SUCCESSFUL MEDICAL-TREATMENT OF PEPTIC PYLORIC-STENOSIS - DR SIPPY REVISITED

Background: Surgery and balloon dilatation are perceived by many as th e principal treatments for peptic pyloric stenosis. We questioned whet her, with the availability of modern acid suppressant treatment, this was still appropriate or whether patients could be managed with medica l treatment alone. Methods: Seventeen consecutive patients with peptic pyloric stenosis were treated with endoscopic gastric drainage, follo wed by oral omeprazole in 15 or cimetidine in two. Gastric emptying ha lf times for solids and liquids were assessed in 11 of the 17 patients when they had become asymptomatic. Results: Endoscopic drainage and m edical treatment successfully relieved symptoms in all 17 patients, al though the gastric emptying studies in 11 patients still showed prolon gation in eight. Symptoms resolved completely after a mean of 28 days. Five patients relapsed when changed from omeprazole to cimetidine tre atment, but all responded to re-starting omeprazole. Four patients rem ain well on cimetidine alone. Conclusions: Medical treatment preceded by endoscopic gastric drainage was effective in all patients in this s eries and may be the preferred choice of treatment in patients with py loric stenosis.