Abstract
Important inroads are being made into understanding the pathophysiology of diarrhea. Clear understanding of key mechanisms should suggest new approaches to combat disease. Exciting developments are occurring in terms of super-ORS solutions, particularly with the promise of short chained glucose polymers and glutamine. Perhaps the most important development is the prospect of a good rotavirus vaccine being available before the end of the decade.
Chronic diarrhea seems to be on the increase globally, probably because of the success of ORS. The mechanisms that lead to mucosal injury are elusive, and therapy still largely supportive and empiric. Celiac disease continues to be a puzzle, because of the uncomfortable feeling that a majority of cases may be missed because of atypical presentations. The successful use of long term parenteral nutrition has allowed survival and better charaterization of cases that otherwise would have perished as ‘lethal protracted diarrhea’. Microvillus inclusion disease may be the commonest congenital secretory diarrhea. The role of the recently reported high prevalence of glucoamlase deficiency may be important. Lastly, attention to micronutrients, particularly low vitamin A and probably zinc may prove to be important in prevention and amelioration of diarrhea and growth failure.
Similar content being viewed by others
References
Lima AA, Guerrant RL. Persistent diarrhea in children: epidemiology, risk factors, pathophysiology, nutritional impact and management.Epidemiol Rev 1992; 14: 222–242.
McGowan K, Guerma V, Wicks J, Donowitz M. Secretory hormones of entamoeba hystiolytica In:Microbial Toxins and Diarrheal Disease. Pitman, London 1985 pp. 139–155.
Sartor RB, Powell DW. Mechanisms of diarrhea in intestinal inflammation and hypersensitivity: immune system modulation of intestinal transport. In:Diarrheal Diseases. Ed., Field M, Elsevier Science Publishing Co., Inc., New York 1991, pp. 75–114.
Lifshitz F, Ament ME, Kleinman REet al. Role of juice carbohydrate malabsorption in chronic nonspecific diarrhea in children.J. Pediatr 1992; 120: 825–829.
Kotloff KL, Losonsky GA, Morris GAet al. Enteric adenovirus infection in childhood diarrhea: an epidemiologic study in three clinical settings.Pediatrics 1989; 84: 219–225.
Mistchenko AS, Huberman KH, Gomez JA, Grinstein S. Epidemiology of enteric adenovirus infection in prospectively monitored Argentine families.Epidemiol Int 1992; 109: 539–546.
Yolken R, Dubovi E, Leisteret al. Infantile gastro-enteritis associated with excretion of pestivirus antigens.Lancet 1989; 1: 517–520.
Heise C, Dandekar Set al. Human immunodeficiency virus infection of enterocytes and mononuclear cells in human jejunal mucosa.Gastroenterology 1991; 100: 1521–1527.
Kotler DP, Francisco Aet al. Small intestinal injury and parasitic infection in AIDS.Ann Int Med 1990; 113: 444–449.
Gazzard BG. Diarrhea in Human Immunodeficiency Virus antibody-positive patients.Semin Liver Dis 1992; 12: 154–166.
Ullrich R, Riecken EO, Zeitz M. AIDS enteropathy (letter).Ann Int Med 1991; 115: 328.
Pavia AT, Long EG, Ryder RW,et al. Diarrhea among African children born to HIV-1 infected mothers: clinical, microbiological and epidemiologic features.Pediatr Inf Dis J 1992; 11: 996–1003.
Levine MM. E. coli that causes diarrhea: enterotoxigenic, enteropathogenic, enteroinvasive, enterohemorrhagic and enteroadherent.J Infect Dis 1987; 155: 377–389.
Gluskin I, Batas D, Shoseyov Det al. A 15-year study of the role of Aeromonas spp. in gastro-enteritis in hospitalized children.J Med Microbiol 1992; 37: 315–318.
Challipalli M, Tess BT, Cunningham DG, Chopra AK, Houston CW. Aeromonas-associated diarrhea in children.Pediatr Infect Dis 1988; 7: 693–698.
Burke V, Gracey M. Bacterial Diarrheas. In:Diarrhea. Ed., Gracey M, CRC Press, Boca Raton, 1991; pp. 48–50.
Pickering LK. Bacteria and parasitic enteropathogens in day care.Semin Pediatr Infect Dis 1990; 1: 263–269.
Ungar BLP, Ward DS, Fayer Ret al. Cessation of Cryptosporidium associated diarrhea in an AIDS patient after treatment with hyperimmune bovine colostrum.Gastroenterology 1990; 98: 486–489.
Sullivan PB, Marsh MN, Mirakian Ret al. Chronic diarrhea and malnutrition-histology of the small intestinal lesion.J Pediatr Gastroenterol Nutr 1991; 12: 195–203.
Roy SK, Behrens RH, Haider Ret al. Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhea and persistent diarrhea syndrome.J Pediatr Gastroenterol Nutr 1992; 15: 289–296.
Arrieta AC, Zaleska M, Stutman HRet al. Vitamin A levels in children with measles in Long Beac, California.J Pediatr 1992; 121: 75–78.
Fekety R. Antibiotic-associated diarrhea. In: Field M (ed):Current Topics in Gastroenterology: Diarrheal Diseases. New York, Elsevier, 1991, pp 293–318.
Snyder JD. Dietary protein sensitivity: is it an important risk factor for persistent diarrhea?Acta Paediatrica 1992; 81: 78–81.
Ament ME. Gastrointestinal manifestations of food protein sensitivity (allergy). In: Balistreri WF, Vanderhoof JA (eds):Pediatric Gastroenterology and Nutrition.London, Chapman and Hall, 1990, pp 57–75.
Ferguson A, Arranz E, O'Mahony S. Clinical and pathological spectrum of celiac disease-active, silent, latent, potential.Gut 1993; 34: 150–151.
Holmes GKT, Prior P, Lane MRet al. Malignancy in coeliac disease-effect of a gluten free diet.Gut 1989; 30: 333–338.
Marsh MN. Gluten sensitivity and latency: Can patterns of intestinal antibody secretion define the great'silent majority'?Gastroenterology 1993; 104: 1550–1554.
Collin P, Halstrom O, Maki Met al. Atypical coeliac disease found with serologic screening.Scand J Gastroenterol 1990; 25: 245–50.
Fine KD, Fordtran JS. The effect of diarrhea on fecal fat excretion.Gastroenterology 1992; 102: 1936–1939.
Lifshitz F, Ament ME, Kleinman RE,et al. Role of juice carbohydrate malabsorption in chronic non-specific diarrhea of children.Pediatrics 1992; 120: 825–829.
Phillips AD, Schmitz J. Familial microvillous atrophy, a clinicopathological survey of 23 cases.J Pediatr Gastroenterol Nutr 1992; 14: 380–396.
Holmberg C. Congenital chloride diarrhea.Clin Gastroenterol 1986; 15: 583–602.
Keller KM, With S, Baumann Wet al. Defective jejunal brush border membrane sodium/proton exchange in association with lethal familial protracted diarrhea.Gut 1990; 31: 1156–1158.
Turk E, Zabel B, Mundlos Set al. Glucose galactose malabsorption caused by a defect in the sodium/glucose cotransporter.Nature 1991; 350: 354–356.
Naim HY, Roth J, Sterchi EEet al. Sucrase-isomaltase deficiency in humans: different mutations disrupt intracellular transport, processing, and function of an intestinal brush border enzyme.J Clin Invest 1988; 82: 667–679.
Santer R, Lebenthal E. Secretory diarrhea in infancy and childhood. In: Lebenthal E, Duffey ME (eds):Textbook of secretory diarrhea. New York, Raven Press, 1990, pp 337–353.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mehta, D.I., Lebenthal, E. & Blecker, U. Chronic diarrhea: Causes, presentation, and mangement. Indian J Pediatr 63, 459–471 (1996). https://doi.org/10.1007/BF02905720
Issue Date:
DOI: https://doi.org/10.1007/BF02905720