DOI: https://doi.org/10.53350/pjmhs2023172431 ORIGINAL ARTICLE P J M H S Vol. 17, No. 02, February, 2023 431 Frequency of Pyloric Stenosis in Patients Presenting with Persistent Vomiting ZABIH ULLAH 1 , RANIA HIDAYAT 2 , HAFIZULLAH KHAN 3 ,WAQAR ZULFIQAR 4 , ADIL NASEER 5 , SHAWANA ASAD 6 1 Assist prof Gastroenterology ward Ayub medical college & teaching hospital Abbottabad 2 Consultant Gastroenterology ward Ayub teaching hospital Abbottabad 3,4 Medical officer Gastroenterology ward Ayub teaching hospital Abbottabad 5 Prof Gastroenterology ward Ayub medical college & teaching hospital Abbottabad 6 Assistant Professor Surgical C Ward.Ayub Teaching Hospital Abbottabad Corresponding author: Shawana Asad, Email: dr_shawana@yahoo.com ABSTRACT Introduction: Pyloric stenosis is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. Clinically infants are well at birth. Then, at 3 to 6 weeks of age, the infants present with "projectile" vomiting which can lead to dehydration and weight loss. Objective: To determine the frequency of pyloric stenosis in patient presenting with persistent vomiting. Material and Method: This Cross Sectional Study was conducted in the department of Gastroenterology, ATH, Abbottabad from 5 th October 2020 to 5 th April 2021. A total of 115 patients of both gender with persistent vomiting for more than 5 days were included in the study. Abdominal ultrasound was done by a consultant gastroenterologist of three years post fellowship experience. Pyloric stenosis was noted. Results: Age range in this study was from 1 to 40 years with mean age of 6.226±6.62 years and mean duration of complaints was 9.869±3.76 days. Male patients were 88.7%% and females were 11.3%%. Pyloric Stenosis was observed in 93% patients. Conclusion: Our study concluded that that pyloric stenosis is 4 times more common in males compared to females and is more common among younger age groups as compared to adult patients. Keywords: Persistent vomiting, pyloric stenosis, Ultrasound, Frequency INTRODUCTION Pyloric stenosis is an uncommon cause of gastric outlet obstruction. It is characterized by an abnormal hypertrophy of the pyloric muscles. 1 The overall incidence of this disease is around 2 – 5 patients per thousand live births per year. It almost exclusively in infants with 3 – 6 weeks of age being the most common age of presentation. 1 Moreover, it occurs almost four times more commonly in the males compare to females. White race is being the most commonly affect ethnicity. The exact etiology is not known, however familial link has been described to be involved in its etiology. It is less commonly seen in Indian, Asian, and Black populations. 2 Pyloric stenosis is caused by abnormal thickening of pyloric muscles of the stomach. 3 Moreover edema develops in the mucosa, and the muscularis layer also undergoes hyperplasia. These abnormal changes leads to the narrowing of the lumen of the gastric antrum. This in turn leads secondarily to lengthening of the pyloric canal and dilatation of the stomach. These structured changes are main reason being immediate postprandial, nonbilious, projectile vomiting, which is the most common symptom seen in these patients. 3 Moreover, severe and profound emesis in turn causes hypochloremia and hypokalemia. 4 Indeed the most common biochemical abnormality seen in hypertrophic pyloric stenosis is hypochloremic, hypokalemic metabolic alkalosis. 4 In a study by Ndongo R, et al. has shown that frequency of pyloric stenosis was 100% in patient presenting with persistent vomiting. 5 In a study by Taylor ND, et al. has shown that frequency of pyloric stenosis was 99.7% in patient presenting with persistent vomiting. 6 No such study has been done before in adult population with persistent vomiting. Pyloric stenosis is a common condition affecting young infants; despite its frequency, it has been recognized only for a little over a century. So it’s a dire need to get data in adult population too. Therefore I have planned to determine the frequency of pyloric stenosis in patient presenting with persistent vomiting. Results of my study will help to estimate the real burden of this morbidity in our general population. MATERIAL AND METHODS This cross sectional study was conducted from 5 th October 2020 to 5 th April 2021 in the department of Gastroenterology, ATH, Abbotabad. A total of 115 patients were enrolled in the study through non probability consecutive sampling. Sample size was calculated using WHO sample size software with 95% confidence level, 1% margin of error and expected prevalence of pyloric stenosis of 99.7% in patient presenting with persistent vomiting. 6 Patients aged 1 to 40 years, both genders and patients with persistent vomiting for more than 5 days were included in the study. Patients with history of diarrhea, anemia, gastritis or surgery were excluded from the study. After getting approval from the hospital ethics’ committee to conduct the study, data was collected from all those patients with persistent vomiting presenting to the Out-patient Department of Gastroenterology, ATH, and Abbottabad. An informed written consent was taken from those patients fulfilling the inclusion criteria. Basic demographics like age, gender, duration of complain was noted. Abdominal ultrasound was done by a consultant gastroenterologist of three years post fellowship experience. Pyloric stenosis was noted as per operational definition and recorded on especially designed proforma. Data was analyzed by the statistical program SPSS 23. Frequencies and percentages were calculated for qualitative variables like gender and pyloric stenosis. Quantitative variables like age, duration of complaints was analyzed for mean ± standard deviation. Pyloric stenosis was stratified among age, gender, duration of complaints. Data was stratified among age, gender, duration of complaints Post stratification chi-square test with p ≤0.05 was considered as significant. RESULTS Age range in this study was from 1 to 40 years with mean age of 6.226±6.62 years and mean duration of complaints was 9.869±3.76 days. Male patients were 88.7% and females were 11.3%% in our study.Pyloric Stenosis was observed in 93% patients.Stratification of Pyloric Stenosis with respect to age, gender and duration of complaints are shown in Tables-I, II and III respectively. Table-1: Stratification of Pyloric Stenosis with respect to age. Age (years) Pyloric Stenosis p-value Yes No 1-20 104(100%) 0(0%) 0.000 21-40 3(27.3%) 8(72.7%) Total 107(93%) 8(7%)