|Kellermayer, Richard -|
|Shulman, Robert -|
Submitted to: UpToDate
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 4, 2008
Publication Date: September 30, 2009
Citation: Kellermayer, R., Shulman, R.J. 2009. Overview of the causes of chronic diarrhea in children. UpToDate. 17:3 Interpretive Summary: Chronic diarrhea is a common problem throughout the world that is responsible for severe illness and even death. In the developing world, chronic diarrhea is usually associated with repeated intestinal infections and malnutrition that lead to decreased ability to digest and absorb nutrients. In developed countries, chronic diarrhea is more likely to be caused by an underlying disease. The different causes of chronic diarrhea in developing countries as compared to those in developed countries calls for different approaches to diagnosis and management in the two settings. This article discusses the nutritional causes and management of chronic diarrhea in developed countries.
Technical Abstract: The major causes and the prevalence of chronic diarrhea differ between developed and developing countries. In the developing world, chronic diarrhea is typically associated with serial enteric infections and malnutrition; it is manifested by a chronic enteropathy, with impaired mucosal healing, and diminished digestive, and absorptive capacity. In developed countries, children are less likely to be exposed to serial enteric infections and malnutrition. In these populations, chronic diarrhea is more likely to be caused by underlying disease causing malabsorption or maldigestion [2-5]. However, enteric infections (particularly in immunocompromised patients), malnutrition, and dietary factors (eg, excessive consumption of juice), play a role in some cases. The difference in pathophysiology underlying most cases of chronic diarrhea in developing countries as compared to those in developed countries calls for different approaches to diagnosis and management in the two settings. The diagnosis and treatment of chronic diarrhea in developing countries is discussed separately. (See "Persistent diarrhea in children in developing countries".) The pathophysiology and management of diarrheal diseases in developed countries will be reviewed here. The approach to diagnosing the cause of these diarrheal diseases is discussed separately. (See "Approach to the diagnosis of chronic diarrhea in children in developed countries".)