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Medical Hypotheses Dec 2020An account is given of the process by which the Primary Hyperacidity pathogenesis of Pyloric Stenosis of Infancy (PS) evolved. The initial discovery that fasting...
An account is given of the process by which the Primary Hyperacidity pathogenesis of Pyloric Stenosis of Infancy (PS) evolved. The initial discovery that fasting gastrins were high at birth and continued to rise within the first 4 days was the starting point. Since acidity was also rising at the same time it was proposed that the usual negative feed-back between gastrin and stomach acidity was not mature in the first few weeks of life. The gastrin model for producing PS in puppy dogs was a further incentive to believe that relatively high gastrins, and secondary high acidity would thereby repeatedly cause sphincter contraction and lead to hypertrophy. When gastrin was found to be normal in PS babies we considered and accepted, the less complicated hypothesis that a Primary Inherited Hyperacidity itself was the driving force. Such a theory explained nearly all the clinical features. When we further considered the expected consequences of an initially ineffective negative feed -back and its later maturation, the known peak acidity in neonatal development was explained. This phenomenon also provided an explanation for the remaining previously unexplained time sensitive features of the condition.
Topics: Animals; Disease Models, Animal; Dogs; Fasting; Gastrins; Humans; Hypertrophy; Infant; Pyloric Stenosis
PubMed: 33075583
DOI: 10.1016/j.mehy.2020.110325 -
Digestive Diseases (Basel, Switzerland) 2016Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination... (Review)
Review
BACKGROUND
Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed.
KEY MESSAGES
Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a 'meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification.
CONCLUSION
Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.
Topics: Adolescent; Adult; Diagnosis, Differential; Dyspepsia; Feeding and Eating Disorders of Childhood; Female; Gastroparesis; Humans; Male
PubMed: 27332558
DOI: 10.1159/000445226 -
Pediatric Annals Oct 2021Point-of-care ultrasound (POCUS) for pediatric abdominal symptoms has expanded in both the inpatient and outpatient settings. POCUS may be used to aid in the diagnosis... (Review)
Review
Point-of-care ultrasound (POCUS) for pediatric abdominal symptoms has expanded in both the inpatient and outpatient settings. POCUS may be used to aid in the diagnosis of appendicitis, hypertrophic pyloric stenosis, and intussusception in the pediatric population. This article reviews the benefits of POCUS for the diagnosis of these pediatric pathologies. This article also provides instruction on how to perform these important examinations. .
Topics: Appendicitis; Child; Humans; Intussusception; Point-of-Care Systems; Ultrasonography
PubMed: 34617844
DOI: 10.3928/19382359-20210916-01 -
Journal of Perioperative Practice Oct 2021
Topics: Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 34034592
DOI: 10.1177/17504589211011006 -
Indian Journal of Pediatrics Sep 2019The bowel is a challenging abdominal organ to image. The main reason is the variable location, convoluted morphology and motility. A variety of bowel disorders such as... (Review)
Review
The bowel is a challenging abdominal organ to image. The main reason is the variable location, convoluted morphology and motility. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Imaging plays a very important role in characterizing these lesions and further guiding the management. This is the first part of the series on imaging of bowel disorders in children. This article will cover the imaging modalities used for the evaluation of bowel and the imaging features of congenital /developmental disorders.
Topics: Abdominal Cavity; Anorectal Malformations; Child; Diagnostic Imaging; Duodenal Diseases; Duodenal Obstruction; Esophageal Atresia; Gastrointestinal Diseases; Humans; Intestinal Atresia; Magnetic Resonance Imaging; Meconium Ileus; Pediatrics; Pyloric Stenosis, Hypertrophic; Tomography, X-Ray Computed; Tracheoesophageal Fistula; Ultrasonography
PubMed: 30767163
DOI: 10.1007/s12098-019-02877-9 -
Asian Journal of Endoscopic Surgery Nov 2015
Topics: Anus, Imperforate; Child; Colon; Fundoplication; Funnel Chest; Gastroesophageal Reflux; Hirschsprung Disease; Humans; Intraoperative Complications; Laparoscopy; Orthopedic Procedures; Pediatrics; Postoperative Complications; Pyloric Stenosis, Hypertrophic; Pylorus; Treatment Outcome
PubMed: 26708583
DOI: 10.1111/ases.12263 -
Pediatric Gastroenterology, Hepatology... May 2021Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric obstruction in newborns. Extra-mucosal pyloromyotomy can be performed through a small laparotomy...
PURPOSE
Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric obstruction in newborns. Extra-mucosal pyloromyotomy can be performed through a small laparotomy or laparoscopy. The aim of this study was to compare the two surgical techniques. We also analyzed the incidence of HPS in infants in the last 10 years in relation to the demographic trend of our province.
METHODS
We analyzed all the cases of HPS treated at our Unit between January 2010 and December 2019. The data were obtained from operating systems. Data about the demographic trends, in particular, the number of births and the population residing in the province of Verona from 2010 to 2019, were also retrieved.
RESULTS
During the study period, 60 patients were treated for HPS and met the inclusion criteria. Of these, 56 males and 4 females with an average age of 38±14 days at surgery were included. No differences were found in terms of the duration of surgery, post-operative complications, duration of hospitalization, and weight at the time of surgery. The only statistically significant data was the chlorine level in cases with and without post-operative vomiting (97±3.5 vs. 102±3.3 mmol/L, <0.05). There was a lower incidence of HPS from 2014 to 2019; however, there was no significant evidence regarding the correlation between this and the reduced birth rate recorded in the province of Verona during the same period.
CONCLUSION
Although laparoscopic pyloromyotomy is a highly complex procedure, it is a feasible alternative to the classic open technique.
PubMed: 34046329
DOI: 10.5223/pghn.2021.24.3.265 -
The Journal of Emergency Medicine Nov 2023Hypertrophic pyloric stenosis is a common cause of nonbilious vomiting in infants younger than 6 months. Its history, physical examination, and point-of-care ultrasound...
BACKGROUND
Hypertrophic pyloric stenosis is a common cause of nonbilious vomiting in infants younger than 6 months. Its history, physical examination, and point-of-care ultrasound (POCUS) have not been compared for their diagnostic test accuracy.
OBJECTIVE
The aim of this systematic review was to quantify and compare the diagnostic test accuracy of a history of vomiting, a pyloric mass on palpation, and POCUS.
METHODS
We performed three searches of the literature from 1977 to March 2022. We evaluated bias using the QUADAS-2 (Quality Assessment Tool for Diagnostic Accuracy-2) tool. We performed a bivariate analysis.
RESULTS
From 5369 citations, we identified 14 studies meeting our inclusion criteria. We quantified three diagnostic elements: POCUS, a pyloric mass on palpation, and vomiting. We identified five studies that analyzed POCUS, which included 329 patients. POCUS had a sensitivity of 97.7% (95% confidence interval (CI) 93.1-99.3%) and a specificity of 94.1% (95% CI 88.7-97.1%) for detecting pyloric stenosis. We identified six studies that analyzed the presence of a pyloric mass, which included 628 patients. The palpation of a pyloric mass had a sensitivity of 73.5% (95% CI 62.6-82.1%) and a specificity of 97.5% (95% CI 93.8-99.0%). We identified four studies that analyzed vomiting, which included 355 patients. Vomiting had a sensitivity of 91.3% (95% CI 82.1-96.0) and a specificity of 60.8% (95% CI 8.5-96.3). Both POCUS and palpation of a pyloric mass had a high positive likelihood ratio (LR+: 17 and 33, respectively). The LR+ for vomiting was 5.0.
CONCLUSIONS
Both POCUS and palpable mass had high specificity and positive LR, whereas vomiting provided the lowest diagnostic test measures.
PubMed: 37722950
DOI: 10.1016/j.jemermed.2023.06.001 -
Pediatrics Mar 2015Use of oral erythromycin in infants is associated with infantile hypertrophic pyloric stenosis (IHPS). The risk with azithromycin remains unknown. We evaluated the...
BACKGROUND AND OBJECTIVE
Use of oral erythromycin in infants is associated with infantile hypertrophic pyloric stenosis (IHPS). The risk with azithromycin remains unknown. We evaluated the association between exposure to oral azithromycin and erythromycin and subsequent development of IHPS.
METHODS
A retrospective cohort study of children born between 2001 and 2012 was performed utilizing the military health system database. Infants prescribed either oral erythromycin or azithromycin as outpatients in the first 90 days of life were evaluated for development of IHPS. Specific diagnostic and procedural codes were used to identify cases of IHPS.
RESULTS
A total of 2466 of 1 074 236 children in the study period developed IHPS. Azithromycin exposure in the first 14 days of life demonstrated an increased risk of IHPS (adjusted odds ratio [aOR], 8.26; 95% confidence interval [CI], 2.62-26.0); exposure between 15 and 42 days had an aOR of 2.98 (95% CI, 1.24-7.20). An association between erythromycin and IHPS was also confirmed. Exposure to erythromycin in the first 14 days of life had an aOR of 13.3 (95% CI, 6.80-25.9), and 15 to 42 days of life, aOR 4.10 (95% CI, 1.69-9.91). There was no association with either macrolide between 43 and 90 days of life.
CONCLUSIONS
Ingestion of oral azithromycin and erythromycin places young infants at increased risk of developing IHPS. This association is strongest if the exposure occurred in the first 2 weeks of life, but persists although to a lesser degree in children between 2 and 6 weeks of age.
Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Incidence; Infant; Infant, Newborn; Male; Odds Ratio; Outpatients; Prognosis; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Risk Assessment; Risk Factors; United States; Whooping Cough
PubMed: 25687145
DOI: 10.1542/peds.2014-2026 -
European Journal of Pediatric Surgery :... Apr 2018Pyloromyotomy is the tried and tested surgical procedure for successful operative treatment of pyloric stenosis. Over time, the operative approach has evolved to take... (Review)
Review
Pyloromyotomy is the tried and tested surgical procedure for successful operative treatment of pyloric stenosis. Over time, the operative approach has evolved to take advantage of cosmetically superior incisions and more recently minimally invasive surgery. During and following surgery, complications are uncommon. The specific complications of an inadequate pyloromyotomy requiring repeated procedure and mucosal perforation during an overzealous pyloromyotomy represent the ends of a spectrum within which sits the perfect procedure. Here, we discuss these specific complications together with the other potential complications following surgery for hypertrophic pyloric stenosis, including anesthetic considerations.
Topics: Anesthesia; Humans; Infant; Infant, Newborn; Intraoperative Complications; Laparoscopy; Postoperative Complications; Pyloric Stenosis, Hypertrophic; Pyloromyotomy
PubMed: 29510427
DOI: 10.1055/s-0038-1637016