Mehta D I, Blecker U
Division of Pediatric Gastroenterology and Nutrition, Alfred I. DuPont Institute, Wilmington, Del., USA.
J La State Med Soc. 1998 Sep;150(9):419-29.
Important inroads are being made into understanding the pathophysiology of acute diarrhea. Clear understanding of key mechanisms should suggest new approaches to combat disease. Exciting developments are occurring in terms of super-ORS solutions, particularly with the promise of short-chained glucose polymers and glutamine. Perhaps the most important development is the prospect of a good rotavirus vaccine being available before the end of the decade. Chronic diarrhea seems to be on the increase globally, probably because of the success of ORS. The mechanisms that lead to mucosal injury are elusive and therapy is still largely supportive and empiric. Celiac disease continues to be a puzzle, not least because of the uncomfortable feeling that a majority of cases may be being missed because of atypical presentations. The successful use of long-term parenteral nutrition has allowed survival and better characterization of cases that otherwise would have perished as "lethal protracted diarrhea". Microvillus inclusion disease may be the most common congenital secretory diarrhea. The role of the recently reported high prevalence of glucoamylase deficiency may be important. Lastly attention to micronutrients, particularly low vitamin A and probably zinc, may prove to be important in prevention and amelioration of diarrhea and growth failure.
在理解急性腹泻的病理生理学方面正在取得重要进展。对关键机制的清晰理解应能提出对抗疾病的新方法。在超级口服补液盐（ORS）溶液方面正在出现令人兴奋的进展，特别是短链葡萄糖聚合物和谷氨酰胺有望带来新进展。也许最重要的进展是在本十年末之前有望获得一种良好的轮状病毒疫苗。慢性腹泻在全球似乎呈上升趋势，这可能是由于ORS的成功使用。导致黏膜损伤的机制尚不清楚，治疗在很大程度上仍然是支持性和经验性的。乳糜泻仍然是一个难题，尤其是因为人们不安地感到，由于非典型表现，大多数病例可能被漏诊。长期肠外营养的成功应用使一些原本会因“致命性迁延性腹泻”而死亡的病例得以存活并得到更好的诊断。微绒毛包涵体病可能是最常见的先天性分泌性腹泻。最近报道的高淀粉酶缺乏症患病率的作用可能很重要。最后，关注微量营养素，特别是低维生素A以及可能的锌，在预防和改善腹泻及生长发育不良方面可能被证明是重要的。
