CAUSES OF CHRONIC NON-INFECTIOUS DIARRHOEA IN INFANTS LESS THAN 6 MONTHS OF AGE: RARELY RECOGNIZED ENTITIES

Authors

  • Iqra Mushtaq The Children's Hospital & The Institute of Child Health, Lahore.
  • Huma Arshad Cheema The Children's Hospital & The Institute of Child Health, Lahore.
  • Hassan Suleman Malik The Children's Hospital & The Institute of Child Health, Lahore.
  • Nadia Waheed The Children's Hospital & The Institute of Child Health, Lahore.
  • Muhammad Almas Hashmi The Children's Hospital & The Institute of Child Health, Lahore.

Abstract

Background: Non-infectious causes of chronic diarrhoea are important and easily missed. The study was done with the objectives to identify different causes of chronic non-infectious diarrhoea in infants less than 6 months of age. Methods: All patients less than 6 months of age presenting for the first time to a Paediatric Gastroenterology tertiary care centre with a history of chronic diarrhoea and negative stool cultures, were enrolled over a period of 8 months. Demographical profile and various factors under observation were recorded in this observational study. Collected data was analysed using SPSS version 20. Chi square test was applied as a test of significance for any qualitative variable, p value (p<0.05) was taken as significant. Results: Among 72 enrolled patients, female to male ratio was1.05:1. Age at onset of symptoms was between15 days to 06 months. Aetiology found was Cow’s milk protein allergy (CMPA) in 58 (80.6%), Primary intestinal lymphangiectasia (PIL) 6 (8.3%), Cystic fibrosis (CF) 3 (4.2%), Immunodeficiency (SCID) 2 (2.8%), 1 (1.4%) for each Abetalipoproteinemia (ABL), Glucose galactose malabsorption (GGM) and Congenital chloride diarrhoea (CCD). Conclusions: Among non-infectious causes of chronic diarrhoea in early infancy, cow’s milk protein allergy is most common followed by Primary intestinal lymphangiectasia and Cystic fibrosis.Keywords: Chronic Diarrhoea; Cow’s Milk Protein Allergy; Primary Intestinal Lymphangiectasia; Cystic Fibrosis; Immunodeficiency; Abetalipoproteinemia; Glucose Galactose Malabsorption; Congenital Chloride Diarrhoea

Author Biographies

Iqra Mushtaq, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Huma Arshad Cheema, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Hassan Suleman Malik, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Nadia Waheed, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

Muhammad Almas Hashmi, The Children's Hospital & The Institute of Child Health, Lahore.

Pediatric Gastroenterology, Hepatology

References

Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013;381(9875):1405–16.

Bbaale E. Determinants of diarrhoea and acute respiratory infection among under- fives in Uganda. Australas Med J 2011;4(7):400–9.

Abdelmalak B, Doyle DJ. Anesthesia for otolaryngologic surgery [Internet]. Cambridge, UK; New York: Cambridge University Press; 2013 [cited 2016 Jan 10]. Available from: http://dx.doi.org/10.1017/CBO9781139088312

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385(9963):117–71.

Shah SM, Yousafzai M, Lakhani NB, Chotani RA, Nowshad G. Prevalence and correlates of diarrhoea. Indian J Pediatr 2003;70(3):207–11.

Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2012;12(2):136e–41.

Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhoea. Gastroenterology 1999;116(6):1464–86.

Sampson HA. Food allergy. Part I: Immunopathogenesis and clinical disorders. J Allergy Clin Immunol 1999;103(5 Pt 1):717–28.

Diagnostic criteria for food allergy with predominantly intestinal symptoms. The European Society for Paediatric Gastroenterology and Nutrition Working Group for the Diagnostic Criteria for Food Allergy. J Pediatr Gastroenterol Nutr 1992;14(1):108–12.

Cantani A. Diagnostic criteria for food allergy with predominantly intestinal symptoms. Acta Dermatovenerol Nutr 1993;16(4):476–8.

Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, et al. Guidelines for the diagnosis and management of cow's milk protein allergy in infants. Arch Dis Child 2007;92(10):902–8.

Host A. Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89(6 Suppl 1):33–7.

Hill DJ, Firer MA, Shelton MJ, Hosking CS. Manifestations of milk allergy in infancy: clinical and immunologic findings. J Pediatr 1986;109(2):270–6.

Björksten B. Genetic and environmental risk factors for the development of food allergy. Curr Opin Allergy Clin Immunol 2005;5(3):249–53.

Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old. Lancet 1995;346(8982):1065–9.

Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, et al. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy 2005;35(3):268–73.

Turjanmaa K. Atopy patch tests” in the diagnosis of delayed food hypersensitivity. Allerg Immunol (Paris) 2002;34(3):95–7.

Bock SA, Sampson HA, Atkins FM, Zeiger RS, Lehrer S, Sachs M, et al. Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual. J Allergy Clin Immunol 1988;82(6):986–97.

Zamel R, Khan R, Pollex RL, Hegele RA. Abetalipoproteinemia: two case reports and literature review. Orphanet J Rare Dis 2008;3:19.

Rafique M, Zia S. Abetalipoproteinemia in a Saudi Infant. J Coll Physicians Surg Pak 2011;21(2):117–8.

Uslu N, Gürakan F, Yüce A, Demir H, Tarugi P. Abetalipoproteinemia in an infant with severe clinical phenotype and a novel mutation. Turk J Pediatr 2010;52(1):73–7.

Wedenoja S1, Höglund P, Holmberg C. Review article: the clinical management of congenital chloride diarrhoea. Aliment Pharmacol Ther 2010;31(4):477–85.

Canani RB, Terrin G, Cirillo P, Castaldo G, Salvatore F, Cardillo G et al. Butyrate as an effective treatment of congenital chloride diarrhoea. Gastroenterology 2004;127(2):630–4.

Khatami G, Mir-Nasseri M, Seyghali F, Allah-Verdi B, Yourdkhani F. Characteristics of Patients with Cystic Fibrosis: Experience in a Large Referral Children’s Hospital in Tehran, Iran. Middle East J Dig Dis 2010;2(1):20–3.

Haghighat M. Cystic Fibrosis in South of Iran. Shiraz: Shiraz Medical University Press; 1999.

AL-Mobareek KF, Abdullah AM. Cystic fibrosis in Saudi Arabia, common and rare presentation. Ann Trop Paediatr 1995;15(4):269–72.

AL-Mahroos. Cystic fibrosis in Bahrain incidence, phenotype, and outcome. J Trop Pediatr 1998;44(1):35–9.

Lee J, Kong MS. Primary intestinal lymphangiectasia diagnosed by endoscopy following the intake of a high-fat meal. Eur J Pediatr 2008;167(2):237–9.

Wen J, Tang Q, Wu J, Wang Y, Cai W. Primary intestinal lymphangiectasia: four case reports and a review of the literature. Dig Dis Sci 2010;55(12):3466–72.

Waldmann TA. Gastrointestinal protein loss demonstrated by Cr-51-labelled albumin. Lancet 1961;2(7194):121–3.

Desai AP, Guvenc BH, Carachi R. Evidence for medium chain triglycerides in the treatment of primary intestinal lymphangiectasia. Eur J Pediatr Surg 2009;19(4):241–5.

Stephan JL, Vlekova V, Le Deist F, Blanche S, Donadieu J, De Saint-Basile G, et al. Severe combined immunodeficiency: a retrospective single-center study of clinical presentation and outcome in 117 patients. J Pediatr 1993;123(4):564–72.

Berni Canani R, Pezzella V, Amoroso A, Cozzolino T, Di Scala C, Passariello A. Diagnosing and Treating Intolerance to Carbohydrates in Children. Nutrients 2016;8(3):157.

Downloads

Published

2017-01-25

Most read articles by the same author(s)

1 2 > >>