A health condition in which the muscle between the stomach and small intestine narrows or thickens is called pyloric stenosis. Sometimes, it is called hypertrophic pyloric stenosis (HPS), and it may cause forceful vomiting that may lead to malnourishment and dehydration. The muscle located between the stomach and small bowel is called the pylorus. It allows the food to pass from the stomach into the small intestine. Usually, doctors recommend surgery to treat this condition.
While some babies vomit after feeding, some of them may experience this symptom after some feedings. In most cases, babies are not born with this condition. The thickening of the pylorus appears within several weeks after birth. You may notice symptoms in your child within 3-6 weeks. In such cases, it is essential to consult a doctor, as vomiting can lead to dehydration and malnutrition.
This condition affects about 1 to 3.5 out of every 1,000 newborns. At the same time, it is the most frequent disorder that requires surgery in infants.
Symptoms
Check below some symptoms that babies with pyloric stenosis often experience:
- Belly (abdominal) pain
- Frequent vomiting (usually within a half hour to one hour after eating)
- Dehydration
- Hunger after feedings
- Irritability
- Small stools (poops)
- Weight loss
In most cases, babies appear healthy, but parents begin to notice something is wrong due to dehydration and malnutrition. In rare cases, babies with this condition may experience jaundice (yellowing of the eyes and skin).
Causes and Risk Factors
Experts do not know what exactly causes pyloric stenosis, but they think there is a combination of genetic and environmental factors. Furthermore, doctors have identified some factors that could increase your risk of developing pyloric stenosis. For example:
- A family history – If you have a parent or sibling with this condition, the risk of developing it significantly increases. Moreover, approximately 15% of babies with pyloric stenosis have a family history of the disease.
- Sex – Male babies are at a higher risk of developing this condition than female babies.
- Race – this condition mostly affects white infants, especially those of European descent.
- Smoking – The risk of pyloric stenosis in babies may also increase if the mother has smoked during pregnancy.
- Antibiotics – In some cases, babies need antibiotics shortly after birth. However, these medicines may also increase the risk of developing pyloric stenosis.
- Approach to feeding – According to some recent studies, babies drinking formula show an increased risk for pyloric stenosis. However, it still remains unclear if the risk comes from the bottle or the formula.
What Are The Long-term Effects of Pyloric Stenosis?
While the primary complications of pyloric stenosis are dehydration and malnutrition, it may also cause other complications if it is left untreated. Check below some examples:
- Electrolyte imbalances (including hypochloremic or hypokalemic metabolic acidosis)
- Severe lethargy
- Treatment complications (including an increased risk of infections, bleeding, mucosal perforation, incisional hernia, aspiration, and others)
- Bloated stomach – Sometimes, the stomach muscle may become enlarged, as it can be seen with the naked eye.
The previous list does not contain a complete list of pyloric stenosis complications. However, you can talk with your healthcare professional about ways to reduce the risk of developing them.
Is There a Way to Prevent Pyloric Stenosis?
Unfortunately, there is no way to prevent this condition. The only way to prevent serious complications is early detection. Do not hesitate to see a doctor if you suspect your child has symptoms of this disorder. It is important to get treatment as soon as possible to prevent dehydration and malnutrition that eventually may lead to more serious health problems.
Diagnosis
The diagnosis of pyloric stenosis often begins with a physical examination to check for abnormalities linked to the disease. They may also ask some questions about your baby’s eating habits, symptoms, and medical history. In some cases, during a physical exam, doctors may notice an olive-sized lump in the abdomen that may indicate a thickened pylorus muscle. When it is not clear, doctors may perform a blood test to check for electrolyte imbalances.
When doctors do not feel a lump in the abdomen, they may perform an abdominal ultrasound. During this test, they will:
- Place a probe (tool) gently against their abdominal area.
- This tool uses sound waves to produce images of the tissue and organs in the abdominal area, which helps see the thickened pyloric muscle.
Rarely, doctors may perform an upper gastrointestinal (GI) test. It is often performed when previous tests and procedures do not show any problems. During this test:
- The baby will drink a specific liquid that doctors can see on an X-ray as it flows through their GI tract (including the stomach and small intestine).
- An upper GI test helps determine how well the pylorus muscle works, which helps doctors confirm or rule out pyloric stenosis.
Treatment
Commonly, doctors recommend a type of pyloroplasty surgery (pyloromyotomy) to treat this condition in babies. In most cases, it lasts less than 1 hour. While most children with this condition are dehydrated, doctors should make sure the baby is properly hydrated before surgery. In some cases, they may recommend intravenous (IV) fluids to rehydrate your child. After that, doctors will perform a blood test to make sure your child is hydrated. In most cases, your baby cannot have milk or formula for at least 6 hours before surgery. During pyloromyotomy, the surgeon will:
- Give your child general anesthesia, in which the baby falls asleep during surgery and does not feel any pain
- Perform a small incision (cut) on the left side of the baby’s abdominal area
- Thereafter, they will also make a small cut in the pylorus muscle to allow the food and drinks to go from the stomach to their intestines
Frequently Asked Questions
Can my baby eat after pyloric stenosis surgery?
Usually, babies remain in the hospital for 2-3 days after surgery. They can get mild or formula several hours after surgery, but in small amounts first. If you are using a formula, you should increase the volume gradually, but if you breastfeed, it is recommended to have breast milk in a bottle for the first feedings.
What if my baby still vomits after surgery?
Sometimes, the babies may vomit after surgery, but it does not mean they still have the condition. In most cases, they vomit due to the following things. For example:
- Anesthesia
- A lack of adequate burping after feedings
- Too much food
If you are following post-surgical recommendations and your baby is still vomiting, you may need to visit a doctor for further testing.
Can older children get pyloric stenosis?
Rarely, older children may get a pyloric obstruction. It occurs when something gets stuck in the passage through the pylorus muscle. While it is usually caused by a peptic ulcer, in some cases it may happen due to a rare disorder called eosinophilic gastroenteritis. In people with this condition, the stomach becomes inflamed. Ask your healthcare provider if you have additional questions.
