Congenital Pyloric Stenosis: Causes, Symptoms, and Treatment

Congenital pyloric stenosis is a condition that affects infants, causing a narrowing of the opening between the stomach and the small intestine. This narrowing can lead to difficulties in food passing through, resulting in symptoms like vomiting and poor weight gain. The main cause of congenital pyloric stenosis is thought to be an overgrowth of muscle in the pylorus, the muscle at the lower end of the stomach.

This leads to a blockage that prevents food from properly entering the small intestine. While the exact reasons for this muscle overgrowth are not fully understood, it is believed to involve a combination of genetic and environmental factors. Understanding the causes of congenital pyloric stenosis is essential for diagnosing and managing the condition effectively.

What Are the Symptoms of Congenital Pyloric Stenosis

Congenital pyloric stenosis is a condition that primarily affects infants, causing symptoms such as forceful vomiting, particularly after feeding, leading to weight loss and dehydration. The baby may appear hungry and feed eagerly but then vomit forcefully, often with a projectile-like motion. They may also show signs of constant hunger and fail to gain weight adequately.

Additionally, affected infants may have fewer wet diapers due to dehydration and appear irritable or lethargic. If your baby displays these symptoms, it is essential to seek medical attention promptly for a proper diagnosis and treatment.

Vomiting forcefully after feeding is a common symptom of congenital pyloric stenosis in infants.
Babies with this condition may show signs of dehydration such as fewer wet diapers than usual.
Constant hunger and irritability in a newborn could indicate possible pyloric stenosis.
Failure to gain weight or even weight loss despite regular feeding might be a red flag for pyloric stenosis.
Visible peristalsis, where waves of contractions move across the baby's abdomen, can be a sign of pyloric stenosis.

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Causes of Congenital Pyloric Stenosis

This thickening results in a narrowing of the passage, making it difficult for food to pass through. While the exact cause is not fully understood, genetic and environmental factors are believed to play a role in the development of this condition.

Factors such as family history, gender (more common in males), and certain medications taken during pregnancy have been implicated as potential contributors to the development of congenital pyloric stenosis.

Genetic factors play a role in congenital pyloric stenosis, with a higher risk in babies born to affected parents.
Maternal smoking during pregnancy has been linked to an increased incidence of congenital pyloric stenosis in newborns.
Certain medications taken during pregnancy, such as erythromycin, have been associated with a higher risk of congenital pyloric stenosis.
Premature birth can be a contributing factor to the development of congenital pyloric stenosis in infants.
In some cases, abnormal development of the pyloric muscle in the womb can lead to congenital pyloric stenosis in newborns.

Types of Congenital Pyloric Stenosis

Congenital pyloric stenosis presents in two main types: hypertrophic and functional. Hypertrophic pyloric stenosis is the most common form, characterized by thickening of the pylorus muscle, leading to narrowing of the passage between the stomach and small intestine.

On the other hand, functional pyloric stenosis is less common and is typically due to muscular spasms rather than anatomical changes. Both types result in symptoms like projectile vomiting, failure to thrive, and dehydration in infants, necessitating prompt medical intervention.

Types of Congenital Pyloric Stenosis:

Hypertrophic Pyloric Stenosis is the most common type, characterized by thickening of the muscle at the outlet of the stomach.
Functional Pyloric Stenosis refers to cases where the muscle function of the pylorus is impaired without significant thickening.
Membranous Pyloric Stenosis is a rare form where a thin membrane obstructs the pyloric channel.
Acquired Pyloric Stenosis can occur in older children or adults due to scarring or inflammation of the pylorus.
Idiopathic Pyloric Stenosis is a term used when the exact cause of the condition is unknown.

Risk Factors

While the exact cause is unknown, certain risk factors may increase the likelihood of this condition. These factors include genetics, with a family history of pyloric stenosis, being more prone to developing it.

Additionally, first-born males are at a higher risk than females, and premature or low birth weight infants may also be more susceptible. Understanding these risk factors can help in early detection and management of congenital pyloric stenosis.

Male gender is a risk factor for congenital pyloric stenosis, with boys being more commonly affected than girls.
Family history of pyloric stenosis increases the likelihood of a baby developing the condition.
Maternal smoking during pregnancy has been linked to an increased risk of congenital pyloric stenosis.
Certain antibiotics, such as erythromycin, used during pregnancy may raise the risk of pyloric stenosis in newborns.
Prematurity is a risk factor for congenital pyloric stenosis, with premature babies having a higher incidence of the condition.

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Diagnosis of Congenital Pyloric Stenosis

Congenital pyloric stenosis is typically diagnosed through a combination of physical examination, imaging studies, and laboratory tests. The initial assessment often involves a thorough physical exam to check for signs such as a palpable olive-shaped mass in the abdomen and visible peristaltic waves. Ultrasonography is commonly used to visualize the thickened pylorus muscle.

Blood tests may be done to assess electrolyte levels, as infants with pyloric stenosis can develop dehydration and electrolyte imbalances due to persistent vomiting. In some cases, a barium swallow study may be performed to further evaluate the gastric outlet obstruction. The diagnostic process for congenital pyloric stenosis aims to confirm the condition and determine the severity to guide appropriate treatment.

Abdominal ultrasound is commonly used to diagnose congenital pyloric stenosis by visualizing the thickened pylorus muscle.
Blood tests may be done to check for electrolyte imbalances and dehydration in infants with suspected pyloric stenosis.
A physical examination by a healthcare provider may reveal a palpable olive-shaped mass in the infant's abdomen.
Imaging studies like upper gastrointestinal series or barium swallow can help confirm the diagnosis of pyloric stenosis.
Pyloric stenosis can also be diagnosed through a procedure called an upper endoscopy, where a flexible scope is inserted into the stomach.

Treatment for Congenital Pyloric Stenosis

The most common treatment is a procedure called a pyloromyotomy, where the thickened muscle blocking the pylorus is cut to alleviate the obstruction. This surgery is minimally invasive and has high success rates with low complication risks.

In some cases, particularly if the condition is severe or complications arise, additional treatments or supportive care may be necessary to ensure the infant's recovery and optimal health. It is essential for parents to consult with pediatric surgeons and healthcare providers to determine the best course of action for their child's specific situation.

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