Introduction:

Pyloric stenosis is one of the most common surgical disorders in infancy, occurring in 3 out of every 1000 live births. It is a gastrointestinal obstruction caused by a narrowing of the pylorus (the lower part of the stomach leading to the small intestine). As the pyloric muscle thickens, digestion becomes more difficult for the infant because food cannot easily pass through from the stomach to the small intestines. Pyloric stenosis may be present at birth or acquired up until 4 months of age. If not treated quickly, the baby will become dehydrated and suffer from electrolyte imbalance. Prompt diagnosis through ultrasound followed by surgery dramatically improves the outlook for infants with this condition.

Signs and Symptoms:

The following signs and symptoms often accompany pyloric stenosis:

• Vomiting, often projectile in the first 3 - 6 weeks of life (may be intermittent or may occur after each feeding)
• Persistent hunger
• Weight loss
• Dehydration
• Lethargy
• Infrequent or absent bowel movements
• Jaundice (yellowing of the skin and eyes)

What Causes It?:

The exact cause of pyloric stenosis is unknown. However, factors that may contribute to its development include:

• Heredity
• Muscle and nerve abnormalities in the stomach region
• Swelling caused by allergies, leading to enlargement of stomach muscles around the pylorus
• Increased production of the hormone gastrin, which increases cell growth in the stomach muscles
• Chromosomal abnormalities
• Maternal stress in the third trimester

Who's Most At Risk?:

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

• Age -- infants ages 3 - 6 weeks; however the condition can appear as early as 1 week or as late as 4 months
• Gender -- much more prevalent in males
• First born infants
• Race -- most common in Caucasians
• Birth weight -- low birth weight is associated with lower incidence
• Maternal age -- older age and higher education level in the mother is associated with lower incidence
• Infants treated with oral erythromycin may be at increased risk

What to Expect at Your Provider's Office:

Pyloric stenosis is a medical emergency. If your baby has symptoms of pyloric stenosis, call 9-1-1 immediately. The emergency medical team will perform a physical examination, check for gastric symptoms, and use ultrasound to determine whether the thickness and length of the pyloric muscle are abnormal.

Treatment Options:

Prevention

Avoid use of erythromycin, an antibiotic, in infants. Infants receiving oral erythromycin may be at increased risk for pyloric stenosis. Therefore, health care providers must use caution when recommending this antibiotic for infants.

Treatment Plan

Once emergency measures have been taken, the baby will probably need surgery. Occasionally, health care providers may consider drug therapy prior to or, rarely, instead of surgery.

Drug Therapies

In some infants, treatment with atropine sulfate, given intravenously initially and then continued by mouth, corrects this situation.

Surgical and Other Procedures

A surgical procedure called a Ramstedt pyloromyotomy can cure the disease. The infant should have nothing to eat or drink before surgery and for 12 - 24 hours after surgery.

Complementary and Alternative Therapies

A woman's nutritional status just before and during pregnancy helps prevent the occurrence of certain abnormalities at the time of or following birth, including pyloric stenosis. Women who are planning to become pregnant should be counseled about proper nutrition. Dietary habits and, in particular, folic acid intake are important. Prenatal vitamins may also supply some of the vital nutrients that the body needs just before conception and during pregnancy.

Tell your health care provider about the herbs and supplements you or your child are using or considering using.

Pyloric stenosis is a serious medical condition and should be treated by qualified health care providers. The following complementary therapies are for prevention and symptomatic relief only, and should be employed only after consulting a qualified medical doctor.

Nutrition and Supplements

The following nutritional tips may help the mother's nutritional status:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• 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.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A prenatal vitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium. Studies report that folic acid and B-vitamins help prevent birth defects.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoon of oil 1 - 2 times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources. Talk to your obstetrician before taking fish oil supplements to make sure it is safe for you and choose a brand that has been proven to be free of heavy metals. Some experts suggest taking vegetarian DHA supplements rather than fish oil.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate your probiotic supplements for best results. Your child may also take probiotic supplements. Consult your health care provider before giving your child any dietary supplements.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Melatonin, 2 - 5 mg before bed, when needed for sleep, and to improve immunity.

Avoiding foods that may cause allergies could also benefit newborns prior to developing pyloric stenosis by decreasing the possibility of stomach upset or colic. Foods that commonly cause allergies include dairy products, peanuts, soy, eggs, fish, and wheat. If you are breast-feeding, avoid caffeine, spicy foods, beans, and certain vegetables such as broccoli. Non-breastfed infants may do better on a soy formula or a hydrosylate formula because these formulas are easier to digest.

Herbs

Herbal formulas for colic may help prevent pyloric stenosis by easing spasms in the stomach and intestines. These formulas typically include dill (Anethum graveolens) or chamomile (Matricaria recutita) given to the infant by drops or to the breastfeeding mother. Traditionally, these herbs have been used to treat upset stomach. Catnip (Nepeta cataria) may also be included. If you are interested in using herbal remedies for your child, your health care professional may be able to counsel you about which ones would be appropriate.

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 -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• 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

Acupuncture

Acupuncture may relieve factors that can cause pyloric stenosis and may help in recovery from surgery. However, to date, no scientific studies have fully investigated these uses of acupuncture. Consult your health care provider if you're interested in acupuncture.

Massage

Touch is an important part of infant well-being. Massage may reduce stress and relieve spasms in the stomach and intestines. Although no scientific studies have evaluated the effectiveness of massage in the treatment or prevention of pyloric stenosis, it may be considered in the case of a baby with colic, for example.

Prognosis/Possible Complications:

Early and quick diagnosis and treatment are necessary to avoid life-threatening fluid and electrolyte imbalance. If detected quickly, the prognosis for recovery and improved growth is very good. Possible complications include vomiting that persists after surgery, gastritis (inflammation of the lining of the stomach), hiatal hernia, or another obstruction.