How long is a piece of string? The variety of ways infant pyloric stenosis (“PS”) can raise its horrible head is like answering that hoary question.
Almost two years ago I posted an attempt to answer this question, It is not only a post still well worth reading if you are asking yourself this question. The post had several responses which underline how frustrating and kaleidoscopic it is to answer several of the questions about PS. Let me run through the main parts to my answer again here.
Pyloric Stenosis or pylorospasm?
Whether there is a significant difference between Pyloric Stenosis and Pylorospasm has been argued at least since the early years of the 20th century and it is still debated in medical circles. Those favouring the distinction describe Pylorospasm as a spasming of the pylorus triggered by the nerves and resulting in the delayed emptying of the stomach – but nothing much more . It is agreed that true PS involves the thickening and hardening of the muscle band of the pyloric ring, and when advanced enough this would not let any food pass into the duodenum, usually with fatal results.
However, others have preferred to see Pylorospasm as the beginning or a milder form of PS. There is a difference, but it may only be clear from an ultrasound study, as this article explains and illustrates. Another useful article may be read (although only in summary) here.
From my simple and probably simplistic description it should be clear that Pylorospasm is not serious enough to warrant surgical and perhaps not even medical intervention, and that a full PS will be fatal unless there is some form of intervention.
To add to the confusion, PS is often termed “Pylorospasm”. I well remember that in my native Netherlands the condition I had was called “pyloruspasmus” even though it was clearly a full-grade PS! I find that the same confusing interchangeability continues in at least several different languages today.
The bottom line is: some misbehaviour of the pylorus is mild enough to not warrant surgery. Not all projectile vomiting is deadly, so doctors will sometimes await further developments. This is not to be confused with the fact that many doctors are accused of belittling parents, not taking time for careful diagnostic questions and tests, and brushing off parents with talk of reflux – all this when the baby has lost significant weight and condition, and even when the parents mention the family’s history of PS.
Many cases of PS do not go to the operating room
Google “I had” together with “pyloric stenosis” and you will find articles, forum comments and posts that support the above statement.
There are many mentions of babies with what was clearly PS and whose condition was responsibly judged not to be severe enough to justify surgery. But these people in later life continued to battle with PS-like symptoms for many years – or lifelong. Some eventually sought surgery (usually more major than an infant pyloromyotomy) and some did as best they could by managing their food intake and distressing symptoms.
Pyloric stenosis can continue to “grumble” whether or not there has been surgery
As I have stated many times, many doctors promise parents that a safe, simple and quick operation will solve all their baby’s PS problems and that there are most unlikely to be any after-effects.
Surgery can be very successful in treating PS but it can also lead to short-term or lifelong symptoms which seem to be similar to some extent to mild PS: reflux and IBS, sensitivity to gagging and vomiting, overweight or chronic under-weight, etc.
Mild PS which is not dealt with by surgery is sometimes not treated at all or is treated with medication such as Atropine sulphate or Ranitidine. Either of these two courses may also lead to lifelong and troublesome gastric misbehaviour.
It seems beyond the ability of medical people to know whether a particular set of borderline or mixed symptoms should be diagnosed as PS, mild PS, pylorospasm, or something else. It also seems to be impossible to predict the future course of any case of PS, whichever way it has been treated or not treated.
A thorough and substantial research project or two would be so valuable to obtain a clearer picture of the consequences of various levels and treatments of this rather common condition in babies.
Medication can treat many pyloric stenosis cases successfully
In most “Western” countries, the medical treatment of PS with Atropine sulphate or Ranitidine has usually been given no or scant consideration.
These two drugs relax muscles and allow the pylorus to relax, reducing its swelling and allowing it to open and shut without surgical intervention, but because of their effect on all muscles they must be introduced over several days and under careful medical supervision. This course of treatment has been used for many years by pediatric specialists in many countries, and a recent Japanese project found its use succeeded in avoiding surgery in almost every case in the trial.
Parents who could or should consider medical treatment for their baby must 1) know the symptoms of PS well, 2) have gathered strong evidence of their baby’s condition and perhaps have had previous experience with this malady, 3) have a baby who is not close to death, and 4) are willing to learn how to use the medication. They may also need a supportive person to stand by their side as they may need to insist on being heard and helped by their doctor. It must be realised that the safe use of medication requires early diagnosis, a baby who is not frail or newborn, and a baby whose condition allows the several days necessary for the drug to take effect.
Interested parents should use the “Categories” search box to the right of this page to find and read posts like this one on “the hushed up alternative to PS surgery.