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Overview of the causes of chronic diarrhea in children in resource-rich countries

Richard Kellermayer, MD, PhD
Robert J Shulman, MD
Section Editor
Deputy Editor
Alison G Hoppin, MD


The major causes and the prevalence of chronic diarrhea differ between resource-rich and resource-limited countries:

In the resource-limited countries, chronic diarrhea is typically associated with serial enteric infections and malnutrition; it is manifested by a chronic enteropathy, with impaired mucosal healing and diminished digestive and absorptive capacity [1,2]. This pathophysiology calls for specific approaches to diagnosis and management, as discussed in a separate topic review. (See "Persistent diarrhea in children in resource-limited countries".)

In resource-rich countries, children are less likely to be exposed to serial enteric infections and malnutrition. In these populations, chronic diarrhea is more likely to be induced by underlying disease causing malabsorption or maldigestion [3-6]. However, enteric infections (particularly in immunocompromised patients), malnutrition, and dietary factors (eg, excessive consumption of juice), can play a role in some cases.

An overview of the different causes of chronic diarrhea seen in resource-rich countries will be reviewed here. The approach to diagnosing the cause of these diarrheal diseases is discussed separately. (See "Approach to the diagnosis of chronic diarrhea in children in resource-rich countries".)


Diarrhea is defined as stool volume of more than 10 grams/kg/day in infants and toddlers, or more than 200 grams/day in older children [7]. This typically translates to persistent loose or watery stools occurring at least three times a day, where the change in stool consistency is more important than stool frequency [8]. To be considered chronic, the symptom must be present for four weeks [9,10]. Some have used two weeks to define chronicity in children [7].

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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