Diarrea crónica en el niño

Abstract

Prolongued diarrhea is defined as the increased frequency, increaded volume or decreasing consistency of passed stool,not relieved and lasting for more than two weeks. Chronic diarrhea is defined when its duration exceeds 30 days, continuously or with intervals of improvement.The stool characteristics and accompanying symptoms vary according to the patho-physiology of diarrhea (i.e. osmotic, secretory, malabsorptive), its impact on the nutritional status of the patient and, some-times, by its etiology.Chronic nonspecific diarrhea of childhood is often functional. It occur in children 12 to 36 months of age and usually resolveswhen toilet training is accomplished. It generally occurs in well-nourished children with a history of frequent abdominal colicin the first months of life. It must be differentiated from irritable bowel syndrome of childhood.Infectious etiology is an uncommon origin for chronic diarrhea in immunocompetent children; however, post-gastroenteritisdiarrhea exhibit a high frequency and occur as a result of complications of acute infectious diarrhea leading to malabsorp-tion of nutrients, especially in malnourished children under one year of age.Disaccharidases deficits are a common cause of chronic diarrhea and are usually secondary to infectious insult (viral or bacterial) or food allergies. Treatment of this condition consists of a lactosefree diet to restore the enzymes present at the ente-rocyte brush border. Allergy to cow's milk is more common in children with a family history of this problem. It can manifestitself immediately or later after the ingestion of the involved allergen, and is generally selflimited by the age of two. Untilthen it is advised to replace this food by hydrolyzed formulas, which elicit a rapid improvement of symptoms.Celiac disease usually develops after exposure to gluten-containing foods in the diet of infants between 9 months and 2years, but may also be seen in early forms (before 6 months) or late (after 2 years, late childhood or even in adulthood).There are four patterns of presentation of this entity, with different clinical features (syndromic, asymptomatic or silent, latentand potential). Cystic fibrosis is one of the most common lethal inborn errors of metabolism, characterized by widespreaddysfunction of the exocrine glands that most often affects the respiratory and digestive systems, and whose red flagsinclude: family and personal history of polyhydramnios, meconium ileus, persistent newborn jaundice, malnutrition, dehydration (sweat crisis), rectal prolapse, recurrent respiratory symptoms, diarrhea and stunting.