الفهرس 
Epidemiology and causesOnly 14 pages are availabe for public view
 |  | from | 145 |  |  |
| | | from | 145 | | |
Abstract
Chronic diarrhea is a common condition affecting 3-5% of infants and accounts for more than half of diarrheal deaths world wide among children younger than 5 years. The major causes of chronic diarrhea vary markedly with age and differ between developed and developing countries. Cow’s milk allergy (CMA) is estimated to affect 2-7.5% of children. Diarrhea is the most frequent gastointestinal symptom due to CMA, observed in 50-90% of cases, and is the presenting symptom in 50% of cases.
This clinical study was conducted on infants and children with chronic diarrhea to establish the etiologic profile of such a problem in the Egyptian Pediatric Population. This work included 124 patients presented to Outpatient Pediatric Clinic, Children’s Hospital, Ain Shams University with the complaint of chronic diarrhea.
This cross-sectional study included 124 patients with chronic diarrhea; they were 77 males and 49 females, with age ranging between 2 and 198 months and a mean age of 27.3 +/- 34.5 months.
Each patient was subjected to medical history taking including age of onset and duration of diarrhea, consistency of stools, presence of blood and mucus, vomiting with or without hematemesis, abdominal distension, fever, allergic manifestations and family history of atopy. Dietetic history included milk feeding during the first 6 months and age of weaning and age of introduction of cow’s milk products.
Examination included general condition “toxic, ill, fair GC” and anthropometric measurements including weight for age “WFA” and height for age “HFA”, Z scores were calculated according WHO growth charts (WHO, 2006).
Laboratory investigations included stool analysis and culture, CBC and all other investigations necessary for diagnosis of the definite cause including RAST for specific IgE against cow’s milk proteins, serology for celiac disease (anti-gliadin and anti tTG), Breath hydrogen test, endoscopy (colonoscopy or esophago-gastro-dudenoscopy) and histopathologic assessment of endoscopic biopsies. CMA was diagnosed on basis of withdrawal and open re-challenge technique.
It was found that Causes of chronic diarrhea included CMA (40.3%), SIBO (13.7%), Giardiasis (12.9%), Celiac disease (10.5%), IBD (6.47%), lactose intolerance (4.03%), chronic non specific diarrhea (3.02%), infectious colitis (3.02%), eosinophilic colitis (1.06%), post-surgery short bowel syndrome (1.06%), glucose galactose malabsorption (0.81%), neuroblastoma (0.81%) and lymphocytic colitis (0.81%).
Among all cases of chronic diarrhea; (72.6%) started during infancy; before 2 years of age; CMA accounted for the most common cause (48.9%) of chronic diarrhea starting during this period. While (21.8%) of chronic diarrhea starting between 2-6 years of age; Giardiasis accounted for the most common cause of chronic diarrhea starting (48.9%) during this period. While (5.6%) of chronic diarrhea starting above 6 years of age; IBD accounted for the most common cause (71.4%) of chronic diarrhea starting during this period.
Patients with CMA had significantly higher frequency of mucoid (62%), bloody diarrhea (40%), vomiting (58%), cow’s milk intake (25.5%), early age of weaning (51%), atopic manifestations (48%) and FH of allergy (40%). Patients with CMA had significantly lower frequency of fever (0%), exclusive breast feeding during the first 6 months (23.5%) and significant anemia (19.6%).
CNOCLUSION:
Cow milk allergy is the most common cause of chronic diarrhea in pediatrics followed by chronic infections (SIBO, Giardiasis and infectious colitis).
CMA should be suspected in the presence of early age of onset before 6 months, early onset of weaning before 4 months, use of cow milk and lack of breast feeding, mucoid bloody diarrhea, vomiting, absence of fever, atopic features or FH of atopy. These clinical predictors may help to choose those infants appropriate for withdrawal and re-challenge test for definite diagnosis of CMA.