Which factors increase the risk for pediatric pyloric stenosis?

Updated: Nov 13, 2018
  • Author: Sathyaseelan Subramaniam, MD, FAAP; Chief Editor: Kirsten A Bechtel, MD  more...
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A meta-analysis that investigated perinatal factors associated with hypertrophic pyloric stenosis onset and reported that first-born (OR 1.19, 95% CI: 1.07-1.33), cesarean section delivery (OR 1.63, 95% CI: 1.53-1.73), preterm birth (OR 1.37, 95% CI: 1.12-1.67), and bottle-feeding (OR 2.46, 95% CI: 1.76-3.43), were associated with the hypertrophic pyloric stenosis onset with bottle-feeding as the most significant risk factor. [3, 4]

 A cohort study found that treatment of young infants with macrolide antibiotics was strongly associated with infantile hypertrophic pyloric stenosis (IHPS). [5]  A meta-analysis of 9 studies reaffirmed a significant association of postnatal exposure of erythromycin and the development of pyloric stenosis. This association is strongest if the exposure occurred in the first 2 weeks of life, although persists to a lesser degree in children between 2 and 6 weeks of age. [6, 7, 8] Maternal use of macrolides during the first 2 weeks after birth was also associated with an increased risk of IHPS. [5]

Nitric oxide has been demonstrated as a major inhibitory nonadrenergic, noncholinergic neurotransmitter in the GI tract, causing relaxation of smooth muscle of the myenteric plexus upon its release. Impairment of this neuronal nitric oxide synthase (nNOS) synthesis has been implicated in infantile hypertrophic pyloric stenosis, in addition to achalasia, diabetic gastroparesis, and Hirschsprung disease.

Another study reported the possibility that low serum lipids could be a risk factor for IHPS. Further studies are needed to determine the significance of these findings. [9]

Rogers has suggested, that persisting duodenal hyperacidity, due to a high parietal cell mass (PCM) and loss of gastrin control, produces pyloric stenosis from repeated pyloric contraction in response to hyperacidity. [10]

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