Serum gastrin level and gastric somatostatin content and binding in long-term pyloromyotomized children

Is Helicobacter pylori a cause of infantile hypertrophic pyloric stenosis?

My hypothesis is that infantile hypertrophic pyloric stenosis (IHPS) is caused in some cases by Helicobacter pylori (HP) a bacterium commonly found in the human stomach. IHPS is an idiopathic condition of infancy. It occurs at about 5 weeks of age in 3 per 1000 newborns. Children with IHPS have structurally normal pylori at birth and do not resemble children with congenital anomalies. Some nonspecific evidence (temporal distribution, seasonality, familial clustering, leukocytic infiltrates, and increased risk with bottle feeding) are compatible with an infectious etiology. Some other epidemiologic features of IHPS, such as its strong male predominance, its racial and social class variation, and a possible drop in its incidence, are also features of HP infection. Clinical features of IHPS, such as vomiting, hematemesis, and esophagitis, are also consistent with HP. Finally, children with IHPS appear to be more likely to develop chronic conditions, such as peptic ulcers, now known to be caused by HP.

The enigma of pyloric stenosis. Some thoughts on the aetiology

A theory is advanced about the cause of pyloric stenosis of infancy (PS). Developmental changes will conspire to produce pathogenetic gastric hyperacidity within the first 4 weeks of life in babies who develop PS. The prime cause will be an increased gastric acidity due to a genetically determined supernormal parietal cell mass. This theory satisfactorily explains many known clinical features.

The pathology of infantile hypertrophic pyloric stenosis after healing

INTRODUCTION

Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical affection of unknown etiology. The muscular hypertrophy is known to resolve within a few months after pyloromyotomy (PM). The pathology of IHPS has been studied extensively at the time of PM, but the fate of the pylorus after healing remains unknown.

MATERIALS AND METHODS

We had the rare opportunity to study two pyloric biopsy specimens obtained 4 months and 2 years (respectively) after an uncomplicated PM for IHPS. They were compared with the initial specimen in one case, with 26 other specimens of IHPS, and with five normal controls. Immunohistochemistry using the avidin-biotin complex (ABC) system was performed for S-100 and nerve growth factor receptor, as markers for the enteric nervous system, and for the tyrosine kinase receptor c-kit, as a marker for the interstitial cells of Cajal (pacemaker cells). NADPH-diaphorase histochemistry was performed as a marker for the neuronal enzyme nitric oxide synthase, which produces the inhibitory neurotransmitter nitric oxide.

RESULTS

In both cases of IHPS, after healing, the circular musculature was not hypertrophic. For all markers studied, the distribution appeared similar to that in the normal pylorus. In contrast, all specimens obtained at the time of PM displayed a severe reduction of the different markers in the hypertrophic musculature.

DISCUSSION

The pathological features observed in the circular layer in IHPS appear to resolve within a few months after PM. This suggests that the involvement of the enteric nervous system in IHPS might be milder than generally assumed. The etiology remains obscure, but our occasional observations may provide new insight into the pathophysiology of IHPS, and are in agreement with the excellent longterm clinical outcome for IHPS.