Pylorostenosis, Gastroesophageal Reflux and Malabsorption - Major Digestive Disorders

Pylorostenosis is a disease of infants of the first month of life due to narrowing of the pyloric canal's aperture because of muscular hypertrophy of the pylorus.

Clinical manifestation
• Latent period
• Regurgitations up to abundant vomit without bile,
• Dehydration
• Malnutrition
• Stomach peristalsis in a form of sand-glass
• Constipation

Gastroesophageal reflux
Gastroesophageal reflux (GER, chalasia cardiochalasia) denotes relaxation or incompetence of the lower esophagus. In newborns, this is considered a normal phenomenon because of immature neuromuscular control of the gastroesophageal sphincter. However, in a small percentage of infants reflux continues, producing symptoms that warrant investigation. The exact cause is not known, although it is thought to result from delayed maturation of lower esophageal neuromuscular function or impaired local hormonal control mechanisms.

Clinical manifestations
• Vomiting
• Weight loss
• Respiratory problems
• Bleeding

Vomiting is the most frequent symptom and in infants is quite forceful. It is frequently so severe that there is a loss of calories sufficient to cause weight loss and failure to thrive.

Reflux of stomach contents to the pharynx predisposes to aspiration and the development of respiratory symptoms, especially pneumonia, Repeated irritation of the esophageal lining with gastric acid can lead to esophagitis and consequently bleeding. Blood loss in turn causes anemia and it is seen as hematemesis or melena (blood in stools). Heartburn is also a frequent symptom in older children who can describe it but may go unrecognized in infants.

Malabsorption syndromes
The term "malabsorption syndrome" is applied to a long list of disorders associated with some degree of impaired digestion and/or absorption. Most are classified according to the locations of the supposed anatomic and biochemical defect.

Digestive defects mainly include those conditions in which the enzymes necessary for digestion are diminished or absent, such as cystic fibrosis, in which pancreatic enzymes are absent biliary or liver disease, in which bile production is affected, or lactose deficiency, in which there is congenital or secondary lactose intolerance.

Absorptive defects include those conditions in which the intestinal mucosal transport system is impaired. It may be because of secondary to inflammatory disease of the bowel, that results in impaired absorption because bowel motility is accelerated, such as ulcerative colitis.

Obstructive disorders, such as Hirschsprung's disease, can also cause secondary malabsorption from enterocolitis, chronic inflammation of the distended small and large bowel, megacolon or large colon. In addition, there is failure of the internal rectal asphincter to relax, which adds to the clinical manifestations because it prevents evacuation of solids, liquids and gas.

Clinical manifestations
Clinical manifestations vary according to the age.

In the newborn the chief signs and symptoms are failure to pass meconium within 24 to 48 hours after birth, reluctance to ingest fluids, bile-stained vomitus, abdominal distention.

If the disorder is allowed to progress, other signs of intestinal obstruction, sich as respiratory distress and shock, develop. During infancy, the child does not thrive and has constipation, abdominal distention, episodes of diarrhea and vomiting. The occurrence of explosive, watery diarrhea, fever, and severe prostration is ominous because it ofter signifies the presence of enterocolitis, which greatly increases the risk of fatality. Enterocolitis may also be present without diarrhea and is first evidenced with unexplained fever and poor feeding.

During childhood, the symptoms include, constipation, passage of ribbon like, foul-smelling stools, abdominal distention, visible peristalsis. Fecal masses are easily palpable. The child is usually poorly nourished, anemic, and hypoproteinemic from malabsorption of nutrients.