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Endoscopic and histopathological evaluation of preschool children with chronic diarrhoea
O P Mishra1, T Dhawan, P N Singla
1Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Insights
Chronic diarrhea in young children is often linked to malnutrition and infections. Histopathological changes, like villous atrophy, are common, but endoscopic findings and specific pathogens don't always correlate with malnutrition.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Nutritional Science
Background:
- Chronic diarrhea is a significant health concern in children, particularly in developing regions.
- Protein-energy malnutrition is frequently associated with persistent gastrointestinal issues in pediatric populations.
- Understanding the interplay between infections, nutritional status, and intestinal pathology is crucial for effective management.
Purpose of the Study:
- To investigate the clinical profile, etiological agents, and pathological findings in children with chronic diarrhea.
- To assess the correlation between malnutrition, identified enteropathogens, and endoscopic/histopathological abnormalities.
- To determine the impact of diarrhea duration on intestinal mucosal changes.
Main Methods:
- A study involving 57 children aged 1-5 years presenting with chronic diarrhea.
- Clinical assessment, stool examination for enteropathogens, lactose intolerance testing, upper gastrointestinal endoscopy, and histopathological analysis were performed.
- Correlation analyses were conducted to evaluate relationships between clinical parameters, etiological agents, malnutrition, and mucosal lesions.
Main Results:
- Protein-energy malnutrition was prevalent in 85.9% of cases. Common findings included anemia (89.5%), mucus/blood in stool (66.6%), abdominal distension (52.6%), and pain (28.1%).
- Enteropathogens were identified in 68.4%, with Escherichia coli being the most common, followed by Candida albicans, E. histolytica, and Giardia lamblia.
- Abnormal histopathology, predominantly villous atrophy with mononuclear cell infiltration (56.7%), was observed in 73.3%. Chronic duodenitis was the most frequent endoscopic finding (16.7%). Diarrhea duration significantly impacted histopathology but not endoscopic appearance. No correlation was found between endoscopic/histopathological lesions and malnutrition or specific etiological agents.
Conclusions:
- Chronic diarrhea in this pediatric cohort is strongly associated with malnutrition and a variety of enteropathogens.
- Histopathological changes, particularly villous atrophy, are common and influenced by diarrhea duration.
- Despite significant pathological findings, endoscopic appearance and histopathology did not correlate with malnutrition or specific identified pathogens in this study.
Abstract:
Fifty-seven children with chronic diarrhoea, aged 1-5 years, were studied. Protein-energy malnutrition was present in 49 (85.9 per cent) children. Anaemia (89.5 per cent), presence of mucus and blood in stool (66.6 per cent), abdominal distension (52.6 per cent), and abdominal pain (28.1 per cent) were the common clinical findings at admission. The enteropathogens isolated from the stool of 68.4 per cent of patients were Escherichia coli (19.3 per cent), Candida albicans (12.3 per cent), E. histolytica (8.8 per cent), and Giardia lamblia (7 per cent). Secondary lactose intolerance was present in 21 per cent of children, endoscopic appearance was abnormal in 23.3 per cent of children and the commonest finding was chronic duodenitis (16.7 per cent). Abnormal histopathology was observed in 73.3 per cent of cases and villous atrophy with mononuclear cell infiltration (56.7 per cent) was the most common abnormality detected. The mean duration of diarrhoea had no impact on endoscopic appearance but it significantly affected the histopathological changes. However, no correlation was found in endoscopic and histopathological lesions in relation to malnutrition and aetiological agents.