Brief overview
- Symptoms: gushing vomiting shortly after a meal, weight loss, dehydration, restlessness and constant hunger in the baby.
- Causes and risk factors: Permanent cramping and enlargement of the pylorus in the hypertrophic form. Genetic factors are likely, smoking during pregnancy is considered a risk. Acquired pyloric stenosis due to foreign body, gastric tumor or scar after gastric ulcer possible.
- Treatment: Mostly surgery in which the gastric pouch muscle is dilated. Rarely treatment with medication only. In the acquired form, removal and treatment of the cause (foreign body, gastric ulcer or tumor).
- Prognosis: With successful treatment, affected children usually develop normally and stenosis does not usually recur. In the case of acquired pyloric stenosis, the prognosis depends on the cause.
What is pyloric stenosis (in babies?)
Doctors usually treat pyloric stenosis quickly, as severe metabolic problems such as hypoglycaemia or nutrient deficiency often develop due to insufficient food intake. Treatment usually involves a minor surgical procedure to loosen the narrowing.
What are the symptoms of pyloric stenosis?
Pyloric stenosis manifests itself in the form of vomiting, which occurs approximately half an hour after meals. A characteristic feature of pyloric stenosis in babies is that the child vomits profusely and profusely at short intervals. The vomit smells strongly sour and in many cases is streaked with blood due to the stomach irritation.
Due to the disturbed gastric emptying, the children develop a massive lack of food and fluids after just a few hours. They are therefore very restless and often drink conspicuously greedily. As gastric acid is also vomited, the pH value (acidity) in the blood shifts into the alkaline range (metabolic alkalosis). As a result of pyloric stenosis, the affected children lose a lot of weight.
This means that the child’s skin remains standing as a fold of skin due to the lack of fluid when it is gently grasped with two fingers. Standing skin folds are a serious sign of severe dehydration of the child and should be treated as soon as possible.
If the child vomits less during the course of the illness, this should not be misinterpreted as an improvement. Rather, it is an expression of the child’s exhaustion and dehydration. The child must be examined and treated by a doctor as soon as possible.
Even in the case of acquired pyloric stenosis caused by foreign bodies or as a result of a gastric ulcer or gastric carcinoma, the symptoms of vomiting, dehydration and emaciation are largely identical to the hypertrophic form.
The pylorus (stomach pylorus) is a ring-shaped muscle between the stomach outlet and the duodenum. It is important for the controlled gradual emptying of the chyme into the intestine. In congenital hypertrophic pyloric stenosis, spasms (cramps) of the ring muscles at the stomach outlet occur repeatedly or continuously for reasons that are as yet unexplained.
The exact cause of this congenital pyloric stenosis has not yet been clarified. However, various causes are being discussed, including faulty control of the pyloric muscles by the nerves. It is also possible that the predisposition to pyloric stenosis is hereditary, as the condition runs in families. In addition, children with blood groups B and 0 are more frequently affected than children with other blood groups.
In the acquired form of pyloric stenosis, which is possible at any age, a foreign body blocks the stomach outlet, for example. Such a narrowing of the pylorus is also possible as a result of scarring, a stomach ulcer or a stomach tumor.
Examinations and diagnosis
The pyloric muscles (stomach pylorus) appear thickened on ultrasound. The thickness of the muscles can also be measured on ultrasound: Pyloric stenosis is present if the ring muscle (pylorus) is longer than sixteen millimeters and the wall thickness is more than four millimeters in the ultrasound image. In newborns less than one month old and in premature babies, these measurements are somewhat smaller.
A gastroscopy is an examination method that is more commonly used in adults in the case of acquired pyloric stenosis.
Diseases that are similar to pyloric stenosis
Food intolerances, poisoning or dietary errors sometimes cause symptoms similar to those of pyloric stenosis. Infections of the gastrointestinal tract and reflux disease (reflux of stomach contents into the oesophagus) are possible causes of vomiting.
Congenital anomalies such as a so-called tracheoesophageal fistula, in which the oesophagus is connected to the windpipe, sometimes occur together with pyloric stenosis for unexplained but probably genetic reasons.
In newborns, the doctor also uses the examinations to rule out other possible malformations with similar symptoms, such as an obstruction of the duodenum (duodenal atresia).
How is pyloric stenosis treated?
The operation of choice for the hypertrophic form is the so-called Weber-Ramstedt pylorotomy, in which all the muscle fibers of the gastric outlet are cut longitudinally with a scalpel without damaging the mucous membrane. This technique enlarges the diameter of the gastric outlet so that food can pass through it normally again.
Doctors recommend early surgery, as the child’s general condition is usually still good at an early stage of the disease. A good general condition significantly reduces the risk of surgery. The operation can be performed endoscopically through a small incision (laparoscopy, “keyhole technique”) or by surgically opening the upper abdomen (laparotomy).
Hypertrophic pyloric stenosis can also be treated conservatively (without surgery). However, this method is usually lengthy. The child is fed small meals (around ten to twelve small meals a day) and is positioned with the upper body elevated by 40 degrees to sleep.
In the case of acquired pyloric stenosis, the doctor usually treats the cause. This means that a foreign body may be removed during a gastroscopy or, if not otherwise possible, by surgery.
The doctor treats gastric ulcers or stomach cancer as the cause accordingly. If the obstruction is permanent and inoperable, the doctor may place a feeding tube directly into the duodenum or small intestine.
Course of the disease and prognosis
In acquired cases, the prognosis depends on the cause.
Complications of pyloric stenosis
If pyloric stenosis is not operated on, there is a risk to life due to the massive metabolic derailments (metabolic alkalosis and dehydration).
Prevention
It is not possible to specifically prevent hypertrophic pyloric stenosis as the cause is not fully understood. However, serious complications can be prevented if the first symptoms, such as gushing vomiting, are immediately investigated by a doctor.
Parents should also inform the pediatrician or the medical team at the hospital if there is a known family history of the condition.
