Pyloric stenosis

Pyloric stenosis (PS) is a disorder characterized in infants by vomiting right after being fed, along with abdominal aches and constant hunger. Read and find out all about the disease, including its causes, symptoms, diagnosis, and treatment options.

Pyloric stenosis Definition

It is a condition occurring due to the narrowing of the Pylorus, a small opening between the stomach and the duodenum that is circular in shape. The disease leads to an expansion of the pylorus muscles in infants.

Pyloric stenosis Synonyms

The disorder is also known by various other names, such as:

Picture of Pyloric stenosis

Picture 1 – Pyloric stenosis

  • Hypertrophic pyloric stenosis
  • Gastric outlet obstruction
  • Congenital hypertrophic pyloric stenosis

Pyloric stenosis ICD9 Code

The ICD9 Code for the Acquired Hypertrophic form of PS is 537.0 while that of its Congenital Hypertrophic type is 750.5.

What Happens in Pyloric stenosis?

The pylorus is situated at the lower end of the stomach. The pyloric muscles attach the small intestine with the stomach. In healthy individuals, foods easily pass from the stomach through the pylorus to the first section of the small intestine. In people affected with PS, the muscles of the pylorus are thickened. This prevents the entry of food materials into the small intestine of sufferers. The pyloric sphincter gets unusually large in size. Due to obstruction in the entry of the foods, patients suffer from a number of discomforting sensations.

Pyloric stenosis Incidence

About 2-4 out of every 1,000 newborns are found to be affected by this disease. The disease usually affects children less than 3-6 months of age. It is generally diagnosed by the time a child is aged 6 months. It is rare in babies who are over 3 months old.

Pyloric stenosis Causes

It is not known what exactly leads to the thickening of the opening. However, genetic factors might be responsible for the condition. Kids who have parents with the disorder are more susceptible to it.

Gender is also believed to be a causative factor for the disease. The condition affects boys more often than girls.

Pyloric stenosis Symptoms

The condition usually leads to persistent vomiting, which is generally the first symptom exhibited by most children. An affected infant may vomit after every time it is fed or some times after being provided with food. This symptom usually arises when the individual is about 3 weeks old. However, it may begin at anytime between 1 and 20 weeks of age.

A sufferer usually vomits forcefully (Projectile Vomiting), expelling milk, formula foods or other eatables up to several feet away within half-an-hour after being fed. The child feels hunger right after vomiting and may want to be fed again.

Some other discomforting symptoms manifested in a PS sufferer include:

  • Belching
  • Persistent hunger
  • Abdominal pain
  • Dehydration, which gets worse as the vomiting becomes more severe
  • Changes in bowel movement, due to possible constipation
  • Weight loss or inability to gain weight
  • Wave-like contraction of the abdomen soon after food intake and right before vomiting

Parents of children affected by PS should get in touch with a doctor in case they notice any of the following problems:

  • Projectile vomiting
  • Frequent vomiting after eating
  • Abnormal display of irritability
  • Reduced level of activity
  • Failure to gain weight
  • Noticeable weight loss
  • Less frequent urination
  • Noticeably fewer bowel movements

Pyloric stenosis Diagnosis

As aforementioned, the condition is usually detected by the time a baby is 6 months of age. The diagnosis of the disease typically begins with a physical examination of an affected newborn. A doctor may feel the abdomen of the sufferer with fingers to feel whether there is an olive-shaped mass. The presence of it confirms an enlarged pyloric muscle.

Other medical exams for the disease involve:

Ultrasound

It involves use of audio waves to render an image of the stomach of an affected newborn.

Blood tests

Tests aim to detect the possible loss of electrolytes like calcium, potassium, sodium and magnesium. Confirmation of this loss can be an indication of the disease and explain dehydration and persistent vomiting.

Contrast X-ray

In this exam, an affected infant is made to swallow a small quantity of a liquid. The fluid coats the stomach and helps reveal any internal abnormalities more clearly in an X-ray.

Pyloric stenosis Treatment

Sufferers of this condition are usually treated by an operative procedure known as Pyloromyotomy. Surgery is often planned on the same day when the condition is diagnosed. If the baby suffers from an electrolyte imbalance or dehydration, an operation would be planned as soon as possible after the initial symptoms have been taken care of with fluid replacement.

Pyloromyotomy is usually conducted under the effects of general anesthesia. The process was traditionally performed through a tiny incision in the right upper abdomen of the baby. The incision may also be made in the region surrounding the navel of the newborn. These days, however, the operation is often carried out through Laparoscopy. Laparoscopic surgery involves insertion of an apparatus, known as Laparoscope, through the incision. The instrument is fitted with tiny surgical instruments and a laser.

Prior to surgery, an infant may be administered with intravenous (IV) fluids to address imbalance of electrolytes and dehydration. During operation, a surgeon cuts the outer layer of the thickened muscles of the pylori and spreads them apart. The inner pyloric lining is kept undamaged.

Following surgery, an infant may be given IV fluids for a few hours or until the time he or she is able to eat. In rare cases, some vomiting may occur for a few days following operation.

Pyloric stenosis and Medications

Although this condition is usually corrected through surgery, use of atropine sulfate can remedy the problem in some infants. Intravenous, followed by oral, administration of the drug resolves the disease at times.

Pyloric stenosis Natural Treatment

Unfortunately, the disease cannot be treated with any herbs or other natural methods. The disorder requires conventional medical care to be resolved. If you are interested about herbal remedy or any natural curative option as a means of supportive treatment measure, you may discuss the issue with your doctor and ask for guidance.

Massage therapy can be an effective measure in alleviating the stress associated with this disease. Gently stroking the hands and feet of an affected baby can reduce stress related with PS.

Mothers who are breastfeeding babies affected with PS may follow these nutritional tips to ensure better health for their newborns.

Incorporate healthy foods

These include foods rich in antioxidants, which include vegetables like squash and fruits such as cherries, blueberries and tomatoes. Sea vegetables, dark leafy greens (like kale and spinach) and foods high in calcium and B-vitamins (such as whole grains, almonds and beans), tofu (soy) and lean meats should also be consumed in higher quantities.

Avoiding unwholesome foods

These include staying away from refined foods like pastas, sugar and white breads. Red meat products should restricted to a minimum.

Avoid beverages

Coffee and other beverages like alcohol should be avoided. Tobacco products should also be done away with. Mothers should drink plenty of water on a daily basis.

Pyloric stenosis Prognosis

When diagnosed and treated quickly, the outcome is found to be quite good. Most infants with PS tend to return home within two days after the surgery is performed. A doctor attending to an affected newborn may request a follow-up visit after operation to ensure that the rate of progress of the baby.

Patients usually experience complete relief from all discomforting symptoms following surgery. Within several hours after operation, infants can generally tolerate frequent feedings in small quantities. The pace of recovery is quicker in case of Laparoscopy than a traditional open surgery. However, the process leaves a small scar.

Pyloric stenosis Complications

The potential complications of an operation include infection and bleeding. If the muscles of the pylori are not completely severed, the discomforting symptoms associated with PS may recur. However, the risk of problems in the intestine or stomach does not increase with Pyloromyotomy.

Other possible complications involve:

Image of Pyloric stenosis

Picture 2 – Pyloric stenosis Image

Jaundice

In rare circumstances, infants affected with PS also develop Jaundice. An accumulation of the substance Bilirubin, secreted by the liver, leads to a yellowish discoloration of the eyes and the skin.

Irritation of stomach

Persistent vomiting can irritate the stomach of a baby. Mild bleeding may ensue from this type of irritation.

Electrolyte imbalance

The term “electrolyte” refers to minerals like potassium and chloride that get dispersed within the fluids of the body and assist in regulating many important functions – such as heartbeat. An imbalance of electrolytes occurs every time a baby vomits after being fed.

There may also be other problems like vomiting (that continues after operation), hiatal hernia, Gastritis (swelling of the stomach lining) or some other internal obstruction. Treatment is required on an immediate basis to prevent the occurrence of such complications. The body of an infant requires treatment on an emergency basis to prevent imbalance of fluids and electrolytes.

Pyloric stenosis Risk Factors

The risk factors for this condition, or the factors that enhance the susceptibility of a person to this disease, include:

Family history

More than 1 out of 10 PS sufferers is found to have a family member who had been affected by it at some point in his/her life.

Sex

The condition affects males more often than females.

Birth order

Around 1/3rd of PS sufferers are usually found to be firstborns.

Early usage of antibiotics

Newborns administered with some types of antibiotics (like Erythromycin) in the initial weeks after birth for whooping cough (Pertussis) are found to have higher susceptibility to PS. Moreover, those born to mothers who were given some antibiotics in late pregnancy may also have a higher risk of suffering from the disease.

Pyloric stenosis Prevention

The condition can be prevented by avoiding use of the antibiotic Erythromycin in infants. Babies who receive oral doses of this medication are found to be highly susceptible to PS.

If your infant is suffering from constant vomiting after being fed, and exhibiting other signs of PS as well, get in touch with a professional healthcare provider as soon as possible. Proper and timely medical attention will help your newborn make a swift recovery and avoid all potential complications for the toddler.

References:

Hunter AK, Liacouras CA. Pyloric stenosis and congenital anomalies of the stomach. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 321.

Ballard RB, Rozycki GS, Knudson MM, Pennington SD. The surgeon’s use of ultrasound in the acute setting. Surg Clin North Am. 1998;78(2):337-364.

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