NNIW06 - Chronic Diarrhea In Children

Editor(s): E. Lebenthal. vol. 06


Introduction Devastating Effects Of Chronic Diarrhea In Childhood

Author(s): E. Lebenthal

A survey conducted by the Programme for Control of Diarrhoeal Diseases(World Health Organization, August 1983) has indicated that in 1980 close to1 billion episodes of acute diarrhea occurred in children under 5 years of agein underdeveloped and developing countries.

Prolonged Small Intestinal Mucosal Injury As A Primary Cause Of Intractable Diarrhea Of Infancy

Author(s): E. Lebenthal

Prolonged or intermittent diarrhea early in life has been shown to be one ofthe main causes of infant death in the developing countries.

Damage And Repair Of Small Intestinal Mucosa In Acute And Chronic Diarrhea

Author(s): O. Brunser, M. Araya

Damage to the mucosa of the digestive tract frequently results in diarrhea.The variety of etiologies leading to this situation is so great that of necessity wefocus this discussion only on a limited number of examples.

Ultrastructural Topography Of Small Bowel Mucosa In Chronic Diarrhea In Infants And Children: Investigations With The Scanning Electron Microscope

Author(s): J. Rainer Poley

The term "ultrastructural topography," or topographic histology, is relativelynew. It has been introduced into the medical literature to mark a new dimensionfor the study of tissue surfaces by the scanning electron microscope.

Specific Etiologies Of Chronic Diarrhea In Infancy

Author(s): D. Branski

Diarrhea is one of the most common symptoms of illness in pediatric practice.It usually appears in the form of acute diarrhea, but it may also progress to achronic state.

Transient Carbohydrate Malabsorption And Intolerance In Diarrheal Diseases Of Infancy

Author(s): P.C. Lee

Carbohydrate intolerance has been shown to be common during and immediatelyfollowing an episode of diarrhea, particularly in infancy and childhood.When these infants and children are maintained on diets with high concentrationsof a specific carbohydrate or class of carbohydrates, the symptoms will continueand often increase in severity.

Net Acid Balance In Infants With Diarrhea And Carbohydrate Intolerance

Author(s): F.R. Carrazza, G.S. Gopalakrishna, G. Sperotto, B.L. Nichols

The most common acid-base disturbance in dehydrated infants with diarrheais a hyperchloremic metabolic acidosis resulting from the loss of intestinal bicarbonateby two different mechanisms: (a) loss into the stool and (b) bufferingby organic acids (OA) produced within the colonic lumen by bacterial fermentationof undigested food.

Peptide Digestion And Absorption In The Small Intestinal Mucosa During Acute And Chronic Diarrhea

Author(s): S. Auricchio

Before dietary protein or endogenous protein of the alimentary tract can beassimilated, it must be hydrolyzed by intraluminal digestive processes into smallpeptides and free amino acids. Borgstrom et al.

Nutrient Absorption In The Developing Colon

Author(s): G.D. Potter, R. Lester

The function of the adult colon has been well denned and thoroughly studiedand includes the transport of salt and water from the colonic lumen to thecirculation in a process that is responsive to aldosterone (1-3) and contributesa large portion of normal body salt and water conservation.

Nutritional Therapy Of Chronic Diarrhea

Author(s): J.R. Hamilton

Before one considers active nutritional therapy for a global problem as devastatingand massive as chronic infant diarrhea, one should consider the preventiveaspects of nutritional care. The favorable impact of breast-feeding onthe incidence and course of diarrheal disease has been rediscovered and reaffirmedin most parts of the world.

Stable Isotope Studies Of Normal And Abnormal Digestion And Absorption In Infants

Author(s): B.L. Nichols, R.J. Shulman, C.H. Lifschitz, P.D. Klein

This chapter describes the use of stable isotopes for the investigation of normaland abnormal digestion and absorption in infants. Isotopes are atoms with equalnumbers of protons but different numbers of neutrons.

Catch-Up Growth In Malnourished Children

Author(s): R.N. Varma, L.L. Suskind, O. Thanangkul, R.M. Suskind

Body weight and height (length) are important anthropometric indices of thenutritional status of children. From the fact that nearly 100 million childrenunder 5 years of age throughout the world suffer from varying degrees of proteinenergymalnutrition (PEM) (1),

The Intestinal Microflora In Malnutrition And Protracted Diarrhea In Infancy

Author(s): M. Gracey

The gastrointestinal tract has a unique place in human ecology. After birthit is continually exposed to potentially harmful external agents—infective, toxic,and antigenic.

Infectious Agents In Acute And Chronic Diarrhea Of Childhood

Author(s): L. Mata, J.J. Urrutia, A. Simhon

Even today acute diarrheal disease is thought of by many laymen as well asby some medical professionals in developing countries as being a syndrome ofalimentary origin.

Giardiasis: Pathogenesis Of Chronic Diarrhea And Impact On Child Growth And Development

Author(s): M.J.G. Farthing

In a letter to the Royal Society (London) dated November 4, 1681, Antonyvan Leeuwenhoek gave what seems to be the first account of the human intestinalprotozoan pathogen Giardia lamblia (1).

Viral Enteritis: A Cause Of Disordered Small Intestinal Epithelial Renewal

Author(s): J.R. Hamilton

In the past decade, human rotavirus (HRV) enteritis has been identified asthe most common cause of significant acute diarrheal illness among infants andyoung children (1,2).

Dietary Lectins And The Possible Mechanisms Whereby They Induce Intestinal Injury

Author(s): M.M. Weiser

Diarrhea of infancy and early childhood has many causes, including viraland bacterial infection. In some of these conditions the intestine may demonstratefew if any histological changes (e.g., cholera) or may show profound alterations(e.g., Salmonella, reovirus, etc.).

The Role Of Hormones In The Pathophysiology Of Acute And Chronic Diarrhea

Author(s): A. Aynsley-Green, S.R. Bloom

It has been estimated that between 5 and 20 million children die each yearas a result of acute and chronic diarrhea. The investigation of the pathogenesisand treatment of this major clinical problem is, therefore, of special importance,representing one of the most important challenges to medicine in the last decadesof this century.

Regulatory Mechanisms Of Secretory Diarrhea And Electrolyte Imbalance In Acute And Chronic Diarrhea In Infancy

Author(s): I.W. Booth, J.T. Harries

Until relatively recently the small intestine was considered to be largely anorgan for the absorption of water and solutes. Over the past decade, however,evidence has accumulated that it is capable of marked secretion of water andelectrolytes, and this chapter summarizes some of the important advances thathave occurred in our understanding of the mechanisms of the small intestinethat regulate this secretion.

Mechanisms Of Secretory Diarrhea Caused By Bacterial Enterotoxins

Author(s): A. Rubino, S. Guandalini

Among the various factors that are known to initiate the pathophysiologicalevents leading to chronic, intractable diarrhea of infancy are intestinal infectionsby bacteria. Such infections, furthermore, are particularly worrisome in malnourishedinfants, where they tend to result more often in protracted diarrheanecessitating vigorous and risk-laden supportive treatment.

Mechanisms Of Adherence Of Escherichia Coli To Enterocytes: Their Possible Role In Intractable Infant Diarrhea

Author(s): E.C. Boedeker

Although the classical definition of intractable diarrhea of infancy (1), whichincludes three or more stools negative for bacterial pathogens, would tend toexclude a role for enteric infection in the pathogenesis of this form of diarrhealdisease, a role for pathogenic E. coli may remain.

Bile-Acid-Induced Intestinal Dysfunction: Implications To Protracted Infantile Diarrhea And Malnutrition

Author(s): W.F. Balistreri

The pharmacologic effect of exogenous bile acids as cathartic agents is wellknown. Early formulations used as purgatives took advantage of the laxativeeffect of bile acids through administration of bile enemas or orally administereddesiccated ox bile.

Atypical Bile Acids And Their Possible Role In Neonatal Diarrhea

Author(s): R. Lester, J.M. Little, E.W. Adcock

Bile acids are both acted on by the gut and act on the gut. Bile acids undergoan enterohepatic circulation and are absorbed by specific mechanisms for bileacid transport in the ileum (1). At the same time, bile acids influence salt andwater transport in the intestine (2).

The Possible Role Of Effector Cells On The Intestinal Mucosa And Gastrointestinal Host Defenses In Intractable Diarrhea

Author(s): M.R. McDermott, A. Dean Befus, J. Bienenstock

The defense of the gastrointestinal (GI) tract against potentially harmful organismsrequires the concerted and integrated functions of diverse host defensemechanisms, both physiologic and immunologic.

The Fate Of Foreign Antigens In The Intestinal Tract In Infancy And Childhood

Author(s): S. Freier, E. Lebenthal, J. Faber

The gastrointestinal tract encounters a greater amount of foreign antigen thanany other mucosal surface of the body.

New Approaches To Antidiarrheal Therapy

Author(s): H.J. Binder

Recent studies of the pathophysiology of diarrhea have resulted in both increasedunderstanding of how existing antidiarrheal drugs work and a rationalapproach to the development of new antidiarrheal therapies.

Electrolyte Therapy In Acute And Chronic Diarrhea

Author(s): I. W. Booth and J. T. Harries

Worldwide, the impact of acute diarrheal disease is immense and is particularlyimportant in infants and young children. It has been estimated that each childexperiences six to eight episodes of diarrhea per year in developing countries(1) and that this represents an annual mortality of up to 18 million childrenunder 5 in those countries (2).

Antibiotic And Antiparasitic Therapy In Chronic Diarrhea

Author(s): M. Gracey

Chronic and recurrent diarrheal illnesses are common in malnourished populations,particularly in young children, and contribute significantly to malabsorptionand undernutrition.

Protein Intolerance As A Cause Of Postenteritis Diarrhea

Author(s): J. A. Walker-Smith, H. Nazer, P. Manuel, D. Jackson, A. D. Phillips, P. Soeparto

Protein intolerance in this study is denned in terms of food protein damagingthe small intestinal mucosa and so resulting in chronic diarrhea.

Gastrointestinal Allergy Or Intolerance To Multiple Foods In Severe Chronic Diarrhea In Early Infancy

Author(s): S. Auricchio, S. Cucchiara, A. M. D'Antonio, G. De Ritis, B. De Vizia, D. Folio, E. Iaccarino

When total parenteral nutrition was first used in the therapy of infants withintractable diarrhea as defined by Avery et al. (1), it was clearly demonstratedthat many of these patients had gastrointestinal allergy or intolerance to foodcomponents (2-6).

Effects Of Pharmacological Agents On Nonelectrolyte Nutrients And Ion Transport In Secretory Diarrhea

Author(s): A. Rubino, S. Guandalini

The present-day concepts on the pathophysiology of secretory diarrhea (1)have opened a new stage in the pharmacological treatment of diarrhea in children.Drugs used in the past as antidiarrheal agents and believed to act only onintestinal motility are now being viewed as antisecretory compounds, and theirantidiarrheal action is being attributed, at least partially, to their action on thefluxes of ions and water in the intestine.

Vaccines And Other Approaches To The Prevention Of Intractable Infant Diarrhea By The Prevention Of Intestinal Colonization

Author(s): E.C. Boedeker

In developing preventive measures and treatments for intractable infant diarrhea,one must first have an understanding of the etiology of these diseases. Itis a reasonable hypothesis, although one not yet proven, that these illnesses areinduced by the establishment of chronic colonization of the small intestine byenteric bacterial pathogens and that this colonization leads to a pattern of chronicand continuing mucosal injury.

Protocol Design: Assessment Of Nutritional Status To Help In Nutritional Rehabilitation Of The Infant

Author(s): B. J. Schmidt

The situations that lead to malnutrition are not only numerous but oftenmultiple and simultaneous.

Feeding Of Children With Protracted Diarrhea In Developing Countries

Author(s): A.M. O'Donnell, M. Orsi

Acute infectious diarrhea with dehydration is among the two main causes ofinfantile morbidity and mortality in less developed countries. The complexetiology of childhood diarrhea and its close relationship with environmentalconditions and nutritional status must be stressed in designing and evaluatingpossible treatments.

Requirements And Utilization Of Macronutrients In Enteral And Parenteral Nutrition In Acute And Chronic Diarrhea

Author(s): T. Heim

In most infants and children, the symptoms of acute diarrhea resolve overthe course of a few days, but in a small proportion, diarrhea persists and becomesprotracted. Protracted diarrhea has been denned as more than four watery stoolsper day for longer than 2 weeks.