Etiology and Diagnosis of Gastric Outlet Obstruction

  • Michael Paul MearaEmail author


Gastric outlet obstruction is not its own disease process but instead a clinical diagnosis associated with bloating, early satiety, and a general feeling of fullness. This results from a mechanical obstruction of the stomach or immediately distal to the stomach in the duodenum. Historically, the majority of gastric outlet obstruction cases were secondary to poorly controlled peptic ulcer disease (S Ian Gan, FRCP(C), Gastric outlet obstruction in adults, UpToDate [updated 05/27/2016; cited 2017 05/03/2017], 2016). With the discovery of the bacteria Helicobacter pylori in 1982 by Australian doctors Barry Marshall and Robin Worth, the incidence of long-term complications from peptic ulcer disease has dramatically fallen (Lichtman, Oncologist 22:542, 2017). For this discovery, they were awarded the Noble Prize in Medicine in 2005. Since that time, obstruction secondary to peptic ulcer disease has dramatically fallen and has been overtaken by malignancy as the primary cause (Poruk and Wolfgang, Surg Oncol Clin N Am 25(2):327–37, 2016). This chapter will explore the current causative spectrum of gastric outlet obstruction and explore tools useful for diagnosis, including noninvasive and invasive modalities.


Gastric outlet obstruction Peptic ulcer disease Caustic ingestion Gastroduodenal Crohn’s disease Gastric bezoar Pancreatitis Malignant obstruction Pancreatic adenocarcinoma Gastric adenocarcinoma Endoscopic diagnosis 


  1. 1.
    S Ian Gan M, FRCP(C). Gastric Outlet Obstruction in Adults UpToDate; 2016 [updated 05/27/2016; cited 2017 05/03/2017].
  2. 2.
    Lichtman MA. A bacterial cause of Cancer: an historical essay. Oncologist. 2017;22:542.CrossRefGoogle Scholar
  3. 3.
    Poruk KE, Wolfgang CL. Palliative Management of Unresectable Pancreas Cancer. Surg Oncol Clin N Am. 2016;25(2):327–37.CrossRefGoogle Scholar
  4. 4.
    Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Am J Gastroenterol. 1996;91(8):1679.PubMedGoogle Scholar
  5. 5.
    Johnson CD. Gastric outlet obstruction malignant until proved otherwise. Am J Gastroenterol. 1995;90(10):1740.PubMedGoogle Scholar
  6. 6.
    Diaz Blasco J, Garcia Valriberas R. [Resolution of a case of gastric outlet obstruction after eradication of Helicobacter pylori]. Rev Esp Enferm Dig 1998;90(12):890–891.Google Scholar
  7. 7.
    de Boer WA, Driessen WM. Resolution of gastric outlet obstruction after eradication of Helicobacter pylori. J Clin Gastroenterol. 1995;21(4):329–30.CrossRefGoogle Scholar
  8. 8.
    Wallace JL. How do NSAIDs cause ulcer disease? Baillieres Best Pract Res Clin Gastroenterol. 2000;14(1):147–59.CrossRefGoogle Scholar
  9. 9.
    Shim YK, Kim N. [Nonsteroidal Anti-inflammatory Drug and Aspirin-induced Peptic Ulcer Disease]. Korean J Gastroenterol. 2016;67(6):300–312.Google Scholar
  10. 10.
    Ong TZ, Hawkey CJ, Ho KY. Nonsteroidal anti-inflammatory drug use is a significant cause of peptic ulcer disease in a tertiary hospital in Singapore: a prospective study. J Clin Gastroenterol. 2006;40(9):795–800.CrossRefGoogle Scholar
  11. 11.
    Papatheodoridis GV, Sougioultzis S, Archimandritis AJ. Effects of Helicobacter pylori and nonsteroidal anti-inflammatory drugs on peptic ulcer disease: a systematic review. Clin Gastroenterol Hepatol. 2006;4(2):130–42.CrossRefGoogle Scholar
  12. 12.
    Tang CL, Ye F, Liu W, Pan XL, Qian J, Zhang GX. Eradication of Helicobacter pylori infection reduces the incidence of peptic ulcer disease in patients using nonsteroidal anti-inflammatory drugs: a meta-analysis. Helicobacter. 2012;17(4):286–96.CrossRefGoogle Scholar
  13. 13.
    Tabib SM, Assadipoya K, Mansorian R, Nasehy N, Assadi M. Acute gastric volvulus presenting with gastric outlet obstruction and upper gastrointestinal bleeding. Turk J Gastroenterol. 2013;24(3):293–5.CrossRefGoogle Scholar
  14. 14.
    Yau KK, Siu WT, Cheung HY, Yang GP, Li MK. Acute gastric volvulus: an unusual cause of gastric outlet obstruction. Minim Invasive Ther Allied Technol. 2005;14(1):2–5.CrossRefGoogle Scholar
  15. 15.
    Ahmed Z, Mohyuddin Z. Complete gastric outlet obstruction following acid ingestion complicated by acute pancreatitis and disseminated intravascular coagulation. Postgrad Med J. 1997;73(861):421–3.CrossRefGoogle Scholar
  16. 16.
    Sood A, Midha V, Sood N. Gastric outlet obstruction as a late complication of ingestion of diazinon. Indian J Gastroenterol. 2003;22(3):106–7.PubMedGoogle Scholar
  17. 17.
    Wilson WH, Winegarner FG, Jesseph JE. Gastric outlet obstruction following alkali ingestion. Ohio State Med J. 1969;65(10):1000–3.PubMedGoogle Scholar
  18. 18.
    Lebeau R, Coulibaly A, Kountele Gona S, Koffi Gnangoran M, Kouakou B, Yapo P, et al. Isolated gastric outlet obstruction due to corrosive ingestion. J Visc Surg. 2011;148(1):59–63.CrossRefGoogle Scholar
  19. 19.
    Reddy RY, Arun AC, Siddappa PK, Sinha SK, Kochhar R. Inflammatory gastric outlet obstruction after acute pancreatitis: a novel method of treatment. Gastrointest Endosc. 2015;81(3):775–6.CrossRefGoogle Scholar
  20. 20.
    Taylor SM, Adams DB, Anderson MC. Duodenal stricture: a complication of chronic fibrocalcific pancreatitis. South Med J. 1991;84(3):338–41.PubMedGoogle Scholar
  21. 21.
    Spisni R, Giusti S, Iacconi C, Giusti P, Berti P, Conte M, et al. Duodenal Crohn’s disease. Ann Ital Chir. 2007;78(5):439–41.PubMedGoogle Scholar
  22. 22.
    Shapiro M, Greenstein AJ, Byrn J, Corona J, Greenstein AJ, Salky B, et al. Surgical management and outcomes of patients with duodenal Crohn’s disease. J Am Coll Surg. 2008;207(1):36–42.CrossRefGoogle Scholar
  23. 23.
    Tonelli F, Alemanno G, Bellucci F, Focardi A, Sturiale A, Giudici F. Symptomatic duodenal Crohn’s disease: is strictureplasty the right choice? J Crohns Colitis. 2013;7(10):791–6.CrossRefGoogle Scholar
  24. 24.
    Aydin I, Ozer E, Rakici H, Sehitoglu I, Yucel AF, Pergel A, et al. Antral hyperplastic polyp: a rare cause of gastric outlet obstruction. Int J Surg Case Rep. 2014;5(6):287–9.CrossRefGoogle Scholar
  25. 25.
    Vlacancich R, Sultan M, Al-Kawas F. Gastric outlet obstruction caused by prolapsed gastric polyp into the pyloric channel. Clin Gastroenterol Hepatol. 2014;12(5):A27–8.CrossRefGoogle Scholar
  26. 26.
    Kosai NR, Gendeh HS, Norfaezan AR, Razman J, Sutton PA, Das S. Prolapsing gastric polyp causing intermittent gastric outlet obstruction. Int Surg. 2015;100(6):1148–52.CrossRefGoogle Scholar
  27. 27.
    Fonseca J, Nunes G, Patita M, Barosa R, Santos CA. Catheter traction and gastric outlet obstruction: a repeated complication of using a Foley catheter for gastrostomy tube replacement. Nutr Hosp. 2017;34(2):499–501.CrossRefGoogle Scholar
  28. 28.
    Feldstein RC, Leong J, Devito B. Gastric outlet obstruction caused by replacement gastrostomy tube. Clin Gastroenterol Hepatol. 2008;6(7):A26.CrossRefGoogle Scholar
  29. 29.
    Than MM, Witherspoon J, Tudor G, Saklani A. Gastric outlet obstruction secondary to percutaneous endoscopic gastrostomy tube placement. Endoscopy. 2012;44(Suppl 2 UCTN):E269–70.PubMedGoogle Scholar
  30. 30.
    Kalpande S, Pandya JS, Tiwari A, Adhikari D. Gastric outlet obstruction: an unusual case of primary duodenal tuberculosis. BMJ Case Rep. 2017;2017.Google Scholar
  31. 31.
    Ecka RS, Wani ZA, Sharma M. Gastric tuberculosis with outlet obstruction: a case report presenting with a mass lesion. Case Rep Med. 2013;2013:169051.CrossRefGoogle Scholar
  32. 32.
    Upadhyaya VD, Kumar B, Lal R, Sharma MS, Singh M. Rudramani. Primary duodenal tuberculosis presenting as gastric-outlet obstruction: its diagnosis. Afr J Paediatr Surg : AJPS. 2013;10(2):83–6.CrossRefGoogle Scholar
  33. 33.
    Arabi NA, Musaad AM, Ahmed EE, Ibnouf MM, Abdelaziz MS. Primary gastric tuberculosis presenting as gastric outlet obstruction: a case report and review of the literature. J Med Case Rep. 2015;9:265.CrossRefGoogle Scholar
  34. 34.
    Guner A, Kahraman I, Aktas A, Kece C, Reis E. Gastric outlet obstruction due to duodenal bezoar: a case report. Int J Surg Case Rep. 2012;3(11):523–5.CrossRefGoogle Scholar
  35. 35.
    Lu L, Zhang XF. Gastric outlet obstruction--an unexpected complication during Coca-Cola therapy for a gastric bezoar: a case report and literature review. Intern Med. 2016;55(9):1085–9.CrossRefGoogle Scholar
  36. 36.
    Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Yoshida Y, et al. Prognostic scoring system for patients who present with a gastric outlet obstruction caused by advanced pancreatic adenocarcinoma. World J Surg. 2017;41:2619.CrossRefGoogle Scholar
  37. 37.
    Oh SY, Edwards A, Mandelson M, Ross A, Irani S, Larsen M, et al. Survival and clinical outcome after endoscopic duodenal stent placement for malignant gastric outlet obstruction: comparison of pancreatic cancer and nonpancreatic cancer. Gastrointest Endosc. 2015;82(3):460–8.e2.CrossRefGoogle Scholar
  38. 38.
    Otabor IA, Abdessalam SF, Erdman SH, Hammond S, Besner GE. Gastric outlet obstruction due to adenocarcinoma in a patient with ataxia-telangiectasia syndrome: a case report and review of the literature. World J Surg Oncol. 2009;7:29.CrossRefGoogle Scholar
  39. 39.
    Shyr YM, Su CH, Wu CW, Lui WY. Prospective study of gastric outlet obstruction in unresectable periampullary adenocarcinoma. World J Surg. 2000;24(1):60–4; discussion 4–5.CrossRefGoogle Scholar
  40. 40.
    Matsumoto T, Wada M, Imai Y, Inokuma T. A rare cause of gastric outlet obstruction: gastritis cystica profunda accompanied by adenocarcinoma. Endoscopy. 2012;44(Suppl 2 UCTN):E138–9.CrossRefGoogle Scholar
  41. 41.
    Lau JY, Chung SC, Sung JJ, Chan AC, Ng EK, Suen RC, et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc. 1996;43(2 Pt 1):98–101.CrossRefGoogle Scholar
  42. 42.
    Rune SJ. The metabolic alkalosis following aspiration of gastric acid secretion. Scand J Clin Lab Invest. 1965;17(4):305–10.CrossRefGoogle Scholar
  43. 43.
    Vaziri ND, Byrne C, Barton CH, Robertson D, Jay K, McDonald L. Prevention of metabolic alkalosis induced by gastric fluid loss using H2 receptor antagonist. Gen Pharmacol. 1985;16(2):141–4.CrossRefGoogle Scholar
  44. 44.
    Ludtke FE, Bertus M, Voth E, Lepsien G. [Long-term results following conservative and surgical treatment of infantile hypertrophic pyloric stenosis]. Helv Chir Acta 1989;56(1–2):15–17.Google Scholar
  45. 45.
    Yau KK, Siu WT, Li MK. An unusual cause of gastric outlet obstruction. Diagnosis: Bourevet’s syndrome. Gut. 2006;55(3):373. 87CrossRefGoogle Scholar
  46. 46.
    Awan A, Johnston DE, Jamal MM. Gastric outlet obstruction with benign endoscopic biopsy should be further explored for malignancy. Gastrointest Endosc. 1998;48(5):497–500.CrossRefGoogle Scholar
  47. 47.
    Nakai Y, Hamada T, Isayama H, Itoi T, Koike K. Endoscopic management of combined malignant biliary and gastric outlet obstruction. Dig Endosc. 2017;29(1):16–25.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA

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