The Management of Persistent Diarrhoea and Malnutrition:

Summary of Meeting Presentation

Peter Sullivan from the Department of Paediatrics, University of Oxford presented a paper on 'the Management of Persistent Diarrhoea and Malnutrition (PDM) at the International Child Health Group Meeting on Managing Childhood Malnutrition: in Birmingham.

Dr Sullivan explained, how a pressing concern amongst paediatricians is the continuing high mortality rates in children with PDM (between 3-20% of diarrhoea becomes persistent). This, he attributed to faulty case-management. For example, inappropriate diets that do not take account of metabolic adaptations to malnutrition are commonplace and may account for many deaths. Another crucial aspect is inadequate treatment of microbial infections which significantly affect the outcome of nutritional rehabilitation in children with PD. Studies have shown that following treatment and cure for PDM many children relapse, and that even after one year the state of the gut is similar to when the child first presented.

It was explained how successful nutritional rehabilitation of children with persistent diarrhoea (PD) requires an understanding of the biology of malnutrition and of guidelines for provision of appropriate diets. MN is an important factor in determining the duration of PD and in the success of treatment. In order to treat PD and MN effectively one needs to have a good understanding of:

i) the severity of the MN and its impact on immunity and body organs

ii) the importance of the effects of microbial infection

iii) the central role of prolonged damage to the gut and its effect on recovery

An understanding of the complex interactions that take place at the surface of the small intestine (luminal-mucosal interface) is central to understanding the nature of PD. Once PD has developed, then nutritional management is the mainstay of treatment and should lead to normal growth in the long term. Therapy involves a three -stage process of addressing acute problems, restoring nutrient balance and ensuring complete nutritional rehabilitation.

In looking to the future, Dr Sullivan stated that establishing the best rehabilitation diet for children with PD is currently a challenge facing many researchers around the world. Questions are being asked about what are the best diets to give the gut a better chance of recovery. For example, certain foods may have an advantageous effect on gut permeability, so that nutrients can be absorbed into the body during PD, while other foods may inhibit microbial attachment to the gut.

An abstract of this presentation can be obtained from Peter Sullivan at the Department of Paediatrics, University of Oxford