TABLE 9

Causes of Chronic Diarrhea in Children

CauseComment
Enteric infectionMAI, Isospora, and Microsporidia occur in immunocompromised children, including those with inadequately treated HIV infection
 Giardia lamblia
 Cryptosporidium parvum
 Cyclospora cayetanensis
 C difficile
 EAEC
 EPEC
 Mycobacterium avium-intracellulare complex
 Isospora belli
 Microsporidia
Immunodeficiency
 Primary immunodeficiencies (enteric infection, including small-bowel overgrowth)Primary immunodeficiencies are uncommon causes
 Secondary immunodeficiencies (protein energy and micronutrient malnutrition, HIV infection)Secondary immunodeficiencies, including HIV infection and malnutrition, are major causes worldwide
Abnormal immune response
 Celiac disease
 Colitis and enteropathy associated with food allergy
 Autoimmune disorders (autoimmune enteropathy, GVHD)
Idiopathic inflammatory bowel diseaseMore common in developed countries
 Crohn disease
 Ulcerative colitis
Congenital persistent diarrheaStructural defects?
 Microvillus inclusion diseaseNeonatal onset; rare
 Tufting enteropathy
 Congenital chloride diarrhea
 Congenital disaccharidase (lactase, sucrase–isomaltase) deficiencies
 Congenital bile acid malabsorption
Hereditary lactase deficiencyOnset after 3 y of age
Chronic nonspecific diarrhea of childhoodOnset between ages 6 and 36 mo and resolution by age 60 mo; child is otherwise thriving
Syndromic persistent diarrhea (associated with malnutrition)Of greatest importance in developing countries and worldwide
  • MAI indicates Mycobacterium avium-intracellulare; EAEC, enteroaggregative E coli; EPEC, enteropathogenic E coli; HIV, human immunodeficiency virus; GVHD, graft-versus-host disease.

  • Adapted from Gibbons T, Fuchs GJ. Chronic enteropathy: clinical aspects. In: Cooke RJ, Vandenplas Y, Wahn U, eds. Nutrition Support for Infants and Children at Risk. Vol 59. Basel, Switzerland: Vevey/S Karger AG; 2007:89 –104. Nutrition Institute Workshop Series: Pediatric Program and Steiner TS, Lima AAM, Nataro JP, Guerrant RL. J Infect Dis. 1998;177(1):88 –96.