Etiological Analysis Of Persistent And Chronic Diarrhea In Children

Objective:To explore the etiology,incidence and clinical characteristics of persistent and chronic diarrhea in children.To study the pathogenesis and clinical characteristics of protein-losing gastroenteropathy in Chinese children.Understand the causes of persistent and chronic diarrhea in Chinese children,and achieve the purpose of early diagnosis and timely treatment of persistent and chronic diarrhea.Research methods:The clinical data of 190 cases of relocation and chronic diarrhea who were hospitalized in the Gastroenterology Department of Children’s Hospital of Capital Institute of Pediatrics from January 2017 to June 2020 were collected.Record the relevant medical history,growth nutrition,auxiliary examinations(blood,stool routine,serum protein,immune function,specific allergen test,etc.),electronic gastrointestinal endoscopy and capsule endoscopy,genetic testing and other information in detail.Data collection uses excel form to register,and data processing uses SPSS 25.0 statistical software for statistics.Research results:In the past 4 years,a total of 190 children with emigration and chronic diarrhea were collected.The male to female ratio was 1.64:1,the age range was 1 month to 17 years,and the median was 11.2 months.Among them,infants aged 0 to 3 accounted for 74.3%,and infants aged 0 to 1 accounted for 54.3%.The duration of diarrhea ranges from 0.5 to 144 months(12 years),with a median of 2.94 months;stool characteristics are mainly loose stools and watery stools(41%),followed by mucous pus and blood stools(33.2%)and mucous stools(21.6%)also accounted for a larger proportion.Fecal traits were mainly loose stools and watery stools(41%),followed by mucus pus and blood stools(33.2%)and mucus stools(21.6%).The detection rate of stool culture was 50.9%.The main pathogens are Klebsiella pneumoniae,Pseudomonas aeruginosa and fungi,mostly conditional pathogens.According to statistics,a total of 359 children were hospitalized due to diarrhea during the same period.Therefore,the overall composition of children with diarrhea and chronic diarrhea in our hospital was 52.9%,persistent diarrhea accounted for 25.9%.and chronic diarrhea accounted for 27%.The length of hospital stay was 1 to 193 days,and the average hospital stay was 6 days;the overall cure and improvement rate was 83.7%.The symptoms associated with the digestive tract are mainly abdominal pain,bloating and vomiting,and the symptoms outside the digestive tract are mainly fever,weight loss,and growth and development disorders.Common complications include malnutrition(46.3%).anemia(35.3%),electrolyte disturbance(20.5%),metabolic acidosis(13.2%)and hypoproteinemia(7.9%).Among them,mild malnutrition accounted for 37.5%,moderate accounted for 26.1%.and severe malnutrition accounted for 36.4%.42.3%and 54.3%of children had varying degrees of humoral and cellular immune function abnormalities.28.9%of children were allergic to different foods and degrees.The main allergenic foods were milk,eggs and cashew nuts.The detection rate of electronic gastrointestinal endoscopy and capsule endoscopy reached 93.1%.Among them,due to the need for diagnosis of comorbidities and etiology,73 cases underwent electronic gastroscopy.A total of 65 lesions were found under the microscope,with a detection rate of 89%;7 cases of capsule endoscopy,5 of which were abnormal,with a detection rate of 71.4%There were 4 cases of Crohn’s disease endoscopic features,and 1 case of small intestinal lymphangiectasis.In 125 cases of electronic colonoscopy,94 cases of mucosal lesions were seen(the detection rate was 75.2%);90 cases of children underwent pathological examination of the large intestine,the pathology was mucosal inflammation,lymphoid follicular hyperplasia,chronic active inflammation with cryptitis,Crypt abscess and mucosal inflammation accompanied by ulcers and granulomas.There were 14 cases of genetic testing,including 13 cases using target genome capture sequencing(panel sequencing),and 1 case using whole exome sequencing(WES).8 cases of abnormally mutated genes were found,with a detection rate of 57.1%.There were 3 cases of IL-10RA,1 case of LRBA,1 case of IL-10RB,1 case of G6PC,1 case of CYBB,1 case of EDNRB.There were 169 cases with a clear cause,and the diagnosis rate was 88.9%.The main causes of children’s migration and chronic diarrhea were food allergy(FA)(32.1%),inflammatory bowel disease(IBD)(12.6%),irritable bowel syndrome(IBS)(8.9%)and infectious factors(5.8%),but 11.1%of children still have no clear cause after a more comprehensive examination.In this group of studies,11 of the 15 children(7.9%)with hypoalbuminemia were diagnosed with protein-losing gastroenteropathy,accounting for 5.8%of all children with migratory and diarrhea in this group.The ratio of male to female was 1:1.2,all are within 1 year old,63.6%of the children have different degrees of malnutrition,and 90.9%of the children have different degrees of anemia.The laboratory examination is characterized by a simultaneous decrease in albumin and globulin.It consisted of 6 cases of small intestinal lymphangiectasis,Crohn’s disease,1 case of post-infection enteritis,and 1 case of eosinophilic gastroenteritis,and 2 cases of unclear etiology.Conclusions:Infant migration and chronic diarrhea occur frequently in infants and young children,especially infants,with various causes,mainly non-infectious factors,and prone to comorbidities such as anemia,malnutrition and hypoproteinemia.FA and IBD are the causes of children migration and chronic diarrhea Important cause.A detailed medical history and physical examination are the prerequisites for the diagnosis and treatment of chronic diarrhea.Fecal routine and culture are the basis for diagnosis.Endoscopy is the key to diagnosis.If necessary,genetic testing is required to determine the cause.In this group of studies,A total of 11 children with PLG were diagnosed,accounting for 5.8%of children with migration and chronic diarrhea.Pediatricians need to strengthen their understanding of this disease.