Successful medical treatment of peptic pyloric stenosis: Dr Sippy revisited

Surgery and balloon dilatation are perceived by many as the principal treatments for peptic pyloric stenosis. We questioned whether, with the availability of modern acid suppressant treatment, this was still appropriate or whether patients could be managed with medical treatment alone.

Seventeen consecutive patients with peptic pyloric stenosis were treated with endoscopic gastric drainage, followed by oral omeprazole in 15 or cimetidine in two. Gastric emptying half times for solids and liquids were assessed in 11 of the 17 patients when they had become asymptomatic.

Endoscopic drainage and medical treatment successfully relieved symptoms in all 17 patients, although the gastric emptying studies in 11 patients still showed prolongation in eight. Symptoms resolved completely after a mean of 28 days. Five patients relapsed when changed from omeprazole to cimetidine treatment, but all responded to re-starting omeprazole. Four patients remain well on cimetidine alone.

Medical treatment preceded by endoscopic gastric drainage was effective in all patients in this series and may be the preferred choice of treatment in patients with pyloric stenosis.