RESUMO
OBJECTIVE: We hypothesize that children who had pyloric stenosis are at greater risk for developing chronic abdominal pain because this cohort combines various risk factors: an early stressful event, gastric surgery, and perioperative nasogastric tube placement in most cases. STUDY DESIGN: This was a case control study of all children diagnosed with pyloric stenosis during infancy (cases) between January 1, 2000, and June 31, 2005, at Children's Memorial Hospital, Chicago. Because of their similar genetic and socioeconomic backgrounds, siblings aged 4 to 20 years without a history of pyloric stenosis were selected as controls. Parents of children with symptoms completed the parental form of the Pediatric GI Symptoms Rome III version questionnaire for both cases and controls. The primary outcome was the prevalence of chronic abdominal pain, and the secondary outcome was the presence of pain-associated functional gastrointestinal disorder (FGID), in accordance with Rome III criteria. RESULTS: Cases (n = 100; mean age, 7.49 ± 1.43 years; 29 girls) and controls (n = 91; mean age, 9.20 ± 4.19 years; 29 girls) participated in the study. Mean time to follow-up was 7.2 ± 1.6 years. Chronic abdominal pain was significantly more common in cases than in controls (20/80 [25%] vs 5/91 [5.8%]; OR, 4.3; 95% CI, 1.5-12; P = .0045). Seven out of 20 subjects (35%) met the Rome III criteria for diagnosis of a pain-associated FGID (3 with irritable bowel syndrome, 2 with functional dyspepsia, and 2 with functional abdominal pain), and 1 patient in the control group (with irritable bowel syndrome) met these criteria (OR, 6.8; 95% CI, 0.82-56; P = .043). CONCLUSION: We have described a new model to study early life events in infants. Our findings suggest that the presence of pyloric stenosis in infancy and factors involved in its perioperative care represent risk factors in the development of chronic abdominal pain in children at long-term follow-up. This study provides important data to sustain the multifactorial theoretical construct of pain-associated FGID and underscores the importance of early life events in the development of chronic abdominal pain in children.
Assuntos
Dor Abdominal/epidemiologia , Estenose Pilórica/epidemiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Doença Crônica , Estudos de Coortes , Dispepsia/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Síndrome do Intestino Irritável/epidemiologia , Masculino , Medição da Dor , Fatores de Risco , Irmãos , Adulto JovemRESUMO
BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS), although fairly frequent, is still an enigmatic disease. Its incidence is increased among relatives of a case and among infants of male sex (M) and of high birthweight. The purpose of this paper is to analyze the pattern of IHPS M predominance according to birthweight (BW). METHODS: 115 consecutive cases charts of IHPS were reviewed and stratified by gender and BW rank (500 g each, beginning at 1,500 g and ending at 3,500 g). Statistical analysis was done by means of chi square and comparation of proportions tests. RESULTS: M predominance was not observed in IHPS patients with a BW of 2,500 g or less (n = 11, 6M). Female infants (F) did not increase their number of cases as the BW rose, but M did, reaching an 8.8 to 1 M to F ratio among those with a BW of 3,500 9 or more (p < 0.005). The proportion of M with a BW of 3,000 g or more was significantly higher than in F (0.826 vs. 0.521, p < 0.005). CONCLUSIONS: In IHPS, the excess of M cases, which is responsible of the M/F disparity, is present only among newborns with a BW of 3,000 g or more. The disease does not show this relation to BW in F.
Assuntos
Estenose Pilórica/epidemiologia , Peso ao Nascer , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipertrofia , Incidência , Masculino , México/epidemiologia , Fatores SexuaisRESUMO
Introducción: La estenosis hipertrófica del píloro (EHP) es una enfermedad cuya frecuencia es mayor entre los niños varones (M) con antecedentes familiares de la enfermedad y elevado peso natal. El objetivo del estudio fue analizar el patrón del predominio de la EHP en M en relación con el peso al nacer (PN).Métodos: Se revisaron y estratificaron 115 casos consecutivos de EHP por su género y rango de PN (rangos de 500 g). El análisis estadístico se hizo por medio de chi cuadrada y comparación de proporciones.Resultados: El predominio de M no se observó en los pacientes con EHP con PN de 2,500 g o menor(n = 11, 6 M). Las niñas (F) no incrementaron su número de casos a medida que el PN aumentó, pero sí lo hicieron los M, alcanzando un 8.8/1 de razón M/F entre aquellos con PN de 3,500 g o más (p < 0.005). La proporción de M con PN de 3,000 g o más fue significativamente superior que en F (0.826 vs. 0.521, p < 0.005).Conclusión: En EHP, el número excesivo de casos de M, responsable de la disparidad MIF, se concentra en los neonatos con PN superior a los 3,000 g. la entidad no muestra esta relación con el PN en F
Assuntos
Humanos , Masculino , Feminino , Estenose Pilórica/epidemiologia , México/epidemiologiaRESUMO
Este trabajo se realizó en el Servicios de Cirugía Pediatrica, Hospital Cayetano Heredia, Lima. Se revisaron Historias Clínicas de abril 1969 a febrero 1991 con Diagnóstico de Estenosis Hipertrófica de Píloro (EHCP), 76 cumplieron los criterios de selección (paciente pediátrico y confirmación diagnóstica post-operatoria). El objetivo fue realizar un estudio sobre EHCP donde se resaltan los hallazgos clínicos de esta patología en un Hospital General; se muestra el porcentaje en lo referente a la palpación de la Oliva Pilorica, estableciendo asi el diagnóstico definitivo; la evaluación clínica, el tratamiento quirúrgico, la morbi-mortalidad. La edad promedio al ingreso fue de 39.11 días; relación varón/mujer: 4.4/1 (p menor 0.01); siendo primogénitos 43.42 por ciento. El 100 por ciento de los pacientes iniciaron con vómitos post prandiales, a la edad promedio de 23.73 días. Estreñimiento en 52.63 por ciento, avidez por alimento en 40.79 por ciento. La oliva pilórica se palpó en el 93.42 por ciento de todos los casos, estableciendose así el diagnóstico clínico definitivo. La palpación fue negativa en 5 pacientes siendo su diagnóstico definitivo radiológico. La anomalía congénita asociada más frecuente fue la hernia inguinal (6.58 por ciento). En todos se realizó piloromiotomía de Fredet-Ramstedt. 22.36 por ciento de los pacientes tuvieron por lo menos una complicación; siendo la mas frecuente la infección de la hernia operatoria (5.26 por ciento), hipotermia (5.26 por ciento) y la perforación iatrogénica de la mucosa pilórica (3.95 por ciento). En el 48.68 por ciento no existió vómitos post-prandiales, y la mortalidad fue 1.32 por ciento (1 de 76 pacientes)
Assuntos
Humanos , Masculino , Feminino , Estenose Pilórica/cirurgia , Estenose Pilórica/congênito , Estenose Pilórica/diagnóstico , Estenose Pilórica/epidemiologia , Hipertrofia/congênito , Hipertrofia/diagnóstico , Hipertrofia/epidemiologia , Hipertrofia/cirurgia , PeruAssuntos
Estenose Pilórica/patologia , Chile , Feminino , Humanos , Hipertrofia , Lactente , Recém-Nascido , Masculino , Estenose Pilórica/epidemiologiaRESUMO
With the idea of clearing out several variables individually found associated with a greater incidence of congenital pyloric stenosis in the same group of children, 298 clinical histories in infants complaining of this deviation were reviewed. Information was obtained as to sex, birth number, blood group and the month these children with stenosis were born. The distribution of frequencies in each one of these variables was compared to that in 309 children surgically operated from peritonitis. The results showed a greater incidence of congenital pyloric stenosis in males than in females; also, the disease appeared more frequently in first-borns. Patients with type A blood group were less prone to present the anomaly. The birth month showed no statistical difference. The findings stress the importance shown by the genetic component of this disease.
Assuntos
Estenose Pilórica/epidemiologia , Antígenos de Grupos Sanguíneos , Feminino , Humanos , Recém-Nascido , Masculino , México , Gravidez , Estenose Pilórica/sangue , Estenose Pilórica/congênito , Estações do Ano , Fatores SexuaisAssuntos
Estenose Pilórica/epidemiologia , Adolescente , Idoso , Feminino , Humanos , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
105 patients with pyloric stenosis, diagnosed at the University Hospital in Jamaica, are reviewed. Eighty of these caused by chronic duodenal ulceration are examined in detail. They presented late, and electrolyte abnormalities were the most important feature of their condition. Treatment by repeated stomach washouts before operation can be dangerous, and may have contributed to the 4 deaths among these patients. Partial gastrectomy has proved a satisfactory procedure in these patients (AU)