Pyloric stenosis is a condition that affects infants. It is a narrowing of the pylorus (the lower part of the stomach leading to the small intestine) due to thickening of the muscle. This makes digestion difficult because food cannot easily pass through from the stomach to the small intestines. Pyloric stenosis may be present at birth or acquired later in life. It is the most common cause of gastrointestinal obstruction in infants, appearing in about 2 of every 1000 live births. If not treated quickly, the baby will become dehydrated and suffer from electrolyte imbalance. In recent years, prompt diagnosis through ultrasound followed by surgery has dramatically improved the outlook for infants with this condition.

Pyloric stenosis is often accompanied by the following signs and symptoms:

• Vomiting, often projectile (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)

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

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

• Age -- infants ages 3 - 12 weeks
• Gender -- much more prevalent in males
• 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

Pyloric stenosis is a medical emergency. If your baby is experiencing 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.

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, drug therapy may be considered prior to or, rarely, instead of surgery.

Drug Therapies

In some infants, treatment with atropine sulfate, given intravenously initially and then continued by mouth, has corrected 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.

Always 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 a qualified medical doctor has been consulted.

Nutrition and Supplements

Following these 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), 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) 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 tablespoonful oil one to two times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results. Your child may also take probiotic supplements. Consult with 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 breastfeeding, 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 be helpful for prevention of 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 for treatment of upset stomach. Catnip (Nepeta cataria ) may also be included. If you are interested in possibly 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 required to cure pyloric stenosis, but one of the following remedies may be used by a professional homeopath 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 individuals 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 acupuncture is of interest to you or your child.

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.

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.

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