Overview
Pyloric stenosis is an uncommon condition in infants in which the muscular valve between the stomach and small intestine, known as the pylorus valve, thickens and becomes abnormally large, blocking food from entering the small intestine. This causes forceful vomiting, dehydration, and weight loss. Symptoms appear within 3 to 5 weeks after birth and include vomiting after feeding, persistent hunger, stomach contractions, dehydration, changes in bowel movements, and weight problems. If your baby exhibits any of these symptoms, it's essential to see their doctor. The exact causes of pyloric stenosis are unknown, but genetic and environmental factors might play a role, and it is more common in boys, premature babies, and children of families with a history of the condition.
Understanding the disease
Symptoms
Symptoms of pyloric stenosis usually appear within 3 to 5 weeks after birth. They include:
- Vomiting after feeding: The baby may vomit forcefully, ejecting breast milk or formula up to several feet away. The vomit may sometimes contain blood.
- Persistent hunger: Babies who have pyloric stenosis often want to eat soon after vomiting.
- Stomach contractions: You may notice wavelike contractions that ripple across your baby's upper stomach area soon after feeding but before vomiting. These contractions are part of the digestive process known as peristalsis. Additionally, babies with pyloric stenosis may exhibit symptoms such as dehydration, changes in bowel movements, and weight loss. If you notice these symptoms in your baby, consult their doctor for further evaluation and guidance.
Risk Factors
The risk factors for developing pyloric stenosis include:
- Sex: Pyloric stenosis is more commonly seen in boys, especially firstborn children, than in girls.
- Race and ethnicity: The disorder is more prevalent in white and Hispanic children.
- Premature birth: Pyloric stenosis is more common in premature babies than in full-term babies.
- Family history: Pyloric stenosis is found at higher rates in certain families, with about 20% of male descendants and 10% of female descendants of affected mothers developing the condition.
- Smoking during pregnancy: Women who smoke during pregnancy can nearly double the risk of their baby developing pyloric stenosis.
- Early antibiotic use: Babies given specific antibiotics, like erythromycin for whooping cough, in the first weeks of life have an increased risk. Antibiotics given to mothers late in pregnancy may also contribute to an increased risk.
- Bottle-feeding: Studies suggest that bottle-feeding, particularly with formula, can increase the risk of pyloric stenosis compared to breastfeeding. However, it is unclear whether the increased risk is related to formula or the mechanism of bottle-feeding.
Assessment and Diagnosis
Triage
You should see a doctor if pyloric stenosis is suspected when your baby is showing the following symptoms: projectile vomiting after feeding, persistent hunger, stomach contractions, dehydration, a decrease in wet diapers, changes in bowel movements, and weight problems (either not gaining weight or losing weight). These signs indicate that your baby might have pyloric stenosis and requires medical attention.
Diagnosis
To diagnose pyloric stenosis, a healthcare provider will start with a physical examination where they may feel an olive-shaped lump in the baby's belly, which is the enlarged pylorus muscles. Wavelike contractions may also be visible when examining the baby's belly. Blood tests can be recommended to check for dehydration or electrolyte imbalance, and an ultrasound can be used to view the pylorus and confirm the diagnosis. In some cases, X-rays of the baby's digestive system may also be recommended if the ultrasound results are unclear.
Management and Treatment
Complications
Complications of pyloric stenosis may include dehydration, electrolyte imbalances, and malnutrition due to persistent vomiting and poor weight gain. In severe cases, it may lead to stunted growth and developmental delays. Besides the direct effects of the condition, the repeated forceful vomiting can also cause irritation and inflammation of the esophagus, stomach, or intestines, potentially leading to other complications. It is important to seek medical attention promptly to address the underlying issue and prevent further complications.
Home Remedies
Medical advice and treatment for pyloric stenosis should be provided by a qualified healthcare professional. Surgery is the primary treatment for pyloric stenosis. It is important to consult a pediatrician or a doctor for proper diagnosis and treatment.
Treatment
The primary treatment for pyloric stenosis is surgery. Surgery is the only effective treatment for this condition and is usually recommended to resolve the symptoms and allow the baby to gain weight and thrive. After surgery, most babies can resume a normal diet and experience a significant improvement in their condition.