Incidence Of Pyloric Stenosis Research Articles

Five years' experience with pylric stenosis in Misan

Infantile hypertrophic pyloric stenosis is the commonest cause of gastric outlet obstruction and vomiting in infancy resulting from gradual hypertrophy of the smooth muscle of the pylorus. Reports have suggested that the incidence of pyloric stenosis is increasing. This is a prospective study aimed to defining the various aspects of IHPS cases. A total no. of 39 patients presented to Alsader general teaching hospital during the period from January 2014 to the end of December 2018. The diagnosis was based on history, clinical examination with U/S study and we rarely need barium meal for the diagnosis. Results revealed that the male: female ratio was 12 to 1) male formed 92.3% while female is 7.6% of cases. The disease is more frequently in the first baby of the family (28 patients: 71.7%). Family history was positive in two cases (5.1%), associated anomalies are found in 2 cases which is about 5.1%. The mortality rate (0 %). In conclusion: The management start with the correction of the general state of patients then followed by operation (Ramstedts pyloromyotomy). Correction of fluid and electrolytes status of the patients preoperatively is very important to prevent operative and postoperative complications. Early feeding results in the retain of symptoms of vomiting so delay in the postoperative feeding up to the next postoperative day decrease the incidence of vomiting and risk of suffocation with overall reduction in the incidence of morbidity and mortality.

Risk factors and management for pyloric stenosis occurred after endoscopic submucosal dissection adjacent to pylorus.

Endoscopic submucosal dissection (ESD) has been widely accepted as a curative treatment for gastric neoplasm. Pyloric stenosis is a chronic complication that can be caused by ESD. The aim of this study is to clarify the risk factors and management for pyloric stenosis. From January 2004 to January 2014, a total of 126 patients who underwent ESD adjacent to pylorus were reviewed retrospectively. Pyloric mucosal defect was defined as when any resection margin of ESD was involved in the pyloric ring. Pyloric stenosis was defined as when a conventional endoscope could not be passed to the duodenum. Among the 126 patients, pyloric stenosis was identified in 9. In a univariate analysis, pyloric stenosis was more common in older patients (P < 0.05) and in lesions with resections over 75% of the pyloric ring circumference (P < 0.001). In a multivariate analysis, the factor that was associated with pyloric stenosis was the extent of the pyloric ring dissection (P < 0.001). Four of the 9 patients with pyloric stenosis had mild dyspepsia, and the others had gastric outlet obstruction symptoms. The 5 symptomatic patients underwent endoscopic balloon dilation (EBD), and the frequency of EBD was 1 to 8 times. The asymptomatic patients were treated conservatively. The incidence of pyloric stenosis was higher in lesions with resections over 75% of the pyloric ring circumference. Although EBD was an effective treatment for pyloric stenosis, conservative management was also helpful in patients who had mild symptoms.

Use and Safety of Erythromycin and Metoclopramide in Hospitalized Infants.

Prokinetic medications are used in premature infants to promote motility and decrease time to full enteral feeding. Erythromycin and metoclopramide are the most commonly used prokinetic medications in the neonatal intensive care unit (NICU), but their safety profile is not well defined. We conducted a large retrospective cohort study using data from 348 NICUs managed by the Pediatrix Medical Group. All of the infants exposed to ≥1 dose of erythromycin, metoclopramide, or both, from a cohort of 8,87,910 infants discharged between 1997 and 2012 were included. We collected laboratory and clinical information while infants were exposed to erythromycin or metoclopramide and described the frequency of laboratory abnormalities and clinical adverse events (AEs). Metoclopramide use increased from 1997 to 2005 and decreased from 2005 to 2012, whereas erythromycin use remained stable. Erythromycin use was most often associated with a diagnosis of feeding problem (40%), whereas metoclopramide was most often associated with a diagnosis of gastroesophageal reflux (59%). The most common laboratory AE during exposure to erythromycin or metoclopramide was hyperkalemia (8.6/1000 infant days on erythromycin and 11.0/1000 infant days on metoclopramide). Incidence of pyloric stenosis was greater with erythromycin than with metoclopramide (10/1095, 0.9% vs 76/19,001, 0.4%; P = 0.01), but odds were not significantly increased after adjusting for covariates (odds ratio 0.52, 95% confidence interval [CI] 0.26-1.02, P = 0.06). More infants experienced an AE while treated with metoclopramide than with erythromycin (odds ratio 1.21, 95% CI 1.03-1.43). Metoclopramide was associated with increased risk of AEs compared with erythromycin. Studies are needed to confirm safety and effectiveness of both the drugs in infants.

İnfantil Hipertrofik Pilor Stenozu Gelişiminde Mevsimsel Etki

Objective: The aim of this report was to determine if seasonal variation exists in the incidence of pyloric stenosis and to review the management of infantile hypertrophic pyloric stenosis (IHPS) in a single tertiary pediatric hospital over a seven-year period. Material and Methods: We conducted a retrospective chart review of all patients who underwent pyloromyotomy between October 2004 and October 2011. Patient data and laboratory results on admission were recorded from medical charts. The total and postoperative length of stay was calculated from the date of admission, surgery and discharge. Patients were divided into four groups according to seasons as winter, spring, summer and autumn. Results: A total of 55 pyloromyotomies were performed. Forty-seven patients were male (85.5%) and 8 were female (14.5%). The age distribution of the patients varied from 3 weeks to 13 weeks (median 6 weeks). There was no perioperative mortality. Oral feeding was achieved by 24 hours in 78.2% of infants and there was persistent vomiting in only 30.9%. There was no significant difference between the groups in terms of age, gender, weight, plasma pH, HCO3, Cl-, and K+ values; in addition, ultrasonographic findings were similar in each group. The highest rate of pyloromyotomy was in spring and the lowest in winter and summer; this difference was statistically significant (p=0.0049). Conclusion: In conclusion, seasonal variation of the hypertrophic pyloric stenosis suggests a possible etiological role for environmental factors and pyloromyotomy is the best treatment of IHPS that can be undertaken safely in specialized pediatric centers.

On the 2:1 Preponderance of Male Infants in the incidence of Pyloric Stenosis and in Convictions for “Shaken Baby Syndrome

Introduction: It is known that in Pyloric Stenosis, Macrocephaly, and convictions for “Shaken Baby Syndrome”(SBS) the infant is twice as likely to be male as female. It has previously been hypothesised that the injuries assumed to prove SBS actually result from transient venous hypertension occurring during violent vomiting caused by pyloric stenosis. Macrocephaly also can be explained in terms of venous hypertension. By 1912 the pylorus had been recognized as a three part organ (antrum, canal, sphincter) independent of the stomach, but capable of cooperative action. Much of this has now been forgotten and the pylorus is considered to be merely the distal part of the stomach. Understanding of the early development and function of the pylorus is essential to understanding the development of stenosis and hence assymetrical gender distribution. Mechanics: At birth the human pylorus is proportionately longer and thinner than in the adult. In the first few months of life, before weaning, it has to grow thicker and more compact to be powerful enough to reduce food lumps to paste before passing food onwards into the duodenum. Testosterone stimulates contractile protein production, but not cell length, in the smooth muscle cells surrounding the pylorus. In males muscle will may grow too bulky for the current circumference and expand inwards, producing stenosis. Conclusion: The 2:1 male gender bias in pyloric stenosis, and hence conviction rate for SBS, arises naturally from this Transient

Seasonal variation of hypertrophic pyloric stenosis: a population-based study

Seasonal variation in the incidence of hypertrophic pyloric stenosis (HPS) has been long debated. The goal of this study was to determine if seasonal variation exists in the incidence of pyloric stenosis. A population-based cohort consisted of all infants in the province of Ontario, Canada with HPS from 1993 to 2000. The incidence of HPS per season was adjusted by birth rate and expressed as number of pyloromyotomies per 100,000 infants less than 12 months of age. One-way analysis of variance was used to compare HPS incidence between seasons. Further time series and spectral analysis were performed to examine for seasonal variation. There were 1,777 infants included in the population-based cohort. June was the month with the highest rate of HPS. The highest rate of pyloromyotomy occurred in the summer 14.92 and the lowest in the winter 10.73, this difference was statistically significant (p = 0.01). Spectral analysis showed that June was the month with the highest rate and February had the lowest rates p = 0.0014. Hypertrophic pyloric stenosis more commonly presents in the summer. Seasonal variation suggests a possible etiological role for environmental factors.

Prone to Sleep, Prone to Pyloric Stenosis?

Dediatricians-in-training, if they are lucky, may palpate the olive (pyloric tumor) in a I weeks-old infant who presents with projectile vomiting. Along with the right history, that physical finding is diagnostic, and after relatively simple surgery, the infant's parents can be reassured that all will be well. Although the diagnosis and treatment of this condition may be quite clear, its etiology remains a mystery. In his doctoral thesis published in 1952, Brian MacMahon focused attention on the epidemiology of pyloric stenosis; we are fortunate that, after a hiatus of 5 decades during which he became a leading and revered epidemiologist, he has revisited the topic, providing a comprehensive summary of the state of our knowledge and our ignorance about this serious but reparable condition.1 Although some might quibble with a point here and there (eg, I think there is good evidence supporting an etiologic role of erythromycin exposure in the first weeks of life), Dr. MacMahon's broad argument is critically important: accumulating data suggest that, at least in part, pyloric stenosis may be a disease of modem Western civilization, and, more particularly, our preference over past decades to place infants to sleep on their stomachs. This suggestion did not come from a prespecified biologically based hypothesis, but rather from observations made by Danish and Swedish researchers, who were struck by recent, unexpected, and very dramatic declines in the incidence of pyloric stenosis. These declines, they observed, coincided with recommendations in the early 1990s that were intended to reduce the rate of sudden infant death syndrome (SIDS) by changing infants' sleep position from prone to supine. The notion of reducing SIDS risk by the back-to-sleep intervention was not based on biologic understanding of SIDS etiology or even a biologic hypothesis. Instead, as was true for pyloric stenosis, it flowed from epidemiologic observations. Indeed, the apparent effectiveness of this intervention with respect to SIDS has prompted formulation of biologic theories to explain why prone sleep position may increase SIDS risk. So once again, an epidemiologic observation may guide us to biologic understanding. However, for pyloric stenosis, how can the strong associations with family history, infant sex, and birth order be reconciled with sleep position as a risk factor? As Dr. MacMahon argues, family history can suggest genetic causes, but choice of sleep position also tracks in families, whether these families are nuclear or racial/ethnic. Male sex is of course genetic, raising the possibility of a gene-environment interaction. The birth order effect is distinctly puzzling; if there is an environmental explanation for it, are we raising the possibility of an environmentenvironment interaction? For all these factors, one could argue that the disease occurs when one or more underlying risk factors (genetic or environmental) are expressed in the presence of the environmental trigger of prone sleep position. We clearly should support Dr. MacMahon's call to explore whether the risks of pyloric stenosis and SIDS are both affected by sleep position. This research should consider, in addition, the possible etiologic role(s) of other behavioral and environmental factors that have also changed in recent years; in some countries, for example, secular changes in sleep position occurred at roughly the same time as increases in exposure to folic acid early in pregnancy. Further epidemiologic study will undoubtedly bear fruit that will help explain the olive's etiology. As a positive application of the law of unintended

Population Demographic Indicators Associated With Incidence of Pyloric Stenosis

To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993-1996 and 1997-2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4-fold and 3.0-fold regional variation in 1993-1996 and 1997-2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23-2.61; P<.005). The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.

The role of ultrasonography in the diagnosis of pyloric stenosis: A decision analysis

Background/Purpose : The appropriate role for ultrasonography (US) as a replacement for the upper gastrointestinal series (UGI) in vomiting infants remains undefined. The authors have used decision analysis techniques to determine whether the use of ultrasonography as an initial screen in vomiting infants is cost effective when compared with the UGI as the only study. Methods : Two diagnostic strategies were compared: 1) UGI alone and 2) ultrasonography followed by an UGI series in 50% of cases when ultrasonography scan was negative for pyloric stenosis. The test sensitivity (US, 0.9; UGI, 1.0) and test specificity (US, 1.0; UGI, 1.0) and the incidence of pyloric stenosis among vomiting infants presenting to the community pediatrician (0.30) or after a negative examination by an experienced examiner (0.02 to 0.18) were obtained from a review of the literature. The relative charges for ultrasonography and UGI were obtained from a national survey from which the cost ratio of US to UGI was estimated to range from 0.67 to 1.81 with a median of 1.06. Results : Under these baseline assumptions, UGI only was the preferred strategy. The results of the decision analysis were sensitive to, or dependent on, assumptions made regarding the incidence of pyloric stenosis, the US to UGI cost ratio, the sensitivity of the US, and the proportion of patients that proceed to UGI when the US scand was negative for pyloric stenosis. When at least 50% of patients whose US scand was negative for pyloric stenosis proceeded to a UGI, UGI remained the preferred strategy for all cost ratios examined (0.6 to 1.7). Even when no patients proceeded to UGI, the cost ratio of US to UGI had to be less than 0.7 under the typical incidence (0.30) of pyloric stenosis among vomiting infants presenting to the community pediatrician for US to be cost effective. Finally, only UGI was indicated when an olive was not appreciated by an experienced examiner. Conclusion : Under assumptions that fit most clinically relevant circumstances, the UGI as the initial study is the most cost-effective radiological diagnostic test in the evaluation of the vomiting infant.

Pyloric Stenosis in Premature Infants

The diagnosis and treatment of pyloric stenosis in infants has been well established for many years. 1 The incidence of pyloric stenosis in premature infants is unusual, 1 the presentation is atypical, 2-5 and the diagnosis delayed, if not difficult. 2-5 Recently, four premature infants with pyloric stenosis demonstrated these features and underscored the limitations of ultrasonographic imaging in premature infants. 5,6 Patient Reports. Patient 1 . A premature male infant (weighing 2100 g at 35 weeks' gestation) with the onset of nonprojectile vomiting at 6 weeks of age was evaluated by ultrasound at 7 weeks of age. Ultrasound findings were normal (pyloric muscle thickness, 2.4 mm), and vomiting persisted. An upper gastrointestinal contrast study performed at 8 weeks of age confirmed pyloric stenosis. Patient 2 . A premature male infant (weighing 1610 g at 31 weeks' gestation) with the onset of nonbilious nonprojectile vomiting at 5 weeks of age was evaluated

Increasing incidence of hypertrophic pyloric stenosis.

The incidence of pyloric stenosis in the Mersey region rose from 1.54/1000 births in 1976-8 to 2.22/1000 births in 1986-8. Reliance on ultrasonography for diagnosis in the 1980s resulted in fewer 'tumours' being felt; diagnostic delay was not shortened overall but serial ultrasonography showed evolving lesions in six patients. Clinical examination and selective use of ultrasonography is advocated.

THE ACTION OF ENVIRONMENTAL FACTORS IN HYPERTROPHIC PYLORIC STENOSIS

The second of two monozygous twin boys had perinatal anoxia and spastic diplegia, and developed hypertrophic pyloric stenosis at eight weeks. The coincidence of these conditions, together with the absence of both conditions in the twin, suggests that anoxia may be important in precipitating pyloric stenosis in hereditarily disposed infants. Previous work showing an increased incidence of pyloric stenosis in first born children may indicate a similar precipitating factor.

Infantile hypertrophic pyloric stenosis: data on 81 pairs of twins.

Summary87 affected twins (in 81 pairs) were identified among 3,982 children with pyloric stenosis. The proportion of twins among affected (1 in 46) is about the same as in the general population of births. The incidence of pyloric stenosis in partners of affected twins is 8.6 per cent, considerably higher than in the general population of births (0.3 per cent) but only slightly higher than in subsequent sibs (5.8 per cent).The frequency of concordance is about the same in MM (4 of 31) and MF (2 of 23) pairs. Of 39 like sexed pairs 4 were concordant; the expected number of monozygotic pairs is 18 (assuming the usual proportion of monozygotic pairs), which suggests that the frequency of concordance among them is not greater than 4 in 18. It is shown that the distribution of MM, FF and MF pairs in the series corresponds closely to the distribution expected in a twin universe which contains the usual proportions of monozygotic and dizygotic twin pairs.

PERFORATION OF THE STOMACH IN THE NEWBORN&lt;subtitle&gt;Report of Two Cases with Necropsy Findings&lt;/subtitle&gt;

PERFORATION stomach in the newborn infant is rare. It is believed that the cases here reported constitute the 21st and 22d instances of such perforation. One of them is the second case of pyloric atresia complicated by perforation. In a comprehensive review of the literature in 1941, Bird, Limper, and Mayer 1 found 245 recorded cases of peptic ulcer in children 15 years of age and under. Of these, 42 were in infants 0 to 14 days of age, with a ratio of duodenal to gastric ulcers of about two to one. It was pointed out that in such ulcers recognized in the early days or months of life, serious bleeding or perforation or both are characteristic. During later childhood, however, the incidence of pyloric stenosis and perforation increases, with a decrease in the incidence of serious hemorrhage. REPORT OF CASES Case1.—T. W., a 3-day-old white boy baby, was

The incidence of pyloric stenosis in Dundee.

The incidence of pyloric stenosis in Dundee.