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Colonic dysfunction during shigellosis.

T Butler, P Speelman, I Kabir

    The Journal of Infectious Diseases
    |November 1, 1986
    PubMed
    Summary
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    Shigella diarrhea stems from colon dysfunction, not increased small intestine flow. The colon shows reduced water and chloride absorption and increased potassium secretion during infection, which improves after recovery.

    Area of Science:

    • Gastroenterology
    • Infectious Diseases
    • Physiology

    Background:

    • Shigella diarrhea is a significant global health concern.
    • Understanding the precise mechanisms of fluid and electrolyte imbalance in shigella infection is crucial for effective treatment.

    Purpose of the Study:

    • To investigate the pathogenesis of shigella diarrhea by evaluating colonic fluid and electrolyte flux in patients.
    • To differentiate between small intestinal and colonic contributions to fluid derangements during shigella infection.

    Main Methods:

    • Assessed colonic fluid and electrolyte flux in 11 patients with shigella diarrhea using ileocecal and fecal flow rate measurements.
    • Employed colonoscopic perfusion techniques to directly measure colonic transport.
    • Compared acute phase findings with those during convalescence in seven patients.

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    Main Results:

    • During acute shigella infection, the colon exhibited a net fluid secretion (-0.04 ml/min) and impaired absorption of water and chloride, alongside increased potassium secretion.
    • Ileocecal flow rate was not significantly increased, indicating the small intestine was not the primary source of fluid loss.
    • During convalescence, colonic function normalized, showing significant net water absorption (+0.65 ml/min) and improved ion transport (P < .05).
    • Extensive colitis correlated with greater impairment of colonic water absorption compared to limited colitis.

    Conclusions:

    • Shigella diarrhea pathogenesis involves colonic dysfunction, characterized by diminished water and chloride absorption and increased potassium secretion.
    • Small intestinal fluid flow rate is not elevated in shigella diarrhea.
    • Restoration of colonic function, including fluid and electrolyte transport, is key to recovery from shigella infection.