Diarrheal syndrome in children and adolescents: the features of pathogenetic therapy





pathogenetic therapy, diarrheal infections, acute intestinal infections, multienzyme preparations


The article presents modern data on syndrome of acute, prolonged and chronic diarrhea in children, its etiology and mechanisms of development of different types of this di­sease and its clinical symptoms. Prolonged diarrhea is usually defined as acute-onset diarrhea lasting for 7 days or more, but less than 14 days. There is a trend towards its decline in recent years because of improvement in the management of acute diarrhea, which represents the ideal strategy to prevent prolonged diarrhea. Prolonged diarrhea is more difficult to treat than acute diarrhea, it often leads to nutritional and metabolic complications. The pathogenesis of prolonged diarrhea is multifactorial and is essentially based on persistent mucosal damage due to specific infections, host-related factors including micronutrient and/or vitamin deficiency, undernutrition, high mucosal permeability caused by previous infectious processes and nutrient deficiency with consequential malabsorption and microbiota disruption. The рathogenetic therapy of prolonged diarrhea is comprehensive and should include an assessment of the intestinal microbiome, evaluation of the enzymatic function of the child’s body, the presence of functional gastrointestinal disorders.


Johnston BC, Shamseer L, da Costa BR, Tsuyuki RT, Vohra S. Measurement issues in trials of pediatric acute diarrheal diseases: a systematic review. Pediatrics. 2010 Jul;126(1):e222-31. doi: 10.1542/peds.2009-3667.

Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013 Apr 20;381(9875):1405-16. doi: 10.1016/S0140-6736(13)60222-6.

Koletzko S1, Osterrieder S. Acute Infectious Diarrhea in Children. Dtsch Arztebl Int. 2009 Aug;106(33):539-47; quiz 548. doi: 10.3238/arztebl.2009.0539.

Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015 Jan 31;385(9966):430-40. doi: 10.1016/S0140-6736(14)61698-6.

Black RE, Cousens S, Johnson HL, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010 Jun 5;375(9730):1969-87. doi: 10.1016/S0140-6736(10)60549-1.

Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012 Mar 21;12:220. doi: 10.1186/1471-2458-12-220.

Thapar N, Sanderson IR. Diarrhea in children: an interface between developing and developed countries. Lancet. 2004 Feb 21;363(9409):641-53. doi: 10.1016/S0140-6736(04)15599-2.

Giannattasio A, Guarino A, Lo Vecchio A. Management of children with prolonged diarrhea. F1000Res. 2016 Feb 23;5. pii: F1000 Faculty Rev-206. doi: 10.12688/f1000research.7469.1.

Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. 2016 May 10;315(18):1966-74. doi: 10.1001/jama.2016.5352.

Dickinson B, Surawicz CM. Infectious diarrhea: an overview. Curr Gastroenterol Rep. 2014 Aug;16(8):399. doi: 10.1007/s11894-014-0399-8.

Platts-Mills JA, Babji S, Bodhidatta L, et al. Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED). Lancet Glob Health. 2015 Sep;3(9):e564-75. doi: 10.1016/S2214-109X(15)00151-5.

Gaffey MF, Wazny K, Bassani DG, Bhutta ZA. Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health. 2013;13 Suppl 3:S17. doi: 10.1186/1471-2458-13-S3-S17.

Zakharenko SM, Mekhtiev SN. The Enzyme Preparations in Pathogenetic Therapy of Diarrhea Infections. Detskie Infekcii (Moskva). 2010;9(3):47-52. (in Russian).

Odetoyin BW, Hofmann J, Aboderin AO, Okeke IN. Diarrhoeagenic Escherichia coli in mother-child Pairs in Ile-Ife, South Western Nigeria. BMC Infect Dis. 2016 Jan 25;16:28. doi: 10.1186/s12879-016-1365-x.

Bernaola Aponte G, Bada Mancilla CA, Carreazo NY, Rojas Galarza RA. Probiotics for treating persistent diarrhoea in children. Cochrane Database Syst Rev. 2013 Aug 20;(8):CD007401. doi: 10.1002/14651858.CD007401.pub3.

Gaón D, García H, Winter L, et al. Effect of Lactobacillus strains and Saccharomyces boulardii on persistent diarrhea in children. Medicina (B Aires). 2003;63(4):293-8. doi: 10.3410/f.726147440.793514611.

Lanata CF, Fischer-Walker CL, Olascoaga AC, Torres CX, Aryee MJ, Black RE; Child Health Epidemiology Reference Group of the World Health Organization and UNICEF. Global causes of diarrheal disease mortality in children < 5 years of age: a systematic review. PLoS One. 2013 Sep 4;8(9):e72788. doi: 10.1371/journal.pone.0072788.

Kotloff KL, Nataro JP, Blackwelder WC, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case–control study. Lancet. 2013 Jul 20;382(9888):209-22. doi: 10.1016/S0140-6736(13)60844-2.

Vesikari T, Van Damme P, Giaquinto C, et al. European Society for Paediatric Infectious Diseases consensus recommendations for rotavirus vaccination in Europe: update 2014. Pediatr Infect Dis J. 2015 Jun;34(6):635-43. doi: 10.1097/INF.0000000000000683.