Abstract
Congenital diarrhea and enteropathies (CODEs) are monogenic disorders causing early onset of intractable diarrhea. Their diagnosis and management are challenging. With the availability of commercial next generation genetic testing, we are now better able to classify and manage these disorders. The authors present their experience with 4 cases. Two patients had congenital tufting enteropathy (CTE) and 1 case each of microvillous inclusion disease (MVID) and trichohepatoenteric syndrome (THES). Age at onset varied from 3 to 38 d of life. Light microscopy and electron microscopy of duodenal and rectal endoscopic biopsies were consistent with the diagnosis. Genetic evaluation was possible in 3 cases indicating causative mutations. Two children (CTE and MVID) were alive at last follow-up. The authors suggest a stepwise approach to the diagnosis and management of these disorders in the Indian context.
References
Thiagarajah JR, Kamin DS, Acra S, et al. Advances in evaluation of chronic diarrhea in infants. Gastroenterology. 2018;154:2045-59.
Sivagnanam M, Mueller JL, Lee H, et al. Identification of EpCAM as the gene for congenital tufting enteropathy. Gastroenterology. 2008;135:429–37.
Schnell U, Cirulli V, Giepmans BNG. EpCAM: Structure and function in health and disease. Biochim Biophys Acta. 2013;1828:1989–2001.
Phillips AD, Schmitz J. Familial microvillous atrophy: a clinicopathological survey of 23 cases. J Pediatr Gastroenterol Nutr. 1992;14:380–96.
Fernández Caamaño B, Quiles Blanco MJ, Fernández Tomé L, et al. Intestinal failure and transplantation in microvillous inclusion disease. An Pediatr (Barc). 2015;83:160–5.
Perry A, Bensallah H, Martinez-Vinson C, et al. Microvillous atrophy: atypical presentations. J Pediatr Gastroenterol Nutr. 2014;59:779–85.
Stankler L, Lloyd D, Pollitt RJ, Gray ES, Thom H, Russell G. Unexplained diarrhoea and failure to thrive in 2 siblings with unusual facies and abnormal scalp hair shafts: a new syndrome. Arch Dis Child. 1982;57:212–6.
Goulet O, Vinson C, Roquelaure B, Brousse N, Bodemer C, Cézard JP. Syndromic (phenotypic) diarrhea in early infancy. Orphanet J Rare Dis. 2008;3:6.
Hartley JL, Zachos NC, Dawood B, et al. Mutations in TTC37 cause trichohepatoenteric syndrome (phenotypic diarrhea of infancy). Gastroenterology. 2010;1:2388–98.
Fabre A, Bourgeois P, Chaix C, Bertaux K, Goulet O, Badens C. Trichohepatoenteric Syndrome. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, editors. GeneReviews®. Seattle (WA): University of Washington, Seattle. 1993.
Author information
Authors and Affiliations
Contributions
RM conceived the study, supervised collection of data and edited the manuscript, made figures and charts; MRM and PC collected the data, reviewed the literature and wrote the manuscript; PD, RY and TN conducted and reported on the histopathology and electron microscopy findings of tissue samples from these patients, provided histological details and photomicrographs for the manuscript, and reviewed/corrected the manuscript. RM is the guarantor of this paper.
Corresponding author
Ethics declarations
Ethical Clearance
Ref No. IEC-804/07.08.20 Dated 8.08.2020.
Conflict of Interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Mantoo, M.R., Malik, R., Das, P. et al. Congenital Diarrhea and Enteropathies in Infants: Approach to Diagnosis. Indian J Pediatr 88, 1135–1138 (2021). https://doi.org/10.1007/s12098-021-03844-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-021-03844-z