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Other Causes of Chronic Diarrhea in Children

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Abstract

Chronic diarrhea is still an important cause of morbidity and mortality in children. There are several causes of chronic diarrhea which may be due to intestinal, extra-intestinal or underlying systemic diseases. The etiology varies depending on the age of onset and may include both common and uncommon disorders. In this article some of the uncommon disorders such as immune deficiencies, intestinal lymphangiectasias, drug induced diarrhea, eosinophilic gastrointestinal disorders, endocrinopathies, neuroendocrine secretory tumors, malignancy and factitious diarrhea have been included. Though these disorders are uncommon it is essential that they are considered in select situations as detailed below and evaluated so that definitive therapy may be offered.

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References

  1. Suri D, Rawat A, Singh S. X-linked agammaglobulinemia. Indian J Pediatr. 2016;83:331–7.

    Article  PubMed  Google Scholar 

  2. Agarwal S, Cunningham-Rundles C. Gastrointestinal manifestations and complications of primary immunodeficiency disorders. Immunol Allergy Clin North Am. 2019;39:81–94.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dunn CP, de la Morena MT. X-linked hyper IgM syndrome. In: Adam MP, Everman DB, Mirzaa GM et al., eds. GeneReviews® [Internet]. 2007 May 31 [Updated 2020 Feb 20]. Seattle (WA): University of Washington, Seattle; 1993–2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK1402/.

  4. Reda SM. Gastrointestinal manifestations in children with primary immunodeficiency diseases. Egypt J Pediatr Allergy Immunol. 2017;15:3–8.

    Article  Google Scholar 

  5. Cagil Y, Tong E, Guimaraes C, et al. Stemming the tide of gastrointestinal chronic granulomatous disease. Dig Dis Sci. 2022;67:2809–12.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chiesa R, Wang J, Blok HJ, et al. Hematopoietic cell transplantation in chronic granulomatous disease: a study of 712 children and adults. Blood. 2020;136:1201–11.

    Article  PubMed  Google Scholar 

  7. Yu H-H, Yang Y-H, Chiang B-L. Chronic granulomatous disease: a comprehensive review. Clin Rev Allergy Immunol. 2021;61:101–13.

    Article  CAS  PubMed  Google Scholar 

  8. Manual on Paediatric HIV Care and Treatment for District Hospitals. Addendum to the Pocket Book of Hospital Care of Children. Geneva: World Health Organization; 2011.

    Google Scholar 

  9. Szajewska H, Canani RB, Guarino A, et al; ESPGHAN Working Group for Probiotics. Probiotics for the prevention of antibiotic-associated diarrhea in children. J Pediatr Gastroenterol Nutr. 2016;62:495–506.

    Article  CAS  PubMed  Google Scholar 

  10. Yachha SK, Sarma MS, Mohan N, et al. Indian Academy of Pediatrics consensus guidelines for probiotic use in childhood diarrhea. Indian Pediatr. 2022;59:543–51.

    Article  PubMed  Google Scholar 

  11. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:e1-48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Oliver MB, Vaughn BP. Fidaxomicin use in the pediatric population with Clostridioides difficile. Clin Pharmacol. 2022;14:91–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Thomas PD, Forbes A, Green J et al. Guidelines for the investigation of chronic diarrhoea, 2nd edition. Gut. 2003;52: v1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Suresh N, Ganesh R, Sankar J, Sathiyasekaran M. Primary intestinal lymphangiectasia. Indian Pediatr. 2009;46:903–6.

    CAS  PubMed  Google Scholar 

  15. Hokari R, Kitagawa N, Watanabe C, et al. Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss. J Gastroenterol Hepatol. 2008;23:e88-95.

    Article  PubMed  Google Scholar 

  16. Kwon Y, Kim MJ. The update of treatment for primary intestinal lymphangiectasia. Pediatr Gastroenterol Hepatol Nutr. 2021;24:413–22.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pusceddu S, Rossi RE, Torchio M, et al. Differential diagnosis and management of diarrhea in patients with neuroendocrine tumors. J Clin Med. 2020;9:2468.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Thiagarajah JR, Donowitz M, Verkman AS. Secretory diarrhoea: mechanisms and emerging therapies. Nat Rev Gastroenterol Hepatol. 2015;12:446–57.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Socha J, Dobrzańska A, Rowecka K, et al. Chronic diarrhea due to VIPoma in two children. J Pediatr Gastroenterol Nutr. 1984;3:143–8.

    CAS  PubMed  Google Scholar 

  20. Kattepura S, Das K, Correa MM, Devarabhavi H. Giant gastrinoma in a child: case report and review. Pediatr Surg Int. 2008;24:1083–5.

    Article  PubMed  Google Scholar 

  21. Cho MS, Kasi A. Zollinger-Ellison Syndrome. [Updated 2022 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537344/.

  22. Sagar VM, Cooper SC, Johnson J, Shetty S, Shah T. Gastrointestinal manifestations of neuroendocrine tumours: their investigation and management. Postgrad Med J. 2017;93:494–7.

    Article  PubMed  Google Scholar 

  23. Gurkan OE, Ozturk H, Karagol HIE, et al. Primary eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr. 2021;72:294–9.

    Article  Google Scholar 

  24. Pesek RD, Greuter T, Lopez-Nunez O, Bernieh A, Straumann A, Collins MH. Clinicopathologic correlations in eosinophilic gastrointestinal disorders. J Allergy Clin Immunol Pract. 2021;9:3258–66.

    Article  CAS  PubMed  Google Scholar 

  25. Papadopoulou A, Amil-Dias J, Auth MK-H, et al. Joint ESPGHAN/NASPGHAN guidelines on childhood eosinophilic gastrointestinal disorders beyond eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2023. https://doi.org/10.1097/MPG.0000000000003877. (Jul 4 [Online ahead of print]).

    Article  PubMed  Google Scholar 

  26. Dimopoulou A, Dimopoulou D, Papakonstantinou D, et al. Eosinophilic gastrointestinal diseases in children: prognostic factors and outcomes. Indian J Pediatr. 2022;89:923.

    Article  PubMed  Google Scholar 

  27. Dellon ES, Spergel JM. Biologics in eosinophilic gastrointestinal diseases. Ann Allergy Asthma Immunol. 2023;130:21–7.

    Article  PubMed  Google Scholar 

  28. Maser C, Toset A, Roman S. Gastrointestinal manifestations of endocrine disease. World J Gastroenterol. 2006;12:3174–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Holmes GK. Celiac disease and type 1 diabetes mellitus - the case for screening. Diabet Med. 2001;18:169–77.

    Article  CAS  PubMed  Google Scholar 

  30. Konda CS, Subramanian G, Gopalaratnam B. Adrenal insufficiency mimicking gastrointestinal disorder: a case report. Int J Sci Study. 2015;3:204–6.

    Google Scholar 

  31. Link MP. Non-hodgkin’s lymphoma in children. Pediatr Clin North Am. 1985;32:699–720.

    Article  CAS  PubMed  Google Scholar 

  32. Goldsby RE, Carroll WL. The molecular biology of pediatric lymphomas. J Pediatr Hematol Oncol. 1998;20:282–96.

    Article  CAS  PubMed  Google Scholar 

  33. Biswas B, Sharma A, Makharia GK, et al. Immunoproliferative small intestinal disease: a report of 6 cases. Trop Gastroenterol. 2014;35:269–72.

    Article  PubMed  Google Scholar 

  34. Ramakrishna BS. Tropical sprue: a riddle wrapped in a mystery inside an enigma. Indian J Med Res. 2013;137:12–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Avelar Rodriguez D, Ryan PM, Toro Monjaraz EM, Ramirez Mayans JA, Quigley EM. Small intestinal bacterial overgrowth in children: a state-of-the-art review. Front Pediatr. 2019;7:363.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ghoshal UC, Sachdeva S, Ghoshal U, et al. Asian-Pacific consensus on small intestinal bacterial overgrowth in gastrointestinal disorders: an initiative of the Indian Neurogastroenterology and Motility Association. Indian J Gastroenterol. 2022;41:483–507.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Katz SL, McGee P, Geist R, Durie P. Factitious diarrhea: a case of watery deception. J Pediatr Gastroenterol Nutr. 2001;33:607–9.

    CAS  PubMed  Google Scholar 

  38. Topazian M, Binder HJ. Brief report: factitious diarrhea detected by measurement of stool osmolality. N Engl J Med. 1994;330:1418–9.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology & Hepatology, Rainbow Children’s Hospital, Chennai, 600015, Tamil Nadu, India

    Malathi Sathiyasekaran

  2. Department of General Pediatrics & Inherited Metabolic Diseases, Rainbow Children’s Hospital, Chennai, 600015, Tamil Nadu, India

    R. Ganesh

  3. Department of General Pediatrics & Pediatric Allergy, Rainbow Children’s Hospital, Chennai, 600015, Tamil Nadu, India

    Suresh Natarajan

Authors
  1. Malathi Sathiyasekaran
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  2. R. Ganesh
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  3. Suresh Natarajan
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MS, RG, SN: reviewed literature and drafted manuscript. MS will act as guarantor for this manuscript.

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Correspondence to R. Ganesh.

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Sathiyasekaran, M., Ganesh, R. & Natarajan, S. Other Causes of Chronic Diarrhea in Children. Indian J Pediatr 91, 606–613 (2024). https://doi.org/10.1007/s12098-023-04918-w

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