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Esophagitis in infants with hypertrophic pyloric stenosis: a source of hematemesis
S Takeuchi1, S Tamate, M Nakahira
1Division of Pediatric Surgery, Osaka City Perinatal Center, Japan.
Insights
Blood in vomitus for infants with hypertrophic pyloric stenosis (HPS) often stems from esophagitis. Excessive acid reflux significantly correlates with esophagitis and bleeding in these HPS patients.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Hypertrophic pyloric stenosis (HPS) is a common cause of vomiting in infants.
- The source of hematemesis (bloody vomitus) in HPS is not fully understood.
- Gastroesophageal reflux (GER) is frequently observed in infants with HPS.
Purpose of the Study:
- To determine the origin of blood in the vomitus of infants diagnosed with HPS.
- To investigate the relationship between gastroesophageal reflux, esophagitis, and hematemesis in HPS.
Main Methods:
- Esophagogastric endoscopy was performed on 21 infants with HPS.
- Histological examination of esophageal mucosa was conducted.
- Preoperative pH monitoring was used to assess acid exposure.
Main Results:
- Esophagitis was present in 100% of infants via endoscopy and 85.7% via histology.
- All infants exhibited gastroesophageal reflux (GER).
- Excessive acid exposure (>7%) correlated with esophagitis severity and hematemesis incidence.
Conclusions:
- The esophageal mucosa, inflamed by esophagitis secondary to excessive acid reflux, is the likely source of bleeding in HPS.
- While GER is evident in HPS, evaluating lower esophageal sphincter function remains challenging.
Abstract:
This study was undertaken to clarify the source of blood in the vomitus of patients with hypertrophic pyloric stenosis (HPS). Twenty-one infants with HPS were examined. Hematemesis was noted in 14 infants. Esophagogastric endoscopy showed a 100% incidence of esophagitis and in one patient gastric erosion was also observed. Histological study of the esophageal mucosa showed evidence of esophagitis in 18 patients (85.7%). Preoperative pH monitoring showed gastroesophageal reflux (GER) in all infants. Excessive acid exposure (> or = 7%) was significantly correlated with the grade of esophagitis and the incidence of hematemesis, whereas acid exposure time was shorter in the cases without histological esophagitis. These results suggested that the source of bleeding in HPS is the esophageal mucosa affected by esophagitis secondary to excessive acid reflux. Although there is obvious massive gastroesophageal reflux in HPS, it is too difficult to evaluate the lower esophageal sphincter function in HPS.