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  • Question 2Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to surgical pyloromyotomy?

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Question 2
Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to surgical pyloromyotomy?
  1. Anita Erika Mercer1,
  2. Robert Phillips2
  1. 1 The Hull York Medical School, University of York, York, UK
  2. 2 Centre for Reviews and Dissemination, University of York, York, UK
  1. Correspondence to Anita Erika Mercer, The Hull York Medical School, John Hughlings Jackson Building, University of York, York YO10 5DD, UK; hy7aem1{at}hyms.ac.uk

https://doi.org/10.1136/archdischild-2013-303655

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    Scenario

    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]?

    Search

    Secondary sources

    None.

    Primary sources

    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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    Footnotes

    • 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.

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