Pre- and Perinatal Risk Factors for Pyloric Stenosis and Their Influence on the Male Predominance

Abstract

Pyloric stenosis occurs with a nearly 5-fold male predominance. To what extent this is due to environmental factors is unknown. In a cohort of all children born in Denmark, 1977-2008, the authors examined the association between pre- and perinatal exposures and pyloric stenosis and investigated whether these factors modified the male predominance. Information on pre- and perinatal factors and pyloric stenosis was obtained from national registers. Poisson regression models were used to estimate rate ratios. Among 1,925,313 children, 3,174 had surgery for pyloric stenosis. The authors found pyloric stenosis to be significantly associated with male sex, age between 2 and 7 weeks, early study period, being first born, maternal smoking during pregnancy, preterm delivery, small weight for gestational age, cesarean section, and congenital malformations. Among cases, 2,595 were males and 579 were females. Lower male predominance was associated with age at diagnosis outside the peak ages, early study period, no maternal smoking during pregnancy, preterm delivery, and congenital malformations. The authors have previously found a strong familial aggregation of pyloric stenosis indicating a genetic influence. This study shows that environmental factors during and shortly after pregnancy also play a role and that several of these modify the strong male predominance.

Association of prematurity with the development of infantile hypertrophic pyloric stenosis

“…Previous literature suggested that preterm infants rarely present with IHPS (11,12). Several recent epidemiological studies have found variable evidence that prematurity might be associated with increased risk of developing IHPS, although this association remains unclear (7,8,13,14).Full-term infants with IHPS typically present in the first 2-7 wk of life (7). The presentation age of preterm infants that develop IHPS is defined less clearly.…”

“…The presentation age of preterm infants that develop IHPS is defined less clearly. Some studies suggest that preterm infants may present with IHPS symptoms at a later chronological age than term infants, but the differences between presentation times in full-term and preterm infants are poorly characterized (7,8,11,(13)(14)(15). Using data from the Military Health System database, this study aims to examine the associations between prematurity and IHPS, and to investigate both gestational age (GA) and chronological age of IHPS among premature infants.…”

“…IHPS is now recognized earlier in its clinical course and is managed successfully with surgical pyloromyotomy (1)(2)(3)(4). There are several established prenatal and perinatal risk factors for IHPS, including macrolide antibiotic use, bottle-feeding, male sex, family history, and birth order (5)(6)(7)(8). The etiology of IHPS remains unclear, but current research suggests that it is caused by an interplay of environmental and genetic factors (9).…”

Food Allergy Mimicking Pylorus Hypertrophy

“…To date none of the theories fully explains the development of the disease [2] [4]. On the other hand, Krohg and collaborators listed a number of risk factors for the development of HPS, including: male gender, the use of macrolides, and bottle feeding, without having been able to clarify whether the cause is infant formula per se or technical supply [5] [6]. In addition to the vomiting, the disease may be accompanied by hypochloremic alkalosis and indirect hyperbilirubinemia [7].…”

Patrones de las enfermedades raras congénitas en pacientes ingresados en un hospital regional

“…Si el estudio se realiza de forma clasificatoria de diagnósticos, las más frecuentes serían las Anomalías del Aparato Circulatorio 13 , igual que la aparición en otras edades, o Anomalías en Aparato Urinario. Si el estudio lo realizamos por diagnóstico, el más frecuente es la Estenosis Pilórica Hipertrófica y con una clara diferencia de frecuencia, predominante en el sexo masculino, aunque esto es bien conocido en la etiopatogenia de esta anomalía 14 . Es coherente que el servicio hospitalario con más ingresos sea el de Cirugía Pediátrica, puesto que la mayoría de las anomalías congénitas tiene como tratamiento la cirugía y las edades de los pacientes son fundamentalmente pediátricas.…”