What is pyloric stenosis?
Pyloric stenosis is a problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem needing surgery in newborns.
The lower portion of the stomach that connects to the small intestine is known as the pylorus. In pyloric stenosis, the muscles in this part of the stomach enlarge. This narrows the opening of the pylorus and eventually prevents food from moving from the stomach to the intestine.
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What causes pyloric stenosis?
Pyloric stenosis is considered a multifactorial trait. Multifactorial inheritance means that many factors are involved in causing a birth defect. The factors are usually both genetic and environmental. Often one gender (either males or females) is affected more often than the other in multifactorial traits. There appears to be a different threshold of expression. This means that one gender is more likely to show the problem, over the other gender. For example, pyloric stenosis is 4 times more common in males than females. Once a child has been born with pyloric stenosis, the chance for it to happen again depends on the gender of the child already born with the condition, as well as the gender of the next child.
Which babies are at higher risk for pyloric stenosis?
Whites seem to develop pyloric stenosis more often than babies of other races.
Boys develop pyloric stenosis more often than girls.
Pyloric stenosis may be inherited. Several members of a family may have had this problem in infancy.
Why is pyloric stenosis of concern?
Because the stomach opening becomes blocked and babies start vomiting, several problems can happen. The most serious problem is dehydration. When a baby vomits regularly, he or she will not get enough fluids to meet his or her nutritional needs. Babies have smaller bodies than adults and cannot tolerate losing fluid as easily as adults can. Minerals that the body needs to stay healthy, such as potassium and sodium, are also lost as the baby vomits. Babies who lack the right amount of water and minerals in their bodies can become very sick very quickly.
Another problem that happens is weight loss. A baby who vomits most of (or all of) his or her feedings will not have enough nutrition to gain weight and stay healthy.
What are the symptoms of pyloric stenosis?
The most common symptoms noted in a baby with pyloric stenosis is forceful, projectile vomiting. This kind of vomiting is different from a "wet burp" that a baby may have at the end of a feeding. Large amounts of breast milk or formula are vomited, and may go several feet across a room. The baby is usually quite hungry and eats or nurses eagerly. The milk is sometimes curdled in appearance. This is because as the milk remains in the stomach and does not move forward to the small intestine, the stomach acid "curdles" it.
Other symptoms may include:
The symptoms of pyloric stenosis may resemble other conditions or medical problems. Always talk with your child's healthcare provider for a diagnosis.
How is pyloric stenosis diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for pyloric stenosis may include:
Blood tests. These tests evaluate dehydration and mineral imbalances.
Abdominal X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
Barium swallow/upper GI series. A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
What is the treatment for pyloric stenosis?
Specific treatment for pyloric stenosis will be determined by your baby's healthcare provider based on:
Your baby's gestational age, overall health, and medical history
The extent of the problem
Your baby's tolerance for specific medicines, procedures, or therapies
Expectation for the course of the problem
Your opinion and preference
Pyloric stenosis must be repaired with an operation. However, healthcare providers may need to treat your baby's dehydration and mineral imbalances first. Water and minerals can be replaced through intravenous (IV) fluid.
Once your baby is no longer dehydrated, surgery can be performed. Under anesthesia, a small incision is made above the navel and the tight pyloric muscle is repaired. In many cases, surgery can be performed laparoscopically.
What is the recovery time for pyloric stenosis surgery?
Babies can often begin drinking small amounts of clear liquids in the first 24 hours. Generally, clear liquids, such as an electrolyte drink, will be given to your baby first. However, babies may still vomit for several days after surgery due to swelling of the surgical site of the pyloric muscle. The swelling goes away within a few days.
Most babies will be taking their normal feedings by the time they go home. Babies are usually able to go home within 2 to 3 days after the operation.
What is the long-term prognosis for pyloric stenosis?
This problem is unlikely to happen again. Babies who have undergone the surgery should have no long-term effects from it.
- Freeborn, Donna, PhD, CNM, FNP
- MMI board-certified, academically affiliated clinician