Gastric Outlet Obstruction

Overview

Gastric outlet obstruction means the exit from your stomach is narrower or blocked. Your stomach is like a bag that churns food and then passes it into the small bowel (the intestine where most food is absorbed). The opening between them is called the gastric outlet, or pylorus. When that opening gets narrowed or blocked, food and fluid build up in the stomach instead of moving on. This can make you feel very full, sick, and cause vomiting — sometimes of food you ate many hours earlier. It is a sign of an underlying problem, not a disease in itself, and it can often be treated.

It is uncommon in adults but is seen regularly in hospital practice. In babies, the infant form (pyloric stenosis) affects roughly 1 in 300 to 500 newborns, so it is well known to children's doctors.

Adults of any age can be affected, but it is more often seen in older adults, especially when cancer is the cause. It also occurs in people with long-standing stomach or duodenal ulcers, and in people who have had surgery or serious injury to the stomach. Babies with the inherited form are usually affected between 3 and 6 weeks of age and are more often boys.

Symptoms

Common symptoms

• Feeling very full after only a small amount of food
• Feeling sick and vomiting, sometimes with food you ate hours or a day earlier
• Vomiting that is not mixed with green bile, because food is not passing into the bowel
• Bloating and a swollen upper belly
• Upper belly pain or discomfort
• Losing weight without trying
• Losing appetite
• Burping, hiccups, or a sour taste
• Signs of not enough fluid: dry mouth, dark urine, feeling dizzy or faint when standing

Symptoms in children

• In babies: forceful vomiting that shoots out of the mouth after feeds (often described as projectile)
• Seeming constantly hungry, or wanting to feed again straight after vomiting
• Not putting on weight, or losing weight
• Fewer wet nappies than usual
• A wave-like movement across the upper belly just before vomiting
• Older children may describe a full feeling, tummy ache, and vomiting of old food

Symptoms in older adults

• Vague fullness or indigestion that lasts for weeks rather than sharp pain
• Eating less at meals and feeling full quickly, which can be mistaken for normal ageing
• Weight loss and tiredness, or a low blood count (anaemia) found on a blood test
• More chance that a growth or tumour is behind the blockage, so tests are done sooner

Causes

Main causes

• Long-standing stomach or duodenal ulcers that heal with scar tissue and narrow the exit
• Stomach cancer, or cancer of the upper bowel, pancreas, or the tube linking the bile system to the bowel
• Inflammation and scarring from long-term inflammation of the pancreas
• Scarring after long-term use of common painkillers called NSAIDs (a type of painkiller used for arthritis and other pain)
• Scarring after damage from swallowing a corrosive substance
• A blockage caused by a ball of undigested food or hair (called a bezoar), which can happen with some medical conditions
• Problems after stomach surgery, or after severe illness such as extensive burns
• In babies: an overgrown muscle at the stomach's exit (pyloric stenosis), which is usually inherited

Risk factors

• A stomach infection called H. pylori, which is a common cause of ulcers
• Regular use of NSAID painkillers
• Smoking
• A family history of stomach cancer, or living in an area where stomach cancer is more common
• Older age
• Previous stomach or upper bowel surgery
• Swallowing a corrosive substance, or repeated body burns
• In babies, a family history of pyloric stenosis, being a first-born boy, and certain medicines given in early infancy

When to see a doctor

See a doctor urgently if:

• You are vomiting repeatedly and cannot keep fluids down
• You are vomiting blood, or your vomit looks like coffee grounds
• Your stools are black and sticky, or you see blood
• You have severe belly pain, or your belly is hard and swollen
• You feel dizzy, confused, drowsy, or have not passed urine for many hours

Book a routine appointment if:

• New or lasting indigestion or feeling full very quickly
• Bloating or discomfort after eating that does not settle
• Nausea or occasional vomiting over a few weeks
• Losing weight without trying
• A baby who is vomiting forcefully after feeds or not gaining weight

Diagnosis

Your doctor will start by asking about your symptoms and how long you have had them, then examine your belly. They may listen for a splashing sound (called a succussion splash) that suggests fluid sitting in the stomach. Blood tests can show dehydration, low body salts, or a low blood count. The key test is usually a camera test of the upper gut (endoscopy), which lets doctors see the narrowing and take a tiny sample to find the cause. Your doctor will then arrange further tests to work out what is causing the blockage.

Tests that may be done

• Blood tests for fluid balance, salts, and blood count
• A tube passed gently through the nose into the stomach to drain built-up fluid
• An X-ray of the abdomen
• Endoscopy (a thin flexible camera passed through your mouth while you are lightly sedated) with small painless samples taken for testing
• CT scan or a special X-ray using a contrast drink to show the level of the blockage
• An ultrasound scan, which is especially useful in babies
• A test that measures how fast your stomach empties (a gastric emptying study)
• Tests for H. pylori, the stomach infection that causes many ulcers

What to expect at your appointment

You will usually be asked not to eat or drink for several hours before an endoscopy. If your stomach is very full, you may have a small tube placed through your nose into the stomach to drain the fluid and make you more comfortable. Most people have sedation for the camera test and remember very little afterwards. You may need to stay in hospital for fluids, tests, and review by a specialist team, and you will usually be told results within a few days.

Treatment

Treatment has two parts: first, making you comfortable and replacing lost fluid and salts; second, dealing with whatever is blocking your stomach. Many people start to feel better within a day or two once the stomach is emptied and fluids are replaced. The plan your team recommends will depend on the cause, your age, your general health, and your own preferences.

Self-care at home

• Follow your team's advice about when it is safe to start drinking and eating again — usually small sips first
• Eat small amounts more often rather than three big meals, once you are allowed to eat
• Choose softer, easier-to-digest foods to begin with, and chew well
• Sit upright during meals and for about an hour afterwards
• Change your position slowly when standing up, to avoid feeling dizzy
• Keep a simple note of what you eat, what you vomit, and your weight, so you can share it with your doctor
• Ask your pharmacist before taking any painkiller, since some common ones can irritate the stomach
• Stop smoking, and get support to help you if you need it

Medical treatments

Doctors usually start with a drip (intravenous fluids) to correct dehydration and low body salts. A small soft tube may be passed through the nose into the stomach to drain fluid and ease pressure, and you will usually be asked to take nothing by mouth for a while. Anti-sickness medicines can help with nausea. If the cause is a stomach infection called H. pylori or an ulcer, you will be offered treatment to heal it and clear the infection. If there is a narrowed scar, a specialist can stretch it with a small balloon during the camera test, or place a small tube (stent) to keep the passage open, which is often used when cancer cannot be removed. A dietitian may help with nutrition, and some people need a temporary feeding tube or extra nutrition through a drip while the stomach recovers. Your team will explain which options apply to you — never start or stop medicines without asking them.

When is surgery considered?

Surgery is considered when other treatments do not work, when the narrowing keeps coming back, or when a cancer may be removable. In babies with pyloric stenosis, the small operation is usually done within a few days of diagnosis and most babies recover quickly.

Living with this condition

After treatment, most people can go back to a fairly normal diet, but the first few weeks often need gentler eating. Small, frequent meals are easier on the stomach than large ones. Take your medicines as prescribed, keep any follow-up appointments, and tell your team early if the fullness, vomiting, or weight loss comes back rather than waiting.

Lifestyle tips

• Eat slowly, chew well, and pause between mouthfuls
• Avoid very large meals, very fatty or very spicy food at first if they bother you
• Limit alcohol and stop smoking — your doctor can offer practical help
• Avoid NSAID painkillers unless your doctor says it is safe
• Try gentle daily movement such as short walks to support digestion and mood
• Keep a note of your weight so you notice changes early

Diet and exercise

A dietitian can help you build a plan that gives you enough energy and protein in small portions. Soft, moist foods are often easier at first, and you can gradually widen your choices as your stomach empties better. Some people find that eating little and often — say a small meal or snack every few hours — suits them best long term. Gentle, regular activity such as walking helps your gut and your wellbeing; build up slowly after any hospital stay or operation.

Mental health and emotional wellbeing

Being unable to eat normally can be distressing, and it is very common to feel anxious, low, or isolated, especially if you have been in hospital or are waiting for test results. These feelings are understandable and worth talking about. If you ever feel overwhelmed or have thoughts of harming yourself, please reach out straight away — contact your local crisis support line or emergency services, or tell someone you trust so they can stay with you. You do not have to cope alone.

Prevention

You cannot prevent every cause, but some of the most common ones can be reduced. Getting lasting indigestion or ulcer symptoms checked and treated early helps prevent scarring at the stomach's exit. Avoiding unnecessary NSAID painkillers, not smoking, and limiting alcohol also protect the stomach. If you have symptoms that suggest poor stomach emptying, telling your doctor early means it can be looked at before it becomes more serious.

Screening programmes

There is no routine screening test for gastric outlet obstruction itself. However, doctors advise checking for and treating H. pylori in people with ulcer symptoms, and some people with a strong family history of stomach cancer or long-standing indigestion may be referred for an endoscopy. Ask your doctor whether this applies to you.

Complications

If left untreated

• Serious dehydration, which can strain the kidneys and cause dizziness or collapse
• Dangerous changes in the salts in your blood, which can affect the heartbeat and muscles
• Severe weight loss and malnutrition
• Food or fluid going into the lungs (aspiration), which can cause chest infection
• Tearing or perforation of the stomach, which is an emergency
• Shock, which needs immediate hospital treatment

Long-term outlook

Many people make a good recovery. When the cause is an ulcer or a scar, treating it or widening the passage often gets the stomach emptying normally again within days or weeks. When a cancer is the cause, care focuses on relieving symptoms and keeping you comfortable, and treatments such as stents, bypass surgery, and nutrition support can help a great deal. Whatever your situation, telling your team early about new symptoms helps them act sooner, and support is available at every stage.

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