Why Pyloric Stenosis of Infancy Occurs-Facing the Facts - Abstract
Background: There has been no shortage of published articles about pyloric stenosis of infancy(PS). Curiously, few have opined a cause despite a galaxy of potentially informative clues. The earliest speculative suggestion was that hyperacidity was involved. More recently the notion that there is a deficit of a relaxing agentnitric oxide(NO) in the sphincter. Others have proposed that there is an abnormal accumulation of growth factors which leads to sphincter hypertrophy. Neither the NO nor the growth factor theories have attempted to link with the classical clinical features.
Materials and methods: The accepted physiological facts and the classical clinical features are linked in a comprehensive theory of cause. An inherited greater than average acid secretory ability is key. An important support is provided by two other normal developmental phenomena- a peak acidity in the early weeks and a temporary insensitivity of the negative feed-back between neonatal gastrin and gastric acidity soon after birth. Inappropriate overfeeding is an important stimulus for sphincter contraction. The evidence for its contribution to pathogenesis is also examined.
Results and conclusion: The Primary Hyperacidity theory has been found to expain all the clinical features.In outlining a conflict between stenosing forces and relaxing forces, it also provides and explanation for the way in which symptoms and signs may come and go.The theory is critically examined and is proposed as the cause.