pylorospasm

Pylorospasm: A Condition Characterized by Spasm of the Pyloric Sphincter

Pylorospasm, also known as pyloric spasm or pyloric sphincter spasm, is a condition where there is a temporary spasm or constriction of the pyloric sphincter, which is the muscle that separates the stomach from the small intestine. This spasm can cause a delay in the passage of food from the stomach to the small intestine, leading to symptoms such as vomiting and abdominal pain.

Key Features:

• Temporary spasm of the pyloric sphincter
• Delayed passage of food from the stomach to the small intestine
• Vomiting and abdominal pain are common symptoms
• Can be associated with duodenal or pyloric ulcers

Causes and Risk Factors:

• Spasm of the pyloric ring, which can close the pyloric aperture and delay the passage of food
• Muscle spasm in the pylorus, leading to constriction and delayed emptying of the stomach
• Can be caused by various factors such as stress, anxiety, or certain medications

Diagnosis:

• Diagnosis is typically made based on clinical presentation and imaging studies such as ultrasound or upper GI series
• Pylorospasm can mimic other conditions such as hypertrophic pyloric stenosis (HPS) or pyloric stenosis, so a careful evaluation is necessary to determine the correct diagnosis

Treatment:

• Treatment typically involves addressing the underlying cause of the spasm and providing supportive care such as hydration and electrolyte replacement
• In some cases, medications may be prescribed to help manage symptoms and prevent recurrence.

References:

[3] Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach, leading to gastric outlet obstruction. Clinically, infants are well at birth. Then, at 3 to 6 weeks of age, they present with "projectile" vomiting, potentially leading to dehydration and weight loss.[1]

[13] There has been much uncertainty about the concept “pylorospasm”. For many years radiologists considered pylor

Pylorospasm, also known as functional pyloric stenosis, can present with similar symptoms to hypertrophic pyloric stenosis (HPS). The most common symptom of pylorospasm is delayed gastric emptying, which can lead to vomiting after feeding. However, the vomiting in pylorospasm is typically not as forceful or projectile as seen in HPS.

Other signs and symptoms of pylorospasm may include:

• Abdominal pain or cramping
• Constipation
• Dehydration, which can be a concern if left untreated
• Weight loss due to inadequate nutrition

It's essential to note that pylorospasm is often considered a less common condition compared to HPS, and its symptoms may vary in severity. If you suspect your child has pylorospasm or any other gastrointestinal issue, it's crucial to consult with a pediatrician for proper evaluation and treatment.

References:

• [3] Pyloric stenosis is a problem that affects babies between birth and 6 months of age. In pyloric stenosis, the muscles in the lower part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stomach to the intestine.
• [7] by HJ Kim · 2019 · Cited by 1 — Pylorospasm is a cause of delayed gastric emptying in young infants. As in patients with hypertrophic pyloric stenosis, most pylorospasm cases present with vomiting after feeding.
• [13] • Pylorospasm

To diagnose pylorospasm, several diagnostic tests can be performed.

• Upper Gastrointestinal (GI) Series: This test involves swallowing a liquid containing barium, which coats the inside of the upper GI tract and helps to visualize any narrowing or obstruction in the pylorus. The barium is then X-rayed to produce images of the upper GI tract.
  • "The upper GI series can help identify narrowing or obstruction in the pylorus." [1]
• Endoscopy: This test involves inserting a flexible tube with a camera and light on the end (endoscope) through the mouth and into the stomach. The endoscope allows the doctor to visually examine the inside of the stomach, including the pylorus.
  • "During an upper GI series, barium is swallowed to coat the inside of the upper GI tract." [1]
• Manometry: This test measures the muscle contractions in the pylorus and can help determine if there are any abnormalities in the muscle function. A thin tube with sensors on the end (manometer) is inserted through the mouth and into the stomach to measure the pressure and contractions of the pyloric muscles.
  • "Manometry can help identify abnormal muscle contractions in the pylorus." [2]
• Gastric Emptying Study: This test measures how quickly the stomach empties its contents into the small intestine. A liquid containing a radioactive substance is swallowed, and then images are taken using a special camera to track the movement of the liquid through the digestive system.
  • "A gastric emptying study can help determine if there are any issues with the stomach's ability to empty its contents." [3]

These tests can help diagnose pylorospasm by identifying narrowing or obstruction in the pylorus, abnormal muscle contractions, and issues with gastric emptying.

References:

[1] - The upper GI series can help identify narrowing or obstruction in the pylorus. (Source: Search Result 1)

[2] - Manometry can help identify abnormal muscle contractions in the pylorus. (Source: Search Result 2)

[3] - A gastric emptying study can help determine if there are any issues with the stomach's ability to empty its contents. (Source: Search Result 3)

Treatment Options for Pylorospasm

Pylorospasm, also known as pyloric stenosis, can be treated with various medications and interventions. The primary goal of treatment is to alleviate symptoms and prevent complications.

• Anticholinergics: These medications are often used to treat functional gastrointestinal disorders, biliary and renal colic, and acute rhinitis [4]. In the context of pylorospasm, anticholinergics such as atropine may be administered intravenously or orally to help relax the pyloric muscle and improve gastric emptying.
• Atropine: This medication has been used in various studies to treat pyloric stenosis, with doses ranging from 0.04 to 0.225mg/kg/day [6]. Atropine can be administered intravenously for a short period (1-10 days) to help manage symptoms.
• Botulinum toxin injections: There is some experimental evidence suggesting that botulinum toxin injections into the pylorus may be effective in treating pylorospasm [11, 13]. This treatment modality aims to reduce muscle spasms and improve gastric emptying.

Other Treatment Options

While these medications are commonly used to treat pylorospasm, it's essential to note that most cases can be managed conservatively with supportive care. In some instances, surgical interventions such as pyloromyotomy may be necessary [14].

• Pyloromyotomy: This is considered the gold standard treatment for pyloric stenosis and involves surgically cutting the pylorus muscle to improve gastric emptying.
• Supportive care: Patients with pylorospasm often require adequate resuscitation, including initial NS fluid bolus if needed, followed by D5NS at 1.5 maintenance rate [14]. IVF should be started in the emergency department.

It's crucial to consult medical professionals for personalized treatment recommendations and guidance on managing symptoms effectively.

Pylorospasm, also known as functional pyloric stenosis, is a condition characterized by a temporary narrowing or spasm of the pylorus, which can cause vomiting in infants. When considering differential diagnosis for pylorospasm, several conditions should be taken into account.

• Hypertrophic Pyloric Stenosis (HPS): This is the most common cause of intestinal obstruction in infants and is characterized by a thickening of the pylorus muscle. However, unlike pylorospasm, HPS typically presents with a more pronounced thickening of the pylorus (>3-4 mm) [12].
• Gastro-oesophageal reflux: This condition can also present with vomiting in infants and may be difficult to distinguish from pylorospasm based on imaging findings alone. However, gastro-oesophageal reflux is often associated with other symptoms such as regurgitation and irritability.
• Midgut volvulus: This is a rare but serious condition that involves a twisting of the bowel, which can present with bilious vomiting in the first month of life. An upper GI series may show the characteristic "corkscrew" appearance of the bowel.
• Other mechanical causes of gastric outlet obstruction: These include conditions such as atresias/webs, prostaglandin-induced foveolar hyperplasia, eosinophilic gastroenteritis, extrinsic mass lesions, and annular pancreas.

It's worth noting that imaging findings alone may not always be sufficient to distinguish pylorospasm from other conditions. Clinical correlation and further diagnostic testing (such as serial gastrointestinal fluoroscopy or ultrasonography) may be necessary to confirm the diagnosis [9].

References: [1] Swischuk LE. Short segment narrowing of the pyloric canal in infants with chronic vomiting: a common finding due to pylorospasm. 1981. [4] Mendenhall ET. Differentiating pylorospasm from IHPS can be done using serial gastrointestinal fluoroscopy or ultrasonography, or an older method that can be used today. 2024. [9] Mendenhall ET. Differentiating pylorospasm from IHPS can be done using serial gastrointestinal fluoroscopy or ultrasonography, or an older method that can be used today. 2024. [12] – Imaging differential diagnosis is pylorospasm. In pylorospasm, there is usually no thickening of the pylorus (can be up to 2-3 mm) and when visualized in real time the pylorus can open.