Çocuklarda Kronik İshale Yaklaşım

Year 2018, , 52 - 58, 01.07.2018

Nafiye Urgancı

https://doi.org/10.5222/j.child.2018.47568

Abstract

İshal genel olarak günlük dışkı miktarının veya dışkının su içeriğinin artmasıdır. Bebek ve çocuklarda dışkı miktarının 10 g/kg/gün; adolesan ve erişkinlerde 200 g/kg/gün olması ishal olarak tanımlanır. İki haftadan uzun sürenler kronik veya persistan ishal olarak tanımlanmaktadır. Esas patofiz- yolojik mekanizmalar osmotik, sekretuvar, motilite bozuk- luğu ve inflamasyondur. İshal nedenleri yaşa göre değiş- kenlik göstermekle birlikte gelişmekte olan ülkelerde enfek- siyonlar sık neden iken gelişmiş ülkelerde fonksiyonel bağırsak hastalıkları, malabsorbsiyon ve inflamatuvar bağırsak hastalıkları en sık nedenlerini oluşturmaktadır. İyi öykü ve fizik muayenenin dikkatli yapılması, tanı için gereksiz test ve girişim yapılmasını engeller. Tedavide amaç nedene yönelik tedavi, beslenme durumunu düzelt- mek ve büyümeyi sağlamaktır

Keywords

İshal, kronik, çocuk

Approach to the Treatment of Chronic Diarrhea in Children

Abstract

Diarrhea is generally an increase in the amount of daily stool or water in the feces. The amount of feces in infants and children is 10 g/kg/day; Adolescents and adults with diarrhea of 200 g/kg/day. Patients who are more than two weeks old are defined as chronic or persistant diarrhea. The main pathophysiological mechanisms are osmotic, secretory, motility disorders and inflammation. While cau- ses of diarrhea vary according to age, in developing count- ries frequent causes of incidence are functional intestinal diseases, malabsorption and inflammatory bowel diseases in developed countries. Careful management of good his- tory and physical examination prevents unnecessary tes- ting and intervention for diagnosis. The goal of treatment is to improve the condition of nutrition and to provide growth

Keywords

Diarrhea, chronic, child

References

• Guarino A, Branski D. Chronic diarrhea. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders Elsevier; 2011. p.1339-46.
• hutta ZA, Ghishan F, Lindley K, Memon IA, Mittal S, Rhoads JM; Commonwealth Association of Paediatric Gastroenterology and Nutrition. Persistent and chronic diarrhea and malabsorption: Working Group report of the second World Congress of Pediatric Gastroente- rology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2004;39 Suppl 2:S711-6.
• Preidis GA, Hill C, Guerrant RL, Ramakrishna BS, Tannock GW, Versalovic J. Probiotics, enteric and diarrheal diseases, and global health. Gastroenterology. 2011;140:8-14.
• World Health Organization. Diarrhoeal Disease: Fact Sheet N 330. Geneva, Switzerland: WHO; 2013.
• Zella GC, Israel EJ. Chronic diarrhea in children. Pediatr Rev. 2012;33:207-17.
• Henry J, Binder JH. Causes of chronic diarrhea. N Engl J Med 2006;355:236-9.
• Kellermayer R, Schulman JR. Overview of the causes of chronic diarrhea in children in resource-rich countri- es. www.Updated .com erişim tarihi 17.1 2017.
• Vernacchio L, Vezina RM, Mitchell AA, Lesko SM, Plaut AG, Acheson DW. Characteristics of persistent diarrhea in a community-based cohort of young US children. J Pediatr Gastroenterol Nutr. 2006 Jul;43(1): 52-8.
• Giannattasio A, Guarino A, Vecchio LA. Management of children with prolonged. F1000Research 2016, 5(F1000 Faculty Rev):206, F1000Research 2016, 5(F1000 Faculty Rev):206 Last updated: 23 FEB 2016 1-11.
• Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology. 1999;116:1464-86.
• Schiller LR. Chronic diarrhea. Gastroenterology. 2004;127(1):287-93.
• Gupta R. Diarrhea. In: Wyllie R , Hyams SJ, Kay M. eds. Pediatric Gastrointestinal and Liver Disease: 5th ed. Phladelphia; 2011: p.104-124.
• Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007;25(4): 349-63.
• Yüce A. Kronik diyare. Katkı Pediatri Dergisi. 1994:283-96.
• Guarino A, Lo Vecchio A, Berni Canani R. Chronic diarrhoea in children. Best Pract Res Clin Gastroenterol. 2012;26:649-61
• Moore SR, Lima NL, Soares AM, Orìa RB, Pinkerton RC, Barrett LJ, et al. Prolonged episodes of acute diarr- hea reduce growth and increase risk of persistent diarr- hea in children. Gastroenterology 2010;139:1156-64.
• Foell D, Wittkowski H, Roth J. Monitoring disease activity by stool analyses: from occult blood to mole- cular markers of intestinal inflammation and damage. Gut 2009;58(6):859-68.
• Eherer AJ, Fordrant JS. Fecal osmotic gap and pH in experimental diarrhoea of various causes. Gastroenterology 1992;103:545-51.
• Sherman PM, Mitchell DJ, Cutz E. Neonatal enteropat- hies: defining the causes of protracted diarrhea of infancy. J Pediatr Gastroenterol Nutr 2004;38(1):16- 26.
• Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child. 2007;92(10):902-8.