Approach to Congenital Diarrhea and Enteropathies (CODEs)

Cracking the Codes for Congenital Diarrhea and Enteropathies (CoDEs): A Case Report and Review

Congenital diarrhea and enteropathies (CoDEs) condition is a rare cause of chronic diarrhea in infants that can be challenging to diagnose. This article discusses key signs to recognize in considering a CoDEs diagnosis and provides an overview of the diagnostic process. We report a late preterm twin infant with intractable watery diarrhea starting shortly after birth. The infant was born from a twin pregnancy to non-consanguineous parents with an unremarkable family history. His twin brother had no complications after birth and continued to thrive. The patient initially presented with bloody stools, leading to a suspected diagnosis of necrotizing enterocolitis or cow's milk protein-induced allergic colitis. However, the emergence of profuse and watery diarrhea, failure to thrive, and hypernatremic dehydration shifted the suspicion toward malabsorptive diarrhea. An extensive workup was significant for hypernatremic metabolic acidosis and positive stool-reducing substances. Several trials of protein-hydrolysate and elemental amino acid-based formulas failed to improve symptoms. However, stool consistency improved with a trial of a carbohydrate-free, hydrolyzed protein-based formula (3232A). As a diagnostic test for specific carbohydrate malabsorption, the infant was challenged with glucose supplementation followed by fructose supplementation; his stool consistency worsened with the glucose challenge but improved with the fructose challenge. His stool pH and reducing substances were abnormal after the glucose challenge and normalized after the fructose challenge, thus indicating a clinical diagnosis of glucose-galactose malabsorption (GGM). At the time of discharge, the infant had documented weight gain and formed stools on carbohydrate-free, hydrolyzed protein-based formula (3232A) supplemented with fructose. At one-year follow-up after discharge, he continued to thrive with normal bowel movements. Outpatient genetic testing confirmed our diagnosis of GGM. GGM should be considered in infants with severe protracted, non-infectious, watery diarrhea lasting longer than two weeks. Early diagnosis and management of infants with GGM with a carbohydrate-free formula with specific carbohydrate supplementation are essential to prevent complications and ensure optimal growth and development.

DGAT1 Mutation Associated With Congenital Diarrhea in a Pediatric Patient: A Case Report

Chronic diarrhea in infants can stem from various etiologies, including congenital disorders affecting intestinal function. Here, we present a case of a one-year-old boy with persistent watery diarrhea, vomiting, and failure to thrive, ultimately diagnosed with DGAT1 deficiency through genetic testing. Despite initial investigations ruling out common causes like celiac disease, genetic analysis confirmed DGAT1 enteropathy. Management included intensive nutritional support and close monitoring, resulting in clinical improvement. This case underscores the importance of early genetic testing and tailored management in congenital enteropathies to prevent severe complications and improve patient outcomes.

Congenital chloride diarrhoea in a Chinese infant with a compound heterozygous SLC26A3 mutation

INTRODUCTION

Congenital chloride diarrhoea (CCD) is an autosomal recessive condition that causes secretory diarrhoea and potentially deadly electrolyte imbalances in infants because of solute carrier family 26 member 3 (SLC26A3) gene mutations.

CASE PRESENTATION

A 7-month-old Chinese infant with a history of maternal polyhydramnios presented with frequent watery diarrhoea, severe dehydration, hypokalaemia, hyponatraemia, failure to thrive, metabolic alkalosis, hyperreninaemia, and hyperaldosteronaemia. Genetic testing revealed a compound heterozygous SLC26A3 gene mutation in this patient (c.269_270dup and c.2006 C > A). Therapy was administered in the form of oral sodium and potassium chloride supplements, which decreased stool frequency.

CONCLUSIONS

CCD should be considered when an infant presents with prolonged diarrhoea during infancy, particularly in the context of maternal polyhydramnios and dilated foetal bowel loops.