PEDBASE.org - The Pediatric Database - Detailed information of CHRONIC PERSISTENT DIARRHEA

CHRONIC PERSISTENT DIARRHEA

DEFINITION:

A chronic diarrhea in developing countries characterized by continued stool output of >30g/kg/day for more than 2 weeks duration.

EPIDEMIOLOGY:

incidence: 10-20% of children < 5 years (in developing countries)
age of onset:
- peak incidence at 2 years of age
risk factors:
- after an episode of gastroenteritis in those patients with:
  - low birth weight
  - Vitamin A deficiency
  - non-breast feed infants
  - concurrent infections (URTI)
  - those with failure to thrive, malnutrition, and/or anorexia
  - less than 3 months of age with repeated episodes of diarrhea

PATHOGENESIS:

1. Etiology

prolonged and severe gastroenteritis damages the small bowel mucosa resulting in:
- fat malabsorption - decreased by 50%
- carbohydrate malabsorption - decreased absorption of mono- and disaccharides

CLINICAL FEATURES:

1. Gastrointestinal Manifestations

malabsorption with steatorrhea
failure to thrive with weight loss
anorexia
chronic persistent diarrhea

2. Complications

may evolve into Intractable Diarrhea of Infancy
multiple episodes of infectious diarrhea and/or secondary infections
- due to a secondary immunodeficiency due to malnutrition
Stagnant Loop Syndrome
- secondary to altered gut motility and local immunodeficiency
Death if diarrhea persists longer than 1 month particularly if the infant is less than 1 year of age

INVESTIGATIONS:

1. For Malabsorption

see file on "Malabsorptive Disorders"

2. Stool

for O&P, C&S, viral cultures
fats: elevated 72hr fecal fat
carbohydrates: reducing substances, acidity (pH < 6.0)

MANAGEMENT:

1. Supportive

oral rehydration fluid (ORF) or intravenous rehydration
correct electrolyte, acid-base disturbances
correct malnutrition

2. Medications

antibiotics if stool cultures positive

Pediatric Database - CHRONIC PERSISTENT DIARRHEA

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