Age and Ageing 2006 35(4):448; doi:10.1093/ageing/afl021
© The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Adult pyloric stenosis—a forgotten entity
Abhay Kumar Das* and
Vivekanand Patil
Pontefract General Infirmary, Medicine for the Elderly, Friarwood Lane, Pontefract, WF8 1PL, UK
* To whom correspondence should be addressed at: Email: abhaylopa{at}yahoo.co.uk
A 73-year-old man was admitted to the medical admission unit with severe metabolic alkalosis (pH 7.62, bicarbonate 53 mmol/l, base excess +30, chloride 93 mmol/l) and acute renal failure (urea 44 mmol/l, creatinine 567 mmol/l) because of persistent vomiting. Before 7 years, a narrow pyloric canal was noted on endoscopy while he was investigated for weight loss. He took Lansoprazole intermittently for epigastric pain. Shortly after admission, he died from ventricular fibrillation.
The prevalence of peptic ulcer disease is decreasing among British population over the years because of Helicobacter pylori eradication and widespread use of acid suppressants [1]. Consequently, elective surgery has also declined dramatically [2]. However, there are older people with complications from previous peptic ulcers whose symptoms will remain at bay with proton pump inhibitors. Severe alkalosis because of pyloric stenosis should be managed in a critical care setting, administering hydrochloric acid through central venous access [3].
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- Kang JY, Tinto A, Higham J et al. Peptic ulceration in general practice in England and Wales 1994–98: period prevalence and drug management. Aliment Pharmacol Ther 2002; 16:1067–74.[CrossRef][ISI][Medline]
- Bardhan KD, Williamson M, Royston C et al. Admission rates for peptic ulcer in the Trent region, UK, 1972–2000: changing pattern, a changing disease? Dig Liver Dis 2004; 36:577–88.[CrossRef][Medline]
- Naka T, Bellomo R. Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit-the role of renal replacement therapy. Crit Care 2004; 8:108–14.[Medline]
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