How Japan handles infant Pyloric Stenosis

Most readers of this blog are more than interested in Pyloric Stenosis (“PS”), either because they or one or more of their children had infant PS as a baby.

PS is the most common form of bowel blockage to affect newborns in their first 4 or so months.  In most developed countries, all but the mildest cases are treated surgically. The surgical technique is a long-standing and firm favourite among surgeons: once mastered it is quick, simple, almost bloodless, and usually immediately effective. Parents who had been traumatised by their baby’s uncontrollable and violent vomiting and then by having to surrender their little one to be anesthetised and then cut open receive their little one back alive and with the promise: All done, you have a new baby, sick no more, home soon, and nothing to worry about in the future!  No wonder surgeons just love the Ramstedt procedure!

But if you look up “pyloric stenosis” on any of the larger social forum websites, you learn more.

  • The parent trauma resulting from PS and infant surgery can be deep and long-lasting,
  • this can affect the child also, and
  • the surgery is not always free of long-term problems, in both the immediate and long terms.

Such problems are probably far from the rule, and most Py babies seem not to look back. However, there are no substantial studies on this subject, and the ongoing effects of infant surgery on parents and sometimes the whole family, let alone the patient, can certainly be significant.

During my 20 years of researching the many issues related to PS, I have been surprised to learn that in some developed countries far from the Anglo-European world, surgery is the exception rather than the rule for PS babies.

The reports relating this are few but persistent.  For many decades now, academics and medical practitioners in countries including Japan, Taiwan, and Turkey have reported on regarding PS  surgery as a last resort.

ranitidine01Their policy is to treat most infant PS medically as the first option. The drugs involved are atropine sulphate and Ranitidine, drugs that reduce gastric acidity production. Very small or fragile babies, and those that do not respond to medical treatment within a stated time, are referred to a surgeon.

The outcomes are comparable by almost every standard: morbidity, mortality, and short-term problems. The hospital stay is longer, but the total cost is lower. Parents are happier and less traumatised.

Now a  2018 Japanese study has reported a small trial of adding a second drug, nitroglycerin or glyceryl trinitrate (GTN), in those cases that do not respond to atropine sulphate.  GTN is widely known as an explosive but is also often used to treat heart conditions.  Using both drugs meant success in treating all the PS infants in the study.

It is well worthwhile clicking on the link in the previous paragraph to read the full article, published by Open Source publisher Science Direct.

This is a story worth recording also! Most medical reports are published by large for-profit companies that first charge researchers for publishing their work and then the readers for access to the reports and discussions.  Open Access publishers believe that new research and discoveries should be published online without cost to the authors and should be freely available to anybody interested.

Posting this great news makes me soooo happy!

I am one of many millions who have gone for years hating our scars from infant surgery. PS survivors know that without this damage most of us might not be alive today!

But what if we knew that our parents had had a choice between a few days or weeks of supervised medical treatment – and disfiguring surgery?  And that they chose surgery without considering how we their child might be affected by that in years to come? We PS babies had no say in our treatment – but our parents were our advocates!  And parents who learn that infant surgery not only saves lives but can come with adhesions, collateral GI damage, and/or long-term psychological effects… who would not give medical treatment a try first?

This free medical article from Japan explains how treating infant PS medically is their first option – and it’s all that’s needed for up to 90% of PS babies to survive. This case reports details 2 cases when old-established medical treatment failed but was successful when combined with skin patches of another drug!

But… can our surgeons wean themselves off their favourite surgery?

1 thought on “How Japan handles infant Pyloric Stenosis

  1. Wendy

    What a thrill! Fabulous post! Thank you so much for your knowledge and perspective on this. A few thoughts: What you wrote about the scarring is so true for me. Early on, I felt excised and alienated from humanity because of it–more like a sea creature (horseshoe crab to be exact) than human. How I wish I could have been medically treated instead of cut! For me though, as I was on death’s door by the time I was admitted to the hospital, medical treatment would have been out of the question. And you are absolutely right about the lie that doctors and the medical profession perpetrate: that the surgery is 100% effective without future problems. You detail the problems that can ensue and these realities are true. For me, the psychological piece has been huge. Not only did my mother have PTSD from her experience dealing with her dying newborn, the condition of which was attributed to her not breastfeeding correctly, but after the trauma of the surgery, I had PTSD, too. Imagine western medicine questioning whether surgery for PS should be the first option. Imagine doctors having to be more patient and work closely with nurses and other hospital staff for the best non-surgical outcome. Imagine western doctors being willing to change their thinking on this. It will take many more articles like the one you linked to for them to even begin to think about the medical option being the first option for PSers. I’m willing to be hopeful, however. I’m willing to imagine medicine changing. After all, medicine’s attitude shifted regarding whether newborns felt pain and could safely tolerate anesthesia. Let’s keep talking this issue up. Let’s agitate for change, like dear Fred posting about the way Japan handles PS. Thank you for this marvelous good-news post!

    Reply

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