Indian Pediatrics

, Volume 48, Issue 1, pp 37–42

Chronic and persistent diarrhea in infants and young children: Status statement

  • Pediatric Gastroenterology Chapter, Indian Academy of Pediatrics
  • John Matthai
Consensus Review

Abstract

Justification

Diarrhea that lasts for more than two weeks is a common cause of mortality and morbidity in infants and children. There is a need to update the information available on this subject in Indian context.

Process

This review has analyzed the available published data on the subject with particular focus on developing countries. It has also outlined the current diagnostic and management practices in India based on the experience of the participants from major hospitals in different parts of the country.

Objectives

Problem areas in both persistent and chronic diarrhea have been identified and remedial measures relevant to India are presented.

Recommendations

Micronutrient supplementation, algorithm based diet regimens, and good supportive care are sufficient in most children above 6 months of age with persistent diarrhea. Paucity of diagnostic facilities limits evaluation of chronic diarrhea in most parts of the country and regional laboratories need to be set up urgently. Lack of awareness regarding cow’s milk protein allergy, celiac disease and immunodeficiency associated diarrhea is of particular concern.

Key words

Chronic diarrhea Consensus Malabsorption Malnutrition Persistent diarrhea 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Memorandum from a WHO meeting. Persistent diarrhea in children in developing countries. Bull WHO. 1988;66:709–717.Google Scholar
  2. 2.
    Bhan M K, Bhandari N, Sazawal S, Clemens J, Raj P, Levine MM, et al. Longitudinal study of diarrhoeal disease among young children in rural north India. Bull WHO. 1989;67:281–288.PubMedGoogle Scholar
  3. 3.
    Schorling JB, Wanke CA, Schorlling SK, McAullife JF, de Souza MA, Guerrat RL. A prospective study of persistent diarrhea among children in an urban Brazilian slum: patterns of occurrence and etiologic agents. Am J Epidemiol. 1990;132:144–156.PubMedGoogle Scholar
  4. 4.
    Fauveau V, Henry FJ, Briend A, Yunus M, Chakraborty J. Persistent diarrhea as a cause of childhood mortality in rural Bangladesh. Acta Paediatr Suppl. 1992;381:12–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Alam S, Admed SH, Lamba LMS. Clinical profile of persistent diarrhea in a DTTU. Indian Pediatr. 1997;34:631–635.PubMedGoogle Scholar
  6. 6.
    Mittal SK. Chronic Diarrhea in tropics. Indian J Pediatr. 1999;66:S4–S15.PubMedGoogle Scholar
  7. 7.
    Ahmed F, Ansaruzzaman M, Haque E, Rao MR, Clemens JD. Epidemiology of post shigellosis persistent diarrhea in young children. Pediatr Infect Dis J. 2001;20:525–530.PubMedGoogle Scholar
  8. 8.
    Fauveau V, Henry FJ, Briend A, Yunus M, Chakraborty J. Persistent diarrhea as a cause of childhood mortality in rural Bangladesh. Acta Paediatr. 1992;381:S 12–14.CrossRefGoogle Scholar
  9. 9.
    Sullivan PB. Studies of the small intestine in persistent diarrhea and malnutrition: the Gambian experience. J Pediatr Gastroenterol Nutr. 2002;34:S11–S13.PubMedCrossRefGoogle Scholar
  10. 10.
    Sazawal S, Black RE, Bhan MK, Bhandari N, Sinha A, Jalla S. Zinc supplementation in young children with acute diarrhea in India. N Engl J Med. 1995;333:839–844.PubMedCrossRefGoogle Scholar
  11. 11.
    Baqui AH, Black RE, Sack RB, Chowdhury HR, Yunus M, Siddique AK. Malnutrition, cell-mediated immune deficiency and diarrhea: a community-based longitudinal study in rural Bangladeshi children. Am J Epidemiol. 1993;137:355–365.PubMedGoogle Scholar
  12. 12.
    Taniguchi K, Rikimaru T, Yartey JE, Akpedonu, P, Armar-Klemesu MA, Nkrumah FK, et al. Immunological background in children with persistent diarrhea in Ghana. Pediatr Int. 1999;4:162–167.CrossRefGoogle Scholar
  13. 13.
    Adejuyigbe EA, Oyelami O, Onayemi O, Durosinmi MA. Paediatric HIV/AIDS in Ile-Ife, Nigeria. Cent Afr J Med. 2003;49:74–78.PubMedGoogle Scholar
  14. 14.
    Amadi B, Kelly P, Mwiya M, Mulwazi E, Sianongo S, Changwe F, et al. Intestinal and systemic infection, HIV, and mortality in Zambian children with persistent diarrhea and malnutrition. J Pediatr Gastroenterol Nutr. 2001;32:550–554.PubMedCrossRefGoogle Scholar
  15. 15.
    Bhutta ZA, Hendricks KH. Nutritional management of persistent diarrhea in childhood: a perspective from the developing world. J Pediatr Gastroenterol Nutr. 1996;22:17–37.PubMedCrossRefGoogle Scholar
  16. 16.
    Bhan MK, Bhandari N, Bhatnagar S, Bahl R. Epidemiology and management of persistent diarrhoea in children of developing countries. Indian J Med Res. 1996;104:103–114.PubMedGoogle Scholar
  17. 17.
    International Working Group on Persistent Diarrhoea. Evaluation of an algorithm for the treatment of persistent diarrhoea: a multicentre study. Bull World Health Organ. 1996;74:479–489.Google Scholar
  18. 18.
    Bhandari N, Bahl R, Saxena M, Taneja S, Bhan MK. Prognostic factors for persistent diarrhea managed in a community setting. Indian J Pediatr. 2000;67: 739–745.PubMedCrossRefGoogle Scholar
  19. 19.
    Sarker SA, Mahalanabis D, Alam NH, Sharmin S, Khan AM, Fuchs GJ. Reduced osmolarity oral rehydration solution for persistent diarrhea in infants: a randomized controlled clinical trial. J Pediatr. 2001;138:532–538.PubMedCrossRefGoogle Scholar
  20. 20.
    Dutta P, Mitra U, Dutta S, Manna B, Chatterjee MK, De A, et al. Hypo-osmolar oral rehydration salts solution in dehydrating persistent diarrhoea in children: double-blind, randomized, controlled clinical trial. Acta Paediatr. 2000;89:411–416.PubMedCrossRefGoogle Scholar
  21. 21.
    Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A, et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000;72:1516–1522.PubMedGoogle Scholar
  22. 22.
    Bhatanagar S, Bhan MK, Singh KD, Srivastav R. Prognostic factors in hospitalized children with persistent diarrhea: Implications for diet therapy. J Pediatr Gastroenterol Nutr. 1996;23:151–158.CrossRefGoogle Scholar
  23. 23.
    Sheth M, Obrah M. Diarrhea prevention through food safety education. Indian J Pediatr. 2004;71:879–882.PubMedCrossRefGoogle Scholar
  24. 24.
    Ganesh R, Suresh N, Sathiasekharan M. Celiac disease, still an uncommon problem in Tamilians? Indian J Gastroenterol. 2009;28:189.PubMedCrossRefGoogle Scholar
  25. 25.
    Yachha SK, Misra S, Malik A K, Nagi B, Mehta S. Spectrum of malabsorption in North Indian children. Indian J Gastroenterol. 1993;12:120–125.PubMedGoogle Scholar
  26. 26.
    Yachha SK, Poddar U. Celiac disease in India. Indian J Gastroenterol. 2007;26:230–237.PubMedGoogle Scholar
  27. 27.
    Poddar U, Yachha SK, Krishnani N, Srivastava A. Cow’s milk protein allergy (CMPA): an entity for recognition in children in developing countries. J Gastroenterol Hepatol. 2010;25:178–182.PubMedCrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2011

Authors and Affiliations

  • Pediatric Gastroenterology Chapter, Indian Academy of Pediatrics
  • John Matthai
    • 1
  1. 1.Department of PediatricsPSG Institute of Medical SciencesPeelamedu, CoimbatoreIndia

Personalised recommendations