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Pyloric Stenosis: Causes, Symptoms & Treatment

Pyloric stenosis is a narrowing of the stomach outlet that prevents food from passing into the small intestine. It most commonly affects infants and causes forceful vomiting.

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Pyloric stenosis is a narrowing of the stomach outlet that prevents food from passing into the small intestine. It most commonly affects infants and causes forceful vomiting.

What is Pyloric Stenosis?

Pyloric stenosis is a narrowing or complete blockage of the pylorus – the muscular valve at the lower end of the stomach that connects to the duodenum (the first part of the small intestine). When this opening becomes too narrow, the stomach contents cannot pass through properly, leading to significant digestive problems. There are two main forms: congenital (infantile) pyloric stenosis, which affects newborns and young infants, and acquired pyloric stenosis, which develops in adults as a result of other conditions.

Causes

Congenital Pyloric Stenosis (Infantile Hypertrophic Pyloric Stenosis)

In infants, the condition is most commonly known as infantile hypertrophic pyloric stenosis (IHPS). The muscle surrounding the pylorus thickens abnormally over the first few weeks of life, progressively narrowing the opening. The exact cause remains unclear, but several risk factors have been identified:

Genetic predisposition (family history increases risk)
Male sex (boys are approximately 4 times more commonly affected)
First-born children have a higher risk
Antibiotic use (e.g., erythromycin) in the first weeks of life
Exposure to tobacco smoke during pregnancy

Acquired Pyloric Stenosis in Adults

In adults, pyloric stenosis typically develops as a complication of other diseases:

Peptic ulcer disease: Scar tissue formed after ulcers near the pylorus can cause narrowing.
Gastric cancer (stomach carcinoma): Tumors located near the pylorus may obstruct the outlet.
Chronic gastric inflammation
Crohn's disease: Inflammatory bowel disease that can occasionally involve the stomach

Symptoms

Symptoms in Infants

Projectile, non-bilious vomiting shortly after feeding
Persistent hunger despite frequent feeding
Poor weight gain or weight loss
Dehydration: sunken fontanelle, dry mucous membranes, decreased urine output
Visible gastric peristalsis (wave-like movements across the abdomen)
Constipation
Irritability and fussiness

Symptoms in Adults

Nausea and vomiting, often containing undigested food
Postprandial pain (pain after meals)
Early satiety (feeling full quickly)
Unintentional weight loss
Bloating and pressure sensation in the upper abdomen

Diagnosis

Pyloric stenosis is diagnosed using several methods depending on the patient's age and clinical presentation:

Ultrasound (sonography): The preferred diagnostic method in infants; a pyloric wall thickness greater than 4 mm and a channel length greater than 16 mm are considered abnormal.
Upper endoscopy (gastroscopy): Used in adults to directly visualize the narrowing and to rule out malignancy or ulcers.
Contrast radiography (upper GI series): Can demonstrate delayed gastric emptying and the narrowed pyloric channel.
Blood tests: To detect electrolyte imbalances (e.g., hypochloraemic metabolic alkalosis in infants) and assess the degree of dehydration.

Treatment

Treatment in Infants

The standard treatment for infantile hypertrophic pyloric stenosis is the Weber-Ramstedt pyloromyotomy. In this surgical procedure, the thickened pyloric muscle is carefully divided without cutting the underlying mucosa, allowing the pylorus to open normally. The procedure can be performed as open surgery or laparoscopically (minimally invasive). Before surgery, it is essential to correct any fluid and electrolyte imbalances.

Success rate exceeds 99 %
Infants can typically resume feeding within a few hours of surgery
Full recovery is expected with no long-term complications

Treatment in Adults

Treatment depends on the underlying cause:

Endoscopic balloon dilatation: Widening of the stenosis using a balloon catheter, suitable for scar-related narrowing
Surgical resection: Partial gastrectomy may be required for tumor-related or treatment-resistant cases
Medical therapy: Proton pump inhibitors and antibiotics (for Helicobacter pylori eradication) in ulcer-related stenosis
Nutritional support: Dietary modifications or parenteral nutrition in cases of severe weight loss

Prognosis

In infants, the prognosis following surgical treatment is excellent, with complete recovery and no lasting effects expected. In adults, the outlook depends largely on the underlying condition. Early diagnosis and appropriate treatment significantly improve outcomes.

References

Puri P, Höllwarth ME (Eds.): Pediatric Surgery. Springer Verlag, 2nd edition, 2009.
Ranells JD, Carver JD, Kirby RS: Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Advances in Pediatrics, 2011;58(1):195-206. PubMed PMID: 21736982.
World Health Organization (WHO): Surgical Care at the District Hospital. WHO Press, Geneva, 2003.

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