Pyloric Stenosis in Babies: A Diagnosis That’s Not Hard to Swallow

In recent weeks we’ve talked a lot about vomiting babies in this space. As we’ve learned, the great majority of “vomiting” babies are really just spitty babies. Many might carry a diagnosis of the benign condition knows as gastroesophageal reflux (GER, not to be confused with gastroesophageal reflux disease, or GERD). On the other hand, true vomiting can mean a more serious condition, such as an infection or a genetic disease. In between are the babies that have conditions that need to be addressed, but if done so promptly, are less life-threatening. We’ve discussed one condition in this category, GERD. This time let’s look at another one that we’ve alluded to—pyloric stenosis.

Pyloric Stenosis Talk—Can You Stomach It?

Like every organ, the stomach has names for its various parts. The part we’re concerned about here is known as the pylorus, which is the area at the “end” of the stomach, where it empties into the intestines. It’s made up of muscle tissue, which sort of acts as the intestine’s doorman to control the exit of stomach contents. In one out of several hundred babies, that muscle is overdeveloped, or hypertrophied, and starts acting like a doorman to an exclusive club. Less stomach contents, then, are admitted, meaning that they have nowhere to go but up. The result? The baby begins vomiting.

Although as abnormalities go, pyloric stenosis is not that rare, no one really knows why some babies get it and most don’t. First-born male infants are more likely to have it, but then again, more babies are first-born males! We do know that’s it’s more common to have the condition if another family member has had it. And associations have been found with early antibiotic use (especially erythromycin, which might be used in early infancy to treat whooping cough) and with Moms smoking while pregnant.

OK, Then, Does YOUR Baby Have Pyloric Stenosis?

Physicians are generally taught to look for the most common diagnoses first before considering other options. This practice helps them maintain their vow to do no harm, among other things. Spitting and mild GER are far more common than pyloric stenosis. However, there are some clues that would increase the likelihood of a pyloric stenosis diagnosis:

  • The vomiting is “projectile”—shoots out of the mouth, maybe even across the room, rather than simply dribbling down the chin.
  • There is a tensing of the stomach muscles.
  • The baby’s growth begins to fall off.

And although if it is pyloric stenosis, it’s important to find it as soon as possible, the following signs help differentiate it from more immediately life-threatening illnesses:

  • The vomiting is nonbilious (no green in the contents) and not bloody.
  • The baby is hungry and (usually) relatively happy.

Often, the pediatrician can feel the pylorus on exam. She may also have the baby’s blood drawn for electrolytes, or chemicals in the blood. Because anyone who vomits will lose stomach acid, which is part of the stomach’s contents, the electrolyte test will often show this loss of acid. But if pyloric stenosis is suspected, additional testing is usually needed. The most common test used to be an upper GI, or “barium swallow,” where the baby drank a liquid that shows up on x-ray. Nowadays, it’s much more common to do an ultrasound. This test can directly show an abnormal pylorus; however, it’s best done by a radiology department with experience in this type of test, which is why it’s often done as an outpatient procedure at a children’s hospital.

Treating Pyloric Stenosis:  The Good News

Fortunately, treating pyloric stenosis involves a one-time procedure for most babies. The treatment does involve surgery, and while no surgery is totally without risk, the great majority of otherwise healthy babies get through it just fine.

The surgery, which is known as pyloromyotomy, involves cutting the thick pyloric muscle so that what’s in the stomach can pass through the area more easily. Often, a small incision is made at the right upper area of the infant’s belly, allowing the surgeon to reach the pylorus. Sometimes  the surgery is done laparoscopically, which involves an even smaller incision and a camera through which the surgeon views the area. Usually, the baby can eat within a few hours of surgery and go home a day later. After that, most never again have a problem feeding, although a small minority might need an additional procedure.

We’d certainly rather not have a vomiting infant at all. And some vomiting can signify a more serious condition. On the other hand, babies that spit without vomiting, as healthy as they generally are, can be a little disconcerting. But if your baby is diagnosed with pyloric stenosis, take comfort in the fact that there’s a good likelihood that he can be cured of the condition relatively easily and go on to be a great feeder and grower.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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