Epidemiology of Chronic Diarrhea Among Children Admitted to Gastroenterology Unit at Assuit University Children Hospital

Infectious diarrhea caused by invasive bacteria (Shigella, Salmonella, Campylobacter) or a cytotoxic organism result ting in mucosal histologic damage and inflammation (Entamoeba histolytica). (Hedberg etal., 1994)

Giardia lamblia Transmission is via the faecal oral route or via ingestion of contaminated water sources. Symptoms of Giardia infection include diarrhea, malaise, flatulence, foul smelling greasy stools, bloating/ distention and, less commonly, nausea, anorexia and vomiting. (Dib etal., 2008)

Entamoeba histolytica is the causative agent of amoebiasis. The majority of patients will have asymptomatic or low level disease with a gradual onset of diarrhea with generalized abdominal tenderness. Fever is not usually associated with amoebic disease. Mucus and/or blood may be present if the organism penetrates the bowel wall and causes mucosal damage. (Van Hal etal., 2007)

Inflammatory bowel diseases, including Crohn disease & ulcerative colitis ,cause chronic diarrhea that is often associated with abdominal pain, elevated inflammatory markers, and increased concentrations of fecal calprotectin. The severity of the symptoms is highly variable with a pattern characterized by long periods of well-being followed by exacerbations (Bunn etal., 2001)

Lactose is the sugar found in milk .Because lactose is not digested properly in the small intestine of individuals who are lactose intolerant; it passes whole into the large intestine or colon. Upon reaching the colon it is broken down by the normal colon bacteria. This breakdown results in the production of carbon dioxide and hydrogen gases. The gas production can lead to (Abdominal distension, excess gas and diarrhea, watery and explosive bowel movements, urgency). The severity of symptoms is usually proportional to the amount of the milk sugar ingested with more symptoms following a meal with higher milk sugar content. (Marsha, 2012).