Lorraine Chong Tai, MD1, Haille Joseph, MBBS2 1Broward Health Medical Center, Fort Lauderdale, FL; 2Scarborough General Hospital, Signal Hill, Tobago, Trinidad and Tobago Introduction: Pyloric stenosis is a condition in which the pylorus, the distal portion of the stomach that regulates gastric emptying into the duodenum, becomes thickened and narrowed. While infantile hypertrophic pyloric stenosis is a well-described condition, adult-onset pyloric stenosis is rarely described in literature, and its association with H. pylori requires further recognition. Pyloric stenosis in adults is typically secondary to peptic ulcer scarring, malignancy, or infiltrative diseases; however, chronic inflammation and fibrosis induced by H. pylori can result in luminal narrowing and obstruction.
Case Description/
Methods: A 64-year-old African American male with a History of Morbid Obesity, Cerebrovascular accident (CVA), Type 2 Diabetes Mellitus, Human immunodeficiency virus (HIV) and Hypertension presented to the emergency department complaining of mid epigastric abdominal pain for two days. He endorsed associated chest pain, dysphagia to solids and liquids, nausea and non-bloody non bilious vomiting. He denied any weight loss, fever, chills or diarrhea. Physical exam was remarkable for epigastric abdominal tenderness to palpation without guarding. Laboratory findings were unremarkable. He underwent an endoscopy to further evaluate his symptoms which showed Pyloric Stenosis with an obstruction of the duodenum (Figure 1). The pyloric lumen was approximately 3 mm lumen in diameter. A dilator catheter was used to dilate the lumen to approximately 18 mm (Figure 2). H pylori screen testing was positive with antral biopsies confirming chronic gastritis with Helicobacter Pylori organisms. He was discharged with triple therapy with Amoxicillin, clarithromycin, and Pantoprazole for 14 days for eradication of H pylori. Discussion: Pyloric Stenosis remains a rare entity in adults with less than 300 cases being reported. Adult Hypertrophic Pyloric Stenosis has been associated with several other conditions including peptic ulcer disease, malignancy, and certain inflammatory diseases. To date, only one other case of H. pylori-associated pyloric stenosis in an adult has been reported in the literature. It is hypothesized that H. pylori-associated Pyloric Stenosis is as a result of chronic ulceration and healing resulting in fibrosis and subsequent narrowing of the pyloric channel, culminating in obstruction. This case highlights the need to recognize H. pylori as a potential cause of pyloric stenosis in adults. Early diagnosis and eradication may prevent severe complications including obstruction.
Figure: Figure 1: Endoscopic Narrowing of the Pylorus consistent with Pyloric Stenosis. The pyloric lumen was approximately 3 mm lumen in diameter.
Figure: Figure 2: Endoscopic findings showing lumen of the Pylorus Post Dilation. A dilator catheter was used to dilate the lumen to approximately 18 mm.
Disclosures: Lorraine Chong Tai indicated no relevant financial relationships. Haille Joseph indicated no relevant financial relationships.
Lorraine Chong Tai, MD1, Haille Joseph, MBBS2. P2092 - <i>Helicobacter pylori</i>-Associated Pyloric Stenosis Presenting as Duodenal Obstruction in an Adult, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
