Corticosteroid-responsive enteropathy of infancy.
Nineteen American infants aged less than three months developed persistent diarrhoea, acidosis, hypoalbuminaemia, and malnutrition, without evidence of enteric pathogens. Symptoms began 11-59 days before admission to the University of North Carolina Children's Hospital, and infants were fed semielemental formula. Despite further treatment with amino acid-based formula by continuous nasogastric infusion, diarrhoea persisted. Endoscopic biopsies showed inflammation in the stomach, duodenum, and/or colon. A trial of intravenous corticosteroids was initiated in 14 infants. Corticosteroids were associated with rapid resolution of diarrhoea (duration after corticosteroids = 3.8 +/- 1.7 days [mean +/- SD]). In contrast, five infants with identical history were not treated with corticosteroids. In three infants, diarrhoea lasted for 92-147 days versus 31 +/- 3 total days in the treated group. In the other two infants, diarrhoea worsened after discharge, but were treated later with corticosteroids, with rapid resolution. Corticosteroids were uneventfully weaned over a four-month period. The results suggest that a trial of corticosteroids in infants with unresponsive persistent diarrhoea of unknown origin is beneficial and deserves prospective evaluation.
Lichtman
Steven N
SN
Department of Pediatrics, University of North Carolina at Chapel Hill, 27599-7220, USA. lichtman@med.unc.edu
Freeman
Katherine B
KB
Rhoads
J Marc
JM
D000138:Acidosis / Q000150:complications; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000596:Amino Acids / Q000008:administration & dosage; D001706:Biopsy / Q000379:methods; D002908:Chronic Disease; D003968:Diarrhea, Infantile / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D009657:North Carolina; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000596:Amino Acids