Persistent and chronic diarrhea and malabsorption: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition

Despite considerable advances in the Understanding C and Management of diarrheal disorders in childhood. they, are still responsible for an estimated 2.2 million childhood deaths worldwide (1). In 1980, the World Health Organization calculated that there were >700 million episodes of diarrhea annually in children <5)years of age in developing countries (excluding China), with >4.6 million deaths (2). More recent reviews indicate that although global mortality has decreased. the incidence remains Unchanged at >3.2 episodes per child-year (3). These findings indicate the Continuing need to focus on the prevention and management of acute and chronic diarrhea in children in developing countries. Diarrheal disorders form a contintuum, the majority of cases resolving within the first week of the illness. However. a smaller proportion of diarrheal illnesses may fail to resolve and persist for >2 weeks. Persistent diarrhea (PD) may be defined as the, passage of 3 watery stools per day for >2 weeks in a child who either fails to gain or loses weight. PD identifies children with a substantial diarrhea-related morbidity and accounts for between 36% and 54% of all diarrhea-related deaths (4). Many infants and toddlers in developing countries may have frequent recurrent episodes of acute diarrhea of PD, resulting in nutritional compromising and/or predisposing these children to PD. The bulk of epidemiological data on the relationship between acute diarrheal disorders and PD are from studies undertaken > 10 to 15 years ago. There is a paucity Of recent data on this subject, especially from non-HIV endemic areas. However, chronic enteropathy and PD have been increasingly recognized as manifestations of advancing, HIV infection and AIDS.