Fact 13: Differentiating Pyloric Stenosis from Gastroesophageal Reflux
To the untrained eye, pyloric stenosis and gastroesophageal reflux (GER) can appear alarmingly similar. Both manifest in infants, and the shared symptom of vomiting can lead to confusion. However, as we delve deeper, understanding the nuanced differences becomes essential for proper diagnosis and timely intervention.
Vomiting is a primary symptom of both conditions, but the characteristics differ. In pyloric stenosis, the vomiting is often described as “projectile.” This forceful ejection happens almost immediately after feeding, indicating an obstruction in the stomach’s outlet. In stark contrast, GER-related vomiting is less intense. Instead of the sudden and forceful ejection, it’s more of a regurgitation, a gentle return of stomach contents, which typically occurs some time after the baby eats.
When conducting a physical examination, an experienced pediatrician or healthcare provider might detect an olive-shaped mass in the infant’s upper abdomen if it’s pyloric stenosis. This palpable mass is essentially the hypertrophied pylorus muscle. Such a telltale sign is not present in GER, making hands-on examination crucial in differentiating the two.
While vomiting stands out, other symptoms help draw the line between these conditions. GER can sometimes lead to respiratory issues in infants. They might cough, wheeze, and even experience growth issues due to either refusing food or not retaining enough nutrients. In comparison, babies suffering from pyloric stenosis are frequently hungrier, given that they obtain minimal nourishment from the food they ingest. They also show signs of dehydration from the repeated and forceful loss of stomach contents.(13)
