Protracted Diarrhea in Infancy: Clinical Aspects and Ultrastructural Analysis of the Small Intestine

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 4; no. 5; pp. 714 - 722
• Main Authors: Fagundes-Neto, Ulysses, Wehba, Jamal, Viaro, Tania, Machado, Nelson Lourenço, da Silva Patricio, Francy Reis
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott-Raven Publishers 01.10.1985; Lippincott
• Subjects: Absorption; Animals; Biological and medical sciences; Cattle; Diarrhea, Infantile - etiology; Diarrhea, Infantile - pathology; Epithelium - pathology; Female; Food Hypersensitivity - complications; Gastroenterology. Liver. Pancreas. Abdomen; Glycine max - adverse effects; Humans; Infant; Intestine, Small - pathology; Intestine, Small - physiopathology; Male; Medical sciences; Microscopy, Electron; Milk - adverse effects; Other diseases. Semiology; Rectum - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Triglycerides - blood; Xylose - metabolism; Human; Pathology; Biopsy; Diarrhea; Digestive diseases; Intestinal disease; Infant; Recurrent; Electron microscopy; Small intestine
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1002/j.1536-4801.1985.tb08944.x

SummaryProtracted diarrhea is a clinical entity characterized by diarrhea lasting >2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal functionD-xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D-Xylose absorption and triglyceride tolerance test in these patients were both significantly tower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the micovilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery, as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cowʼs milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.