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[Old and new data on diarrhetic diseases in childhood I. Etiology and pathophysiology]
Insights
Acute diarrhea is often caused by an imbalance in gut bacteria, leading to increased fluid secretion and nutrient malabsorption. Recent research highlights the roles of specific bacteria and toxins in this common condition.
Area of Science:
- Gastroenterology
- Microbiology
- Pathophysiology
Context:
- Acute diarrhea is a prevalent condition with significant morbidity.
- Understanding its etiology and pathophysiology is crucial for effective treatment.
Purpose:
- To provide a comprehensive review of recent research on the etiology and pathophysiology of acute diarrhea.
- To highlight novel insights into the role of intestinal bacterial homeostasis.
Summary:
- Disturbances in intestinal bacterial homeostasis, including small intestinal bacterial overgrowth, are central to acute diarrhea.
- Anaerobic organisms alter bile acid metabolism and fatty acid metabolism, increasing intestinal fluid secretion.
- Enterotoxigenic *Escherichia coli* (E. coli) is a major cause of infantile diarrhea, with distinct enterotoxic and enteroinvasive mechanisms identified.
- Bacterial overgrowth leads to disaccharidase deficiencies in the intestinal mucosa.
Impact:
- This review emphasizes a paradigm shift in understanding acute diarrhea, moving beyond older views to incorporate microbial dysbiosis.
- Identifies specific bacterial mechanisms contributing to fluid and electrolyte imbalance.
- Provides a foundation for developing targeted therapies for acute diarrhea based on its underlying pathophysiology.
Abstract:
Etiology and Pathophysiology. The present article is a comprehensive review of recent research results in the field of acute diarrhea. The most important new idea in contrast to older views is that almost all acute diarrheas are associated with a disturbance of intestinal bacterial homeostasis: overgrowth of the small intestine with apathogenic or pathogenic organisms is followed by changes in intestinal metabolism with increase in intestinal water and electrolyte secretion. Anaerobic organisms cause by enzymatic deconugation and dydroxylation of bile acids secretion of fluid into the small intestine and inhibition of fluid absorption from the large intestine. 10-OH-fatty acids, which are formed intraluminally by enzymatic hydroxylation of long-chain unsaturated fatty acids from the diet by similar anaerobic organisms, produce profuse secretion of fluid into the small intestine. The ability of numerous strains of E. coli to produce enterotoxin, which has a qualitatively similar action to cholera toxin, is now considered to be a major cause of infantile diarrhea. The separation of two completely different pathophysiologic mechanisms of E. Coli, the enterotoxic and the enteroinvasive action which are determined by extranuclear chromosomal material, is an important result of recent research. Overgrowth of the small intestine with different bacteria is followed by loss of actiivity of lactase, and later of all disaccharidases in the intestinal mucosa.