The post-enteritis syndrome in infants or young children can be caused by bacteria or viruses on the one hand, but can also occur due to a lack of nutrients or as a side effect of another organic disease. In addition to these factors, psychological factors and social circumstances must also be explored and taken into account for therapy.
What is Postenteritis Syndrome?
Postenteritis syndrome is a malabsorption syndrome resulting from chronic gastroenteritis accompanied by recurrent or protracted diarrhea. Acute characterization is four to eight weeks. See howsmb for Lafora Disease Definition and Meaning.
It is associated with underweight or weight loss with or without insufficient weight and height growth in childhood. This disease is most common between the ages of 6 and 24 months. In the run-up to this, the children often contract acute gastroenteritis of bacterial or viral origin, for example from rotaviruses.
Causes
Acute gastroenteritis of bacterial or viral origin can be the cause of postenteritis syndrome. The cause is that the intestinal flora changes with dejugation of bile acids and hydroxylation of fatty acids and toxin products, but also as a result of superficial mucosal lesions with secondary disaccharidase deficiency.
Another cause is a pronounced lack of nutrients, which is why a very high percentage of children in developing countries become ill. In highly developed countries of the so-called “First World”, these symptoms are usually found as an accompaniment to an organic disease.
Particularly common in neurological and gastrointestinal diseases, but also in connection with infantile cerebral palsy. Nevertheless, depending on the underlying criteria regarding underweight or the frequency of an existing underlying disease, between 2 and 24 percent of the small patients are in inpatient treatment. Sugar intolerance is also common.
Symptoms, Ailments & Signs
Chronic, recurrent diarrhea occurs between the ages of 6 and 24 months during the period of nutritional development. Despite this, the children develop without signs of malabsorption. A significantly reduced general condition with excessive tiredness up to lethargic phases increasingly accompanies the postenteritis syndrome.
An abdomen that is clearly diffusely distended meteoistically is evident on palpation. Nausea and chewing and swallowing disorders are common side effects. Sometimes there is a transport disorder in the esophagus. Pneumonia that is already present or developing in the course of the disease can lead to shortness of breath.
Diagnosis & course of disease
In any case, the underlying disease must be diagnosed as well as the pathology of the concomitant failure to thrive. It is also important to exclude other recurrent diarrhea in the differential diagnosis. These include cystic fibrosis, celiac disease, cow’s milk intolerance or food allergy and congenital disaccharidase deficiency.
The extent is based on standard values from body weight, body length and their relation to each other. A possible sugar intolerance can be diagnosed by laboratory stool tests and a breath test. If the sugar substance recognized as an allergen is removed from the food chain, the problem of the disease often resolves itself.
The preceding anamnesis deals, among other things, with the family and social environment. Factors such as neglect, available food and mental or psychiatric illnesses in the parents can thus be ruled out. Genetic reasons can also be identified in this way.
The first priority is the diagnosis and the determination of the exact extent, followed by a clarification of the pathogenesis. This is divided into the areas:
- 1. Insufficient food intake due to chronic vomiting, swallowing or chewing disorders, transport disorders of the esophagus, but also shortness of breath with an existing heart or lung disease.
- 2. an increased energy requirement
- 3. Disturbed intestinal absorption (malabsorption)
If an iron deficiency is determined in the laboratory, this can be an indication of an existing malabsorption in the upper duodenum. In rare cases, a duodenal biopsy including a determination of the activity of the disaccharidases or the detection of a partial villous atrophy is necessary.
The conclusion is a physical assessment. This often reveals a restricted general condition accompanied by paleness and sometimes also signs of incipient dehydration with tiredness and even lethargy. In addition, the palpation examination often reveals a tender and diffusely meteoistically distended abdomen. The skin of the perianal region is often sore from liquid stools. Sometimes there is even superinfection caused by thrush.
There is also the possibility of dysfunction in the form of disaccharide or monosaccharide adsorption (lactose or fructose) through damaged intestinal mucosa due to acute gastroenteritis. Osmotic diarrhea can be exacerbated by unabsorbed carbohydrates. This encourages their persistence or secondary malabsorption.
Unfortunately, the further course of the disease is characterized by a more or less severe impairment of the somatic and psychosocial as well as motor development. This fact has a negative effect on future cognitive performance as well as vital immune functions and defense against infection.
This construct of limitations requires early fixes to minimize damage. In addition, post-enteritis syndrome can lead to a vicious cycle of malnutrition, malabsorption, and chronic failure to thrive in malnourished children in underdeveloped countries, as well as in non-breastfed children in civilized countries.
Complications
Due to the postenteritis syndrome, the affected patients usually suffer from severe diarrhea that occurs permanently. As a result, babies lose a lot of fluids and sometimes suffer from severe dehydration. Parents and relatives also experience mental health problems or depression.
The children’s stomachs are bloated, and it is not uncommon for the children to suffer from nausea and vomiting. Swallowing disorders can also occur as a result of the postenteritis syndrome, making it significantly more difficult for the person affected to take in food and liquid. If the postenteritis syndrome is not treated, pneumonia will also occur.
The children can then no longer breathe properly, so that the internal organs are no longer supplied with enough oxygen. In the worst case, this can lead to irreversible damage to the organs or to a delay in development. The patient’s quality of life is significantly reduced by the postenteritis syndrome.
Postenteritis syndrome is usually treated with a healthy and proper diet. This can limit most complaints. There are no particular complications. Possible deficiencies must be compensated for.
When should you go to the doctor?
Children who suffer from chronic diarrhea or other gastrointestinal complaints should be presented to a pediatrician as soon as possible. Medical advice is particularly necessary in the case of severe symptoms associated with deficiency symptoms or dehydration. Parents who repeatedly notice gastrointestinal problems in their child are best advised to speak to the pediatrician or a gastroenterologist so that the disease can be quickly clarified or ruled out. Postenteritis syndrome can be effectively treated with dietary changes and short-term medication.
However, if no therapy is given, the chronic, recurrent diarrhea can be life-threatening. Children who are already physically weakened by another illness are particularly at risk. Acute gastroenteritis and viral or bacterial diseases such as rotavirus also increase the risk of serious complications. In addition to the pediatrician or general practitioner, gastroenterologists treat postenteritis syndrome. Other contacts are nutritionists and alternative medicine professionals who can help put together a suitable diet. In the case of chronic complaints, the child should be taken to a specialist clinic for gastrointestinal diseases.
Treatment & Therapy
The diet should be built up step by step with food rich in protein and carbohydrates that is low in lactose. To do this, cow’s milk proteins, gluten and fructose-containing drinks must be avoided for at least six to eight weeks. The chance that the symptoms will improve with this is relatively high.
If the amount of food cannot be increased, the foods selected should be high in calories. Ready-to-eat food can be added. In connection with re-alimentation, the milk formula that was tolerated before the illness and contained lactose and cow’s milk protein can be administered. This is possible in our region because eutrophic children very rarely develop lactose or cow’s milk intolerance after gastroenteritis.
Nutrition with special additional or substitute food can be administered in balanced or unbalanced form as tube feeding orally, by tube or by means of PEG (percutaneous endoscopic gastrostomy). In severe cases, supplementation with potassium, magnesium and phosphate must be made. A vicious circle of malabsorption, malnutrition and failure to thrive can arise in developing countries.
Prevention
The greatest chance of not developing postenteritis syndrome is to breastfeed as long as possible.
Aftercare
If the child is symptom-free after the therapy has been carried out, no further follow-up care is required. The intestinal flora has then usually completely recovered from its derailment. The nutritional structure with the addition of porridge and baby food can now be carefully continued.
If, despite this, diarrhea occurs again, the composition of the complementary food should be examined again. A new test for potential allergens such as lactose, fructose or gluten is advisable at this point. If this measure leads to a symptom-free result, an elimination diet should be carried out. Individual foods are gradually added to the menu.
This enables an exact identification of the diarrhea trigger. Over time, very specific intolerances can also be diagnosed. If anything is unclear or you have any questions, a trained nutritionist will help you. They can give tips on how to build up a healthy diet or even develop a meal plan for the child.
This is particularly advisable if there are signs of malnutrition as a result of postenteritis syndrome. Minor deficiencies can usually be compensated for through nutrition. Under certain circumstances, however, the targeted use of dietary supplements is also indicated. The corresponding blood values should be checked regularly.
You can do that yourself
The disease occurs primarily in children. Relatives, legal guardians or guardians should ensure that the child receives adequate and healthy nutrition. The weight must be documented at regular intervals and compared with the specifications for the normal weight of children of that age. If you are severely underweight or have signs of a nutrient deficiency, you should see a doctor.
In cooperation with the doctor, it should be discussed which nutrient needs to be taken up more. There are also swallowing disorders. For this reason, the consistency of the food must be optimized. If you are underweight, you should avoid activities that involve a significant loss of calories. The practice of sporting activities should be adapted to the possibilities of the organism and not take up any additional resources. The intake of food is to be aligned with the needs of the body and should be optimised. A diet rich in vitamins is necessary for the recovery process.
Shortness of breath threatens anxiety or panic attacks. The person concerned must be provided with sufficient information in advance about appropriate behavior in an emergency situation.
Since there is often an intolerance to sugar, the intake of food should be completely sugar-free. In many cases, a restructuring of the diet plan is necessary so that the organism is not fed any products containing sugar.
