Dysfunction of the pyloric region of the stomach: mechanisms of occurrence, diagnosis and treatment

Pyloric dysfunction is defined as hypertonicity or spasm of the pyloric sphincter. The pylorus plays a key role in the evacuation of gastric juice, but its function remains poorly understood, as most studies on the diagnosis of gastroparesis, regardless of its underlying pathophysiology, focus on the sphincter. Given the insufficient understanding of diagnostic and therapeutic approaches to pyloric dysfunction, it has been described in only a few studies examining patients with gastroparesis. However, the introduction of high-resolution antroduodenal manometry and endoluminal functional imaging into clinical practice will require a new approach to assessing pyloric function. Furthermore, new therapeutic approaches have been proposed for the development of pylorus, including pharmacological therapy, intrapyloric botulinum toxin injections, endoscopic balloon dilation, stent placement, pyloroplasty, and, consequently, peroral endoscopic pyloromyotomy. Among perineal endoscopic gastric pyloromyotomy, a new, minimally invasive treatment method with proven efficacy and safety has been established for refractory gastroparesis. This article examines the pathophysiological aspects of pyloric dysfunction and evaluates the effectiveness and potential of diagnostic and therapeutic methods, taking into account the latest literature.