641 THERAPY OF CHRONIC NONSPECIFIC DIARRHEA OF CHILDHOOD: A PROSPECTIVE STUDY

Abstract

Chronic nonspecific diarrhea of childhood (CNDC) is a common and frequently frustrating problem seen between 6 and 30 months of age. It is characterized by 2 or more loose, voluminous, foul smelling stools per day for more than 4 weeks, unassociated with pain or failure to thrive. The etiology of this disorder is unknown and little information as to proper treatment is available.In order to assess bulk agents as therapy in this problem, 19 consecutive children with the clinical diagnosis of CNDC were studied. A 24 hour diet recall and stool examination for parasites, bacteria, occult blood, pH, and carbohydrate were obtained. All patients were negative for carbohydrate intolerance and occult blood. One child had campylobacter and 2 had giardia as the cause of their diarrhea. Sixteen remaining children were treated first with an unrestricted diet for 1 week, then psyllium containing bulk agents for 2 weeks (1 tbsp bid), and if no response, cholestyramine (2½ gms qid) for 2 weeks. 81% of the patients responded to therapy. Three (19%) responded to normalization of the diet only, 9 (56%) to psyllium, and 1 (6%) to cholestyramine. Only 3 (19%) did not respond. Of the patients who responded, most did so promptly and required only 2-3 weeks of therapy. A therapeutic approach consisting of normalization of the diet and bulk agents seems to be an effective mode of therapy in this common childhood disorder.