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Persistent Diarrhea in Children in Developing Countries

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Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

Abstract

Persistent diarrhea continues to pose enormous challenges globally. With the substantial overall reduction in childhood mortality from acute diarrhea, the share of mortality due to persistent diarrhea is rising. It is therefore more important now to know how best to define, diagnose, triage, and treat persistent diarrhea. As the duration of illness lengthens, malnutrition becomes increasingly manifest and this relationship is bidirectional. Many, but not all, episodes of persistent diarrhea are infectious in origin, and the responsible organisms depend on endemicity. A few common pathogens have been particularly associated with persistent diarrhea, including bacteria (Aeromonas, Campylobacter, Clostridium difficile, Escherichia coli, Plesiomonas, Salmonella, Shigella), parasites (Cryptosporidium, Cyclospora, Entamoeba histolytica, Giardia, Microsporidia), and viruses (rotavirus, norovirus). Treatment is focused on reversing dehydration (if present), nutritional interventions including balanced protein energy and micronutrient supplements, pancreatic enzyme replacement therapy (PERT), and judicious use of antibiotics for certain types of inflammatory diarrhea. Strategies should also be directed toward preventing concurrent infections and identifying optimal diets to prevent persistent diarrhea. Multidisciplinary research into the epidemiology, host response, etiology, and treatment of persistent diarrhea is needed.

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Authors and Affiliations

  1. Division of Women and Child Health, Aga Khan University, Karachi, Pakistan

    Jai K. Das & Zahra Ali Padhani

  2. Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Zulfiqar A. Bhutta

  3. Division of Woman and Child Health, Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan

    Zulfiqar A. Bhutta

  4. Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning (PGCRL), Toronto, ON, Canada

    Zulfiqar A. Bhutta

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  1. Jai K. Das
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Correspondence to Zulfiqar A. Bhutta .

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  1. Section of Pediatric Gastroenterology Hepatology and Nutrition, University of Chicago, Chicago, IL, USA

    Stefano Guandalini

  2. Pediatric Liver, GI and Nutrition Center, Child Health, King’s College Hospital, London, UK

    Anil Dhawan

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Das, J.K., Padhani, Z.A., Bhutta, Z.A. (2022). Persistent Diarrhea in Children in Developing Countries. In: Guandalini, S., Dhawan, A. (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-030-80068-0_17

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