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Postenteritis enteropathy in infancy. A prospective study of 10 patients with special reference to growth pattern,
A Paerregaard1, K Hjelt, L Christiansen
1Department of Paediatrics L, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Insights
Postenteritis enteropathy in children, following acute gastroenteritis, causes severe growth issues. However, elemental and lactose-free diets can lead to satisfactory long-term recovery and catch-up growth.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutrition
Background:
- Postenteritis enteropathy is a condition characterized by chronic diarrhea, failure to thrive, and small intestinal mucosal damage after acute gastroenteritis.
- Children with this condition experience significant growth retardation, with median deviations of -1.7 SD for height and -3.1 SD for weight from age-correlated norms.
Purpose of the Study:
- To prospectively study the clinical course and long-term outcomes of children diagnosed with postenteritis enteropathy.
- To evaluate the effectiveness of dietary interventions, including elemental and lactose-free diets, in managing postenteritis enteropathy.
- To assess the potential for catch-up growth and recovery in affected children.
Main Methods:
- Prospective study of ten pediatric patients with postenteritis enteropathy.
- Monitoring of growth parameters (height and weight) before illness and during follow-up.
- Assessment of treatment outcomes, including diarrhea resolution and catch-up growth, following dietary interventions (elemental diet, parenteral nutrition, lactose-free diet).
Main Results:
- Nine out of ten surviving children showed satisfactory long-term outcomes.
- Dietary treatment led to diarrhea resolution within 0.5 to 10 months.
- Catch-up growth occurred over 4 to 36 months, with median final height and weight deviations of -0.6 SD and -0.8 SD, respectively.
Conclusions:
- Postenteritis enteropathy can cause severe initial growth retardation but is manageable with appropriate dietary interventions.
- Elemental and lactose-free diets are effective in resolving diarrhea and promoting catch-up growth in affected children.
- Predicting the duration of diarrhea or catch-up growth based on initial parameters was unsuccessful.
Abstract:
Ten patients, who developed postenteritis enteropathy with chronic diarrhoea, failure to thrive and small intestinal mucosal damage after an episode of acute gastroenteritis, were studied prospectively. All patients experienced severe growth retardation. Maximum deviation of height and weight from mean values of age-correlated normal children were -1.7 and -3.1 SD (median values), respectively, as compared to -0.1 and 0 SD before onset of the illness. One child died after 14 months of illness. The long-term outcome was satisfactory for the 9 surviving children. For these children, treatment with an elemental diet (in some cases supplemented initially with parenteral nutrition) and later a lactose-free diet lead to resolution of diarrhoea within periods ranging from 0.5 to 10 months. The phase of catch-up growth lasted from 4 to 36 months, resulting in final height and weight deviating -0.6 and -0.8 SD (median values), respectively, from normal mean values. Attempt to predict duration of diarrhoea or length of catch-up growth phase by means of age, weight before illness, characteristics of small intestinal biopsy or maximum deviation of height or weight were unsuccessful. The incidence of postenteritis enteropathy for children of North European ethnic origin was estimated to be 7.6/1,000,000 children below 7 years of age/year, corresponding to 1.2/1,000 children hospitalized for acute gastroenteritis.