CARBOHYDRATE MALABSORPTION SYNDROME IN CHILDREN WITH VIRAL GASTROENTERITIS

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Abstract

Background: Enteric viruses (mainly rotaviruses) are the most common cause of infectious diarrhea in infants. One  of the  pathophysiologic mechanisms in rotaviral gastroenteritis is the  reduction of the  surface  activity of enterocyte disaccharidases  and  osmotic  diarrhea. Aim: To determine the clinical significance of metabolic activity of intestinal microbiota in the formation of the osmotic component of viral diarrhea in children of various ages. Materials and methods: The study involved 139 children aged  from 1 month  to 14 years admitted to the hospital in the first 24 to 72 hours of moderate-degree  viral gastroenteritis.  Rotaviral infection was the most prevalent  (90%). Viral etiology was confirmed  by the  reaction  of indirect hemagglutination and multiplex real-time PCR (in feces). Total carbohydrate content in the feces was measured and fecal microflora was investigated by two methods: bacteriological and gas liquid chromatography with the determination of short-chain fatty acids. Results: The mean carbohydrate content in the feces of children below 1.5 years of age was higher than  that  in older children (p = 0.014). There was an inverse correlation between the concentration of rotaviral antigens  and carbohydrate   contents (r = -0,43, p < 0.05) and the production of acetic and propionic acids (R = -0,35, p < 0.01). The carbohydrate content in acute stage of the disease was linearly associated with time to normalization of the stool (r = +0,47, p < 0.01). Previous acute  respiratory or intestinal  infections within 2 months (odds ratio [OR], 14.10; 95% confidence interval [CI] 3.86–51.53), previous  hospitalizations  (OR = 14.17; 95% CI 2.74–74.32) and  past  history of intestinal dysfunction (OR 5.68; 95% CI 1.67–19.76) were predictive of severe  carbohydrate malabsorption in children below 1.5 years of age. Conclusion: The lack of microbiota functional activity (assessed by production of short-chain  fatty acids) determines the  development of osmotic  phenotype of diarrhea, that marks the total carbohydrate contents in the feces. Its predisposing factors should be taken into account  when making a decision to hospitalize.

About the authors

E. R. Meskina

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: meskinaelena@rambler.ru
Meskina Elena R. – MD, PhD, Professor, Head of Department of Pediatric Infections Russian Federation

References

  1. Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr. 2014;59(1):132– 52. doi: 10.1097/MPG.0000000000000375.
  2. Hodges K, Gill R. Infectious diarrhea: Cellular and molecular mechanisms. Gut Microbes. 2010;1(1):4–21.
  3. Lorrot M, Vasseur M. Physiopathology of Rotavirus diarrhea. Arch Pediatr. 2007;14 Suppl 3:S145–51.
  4. Gupta SK, Chong SK, Fitzgerald JF. Disaccharidase activities in children: normal values and comparison based on symptoms and histologic changes. J Pediatr Gastroenterol Nutr. 1999;28(3):246–51.
  5. Greenberg HB, Estes MK. Rotaviruses: from pathogenesis to vaccination. Gastroenterology. 2009;136(6):1939–51. doi: 10.1053/j.gastro.2009.02.076.
  6. Collins J, Candy DC, Starkey WG, Spencer AJ, Osborne MP, Stephen J. Disaccharidase activities in small intestine of rotavirus-infected suckling mice: a histochemical study. J Pediatr Gastroenterol Nutr. 1990;11(3):395–403.
  7. Topping DL, Clifton PM. Short-chain fatty acids and human colonic function: roles of resistant starch and nonstarch polysaccharides. Physiol Rev. 2001;81(3):1031–64. дации. Утверждены Минздравом РСФСР 14.04.1977. М.; 1977. 20 с.
  8. Мухина ЮГ, Шумилов ПВ, Дубровская МИ, Чубарова АИ, Корнева ТИ, Кургашева ЕК. Современные подходы к диагностике и терапии дисахаридазной недостаточности у детей. Трудный пациент (Педиатрия). 2006;4(9–1):12–6.
  9. Московский научно-исследовательский институт эпидемиологии и микробиологии МЗ РСФСР. Бактериологическая диагностика дисбактериоза: методические рекомендации. Утверждены Минздравом РСФСР 14.04.1977. М.; 1977. 20 с.
  10. Кондракова ОА, Затевалов АМ, Мазанкова ЛН, Ильина НО, Затевалова ЕА, Гусарова МП, Бабин ВН, Владимирова НП, Холодова ИН, Татищева НБ, Ваулина ОВ. Дисбактериоз кишечника у детей. Определение метаболической активности анаэробной микрофлоры по содержанию летучих жирных кислот в кале и слюне для характеристики дисбиотических состояний кишечника и ротовой полости у детей: пособие для врачей. М.: Прототип; 2005. 56 с.
  11. Гланц С. Медико-биологическая статистика. Пер. с англ. М.: Практика; 1998. 459 с.
  12. Гринхальх Т. Основы доказательной медицины. Пер. с англ. М.: ГЭОТАР-Медиа; 2008.
  13. с.
  14. Bala L, Ghoshal UC, Ghoshal U, Tripathi P, Misra A, Gowda GA, Khetrapal CL. Malabsorption syndrome with and without small intestinal bacterial overgrowth: a study on upper-gut aspirate using 1H NMR spectroscopy. Magn Reson Med. 2006;56(4):738–44.
  15. Graf D, DiCagno R, Fåk F, Flint HJ, Nyman M, Saarela M, Watzl B. Contribution of diet to the composition of the human gut microbiota. Microb Ecol Health Dis. 2015;26:26164. doi: 10.3402/mehd.v26.26164.
  16. Xu Z, Knight R. Dietary effects on human gut microbiome diversity. Br J Nutr. 2015;113 Suppl:S1–5. doi: 10.1017/S0007114514004127. 16. Edwards CA, Parrett AM. Intestinal flora during the first months of life: new perspectives. Br J Nutr. 2002;88 Suppl 1:S11–8.
  17. Мартынова ГП, Коган НВ, Соловьева ИА. Нарушения метаболической активности кишечной микрофлоры и местного иммунитета при ротавирусной инфекции. Детские инфекции. 2014;(2):5–8.
  18. Кондракова ОА, Мазанкова ЛН, Затевалов АМ, Бегиашвили ЛВ, Бабин ВН, Дубинин АВ. Нарушения микробиоценоза кишечника у детей раннего возраста с вторичной лактазной недостаточностью. Российский вестник перинатологии и педиатрии. 2008;53(2):74–81.
  19. Феклисова ЛВ, Мескина ЕР, Воропаева ЕА, Пожалостина ЛВ, Моисеева КД. Микробиоценоз ротоглотки и кишечника у детей, посещающих дошкольные учреждения. Эпидемиология и инфекционные болезни. 2007;(4):14–9.
  20. Wiegering V, Kaiser J, Tappe D, Weissbrich B, Morbach H, Girschick HJ. Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients. Int J Infect Dis. 2011;15(6):e401–7. doi: 10.1016/j. ijid.2011.02.006.

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