17. Gastric outlet obstruction (GOO)

It occurs in less than 5% cases of PUD. Duodenal ulcer and pyloric channel ulcer are generally associated with GOO. Pathophysiologically, reversible causes like inflammation, edema, spasm, and pyloric dysmotility and irreversible cause like fibrosis may lead to GOO. Patients present with nausea, vomiting, early satiety, epigastric pain, and weight loss. Patients may develop severe dehydration, azotemia, hyponatremia, and hypochloremic and hypokalemic metabolic alkalosis with paradoxical aciduria due to prolonged vomiting. First, the fluid and electrolyte deficit should be corrected. Gastric contents should be removed by large-bore Ewald tube, and then intermittent nasogastric tube suction should be continued for a few days. Many cases of GOO due to PUD have reversible components which may respond to this conservative treatment. Patients not responding to the conservative treatment need endoscopic dilation or surgery [82, 83].
