S6280 Helicobacter pylori-Associated Pyloric Stenosis Presenting as Duodenal Obstruction in an Adult

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 Helicobacter 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 man with a history of morbid obesity, cerebrovascular accident (cva), type 2 diabetes mellitus, HIV, and hypertension presented to the emergency department complaining of mid epigastric abdominal pain for 2 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. The pyloric lumen was approximately 3 mm lumen in diameter. A dilator catheter was used to dilate the lumen to approximately 18 mm. H. pylori screen testing was positive with antral biopsies confirming chronic gastritis with H. 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 1 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.