Physiological mechanism and pathogenesis of weanling diarrhea

Abstract

Quantitative aerobic and anaerobic bacteriological studies of the upper and lower jejunum were performed in six malnourished children without diarrhea and in a group of five malnourished children with weanling diarrhea. A third group of children was tested after prolonged treatment in the hospital. All three groups of children had small numbers of mixed aerobic and anaerobic bacteria in the upper and lower intestine; only four children had a total bacterial count above 10⁴/g, and there was no correlation between the numbers or type of organisms and the nutritional state of the child. Jejunal perfusion studies showed that the children with weanling diarrhea had a marked jejunal accumulation of fluid, i.e., net secretion, similar to that seen in cholera. Malnourished or treated children without diarrhea did not show this abnormality. Glucose promoted water absorption even in children with gastroenteritis who had reduced glucose absorption rates. No enterotoxin-producing organisms were isolated to account for these functional changes. Treating cases of weanling diarrhea with low concentrations of oral glucose should promote positive water and electrolyte balance, but this effect will be limited by the degree of glucose malabsorption in the individual child.