Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to surgical pyloromyotomy?
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- Gastrointestinal system diseases
- Stomach diseases
- Gastric outlet obstruction
- Pyloric stenosis
- Pyloric stenosis hypertrophic
A 6-week-old boy with projectile non-bilious vomiting is diagnosed with infantile hypertrophic pyloric stenosis (IHPS). His parents are advised that surgical pyloromyotomy is the gold standard treatment for their son's condition, yet they are not keen for him to have an operation and a general anaesthetic. When looking for alternatives, you come across medical therapy of IHPS with atropine. You wonder if this treatment really works?
Structured clinical question
In a 3-week-old infant with hypertrophic pyloric stenosis [patient], does therapy with atropine [intervention] achieve sufficient resolution of the condition so as to avoid the need for surgical pyloromyotomy [outcome]?
We searched the Ovid MEDLINE and EMBASE databases, using the search criteria ‘pyloric stenosis’ and ‘atropine’, and limiting the results to ‘children’. These searches retrieved 41 individual articles, 14 of which were initially considered relevant. However, four studies were subsequently excluded from further analysis as they provided insufficient data on patient characteristics, treatment dosage or duration of treatment. The remaining 27 publications were excluded as they were review articles or concerned atropine use in an anaesthetics context. Further searches of SumSearch and TripDatabase did not retrieve any additional publications. The 10 selected articles are summarised in table 2.
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Contributors AEM conducted the database searches, appraised the identified evidence and wrote the draft for this submission. She is the guarantor. RP supervised her work and carried out the meta-analysis.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.