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Protracted diarrhea in infancy: clinical aspects and ultrastructural analysis of the small intestine
Insights
Protracted diarrhea in infants involves severe nutritional issues and intestinal damage. Ultrastructural analysis revealed reversible mucosal changes, often linked to secondary food intolerances.
Area of Science:
- Pediatrics
- Gastroenterology
- Cell Biology
Background:
- Protracted diarrhea is defined as diarrhea lasting over two weeks in infants under three months, causing severe malnutrition.
- It is characterized by negative stool cultures for enteropathogens, suggesting non-infectious causes.
Purpose of the Study:
- To investigate the ultrastructural abnormalities in the intestinal mucosa of infants with protracted diarrhea.
- To identify the underlying causes and assess the reversibility of these mucosal changes.
Main Methods:
- Studied 40 infants with protracted diarrhea (mean age 5.1 months).
- Performed D-xylose absorption tests, triglyceride tolerance tests, and sweat tests.
- Conducted light and electron microscopy on small bowel biopsies (12 patients).
- Performed sigmoidoscopy on all patients.
Main Results:
- Infants showed significantly lower D-xylose absorption and triglyceride tolerance compared to controls.
- Electron microscopy revealed shortened microvilli, increased multivesicular bodies, and mitochondrial/endoplasmic reticulum vacuolation in the small bowel.
- These ultrastructural lesions were reversible upon clinical and nutritional recovery.
Conclusions:
- Protracted diarrhea in infants is associated with significant intestinal mucosal damage.
- Secondary carbohydrate and food protein intolerances (cow's milk, soy) are common causes, leading to colitis or malabsorption.
- The observed intestinal lesions are reversible, highlighting the importance of nutritional and clinical management.
Abstract:
Protracted diarrhea is a clinical entity characterized by diarrhea lasting greater than 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 function: D-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 lower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the microvilli, 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 cow's milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.