[Show abstract][Hide abstract] ABSTRACT: Functional diarrhea (FD) or non-specific chronic diarrhea (NSCD) is considered as the most frequent cause of chronic diarrhea
without failure to thrive in toddlers. According to the Rome III classification, this clinical entity is defined as a daily
painless, recurrent passage of three or more, large, unformed stools during a period of at least 4 weeks, with an absence
of alarm signs such as failure to thrive if caloric intake is adequate, abdominal pain, or blood in the stool and emesis.
The clinical history is the key point to identify patients with FD. Minimal blood and stool tests may help to differentiate
between the causes of diarrhea such as infection, celiac disease, and inflammatory conditions. The pathophysiology of FD is
not well understood. Starch, fructose, and sorbitol malabsorption have been implicated as important nutritional substances
in the development of FD. In the same hand, parental factors are important in the perpetuation of functional diarrhea and
induction of complications such as malnutrition. Functional diarrhea in childhood is a self-limiting disease and therefore
no treatment is necessary. The recognition that dietary factors play a key role in the majority of these children has focused
awareness upon the dietary intervention of this FGID.
Key WordsFunctional diarrhea-Toddler’s diarrhea-Unspecific diarrhea-Chronic diarrhea
[Show abstract][Hide abstract] ABSTRACT: Endocrine neoplasms of the gut are a rare cause of chronic diarrhea and account for <1% of patients who present with chronic
diarrhea. However, diarrhea associated with endocrine neoplasms can cause significant morbidity and mortality, and clinicians
should recognize the diarrheal syndromes associated with endocrine neoplasms. This chapter discusses pathophysiology, diagnostic
tests, and treatment options for diarrhea associated with endocrine neoplasms.
Key WordsChronic diarrhea-Secretory diarrhea-Neuroendocrine tumors
[Show abstract][Hide abstract] ABSTRACT: Celiac disease (CD) is an autoimmune disorder occurring in genetically susceptible individuals, triggered by gluten and related
prolamins, and plant storage proteins found in wheat, barley, and rye. It affects primarily the small intestine, where it
progressively leads to flattening of the small intestinal mucosa and subsequent nutrient malabsorption. Its pathogenesis involves
interactions among genetic, environmental, and immunological factors. Well-identified haplotypes in the HLA class II region
(DQ2, DQ8) confer a large part of the genetic susceptibility to CD. Four possible presentations of CD are recognized: (1)
typical, characterized mostly by gastrointestinal signs and symptoms; (2) atypical or extra-intestinal, where gastrointestinal
signs/symptoms are minimal or absent and a number of extra-intestinal manifestations are present; (3) silent, where the small
intestinal mucosa is damaged and CD autoimmunity can be detected by serology, but there are minimal or no symptoms; and finally
(4) latent: these individuals, who possess genetic compatibility with CD and may also show positive autoimmune serology, have
a normal mucosa morphology and may or may not be symptomatic. The diagnosis of celiac disease still rests on the demonstration
of changes in the histology of the small intestinal mucosa. Currently, serological screening tests (serum levels of IgA–anti-tissue
transglutaminase are generally acknowledged as the first choice) are utilized primarily to identify those individuals in need
of a diagnostic endoscopic biopsy. Serology, including the newer anti-deamidated gliadin peptides, is also employed in monitoring
the response to a gluten-free diet, which constitutes the only available treatment. Newer forms of treatment which will probably
be available include enzymes degrading gluten to be ingested with meals; the use of substrates regulating intestinal permeability
so as to prevent gluten entry across the epithelium; the development of genetically modified grains; and finally the development
of different forms of immunotherapy.
Key WordsCeliac-Malabsorption-Chronic diarrhea-Autoimmunity-Diabetes-Down syndrome-Short stature-Gluten-Gliadin-Tissue transglutaminase-Anti-endomysium antibodies-Deamidated gliadin peptides-Marsh-Villous atrophy-Intraepithelial lymphocytes-Refractory sprue-EATL-Enamel hypoplasia
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