Abstract

PROTRACTED DIARRHEA-A CLINICAL STUDY OF ETIOLOGY AND RISK FACTORS IN CHILDREN OF LOW SOCIO-ECONOMIC STATUS

Dr. V. K. Tandon and Dr. Vishal Mehrotra*

Abstract

Protracted diarrhea is the most severe form of diarrhea in infancy and has also been defined as intractable diarrhea. Its etiology is poorly defined. We have retrospectively evaluated the etiology, the outcome, and the risk factors of 38 children, admitted with protracted diarrhea and need for hospitalization from 2010 to 2014. Children with anatomic abnormalities and/or primary immunodeficiency were excluded. There was an inverse relationship between the number of patients and the age of diarrheal onset (mean age: 2.9 to 3.5 months). Etiology of protracted diarrhea was an enteric infection in 18 cased (eight Salmonell, there Staphylococcus, five rotavirus, one adenovirus, one Cryptosporidium), multiple alimentary intolerance (eight cases), familial microvillour atrophy (two), autoimmune enteropathy (two), celiac disease, lymphangectasia, eosinophilic enteropathy, intestinal pseudoobstructiopn and intestinal neurodysplasia (1 case each). Etiology was not detected in three cases. Overall, 12 children died, five are presently being treated and 21 had full remission. Comparative evaluation of risk factors between children with protracted diarrhea and a control population of children with diarrhea but without the need for hospitalization showed that low birth weight, no breast feeding, history of fatal diarrhea in a relative and early onset of diarrhea had a significantly higher incidence in the former. Social background was similar in the two populations. We conclude that at specific etiology can be identified in the majority of cases of chronic diarrhea. The etiologic spectrum of chronic diarrhea is broad, but an enteric infection is the most common cause of chronic diarrhea. The severity of this condition is related, at least in part, to establish risk factors.

Keywords: Intractable diarrhea- Parenteral nutrition-Enteric infection- Food intolerance – Congenital enteropathy.