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- Garrett C. Zella, MD*
- Esther J. Israel, MD*
- *Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA.
Author Disclosure
Drs Zella and Israel have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.
- CCD:
- congenital chloride diarrhea
- CF:
- cystic fibrosis
- CNSD:
- chronic nonspecific diarrhea
- CSD:
- congenital sodium diarrhea
- IBD:
- inflammatory bowel disease
- IBS:
- irritable bowel syndrome
- IDI:
- intractable diarrhea of infancy
- TTG IgA:
- tissue transglutaminase immune globulin A
- ZES:
- Zollinger-Ellison syndrome
Educational Gap
It is estimated that diarrheal illnesses are responsible for ∼2 to 4 million childhood deaths worldwide each year, representing 13.2% of all childhood deaths worldwide.
Objectives
After completing this article, readers should be able to:
Understand the pathophysiologic mechanisms involved in chronic diarrhea.
Know how to evaluate a child who has chronic diarrhea, including appropriate elements of history, physical examination, stool analysis, and blood testing.
Be familiar with the many disorders that cause chronic diarrhea, both with and without failure to thrive.
Know the therapies for the many causes of chronic diarrhea.
Definitions
Chronic diarrhea is a common complaint in pediatric medicine and can pose a complex situation for practitioners and families. This complaint is both a symptom and a sign. (1) Although patients or their parents often assess the presence of diarrhea by reporting stool consistency and frequency, one can more scientifically define diarrhea as stool volume >10 g/kg per day in infants and toddlers, and >200 g/day in older children. (2) However, diarrhea should not be defined solely by stool weight. Some adolescents and adults may have up to 300 g of formed stool per day without any complaints. (3) The duration of symptoms necessary to define diarrhea as “chronic” also is not definitive. Most authors agree that 14 days of symptoms meets criteria, although others use a cutoff of 4 weeks. (4) An additional term, “persistent” diarrhea, acknowledges diarrhea lasting more than 14 days but implies a more abrupt onset compared with chronic diarrhea. Regardless of the specific term or number of days of symptoms, it should be understood that this definition should allow for the usual resolution of most …
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