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The Pan African Medical Journal 2016
Topics: Abdominal Pain; Adult; Constipation; Humans; Male; Pyloric Stenosis; Vomiting
PubMed: 28154715
DOI: 10.11604/pamj.2016.25.23.10707 -
Journal of Pediatric Surgery Aug 2014The incidence of infantile hypertrophic pyloric stenosis (IHPS) in Sweden decreased dramatically during the 1990s. The aim of the study was to examine IHPS risk factors...
BACKGROUND/PURPOSE
The incidence of infantile hypertrophic pyloric stenosis (IHPS) in Sweden decreased dramatically during the 1990s. The aim of the study was to examine IHPS risk factors and the possible change in them as the incidence declined.
METHODS
This is a case-control study including 3608 surgically treated IHPS cases and 17588 matched controls during 1973-2008. Cases were identified in the Swedish National Patient Register and data on possible risk factors were collected from the Swedish Medical Birth Register. The association between study variables and IHPS was analyzed using conditional logistic regression for the whole study period and separately for periods with high and low IHPS incidences.
RESULTS
Prematurity (OR, 2.54; 95% CI, 2.06-3.14), caesarean delivery (OR, 1.67; 95% CI, 1.51-1.86), maternal smoking (OR, 1.82; 95% CI, 1.53-2.16), and young maternal age (< 20yrs) (OR, 1.42; 95% CI, 1.17-1.73) were associated with an increased IHPS risk. Birth order 2 (OR, 0.78; 95% CI, 0.71-0.85) or more was associated with a lower IHPS risk. ORs for smoking increased at low incidence rate.
CONCLUSION
We report caesarean section, prematurity, primiparity, young maternal age, and smoking as significant IHPS risk factors. The impact of smoking was higher during periods with a low incidence.
Topics: Adult; Cesarean Section; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Maternal Age; Pregnancy; Prognosis; Pyloric Stenosis, Hypertrophic; Risk Assessment; Risk Factors; Smoking; Sweden; Young Adult
PubMed: 25092081
DOI: 10.1016/j.jpedsurg.2014.01.053 -
Maternal and Child Health Journal Sep 2014Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses...
Similar temporal declines in infantile hypertrophic pyloric stenosis (IHPS) and sudden infant death syndrome (SIDS) and other common features have led to hypotheses about a shared etiology. We carried out a population-based study to highlight similarities and differences between IHPS and SIDS. We used vital statistics and hospitalization data on all live births in Washington State, USA (1987-2009). Changes in IHPS and SIDS rates over time were quantified using rate ratios with 95 % confidence intervals (CI). The duration between birth and diagnosis of IHPS or SIDS was examined as a function of gestational age at birth. Logistic regression analysis was used to identify risk factors and quantify adjusted temporal trends (2000-2008). Although both IHPS and SIDS rates declined significantly between 1987 and 2008, the patterns and magnitude of the declines (40 and 74 %, respectively) were different. IHPS and SIDS shared risk factors such as maternal smoking and single parent status but other factors showed qualitatively or and quantitatively different associations. Primiparity was a risk factor for IHPS [odds ratio (OR) 1.24, 95 % CI 1.09-1.41], and a protective factor for SIDS (OR 0.44, 95 % CI 0.36-0.55), while male sex had a stronger association with IHPS (OR 4.51, 95 % CI 3.85-5.28 vs 1.36, 95 % CI 1.13-1.64). Both IHPS and SIDS showed significant inverse associations between gestational age at birth and chronologic age at diagnosis/death. IHPS and SIDS share some epidemiologic features and risk factors but other risk factors have qualitatively or quantitatively different effects and recent temporal trends in the two diseases are dissimilar.
Topics: Female; Humans; Infant; Logistic Models; Parity; Pregnancy; Pyloric Stenosis, Hypertrophic; Risk Factors; Sudden Infant Death; Washington
PubMed: 24337864
DOI: 10.1007/s10995-013-1417-4 -
Pediatric Surgery International Dec 2016Macrolide antibiotics, erythromycin, in particular, have been linked to the development of infantile hypertrophic pyloric stenosis (IHPS). Our aim was to conduct a... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Macrolide antibiotics, erythromycin, in particular, have been linked to the development of infantile hypertrophic pyloric stenosis (IHPS). Our aim was to conduct a systematic review of the evidence of whether post-natal erythromycin exposure is associated with subsequent development of IHPS.
METHODS
A systematic review of postnatal erythromycin administration and IHPS was performed. Papers were included if data were available on development (yes/no) of IHPS in infants exposed/unexposed to erythromycin. Data were meta-analysed using Review Manager 5.3. A random effects model was decided on a priori due to heterogeneity of study design; data are odds ratio (OR) with 95 % CI.
RESULTS
Nine papers reported data suitable for analysis; two randomised controlled trials and seven retrospective studies. Overall, erythromycin exposure was significantly associated with development of IHPS [OR 2.45 (1.12-5.35), p = 0.02]. However, significant heterogeneity existed between the studies (I = 84 %, p < 0.0001). Data on erythromycin exposure in the first 14 days of life was extracted from 4/9 studies and identified a strong association between erythromycin exposure and subsequent development IHPS [OR 12.89 (7.67-2167), p < 0.00001].
CONCLUSION
This study demonstrates a significant association between post-natal erythromycin exposure and development of IHPS, which seems stronger when exposure occurs in the first 2 weeks of life.
Topics: Anti-Bacterial Agents; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Odds Ratio; Pyloric Stenosis, Hypertrophic; Retrospective Studies
PubMed: 27655365
DOI: 10.1007/s00383-016-3971-5 -
Paediatric Anaesthesia Jul 2015Infants with pyloric stenosis are considered to be at high risk of aspiration on induction of anesthesia. Traditionally, texts have recommended classic rapid sequence...
BACKGROUND
Infants with pyloric stenosis are considered to be at high risk of aspiration on induction of anesthesia. Traditionally, texts have recommended classic rapid sequence induction (RSI) or awake intubation (AI). AI has generally fallen out of favor, while the components of RSI have become increasingly controversial. Infants are at high risk of hypoxemia if ventilation is not maintained while waiting for neuromuscular blockade to establish. The efficacy of cricoid pressure (CP) to prevent aspiration has not been proven. It can impair visualization of the glottis and make intubation difficult. It is debatable whether any RSI technique is needed for pyloromyotomy. A recent review of 235 infants reported no aspiration events. These children were anesthetized with a variety of techniques, including RSI, gas induction, and AI. In our institution, we teach a gaseous induction. The nasogastric tube is used to empty the stomach and anesthesia is induced with sevoflurane. A nondepolarizing muscle relaxant is administered and ventilation maintained until neuromuscular blockade is established and intubating conditions are optimal. We report our experience of this technique.
METHOD
A retrospective medical notes review of all patients undergoing pyloromyotomy between 2005 and 2012.
RESULTS
There were 269 patients (84.4% male, mean weight 3.74 kg ± 0.74). Two hundred and fifty-two (93.7%) received gas inductions and 17 (6.3%) intravenous (IV) inductions. Two children received an RSI. No patient-specific factors were identified to explain operator choice in those receiving IV inductions. There were no recorded aspiration events.
CONCLUSION
Gas induction can be considered for children undergoing pyloromyotomy.
Topics: Anesthetics, Inhalation; Female; Humans; Infant; Intubation, Intratracheal; Male; Methyl Ethers; Pyloric Stenosis; Pylorus; Retrospective Studies; Sevoflurane
PubMed: 25704405
DOI: 10.1111/pan.12633 -
Tidsskrift For Den Norske Laegeforening... Feb 2016Antibiotics are the most widely used medication on prescription in pregnancy. It is therefore important to investigate whether antibiotic use in pregnancy can harm the... (Review)
Review
BACKGROUND
Antibiotics are the most widely used medication on prescription in pregnancy. It is therefore important to investigate whether antibiotic use in pregnancy can harm the foetus. During the last decade the availability of data from national registries has made it possible to conduct large-scale epidemiological studies. In this article we aimed to review recent studies on the risk of congenital anomalies and miscarriage resulting from the use of antibiotics in pregnancy.
METHOD
A literature search was conducted in MedLine, Embase and PubMed for the period 1 December 2005-1 December 2015. We identified 1,316 articles, of which 23 met the inclusion criteria.
RESULTS
Recent epidemiological studies have focused on investigating the risks of malformations and pyloric stenosis after exposure to macrolides, nitrofurantoin, penicillins and trimethoprim-sulphamethoxazole. In nine of ten studies that included in total more than 38,000 patients exposed to macrolides, and two studies with more than 7,000 exposed to nitrofurantoin, no significantly increased risk of malformations was discovered. There are some contradictory findings for certain groups of antibiotics with regard to the risk of miscarriage, heart defects and pyloric stenosis.
INTERPRETATION
Recent studies indicate that erythromycin and nitrofurantoin can be used as second-line drugs in the first trimester. The results from recent studies concur with the recommendations for pregnant women in national guidelines regarding antibiotic use in the primary health service.
Topics: Abnormalities, Drug-Induced; Anti-Bacterial Agents; Female; Humans; Pregnancy; Pregnancy Trimesters; Risk Factors
PubMed: 26905846
DOI: 10.4045/tidsskr.15.0451 -
Australasian Journal of Ultrasound in... Aug 2022Ultrasound is the examination of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). A correct diagnosis is dependent on the technique and measurement...
INTRODUCTION
Ultrasound is the examination of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). A correct diagnosis is dependent on the technique and measurement accuracy. However, in the world literature there is a wide range of values suggested for the diagnosis of this condition. The current minimum measurements used to diagnose HPS seem excessively large, and therefore, we set out to redefine these values.
METHODS
A retrospective study was performed on 607 patients (615 scans) being investigated for HPS. The length and transverse diameter of the pyloric canal, and thickness of the pyloric muscle were measured. All results were correlated with clinical and surgical findings.
RESULTS
In this study, the muscle thickness in the normal group was <2.0 mm than in HPS infants having a muscle thickness of 2.0-5.0 mm. All the pyloric canal lengths in the normal group were <5.0 mm than in those with HPS having a length of 10.0-24.0 mm. The transverse diameters ranged from 6.0 to 11.0 mm in the normal group compared with those with HPS having a diameter between 8.0 and 16.0 mm.
CONCLUSIONS
The current criteria for sonographic diagnosis of HPS should be redefined. The canal length is the single most important discriminator, with a clear separation between normal and abnormal. The commonly used 16.0-mm measurement is too long and should be reduced to 10.0 mm (without the risk of false positives). In many cases, the muscle thickness in those with HPS is as low as 2.0 mm, considerably less than the 3.0 mm that is currently used. The transverse diameter is not a useful discriminator for HPS. The use of current values will delay the diagnosis and timely treatment of this condition.
PubMed: 35978726
DOI: 10.1002/ajum.12305 -
Pediatric Surgery International Jul 2022To investigate the occupational and environmental factors in the etiology of infantile hypertrophic pyloric stenosis (IHPS). (Meta-Analysis)
Meta-Analysis
PURPOSE
To investigate the occupational and environmental factors in the etiology of infantile hypertrophic pyloric stenosis (IHPS).
METHODS
Protocol was drafted according to the PRISMA guidelines and registered on PROSPERO (CRD42020152460). A search for a combination of terms related to IHPS, fetus and neonates, and environmental exposure was performed for studies published between 2000 and 2020 in the EMBASE, Pubmed, and MEDLINE databases.
RESULTS
Overall, 2203 abstracts were identified and 829 were screened. The full text of the selected articles (N = 98) was assessed for eligibility. Fifteen studies were included in quantitative synthesis. IHPS risk was significantly lower in black and Hispanic mothers than in white mothers [OR 0.47 (95% CI 0.44-0.51, p < 0.001), OR 0.85 (95% CI 0.77-0.94, p = 0.002), respectively]. Lower maternal education level and maternal smoking were risk factor for IHPS. We further observed a non-significant association between maternal folic acid usage and IHPS risk. Data were insufficient to evaluate occupational exposure.
CONCLUSION
This review provides an understanding of the role of environmental exposures in IHPS etiology. Lower maternal educational level, maternal smoking, and white ethnicity are associated with a significantly increased risk of IHPS, while folic acid use seems non-significantly associated with IHPS risk.
LEVEL OF EVIDENCE
III.
Topics: Environmental Exposure; Fetus; Folic Acid; Humans; Infant; Infant, Newborn; Pyloric Stenosis, Hypertrophic; Risk Factors
PubMed: 35441884
DOI: 10.1007/s00383-022-05128-9 -
World Journal of Clinical Cases Jun 2020Achalasia is a type of esophageal motility disorder, consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis. Related clinical... (Review)
Review
Achalasia is a type of esophageal motility disorder, consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis. Related clinical symptoms include dysphagia, regurgitation, chest pain, and weight loss. Traditional treatment options include endoscopic botulinum toxin injection, endoscopic pneumatic dilation, and laparoscopic Heller's myotomy. These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction. Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery, peroral endoscopic myotomy (POEM) is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators. Since then, numerous studies have shown the significant clinical efficacy and safety of POEM. The purpose of this article is to introduce different modified POEMs, special indications for different POEMs, and their advantages as well as disadvantages.
PubMed: 32548141
DOI: 10.12998/wjcc.v8.i11.2116 -
Pediatric Radiology Jul 2020Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in young infants. Infants with HPS present with projectile vomiting, sometimes have...
BACKGROUND
Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in young infants. Infants with HPS present with projectile vomiting, sometimes have electrolyte abnormalities and typically undergo pyloromyotomy to alleviate the obstruction. Abdominal US is the gold standard imaging study for diagnosis. Case reports of incidental hepatic portal venous gas have been reported in infants with HPS; however, no large studies have been conducted to determine the incidence or possible clinical implications of this finding.
OBJECTIVE
To assess the incidence of portal venous gas in infants with HPS and to determine whether the presence of this gas in infants with HPS indicates a more unstable patient, increased length of stay or worse outcome.
MATERIALS AND METHODS
We conducted a retrospective review of sonographic reports containing "pyloric stenosis," excluding negative descriptor, at a tertiary-care children's hospital from November 2010 to September 2017. Data collected included pyloric thickness/length, liver evaluation, portal venous gas, any additional imaging, demographics, symptomatology days, electrolyte abnormality, and length of hospital stay.
RESULTS
In a 7-year period, 545 US exams were positive for HPS. Of these, 334 exams included enough hepatic parenchyma to evaluate for portal venous gas. Infants in 6 of the 334 exams demonstrated portal venous gas (1.8%). Clinical presentation (length of symptoms and electrolyte abnormalities), demographics (male predominance and age at presentation) and imaging characteristics (pyloric thickness and length) were similar for the HPS groups with and without portal venous gas. There was no significant difference in outcome or length of hospital stay.
CONCLUSION
Visualization of portal venous gas in infants with HPS is not rare and appears benign, without need for further imaging. Portal venous gas in infants with HPS does not portend a more severe patient presentation or outcome.
Topics: Female; Gases; Hospitals, Pediatric; Humans; Incidence; Incidental Findings; Infant; Infant, Newborn; Male; Portal Vein; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Ultrasonography
PubMed: 32462306
DOI: 10.1007/s00247-020-04694-1