Chronic Diarrhoea
What is it?
Chronic diarrhea is defined as passing loose, watery stools occurring three or more times a day for at least four weeks infectious cause has been ruled out. It is sometimes accompanied by blood or mucus in the stool.
How common is it?
It is reported in up to 10% of school aged children experience diarrhoea at some point of their lives. There are many causes for chronic diarrhoea such as food protein intolerance or allergies, sugar intolerances (lactose, fructose, sucrose), small intestinal bacterial overgrowth, fat mal-absorption (bile salt deficicency, plancreatic deficiency), inflammatory bowel disease, coeliac disease, irritable bowel syndrome, antibiotics and congenital conditions such as microvillus atrophy. It is either caused by inadequate food intake or excessive loss of nutrients (diarrhoea).
What are the signs and symptoms?
The signs and symptoms are dependent of the underlying medical conditions. Children with chronic diarrhoea may experience poor growth, malnourished, perianal rash. They may have evidence of chronic dehydration such as sunken eyes, dry coated tongue and inadequate urine output.
How is it diagnosed?
It is also very important to rule out potential medical conditions such as hypothyroidism, coeliac disease, Down syndrome, Turner syndrome, Silver-Russell syndrome, Crohn's disease, cystic fibrosis, congenital heart conditions, growth hormone deficiency and immune deficiency.
Children who presented with failure to thrive will need to have tests for coeliac disease, hypothyroidism, growth hormone, inborn errors of metabolism and also underlying genetic conditions.
Investigations should include thyroid function tests, coeliac disease, inflammatory markers (ESR, CRP, faecal calprotectin level - checking for Crohn's disease), ferritin, vitamin B12, folate, growth hormone, genetic screening and karyotype.
80% of failure to thrive is non-organic. Only 20% is organic.
What is the treatment?
A detailed history of food intake and nutritional analysis by a dietitian will provide useful information about the adequacy of food and nutrient intake. A child may require nutritional supplement to ensure adequate intake of nutrients. The treatment is dependent on the underlying medical condition.
Important notes:
It is also important to rule out severe gastro-oesophageal reflux disease, pyloric stenosis, severe cow's milk protein allergy and hypothyroidism in children less than a year old.
An endocrinology consultation is required to find out whether there is a hormone deficiency contributes to failure to thrive.
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