What is Pyloric Stenosis?
Pyloric stenosis is a problem that affects many newborns and causes forceful vomiting that can lead to dehydration. These babies require a high level of care and will be admitted to the NICU. It is the second most common problem requiring surgery in newborns.
The lower portion of the stomach that connects to the small intestine is known as the pylorus. In pyloric stenosis, the muscles in this part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stomach down to the intestine. Normally, this muscular valve (pylorus) holds food in the stomach until it is ready for the next stage in the digestive process. In pyloric stenosis, the pylorus muscles thicken and become abnormally large, blocking food from reaching the small intestine.
These babies will experience persistent, projectile vomit, ejecting breast milk or formula up to several feet away. Vomiting might be mild at first and gradually become more severe as the pylorus opening narrows. The vomit may sometimes contain blood.
Which Babies are at Highest Risk?
Pyloric stenosis can be inherited; several members of a family may have had this problem during infancy. In addition, pyloric stenosis is four times more common in males than females.
Why is Pyloric Stenosis Concerning?
The most serious problem that can result from pyloric stenosis is dehydration. When a baby vomits regularly, he or she will not get enough fluids to meet his or her nutritional needs. Babies have smaller bodies than adults and cannot tolerate losing fluid as easily as we can. Your baby might cry without tears or become lethargic. You might find yourself changing fewer wet diapers in a day or diapers that are completely dry.
Electrolyte imbalance is another problem that pyloric stenosis causes. Minerals that the body needs to stay healthy, such as potassium and sodium, are lost from the frequent vomiting. Babies who are deficient in key electrolytes can become sick very quickly. Lack of vitamins and nutrients can lead to malnutrition, and ultimately—weight loss. A baby who vomits most of (or all of) his or her feedings will not have adequate nutrition to gain weight and stay healthy. This can lead to failure to grow, develop, and thrive.
Lastly, stomach irritation is another complication that can occur. Repeated vomiting can irritate your baby's stomach and may cause mild bleeding or ulcers.
What are the Symptoms of Pyloric Stenosis?
The most common symptoms noted in a baby with pyloric stenosis is forceful, projectile vomiting. This kind of vomiting is different from a "wet burp" or an occasional spit up that a baby may have at the end of a feeding. Large amounts of breast milk or formula are vomited and may project several feet across the room. The milk is often curdled in appearance—as the milk remains in the stomach and does not move forward to the small intestine, the stomach acid "digests" it.
In addition to the complications previously discussed, other symptoms may include:
Persistent, constant state of hunger
Eats or nurses eagerly
Lack of energy
Fewer bowel movements (constipation)
Frequent, mucous stools
Stomach contractions
How is Pyloric Stenosis Diagnosed?
In addition to a complete and thorough medical history and physical examination, a barium swallow study/upper GI series is typically warranted. This is a diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chalky liquid) is swallowed and used to coat the inside of your baby’s organs so that they illuminate on X-ray. A series of X-rays are then taken to evaluate the digestive organs and to track the progression of the dye through the tract.
How is Pyloric Stenosis Treated?
Pyloric stenosis MUST be repaired with an operation and will NOT resolve on its own. A pyloromyotomy is performed, which is an operation to loosen the tight muscle causing the blockage between the stomach and small intestine. The surgeon makes an incision in the muscle fibers of the enlarged pyloric muscle. He will cut through the wall of the pylorus to widen the opening into the intestine. This loosens the tight muscle causing the blockage. The lining of the pylorus will then bulge through the incision, opening a channel from the stomach to the small intestine. After surgery, your baby may still vomit, but this will resolve after a few days. Dehydration and electrolyte imbalances will be treated via IV fluids. In addition, he or she will remain on antiemetic medications such as Pepcid, Reglan, Prevacid, etc.
