining leading to an obstruction in the gastrointestinal tract.

• Soft, bland foods: Foods that are soft and easy to digest, like mashed potatoes, cooked cereals, oatmeal and applesauce are good choices for people with gastric outlet obstruction.
• Avoid acidic and spicy foods: People with gastric outlet obstruction should avoid acidic and spicy foods, such as citrus fruits, tomatoes, pepper and other spices.
• Eat frequent, small meals: Consuming a greater number of smaller meals throughout the day as opposed to three larger ones may be helpful in alleviating some of the symptoms of gastric outlet blockage.
• Avoid high-fat foods: High-fat foods can be difficult to digest and may worsen symptoms of gastric outlet obstruction.
• Low-fibre foods: Foods that are low in fibre can be easier to digest and help reduce symptoms of gastric outlet obstruction.
• Clear liquids: Drinking clear liquids like water, broth and apple juice can help keep you hydrated while providing essential nutrients.
• Protein-rich foods: Eating protein-rich foods like eggs, fish or lean meats can help your body repair itself and prevent muscle loss due to the condition.
• Dairy products: Dairy products like yoghurt, cottage cheese or milk can provide essential vitamins and minerals while being easy to digest for people with gastric outlet obstruction.

• High-fat foods: Foods that are high in fat, such as fried foods, processed meats, and full-fat dairy products, should be avoided as they are more difficult to digest and can worsen symptoms of gastric outlet obstruction.
• High-fibre foods: Fibre is an essential part of a healthy diet but it can be difficult to digest for someone with a gastric outlet obstruction.
• Spicy foods: Spicy foods can trigger digestive issues in anyone prone to them but they can especially aggravate the symptoms of gastric outlet obstruction. Try to avoid spicy foods as much as possible.
• Carbonated drinks: Carbonated beverages contain gas which can increase pressure on the stomach and make symptoms worse for those with a gastric outlet obstruction. Avoid drinking soda or other carbonated drinks if you have this condition.
• Caffeinated beverages: Caffeine is known to cause digestive issues like heartburn or acid reflux and these effects can be amplified when someone has a gastric outlet obstruction.

• Supportive care: Provide supportive care, including IV hydration, electrolyte correction and pain relief.
• Nasogastric (NG) tube Decompression: Consider nasogastric (NG) tube decompression when the patient is hemodynamically stable and has persistent vomiting.
• Early surgical consultation should be obtained if endoscopic therapy is not feasible or if the patient is hemodynamically unstable or has poor general condition with signs of peritonitis or sepsis.
• Gastrojejunostomy: Depending on the underlying reason and the state of the patient, surgery may entail gastrojejunostomy or resection with anastomosis. Both of these procedures require the connecting of two digestive tracts.
• Laparoscopic surgery: In some cases, laparoscopy may be used to diagnose and treat gastric outlet obstruction with a minimally invasive approach; this is typically used for benign obstructions or those caused by adhesions due to prior abdominal surgery.
• Nutrition support: Nutritional support via total parenteral nutrition (TPN) may be needed in cases where endoscopy and/or surgery is not possible due to patient comorbidities or other factors; this would provide nutrition without passing through a blocked gastric outlet.1. Adequate
• hydration: The patient should be given enough fluids to prevent dehydration.
• Dietary changes: A low-fat, low-fibre diet may help to reduce symptoms of gastric outlet obstruction.
• Medications: Proton pump inhibitors (PPIs) are often used to reduce the production of stomach acid and relieve symptoms of obstruction. Other medications like prokinetics, antispasmodics, H2 blockers may also be prescribed as needed to alleviate symptoms.
• Endoscopic therapy: Endoscopic techniques such as balloon dilation or stent placement can be used to open up a blockage in the gastroesophageal junction (GEJ). This is usually reserved for more severe cases that do not respond to other therapies or when surgery is not feasible due to the patient’s health status.

• The best type of doctor to consult for this condition is a gastroenterologist, as they specialise in digestive diseases and conditions such as Gastric Outlet Obstruction.
• A gastroenterologist can diagnose the condition and recommend treatment options. Additionally, they can provide advice on how to prevent further complications from occurring.
• Other specialists that may be involved in treating Gastric Outlet Obstruction include surgeons and radiologists who can help diagnose the underlying cause of the obstruction and assist with any necessary surgical procedures.
• Nutritionists or dietitians may also be consulted to help ensure proper nutrition during recovery and provide advice on lifestyle changes that can help reduce symptoms associated with Gastric Outlet Obstruction.

• Proton pump inhibitors (PPIs) such as omeprazole, lansoprazole, and pantoprazole can be used to reduce the production of stomach acid and improve symptoms of gastric outlet obstruction.
• H2-receptor antagonists: Some of these drugs, such cimetidine, ranitidine, and famotidine, can also be used to decrease the amount of acid that is produced by the stomach, which in turn helps alleviate symptoms.
• Antacids: Some of the medications, such as magnesium hydroxide and aluminium hydroxide, may give some relief from the symptoms of gastric outlet blockage, but only on a short basis.
• Prokinetics such as metoclopramide can help to speed up digestion and reduce the risk of food getting stuck in the stomach which may help with symptoms of gastric outlet obstruction.

• Recovery time depends on several factors, including the cause of the obstruction, the severity of symptoms, and any additional treatments necessary.
• The cause of GOO will affect recovery time: If the obstruction is caused by a tumor or gallstones, recovery may take longer than if it is caused by an ingested foreign object.
• Severity of symptoms: Patients with severe symptoms may require more intensive treatments that can extend recovery time beyond that of milder cases.
• Additional Treatments: In some cases, patients may need surgery or other treatments in order to fully clear the obstruction and aid in their recovery process.
• Ultimately, each patient's recovery timeline will depend on their individual situation and treatment plan prescribed by their doctor.

• The results of treatment for GOO vary depending on the cause of the obstruction and how it is treated. However, it is important to note that in some cases GOO can recur or worsen over time if not adequately managed.
• In general, medications used to treat GOO are not considered permanent solutions as they often need to be adjusted or changed over time depending on the patient’s response.
• Therefore, while treatment for GOO may provide some level of permanent relief from symptoms, it is important to note that ongoing monitoring and management may be necessary even after successful treatment has been achieved.

Post treatment guidelines for gastric outlet obstruction include:

• Administering intravenous fluids to maintain hydration and electrolyte balance.
• Administering nutrition through an enteral feeding tube or parenteral nutrition as needed.
• Performing x-rays or other imaging studies to assess the progression of the disease and determine if any further surgery is required.
• Monitoring for any signs of infection or complication from the surgery such as bleeding, abscesses, fistulas, etc., and treating them as necessary with antibiotics or other medications as appropriate.
• Encouraging physical activity and a healthy diet to promote healing and prevent complications such as nausea, vomiting, constipation, diarrhoea, etc., which can be caused by gastric outlet obstruction surgery.

The cost of treatment for gastric outlet obstruction in India will depend on a variety of factors, such as the severity of the condition, the type of treatment needed, and where the patient is seeking care. Generally speaking, treatments for gastric outlet obstruction can range from relatively inexpensive to quite costly.

The costs associated with minimally invasive laparoscopic surgeries to complex open surgeries will vary depending on where they are performed and which type is needed.

These treatments are generally less expensive than surgery, but may still cost several hundred dollars depending on which medications or lifestyle modifications are prescribed by your doctor.

Overall, the cost of treating gastric outlet obstruction in India can range from relatively inexpensive to quite costly depending on the severity and complexity of your condition as well as which type of treatment you need and where you seek care.

• Nausea and vomiting
• Diarrhoea
• Abdominal pain and discomfort
• Loss of appetite
• Weight loss
• Dehydration
• Malnutrition
• Infection of the gastrointestinal tract

If you are suffering from any complications relating to Gastric Outlet Obstruction disease then you should consult a doctor nearby as they can cause complications like ' Bowel Perforation and bleeding ' in which treatment courses can range from a few months to years depending on the severity of the situation.