Chronic diarrhea in North Indian children: a widening etiological spectrum

Background: Objectives of current study were to define the etiological spectrum and outcome of children with chronic diarrhea and to evaluate for any change in etiological spectrum of chronic diarrhea over five years. Methods: In this retrospective study the hospital records of all patients with chronic diarrhea evaluated at the Department of Pediatric, Era's Lucknow medical college and hospital Lucknow & Vivekananda polyclinic & institute of medical sciences Lucknow, India over a period of five years i.e. from July 2006-July 2011, were reviewed. Results: During the study period of 5 years, a total of 135 children [mean age 5.6 ± 4.2 year, 83 (61.48%) boys] of chronic diarrhea were seen (19 large bowel, 103 small bowel type, 13 mixed type). Of them 50 children with incomplete workup were excluded from data analysis, hence evaluation was done for a total 85 children, in which 6 cases (7.05%) had no definite etiology discerned and were labeled in indeterminate group. We had only 2 cases of abdominal tuberculosis presenting as chronic diarrhoea with other symptoms of fever, anorexia and lymphadenopathy. We had 1 case of inflammatory bowel disease (ulcerative colitis) & 1 cases of intestinal lymphangiectasia. Diagnosis was made on demonstration of AFB on ileal biopsy. Conclusion: Chronic diarrhea accounted for 13-15% of total patients from two multispecialty hospitals of Lucknow which cater to a large population from U. P. Celiac disease remains the most important cause of chronic diarrhea in children from this region. Non-specific diarrhea and giardiasis still are important treatable etiologies. In case of chronic diarrhea with presence of blood in stool in young children, cow milk allergy was most common etiology. Immunodeficiency entity should be looked for in children, when routine work up for chronic diarrhea does not give any result. Intestinal TB is uncommon cause of chronic diarrhea as shown in our study; hence inadvertently ATT should not be prescribed for child presenting with diarrhea without any firm evidence.