Pyloric stenosis as a presenting symptom of crohn's disease treated with infliximab monotherapy

We report a rare case of pyloric stenosis as a presenting symptom of Crohn's disease. Clinical improvement and long term relief of pyloric obstruction were obtained following a one year course of infliximab [Remicade]. In contrast to most of the cases described previously in the literature, surgical treatment was not required and infliximab was used as a monotherapy

Successful management of infantile hypertrophic pyloric stenosis with atropine sulfate.

OBJECTIVE: To evaluate the effectiveness of atropine sulfate in management of infantile hypertrophic pyloric stenosis (IHPS). DESIGN: Prospective observational. SUBJECT: Patients attending the hospital with complaints of persistent vomiting and later clinically and sonographically diagnosed as cases of IHPS were selected for the trial. METHODS: Atropine was initially administered intravenously in a dose of 0.06 mg/kg/day in eight divided doses, increased by 0.15 mg/kg/day till vomiting ceased and remained so for a period of 24 hours at a stretch and ultrasonography showed a transit time (of gastric contents through pyloric canal) of less than 1 minute. Intravenous atropine was then substituted by oral atropine at double the effective IV dose for 3 weeks. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of IV treatment, after completion of oral treatment and at 3,6,9,12 and 15 months follows up. Transit time of gastric contents was measured at the commencement of intravenous treatment and then daily after the vomiting stopped for more than 24 h at a stretch. RESULTS: Medical treatment of IHPS with atropine was successful in 50/52 (96.2%) cases. Vomiting ceased in 1-3 days in all patients with mild hypertrophy and in 4-7 days in all the cases with moderate hypertrophy. In all except 2 patients with severe hypertrophy, vomiting ceased in 8-12 days. These two cases continued to vomit at least once daily even after 2 weeks of IV treatment and ultimately opted out for pyloromyotomy. All the 50 medically treated children made uneventful recovery during oral therapy except 3 cases (6%) in whom vomiting recurred during the follow-up. These 3 children later responded by increasing the dose of oral atropine. All of them began to gain weight by the time oral therapy was commenced and ultrasonographic evidence of normalization of pylorus was observed in all these children 3-15 months after completion of oral therapy. CONCLUSION: Atropine sulfate proved to be an effective and safe treatment option for IHPS.