Pyloric stenosis is a condition that affects infants. It is a narrowing of the pylorus (the lower part of the stomach leading to the small intestine) due to thickening of the muscle. This makes digestion difficult because food cannot easily pass through from the stomach to the small intestines. Pyloric stenosis may be present at birth or acquired later in life. It is the most common cause of gastrointestinal obstruction in infants, appearing in approximately 2 out of every 1000 live births. If not treated quickly, the baby will become dehydrated and suffer from electrolyte imbalance. In recent years, prompt diagnosis by ultrasound followed by surgery has dramatically improved the outlook for infants with this condition.
Signs and Symptoms
Pyloric stenosis is often accompanied by the following signs and symptoms:- Vomiting, often projectile (may be intermittent or may occur after each feeding)
- Persistent hunger
- Weight loss
- Dehydration
- Lethargy
- Infrequent or absent bowel movements
- Jaundice (yellowing of the skin and eyes)
What Causes It?
The exact cause of pyloric stenosis is unknown. However, factors that may contribute to its development include heredity; muscle and nerve abnormalities in the stomach region; swelling caused by allergies, leading to enlargement of stomach muscles around the pylorus; increased production of the hormone gastrin, which increases cell growth in the stomach muscles; chromosomal abnormalities; and maternal stress in the third trimester.Who's Most At Risk?
Persons with the following conditions or characteristics are at risk for developing pyloric stenosis:- Age: infants ages 3 to 12 weeks
- Gender: much more prevalent in males
- Race: most common in Caucasians
- Birth weight: low birth weight is associated with lower incidence
- Maternal age: older age and higher education level in the mother is associated with lower incidence
- Infants treated with oral erythromycin may be at increased risk
What to Expect at Your Provider's Office
Pyloric stenosis is a medical emergency. If your baby is experiencing symptoms of pyloric stenosis, call Emergency Assistance, 9-1-1, immediately. The emergency medical team will perform a physical examination, check for gastric symptoms, and use ultrasound to determine whether the thickness and length of the pyloric muscle are abnormal.Treatment Options
Prevention
Avoid use of erythromycin, an antibiotic, in infants. Infants receiving oral erythromycin may be at increased risk for pyloric stenosis. Therefore, healthcare providers must use caution when recommending this antibiotic for infants. Reduce stress during pregnancy, particularly during the third trimester.Treatment Plan
Once emergency measures have been taken, the baby will probably need surgery. Occasionally, drug therapy may be considered prior to or, rarely, instead of surgery.Drug Therapies
In some infants, treatment with atropine sulfate, given intravenously initially and then continued by mouth, has corrected this situation.Surgical and Other Procedures
A surgical procedure called a Ramstedt pyloromyotomy can cure the disease. The infant should have nothing to eat or drink before surgery and for 12 to 24 hours after surgery.Complementary and Alternative Therapies
A woman's nutritional status just before and during pregnancy helps prevent the occurrence of certain abnormalities at the time of or following birth, including pyloric stenosis. Women who are planning to become pregnant should be counseled about proper nutrition. Dietary habits and, in particular, folic acid intake are important. Prenatal vitamins may also supply some of the vital nutrients that the body needs just before conception and during pregnancy.Nutrition
In a 3-year multicenter scientific study, the data revealed that prenatal multivitamins, containing micronutrients including folic acid, may protect against neural tube (the structure that gives rise to the central nervous system) defects as well as other birth defects such as pyloric stenosis.
Folic acid is usually an ingredient in prenatal vitamins. A review of recent studies confirms that using folic acid supplements daily around the time of conception plays a key role in reducing the occurrence of birth defects. The suggested dose is at least 0.4 mg folic acid per day. Daily doses as high as 4 to 5 mg may be necessary in high risk mothers, mothers who have previously given birth to a child with neural tube defects, mothers with diabetes mellitus, and women on antiepileptic medications and other drugs that interfere with folate. Because up to 50% of pregnancies are not planned, all women of childbearing age, especially women who are thinking of getting pregnant, should take folic acid supplements.
Synthetic folic acid, which is a monoglutamate, is preferable to folate that occurs naturally because it is absorbed faster and is more resistant to temperature changes. Folate obtained from food sources is fragile and easily destroyed by the heat of cooking. In addition, dietary folate, which comes as a polyglutamate, has to be converted into the monoglutamate form by the body before it can be absorbed.
Additional nutritional measures that may be helpful in the treatment of pyloric stenosis in infants include the use of probiotics. These substances encourage the growth of normal, helpful bacteria in the intestinal tract. Although scientific studies have not yet established that probiotics are useful for the prevention or treatment of pyloric stenosis, taking a Lactobacillus supplement along with antibiotics may reduce irritation and inflammation in the infant's stomach. The breastfeeding mother can take one capsule with meals. Alternatively, one capsule per day in three divided doses may be given to the newborn (using the powder inside an opened capsule).
Avoiding foods that may cause allergies could also benefit newborns prior to developing pyloric stenosis by decreasing the possibility of stomach upset or colic. Foods that commonly cause allergies include dairy products, peanuts, soy, eggs, fish, and wheat. If you are breastfeeding, then caffeine, spicy foods, beans, and certain vegetables such as broccoli should also be avoided. Non-breastfed infants may do better on a soy formula or a hydrosylate formula because these formulas are easier to digest.
Herbs
Herbal formulas for colic may be helpful for prevention of pyloric stenosis by easing spasms in the stomach and intestines. These formulas typically include dill (Anethum graveolens) and/or chamomile (Matricaria recutita) given to the infant by drops or to the breastfeeding mother. Traditionally, these herbs have been used for treatment of upset stomach. Catnip (Nepeta cataria) may also be included. If you are interested in possibly using herbal remedies, your healthcare professional may be able to counsel you about which ones would be appropriate, or refer you to an herbal specialist.
Homeopathy
Surgery is generally required to cure pyloric stenosis, but one of the following remedies may be used by a professional homeopath to treat the vomiting associated with this condition. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Arsenicum album — for vomiting immediately following ingestion of food or drink; vomiting is accompanied by excessive abdominal pain, restlessness, fatigue, chills, and dehydration
- Bryonia — for individuals whose stomachs are sensitive to touch but may experience relief from lying on the stomach
- Phosphorus — for excessive vomiting immediately following ingestion of food or drink; vomiting is accompanied by weakness, drowsiness, anxiety, restlessness, and dehydration; the infant for whom this treatment is appropriate tends to be mild-mannered and generally to have a good appetite
- Silicea — for vomiting after drinking milk (including breast milk) in those who have a delicate constitution and are slow to develop
Acupuncture may relieve factors that can cause pyloric stenosis and may help in recovery from surgery. However, to date, no scientific studies have fully investigated these uses of acupuncture. Consult your healthcare provider if acupuncture is of interest to you.
Massage
Touch is an important part of infant well-being. Massage may reduce stress and relieve spasms in the stomach and intestines. Although no scientific studies have evaluated the effectiveness of massage in the treatment or prevention of pyloric stenosis, it may be considered in the case of a baby with colic, for example.
Prognosis/Possible Complications
Early and quick diagnosis and treatment are necessary to avoid life-threatening fluid and electrolyte imbalance. If detected quickly, the prognosis for recovery and improved growth is very good. Possible complications include vomiting that persists after surgery, gastritis (inflammation of the lining of the stomach), hiatal hernia, or another obstruction.References
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