Pyloric spasm (the muscles at the exit of the stomach) or pilorospasm is a pathological condition in which there is a strong spastic contraction of the muscles in the pyloric region of the stomach.
As a result of pylorospasm, the timely removal of food from the stomach is disturbed and unpleasant symptoms occur, the digestion process is disturbed.
Primary and secondary forms of pylorospasm occurring on the background of various pathologies are distinguished.
Primary pylorospasm results from:
- impaired timely delivery of relaxing stimuli to the pyloric receptors that occur during malfunction of the nervous system,
- vitamin deficiency (especially group B),
- severe fatigue (physical or mental),
- reflex, with irritation in the area of the initial intestine or in the region of the ileocecal angle (place of passage of the small intestine into the colon),
- intoxication with nicotine or morphine,
- disorders of the autonomic nervous system (improving the tone of the vagus nerve).
Secondary pyloropasm occurs when:
- peptic ulcer disease, especially when the ulcer is localized in the pyloric region,
- chronic gastritis, especially with high acidity,
- inflammation of the outlet of the stomach and the initial part of the intestine (pyloroduodenitis),
- gastric polyposis,
- diseases of the lower digestive tract – colitis, gut polyposis , Crohn’s disease or chronic appendicitis,
- diseases of the biliary tract,
- adhesive process,
- inflammation in the pelvic area in women (reflexive pyloric spasm occurs due to the appearance of pathological impulses).
Provocating factors for the development of pylorospasm is smoking, working in hazardous chemical plants, taking certain medications.
Pilorosprazm often occurs in infants as a result of difficult childbirth and prolonged hypoxia, immaturity or pathology of the nervous system. In adults, it usually occurs on an unfavorable, painful background or when the body is depleted.
The gatekeeper is a special muscle of the digestive system, it is constantly reduced, regardless of the digestive process. However, the pylorus tone is sensitive to the active work of all the digestive and nervous system impulses, as well as changes in the concentration of digestive juices.
Too strong stimuli result in a convulsive contraction of the pylorus, a spasm arises. Long spasms violate the internal structure of the pylorus – this can result in a more serious condition – pyloric stenosis (organic muscle disorders).
Because of the spasm, the stomach begins to contract more, trying to overcome the force of contraction of the pylorus and push the food further into the intestine. There are unpleasant symptoms of pylorospasm.
There are 2 forms of pylorospasm:
- compensated, the spasm is overcome by the efforts of the stomach, the food is pushed through the narrowed space of the pylorus,
- uncompensated – the walls of the stomach become tired and stop contracting, food stagnates.
The pyloric spasm can be absolute or complete, while the opening is completely blocked by the muscles, and relative – there remains a small opening for the passage of food.
When pylorospasm can occur:
- pain in the stomach of a colicky character,
- painful cramps in the pod area,
- weight loss occurs,
- after the pain passes, there is a “urinary crisis”, the patient releases a large amount of urine with low density and light color,
- there may be nausea and heaviness in the stomach, especially after eating,
- in severe cases, vomiting occurs, bringing relief,
- due to vomiting, loss of salts occurs, weakness occurs,
- with prolonged stagnation of food in the stomach vomit have a bad smell.
The last three symptoms may be a sign of pylorospasm transition to stenosis, which requires more active therapeutic measures.
In young children, pylorus spasm occurs
- persistent regurgitation of more than 2 tablespoons, even 1-2 hours after feeding,
- sometimes vomit fountain
- poor weight gain, flattened weight curves,
- common anxiety, frequent weeping,
- sleep disorders
- bouts of colic.
Symptoms of damage to the nervous system with impaired overall muscle tone are noted.
The diagnosis and treatment is done by a gastroenterologist.
The basis of the diagnostics is x-ray of the stomach with a contrasting substance, on radiographs there is a delay in food, the contrast mixture flows from the stomach into the intestine in small portions.
The stomach gets an unusual form on a roentgen. To distinguish the pyloric spasm from its stenosis, a muscle relaxant drug is injected. After it, the spasm disappears and the normal passage of the contrast mixture into the intestine is detected on the x-ray.
An endoscopic examination (swallowing a “bulb”) complements the study, in which the spasmodic pyloric part of the stomach and content retention are visually visible on the monitor.
Begin therapeutic measures with the maximum elimination of causal factors. The basis of pylorospasm treatment is
- a special diet with the exception of a sharp, irritating diet, coarse fiber,
- strict day regimen and nutrition, adequate rest,
- when dehydrating and losing salts with vomiting, saline solutions are administered orally or intravenously,
- physical therapy, massage and breathing exercises are held,
- in severe cases, spasmolytics are used (no-shpa, drotaverine, papaverine) and muscle relaxants (atropine and its analogues).
Approximate treatment of pylorospasm
- Diet: fractional feeding with an increase in the number of feedings and a decrease in single volume; breastfed: breast milk; when artificial feeding should use mixtures with thickeners (for example, “Frisovom”, “Nutrilon-anti-reflux”, “Nestargel”, “Semper Lemolak”)
- Antispasmodics: chlorpromazine 0.002 g 3 r / day inside (0.5-1 ml of 0.25% solution of chlorpromazine); Promethazine 2.5% for 1-2 drops 15 minutes before feeding;
- Physiotherapy: electrophoresis papaverine hydrochloride, drotaverine on the upper abdominal No. 5-10; paraffin application on the abdominal area number 5-6 every other day.
Treatment in children
In children, pylorospasm is treated by the use of fractional rations with a small volume, the adoption of special provisions in the crib, the taking of antispasmodics, massages and sedative therapy (the use of sedatives – valerian, motherwort, Novospassita). As the nervous system matures, pylorospasm gradually disappears.
Often, patients do not attach importance to the symptoms that arise, taking them for nutritional errors, with the result that pylorospasm flows into a severe and progressive disease – pyloric stenosis, when the damage to the pyloric muscles becomes irreversible.
This disrupts the patient’s normal life and may lead him to the operating table.