Abstract
Chronic non-specific diarrhea (CNSD) still represents the most common cause (85%) of chronic diarrhea in childhood. Although self-limited, this condition has been a therapeutic enigma for gastroenterologists. In an attempt to control this problem, we have assessed the association of CNSD with altered dietary intake due to either iatrogenic measures used to treat post-infectious diarrhea or due to dietary idiosyncrasies within families. Of 86 consecutive patients referred with chronic diarrhea, 48 were classified as having CNSD (Davidson's criteria) after a negative mala, sorption workup including lactose tolerance test. Duration of symptoms ranged from 3 weeks to 6 months. When a complete dietary history was obtained on 23 patients, 19 reported a low fat ( 50%) intake. Fourteen additional patients gave histories suggestive of similar intakes. When placed on diets with increased levels of fat (>50%) and with lower carbohydrate levels (<20%), 19 of 23 patients demonstrated normalization of stool frequency and consistency within 5 days to 2 weeks. In addition, 4 patients with a normal dietary intake also responded to an increase in dietary fat. These observations suggest that iatrogenic changes in diet to treat diarrhea (low fat, high carbohydrate) may account for chronicity in numerous instances and an increased fat intake may decrease bowel motility.
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