587 ILEAL INVOLVEMENT IN THE INTRACTABLE DIARRHEA SYNDROME OF INFANCY

Abstract

The intractable diarrhea syndrome of infancy is a multifactorial enterocolitis associated with nutritional failure (AJDC 125: 358, 1973). Impaired upper intestinal function may persist for months despite clinical recovery (Ped. 66:730, 1980). Ileal function was assessed by the Schilling test with and without intrinsic factor (Co57 and Co58) in 13 patients. All required i.v. hyperalimentation and/or elemental diet. Mean duration of hospitalization was 4.5 mos. Renal function was normal and none were on antibiotics. Hypoalbuminemia and impaired xylose absorption were present in 12/13. Intestinal biopsies ranged from normal to total villus atrophy. Fecal flora in the upper intestine was only present in 1/12. Results showed impaired vitamin B12 absorption in 9/13 (mean ± 1 SD % excreted Co57 = 2.32 ± 1.93, Co58 2.63 ± 2.17, normal >10%). Response to Cholestyramine was inconsistent. Follow up studies in 4 patients showed persistent abnormalities, but serum vitamin B12 levels remained normal. Schilling tests in 36 other patients showed abnormalities in Crohn's disease (8/18), immunodeficiency syndromes (2/6), post-resection (2/6) and other malabsorption syndromes (0/6). Conclusions: 1) Ileal involvement is present in the majority of infants with intractable diarrhea. 2) Recovery of ileal function is delayed.