What are the signs and symptoms of pyloric stenosis in adults?
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A 65-year-old woman with a history of peptic ulcer disease consulted a gastroenterologist after experiencing symptoms of nausea, vomiting, and early satiety for several months. Show
A standard endoscope could not be advanced through the pylorus into the duodenum, and findings on upper endoscopy revealed a large volume of retained food in her stomach. The patient was diagnosed with high-grade pyloric stenosis. Given the high-grade nature of the pyloric stenosis, the gastroenterologist referred the patient to Rebecca A. Burbridge, MD, gastroenterologist and director of Advanced Endoscopy at Duke University Hospital. Question: What innovative approach did Burbridge take to dilate the pylorus? View case conclusion Answer: Burbridge used an AXIOS stent (Boston Scientific, Marlborough, MA), a novel, endoscopic, fully covered, metal-apposition stent, to take an aggressive approach to dilating the patient's pylorus. Findings on upper endoscopy performed at Duke confirmed high-grade stricture of the pylorus that nearly obstructed the outflow of the patient's stomach. Although Burbridge initially considered performing standard balloon dilation, she decided to deploy the AXIOS stent because it has been shown to be more effective in aggressively dilating severe short stenoses of the gastrointestinal (GI) tract than standard balloon dilation alone. “The stent is quite effective in stretching open these strictures to the point where patients hopefully experience many months—and maybe even years—of relief,” Burbridge says. After a few days with the stent in place, the patient was able to tolerate a soft/low-residue diet for the first time in many months without nausea, vomiting, or early satiety. The stent will remain in place for 3 months before the patient will return to have it removed. Duke is one of few centers using the stent for this off-label use. Burbridge explains that the stent’s approved indication is to aid in the drainage of pancreatic pseudocysts. Use of the AXIOS stent has also evolved into other areas of treatment, such as gallbladder drainage in the setting of acute cholecystitis and palliative GI bypass of malignant luminal blockages, in addition to the treatment of short strictures of the GI tract, including pyloric and anastomotic strictures. Because use of the AXIOS stent for this off-label purpose is relatively novel, Burbridge notes that long-term outcomes following its removal are not well known. Still, she is optimistic about the stent’s potential: “I've successfully treated 3 patients with pyloric stricture using the AXIOS stent,” she says. “All are doing clinically well with much improvement in their symptoms and, more importantly, their quality of life.” Pyloric stenosis is a rare condition that occurs when the passage between the stomach and the small intestine narrows. It typically occurs in infants and can cause an obstruction, leading to projectile vomiting, abdominal cramps, dehydration, and hunger. Experts estimate that pyloric stenosis affects2–5 in every 1,000 births. They also report that it usually affects infants under 6 months of age and is less common in older children. Without treatment, pyloric stenosis may affect growth and development. This article outlines the causes and symptoms of pyloric stenosis, along with information on diagnosis and treatment. What is pyloric stenosis?
Pyloric stenosis is a rare condition that occurs when the pylorus, a muscular valve that sits at the bottom of the stomach, thickens. This causes the pylorus to narrow. Typically, the pylorus opens and closes to allow food through to the small intestine during digestion. When pyloric stenosis develops, this cannot happen as it should. Food and fluids cannot get through easily, so the body cannot digest and absorb them. Although this condition can occur anytime from birth onward, it usually develops within2–8 weeksof age. Symptoms of pyloric stenosisBabies with pyloric stenosis often have no symptoms at birth. When they do develop, symptoms can include:
When to seek helpA person should contact a doctor as soon as possible if a baby has any of the following signs and symptoms:
If the baby cannot keep any food or water down or shows signs of dehydration, dial 911 or the number of the nearest emergency department. Signs of dehydration in infants include:
Causes and risk factors for pyloric stenosisHealthcare experts do not know what causes pyloric stenosis but have identified certain risk factors that may increase the likelihood. These include:
Diagnosing pyloric stenosisIf an infant shows any signs or symptoms that could indicate pyloric stenosis, their caregiver should immediately contact a pediatrician. The pediatrician will perform a physical examination to check if an abdominal mass around the size of an olive is present in the child’s upper abdomen. They may also order other tests, including:
Treatment for pyloric stenosisThe gold standard treatment for pyloric stenosis is a surgical procedure known asRamstedt’s pyloromyotomy. This widens the space inside the pylorus, allowing food and fluids to pass through more easily. Ramstedt’s pyloromyotomy procedureBefore the surgery, a healthcare professional will test the baby’s blood to check they have healthy fluid and electrolyte levels. If they do not, the baby will receive IV fluids. Next, a medical professional will administer general anesthesia, so the baby feels no pain. Then a pediatric surgeon will begin the surgery. Surgeons can perform a pyloromyotomy in one of two ways: laparoscopically, which is minimally invasive, and through open surgery. In a laparoscopic pyloromyotomy, the surgeon will make three small incisions and use a camera to see inside the abdomen. They then use small tools to cut the muscle around the pylorus. In an open pyloromyotomy, the surgeon makes a bigger incision on the right side of the stomach and cuts the pylorus. The surgery usually takes about 30 minutes. After surgeryAround 6 hours after surgery, the infant can begin having small amounts of food. These amounts can gradually increase as the baby tolerates it. The baby will usually go home after 1–2 days in the hospital. Healthcare professionals will monitor the baby for any postoperative complications during this period. After going home, they will need some special care while they recover. This involves:
Complications of pyloric stenosisWithout treatment, pyloric stenosis can cause the following complications:
Surgery for pyloric stenosis also involves a few potential complications, such as infection. However, the benefits vastly outweigh the risks, and most babies recover quickly with no adverse outcomes. Speak with a doctor if a baby develops any of the following after surgery:
Frequently asked questionsHere are answers to some common questions about pyloric stenosis. Will pyloric stenosis go away on its own?No, pyloric stenosis cannot get better on its own. It requires treatment from a doctor. Can pyloric stenosis affect adults?According to a2018 review, pyloric stenosis occurs very rarely in adults. Sometimes it is idiopathic, meaning the cause is unknown. At other times, it can appear alongside other medical conditions such as ulcers, gastrointestinal tumors, or postoperative adhesions. What is the long-term outlook for an infant with pyloric stenosis?If untreated, pyloric stenosis can cause severe complications. However, the outlook for infants who do receive the surgery is generally good. Most make an excellent recovery, and very few experience any long-term problems due to the condition. Summary Pyloric stenosis is a rare condition that typically affects infants below the age of6 months. It occurs when the pylorus, the muscular valve at the bottom of the stomach, thickens. Infants with pyloric stenosis may not appear sick at first, but as the pylorus narrows, it becomes more difficult for food and water to pass through. Symptoms of pyloric stenosis include projectile vomiting, stomach cramps, constipation, and dehydration. If someone is concerned a child may have pyloric stenosis, they should talk with a doctor immediately. A person with pyloric stenosis needs surgery to correct the condition and improve digestive function. How is pyloric stenosis diagnosed in adults?The condition is diagnosed using imaging studies and endoscopy.
How is pyloric stenosis treated in adults?Pyloromyotomy. In surgery to treat pyloric stenosis, called a pyloromyotomy, the surgeon makes an incision in the wall of the pylorus. The lining of the pylorus bulges through the incision, opening a channel from the stomach to the small intestine. Surgery is needed to treat pyloric stenosis.
What symptoms will a patient with pyloric stenosis have?What are the symptoms of pyloric stenosis?. Frequent projectile vomiting (forceful vomiting), usually within a half hour to an hour after eating.. Abdominal (belly) pain.. Dehydration.. Hunger after feedings.. Irritability.. Small stools.. Wave-like stomach motion right after eating, just before vomiting starts. ... . Weight loss.. What is pyloric stenosis and what is its characteristic symptom?Pyloric stenosis is a thickening or swelling of the pylorus — the muscle between the stomach and the intestines — that causes severe and forceful vomiting in the first few months of life. It is also called infantile hypertrophic pyloric stenosis.
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