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The changing presentation of pyloric stenosis
K Papadakis1, E A Chen, F I Luks
1Division of Pediatric Surgery, Brown University School of Medicine and Hasbro Children's Hospital, Providence, RI 02905, USA.
The American Journal of Emergency Medicine
|February 3, 1999
Summary
Pyloric stenosis is diagnosed earlier now, leading to fewer metabolic issues. While ultrasonography aids diagnosis, earlier recognition predates its widespread use, making severe electrolyte imbalances rare.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Trends
Background:
- Metabolic abnormalities in pyloric stenosis were once common but are now rare.
- Prompt recognition of infantile hypertrophic pyloric stenosis (IHPS) has likely reduced the incidence of severe presentations.
Purpose of the Study:
- To review trends in the presentation of pyloric stenosis over three decades.
- To assess the impact of diagnostic advancements, particularly ultrasonography, on early diagnosis and presentation of pyloric stenosis.
Main Methods:
- Retrospective review of infants treated for pyloric stenosis during three mid-decade periods (1975, 1985, 1995).
- Analysis of age at diagnosis, incidence of water and electrolyte imbalance, and hospitalization duration.
- Statistical comparison between patient groups across the decades.
Main Results:
- Mean age at presentation decreased significantly from 5.4 weeks in 1975 to 3.4 weeks in 1995 (P < .05).
- No significant difference in the frequency of electrolyte abnormalities was observed across the decades, with 88% of patients having no anomalies.
- Hospitalization duration (total and postoperative) significantly decreased in the later decades.
Conclusions:
- Pyloric stenosis is being recognized and diagnosed earlier than in previous decades.
- The trend towards earlier diagnosis predates the widespread availability of ultrasonography.
- The classic severe metabolic derangements associated with pyloric stenosis are now uncommon.