Gastrointestinal Disease in Malnourished Children
Abstract
In communities where malnutrition is common, gastrointestinal diseases are prominent and contribute largely to unfavourable morbidity and mortality statistics. Patterns of gastrointestinal disease were studied in two such cotnmunities; Aboriginal children in Western Australia and children admitted to the Dr. Cipto Mangunkusumo General Hospital, Jakarta.
Two hundred and fifty one (251) young Aborigines were studied. Forty percent of them malnourished, 37% were anaemic and more than 50% had enteric pathogens in their stools. Sugar intolerance was also common (25%). Similar clinical features are seen in the children from Jakarta but more severe forms of malnutrition and gross vitamin deficiency occurred more often.
Thirteen of the Aboriginal children died; at necropsy the most remarkable finding wass fatty infiltration of the liver which some cases was extreme. This, of course, is characteristic of protein-calorie malnutrition add has been well documented in other studies. Other pathological findings included severe purulent infections, septic infarcts, haemolysis, acanthocytosis, thrombocytopenia and vascular catastrophes.
References
BELL, R.G., TURNER, K.J. and GRACEY, M. : Serum and intestinal immunoglobulins in malnourished children. Proc. aust. Soc. med. Re-s. 3 : 140 (1973).
BISHOP, R.F. DAVIDSON, G.P., HOLMES, I.H, and RUCK, B.J. : yirus par- tides in epithelial cells of duodenal mucosae from children with non-bacterial gastroenteritis. Lancet ii: 1281 (1973).
BOWIE, M.D., BRINKMAN, G.L. and HANSEN, J.D, : Acquired disaccharide intolerance in malnutrition. J. Pediatr. 66 : 1083 (1965).
BRUSNER, O., REID, A., MONCKEBERG, F., MACCIONI, A. and CONTRERAS, I.: Jejunal biopsies in infant malnutrition: with special reference to mitotic index. Pediatrics 38: 605 (1966).
BURKE, V. and DANKS, D.M. : Monosaccharide malabsorption in young infants. Lancet i: 1177 (1966).
BURMAN, D. : The jejunal mucosa in kwashiorkor. Arch. Dis Child. 40 : 526 (1965).
CHANDRA, R.K. : Immunocompetence in undernutrition. J. Pediatr 81 : 1194 (1972).
GRACEY, M. : Intestinal absorption in the ’’contaminated small-bowel syndromeâ€, Gut 12 :403 (1971). Enteric disease in young Australian Aborigines. Aust. N.Z.J. Med. 3: 576 (1973).
GRACEY, M., SUHARJONO, SUNOTO and STONE, D.E. : Microbial contamination of the gut; Another feature of malnutrition. Am. J. Clin. Nutr. 26: 1170 (1973).
GRACEY, M. and STONE, D.E. : Small-intestinal microflora in Australian aboriginal children with chronic diarrhoea. Aust, N.Z.J. Med. 3 : 215.
GRACEY, M., STONE, D.E., SUHARJONO and SUNOTO : Oro-pharyngeal microflora in malnourished children. Aust. Paediatr. J. 9: 260 (1973). Isolation of Candida species from the gastrointestinal tract in malnourished children. Am. J. clin. Nutr. (in press)
HARRIS, M.J., DUFFY, B.J. and BEVERIDGE, J. Studies on the small bowel of a group of New South Wales Aboriginal, Children. Med. J. Aust.
1 : 356 (1870).
JELLIFEE, D.B. : Diarrhoeal disease of early childhood in Woodruff’s Alimentary and Haematological Aspects of Tropical Disease pp. 145-181 (Edward Arnold, London 1970).
KERRY, K.R. and ANDERSON C.M.: A ward test for sugar in faeces. Lancet i : 981 (1964).
LIFSHITZ, F., COELLO_RAMIREZ, P. and GUTIERRES-TQPETE, G. : Monosaccharide intolerance and hypoglycaemia in infant with diarrhea. I. Clinical course of 23 infants. J. Pediatr 77 : 595 (1970).
MILLER, D. and CRANE, R.K. : The digestive function of the epithelium of the small intestine. II. Localization of disaccharide hydrolysis in the isolated brush border portion of intestinal epithelial cells. Biochem. biophys. Acta 52: 293 (1961).
SCRIMSAW, N.S., TAYLOR C.E. and GORDON J.E. : Interactions of Nutrition and Infection. WHO Monogr. Ser. No. 57, Geneva (1968).
SHINER, M. : A comparison of ultrastructural
appearances fo Reticulin, Endothelium and Inflammatory cells of the jejunal mucosa in children with normal mucosae, untreated Coeliac Disease and Protein-Energy Malnutrition. in Proc. 6th annu. Meet. eur. Soc. paediatr. Gastroenterol. Helsinki, August, 1973, p. 12 (1973).
STANFIELD, J.P., HUTT, M.S.R. and TUNNICLIFFE, R. : Intestinal biopsy in kwashiorkor. Lancet ii : 519 (1965).
SUHARJONO, SUNOTO, ASWITHA BUDIARSO and SUTEJO : Lactose
malabsorption in healthy Indonesian pre-school children. Paediatr. Indones. 11 : 251 (1971).
WALKER, A.C. and HARRY, J.G. : A survey of diarrhoeal disease in malnourished Aboriginal children. Med. J. Aust. 1 : 904 (1972).
WALKER-SMITH, J.A. and REYE, R.D.K. : Small Intestinal Morphology in Aboriginal Children. Aust. N.Z.J. Med. 1 : 377 (1971).
WHARTON, B.A. HOWELLS, G. and PHILLIPS, I. : Diarrhoea in kwashiorkor. Br. med. J. 4 : 608 (1968).
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Accepted 2017-05-22
Published 2017-05-29