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 approximately 2 out of
every 1000 live births. If not treated quickly, the baby will become dehydrated
and suffer from electrolyte imbalance. In recent years, prompt diagnosis by
ultrasound followed by surgery has dramatically improved the outlook for infants
with this condition.
|Signs and Symptoms|
Pyloric stenosis is often accompanied by the following signs and
- Vomiting, often projectile (may be intermittent or may occur after
- Persistent hunger
- Weight loss
- Infrequent or absent bowel movements
- Jaundice (yellowing of the skin and
|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;
and maternal stress in the third trimester.
|Who's Most At Risk?|
Persons with the following conditions or characteristics are at risk for
developing pyloric stenosis:
- Age: infants ages 3 to 12 weeks
- Gender: much more prevalent in males
- Race: most common in Caucasians
- Birth weight: low birth weight is associated with lower
- 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
|What to Expect at Your Provider's Office|
Pyloric stenosis is a medical emergency. If your baby is experiencing
symptoms of pyloric stenosis, call Emergency Assistance, 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.
Avoid use of erythromycin, an antibiotic, in infants. Infants receiving oral
erythromycin may be at increased risk for pyloric stenosis. Therefore,
healthcare providers must use caution when recommending this antibiotic for
infants. Reduce stress during pregnancy, particularly during the third
Once emergency measures have been taken, the baby will probably need surgery.
Occasionally, drug therapy may be considered prior to or, rarely, instead of
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 to 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
In a 3-year multicenter scientific study, the data revealed that prenatal
multivitamins, containing micronutrients including folic acid, may protect
against neural tube (the structure that gives rise to the central nervous
system) defects as well as other birth defects such as pyloric stenosis.
Folic acid is usually an ingredient in prenatal vitamins. A review of recent
studies confirms that using folic acid supplements daily around the time of
conception plays a key role in reducing the occurrence of birth defects. The
suggested dose is at least 0.4 mg folic acid per day. Daily doses as high as 4
to 5 mg may be necessary in high risk mothers, mothers who have previously given
birth to a child with neural tube defects, mothers with diabetes mellitus, and
women on antiepileptic medications and other drugs that interfere with folate.
Because up to 50% of pregnancies are not planned, all women of childbearing age,
especially women who are thinking of getting pregnant, should take folic acid
Synthetic folic acid, which is a monoglutamate, is preferable to folate that
occurs naturally because it is absorbed faster and is more resistant to
temperature changes. Folate obtained from food sources is fragile and easily
destroyed by the heat of cooking. In addition, dietary folate, which comes as a
polyglutamate, has to be converted into the monoglutamate form by the body
before it can be absorbed.
Additional nutritional measures that may be helpful in the treatment of
pyloric stenosis in infants include the use of probiotics. These substances
encourage the growth of normal, helpful bacteria in the intestinal tract.
Although scientific studies have not yet established that probiotics are useful
for the prevention or treatment of pyloric stenosis, taking a
Lactobacillus supplement along with antibiotics may reduce irritation and
inflammation in the infant's stomach. The breastfeeding mother can take one
capsule with meals. Alternatively, one capsule per day in three divided doses
may be given to the newborn (using the powder inside an opened capsule).
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, then caffeine, spicy foods,
beans, and certain vegetables such as broccoli should also be avoided.
Non-breastfed infants may do better on a soy formula or a hydrosylate formula
because these formulas are easier to digest.
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) and/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, your healthcare professional may be able to counsel you about
which ones would be appropriate, or refer you to an herbal
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. In homeopathic terms, a person's
constitution is his or her 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; vomiting is accompanied by
excessive abdominal pain, restlessness, fatigue, chills, and
- Bryonia — for individuals whose
stomachs are sensitive to touch but may experience relief from lying on the
- Phosphorus — for excessive vomiting
immediately following ingestion of food or drink; vomiting is accompanied by
weakness, drowsiness, anxiety, restlessness, and dehydration; the infant for
whom this treatment is appropriate tends to be mild-mannered and generally to
have a good appetite
- Silicea — for vomiting after drinking
milk (including breast milk) in those who have a delicate constitution and are
slow to develop
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 healthcare provider if
acupuncture is of interest to you.
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
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.
Ballard RB, Rozycki GS, Knudson MM, Pennington SD. The surgeon's use of
ultrasound in the acute setting. Surg Clin North Am.
Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy.
Whitehouse Station, NJ: Merck & Co.; 1999:2213.
Blumenthal M, Busse WR, Goldberg A, et al., eds. The Complete German
Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston,
Mass: Integrative Medicine Communications; 1998:107, 121.
Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines.
3rd ed. New York, NY: Penguin Putnam; 1997: 157, 344.
Czeizel AE. Nutritional supplementation and prevention of congenital
abnormalities. Curr Opin Obstet Gynecol. 1995;7(2):88-94.
Hall J, Solehdin F. Folic acid for the prevention of congenital anomalies.
Eur J Pediatr. 1998;157(6):445-450.
Honein MA, Paulozzi LJ, Himelright IM, et al. Infantile hypertrophic pyloric
stenosis after pertussis prophylaxis with erythromycin: a case review and cohort
study. Lancet. 1999;354(9196):2101-2105.
Hulka F, Campbell TJ, Campbell JR, Harrison MW. Evolution in the recognition
of infantile hypertrophic pyloric stenosis. Pediatrics.
Lowe LH, Banks WJ, Shyr Y. Pyloric ratio: efficacy in the diagnosis of
hypertrophic pyloric stenosis. J Ultrasound Med. 1999;18(11):773-777.
Marks DR, Marks LM. Food allergy. Manifestations, evaluation, and management.
Postgrad Med. 1993;93(2):191-196, 201.
Nagita A, Yamaguchi J, Amemoto K, Yoden A, Yamazaki T, Mino M.
Management and ultrasonographic appearance of infantile hypertrophic pyloric
stenosis with intravenous atropine sulfate. J Pediatr Gastroenterol Nutr.
Singh J. Pediatrics, Pyloric Stenosis. In: Adler J, Brenner B, Dronen S, et
al., eds. Emergency Medicine: An On-line Medical Reference. Accessed at
on August 18, 2000.
Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin
Putnam; 1995: 242.
Vaughan EE, Mollet B. Probiotics in the new millennium. Nahrung.
Werler MM, Hayes C, Louik C, Shapiro S, Mitchell AA. Am J Epidemiol.
|Review Date: October 2000|
|Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University
and Senior Medical Editor Integrative Medicine, Boston, MA; Leonard Wisneski,
MD, FACP, George Washington University, Rockville,
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed