Pyloric Stenosis

The pylorus is the muscular opening between the stomach and the small intestines. It is where food that has been digested in the stomach goes through to move into the small intestines. When your food is digesting the pylorus is closed, when your food is done being digested it opens to allow foods to flow to the small intestines. Pyloric stenosis is a rare condition that affects three out of each one thousand babies in the United States.

Also known as hypertrophic pyloric stenosis is the condition where there is thickening and narrowing of the pylorus. This thickening and narrowing stops food from moving from the stomach to the intestines. Babies are not born with this condition. The cause of this condition is not clear. Most babies will start to show symptoms around 3 to 6 weeks after being born. Sometimes this condition is not diagnosed until the child is closer to 5 months of age.

Symptoms

The first symptom that can signify if your child has pyloric stenosis is if they vomit. They may vomit after every feed or only some feeds. The vomit will differentiate from baby spit up. It will be forceful and can sometimes be projectile, meaning it can shoot feet in distance from the force. Vomiting can start as early as three weeks of your baby’s age, or it may take up to 5 months to develop this forceful vomit. The vomit will be clear or be partially digested, may have a sour smell and look like curdled milk. After your child vomits they may be acting like they are hungry and want to feed.

Other symptoms of pyloric stenosis are abdominal pain, belching, constant hunger, dehydration, and failure to gain weight. Dehydration can occur in babies quickly especially when their only source of food is breastmilk or formula. Your child may also develop jaundice which is the yellowing of your baby’s skin and whites of their eyes as a complication of pyloric stenosis. Sometimes these symptoms may not be of concern until your child is no longer gaining weight or they are losing weight.

Causes

The exact cause of pyloric stenosis is unclear. Babies who have a family history of pyloric stenosis tend to have a higher risk of developing the condition as well. There are more male babies with this condition than female babies. If the mother smoked during pregnancy it also raises the risk. A baby needing antibiotics quickly after being born, or a mother who had antibiotics late in the pregnancy also raises the risk.

There are more studies needed but there may be a link to how your baby is fed between bottle fed and breastfed babies if that has any correlation with babies who develop pyloric stenosis.

Diagnosis

If your child is projectile vomiting and seems to not keep any food down it is important to get them checked out by their physician. During the exam your doctor will listen to their symptoms as well as do a physical exam. They may feel your baby’s stomach. Your doctor will be able to feel if there is an enlarged pylorus. After the initial exam your doctor may want to do some other tests. An ultrasound can help your doctor be able to look at your child’s stomach and digestive tract to see if there is a blockage. A barium swallow with upper GI can also be beneficial. In this your child will drink a liquid that has the chemical element barium in it. Then special X-rays will be taken of the stomach. The barium makes the stomach and the intestines show up more clearly. Your doctor may also want to take blood work to check your child’s potassium and sodium levels which may be off if they are dehydrated.

Treatment

The first step in treatment is to correct any dehydration your child may be experiencing. This can be done with your child receiving IV fluids.

Surgery is the main treatment option for pyloric stenosis. A pyeloplasty surgery called a pyloromyotomy. Usually this can be done laparoscopically which means a small incision is used to place a tube that the doctor can feed cameras and tools through so a larger incision is not needed. This type of surgery is less invasive and has less chance of complications as well as a quicker recovery time. During the surgery your child will be under anesthesia meaning they will be asleep during the surgery and won’t feel any pain. A small incision will be cut slightly higher than their belly button. The doctor will use a tool to make a small incision in the thickened pylorus to allow food to move through easier. The total procedure will take less than an hour. Your child will most likely need to stay in hospital for 1-3 days afterwards to check on their progress and how they are handling eating and keeping food down. Your doctor will have a feeding plan and schedule for you to follow. The amount of food you give your child to start will be crucial to measure accurately. Even breastfed babies will need to drink breastmilk from a bottle to start off with. Once your child is showing they are handling feedings alright you will be discharged to go home. After the surgery your child should be able to eat regularly and have no other complications or problems.