Chronic protracted diarrhea of infancy: A nutritional disease: Lo CW, Walker WA. Pediatrics 1983; 72:786–800

Abstract

?? CHRONIC PROTRACTED DIARRHEA OF INFANCY: A NUTRITIONAL DISEASE, Lo CW, Walker WA. Pediatrics 1983; 72:786-800. Diarrhea1 disease is an extremely common cause of morbidity in infancy. Although its impact is especially severe in children of underdeveloped countries, in industrialized countries the mortality for infants hospitalized with diarrhea still exceeds 1%. Stool weight, consistency, and frequency are not reliable guides to etiology. Clinical findings of dehydration, malabsorption, and failure to thrive are easily recognized and require careful management. The majority of cases of intractable diarrhea seen in this country are due to postinfectious diarrhea, cow’s milk allergy, giardia and parasites, and celiac sprue. Chronic nonspecific diarrhea is easily distinguished from intractable diarrhea by the absence of malabsorption characteristics and dehydration. More common in the first 30 months of life, it is thought to be the childhood counterpart of irritable bowel syndrome and has psychologic overlay. Postinfectious and viral diarrhea are probably the most common causes of intractable diarrhea. Rotavirus has been found in 40% to 70% of infants with gastroenteritis. Bacterial pathogens (Shigelia, Salmonella, Escherichia coil) are found in 4% to 33Vo; the virulence of these agents is due to their invasiveness of the bowel mucosa. Cow’s milk allergy usually occurs before the age of 6 months and is felt to be due to an antigenic response to the milk protein, leading to villous atrophy. Symptoms resolve on milk-free formulas. Giardiasis occurs frequently in some parts of the United States. Most infections are asymptomatic. The degree of malabsorption and steatorrhea does not correlate with the number of parasites or severity of mucosal injury. Entamoeba histolytica, Strongyloides, and Ascaris are other causes of parasitic diarrhea. Celiac sprue, a toxic reaction to gluten, causes mucosal atrophy, crypt hyperplasia, and malabsorption. Gluten-free diets are essential to prevent growth failure. Treatment. of diarrhea includes glucose and electrolyte repletion. The inherent danger of standard electrolyte solutions is calorie and protein starvation after several days. Dehydration and failure to thrive require hospitalization and electrolyte replacement to break the cycle of malabsorption, failure to heal mucosal damage, and further wasting. [Ramon Pabalan, MD] Editor’s Note: Although not emphasizing emergency department diagnosis and treatment, . this article is an excellent review of the etiology and pathogenesis of chronic diarrhea in infancy.