Chronic Diarrhea of Childhood: An Analysis of 61 Cases

Abstract

Objective To investigate the clinical features, treatment and prognosis of chronic diarrhea. Methods A total of 61 patients with chronic diarrhea children patients were admitted to the Children's Hospital of Fudan University from August 1997 to August 2007. The ratio of male to female was 1.65∶1.00. The youngest patient was 40-day old and clinical course varied from 2 mouths to 10 years. Apart from diarrhea, other clinical features included fever, abdominal pain, vomiting, anemia, and malnutrition, while others were accompanied with varies degree of dehydration, electrolyte imbalance, and metabolic acidosis. The general features, clinical presentation, laboratory investigations, causes and prognosis were examined retrospectively. Results Laboratory examination of stool scopy of 61 patients showed that 34 cases (55.7%) were normal. The whole bacterial culture of stool was negative, and 14 cases (23.0%) of stool lactose were positive, 13 cases (21.3%) were alteration of intestinal flora, 3 cases (4.9%) of stool infected mycetes, 3 case (4.9%) infected amoeba, and 1 case was positive for rotavirus. 15 cases (53.6%) among 28 cases were abnormal who were detected by serum immune globulin. The seroimmunity index showed 7 cases (29.2%, 7/24) were abnormal who were detected by CD series. Electronic colonoscope and pathology showed that mucosa process was 27 cases, and ulcerative colitis was 3 cases, Crohn's disease was 10 cases, non-specific enterocolitis was 6 cases, lymphoplasia enterocolitis was 1 case, allergic enterocolitis was 3 cases, polyps and enterocolitis was 4 cases. Others(including X-ray Ba enem, barium swallow test, electronic gastroscope, abdominal ultrasound and radioactive nuclide) showed that gastritis was 6 cases, and duodenitis was 3 cases, intestinal lymphangiectasia was 1 case, enteritis was 4 cases, and colonitis was 9 cases. Abdominal (right lower quadrant) mass was 1 case, bowel polypus was 4 cases, and left adrenal gland tumor was 2 cases. Moreover, exploratory laparotomy was 3 cases, 2 cases were diagnosed as tumor (1 case of including neuroblastoma and 1 case of ganglioneuroma), 1 case was diagnosed as Crohn's disease. Among 61 patients, 56 cases (91.8%) had a definitive cause, etiological factors in order including inflammatory bowel disease, infective enterocolitis (including fungal infection, amebic infestation) non-specific enterocolitis, polyps and enterocolitis, lactose intolerance, antibiotic associated diarrhea, allergic diarrhea, immunodeficiency, tumor (including neuroblastoma and ganglioneuroma), acquired immunodeficiency, intestinal lymphangiectasia, irritable bowel syndrome, and congenital lactase deficiency. Of the 61 patients, 21 cases were cured, and 39 cases were improved, 1 patient died of generalized peritonitis and septic shock. Conclusion Clinical manifestations of children's chronic diarrhea are diversified, and the pathogenesis is complex. It should be strength the inspection and treat as early as possible. Key words: chronic diarrhea; child