An 11-year-old female spayed Burmese cat presented with a history of several years of chronic intermittent vomiting of undigested food. Clinical signs had begun with vomiting 7 years previously and increased in frequency so that by the time of presentation, the cat was vomiting chronically a few times a week. Vomiting with food generally occurred directly after food ingestion (within 15–30 mins) but occasionally after a few hours without food. Diet changes advised by the referring veterinarian (renal diet, hypoallergenic diet, mono-protein diet) had not been effective. PCR was negative for Helicobacter species in the faeces. Previous medical treatment with a proton pump inhibitor (Lansoprazol AL; Aliud Pharma) and sucralfate (Sucrabest; Combustin) was unsuccessful. The cat was showing increasing discomfort after eating and had one episode of haematemesis, and was referred for further evaluation and endoscopy. On presentation, the patient was alert, responsive and had a normal body condition. A systolic heart murmur grade II/VI was found on auscultation. Ultrasonographic examination of the abdominal cavity showed no foreign material in the pylorus () and a slightly thickened pyloric muscular layer (). A haematological profile and clinical chemistry panel, as well as feline pancreas-specific lipase and total thyroxine concentrations, were within the reference intervals, thus giving no evidence of any extragastrointestinal causes. Based on the owner’s description of the cat’s problems, regurgitation could not be completely excluded. Fluoroscopy was unavailable, so an oral contrast study was conducted. Three minutes after barium sulfate 2 ml/kg (Micropaque; Guerbet) had been given orally, thoracic radiographs revealed some contrast medium in the oesophagus at the heart base (). After 10 mins, the whole of the contrast medium had passed into the stomach (). An oesophageal dilation or an oesophageal motility disorder were strongly suspected, but the clinical presentation and history were atypical and therefore it was decided to perform an oesophagogastroduodenoscopy. Endoscopy revealed an oesophagus of normal appearance without any signs of megaoesophagus. The pyloric region showed a significantly narrowed pyloric lumen compared with the size of a 2.3 mm biopsy forceps (). Several biopsies were taken from the pyloric region. Therapy with lansoprazole (1 mg/kg PO q12h [Lansoprazol AL; Aliud Pharma]) and sucralfate (60 mg/kg PO q8h [Sucrabest; Combustin]) was started. Histopathological examination of the pyloric biopsies revealed moderate chronic erosive lymphoplasmacytic and mild eosinophilic hyperplastic gastritis with mild-to-moderate mucosal fibrosis. No neoplastic process was found. In the pathologist’s report, it was suspected that the fibrosis could have contributed to the pyloric stenosis. As the inflammation was not pronounced and anti-inflammatory treatment was not effective, surgical treatment of the fibrosis was suggested. The severe pyloric obstruction was treated surgically by Y-U pyloroplasty (). A full-thickness biopsy was taken from the pyloric sphincter. Histopathological examination of the pyloric sphincter biopsy showed focal hyperplasia of the pyloric smooth muscles (). No inflammatory, fibrotic or neoplastic process was found. The biopsy taken from the duodenum had a normal appearance and there were no signs of any inflammatory process. No other biopsy samples were taken from the gastrointestinal tract. The cat was hospitalised after surgery and discharged after 4 days. Treatment with lansoprazole (Lansoprazol AL; Aliud Pharma) was continued postoperatively and tapered out after 1 week. Three weeks postoperatively, the cat was presented for a follow-up appointment. The owner mentioned lethargic behaviour after feeding during the first week and three episodes of vomiting directly after food intake since discontinuing lansoprazole. The ultrasonographic examination showed normal peristalsis of the gastrointestinal tract, an open lumen of the pylorus and chymus in the most proximal duodenum (). Lansoprazole was reinstituted and the owner reported no further vomiting when the cat was fed tinned food of one commercial brand based on various animal protein sources. According to the owner, hypoallergenic diets were not accepted by the cat. To document pyloric viability, a follow-up contrast study was conducted, which demonstrated prompt gastric emptying and good intestinal propulsion () after the oral administration of barium sulfate 10 ml/kg. The cat was discharged with lansoprazole (1 mg/kg PO q24h) for the next 6–12 weeks. The patient did not have further gastrointestinal signs during the 6-month follow-up period.