Adult hypertrophic pyloric stenosis

　　The pathological changes of adult hypertrophic pyloric stenosis show that the pyloric muscle layer is significantly thickened to 2-4 cm, with thickening in a circular or spindle shape. The circular muscle fibers are thickened and irregularly arranged, and the mucosa and submucosal tissue may be edematous with inflammatory changes. In some cases, local hyperplasia is caused by fibrous connective tissue replacement hyperplasia.

　　As for the etiology of adult hypertrophic pyloric stenosis, it is not very clear at present. Adult hypertrophic pyloric stenosis is generally divided into two types, namely primary and secondary. Most of the reported cases in the first half of the 20th century were secondary. The main accompanying conditions include gastric ulcer, duodenal ampulla ulcer, history of cancer or postoperative adhesion, and gastric stone, which are related to the long-term spasm of the pyloric sphincter due to local inflammation and ulcers. Some people believe that the disease is the continuation of infantile hypertrophic stenosis, with 20% having a history of vomiting and surgery after birth. Primary cases are rare and are mostly the continuation of congenital hypertrophic pyloric stenosis, with no obvious gastrointestinal symptoms after birth, often manifesting in adulthood. But there have been cases reported in a family where both childhood onset and adult onset can occur. 80% of the cases are male patients, with a wide range of onset ages. In some cases, routine gastric barium meal examination has a detection rate of only 0.04% to 1%.

　　Adult hypertrophic pyloric stenosis may have complications such as pyloric obstruction, gastric ulcer, mucosal erosion, bleeding, and cancer. Particularly prominent is the discomfort in the upper abdomen, which is often due to dyspepsia and other conditions.

　　The symptoms of adult hypertrophic pyloric stenosis include upper abdominal discomfort, dyspepsia, hypertrophy of the pyloric muscle, and pyloric pre-ulcer. We divide adult hypertrophic pyloric stenosis into three types:

　　1. There is a sense of discomfort in the upper abdomen, with periodic vomiting since infancy,即从婴儿及儿童期有间歇性幽门功能障碍表现，and intermittent pyloric dysfunction is present from infancy and childhood until entering adulthood. However, some primary cases have no history of repeated vomiting in infancy.

　　2. Upper abdominal discomfort and dyspepsia symptoms begin in adulthood, with pain加重伴呕吐as a common symptom after eating.

　　3. Pyloric obstruction symptoms appear only from middle age to old age, with a short history of ulceration, but progressive, and may be accompanied by bleeding. After detailed examination, the final surgery only found hypertrophy of the pyloric muscle.

　　The clinical symptoms are related to the degree of pyloric stenosis and the duration of the disease, and may be asymptomatic. Symptoms usually appear in adulthood,表现为餐后上腹部饱胀不适或有餐后呕吐，after meals, with postprandial upper abdominal fullness and discomfort or postprandial vomiting. The discomfort in the upper abdomen is relieved after vomiting,呈间歇发作，and presents intermittently. Pyloric pre-ulcer is often associated with the above symptoms, with rare signs, rarely palpating a thickened pyloric canal, and severe cases may have signs of pyloric obstruction.

　　The etiology of adult hypertrophic pyloric stenosis is not very clear, and it is generally divided into two types: primary and secondary. If it is caused by secondary causes, such as local inflammation of the stomach or ulcers, it is particularly important to prevent the primary disease. Pay attention to the ten戒 in life.

　　The first戒: Do not have long-term mental stress

　　Long-term mental stress can affect the autonomic nervous system through the cerebral cortex, causing vasoconstriction of the gastric mucosal blood vessels, dysfunction of the gastric function, excessive secretion of gastric acid and pepsin, leading to gastritis and ulcers. In clinical observations, patients with long-term stress, anxiety, and depression have a significantly higher incidence of gastric ulcers and duodenal ulcers.

　　The second戒: Do not overwork

　　Whether engaged in physical labor or intellectual labor, one cannot overwork, otherwise it will cause insufficient blood supply to the digestive organs, disordered secretion of the gastric mucosa, and lead to various stomach diseases.

　　The third戒: Do not have unbalanced eating habits

　　Unbalanced eating habits can cause great harm to the stomach. During hunger, the stomach is empty, and the secretion of gastric acid and pepsin by the gastric mucosa can easily harm the gastric wall, leading to acute or chronic gastritis or ulcers. Overeating can cause the gastric wall to over-expand, and food to stay in the stomach for too long, which is also easy to cause acute or chronic gastritis or ulcers, or even acute gastric dilatation and gastric perforation.

　　The fourth戒: Do not drink excessively

　　Alcohol can cause hyperemia, edema, and even erosion and bleeding of the gastric mucosa, leading to ulcers. Long-term alcohol consumption also damages the liver, causing alcoholic cirrhosis. The occurrence of pancreatitis is also related to excessive alcohol consumption, which in turn aggravates the damage to the stomach.

　　The fifth戒: Do not be addicted to smoking

　　Smoking can cause vasoconstriction of the gastric mucosal blood vessels, reducing the synthesis of prostaglandins in the gastric mucosa, which is a protective factor for the gastric mucosa. The reduction of prostaglandins can harm the gastric mucosa. Smoking also stimulates the secretion of gastric acid and pepsin, so being addicted to smoking is an important cause of various stomach diseases.

　　The sixth戒: Do not drink strong tea and coffee

　　Strong tea and coffee are central nervous system stimulants that can cause hyperemia of the gastric mucosa, disordered secretion function, and destruction of the mucosal barrier through neural reflexes and direct effects, leading to the occurrence of ulcer disease. In addition, foods that are strongly stimulating to the stomach should be eaten in moderation.

　　The seventh戒: Do not eat quickly and without proper chewing

　　Chewing slowly and thoroughly is beneficial for digestion. Eating quickly and without proper chewing increases the burden on the stomach. Studies have also found that when chewing slowly, saliva secretion increases, which can protect the gastric mucosa and avoid damage from harmful stimuli.

　　The eighth戒: Do not eat before going to bed

　　Eating before going to bed not only affects sleep but also stimulates the secretion of gastric acid, which is prone to induce ulcers.

　　The ninth戒: Do not maintain hygiene

　　It has been found that Helicobacter pylori infection is the primary cause of gastritis, ulcers, and gastric cancer. It can be transmitted through tableware, toothbrushes, kissing, and other means. Therefore, maintaining hygiene, not using others' tableware or toothbrushes, can prevent Helicobacter pylori infection and thus prevent various stomach diseases.

　　Ten戒 against drug abuse

　　Many drugs can damage the gastric mucosa after long-term use, leading to erosive gastritis, hemorrhagic gastritis, and gastric ulcer. Among them, there are three types of commonly used drugs that can damage the gastric mucosa: one is antipyretic and analgesic drugs such as aspirin, phenylbutazone, indomethacin, etc.; one is hormone drugs such as prednisone, dexamethasone; and the other is antibacterial drugs such as erythromycin. Pay attention to strictly follow the doctor's advice and use these drugs carefully to avoid causing damage to the stomach.

　　Examinations for adult hypertrophic pyloric stenosis include laboratory tests and other auxiliary examinations. Laboratory tests refer to diagnosing through histological examination. Among other auxiliary examinations, gastroscopy and X-ray barium meal are commonly used examination methods. Gastroscopy can see changes in gastritis, pre-pyloric ulcer, and when obstruction occurs, the pylorus is obviously narrowed with smooth edges. X-ray barium meal shows a narrow and long pyloric canal, with small triangular pouch-like protuberances on one or both sides of the middle segment, which can disappear after local pressure. The mucosal folds of the lumen are generally arranged in a longitudinal direction, and sometimes they are also relatively curved in an irregular shape. A crescent-shaped depression appears at the base of the duodenal ampulla, which is caused by part of the hypertrophic pylorus.

　　It should be noted that this disease should be differentiated from pyloric spasm, duodenal obstruction, achalasia of the esophagus, gastric volvulus, and other non-obstructive vomiting.

　　The diagnosis of the disease is relatively difficult. If the clinical manifestations are similar to the disease, further examination should be carried out to clarify. Gastric retention often increases, and gastric acid secretion is normal. Endoscopy and X-ray barium meal can help with diagnosis. The diagnosis relies on pathological tissue examination.

　　(1) Choose easily digestible liquid food such as vegetable soup, congee, egg soup, egg custard, milk, etc.

　　(2) Eat light and non-greasy food, which not only meets the nutritional needs but also increases appetite. It can provide white rice porridge, millet porridge, red bean porridge, and accompany with sweet preserved vegetables, turnip, pickled radish, or bean curd as side dishes, with lightness and freshness as the preference.

　　(3) Ensure adequate water intake, and drink more acidic fruit juices such as hawthorn juice, kiwi juice, red date juice, fresh orange juice, watermelon juice, etc., to promote gastric juice secretion and increase appetite.

　　(4) Eat more foods rich in vitamin C, E, and red ones, such as tomatoes, apples, grapes, jujubes, strawberries, beets, oranges, watermelons, and milk, eggs, etc., to prevent the occurrence of colds.

　　(5) Eat small and frequent meals. After fever subsides and appetite improves, semi-liquid food can be changed, such as noodles in soup, clear chicken soup with Vermicelli, small wontons, vegetable porridge, meat flake porridge, liver paste porridge, egg flower porridge.

　　Traditional Chinese medicine differential diagnosis and treatment for adult hypertrophic pyloric stenosis:

　　Syndrome of deficiency-cold in spleen and stomach

　　Symptoms: Abdominal distension and fullness after eating, vomiting in the morning or evening, vomiting un消化d digested food and thin fluid, symptom relief after vomiting, fatigue, aversion to cold, cold limbs, loose stools, pale tongue, white fur, weak pulse.

　　Therapeutic Method: Warm and invigorate the spleen and stomach.

　　Principal Formula: Li Zhong Decoction combined with Xiang Sha Liu Jun Zi Decoction

　　Additions and Subtractions: For those with kidney-yang deficiency, add Shu Fu Pian; for those with qi stasis and blood stasis, add Dan Shen, San Qi, Taoren, and Su Geng; for those with food retention, add Shen Qu, Zhi Shi, Sha Zhang, and Mai Ya.

　　Syndrome of Stomach-Heat and Reverse Flow

　　Syndrome: Abdominal distension and fullness, vomiting in the morning and eating in the evening, or vomiting in the evening and eating in the morning, undigested food in the vomit with a foul and sour smell, dry lips and thirst, restlessness and poor sleep, dark urine, constipation, red tongue, yellow or greasy tongue coating, slippery and rapid pulse.

　　Therapeutic Method: Cool the stomach and reverse the flow.

　　Principal Formula: Zhu Ru Decoction

　　Additions and Subtractions: Generally, it is advisable to remove生姜 and Da Zao, and add Huang Qi, Coptis, Da Huang, and Zhi Shi; for those with deficiency of both stomach-qi and yin, remove生姜, and add Xiyang Shen, Mai Dong, and Shí Hu; for those with blood stasis blocking the stomach collaterals, add Dan Shen, San Qi, Taoren, and Yu Jin.

　　Syndrome of Cold Fluid Retention in the Stomach

　　Syndrome: Severe abdominal and anal fullness, possibly palpable mobile mass in the upper abdomen, vomiting in the morning and eating in the evening, or vomiting in the evening and eating in the morning, or vomiting shortly after meals, undigested food in the vomit, mixed with phlegm and fluid, gastrointestinal gurgling sounds, dizziness, palpitations in the chest, white and slippery tongue coating, wiry and slippery pulse.

　　Therapeutic Method: Warm the stomach and resolve fluid retention.

　　Principal Formula: Ling Gui Zhu Ye Decoction combined with Daoyan Decoction

　　Additions and Subtractions: For those with deficiency of stomach-yang, add Dried Ginger and Wu Zhu Yu; for those with qi stasis and blood stasis, add Taoren, Hong Hua, Dan Shen, and Yu Jin; for those with deficiency of stomach-qi, add Ginseng and Huang Qi.

　　Syndrome of Blood Stasis Blocking the Stomach Collaterals

　　Syndrome: Abdominal distension and fullness, or accompanied by stabbing pain and resistance to pressure, more severe after meals, there may be a mass in the upper abdomen, vomiting in the morning and eating in the evening, or vomiting in the evening and eating in the morning, or vomiting yellow foam, or vomiting brown turbid fluid, or vomiting blood and hematochezia, purple and dark tongue coating with spots, wiry and涩 pulse.

　　Therapeutic Method: Resolve blood stasis and harmonize the stomach.

　　Principal Formula: Ge Xia Zhu Yu Decoction

　　Additions and Subtractions: For those with deficiency-cold in the spleen and stomach, remove Wu Ling Zi, Chi Shao, and Dan Pi, and add Ginseng, Bai Zhu, Dried Ginger, and Bibo Tiao; for those with cold fluid retention in the stomach, remove Chi Shao and Dan Pi, and add Dried Ginger, Wu Zhu Yu, Fa Xia, and Fu Ling; for those with stomach-heat and reverse flow, remove Xiang Fu and Wu Yao, and add Coptis, Zhu Ru, and Su Ye.

　　Syndrome of Food Retention in the Gastrointestinal Tract

　　Syndrome: Abdominal distension and pain that is resistant to pressure, belching and vomiting of sour food, nausea and aversion to food, abdominal pain and intestinal noise, stools with an odor like rotten eggs, thick and turbid tongue coating, wiry and slippery pulse.

　　Therapeutic Method: Promote digestion and relieve retention.

　　Principal Formula: Bao He Wan

　　Additions and Subtractions: For those with deficiency-cold in the spleen and stomach, remove Forsythia and add Ginseng, Dried Ginger, Bai Zhu, and Braised Licorice Root; for those with stomach-heat and reverse flow, add Coptis, Su Ye, Zhu Ru, and Pipaye; for those with cold fluid retention in the stomach, remove Forsythia and add Wu Zhu Yu, Dried Ginger, Fa Xia, and Fu Ling.