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Query: UMLS:C0024523 (malabsorption)
 7,319 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the findings of a two-year survey of faecal specimens for the protozoal pathogen, Cryptosporidium. Of the 2248 patients who were tested, 55 (2.5%) patients were found to have cryptosporidial infection. Transmission of the parasite appeared mainly to occur from person to person. In immunocompetent patients it caused an acute and sometimes severe gastroenteritis. Immunoincompetent patients experienced a variable illness that ranged from asymptomatic carriage to severe diarrhoea, causing malabsorption and ultimately death. Cryptosporidium is an important cause of gastroenteritis and may be the presenting feature of the acquired immunodeficiency syndrome. Therefore, it is pertinent to screen for this pathogen in all patients with acute diarrhoea.
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PMID:Human infection with Cryptosporidium spp.: results of a 24-month survey. 365 29

A better understanding of the physiologic response to and nutritional consequences of acute diarrhea can facilitate an improved outcome for this and other infectious diseases. Acute diarrhea causes the host to undergo a sequence of hormonal, metabolic, and immunologic responses, all of which have nutritional consequences. Its most profound effect is on the malabsorption of water and electrolytes by the intestinal epithelial cell, the electrolyte, leading to dehydration. Diarrhea is defined as any alteration of fluid and electrolyte movement that results in increased fecal water due to an excessive amount of solute in the stool. Infectious agents that damage the enteric mucosa cause villous atrophy, which is accompanied by increased proliferation, migration, and extrusion of epithelial cells; this results in alterations of fluid and electrolyte movement and is the final common pathway to the development of diarrhea. During the acute stages of diarrhea, there are increased losses of fecal weight and volume as well as sodium and chloride and the level of disaccharidase enzymes is depressed. Different bacteria affect different parts of the gastrointestinal tract. After bacterial adherence and surface colonization of the intestinal epithelium, diarrhea can result from any of 3 major mechanisms: 1) production and release of enterotoxins, 2) direct invasion of the mucosa or submucosa, and 3) adhesion and cytotoxic disruption of the microvilli of the enterocyte. There is evidence of diarrhea-associated changes in the plasma concentration of certain gastrointestinal hormones and indications that calcium plays a key role in the intracellular regulation of electrolyte transport. The impact of diarrhea will be more significant in the debilitated or marginally nourished child. To improve the host response to infection, nutrients that are essential for optimal immune function and are rapidly being metabolized should be selectively replaced, while nutrients needed by the offending organism can be withheld.
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PMID:Nutritional implications and physiologic response to pediatric diarrhea. 394 85

Fifty children with acute diarrhoea, in which the only germ found in stools was Campylobacter fetus jejuni, are studied. Digestive complications occurred are discussed. Nine (18%) had lactose malabsorption, associated in two (4%) with saccharose malabsorption and in one (2%) with cow's milk protein intolerance. All complications were temporary, and carbohydrate malabsorption disappeared between one and three months.
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PMID:[Digestive complications of Campylobacter enteritis]. 400 54

An epidemic of acute diarrhea in a village in southern India in 1972 was associated with a high rate of isolation of enteric pathogenic bacteria from the patients and lasted for three months. There was no significant association between the prevalence of enteroviruses or parasites and cases of diarrhea. The epidemic started as a common-source outbreak due to the contamination of well water, and there were many secondary cases probably due to a person-to-person spread. The illness did not produce chronic diarrhea or malabsorption.
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PMID:A common-source epidemic of mixed bacterial diarrhea with secondary transmission. 609 2

The literature on oral sugar-electrolyte mixtures for treatment of acute diarrhoea is reviewed. Several trials have shown that the solution proposed by the WHO for developing countries containing inter alia 90 mmol/l of sodium and 111 mmol/l of glucose is safe for short term oral rehydration. When used in this manner there is no risk for development of hypernatraemia. The surplus base of the solution is not essential and, furthermore, other anions e.g. acetate may be substitute for bicarbonate. Other modifications of the WHO formula have also been successfully tried, e.g. sucrose 4% (117 mmol/l) instead of glucose 2% (111 mmol/l). A somewhat lower concentration of sucrose may, however, prove to be better. Most acute childhood diarrhoeas are not mediated by enterotoxin and thus not of the secretory type, but temporary malabsorption is common. Therefore, the amount of carbohydrate in oral sugar-electrolyte mixtures should be limited. Osmotic diarrhoea due to carbohydrate malabsorption is a more likely cause of hypernatraemia in dehydrated children than too much dietary sodium. In developed countries prepacked oral sugar-electrolyte mixtures are mainly designed for moderately sick children treated at home. There is no reason to raise the carbohydrate content of these mixtures above that of the WHO formula, but the sodium content must be lower. For most situations in home treatment 50 mmol/l of sodium will be adequate.
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PMID:High sugar worse than high sodium in oral rehydration solutions. 634 Apr 10

Whether fasting during an episode of acute diarrhea is necessary or desirable has recently been questioned. The principal argument advanced for limited fasting is the avoidance of the consequences of malabsorption, namely acidosis, excessive fluid losses, depletion of the bile acid pool, and possible mucosal injury from unabsorbed foods. Advocates of continued feeding during acute diarrhea suggest that the practice will prevent deficits of intakes of protein and calories, maintain or stimulate repair of the intestinal mucosa, and sustain breast-feeding in the breast-fed infant. There are only a limited number of clinical studies that address the issue. Available evidence suggests that, in most cases, current practice should be modified to minimize food withdrawal.
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PMID:Nutritional management of acute diarrhea: an appraisal of the alternatives. 636 24

Besides the considerable differences in the intestinal absorption of the different antibiotic classes as described in part I of this paper galenic preparations and the administration in form of a capsule -- tablet or sirup play a major role too. The particle size of antimicrobial drugs in sirup form has to be carefully selected. It should not be too small to prevent a rapid decay of the substance by gastric acid; if it is too large the dissolution of the substance is not fast enough for maximal absorption in the upper intestinal tract. Enteric coating, soluble binders, the dissolution time of a tablet are other important variables in the absorption of orally administered antibiotics. The most important influence on the resorption of orally administered antibiotics comes from the patient. Individual variations in the absorption are exceptionally high with amoxycillin. Different age groups show considerable variations in intestinal absorption which can amount to an extent of a two to threefold increase or decrease over the mean. Simultaneous administration of food or drugs have significant influences on the absorption of certain antibiotics. The pharmacokinetic investigation and bioavailability studies are done on healthy young adults. Diseases of the intestinal tract like acute diarrhea or malabsorption syndromes influence the absorption of orally administered antibiotics to a considerable extent which even renders some drugs completely ineffective. In cystic fibrosis the enteral absorption is retarded and pharmakokinetic parameters sizably altered.
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PMID:[Studies on resorption of orally administered antibiotics and chemotherapeutic agents in children and its modification. 2]. 711 Jul 36

Sucrose absorption was studied by the Breath Test method (BTH) in 41 infants presenting with acute diarrhea. In 28, studies were performed in children treated orally with a 40% sucrose solution. Malabsorption was demonstrated in 8 cases. In 36 infants, sucrose loading test (1 g/kg) was carried out between the 3rd and the 7th days of the diarrhea: malabsorption was present in 9 cases. Malabsorption was transitory in all children. The frequency of this sucrose malabsorption during acute diarrhea is not sufficient to prevent the therapeutic use of sucrose solution, but differs from the usual lack of sucrose malabsorption in chronic diarrhea, even, as shown here, in children with complete villous atrophy.
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PMID:[Breath test study of sucrose absorption in infants with acute diarrhea ]. 712 38

In acute diarrhea of infancy we distinguish between infectious and noninfectious causes. In the latter we know some autosomal recessive disorders, e.g. the glucose-galactose-malabsorption, the lactase deficiency as well as the sucrase-isomaltase deficiency. In addition the most frequent acquired disorders like the cow's milk protein intolerance and celiac disease contribute also to the group of noninfectious causes of diarrhea. Here the most effective therapy consists of the elimination of the toxic agent from the diet. In infectious diarrhea we find most frequently rotavirus as the agent but also yersinia, campylobacter fetus, salmonella, shigella, E. coli, lamblia giardia and entameba hystolytica. Generally a conservative treatment with a dietetic regimen is preferred. Only in severe cases with yersinia and campylobacter infection the addition of antibiotic drugs is necessary. Giardia lamblia and amebiasis however have to be treated with metronidazol. As the absorption of glucose is coupled with that of sodium within the small intestine in acute gastroenteritis we find a combined disturbance between salt and carbohydrate absorption. A solution containing glucose and salt is recommended therefore for oral rehydration. The amount administered within the first 24 hours should be between 150-250 ml/kg per day. So called "antidiarrhoic drugs" are questionably effective.
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PMID:[Useful and superfluous measures in the treatment of infant diarrhea]. 717 37

Oral rehydration therapy (ORT) has simplified treatment of diarrheal dehydration. Hospitals in India have diarrheal treatment and training units (DTUs) to help manage the many diarrheal cases. DTU staff keep children for 4-6 hours to correct the dehydration with ORT and feeding. Health personnel undergo training in diarrhea management at DTUs. ORT is the preferred treatment in almost all cases of acute diarrhea. It is not best for diarrheal cases which exhibit shock, profuse vomiting (3 times/hour), glucose malabsorption, abdominal distension or paralytic ileus, and high rate of purging (15 ml/kg body weight/hour). ORT successfully treats 95% cases of infantile diarrhea, even Rotavirus-caused diarrhea. Health workers should begin treating cases of severe dehydration with intravenous (IV) therapy and then administer ORT 3-4 hours later for infants and 1-2 hours later for adults. If IV therapy is not possible, the patient should receive oral rehydration solution (ORS) nasogastrically and then referred to a facility with IV therapy. WHO's ORS formula is safe for newborns and young infants. ORT is appropriate even when diarrheal cases are vomiting. ORT tends to stop vomiting 1-2 hours after initial ORS administration because it corrects acidosis. The glucose in WHO's ORS facilitates absorption of adequate sodium across the intestinal mucous membrane. ORS also restores the loss potassium ions and HCO3/citrate. If ORS is not available, sugar salt solution can be used. To achieve the optimum concentration, the amount of sucrose has to be twice that of glucose. ORS should be stored in a cool place, be covered, and used for no more than 24 hours. Antiemetics should not be given during ORT. Most diarrheas do not require any antibiotic. Sterile water is not necessary to prepare ORS. Rice gruel, coconut water, and pulse water are home available fluids which can treat dehydration. Breast feeding and regular feeding should continue during diarrheal episodes.
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PMID:Answers to questions in relation to oral rehydration therapy. 783 4


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