Abstract
AbstractSevere protracted diarrhoea of infancy (SPDI) remains a major problem in diagnosis and management. The commonest diagnoses are coeliac disease, disaccharide intolerance, and cow's milk protein intolerance, but a wide variety of other inherited, congenital, infective and immunological disorders should be sought. The pathophysiology of the progression of the diarrhoeal illness, which may be trivial at onset, to a severe life threatening disease is discussed. In approximately 30% of cases a diagnosis cannot be established; in those with a familial basis a defect in cell differentiation and replication may be operative and results in a high (80%) mortality rate. In non‐familial SPDI the mortality rate is low and response to an oligoantigenic diet excellent, suggesting that sensitisation to dietary antigens plays an important role. The devastating effect of protracted diarrhoea on the neonate and young infant is due to the increased nutritional demands of rapid growth occurring at a time when intestinal absorptive processes are as yet poorly developed.
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