Question of an Infectious Etiology or Contribution to the Pathogenesis of Infantile Hypertrophic Pyloric Stenosis

Abstract

Infantile hypertrophic pyloric stenosis is a concerning cause of nonbilious vomiting in the neonatal population. Although a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. The present review discusses the published literature regarding infectious etiologies of infantile hypertrophic pyloric stenosis. Furthermore, it attempts to demonstrate that newer research regarding an NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology.

Food Allergy Mimicking Pylorus Hypertrophy

“…However, the following have been described as triggers: abnormalities in the hormonal control, intrinsic abnormalities of muscle fibers, the cells of Cajal and nerve fibers, infections, and increased insulin-like growth factors, as well as genetic predisposition. 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].…”

Infantile Hypertrophic Pyloric Stenosis

“…The etiology is complex, but includes a genetic predisposition likely modulated by environmental factors such as erythromycin exposure, feeding practices, among others (1,2). It is within this conceptual framework that Modarressi in the present issue of the Journal of Pediatric Gastroenterology and Nutrition presents the hypothesis for infection or an infectious component to the etiology of IHPS (3).…”