Chronic diarrhea in children

Comparison of safety, effectiveness and serum inflammatory factor indexes of Saccharomyces boulardii versus Bifidobacterium triple viable in treating children with chronic diarrhea: a randomized trial

BACKGROUND

Diarrhea is common in children under 5 years of age and is an important public health problem in China. CD is the main obstacle to the growth and development of children, which brings a great burden to individuals, families and society. The objective of this work is to study the efficacy and safety of Saccharomyces boulardii versus Bifidobacterium triple viable in the treatment of CD in children.

METHODS

From October 2018 to October 2020, a total of 161 children aged 2-8 years hospitalized with CD were randomly allocated into S. boulardii group, Bifidobacterium triple viable group and control group. After 14 days of treatment, the curative effect and recovery time of the three groups were evaluated. The levels of serum interleukin (IL)-6, IL-7 and tumor necrosis factor-alpha (TNF-α) before and after the treatment were valuated and compared among the three groups, together with clinical efficacy and safety.

RESULTS

The recovery time of the Bifidobacterium triple viable group was significantly shorter than that of S. boulardii group (P<0.05). The marked effective rate and total effective rate of the Bifidobacterium triple viable group were significantly higher than those of the control group (P<0.05); the total effective rate of the S. boulardii group was significantly higher than that of the control group (P<0.05). The improvement in the levels of IL-6, IL-7 and TNF-α in the Bifidobacterium triple viable group was greater than that in the control group; the improvement in IL-6 and IL-7 levels in the Bifidobacterium triple viable group was greater than that in the S. boulardii group; the improvement in IL-6 and IL-7 levels in the S. boulardii group was greater than that in the control group, and the differences were statistically significant (P<0.05).

CONCLUSIONS

The efficacy of Bifidobacterium triple viable and S. boulardii in the treatment of children with CD was better than that of conventional treatment. The treatment effect for Bifidobacterium triple viable was more significant, and it was proved to be safe, to shorten the course of disease, and have clinical relevance.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100046444.

Chronic diarrhea

Chronic diarrhea is a complex and common problem faced by primary care clinicians. Its causes can range from the common and relatively benign excessive juice consumption to the more alarming inflammatory bowel disease (IBD). This paper will review the definition and etiology of chronic diarrhea and aims to provide a simple approach to its diagnosis and management including when, if appropriate, to refer to GI specialist.

Detection of parasites in children with chronic diarrhea

The aim of this study was to investigate the frequency of intestinal parasites in patients with chronic diarrhea and clarify the importance of these parasitic pathogens in such cases. A total of 60 pediatric patients with chronic diarrhea between June 2012 and October 2014 were enrolled in the study. Out of 60 stool samples, five were positive for Giardia lamblia, two, Dientamoeba fragilis, and one, Blastocystis hominis. One stool sample was positive for Entamoeba hartmanni and B. hominis, another one was positive for G. lamblia and B. hominis, another, G. lamblia and E. hartmanni and one sample was positive for Enterobius vermicularis, D. fragilis and B. hominis together. Parasitic infection, which decreases quality of life and increases susceptibility to other infections, should not be neglected, particularly in patients with chronic diarrhea. Accurate diagnosis decreases morbidity and mortality in patients with parasite infection.

Two single group, prospective, baseline-controlled feeding studies in infants and children with chronic diarrhea fed a hypoallergenic free amino acid-based formula

Background

Infants and children with chronic diarrhea (CD) often require specialized foods or parenteral nutrition (PN) to achieve adequate nutrient intakes to support growth and development. We assessed the efficacy of an amino acid-based formula (AAF) in supporting growth and improving symptoms in infants and children with CD from multiple etiologies.

Methods

Two studies were conducted: CD study in children (CD-C) and CD study in infants (CD-I). Each was a single group, baseline-controlled study in which each subject served as his/her own control. At enrollment, all subjects had CD lasting > 2 weeks and had ≥ 4 stools/day. Subjects were fed an AAF for 80 days starting at SD5, and were assessed at SD 28 and 84.

Results

CD-C: 18 of 19 subjects completed the study. At enrollment, the mean age was 5.6 ± 0.7 years, the most common diagnosis was short bowel syndrome (SBS) (n = 13), and 5 subjects with SBS were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.026). Over 50% of subjects achieved improvements in clinical outcomes targeted most frequently by their physicians. Of the five subjects on PN at enrollment, four had substantial weight gain and four had their PN requirements decreased. CD-I: 22 of 27 subjects completed the study. At enrollment, the mean age was 3.3 ± 0.3 months, the most common diagnosis was food allergy (n = 20), and no subjects were on PN. Subjects achieved significant increases in weight-for-age z-scores (p = 0.0023), significant decreases in the number of stools/day (p = 0.0012), and improvements in stool consistency (p = 0.0024). Over 80% of subjects achieved improvements in the clinical outcomes targeted most frequently by their physicians.

Conclusions

Infants and children with CD fed an AAF for three months displayed significant improvements in weight-for-age z-scores and clinical symptoms. Children dependent on PN also grew well and four of five decreased their dependence on PN.

Trial registration

Both trials were registered on ClinTrials.gov (CD-C, NCT01812629; CD-I, NCT01820494).

Enteroaggregative coli: A Pathogen Bridging the North and South

Enteroaggregative Escherichia coli (EAEC) is a heterogeneous emerging enteric pathogen. Identified during the 1980's when EAEC strains where isolated from cases of acute and persistent diarrhea among infants from developing countries and of traveler's diarrhea. Subsequently, EAEC strains were linked with foodborne outbreaks and diarrhea illness in adults and children from industrialized countries, HIV-infected subjects and stunting of malnourished poor children. Nowadays, EAEC is increasingly recognized as a major cause of acute diarrhea in children recurring hospitalization and of traveler's diarrhea worldwide. EAEC strains defining phenotype is the aggregative adherence (AA) pattern on epithelial cells. AggR a transcriptional regulator of several EAEC virulence genes has been a key factor in both understanding EAEC pathogenesis and defining typical EAEC (tEAEC) strains. EAEC virulence genes distribution among these strains is highly variable. Present challenges are the identification of key virulence genes and how they coordinately function in the setting of enteric disease.

Method development for fecal lipidomics profiling

Robust methodologies for the analysis of fecal material will facilitate the understanding of gut (patho)physiology and its role in health and disease and will help improve care for individual patients, especially high-risk populations, such as premature infants. Because lipidomics offers a biologically and analytically attractive approach, we developed a simple, sensitive, and quantitatively precise method for profiling intact lipids in fecal material. The method utilizes two separate, complementary extraction chemistries, dichloromethane (DCM) and a methyl tert-butyl ether/hexafluoroisopropanol (MTBE) mixture, alone or with high pressure cycling. Extracts were assessed by liquid chromatography-high-resolution mass spectrometry-based profiling with all ion higher energy collisional dissociation fragmentation in both positive and negative ionization modes. This approach provides both class-specific and lipid-specific fragments, enhancing lipid characterization. Solvents preferentially extracted lipids based on hydrophobicity. More polar species preferred MTBE; more hydrophobic compounds preferred DCM. Pressure cycling differentially increased the yield of some lipids. The platform enabled analysis of >500 intact lipophilic species with over 300 lipids spanning 6 LIPID MAPS categories identified in the fecal matter from premature infants. No previous report exists that provides these data; thus, this study represents a new paradigm for assessing nutritional health, inflammation, and infectious disease in vulnerable populations.

How to do in persistent diarrhea of children?: concepts and treatments of chronic diarrhea

Chronic diarrhea is defined as passing watery stools that lasts for more than 2 weeks. Persistent diarrhea belongs to chronic diarrhea and is a chronic episode of diarrhea of infectious etiology. The etiology of chronic diarrhea is varied. It is important to consider the child's age and clinical manifestations with alarm signals for an application of proper treatments to children with chronic diarrhea. Vicious cycle is present in chronic diarrhea and nutritional rehabilitation can break the vicious cycle of chronic diarrhea and is one of the main one thing among treatments. We should know the exact concept of chronic diarrhea and provide appropriate treatments according to etiologies of chronic diarrhea.