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Abstract
Chronic diarrhea in children has a long differential diagnosis, but the clinician can usually distinguish disease from functional diarrhea. A careful history will provide information on medical and dietary problem, growth disturbance, associated symptoms and signs. The extent of laboratory evaluation should be guided by common sense. In the absence of the worrisome historical items noted, or abnormal findings on examination or growth history, reassurance may be all that is required. This article reviewed the diagnostic approach and differential diagnosis of chronic diarrhea, and summarized common non pathologic conditions of chronic diarrhea such as chronic nonspecific diarrhea (toddler's diarrhea) and secondary lactase deficiency.
Figures and Tables
Table 2
Differential Diagnosis of Chronic/Persistent Diarrhea
Adopted and modified from Reference 1.
References
1. Veereman-Wanters G, Taminiau J. Wyllie R, Hyams JS, editors. Diarrhea. Pediatric gastrointestinal and liver disease. 2006. 3rd ed. Philadelphia: W.B. Saunders;151–167.
2. Weaver L. Bowel habit from birth to old age. J Pediatr Gastroenterol Nutr. 1988. 7:637.
3. Baldassano RN, Liacouras CA. Chronic diarrhea. A practical approach for the pediatrician. Pediatr Clin North Am. 1991. 38:667–686.
4. Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, et al. Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg. 2002. 66:590–593.
5. Heaton K, Thomson WG. Heaton K, Thomson WG, editors. Irritable bowel syndrome. Diagnosis. 1999. 1st ed. Oxford: Health Press;27.
6. Hwang JB. Chronic diarrhea in infancy: What is the definition of diarrhea? 2009. In : 2009 The Symposium of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition; Seoul, Korea. 29–39.
7. Weaver LT, Steiner H. The bowel habit of young children. Arch Dis Child. 1984. 59:649–652.
8. Hyams JS. Functional gastrointestinal disorders. Curr Opin Pediatr. 1999. 11:375–378.
9. Hjelt KA, Paerregaard A, Krasilnikoff PA. Giardiasis causing chronic diarrhoea in suburban Copenhagen: incidence, physical growth, clinical symptoms and small intestinal abnormality. Acta Paediatr. 1992. 81:881–886.
10. de Vizia B, Poggi V, Conenna R, Fiorillo A, Scippa L. Iron absorption and iron deficiency in infants and children with gastrointestinal diseases. J Pediatr Gastroenterol Nutr. 1992. 14:21–26.
11. Bhutta ZA, Nelson EA, Lee WS, Tarr PI, Zablah R, Phua KB, et al. Persistent diarrhea working group. Recent advances and Evidence gaps in persistent diarrhea. J Pediatr Gastroenterol Nutr. 2008. 47:260–265.
12. Kneepkens CM, Hoekstra JH. Chronic nonspecific diarrhea of childhood: pathophysiology and management. Pediatr Clin North Am. 1996. 43:375–390.
13. Walker AR, Walker BF. Bowel behaviour in young black and white children. Arch Dis Child. 1985. 60:967–970.
14. Boyne LJ, Kerzner B, McClung HJ. Chronic nonspecific diarrhea: the value of a preliminary observation period to assess diet therapy. Pediatrics. 1985. 76:557–561.
15. Walker-Smith JA. Toddler's diarrhoea. Arch Dis Child. 1980. 55:329–330.
16. Tripp JH, Muller DP, Harries JT. Mucosal (Na+-K+)-ATPase and adenylate cyclase activities in children with toddler diarrhea and the postenteritis syndrome. Pediatr Res. 1980. 14:1382–1386.
17. Hamdi I, Dodge JA. Toddler diarrhoea: observations on the effects of aspirin and loperamide. J Pediatr Gastroenterol Nutr. 1985. 4:362–365.
18. Greene HL, Ghishan FK. Excessive fluid intake as a cause of chronic diarrhea in young children. J Pediatr. 1983. 102:836–840.
19. Moukarzel AA, Lesicka H, Ament ME. Irritable bowel syndrome and nonspecific diarrhea in infancy and childhood--relationship with juice carbohydrate malabsorption. Clin Pediatr (Phila). 2002. 41:145–150.
20. Lebenthal-Bendor Y, Theuer RC, Lebenthal A, Tabi I, Lebenthal E. Malabsorption of modified food starch (acetylated distarch phosphate) in normal infants and in 8-24-month-old toddlers with non-specific diarrhea, as influenced by sorbitol and fructose. Acta Paediatr. 2001. 90:1368–1372.
21. Hoekstra JH, van den Aker JH, Ghoos YF, Hartemink R, Kneepkens CM. Fluid intake and industrial processing in apple juice induced chronic non-specific diarrhoea. Arch Dis Child. 1995. 73:126–130.
22. Hyams JS. Diet and gastrointestinal disease. Curr Opin Pediatr. 2002. 14:567–569.
23. Heyman MB. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006. 118:1279–1286.
24. 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.
25. Gremse DA, Greer AS, Vacik J, DiPalma JA. Abdominal pain associated with lactose ingestion in children with lactose intolerance. Clin Pediatr (Phila). 2003. 42:341–345.
26. Kokkonen J, Haapalahti M, Tikanen S, Karttunen R, Savilahti E. Gastrointestinal complaints and diagnosis in children: a population-based study. Acta Paediatr. 2004. 93:880–886.
27. Kukuruzovic RH, Brewster DR. Milk formulas in acute gastroenteritis and malnutrition: a randomized trial. J Paediatr Child Health. 2002. 38:571–577.
28. American Academy of Pediatrics. Provisional Committee on Quality Improvement. Subcommittee on Acute Gastroenteritis. Practice parameter: the management of acute gastroenteritis in young children. Pediatrics. 1996. 97:424–435.
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