SEVERE INTRACTABLE DIARRHEA IN INFANTS

The definition and prognosis of severe intractable diarrhea (SID) in i nfants have changed since the condition was first described in 1978. S ID due to abnormalities of the intestinal mucosa is discussed in this article. Microvillous atrophy and villous atrophy can be individualize d based on clinical data (age at onset, family history, characteristic s of the diarrhea) and on findings from histologic (degree of atrophy, appearance of the glands and epithelium), ultrastructural, and immuno histochemical (evidence of T cell activation) studies. Some cases of S ID with villous atrophy are due to an immune or autoimmune process or to epithelial dysplasia, whereas others are associated with a characte ristic dysmorphic syndrome. These forms of SID carry a grim prognosis and usually require prolonged or life-long parenteral nutrition.