Stenosis of the pylorus of the stomach and esophagus
Definition of pyloric stenosis
Pyloric stenosis (pyloric stenosis) is a complication of gastric ulcer, in which the lumen in this area of the digestive tract narrows and the passage of food into the intestine from the stomach is disrupted. Over time, this pathology leads to the development of severe disorders in the state of the body and a change in homeostasis. Such stenosis occurs in adults and is only acquired.
Reasons for the development of pyloric stenosis
One of the reasons for the development of gastric stenosis is a scar consisting of connective tissue and formed during the healing process of peptic ulcer disease. It tightens the wall of the stomach, makes it inactive.
Another reason for the development of stenosis may be intramural cancer. The neoplasm grows into the tissue, as a result of which the lumen of the gastrointestinal tract narrows. Food, moving along the digestive tract, cannot enter the intestines in full. It stagnates. To evacuate the contents from the stomach, the muscular membrane begins to grow. This to some extent compensates for stenosis.
However, over time, the hypertrophied muscle layer of the stomach cannot cope with the load, and an increase in the volume of the contents of the stomach leads to its stretching. As a result of stagnation, food under the influence of microbes begins to decompose and ferment.
The following stages are distinguished in the disease:
1. The first stage is compensated pyloric stenosis. The hole is slightly narrowed. The patient has complaints of belching with a sour taste, a feeling of a full stomach after eating. Occasionally vomiting occurs, which brings a feeling of relief for a short time. The patient's condition is generally satisfactory.
2. The second stage is the stage of subcompensation. The patient already has a constant feeling of a full stomach, which is combined with belching and pain. Vomiting occurs after a while or immediately after eating, and brings relief. Over time, a person loses weight. On palpation and examination of the abdomen, a splash noise is heard in the navel.
3. The third stage is the stage of decompensation. Over time, the disease progresses, the stomach is distended. The condition deteriorates significantly, depletion and dehydration develop. Vomiting is frequent, does not bring relief. Vomit in large quantities, offensive, have a large amount of remnants of food for many days.
Diagnosis and treatment of gastric pyloric stenosis
Diagnosis of the disease is carried out on the basis of the following studies:
· X-ray examination. In this case, there may be an increase in the size of the stomach, a decrease in peristaltic activity, narrowing of the canal, an increase in the time of evacuation of the contents of the stomach;
· Esophagogastroduodenoscopy. It shows constriction and deformation of the stomach at the exit site, expansion of the stomach;
· Study of motor function (using the method of electrogastroenterography). This method makes it possible to learn about the tone, electrical activity, frequency and amplitude of stomach contractions after meals and on an empty stomach;
· Ultrasound. In later stages, it allows visualization of an enlarged stomach.
Treatment of pyloric stenosis (pyloric stenosis) is only surgical. Drug therapy includes therapy for the underlying disease, preoperative preparation. Anti-ulcer drugs are prescribed, correction of violations of protein, water-electrolyte metabolism, restoration of body weight.
Prevention includes timely treatment of peptic ulcer disease.
Congenital pyloric stenosis
In children, you can find pyloric stenosis of a congenital nature. The disease is often hereditary. With stenosis, there is an overgrowth of connective tissue in the area of the excretory section of the stomach. It is the most common cause of gastric obstruction in infants, with boys being four times more likely than girls.
The disease manifests itself in the second to fourth week of life. The main symptom is frequent and violent vomiting in a "fountain" after feeding. Treatment is only operative. The prognosis after surgery is favorable, provided that the treatment started is timely.
Esophageal stenosis
With congenital stenosis of the esophagus, the cause is an embryonic malformation. The disease manifests itself immediately from the first days of life when feeding a baby. The baby immediately begins to vomit milk. If the stenosis is insignificant, then the symptoms appear with the introduction of solid food.
With acquired stenosis of the esophagus, its lumen also narrows. There are several reasons leading to a violation of the normal patency of the esophagus:
· Cicatricial changes due to inflammatory, infectious diseases, peptic ulcers of the stomach, gastroesophageal reflux disease;
· Injuries, burns of the esophagus;
· Neoplasms of the esophagus and surrounding tissue;
· Aortic aneurysm, enlarged lymph nodes, abnormal arrangement of blood vessels.
The main symptoms of stenosis are: pain when eating, along the esophagus, profuse salivation, belching, sometimes vomiting, bleeding. With esophageal stenosis, the following degrees are distinguished:
1. The first degree is characterized by intermittent disturbance of ingestion of solid food.
2. The second degree is characterized by the passage of only semi-liquid food through the esophagus.
3. Third degree - only liquid food passes.
4. Fourth degree of stenosis - water and saliva are hardly swallowed.
For the purpose of diagnostics, esophagoscopy, X-ray examination with a suspension of barium are performed. Treatment depends on the cause and severity of the disease and will be prompt or conservative. With conservative treatment, correction of nutritional disorders, drug therapy, and bougienage of the esophagus are carried out. Surgical treatment involves plastic surgery of the esophagus, dissection of scars, and a gastrostomy tube.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
