{
"topic": "Chronic Diarrhea",
"slug": "chronic-diarrhea",
"category_id": 15480,
"passage_count": 14,
"source_chars": 13032,
"enough_material": true,
"references": [
{
"title": "Algorithms in Pediatrics",
"author": null,
"pages": [
377,
378,
383
]
},
{
"title": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga)",
"author": "CamScanner",
"pages": [
303
]
},
{
"title": "Cover",
"author": "Vitalsource Download",
"pages": [
5410,
5416,
5677
]
},
{
"title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
"author": null,
"pages": [
729
]
},
{
"title": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer)",
"author": null,
"pages": [
818,
824
]
},
{
"title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
"author": null,
"pages": [
2390
]
},
{
"title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)",
"author": null,
"pages": [
36
]
},
{
"title": "Pediatric Nutrition Handbook",
"author": "Kleinman, Ronald E.",
"pages": [
699
]
}
],
"passages": [
{
"source": "Algorithms in Pediatrics, p. 377",
"text": "Chronic diarrheas may arise from intestinal diseases (small or large bowel), pancreatic, hepatobiliary, or systemic causes. Their differentiation is elaborated in the next chapter \u201cChronic Diarrhea in Children More than 3 Years of Age\u201d. Gastrointestinal and systemic causes of chronic diarrhea in children less than 3 years of age are shown in boxes 1 and 2. ## **DEFINITIONS** Before embarking upon the details of this topic, a few clarifications regarding the terminologies used in diarrhea need to be understood. While describing diarrhea of a fairly large duration, the terms \u201cchronic\u201d, \u201cpersistent\u201d, \u201cprotracted\u201d, and \u201cintractable\u201d are loosely interchanged in literature and creates confusion in the minds of the pediatricians. ## **Chronic Diarrhea** Chronic diarrhea is defined as an insidious onset diarrhea of >2 weeks duration in children rarely leading to dehydration with **Box 1: Gastrointestinal causes of chronic diarrhea in children less than 3 years of age**"
},
{
"source": "Ghai Essential Pediatrics, 9e (Vinod K Paul, Arvind Bagga), p. 303",
"text": "specialized pediatric gastroenterology centers. CHRONIC DIARRHEA Chronic diarrhea is a common problem in children. It is defined as an insidious onset diarrhea of >2 weeks duration in children and >4 weeks in adults. The term chronic diarrhea is not synonymous with persistent diarrhea. The approach, etiology and management of chronic diarrhea along with a brief outline of some common causes is discussed. Approach Approach to chronic diarrhea must be considered with the following points in mind: Age of onset: A list of common causes of chronic diarrhea according to age of onset is shown in Table 12.14. Small or large bowel type of diarrhea: Features in history and examination that help in differentiating small bowel from large bowel diarrhea is shown in Table 12.15. Typically, large volume diarrhea without blood and mucus suggests small bowel type of diarrhea and small volume stools with blood and mucus suggest large bowel type of diarrhea. Gastrointestinal versus systemic causes: Diarrhea is most"
},
{
"source": "Algorithms in Pediatrics, p. 383",
"text": " _Surender K Yachha, Moinak S Sarma_ ## **INTRODUCTION** Chronic diarrhea is defined as an insidious onset diarrhea of more than 2\u20133 weeks duration in children. Causes of chronic diarrhea in older children (>3 years) and adolescents are distinctly different from those in younger age. ## **APPROACH TO CHRONIC DIARRHEA** Approach to chronic diarrhea should be considered with the following points in mind: - Small or large bowel type of diarrhea: features in history and examination that help in differentiating small from large bowel diarrhea shown in table 1. To summarize, large volume diarrhea without blood and mucus suggests \u201csmall bowel type\u201d and small volume stools with blood and mucus suggests \u201clarge bowel type\u201d of diarrhea."
},
{
"source": "Cover, p. 5677",
"text": "Chronic idiopathic diarrhea of infancy is also known as intractable diarrhea of infancy, protracted diarrhea of infancy, severe persistent diarrhea of infancy, and prolonged diarrhea of infancy. A number of new disorders that cause diarrhea during infancy have been recognized in recent years, but despite these advances, there remains a group of infants for whom no specific etiology can be identified. The term _chronic idiopathic diarrhea of infancy_ remains appropriate for these cases. In the past, this term was applied to infants less than 3 months of age, but it now is often used to describe any infant with otherwise unexplained chronic diarrhea, characterized by ongoing watery diarrhea lasting for more than 2 weeks. Stool losses often exceed 30 mL/kg/day. The volume of stool loss is usually of such magnitude that the infant is unable to maintain adequate hydration without additional intravenous fluids. Without appropriate management, mortality rates are exceedingly high, thus early recognition of the"
},
{
"source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 729",
"text": "## CHRONIC DIARRHEA (Figure 111-2) ## **ETIOLOGY AND PATHOGENESIS** Chronic diarrhea manifesting as two to eight large, loose bowel movements per day, occurring during the daytime, in an otherwise healthy and normally growing child is usually attributable to functional diarrhea. Chronic nonspecific diarrhea of childhood (toddler\u2019s diarrhea) most commonly affects young children 6 months to 5 years of age and is typically due to excessive fluid or carbohydrate intake, low fat intake, or rapid transit. Irritable bowel syndrome (IBS) is another cause of functional diarrhea in older children with a prevalence of 11% and is two times more common in girls than boys. Functional diarrhea is mainly caused by osmotic effects of carbohydrates such as sorbitol and fructose or dysmotility with rapid transit."
},
{
"source": "Cover, p. 5416",
"text": "As described above, the objective in evaluating children with chronic diarrhea is to identify specific treatable conditions and institute appropriate therapy. Complete discussion of treatment strategies is disease specific and is beyond the aim of this chapter. Examples of treatment for common causes of chronic diarrhea include the gluten-free diet for celiac disease, anti-inflammatory and immunosuppressant medications for inflammatory bowel disease (Crohn disease or ulcerative colitis), pancreatic enzyme supplementation for CF or other causes of pancreatic insufficiency, and surgery for Hirschsprung disease. Infectious disorders including giardia can be appropriately identified and treated. It is just as important to identify those causes of chronic diarrhea that are benign and require minimal diagnostic workup and largely supportive therapy. Chronic nonspecific diarrhea of childhood (toddler\u2019s diarrhea) is characterized by the presence of loose stools in a child with normal growth and who is otherwise"
},
{
"source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 824",
"text": " **----- Start of picture text -----**
VI
**----- End of picture text -----**
## **Summary** Chronic diarrhea in childhood can result from many different causes that often must be defined before definitive treatment can be initiated. Particular attention should be paid to growth measurements to distinguish between chronic diarrhea with or without associated growth failure/malnutrition. Understanding the basic pathophysiologic mechanisms of diarrhea\u2014osmotic, secretory, intestinal dysmotility, fatty, and Section VI: Nutrition in Acute and Chronic Illness **811** **812** Chapter 27 inflammatory\u2014may also aid in making a diagnosis. Nutrition support is the mainstay of treatment in children with an undefined cause of chronic diarrhea. Throughout the evaluation process, appropriate nutrition must be provided to meet the child\u2019s needs, enterally or parentally if necessary, to facilitate healing and good health. ## **References**"
},
{
"source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2390",
"text": "**Chronic** diarrhea is defined as stool volume of more than 10 g/ kg/day in toddlers/infants and greater than 200 g/day in older children that lasts for 4 weeks or more. **Persistent** diarrhea begins acutely but lasts longer than 14 days. In practice this usually means having loose or watery stools more than 3 times a day, with a deviation from the previous regular stool pattern _. Awakening at night to pass stool, beyond the period of infancy, is often a sign of an organic cause of diarrhea._ The epidemiology has two distinct patterns. In _developing_ countries, chronic diarrhea is, in many cases, the result of an intestinal infection that persists longer than expected. This syndrome is often defined as **protracted (persistent) diarrhea** , but there is no clear distinction between protracted (persistent) and chronic diarrhea. In countries with higher socioeconomic conditions, chronic diarrhea is less frequent, and the etiology often varies with age. The outcome of diarrhea depends on the cause and"
},
{
"source": "Algorithms in Pediatrics, p. 378",
"text": "**Box 2: Systemic causes of chronic diarrhea in children less than 3 years of age** ## **Common causes** - Urinary tract infection (most important) - Nephrotic syndrome - Septicemia - Drugs: laxatives, antacids, antineoplastic ## **Uncommon causes** - Endocrinal causes, e.g., Addison\u2019s disease, hypoparathyroidism (autoimmune polyendocrinopathies) - Neuroblastoma and ganglioneuroblastoma - Constrictive pericarditis and restrictive cardiomyopathy a wide range of underlying structural or chronic inflammatory causes (acquired or congenital) causing malabsorptive or maldigestive states. ## **persistent Diarrhea** Persistent diarrhea is an episode of diarrhea of presumed infectious etiology, which starts acutely but lasts for >14 days commonly seen in children <2 years age resulting dehydration and dyselectrolytemia with or without gain in weight or loss in weight and not responding to usual therapy. ## **protracted Diarrhea**"
},
{
"source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 818",
"text": "Pediatric Nutrition, 8th Edition Table 27.1. ## **Chronic Diarrhea in Childhood** ## **Diarrhea Without Failure to Thrive** Functional diarrhea Irritable bowel syndrome\u2014diarrhea predominant Substrate-induced diarrhea - Excessive juice - Disaccharide intolerance: lactose, sucrose - Laxative use - Caregiver-induced (Munchausen by proxy) - Infectious enteritis[a] - Parasitic: _Giardia, Strongyloides, Cryptosporidium, Cyclospora_ species - Bacteria: _Salmonella, Yersinia, Aeromonas, Plesiomonas_ species - Small-bowel bacterial overgrowth Overflow diarrhea from constipation ## **Diarrhea With Growth Failure/Malnutrition** Pancreatic insufficiency-steatorrhea - Cystic fibrosis - Shwachman-Diamond syndrome Disorders of lipid digestion, absorption, or transport - Abetalipoproteinemia - Chylomicron retention disease - DGAT1 deficiency - Intestinal lymphangiectasia Enterocyte structural disorders - Microvillus inclusion disease - Tufting disease"
},
{
"source": "Cover, p. 5410",
"text": "The clinical manifestations of chronic diarrhea can be quite variable related to the broad differential diagnosis. The clinical symptoms are largely dependent upon the underlying etiology ( **Table 380-2** ). In general, the approach to the child with chronic diarrhea involves first trying to determine the primary underlying mechanism (malabsorptive, secretory, osmotic, inflammatory, dysmotility) and then determining the specific cause. Chronic diarrhea may be benign with no risk for any complications (eg, chronic, nonspecific diarrhea of childhood) or may be indicative of a serious underlying condition for which the diagnostic workup needs to be expedited to reduce the risk of increased morbidity and mortality especially in infants and young children. It is important for clinicians faced with interpreting symptoms of chronic diarrhea to recognize the broad differential diagnosis and create a systematic and structured clinical approach. A thorough history can allow focused diagnostic studies that then guide"
},
{
"source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 36",
"text": "**The Spectrum of Autoimmune Enteropathy**  **2** Natalia Nedelkopoulou, Huey Miin Lee, Maesha Deheragoda, and Babu Vadamalayan ## **Introduction** Chronic, unexplained diarrhea in children younger than 3 months old was first characterized as \u201cintractable diarrhea\u201d [1]. The term \u201cprotracted diarrhea\u201d was later used to describe infants with frequent and loose stools severe enough to often require parenteral alimentation as nutritional support [2]. The differential diagnosis of enteropathies in infancy and childhood includes inherited epithelial and congenital transport defects, enzymatic deficiencies, and allergic enteropathy (Table 2.1)."
},
{
"source": "Pediatric Nutrition Handbook, p. 699",
"text": "## **Summary** Chronic diarrhea in childhood can result from many different causes that often must be defi ned before defi nitive treatment can be initiated. Nutrition support is the mainstay of treatment in children with an undefi ned cause of chronic diarrhea. Throughout the evaluation process, appropriate nutrition must be provided to meet the child\u2019s needs, either enterally or parentally if necessary, to facilitate healing and good health. ## **References** 1. Snyder JD, Merson MH. The magnitude of the global problem of acute diarrheal disease: a review of active surveillance data. _Bull World Health Organ_ . 1982;60:605\u2013613 2. Vanderhoof JA. Chronic diarrhea. _Pediatr Rev._ 1998;19:418\u2013422 3. Hyams JS, Etienne NL, Leichtner AM, Theuer RC. Carbohydrate malabsorption following fruit juice ingestion in young children. _Pediatrics_ . 1988;82:64\u201368"
},
{
"source": "MedStudy Pediatrics Core 11th Edition 2024-2025, p. 335",
"text": "[Figure OCR, page 335, figure 1] CHRONIC DIARRHEA PREVIEW | REVIEW \u00a2 When is diarrhea considered chronic? \u00a9 What is the most common cause of chronic diarrhea in older children and adolescents? \u00a9 By what age does a patient with functional diar- thea (toddler's diarrhea) typically obtain a normal stool pattern? Diarrhea is considered chronic when loose or watery stools occur > 3x/day for > 14 days. In developing coun- tries, the main causes are infections and malnutrition (often both). Because there are many etiologies for chronic diarrhea, the discussion here is limited to some common causes in developed countries. Irritable bowel syndrome (IBS) is the most common cause of diarrhea in older children and adolescents. Patients tend to have a variable number of loose bowel movements, especially after eating. This disorder is heav- ily influenced by stress and diet (recommend the low FODMAP [short-chain carbohydrate] diet). Functional diarrhea (a.k.a. toddler's diarrhea) occurs in"
}
]
}