Pyloric stenosis

Pyloric stenosis is a fairly rare condition that affects newborns and infants. The muscles of the pylorus, which are in the lower part of the stomach, get thick and prevent food from reaching the small intestine. Babies may vomit, become dehydrated, and lose weight. They may seem to always be hungry.

Babies with pyloric stenosis need surgical treatment right away to avoid life-threatening dehydration and electrolyte imbalance. Pyloric stenosis happens in about 3 out of every 1,000 births. But surgery can fix the problem.

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Signs and Symptoms

Babies with pyloric stenosis may have symptoms, such as:

• Vomiting, often projectile in the first 3 to 6 weeks of life. Vomiting may come and go or may happen after each feeding.
• Always hungry.
• Weight loss.
• Dehydration.
• Lethargy.
• Few or no bowel movements.
• Jaundice, yellowing of the skin and eyes.

What Causes It?

No one knows what causes pyloric stenosis. Medication, including antibiotics, hormones, and growth factors have all been associated with pyloric stenosis. Genetics may also play a role.

Who Is Most At Risk?

Babies with the following conditions or characteristics are at greater risk for developing pyloric stenosis:

• Baby boys; four times more common in boys than girls.
• First-born infants.
• Most common in Caucasians.
• Bottle-fed infants are more likely to develop pyloric stenosis than breastfed infants.
• Babies who have been exposed to environmental pesticides.
• Babies who have taken certain antibiotics.

What to Expect at Your Doctor's Office

If your baby has symptoms of pyloric stenosis, take the baby to the doctor or the hospital right away. Your doctor will do a physical examination, check for stomach symptoms, and use ultrasound to see whether the thickness and length of the pyloric muscle are abnormal.

Treatment Options

Prevention

DO NOT give the antibiotic erythromycin to infants. Babies receiving oral erythromycin may be at higher risk for pyloric stenosis.

Treatment Plan

Pyloric stenosis is usually treated with surgery.

Drug Therapies

Some babies may get better when given atropine sulfate -- intravenously (IV) at first, and then by mouth.

Surgical and Other Procedures

Usually, laparoscopic surgery resolves pyloric stenosis. The surgeon makes a small incision near the baby's navel and uses a camera and surgical instruments to cut the muscles around the pylorus. Symptoms usually get better around 24 hours after surgery.

Complementary and Alternative Therapies

Pyloric stenosis is a serious condition and should be treated by a medical doctor. Ask your doctor before using any complementary and alternative therapies (CAMs) on an infant.

Making sure that you are eating right and getting enough vitamins and minerals while you are pregnant can help you deliver a healthy baby. Make sure you eat lots of fruits, vegetables, whole grains, dairy, and protein. Take a prenatal vitamin as directed by your doctor. Tell your doctor about any herbs and supplements you are using or considering using.

Nutrition and Supplements

Your baby may lose weight or be undernourished. Ask your doctor how to best help your baby get the nutrients they need after pyloric stenosis has been treated.

If you are breastfeeding, make sure you eat a healthy diet so that the benefits are passed on to your baby. The following nutritional tips may help breastfeeding mothers:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy is present), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Use healthy oils, such as olive oil and coconut oil.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Drink plenty of water every day.

Getting 5 to 10 billion CFUs a day of probiotic supplements (containing Lactobacillus acidophilus) can help maintain good gastrointestinal health. Refrigerate your probiotic supplements for best results. If you are breatfeeding, ask your doctor if your baby would benefit from taking probiotics before taking them. Always ask your doctor before giving your child any dietary supplements.

Herbs

There are no herbs that can treat pyloric stenosis. Pyloric stenosis needs conventional medical care. If you want to use herbs to help your baby recover from surgery, ask your pediatrician which herbs might help. DO NOT give any herbs to your child without asking your doctor first.

Homeopathy

Surgery is generally needed to cure pyloric stenosis. But a professional homeopath may use one of the following remedies to treat the vomiting associated with this condition. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. You should only use homeopathy under the supervision of an experienced homeopath, and in close consultation with the child's pediatrician.

• Arsenicum album. For vomiting immediately following ingestion of food or drink.
• Bryonia. For people 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.
• Silicea. For vomiting after drinking milk (including breast milk) in those who have a delicate constitution and are slow to develop

Massage

Touch is an important part of infant well-being. Gently stroking your baby's hands and feet may reduce stress and be soothing to your baby, especially while in the hospital.

Prognosis/Possible Complications

Your baby needs quick emergency treatment to avoid life-threatening fluid and electrolyte imbalance. If found quickly, the prognosis for recovery and improved growth is very good. Possible complications include vomiting that continues after surgery, gastritis (inflammation of the lining of the stomach), hiatal hernia, or another obstruction.

Supporting Research

Acker SN, Garcia AJ, Ross JT, Somme S. Current trends in the diagnosis and treatment of pyloric stenosis. Pediatr Surg Int. 2015;31(4):363-366.

Carmichael SL, Shaw GM, Yang W, et al. Correlates of intake of folic acid-containing supplements among pregnant women. Am J Obstet Gynecol. 2006;194(1):203-210.

Gallagher S. Omega 3 oils and pregnancy. Midwifery Today Int Midwife. 2004;(69):26-31.

Goh YI, Bollano E, Einarson TR, Koren G. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. J Obstet Gynaecol Can. 2006;28(8):680-689. Review.

Gupta AK, Guglani B. Imaging of congenital anomalies of the gastrointestinal tract. Indian J Pediatr. 2005;72(5):403-414.

Hall J, Solehdin F. Folic acid for the prevention of congenital anomalies. Eur J Pediatr. 1998;157(6):445-450.

Hulka F, Campbell TJ, Campbell JR, Harrison MW. Evolution in the recognition of infantile hypertrophic pyloric stenosis. Pediatrics. 1997;100(2):E9.

Jeckovi M, Lovrenski J, Till V, Luci Z. Ultrasonography in the diagnosis of hypertrophic pyloric stenosis and intussusception -- emergency conditions in pediatric gastroenterology. Med Pregl. 2007;60(9-10):467-472.

Krogh C, Biggar RJ, Fischer TK, Lindholm M, Wohlfahrt J, Melbye M. Bottle-feeding and the Risk of Pyloric Stenosis. Pediatrics. 2012;130(4):e943-e949.

Lowe LH, Banks WJ, Shyr Y. Pyloric ratio: efficacy in the diagnosis of hypertrophic pyloric stenosis. J Ultrasound Med. 1999;18(11):773-777.

Lozada LE, Royall MJ, Nylund CM, Eberly MD. Development of pyloric stenosis after a 4-day course of oral erythromycin. Pediatr Emerg Care. 2013;29(4):498-499.

Naik-Mathuria B. Foregut abnormalities. Surg Clin North Am. 2006;86(2):261-284, viii.

Pandya S, Heiss K. Pyloric stenosis in pediatric surgery: an evidence-based review. Surg Clin North Am. 2012;92(3):527-539.

Shaoul R, Enav B, Steiner Z, Mogilner J, Jaffe M. Clinical presentation of pyloric stenosis: the change is in our hands. Isr Med Assoc J. 2004;6(3):134-137.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-2119.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-596.

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Review Date: 1/1/2017  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.

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