Chronic Diarrhea In Children Research Articles

Innovative Diagnostic Tool: Convolutional Neural Network for Early Fat Malabsorption Detection in Pediatric Patients with Chronic Diarrhea

Background: Chronic diarrhea in children poses a significant clinical challenge and can lead to adverse health outcomes. Among various causes, fat malabsorption is particularly concerning, as it may lead to inadequate nutrient absorption, malnutrition, and impaired growth. Prompt and precise diagnosis is crucial for implementing effective treatments. Objectives: The goal of this study is to utilize deep learning to create a superior diagnostic tool that exceeds traditional methods, facilitating the early identification of fat malabsorption in children suffering from chronic diarrhea. Methods: In a preliminary study involving 100 pediatric patients, 25 machine learning algorithms were evaluated. The convolutional neural network (CNN) was identified as the most effective and subsequently refined through hyperparameter tuning. Results: The CNN model exhibited exceptional performance, attaining a test accuracy of 97% and an area under the curve (AUC) score of 99.4%. These results underscore its reliability in accurately identifying cases of fat malabsorption. Conclusions: This research represents noteworthy progress in pediatric gastroenterology, merging deep learning techniques with medical expertise to develop a dependable and rapid diagnostic tool. This innovative method promises significant improvements in detecting fat malabsorption, potentially transforming clinical practices and enhancing patient outcomes in children with chronic diarrhea.

Epidemiological aspects of chronic diarrhea in children in the Samara region

The aim of the research: to study the structure and epidemiological features of chronic diarrhea in children in different age periods. Materials and methods: data on outpatient cases of children and inpatient care with diseases that are clinically manifested by chronic diarrhea syndrome were analyzed. A survey of 1509 children of different ages was also conducted at an outpatient appointment with a pediatrician on the day of a healthy child, in preschool and educational institutions in the city of Samara. Results of the study: as a result of the study, it was revealed that in the structure of gastroenterological pathology in children, diseases manifested by chronic diarrhea account for 1.8%, while at the outpatient stage, unspecified diseases are more common. Among the children surveyed, it was found that clinical manifestations of chronic diarrhea were observed in 53.4% of cases at the time of the survey, while among these children, only 8% had a gastroenterological diagnosis that explained chronic diarrhea. Slightly less than half of the children surveyed had the so-called causal nature of chronic diarrhea. Conclusion: The relevance of the problem of chronic diarrhea in childhood is confirmed by the data of its high prevalence. It has been shown that insufficient attention is paid to the problem of chronic diarrhea - the registered prevalence is at least 5 times lower than the real one. Particular attention should be paid to children with cause-related diarrhea, and restriction of the use of cause-significant products stops clinical manifestations and leads to a decrease in seeking medical help.

Zapažanja u vezi sa kliničkim karakteristikama hronične dijareje kod dece i procena prognostičke vrednosti nutritivnih i imunskih indikatora

Background: This research aimed to assess the clinical characteristics of chronic diarrhoea in children and explore the prognostic value of nutritional status and immune indicators. Methods: A total of 190 patients with chronic diarrhoea from January 2017 to June 2020 were enrolled to analyze their epidemiology. The patients were divided into a better prognosis group (cured and improved) and a poor prognosis group (uncured). The efficacy of nutritional status and immune indicators in children's chronic diarrhoea prognosis was analyzed. Results: Most patients were 0-3 years old (74.2%), of which 54.3% were less than 1 year old, and 48.95% had a course of 1 to 2 months. The albumin, immunoglobulin G (IgG), IgA and IgM levels, albumin, globulin, and the ratio of albumin to globulin in the better prognosis group were higher than those in the poor prognosis group. The AUC (area under the curve) of the combined detection in evaluating the prognosis of children with chronic diarrhoea was greater than that of the albumin and globulin alone (P<0.05). IgG 10.05 g/L and IgA 7.72 g/L were protective factors affecting the prognosis of children with chronic diarrhoea. Conclusions: Children with chronic diarrhoea are mainly infants and young children with various clinical symptoms and are prone to comorbidities such as malnutrition, anemia, hypoalbuminemia, and impaired immune function. In evaluating the prognosis of children, evaluating nutritional status and immune indicators together is valuable.

Other Causes of Chronic Diarrhea in Children.

Chronic diarrhea is still an important cause of morbidity and mortality in children. There are several causes of chronic diarrhea which may be due to intestinal, extra-intestinal or underlying systemic diseases. The etiology varies depending on the age of onset and may include both common and uncommon disorders. In this article some of the uncommon disorders such as immune deficiencies, intestinal lymphangiectasias, drug induced diarrhea, eosinophilic gastrointestinal disorders, endocrinopathies, neuroendocrine secretory tumors, malignancy and factitious diarrhea have been included. Though these disorders are uncommon it is essential that they are considered in select situations as detailed below and evaluated so that definitive therapy may be offered.

Approach to a Child with Chronic Diarrhea.

Chronic diarrhea in children is challenging both with regards to etiological diagnosis and for management. Etiology and pathophysiological mechanisms vary widely from neonates to adolescents. Congenital or genetic causes are more frequent in neonates, while infections, allergy and immune-mediated mechanisms are more frequent in childhood. A thorough history and proper physical examination are required to decide for further diagnostic evaluation. The approach to a child with chronic diarrhea should be age specific and based predominantly on the pathophysiological mechanism involved. The nature of the stool like watery, bloody or fatty (steatorrhea) can suggest the probable etiology and organ system involved. After routine tests, evaluation with specific serological tests, imaging, endoscopy (gastroscopy/colonoscopy), histopathology of intestinal mucosa, breath tests or radionuclide imaging may be required to make a definitive diagnosis. Genetic evaluation is important in congenital diarrheas, monogenic inflammatory bowel disease (IBD) and immunodeficiency disorders. Management is aimed at stabilization, nutritional support and etiology specific treatment. Specific therapy can be as simple as exclusion of specific nutrient or as complicated as small bowel transplant. Evaluation and management require expertise and thus patients need to be referred in a timely fashion. This will minimise morbidity including nutritional consequences and improve outcome.

Inflammatory Bowel Disease in Children.

Inflammatory bowel disease is an important cause of chronic diarrhea in children, with a rising incidence, globally. The two main subtypes include Crohn's disease and ulcerative colitis. The clinical features are variable, and diagnosis requires initial first-line investigations followed by the involvement of specialist input for targeted imaging and endoscopy with biopsy, to confirm the diagnosis. Despite detailed investigation, inflammatory bowel disease may be clinically indistinguishable from chronic infections such as intestinal tuberculosis, and anti-tuberculosis treatment may be considered prior to further management considerations. The medical management of inflammatory bowel disease depends on subtype classification and severity, and may involve a step-wise approach to immunosuppressive therapies. In children, the consequences of poorly controlled disease are wide ranging, from psychosocial impacts and school non-attendance, to growth impairment and pubertal delay with subsequent impacts on bone health. In addition, an increased need for hospitalization and surgical intervention, and ultimately risk of cancer long-term. A multi-disciplinary team with expertise in inflammatory bowel disease is recommended to mitigate these risks and help to achieve the goal of sustained remission with endoscopic healing. This review focuses on updates on best clinical practice on the diagnosis and management of inflammatory bowel disease in children.

Enteroaggregative Escherichia coli induced activation of epidermal growth factor receptor contributes to IL-8 secretion by cultured human intestinal epithelial cells

Enteroaggregative Escherichia coli (EAEC) has been identified as a new enteropathogen that causes acute and chronic diarrhea in children and travelers. One defining aspect of EAEC-pathogenesis is the induction of an inflammatory response in intestinal epithelium. In this study, we have found that EAEC-induced EGFR activation in human small intestinal and colonic epithelial was attenuated in the presence of a specific inhibitor of EGFR (Tyrphostin AG1478). Further, the aggregative stacked-brick type of adherence of this organism to both the cell lines and this pathogen-induced cytoskeletal rearrangement of these cells was also reduced in the presence of Tyrphostin AG1478. Moreover, EAEC-induced activation of downstream effectors (ERK-1/2, PI3K and Akt) of EGFR mediated cell signaling pathways were found to be suppressed in the presence of EGFR inhibitor. A decrease in IL-8 response in EAEC infected both the cell types were also noted in the presence of specific inhibitors of these downstream effectors, transcription factors and Tyrphostin AG1478. We propose that EAEC-induced activation of EGFR is quintessential for stacked-brick adherence of EAEC to human intestinal epithelial cells, their cytoskeletal rearrangements and stimulation of ERK-1/2 and PI3K/Akt mediated signal transduction pathways, resulting in the activation of NF-κB, AP-1, STAT-3 and finally IL-8 secretion by these cells.

The Clinical Spectrum of Chronic Diarrhea in Children

The Clinical Spectrum of Chronic Diarrhea in Children

Rapid health technology assessment of four oral Chinese patent medicines in treatment of functional gastrointestinal disorders

To provide proof of the evidence-based medicine and decision-making information for the clinical decision of functional gastrointestinal disorders(FGIDs), this study evaluated and compared the efficacy, safety, and economy of four oral Chinese patent medicines(CPMs) in the treatment of FGIDs using the method of rapid health technology assessment. The literature was systematically retrieved from CNKI, Wanfang, VIP, SinoMed, EMbase, PubMed, Cochrane Library and ClinicalTrials.gov from the establishment of the databases to May 1, 2022. Two evaluators screened out the literature, extracted data, evaluated the quality of the literature, and descriptively analyzed the results according to the prepared standard. Eventually, 16 studies were included, all of which was rando-mized controlled trial(RCT). The results showed that Renshen Jianpi Tablets, Renshen Jianpi Pills, Shenling Baizhu Granules, and Buzhong Yiqi Granules all had certain effects on the treatment of FGIDs. Renshen Jianpi Tablets treated FGIDs and persistent diarrhea. Shenling Baizhu Granules treated diarrhea with irritable bowel syndrome and FGIDs. Buzhong Yiqi Granules treated diarrhea with irritable bowel syndrome, FGIDs, and chronic diarrhea in children. Renshen Jianpi Pills treated chronic diarrhea. The four oral CPMs all have certain effects on the treatment of FGIDs and have specific advantages for specific patients. Compared with other CPMs, Renshen Jianpi Tablets have higher clinical universality. However, there are problems such as insufficient clinical research evidence, generally low quality of evidence, lack of comparative analysis among medicines, and lack of academic evaluation. More high-quality clinical research and the economic research should be carried out in the future, so as to provide more evidence for the evaluation of the four CPMs.

Abdominal massage alleviates functional diarrhea in immature rats via modulation of intestinal microbiota and tight junction protein.

Functional diarrhea (FD) is a common type of chronic diarrhea in children. Recurrent diarrhea can negatively impact children's quality of life and raise healthcare costs significantly. However, conventional treatments are ineffective and limited. Moreover, children with chronic conditions have poor medication compliance. Therefore, non-pharmacological and complementary treatments are urgently needed. In China, abdominal massage is widely used to treat diarrhea in children. Numerous clinical studies have verified its usefulness in treating gastrointestinal disorders as well. Nevertheless, its intrinsic mechanisms are still unclear, and the impact of massage direction on treatment effects has received less attention. In our study, we found that FD was not associated with pathogen infection. A dysbiosis of the intestinal microbiota and disruption of the intestinal barrier are most likely to cause FD. Moreover, this study also substantiates that abdominal massage can mitigate functional diarrhea by altering the intestinal microbiota structure and decreasing the number of bacteria that damage intestinal mucosal barriers. The reduction of Ruminococcus_torques_group and Clostridium_innocuum_group at the genus level potentially mediated the beneficial effects of abdominal massage on alleviating diarrhea. Furthermore, massaging from two different directions, clockwise (CW) and counter-clockwise (CCW) massage, would not significantly influence the effect of the massage on intestinal microbiota or tight junction proteins. In summary, abdominal massage is an effective complementary therapy for children suffering from functional diarrhea.

Синдром діареї у дітей і підлітків: особливості патогенетичної терапії

У статті надані сучасні дані щодо синдрому гострої, тривалої і хронічної діареї у дітей, етіології і механізмів розвитку різних типів діареї та їх клінічних проявів. Тривала діарея зазвичай визначається як гостра діарея, що триває більше 7, але менше 14 днів. Останніми роками зменшується тенденція до затягування діареї через поліпшення в лікуванні гострої діареї, і це є ідеальною стратегією щодо запобігання тривалої діареї. Терапія тривалої діареї є більш складною, ніж терапія гострої діареї, бо тривала діарея загрожує формуванням харчових і метаболічних ускладнень. Патогенез тривалої діареї є багатофакторним і фактично заснованим на персистенції пошкодження слизової оболонки через специфічні інфекції, індивідуальні особ­ливості, включаючи дефіцит поживних мікроелементів і/або вітамінів, мальнутриції, високої проникності слизової оболонки через попередні інфекційні процеси та дефіциті поживних речовин з подальшою мальабсорбцією і порушенням з боку мікробіоти. Патогенетична терапія тривалої діареї є комплексною і повинна включати до себе оцінку мікробіома кишечника, оцінку ферментативної функції організму дитини, наявність супутніх функціональних гастроінтестинальних розладів.

Apple diet in the treatment of diarrhea in children

Diet therapy of diarrhea in children in some cases is an extremely difficult task. Knowing the etiological moment, pathogenesis, constitutional properties and condition of the child, we still, especially with chronic diarrhea in children, can not always easily achieve the desired success, and we have to find more and more new ways and means in the fight against the disease.

Chronic Diarrhea in Children

Chronic Diarrhea in Children

Infections and Chronic Diarrhea in Children.

Infections and Chronic Diarrhea in Children.

Chronic Diarrhea in Children: Experience at A Tertiary Hospital of Bangladesh

Background: Chronic diarrhea is insidious onset that persists for 14 days and more, usually of noninfectious origin. Chronic diarrhea in children is not an uncommon problem in our country.
 Objectives: Objective of this study was to evaluate children with chronic diarrhea by clinical-biochemical profile and outcome.
 Methods: It was a retrospective observational study done in the department of paediatric gastroenterology and nutrition, BSMMU. The study was done during January 2017 through December 2018. Forty-five patients diagnosed as chronic diarrhea between the ages of 6 months to 18 years were included in this study. We Clinical, laboratory data and outcome of patients were analyzed.
 Results: Mean age of children was 5.96±2.3 year, 60%(27) were male and 40% (18) were female. Among them under 5 years were 55%(25). All children presented with diarrhea (100%) along with fever (24%), FTT (22%), abdominal pain (20%) and weight loss (20%). About 58% of children had anemia and 14% had hepatomegaly and/or splenomegaly. Raised ESR (40%), leukocytosis (20%), thrombocytosis (16%), raised CRP (13%) and electrolyte imbalance (16%) were observed. Intestinal TB (18%) was the most common etiology of chronic diarrhea. Moreover, chronic constipation with fecal incontinence mimicking diarrhea (11%), IBD (9%), coeliac disease (8%), IBS (7%), HIV enteropathy (4%), primary immunodeficiency disorder (4%) were also found. Improvement of diarrhea was observed in 96% children, 4% patient died due to diarrhea-related complications.
 Conclusion: Chronic diarrhea in children is not uncommon in Bangladesh and diagnosis of etiologies are challenging. Intestinal tuberculosis found to be an important cause of chronic diarrhea in this study. Although in the majority of the cases, etiology could not be identified, some remote etiologies were found on this study, like chronic constipation with fecal incontinence mimicking diarrhea, IBD, HIV enteropathy, primary immunodeficiency.
 DS (Child) H J 2020; 36(1) : 46-51

Chronic Diarrhea in Children Under Five Years Old

Diarrhea is an endemic disease in Indonesia and has the potential to cause outbreaks that are often accompanied by death, even the mortality rate during outbreaks in 2017, amounting to 1.97%, had not yet reached the expected target by the government, which is less than 1%. This study aims to determine the distribution of sex, age, nutritional status based on weight/age, and how to leave the hospital for chronic diarrhea patients and to know the correlation between nutritional status based on weight/age and death cases of chronic diarrhea in children under five years old treated at RSUD Dr. Soetomo in the period 2015-2019. This research was a retrospective analytical and descriptive study using secondary data from a patient's electronic medical record. Results showed that out of 45 chronic diarrhea patients, 28 (62,2%) were male, 16 (35,6%) children were in the 0 - 5 months age group, 18 (40,0%) children had good nutritional status, 39 (86,7%) children were discharged from the hospital, and there was a significant correlation between nutritional status based on weight/age and death cases of chronic diarrhea in children (p = 0,017). It could be concluded that the majority of children with chronic diarrhea were male, were in the 0 - 5 months age group, had good nutritional status, and were discharged from the hospital which meant that their condition had improved or cured and there was a significant correlation between nutritional status based on weight/age with death cases of chronic diarrhea in children.

Chronic diarrhoea in children: A practical algorithm-based approach.

Diarrhoea is a leading cause of morbidity and mortality world-wide. Most diarrhoeal episodes are acute and infectious in origin. Diarrhoea lasting for longer than 4 weeks with no discernible infectious aetiology warrants thorough evaluation. The aim of this review is to elucidate an approach to evaluation of diarrhoea based on its pathophysiologic mechanisms with focus on aetiology, investigation and management of chronic diarrhoea. It includes a brief description of normal fluid homeostasis in the gut and pathophysiology of diarrhoea. Further, diarrhoea is classified as 'watery', 'fatty' and 'bloody' based on stool characteristics. Relevant history, physical examination findings, first and second-line investigations which help in differentiating the different types of diarrhoea are listed and an algorithmic approach to individual types of diarrhoea has been devised. Principles of management and recent advances in diagnostics and therapeutics of diarrhoea are briefly discussed.

The application research of xTAG GPP multiplex PCR in the diagnosis of persistent and chronic diarrhea in children

BackgroundPersistent and chronic diarrhea is difficult to treat, and infection is still the main cause. In this study, we investigate the application value of xTAG gastrointestinal pathogen panel (xTAG GPP) multiplex PCR in the early diagnosis of persistent and chronic diarrhea in children and to understand the epidemiology of intestinal diarrhea pathogens.MethodsOne hundred ninety-nine specimens were collected from Nanjing Children’s Hospital Affiliated to Nanjing Medical University (Nanjing, China). We compared the xTAG GPP multiplex PCR assay with traditional methods (culture, rapid enzyme immunoassay chromatography, and microscopic examination) and performed a statistical analysis.ResultsThe positive rate of the xTAG GPP multiplex PCR assay of diarrhea specimens from 199 patients was 72.86% (145/199). The virus detection rate was 48.7%, and rotavirus A was the most common organism detected (34.67%), concentrated in winter, and was common in children. The second most common organism detected was norovirus GI/GII (20.6%). The positive rate of this bacteria was 40.2%, and Campylobacter (22.11%, 44/199) was most frequently detected. C. difficile toxins A/B and Salmonella was detected in 44 and 17 samples, respectively. Infections with Shigella occurred 4 times, and E. coli O157 was only detected once. Three samples were parasitic (1.51%), two samples were positive for Entamoeba histolytica, and one was positive for Cryptosporidium. Adenovirus 40/41, STEC, ETEC, Giardia, Yersinia enterocolitica and Vibrio cholerae were not detected. In total, 86 (43.2%) infected specimens with a single pathogen were detected. There were 59 coinfections (29.65% of the samples) of viruses and/or bacteria and/or parasites. Coinfections involved 49 double infections (24.62%), 9 triple infections (4.52%) and 1 quadruple infections (0.5%). Norovirus GI/GII was found to have the highest involvement, with 32 coinfections (16.08%).ConclusionThe xTAG GPP multiplex PCR assay is simple, sensitive, and specific and can be used as a quick way to diagnose persistent and chronic diarrhea in children.

A110 DGAT1 MUTATION OF LIPID TRAFFICKING ASSOCIATED WITH A RARE CASE OF CONGENITAL DIARRHEA

Abstract Background Congenital diarrheas and enteropathies (CODEs) are rare and cause severe chronic diarrhea in children under 2 years of age.1 Current genomic research has identified several monogenic defects resulting in epithelial disorders of nutrient and electrolyte transport, enzymes function, metabolism and trafficking. Aims To discuss a rare case of congential diarrhea. Methods Case Report. Results A 10-month-old Ashkenazi Jewish boy was referred to Pediatric Gastroenterology for loose stools and failure to thrive. Born at 27 weeks, he was a NICU inpatient for his first 3 months of life. Explosive loose stools were first noticed after discharge and treated as cow’s milk protein allergy. At aged 10 months he was admitted to his local hospital with irritability, abdominal distension, foul smelling loose stools and developmental delay. Despite an intake of 130kcal/kg/day he failed to gain weight (weight and length < 3rd centile). His abdomen was distended but there was no organomegaly on examination. On transfer to Sick Kids he underwent extensive work up with low albumin 24 g/L but normal CBC, amylase, lipase and IgA and anti-TTG negative. The lipid profile showed hypertriglyceridemia 2.98 mmol/L (normal <0.85), low HDL 0.81 mmol/L but normal total cholesterol. Low apoliprotein A1 0.79 g/L (0.92 - 1.96), low apoliprotein B 0.54 g (0.59 - 1.46) and vitamin E deficiency 9.6 umol/L (14.5 - 33.0). Normal fecal elastase (> 500 ug/g stool). Upper GI endoscopy showed duodenal villi blunting with non-specific chronic inactive duodenitis on histopathology. Due to ongoing poor weight gain he commenced TPN. A repeat endoscopy four weeks after admission revealed patchy villous blunting, crypt hyperplasia and enterocyte vacuolization. However, ultrastructural electron microscopy examination showed normal enterocyte brush border with well-formed microvilli with no inclusions or vesicular bodies. With a differential diagnosis of chylomicron retention disorder, abetalipoproteinemia or hypolipoproteinemia he was commenced on a low-fat diet with MCT feeds. A 72-hour fecal fat collection on this diet was within normal range 5.4 mmol/day (2–7). One year later his weight is now on 3rd centile and his albumin levels have normalized. However, triglycerides remain elevated. Whole exome sequencing identified two pathogenic variants in the DGAT1 gene; c.629_631delCCT, pSer210del and c751 + 2T>C, IVSB+2T>C. Conclusions Diacylglycerol acyltransferase (DGAT)1 catalyzes triglyceride biosynthesis.2 Loss of function DGAT1 gene mutations are described in several cases studies3,4 characterized by electrolyte transport–related diarrhea, protein-losing enteropathy and growth failure. Our cases adds to the understanding of the phenotypic and histological spectrum of DGAT1 mutations. Management strategies currently focus on growth with dietary lipid restriction, while substituting fat-soluble vitamins and essential fatty acids. Funding Agencies CAG

Chronic Diarrhea in Children: Causes, Mechanisms, Primary Diagnostics and Management

The chronic diarrhea is pretty relevant problem in children due to its incidence, wide range of causes, heterogeneity of pathogenetic mechanisms and clinical manifestations. Meantime there is no common algorithm for screening of such patients with chronic diarrhea. This usually aggravates the diagnosis, timely treatment, and finally decreases patient quality of life. This review provides updated data on etiology, pathogenesis, clinical manifestations and diagnostic approaches of chronic diarrhea in children. Issues of structure and management of different diseases manifested in children with chronic diarrhea are considered.