What are the causes of gastrointestinal obstructions?
The gastrointestinal tract is essentially a long tube where food breakdown, digestion, absorption, and waste elimination take place. Different parts of this tube have varying widths according to their functions. However, the entire length of the tract needs to maintain a minimal width to enable proper passage of its contents. Obstructions, on the other hand, occur when there is a narrowing in the diameter of the intestines, which can impede the passage of the intestinal content or even cause complete blockage.
Gastrointestinal obstructions can occur in any part of the digestive system, whether in the upper or lower gastrointestinal tract (including all organs: esophagus, stomach, duodenum, small intestine, and large intestine).
What are the symptoms of obstructions in the gastrointestinal tract?
The symptoms vary depending on the location of the obstruction. In the esophagus, it may manifest as swallowing difficulties (dysphagia). In other areas, symptoms resulting from partial or complete blockage may include severe abdominal pain, abdominal distention, nausea, and vomiting.
What are the reasons for gastrointestinal obstructions?
Gastrointestinal obstructions can arise from various causes, which can be broadly categorized as benign and malignant. Among the common causes are:
- Prolonged exposure of the esophagus to acidic stomach contents in patients with Gastroesophageal Reflux Disease (GERD).
- Growths.
- Inflammatory bowel diseases (such as Crohn's disease and colitis).
- Ingestion of caustic substances that damage the intestinal lining (e.g., cleaning agents).
- Post-radiation therapy in cancer patients with damage to one of the areas of the digestive system.
- Post-surgery complications in the intestines or colon.
How are gastrointestinal obstructions diagnosed?
Diagnosis is determined based on the clinical picture, complaints, and symptoms of the patient combined with appropriate imaging tests to identify the location of the obstruction. Advanced imaging techniques are available nowadays, and the choice of the correct examination is crucial. For instance, not every CT scan is suitable for demonstrating obstructions in the small intestines, and sometimes specific protocols like CT enterography are necessary. Endoscopic examinations are also highly valuable for assessing and diagnosing obstructions.
Imaging Tests:
- Barium Swallow: This test is used to examine the esophagus, stomach, duodenum, and small intestine. It can help locate the problematic area.
- CT Enterography (CT-E): This examination combines the advantages of CT scans, allowing imaging of abdominal organs outside the intestines, with the use of contrast material and reconstruction that allows visualization of the small intestine. The combination of data allows for determining the thickness of the intestinal wall and identifying findings that may not be visible on regular CT scans but can be seen on CT enterography.
- Magnetic Resonance Enterography (MRE): MRI imaging of the small intestine also provides visualization of abdominal organs outside the intestines, as well as reconstructions of the small intestine. An essential advantage of this imaging modality over CT enterography is the absence of radiation.
How are gastrointestinal obstructions treated?
In cases where surgical intervention is not required, the most efficient and accepted treatment worldwide for obstructions is mechanical dilation of the narrowed area using a balloon or the insertion of a stent into the affected region. This allows relief of symptoms and may prevent future obstructions. The choice of treatment depends on the location of the obstruction and the clinical response. Treatment with endoscopy is common in these cases, such as gastroscopy, colonoscopy, or double-balloon enteroscopy. At the Gastro Surgical Institute in Shaare Zedek, there is extensive experience in endoscopic treatment of gastrointestinal obstructions, including inflammatory bowel diseases (Crohn's disease and colitis), without the need for surgery.
Conclusion:
Gastrointestinal obstructions can occur in any part of the digestive system, leading to abdominal pain, bloating, and even complete blockage. Advances in gastroenterology technology have allowed for many non-surgical approaches to diagnose and treat these obstructions, reducing the need for surgical interventions. To determine the appropriate imaging examination for a specific patient and decide on the appropriate treatment, it is recommended to schedule a meeting with a gastroenterologist.