Secondary to Chronic Peptic Ulcer Disease

Presented in 15th World Gastroenterology, IBD & Hepatology Conference from December 17-19, 2025, in Dubai, UAE & Online. 
Speaker Name: Dr. Mahmood Albo Ahmed
Location: UK
Category: (Speaker/Oral Presentation)
Affiliation: Internal Medicine Trainee
Organization: Leeds Teaching Hospitals

Biography: Dr Mahmood Albo Ahmed is a medical doctor currently working as an Internal Medicine Trainee (IMT2) with Leeds Teaching Hospitals NHS Trust. He holds the MRCP (UK) qualification and is currently pursuing a Master’s degree in Gastroenterology at the University of South Wales. He has a strong interest in gastroenterology and has prior experience managing a wide range of gastrointestinal disorders. He is actively preparing for higher specialty training in the UK. Dr Albo Ahmed has presented at international conferences and is passionate about academic medicine, quality improvement, and evidence-based practice. His current focus includes upper GI pathology, patient-centred care, and improving endoscopy outcomes.

Global Journal of Gastroenterology & Hepatology Research [GJGHR]
Visit Speaker page: https://gastroenterology.utilitarianconferences.com/speaker/dr-mahmood-albo-ahmed

Background

Obstruction of Gastric Outlet (GOO) is a complication of peptic ulcer disease (PUD) series. Incidence has fallen with better H. pylori management and PPI therapy. Clinical presentation of GOO is typically with postprandial vomiting, early satiety, and weight loss. One of the common causes is chronic PUD, malignant Crohn’s disease, and pancreatic cancer. A high level of clinical suspicion — particularly in areas where PUD remains untreated.

Pathophysiology of GOO

• Chronic inflammation from PUD leads to fibrosis and scarring in the pyloric channel.
  • This causes narrowing and impaired gastric emptying.
  • Residual food retention leads to nausea, vomiting, and metabolic alkalosis.
  • Over time, nutritional deficiencies and dehydration can occur.

Case Presentation

48-year-old M, no past medical history.
• Symptoms: early satiety and postprandial vomiting, 10 kg weight loss over 6 weeks
• Vitals: BP regular, mild tachycardia; dry mucous membranes.
• Biochemistry: hypokalaemia, hypochloraemic metabolic alkalosis.
• Urgent referral with suspicion of obstructive upper GI pathology

Diagnostic Workup

Initial labs: CBC, electrolytes, renal function.
Imaging:
– Abdominal X-ray: dilated stomach with fluid level.
– Upper GI endoscopy: tight pyloric stenosis, residual food, inflamed duodenal bulb.
Biopsies: negative for malignancy.
Diagnosis: GOO secondary to chronic duodenal ulceration.

Management Strategy

Initial stabilization:
– IV fluids and electrolyte repletion.
– Nasogastric decompression.
– Proton pump inhibitor (PPI) therapy.
Definitive treatment:
– Endoscopic balloon dilatation of pyloric stenosis.
– Triple therapy for eradication of H. pylori.
– Dietician for nutritional support.

Patient Outcome

• No complications with balloon dilatation.
  • Stepwise resumption of oral intake.
  • Received 3.5 kg in the first 4 weeks.
  • Symptoms wholly resolved.
  • Here in 3 months for repeat endoscopy.

Discussion

GOO is an uncommon but relevant diagnosis in contemporary GI practice.
• Non-malignant etiologies (especially chronic PUD) should be suspected, particularly among marginalized populations.
• Endoscopic management is a safe and effective approach for these individuals without surgical intervention.
• Early detection leads to prevention of malnutrition and long-term complications.

Learning Points

• Always consider GOO in patients with persistent vomiting and weight loss.
  • Endoscopy is both diagnostic and therapeutic.
  • Chronic PUD can still present with serious complications.
  • Early multidisciplinary input improves outcomes.

References

• Liao, J.G., Fang, L., Jin, M. and Liu, J. (2018). Gastric outlet obstruction: current status and future directions. World Journal of Gastroenterology, 24(25), pp.2652–2662.
• Sung, J.J.Y., Kuipers, E.J. and El-Serag, H.B. (2009). Systematic review: the global incidence and prevalence of peptic ulcer disease. The Lancet, 374(9690), pp.1435–1444.
• National Institute for Health and Care Excellence (NICE). (2014, updated 2019). Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184).
• Khashab, M.A. and Kalloo, A.N. (2011). Endoscopic treatment of benign gastric outlet obstruction. Clinical Gastroenterology and Hepatology, 9(2), pp.108–112.

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