Iv Commonwealth Congress On Diarrhoea And Malnutrition; Karachi, Pakistan; Meeting Of The Commonwealth Association Of Pediatric Gastroenterology And Nutrition; November 21-24, 1997
THE OPTIONS FOR FEEDING IN THE TREATMENT OF PERSISTENT DIARRHOEA
Successful nutritional rehabilitation of children with persistent diarrhoea (PD) requires an understanding of the biology of malnutrition and of the dietary guidelines for provision of appropriate diets. Malnutrition is a significant factor determining diarrhoeal duration and predisposes to treatment failure in children with PD. A clear understanding of the pathophysiology of these processes is essential to successful management. This entails an appreciation of: (i) the severity of malnutrition and its impact on cellular function and on all the body's organ systems; (ii) the importance of the effects of microbial infection and (iii) the central role of prolonged damage to the organ of digestion and assimilation of the food - the small intestine. Damage to the small intestinal mucosa both in terms of structure and function has been demonstrated in several studies of children with PD. An understanding of the complex interactions that take place at the small intestinal luminal-mucosal interface is central to an understanding of the nature of PD.
A likely cause of the continuing high mortality in children with PDM is faulty case-management. Inappropriate diets (eg with high protein and sodium concentrations) that do not take account of the reductive metabolic adaptations to malnutrition are commonplace and may account for many iatrogenic deaths in children. Another crucial aspect of improving case-management is adequate treatment of systemic microbial infection which contributes significantly to the outcome of nutritional rehabilitation in children with PD.
Once PD has developed then nutritional management is the mainstay of treatment and this should lead not only to short term improvements in symptoms and weight gain but also to normal growth in the long term. Several studies have documented the improvement in clinical, biochemical and immunological status that accompanies short term nutritional rehabilitation. Therapy involves a three-stage process of addressing acute problems, restoring nutrient balance, and ensuring complete nutritional restitution. Establishing the optimum formulation for the rehabilitation diet for children with PD is currently a challenge facing may researchers around the world.
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