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Duodenal or pyloric stenosis

Stenosis is a medical term meaning narrowing.

 

In Infants

Pyloric stenosis in infants typically arises in infants in the first few months of life as a result of hypertrophy (excess growth) of the muscles around the pylorus. In infants it typically presents in first born male babies with projectile vomiting and is treated surgically.

In Adults

In adults pyloric or duodenal stenosis usually arises as a result of scarring in the context of duodenal ulceration, which then leads to gradual narrowing of the outlet of the stomach, or due to tumour, which grows around the gastric outlet or the duodenum and causes progressive narrowing. Pyloric and duodenal stenosis usually present with nausea, vomiting and reduced appetite which often leads to significant unintentional weight loss.

Treatment depends very much on the cause. Patients with gastric or duodenal tumours or cancers often require stenting of the narrowed segment, or on occasional surgery or chemotherapy. Patients with benign disease often require endoscopic dilation. In either case it is important that whilst careful consideration of treatment is undertaken they should have a proper assessment of their nutrition and appropriate steps taken to ensure they are adequately nourished.

Nutrition in such circumstances is where possible best done by feeding into the gut rather than intravenously (into a vein), which caries significant risks over and above those associated with oral or enteral (feeding into the gut) feeding. This may be achieved by a liquid diet, which is able to pass through the narrowing or a naso gastric or naso-jejunal tube, through which liquid nutritional formulations can then be administered.

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