Chronic diarrhoea in children

Question 1

Sugar intolerance

Answer 1

Synonyms: carbohydrate intolerance, lactose intolerance.

The commonest offending sugar is lactose.

Diarrhoea often follows acute gastroenteritis when milk is reintroduced into the diet.

Stools may be watery, frothy, smell like vinegar and tend to excoriate the buttocks.

They contain sugar.

Investigation: lactose breath hydrogen testing.

Treatment:

Remove the offending sugar from the diet.

Use milk preparations in which the lactose has been split to glucose and galactose by enzymes, or use soya protein.

Question 2

Cows milk protein intolerance

Answer 2

Not as common as lactose intolerance.

Diarrhoea is related to taking a cows milk formula and relieved when it is withdrawn.

Replace with either:

• soy
• a hydrolysed or
• an elemental formula

Question 3

Chronic enteric infection

Answer 3

Responsible organisms include:

• Salmonella sp.
• Campylobacter
• Yersinia, Giardia lamblia
• Entamoeba histolytica.

With persistent diarrhoea it is important to obtain microscopy of faeces and aerobic and anaerobic stool cultures.

G. lamblia infestation is not an uncommon finding and can mimic coeliac disease.