Leung A K, Robson W L
University of Calgary, Alberta, Canada.
Am Fam Physician. 1996 Feb 1;53(2):635-43.
The occurrence of chronic diarrhea in infants younger than three months suggests disaccharidase deficiency, cow's milk or soy protein intolerance, cystic fibrosis or an immunodeficiency state, while chronic diarrhea in children three to 18 years of age suggests celiac disease, late-onset primary lactose deficiency and inflammatory bowel disease. Gastrointestinal infection is the most common cause of chronic diarrhea in children of all ages. Diarrhea that develops after the introduction of cow's milk, cereals and fruits suggests an enzyme deficiency or protein intolerance. Watery, explosive stools suggest sugar intolerance, and foul-smelling, greasy, bulky stools suggest fat malabsorption. Marked weight loss suggests malabsorption, inflammatory bowel disease, hyperthyroidism or malignancy. The presence of neutrophils or red blood cells in the stool indicates bacterial gastroenteritis or inflammatory bowel disease, while the presence of eosinophils suggests protein intolerance or parasitic infestation. A toddler who is thriving and cheerful despite having diarrhea may have chronic nonspecific diarrhea of childhood.
三个月以下婴儿出现慢性腹泻提示存在双糖酶缺乏、牛奶或大豆蛋白不耐受、囊性纤维化或免疫缺陷状态，而3至18岁儿童出现慢性腹泻提示患有乳糜泻、迟发性原发性乳糖缺乏和炎症性肠病。胃肠道感染是各年龄段儿童慢性腹泻最常见的原因。引入牛奶、谷物和水果后出现的腹泻提示酶缺乏或蛋白质不耐受。水样、暴发性大便提示糖不耐受，而恶臭、油腻、量大的大便提示脂肪吸收不良。明显体重减轻提示吸收不良、炎症性肠病、甲状腺功能亢进或恶性肿瘤。粪便中存在中性粒细胞或红细胞提示细菌性肠胃炎或炎症性肠病，而嗜酸性粒细胞的存在提示蛋白质不耐受或寄生虫感染。尽管腹泻但茁壮成长且心情愉快的幼儿可能患有儿童慢性非特异性腹泻。
