Chronic Diarrhea Clinical Trial
Official title:
Epidemiology of Chronic Diarrhea Among Children Admitted to Gastroenterology Unit at Assuit University Children Hospital
Chronic diarrhea is defined as stool volume of more than 10g/kg/day in toddlers/infants and
greater than 200 g/day in older children that lasts for 14 days or more.
Chronic diarrhea has many of causes can calcified as infectious & noninfectious causes.
- Infectious causes as: - Escherichia coli, Giardia Lamblia, tuberculosis, Clostridium
difficile & Shigella.
- Noninfectious causes as(Abnormal digestive processes- Nutrient Mal -absorption- Immune/
inflammatory- Defects of electrolyte And metaboliteTransport- Motility disorders-
Diarrhea associated With exogenous substances)
There are four basic pathophysiological categories of diarrhea: as ( osmotic diarrhea-
secretory diarrheas- motility related diarrhea- Inflammatory diarrhea)
Infectious diarrhea caused by invasive bacteria (Shigella, Salmonella, Campylobacter) or a
cytotoxic organism result ting in mucosal histologic damage and inflammation (Entamoeba
histolytica). (Hedberg etal., 1994)
Giardia lamblia Transmission is via the faecal oral route or via ingestion of contaminated
water sources. Symptoms of Giardia infection include diarrhea, malaise, flatulence, foul
smelling greasy stools, bloating/ distention and, less commonly, nausea, anorexia and
vomiting. (Dib etal., 2008)
Entamoeba histolytica is the causative agent of amoebiasis. The majority of patients will
have asymptomatic or low level disease with a gradual onset of diarrhea with generalized
abdominal tenderness. Fever is not usually associated with amoebic disease. Mucus and/or
blood may be present if the organism penetrates the bowel wall and causes mucosal damage.
(Van Hal etal., 2007)
Inflammatory bowel diseases, including Crohn disease & ulcerative colitis ,cause chronic
diarrhea that is often associated with abdominal pain, elevated inflammatory markers, and
increased concentrations of fecal calprotectin. The severity of the symptoms is highly
variable with a pattern characterized by long periods of well-being followed by exacerbations
(Bunn etal., 2001)
Lactose is the sugar found in milk .Because lactose is not digested properly in the small
intestine of individuals who are lactose intolerant; it passes whole into the large intestine
or colon. Upon reaching the colon it is broken down by the normal colon bacteria. This
breakdown results in the production of carbon dioxide and hydrogen gases. The gas production
can lead to (Abdominal distension, excess gas and diarrhea, watery and explosive bowel
movements, urgency). The severity of symptoms is usually proportional to the amount of the
milk sugar ingested with more symptoms following a meal with higher milk sugar content.
(Marsha, 2012).
There are four basic pathophysiological categories of diarrhea:
In osmotic diarrheas, osmotically active substances draw fluids from the plasma into the
jejunum along the osmotic gradients through the highly permeable jejunal epithelium. Examples
of chronic diarrhea due to an osmotic cause include malabsorption states such as celiac
disease, bacterial overgrowth, osmotic laxatives including salts, and lactulose and
maldigestion as occurs in disaccharidase deficiency and pancreatic exocrine
insufficiency.Osmotic diarrheas might result in steatorrhea (passage of fat in to the stool).
(Pardi etal., 2002)
In secretory diarrheas, there is secretion of isoosmolar fluid into the intestine. In this
situation, other electrolyte abnormalities might coexist. Thus, hypokalemia and acidosis are
associated with Verner-Morrison syndrome or VIPoma; Examples of secretory diarrheas include
congenital abnormalities such as congenital chloridorrhea, in which an abnormality in the
genetic control of chloride-bicarbonate exchange in the ileum results in the loss of chloride
into the stool. (Long etal., 1981) Secretory diarrhea might be associated with altered motor
functions induced by the hormone or transmitter produced by the tumor, as in carcinoid
diarrhea. (Von etal., 1993) The typical features of secretory diarrhea include the
persistence of the diarrhea with fasting and the absence of steatorrhea, hypokalemia and
acidosis typically suggest VIPoma syndrome (Camilleri etal., 1982)
In motility related diarrhea, Motility disorders cause diarrhea by either accelerating
gastrointestinal transit (e.g., post vagotomy diarrhea) or by slowing transit, thereby
predisposing to small intestinal bacterial overgrowth (SIBO) (e.g., scleroderma).The most
prevalent forms of motility-related diarrheas is IBS-D, Rapid small-bowel transit is a
relatively common finding in patients with diabetes or autonomic neuropathies, or patients
who have undergone upper gastrointestinal tract surgery. (Posserud etal., 2007)
In Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border,
which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these
lost fluids. It can be caused by bacterial infections, viral infections, parasitic
infections, or autoimmune problems. It can also be caused by tuberculosis, colon cancer, and
enteritis (Camilleri etal., 2014)
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT03269305 -
An Audit on Management of Chronic Diarrhea
|
||
Completed |
NCT03876717 -
Effect of the Sequestrant Colesevelam in Bile Acid Diarrhoea
|
Phase 4 | |
Not yet recruiting |
NCT03598010 -
Safety, Tolerability and Preliminary Efficacy of Lenodiar Pediatric in Diarrhea
|
N/A | |
Completed |
NCT05690321 -
Opium Tincture Against Chronic Diarrhea - Patients
|
Phase 2 | |
Terminated |
NCT01866774 -
Evaluation of Fecal Calprotectin Screening and a Gastroenterology Questionnaire for Triaging Children With Chronic Abdominal Pain and/or Diarrhea Referred to a Pediatric Gastroenterology Service
|
N/A | |
Completed |
NCT01545063 -
CAre of Patients With PArenteral Nutrition At Home
|
N/A | |
Completed |
NCT05702190 -
Opium Tincture Against Chronic Diarrhea - Healthy
|
N/A | |
Not yet recruiting |
NCT05811091 -
Pathological Patterns in Chronic Diarrhea With Normal Colonoscopy
|
||
Not yet recruiting |
NCT05724381 -
Auramine Phenol Staining Technique for Revealing Different Coccidian Parasites
|
||
Recruiting |
NCT01070277 -
Antiparasitic Treatment for Returning Travelers With Chronic Diarrhea
|
N/A | |
Completed |
NCT02642250 -
Comparative Evaluation of Herbal and Allopathic Drugs for the Treatment of Chronic Diarrhea
|
Phase 2/Phase 3 | |
Recruiting |
NCT06152289 -
Development of New Diagnostic Tools in Capsule Endoscopy
|
||
Completed |
NCT03270085 -
Trial to Understand Efficacy of Colesevelam in Diarrhea Predominant IBS Patients With Bile Acid Malabsorption
|
Phase 2 | |
Completed |
NCT05130047 -
Aldafermin (NGM282) for Chronic Diarrhea Due to Bile Acid Malabsorption (BAM)
|
Phase 2 | |
Completed |
NCT01840891 -
Secondary Lactose Intolerance Due to Chronic Norovirus Infection
|
N/A | |
Completed |
NCT03143517 -
Fecal Calprotectin Collection Protocol
|