DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20182410

The clinical spectrum of chronic diarrhoea in children in a tertiary care hospital in Bangalore, India

Bhaskar Shenoy, Sunil Kumar Dodderi

Abstract


Background: In the developing world, chronic diarrhea is typically associated with serial enteric infections and malnutrition. There are many causes for chronic diarrhea and with better facilities these are being increasingly diagnosed in India. To study the clinical spectrum of chronic diarrhoea in children. in a tertiary care hospital in Bangalore

Methods: This was a prospective observational study conducted at the Dept of Pediatrics, Dr.B.R.Ambedkar Medical College , Bangalore from April 2015 to April 2017. All the patients who presented with symptoms suggestive of chronic diarrhoea were enrolled for the study. 50 children fulfilling inclusion criteria were selected for the study.

Results: Of 50 cases, 31(62%) showed cow milk protein intolerance (CMPI), 6 (12%) celiac disease, 5(10%) post infectious, 2(4%) glucose galactose intolerance, 1(2%) non-specific, 1(2%) cystic fibrosis, 1(2%) IBD, TB 1(2%) and 2(4%) lympangiectesia. In children below 2 years, cow milk protein intolerance was the most common cause of diarrhea whereas post infectious was the most common cause in 2-6 years age group and celiac disease in above 6 years of age group.

Conclusions: Cow milk protein intolerance is the most common etiological factor. The incidence of celiac disease was the second most common cause after CMPI in the present study. The incidence of CMPI as a cause of chronic diarrhoea reduces as the age increases as seen in present study. The high incidence of celiac diseases may be due to referral to our institution by various peripheral hospitals when they could not diagnose after routine investigations.


Keywords


Cow milk protein intolerance, Chronic diarrhoea, Celiac disease, Galactose intolerance

Full Text:

PDF

References


Darrow DC, Yannet H. The changes in the distribution of body water accompanying increase and decrease in extracellular electrolyte. J Clin Invest. 1935;14:266-75.

Hirschhorn N, McCarthy BJ, Ranney B. Ad libitum oral glucose-electrolyte therapy for acute diarrhea in Apache children. J Pediatr. 1973;83:562-71.

Bhan MK, Bhandari N, Sazawal S, Clemens J, Raj P, Levine MM, et al. Longitudinal study of diarrhoeal disease among young children in rural north India. Bull WHO. 1989;67:281-8.

Altuntas B, Gul H, Yarali N, Ertan U. Etiology of chronic diarrhoea. Indian J Pediatr. 1999;66:657-61.

Rastogi A, Malhotra V, Uppal B. Etiology of chronic diarrhoea in children. Trop Gastroenterol. 1998;19:45-9.

Malaty HM, Fan X, Opekun AR, Thibodeaux C, Ferry GD. Rising incidence of inflammatory bowel disease among children. J Pediatr Gastroenterol Nutr. 2010;50:27-31.

Report of Working Group of European Society of Pediatric Gastroenterology and Nutrition. Revised criteria for diagnosis of celiac disease. Arch Dis Child. 1990;65:909-11.

Iyngkaran N, Robinson MJ, Prathap K, Yadav M. Cow’s milk-protein sensitive enteropathy: combined clinical and histopathological criteria for diagnosis. Arch Dis Child. 1978;53:20-6.

Cohen SA, Hendricks KM, Mathis RK, Laramee S, Walker WA. Chronic nonspecific diarrhea: dietary relationships. Pediatr. 1979;64:402-7.

Vardy PA, Lebenthal E, Schwachman H. Intestinal lymphangiectasia: a reappraisal. Pediatr. 1975;55:842-51.

The Porto Criteria. Inflammatory bowel disease in children and adolescents: recommendations for diagnosis. J Pediatr Gastroenterol Nutr. 2005;41:1- 7.

Yachha SK, Mishra S, Malik AK, Nagi B, Mehta S. Spectrum of malabsorption syndrome in North Indian children. Indian J Gastroenterol. 1993;12:120-5.

Lee WS, Boey CCM. Chronic diarrhoea in infants and young children: causes, clinical features, and outcome. J Pediatr Child Health. 1999;35:260-3.