SHM Converge Scientific Abstract ePoster Gallery-Cancer Until Proven Otherwise: An Unusual Cause of Gastric Outlet Obstruction

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This case describes a 65-year-old woman with opioid use disorder who presented with abdominal pain, vomiting, severe cachexia, and gastric outlet obstruction (GOO). CT showed massive gastric distension, and nasogastric decompression produced coffee-ground output. Endoscopy revealed a 2.5 cm cratered gastric ulcer compressing the pylorus and obstructing gastric emptying. Biopsy showed Helicobacter pylori gastritis with focal intestinal metaplasia.<br /><br />The report highlights that peptic ulcer disease is most commonly caused by H. pylori infection or NSAID/aspirin use, but only a small minority of cases lead to GOO. Obstruction occurs through a combination of acute edema/spasm and chronic fibrosis. In many patients, treating H. pylori reduces inflammation and resolves the obstruction, often within about two months. Recurrent obstruction is uncommon, but refractory cases may require endoscopic balloon dilation or surgery such as gastrectomy.<br /><br />Management in this patient was complicated by several factors. Standard clarithromycin-based therapy was avoided because of QT prolongation concerns and concurrent methadone use. She received quadruple therapy but developed significant side effects, including nausea, abdominal pain, and diarrhea. Because of profound malnutrition, she also required nasogastric tube feeding. Despite initial treatment, she was readmitted less than two months later with recurrent GOO, and repeat endoscopy showed persistence of the ulcer. She was later found dead at home.<br /><br />The case emphasizes that H. pylori-associated GOO is rare but important, and that social and medical barriers can worsen outcomes. In this patient, QT prolongation risk, treatment intolerance, malnutrition, and lack of insurance likely contributed to delayed care, readmission, and poor outcome.

Asset Subtitle

Arti Tewari

Meta Tag

Author List Arti Tewari, David Deshpande, Ethan Molitch-Hou

Category Clinical Vignettes

Concept Peptic Ulcer Disease

Concept Gastric Outlet Obstruction

Concept Helicobacter pylori Infection

Concept Upper Endoscopy

Concept Eradication therapy

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Arti Tewari

Track Adult

Keywords

gastric outlet obstruction

peptic ulcer disease

Helicobacter pylori

gastric ulcer

nasogastric decompression

cachexia

intestinal metaplasia

quadruple therapy

methadone

malnutrition

Peptic Ulcer Disease

Gastric Outlet Obstruction

Helicobacter pylori Infection

Upper Endoscopy

Eradication therapy