Pylorospasm in newborns and adults: symptomatology, differential diagnosis, treatment, ICD-10

Pylorospasm refers to a pathological condition characterized by spasms of the pylorus of the stomach( sphincter separating the stomach from the duodenum) due to a number of functional disorders of the neuromuscular apparatus in this part of the basic digestive organ.

As a result of the difficult advancement of the food gruel( chyme) through the spasmodic area, there is a problem with its timely removal from the stomach into the duodenum, fraught with stagnation of chyme and a violation of the digestive process.

Duration of the course and neglect of this disease is associated with the danger of its transition to a more severe stage. As a result of an atrophic change in the structure of the mucous membranes, a condition capable of requiring emergency surgical care may arise.

Pylorospasm, most commonly observed in infancy, can occur in preschool children, school children and adult patients for various reasons.

Forms of the disease

According to the tenth version of the International Classification of Diseases( ICD-10), pylorospasm belongs to the eleventh class, including diseases of the digestive system, in which hypertrophic pilorospasm in adults has been given the code K31.1.

Cases of neurotic and neurogenic pilorospasm are classed as V class of mental and somatoform disorders under code F45.3.

Depending on the condition of the gastric muscles, the pylorospasm can occur in one of two forms: compensated and uncompensated.

  • With compensated pylorospasm, the food gruel manages to overcome the narrowed pyloric sphincter( this is synonymous with the pylorus) with a powerful force of the hypertrophied muscles of the stomach. As a result, the process of digestion is not interrupted.
  • With an uncompensated form of pylorospasm, overstretched musculature of the stomach is unable to help the chyme overcome the resistance of the spasmodic pylorus. Nutritional coma, which has been delayed for a long time in the stomach, begins to decay and decompose, provoking the occurrence of profuse vomiting( which has a putrefactive smell) and symptoms of general intoxication of the body: fever, sweating and severe weakness.

Causes of

Pylorospasm can be primary and secondary.

In infants and young children, primary pilorospasm may occur due to:

  • Severe pregnancy course. Among the reasons that complicate its course, include the presence of violations of the fetoplacental blood circulation, severe gestosis( late toxicosis), viral infections, complex endocrine pathologies capable of provoking chronic hypoxia( impaired vital functions of the embryo as a result of insufficient oxygen supply) of the fetus.
  • Heavy labor activity, leading to perinatal damage to the nervous system and birth injuries.
  • Insufficient maturity of the digestive and nervous system.

The emergence of primary pilporospasm in adult patients, adolescents and preschool and primary school age children can occur with:

  • A violation of the mechanism responsible for the innervation or timely transmission of relaxing nerve impulses to pyloric sphincter receptors. Most often this occurs as a result of significant malfunctions in the functioning of the nervous system( vegetative or central).
  • The intoxication occurring as a result of an overdose of morphine and in malicious smokers.
  • Presence of hypovitaminosis( especially sensitive organism reacts to an acute shortage of vitamins of group B).
  • Increase in the tone of the vagus( vagus nerve), responsible for the work of a number of vital reflexes and body functions. This process can provoke significant violations in the functioning of the autonomic nervous system.
  • There are strong physical strains and marked psychological overwork.
  • Prolonged exposure to stressful situations.
  • Excessive irritation of the ileocecal region of the small intestine or its initial sections.

The development of secondary pilorospasm in patients of adolescent and adulthood occurs against the background:

  • of pelvic inflammatory disease( in women);
  • ulcerative defects located in the pyloric sphincter area;
  • stomach polyposis;
  • pyloroduodenitis and hyperacid gastritis;
  • pathological condition, accompanied by the appearance of intraperitoneal adhesions( the so-called adhesive disease);
  • inflammatory bowel diseases( Crohn's disease and all kinds of colitis) and bile ducts( cholecystitis and cholangitis).

Symptoms of pilorospasm in newborns and adults

In newborns and young children, pylorospasm may be manifested:

  • The presence of strong - "fountain" - vomit , which looks like curdled milk and has an acidic odor. Occurring between feedings( vomiting can open and two hours after the baby was fed), newborn babies it bothers only occasionally. As the child grows, vomiting becomes more frequent. The volume of vomit, not containing bile, usually is small.
  • A reduced amount of urination and dehydration of , because of the constant regurgitation in the body of the baby there is little liquid. When the pathology is started, frequent constipation is observed.
  • Poor weight gain ( in very severe cases, body weight decreases).
  • Anxiety, crying, irritability, sleep disturbance.
  • Clotting of blood and a decrease in the level of hemoglobin, potassium and chlorine in it. All children with pylorospasm are characterized by the presence of alkalosis, a condition characterized by a shift in the acid-base balance( pH) of blood and other biological fluids towards alkalization.
  • The symptom of the "hourglass" , in which the stomach of an exhausted baby begins to stick out a couple of hours after feeding, forming two rounded tubercles, separated by a small depression.

For older children and adult patients with pylorospasm, the presence of:

  • Heartburn.
  • Periodic colic or raspiruyuschih pain.
  • Difficulty breathing.
  • Sensations of severity and painful spasms in the area of ​​the epigastrium( the so-called part of the anterior abdominal wall, the upper border of which passes along the xiphoid process and the costal arch, and the lower boundary is indicated by the line connecting the lower points of the tenth pair of ribs).
  • The disorders of the swallowing act.
  • Dynamics of weight loss.
  • The destruction of tooth enamel.
  • Urinary crisis, which is characterized by the release of a large amount of clarified urine, which has a low specific gravity.
  • Nausea( the appearance of a foul-smelling - due to food stagnation in the stomach - vomiting, which gives the patient a significant relief, is observed only in the most severe cases).In connection with the loss of a large number of chlorides and fluids in all patients, they detect chloropenia and alkalosis.
  • Transient weakness due to acute deficiency of salts leaving the body of the patient along with vomit.

Differential diagnosis

  • At the initial stage of the diagnosis, the collection of the medical history is required. The gastroenterologist will necessarily ask about the presence of chronic diseases, ask about whether the patient was subjected to surgical interventions on the abdominal cavity( this question is asked in order to exclude suspicion of having an adhesion process).

If pyloric stenosis is diagnosed in a child, parents will be asked questions about the course of pregnancy: whether there was a possibility of hypoxia of the fetus and perinatal encephalopathy, as well as the risk of spontaneous abortion.

Clinical manifestations of pathology are taken into account while collecting the history, although neither pain syndrome, nor vomiting and nausea are classified as pathognomonic symptoms, which are indisputable grounds for diagnosing pilorospasm.

Only the presence of bubbling vomiting, which is often found only in young children, is the only specific sign of this pathology.

  • Laboratory tests of urine and blood in patients with mild form of pylorospasm will give little information, since their characteristics will be close to normal. Analyzes of patients suffering from severe uncompensated form of pylorospasm will indicate the presence of chloremia( low chlorine content in the blood), anemia( decrease in the concentration of red blood cells and hemoglobin in the blood), hypokalemia( a condition characterized by a low amount of potassium ions in the blood) and a low specific gravity of urine.

The main diagnostic methods for detecting pilorospasm are instrumental studies:

  • Radiography of the intestine with the introduction of radiopaque substance - barium suspension. Young children receive a bottle of pacifier containing 50 ml of milk or breast milk and 30 ml of barium sulfate. In the presence of a light form of pylorospasm, the radiograph shows the unbroken patency of the pyloric sphincter passing small portions of barium sulphate into the intestine. The radiopaque substance will leave the patient's stomach after a few hours. If suspected of pylorospasm, the patient must be treated with an antispasmodic drug. Under the influence of spasmolytic spasm of the pyloric sphincter will pass, and the radiopaque substance will freely enter the intestine. Such a picture, as a rule, indicates the presence of a severe form of the disease, accompanied by hypotrophy( a pathology leading to degenerative-dystrophic changes) of the muscles.
  • The procedure of fibro-eszogastroduodenoscopy in a patient with uncomplicated form of pylorospasm allows to detect a pyloric sphincter( the opening of which does not interfere with the passage of the endoscope) and complete absence of food residues in the stomach. With insufflation( injection) of air, a slow opening of the pyloric sphincter is observed. This phenomenon also indicates the presence of pylorospasm. In patients with severe forms of pathology, during the procedure, a certain amount of digested food is found in the stomach, a spasmed pylorus and complete absence of morphological changes.

Differential diagnosis of pilorospasm with similar diseases is carried out in connection with the nonspecificity of its clinical manifestations.

  • Primarily, pylorospasm is compared with pyloric stenosis, characterized by the presence of gushing vomiting( the first manifestations of this symptom can be observed at two weeks of age), constipation and rapid deterioration of well-being. With pyloric stenosis, radiographic images will help to identify the presence of a long spasmodic pyloric sphincter. The pectoral region of the stomach looks like a thin thread on them. The use of antispasmodics does not affect the condition of the gatekeeper in any way. Endoscopic examination indicates the presence of morphological changes in the tissues that form the walls of the pyloric part of the stomach, as well as hypertrophy of the muscles.
  • The cases of pilorospasm in children require mandatory differentiation with achalasia of the cardiac valve and diaphragmatic hernia of the esophagus. In all these cases, an X-ray examination is required.
  • If suspected pylorospasm in adult patients, differential diagnosis is performed with a variety of diseases of the gastrointestinal tract: gastritis, cholecystitis, ulcer and cholelithiasis.

Treatment of pilorospasm

The main goal of pilorospasm therapy is to eliminate the causes that caused its occurrence. In patients suffering from secondary pilorospasm, the primary disease is primarily treated.

In cases of vegetative dystonia proceeding according to the sympathetic type, therapy is carried out with the help of sedatives, which allow to achieve a significant reduction in emotional stress without having a hypnotic effect.

Breastfeeders who have an easy form of pylorospasm do not need to follow a special diet. The feeding of such children should take place in a very comfortable and peaceful environment. The amount of food to be eaten and the schedule of feedings should be appropriate for the child's age.

The best food for babies with a mild form of pylorospasm are thick porridges. Before each feeding, he must give a pair of teaspoons of alkaline still mineral water.

Due to the presence of locust bean gum, which increases the viscosity of gastric contents, it is possible to significantly reduce the vomiting volume. Another advantage of this ingredient is the stimulating effect on intestinal motility, which helps to eliminate intestinal colic.

A nourished toddler must be placed in a "post" and held for half an hour on his hands. After this, it is required to lay it on your tummy.

Adults should strictly follow a specialized diet that involves the use of exclusively sparing( both in mechanical and chemical terms) dishes that do not contain coarse plant fibers. All food should be served in a warm and frayed form: in small portions, but often.

For feeding patients with pylorospasm, all kinds of viscous cereal are ideal, but acid, salty and spicy food is best excluded from their diet. The same strict prohibition applies to smoking and drinking alcoholic beverages.

Drug therapy pilorospazma provides for the use of:

  • Myotropic antispasmodics - drugs that have vasodilating and spasmolytic effects. For the treatment of adult patients, drotaverin and papaverine hydrochloride are most commonly prescribed.
  • Antihistamines( represented by pipolfen and promethazine).
  • Sedative medicines( motherwort, valerian drops) that have a mild soothing effect.
  • Vegetative adaptogens, allowing to normalize the functioning of the autonomic nervous system, to remove unnecessary anxiety, to get rid of stress.
  • Nootropic drugs( eg, phenibut), which have a calming effect without muscle relaxation.
  • Antipsychotic drugs( neuroleptics), intended for the therapy of psychotic disorders. One of the most popular means is chlorpromazine.

As a source of vitamin B1, patients are prescribed intramuscular injections of thiamine. The duration of the course is ten days.

Patients suffering from severe vomiting to eliminate dehydration and replenish the reserve of salts leaving the body together with vomit are shown infusion therapy involving parenteral administration of 500 ml of physiological saline and 10% glucose solution( its volume may range from 500 to 1500 ml).

In the presence of indications in the glucose solution, one or two insulin units or 20 ml of a 10% solution of potassium chloride( for every 5-10 ml of solution) are allowed.

In the complex treatment of pilorospasm resort to physiotherapy, which facilitates the removal of muscle spasms. The most effective procedures differ:

  • Electrophoresis with novocaine or antispasmodic drugs( apply drotaverin and papaverine) on the area of ​​the epigastrium. The duration of the course is from five to ten sessions.
  • Paraffin or ozocerite applications performed every other day. The maximum duration of treatment is ten sessions.

An excellent addition to medical treatment is exercise therapy, respiratory gymnastics, a course of massage.

Prognosis and prevention of

Pylorospasm prognosis, generally favorable, largely depends on the factors that provoked the disease.

The cases of primary pilorospasm, which are most often observed in children, require only the observance of the correct regime of the day and healthy eating. If parents strictly follow the recommendations of the pediatrician, by the age of four months the pylorospasm passes by itself.

Treatment of secondary pilorospasm in adult patients is determined by the nature of the ailment that caused it. In this case, all efforts are directed to therapy of this disease. Often, the primary manifestations of pylorospasm mistaken for the consequences of malnutrition or digestive disorders associated with imbalance of the diet or with an inadequate synthesis of digestive enzymes.

To prevent the development of pylorospasm, each person should:

  • Completely abandon the use of alcoholic beverages and smoking.
  • Avoid overeating.
  • Adhere to a sparing diet, avoiding excessive consumption of seasonings, spicy, salty and rough food, abundant in plant fiber. We welcome the use of viscous cereals and dishes with a puree-like consistency.
  • Regularly engage in physical education.
  • Sleep at least eight hours a night.

Video about the difference between pyloric stenosis and pylorospasm:

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