La diarrea inducida con lactosa es mas severa, prolongada y produce mayores pérdidas fecales de macronutrientes en ratas cecotomizadas que en ratas intactas / Lactose-induced diarrhea is more severe, last longer and produces more fecal macronutrient losses in cecectomized than in intact rats

La diarrea inducida con lactosa en ratas ha servido para estudiar la alimentación durante la diarrea. Sin embargo, las ratas se adaptan al consumo de lactosa por lo que la diarrea dura aproximadamente una semana. Para establecer si la remoción del ciego podría prolongarla, aquí se comparó esta diarrea en ratas intactas y cecotomizadas. El experimento incluyó 16 ratas intactas y 16 cecotomizadas. A la mitad de las ratas en cada grupo se les ofreció una dieta con 45% de lactosa (grupo diarrea) y a la otra mitad una dieta sin lactosa (grupo control). El experimento duró 21 días con 3 recolecciones de heces de 48 h (días 2-4, 9-11 y 17-19). Los resultados mostraron que durante la primera recolección hubo diarreas similares tanto en los grupos de ratas intactas como cecotomizadas, pero en las próximas, sólo las cecotomizadas tenían una diarrea cuya severidad aumentó (3,5 veces) con el tiempo. Adicionalmente, en los dos tipos de ratas, las pérdidas fecales de proteína y grasa fueron proporcionales a la masa fecal húmeda excretada, pero fueron 2 veces más altas en las cecotomizadas. Se concluye que la cecotomía previene la adaptación, aumenta la severidad y prolonga la diarrea inducida con lactosa e incrementa notablemente las pérdidas fecales de los macronutrientes y reduce la eficiencia del alimento(AU)

Lactose induced diarrhea in rats has been used for studying the appropriated feeding during diarrhea. However, rats adapt to lactose and this diarrhea last approximately one week. In order to establish if cecum removal could prolong it, here lactose induced diarrhea was produced in intact and cecectomized rats. In the experiment there were 16 intact and 16 cecectomized rats. Halve of the rats in each group were fed a diet with 45% lactose (Diarrhea group) and the other halve a lactose free diet (Control group). The experiment lasted 21 days and included three 48h fecal collections (days 2-4, 9-11 and 17-19). The results showed that during the first collection both groups had diarrheas of similar severity but thereafter, only the cecectomized had a diarrhea whose severity increased (3.5 times) with time. Additionally, in both groups of rats, protein and fat fecal losses were proportional to fecal output but they were higher (2 times) in the cecectomized group. In conclusion, cecectomy prevents lactose adaptation and results in a diarrhea that last longer and it is more severe (3.5 times). Also in these rats fecal losses of macronutrients are higher whereas feed efficiency is lower(AU)

Diarrea crónica en el diabético: Una revisión de la literatura / Chronic diarrhea in the diabetic: A review of the literature

Desde hace más de 70 años se conoce la asociación de diarrea con diabetes mellitus. En pacientes diabéticos su prevalencia es de alrededor del 20%. Sus manifestaciones clínicas son diversas, y representa un reto diagnóstico y terapéutico. Existen ciertos diagnósticos de mayor prevalencia en pacientes diabéticos que en la población general. Las distintas etiologías relacionadas pueden ser diagnosticadas adecuadamente a través de la historia clínica y pruebas diagnósticas complementarias. Los medicamentos utilizados por el paciente diabético para el manejo de su enfermedad, frecuentemente causan diarrea crónica, por lo que se debe profundizar en los antecedentes farmacológicos al momento de estudiar la diarrea. Los pacientes diabéticos pueden presentar otras condiciones patológicas asociadas, como enfermedad celíaca o colitis microscópica, cuya molestia única es la diarrea. La función del páncreas exocrino puede estar disminuida en el paciente diabético, frecuentemente llevando a insuficiencia pancreática exocrina. Factores dietarios, como los edulcorantes libres de azúcar y otros agentes, pueden causar diarrea en el paciente diabético. La presencia de condiciones como la neuropatía autonómica y neuropatía periférica secundarias a la diabetes mellitus, pueden explicar desordenes como la disfunción anorrectal y la incontinencia fecal. Finalmente, la enteropatía diabética per se o con sobrecrecimiento bacteriano asociado, puede causar diarrea. Lograr un control glicémico adecuado constituye el pilar del tratamiento de la diarrea en el diabético, después de esto existen medidas adicionales que se aplican según el contexto especifico del paciente. En el presente artículo se revisan las causas de mayor incidencia diarrea en el paciente diabético y los mecanismos fisiopatológicos implicados

The association of diarrhea with diabetes mellitus has been known for more than 70 years. In diabetic patients its prevalence is around 20%.Its clinical manifestations are diverse, and represents a diagnostic and therapeutic challenge.There are certain diagnoses of higher prevalence in diabetic patients than in the general population.The different related etiologies can be adequately diagnosed through the clinical history and complementary diagnostic tests.The medications used by the diabetic patient to manage their disease often cause chronic diarrhea, so the pharmacological background should be studied at the time of the study of diarrhea.Diabetic patients can present other associated pathological conditions, such as celiac disease or microscopic colitis, which only discomfort is diarrhea.Exocrine pancreatic function may be decreased in the diabetic patient, frequently leading to exocrine pancreatic insufficiency. Dietary factors, such as sugar-free sweeteners and other agents, can cause diarrhea in the diabetic patient.The presence of conditions such as autonomic neuropathy and peripheral neuropathy secondary to diabetes mellitus may explain disorders such as anorectal dysfunction and faecal incontinence. Finally, diabetic enteropathy alone or with associated bacterial overgrowth can cause diarrhea.Achieving adequate glycemic control is the pillar of the treatment of diarrhea in the diabetic, after which there are additional measures that are applied according to the specific context of the patient.This article reviews the causes of higher diarrhea incidence in the diabetic patient and the pathophysiological mechanisms involved

Signs and symptoms associated with digestive tract development / Sinais e sintomas associados com o desenvolvimento do trato digestivo

ABSTRACT Objective: To analyze the development and prevalence of gastrointestinal signs and symptoms associated with the development of the digestive tract, and to assess the measures aimed to reduce their negative impacts. Source of data: Considering the scope and comprehensiveness of the subject, a systematic review of the literature was not carried out. The Medline database was used to identify references that would allow the analysis of the study topics. Synthesis of results: Infants frequently show several gastrointestinal signs and symptoms. These clinical manifestations can be part of gastrointestinal functional disorders such as infantile colic, infant regurgitation, and functional constipation. Allergy to cow's milk protein and gastroesophageal reflux disease are also causes of these clinical manifestations and represent an important and difficult differential diagnosis. The diseases that course with gastrointestinal signs and symptoms can have an impact on family dynamics and maternal emotional status, and may be associated with future problems in the child's life. Comprehensive pediatric care is essential for diagnosis and treatment. Maternal breastfeeding should always be maintained. Some special formulas can contribute to the control of clinical manifestations depending on the established diagnosis. Conclusion: During the normal development of the digestive tract, several gastrointestinal signs and symptoms may occur, usually resulting from functional gastrointestinal disorders, gastroesophageal reflux disease, and allergy to cow's milk protein. Breastfeeding should always be maintained.

RESUMO Objetivo: Analisar o desenvolvimento e a prevalência de sinais e sintomas gastrintestinais associados com o desenvolvimento do tubo digestivo e as medidas que visam a diminuir suas repercussões negativas. Fontes dos dados: Considerando a abrangência e amplitude do tema, não foi feita revisão sistemática da literatura. Usou-se a base de dados do Medline para a identificação de referências bibliográficas que permitissem contemplar os temas de estudo. Síntese dos resultados: O lactente apresenta com elevada frequência sinais e sintomas gastrintestinais. Essas manifestações clínicas podem fazer parte de distúrbios funcionais gastrintestinais, como cólica, regurgitação e constipação intestinal funcional. A alergia à proteína do leite de vaca e a doença do refluxo gastroesofágico também são causas dessas manifestações clínicas e representam um importante e difícil diagnóstico diferencial. As doenças que cursam com sintomas e sinais gastrintestinais podem ter consequências na dinâmica familiar e no estado emocional das mães. Podem se associar com problemas na vida futura da criança. A atenção pediátrica completa é fundamental para o diagnóstico e o tratamento. O aleitamento natural deve sempre ser mantido. Algumas fórmulas especiais podem contribuir para o controle das manifestações clínicas na dependência do diagnóstico estabelecido. Conclusão: Durante o desenvolvimento normal do tubo digestivo podem ocorrer sinais e sintomas gastrintestinais em geral decorrentes dos distúrbios gastrintestinais funcionais, da doença do refluxo gastroesofágico e da alergia à proteína do leite de vaca. Aleitamento natural deve sempre ser mantido.

Diarrea aguda / Acute diarrhea

En este artículo se enfocará la diarrea aguda del adulto desde una perspectiva clínica, incorporando definiciones básicas de epidemiología, fisiopatología, enfrentamiento clínico, estudio cuando corresponda y tratamiento. Se presentarán nuevas herramientas diagnósticas basadas en biología molecular, de reciente introducción en clínica y que han significado un aporte en casos seleccionados. Además, se enfrentan situaciones especiales como la diarrea del viajero y de los pacientes inmunocomprometidos. La diarrea asociada a antibióticos se tratará en un artículo aparte.

In this article of acute diarrhea in adults, will present from a clinical perspective, including different basic definitions from epidemiology, pathophysiology, clinical approach, corresponding studies and treatment. It includes new diagnostic tools based on molecular biology, of recent use in medical practice, that have had a relevant effect in selected cases. It also includes special situations, such as traveler's diarrhea and immunosuppressed patients. We exclude from this article antibiotics-related diarrhea.

The Role of Protease Activated Receptors and Proteases in Subtly Inflamed Diarrhea-Predominant Irritable Bowel Syndrome / 대한소화기학회지

No abstract available.

Diarrea crónica en el niño / Chronic diarrhea in children

Chronic diarrhea, defined as that lasting more than 4 weeks, is a common complaint in patients who present to the pediatrician's or pediatric gastroenterologist's office. Causes of Chronic Diarrhea vary widely and differ according to the patient's age. In children under 6 months of age congenital anomalies and food allergies prevail; in preschoolers disaccharide intolerance, Giardiais, nonspecific diarrhea and tumors are seen; in children of school age inflammatory bowel disease must be considered. Celiac Disease and infectious etiologies must be ruled out at all ages. The diagnostic approach should be organized, progressive and systematic; based on clinical history, starting with a nutritional evaluation and general workup to rule out infection, malabsorption or maldigestion. Some cases may require further and more specific evaluation at the hands of a specialist. Treatment should focus on preserving nutritional status, while specific therapies are instituted. Chronic diarrhea should be managed initially by the general pediatrician, and referral to a pediatric gastroenterologist at a specialized facility may be needed at times for further management.

La Diarrea Crónica, definida como aquella que se prolonga por más de 4 semanas, es motivo común de consulta al Pediatra y Gastroenterólogo infantil. Las causas son muy variadas y dependen principalmente de la edad del paciente. En menores de 6 meses, predominan las anomalías congénitas y las alergias alimentarias; en preescolares aparecen las intolerancias a disacáridos, giardiasis, diarrea inespecífica y tumores; en escolares se agrega la Enfermedad inflamatoria intestinal. A cualquier edad debe considerarse además, la etiología infecciosa y en ciertas circunstancias la Enfermedad celíaca. El estudio debe ser sistemático y progresivo, orientado por la historia clínica. Se inicia con una evaluación del estado nutricional y con exámenes generales destinados a descartar infección y evaluación de las funciones digestivas y absortivas. Luego, en algunos casos, se requerirá de estudios más específicos a cargo del especialista. El tratamiento debe enfocarse en preservar un adecuado estado nutricional del paciente, mientras se toman medidas terapéuticas específicas cuando corresponda. La Diarrea crónica debe inicialmente ser manejada por el Pediatra general y cuando sea necesario se requerirá de la participación del Gastroenterólogo infantil en Centros de Salud de mayor complejidad.

Series clínicas de medcina de urgencia: evaluación del paciente adulto con diarrea aguda en la unidad de emergencia / Evaluation and management of acute diarrhea in the emergency department

El síndrome diarreico agudo (SDA) es un motivo de consulta frecuente en la unidad de emergencia, correspondiendo entre 5-10 por ciento de todas las consultas. El cuadro clínico suele ser autolimitado y benigno en la mayoría de los casos, pero puede ser causa importante de morbimortalidad. El SDA es una causa frecuente de ausencia laboral y escolar. La historia clínica y el examen físico sistematizados permiten identificar la mayoría de las causas de SDA, valorar la gravedad del paciente, necesidad de hospitalización y decidir el tratamiento. En casos determinados se recomienda solicitar exámenes de laboratorio que orientan sobre la etiología como los leucocitos fecales, lactoferrina fecal, coprocultivo, toxina de Clostridium difficile y examen parasitológico seriado de deposiciones. El manejo básico en el servicio de urgencia consiste en rehidratación y analgesia. Las indicaciones de egreso incluyen hidratación oral, dieta, analgésicos, antidiarreicos, probióticos y antibióticos según el caso particular. Basados en un caso clínico discutiremos la evaluación y manejo del paciente adulto con diarrea aguda en la unidad de emergencia.

The acute diarrhea (AD) is a frequent complaint in emergency department, identifying about 5 to 10 percent of all queries. It is self limiting and benign in most cases but may be an important cause of morbidity and mortality. Determines a significant number of work and school absences. The history and physical examination achieve to identify most causes of AD, patient severity, need for hospitalization and treatment. In certain cases can be used etiological laboratory tests like fecal leukocytes, fecal lactoferrin, stool culture, Clostridium difficile toxin and parasitologic serial stool examination. Emergency management consists in rehydration and analgesia. The discharge instructions include oral hydration, diet, analgesics, antidiarrhoeal therapy, probiotics and antibiotics according to each case. Based on a clinical case we will discuss the evaluation and management of acute diarrhea in the emergency department.

Actualización en el manejo nutricional de la diarrea infantil / Update on nutritional management of infant diarrhea

Los niños con enfermedad diarreica (ED) continúan siendo un problema de salud pública en los países en vía de desarrollo como el nuestro. Es necesario definir una serie de términos que ayudan al mejor entendimiento en el manejo de la ED como son su etiología, la manera de hidratar, las intolerancias, las fórmulas infantiles, y la dieta absorbente o astringente. Sigue siendo válido en el manejo de la ED, el concepto “primero hidratar, para luego alimentar”. El tratamiento incluye desde lactancia materna, fórmulas infantiles especiales, dieta absorbente o astringente, zinc, probióticos, antibióticos y en casos extremos hasta de nutrición parenteral.

Children with diarrheal disease (DD) remains a public health problem in developing countries like ours. It isnecessary to define a set of terms that help the better understanding of the management of DD, such as theircauses, how to hydrate, intolerance, infant formulas, and diet absorbent or astringent. Remains valid in the management of DD, the term "hydrate first, then feed." Treatment ranges from breastfeeding, special infantformulas, diet absorbent and astringent, zinc, probiotics, antibiotics, andinextremecasesof parenteral nutrition.

Seroprevalence of human immunodeficiency virus-2 in and around Amritsar.

A total of 14555 serum samples collected between January, 2001 to April, 2006 were screened for HIV infection. Antibodies to HIV-1/ HIV-2 were present in 985 (6.76%) of which 964 (97.86%) and 2 (0.22%) were positive for HIV-1 and HIV-2 alone respectively and 19 (1.92 %) for both HIV-1 and HIV-2. Of the 21 in whom HIV-2 infection was detected (alone and dual), 19 (90.5%) were in the age group of 21-40 years and 2 were children below the age of 11 years. Predominantly mode of transmission in them was heterosexual (85.71%) while the 2 children (9.53%) had most probably got the infection through perinatal route. Nine (42.85%) were asymptomatic and 12 (57.15%) clinically presented with chronic diarrhoea (5), prolonged fever (4) and symptoms related to sexually transmitted diseases (3). Opportunistic infections like Oral candidiasis was observed in 3 and pulmonary tuberculosis in 2.

Síndrome Urémico Hemolítico: manifestaciones clínicas: tratamento / Hemolytic uremic syndrome: clinical manifestations: Treatment

Clinical manifestation are described in children with epidemic HUS. The intestinal involvement in the prodromic period, is outlined and the most common disturbances such acute renal failure, thrombocytopenia, hemolytic anemia, leucocitosis hypertension, neurological, pancreatic and cardiac manifestations are described. We discuss the acid-base and electrolyte disturbances, metabolic acidosis, hyponatremia, hyperkalemia. The etiopathogenic treatment and the control of renal sequelae are also discussed.

Dos casos de enteritis con bacteriemia por Campylobacter jejuni / Two cases of enteritis with bacteremia due to Campylobacter jejuni

Campylobacter es un importante agente causante de enfermedad en el ser humano en nuestro medio. Los casos de bacteriemia ocurren principalmente en pacientes inmunosuprimidos y sondebidos frecuentemente a C. fetus. Sin embargo la bacteriemia es un episodio que también se ha observado enpacientes con enteritis por C. jejuni. Referimos dos pacientes con enteritis grave y bacteriemia, ambos con enfermedades concomitantes compatibles con inmunodepresión: uno con síndrome nefrótico de larga data y otro con hepatopatía crónica con cirrosis. Destacamos que los dos casos presentaron hematemesis y uno de ellos,enterorragia. Sugerimos prestar atención a la coloración de Gram durante el subcultivo de los caldos conhemocultivos, en busca de formas características de esta especie, y en ese caso emplear medios de cultivo enmicroaerofilia a 37 y 42 °C

Campylobacter is an importantagent of illness in human beings. Bacteremia occurs principally in the immunocompromissed host and is frequently due to C. fetus. Nevertheless bacteremia also has been observed in patients with enteritis due to C. jejuni. We refer two cases of patients with severe enteritis and bacteremia, both of them with immunosupressive concomitant diseases such as nephrotic syndrome and chronic cirrotic hepatopathy. Both patients presented hemathemesis

Postdiarrheal Shiga toxin-mediated hemolytic uremic syndrome similar to septic shock

The inflammatory response of host endothelial cells is included in the development of vascular damage observed in enterohemorrhagic Escherichia coli (EHEC) infection, resulting in hemolytic uremic syndrome (HUS). The response to a non-conventional treatment for a group of D+ HUS (diarrhea positive HUS) patients, with clinical hemodynamic parameters of septic shock was evaluated in this prospective study (1999-2003). Twelve children 2.8 +/- 0.6 years old, with D+ HUS produced by E. coli infection with serological evidence of Shiga toxin, presenting severe unstable hemodynamic parameters and neurological dysfunction at onset, were studied. The protocol included fresh frozen plasma infusions, methylprednisolone pulses (10mg/k/day) for three consecutive days and plasma exchange for five days, starting after admission to the intensive care unit (ICU). The twelve patients with increased pediatric risk of mortality (PRISM) score: 18 +/- 2 after admission to intensive care unit (ICU), required dialysis for 17.4 +/- 4 days, mechanical ventilator assistance for 10 +/- 1 days and early inotropic drugs support for 10.5 +/- 1 days. Neurological dysfunction included generalized tonic-clonic seizures lasting for 5.4 +/- 1 days, n:8. Focal seizures were present in the remaining patients. Dilated cardiomyopathy was present in 6 children. Eight children suffered hemorrhagic colitis. Nine patients survived. Within one year of the injury, neurological sequelae, Glasgow outcome scale (GOS) 3 and 4, were present in two patients, chronic renal failure in one patient. We suggest that early introduction of this protocol could benefit D+ HUS patients with hemodynamic instability and neurological dysfunction at onset. Further studies are likely to elucidate the mechanisms involved in this early adverse clinical presentation of D+ HUS patients.

La respuesta inflamatoria de la célula endotelial se incluye en el desarrollo del daño vascular observado en la infección por Escherichia coli enterohemorrágica que deviene en Síndrome Urémico Hemolítico (SUH). Se evaluó en forma prospectiva, entre 1999 y 2003, la respuesta a un tratamiento no convencional, en doce pacientes, edad 2.8 ± 0.6 años, que desarrollaron SUH con presencia de diarrea sanguinolenta (SUH D+) y evidencia serológica de toxina Shiga, los cuales en fase inicial presentaron parámetros hemodinámicoscompatibles con shock séptico y compromiso neurológico grave. El protocolo incluyó transfusión de plasmafresco, pulsos de metilprednisolona (10mg/k/día) por tres días consecutivos y plasmaféresis por cinco días, iniciados en las primeras 48 horas. Los doce pacientes ingresaron en terapia intensiva, presentando unapuntuación de riesgo de mortalidad pediátrica (PRISM): 18 ± 2, con requerimiento de diálisis por 17.4 ± 4 días, asistencia ventilatoria mecánica por 10 ± 1días y soporte temprano con drogas inotrópicas por un período de10.5 ± 1 días. La disfunción neurológica se presentó con convulsiones tónico-clónicas generalizadas por 5.4 ±1 días en 8 pacientes y con convulsiones focalizadas en los restantes. Seis pacientes desarrollaron miocardiopatíadilatada y 8 presentaron colitis hemorrágica. Sobrevivieron a la etapa aguda de la enfermedad 9 pacientes. Alfinalizar el primer año de seguimiento, dos de ellos presentaban secuelas neurológicas (escala de seguimientode Glasgow; GOS 3 y 4 respectivamente) y uno, fallo renal crónico. La introducción temprana de este protocolo podría beneficiar a pacientes con SUH D+ con inestabilidad hemodinámica grave y disfunción neurológica al inicio. Los mecanismos involucrados en esta temprana presentación clínica adversa de SUH D+ permanecen aún sin dilucidar.

Chronic non-specific diarrhea, transit time and fat supplementation

Among seventy patients under the age of five referred over a ten month period with diarrhea at booth hall children's hospital, were seventeen with characteristic features of chronic non-specific diarrhoea i.e. diarrhea for more than 3 weeks, with normal growth and without evidence of malabsorption, food intolerance or infection. Supplementation of meals with long chain triglyceride emulsion in a dose of 10 ml three times a day for three weeks markedly prolonged the whole gut and colonic transit times as measured by lactulose breath hydrogen test and carmine marker. Fat supplementation significantly reduced the average frequency of stool per day and markedly improved the consistency of stool per day and markedly improved the consistency of stool by the third week of treatment, after an initial time lag. No correlation was observed between the transit time and the frequency or the consistency. We conclude that fat supplementation improves the frequency and the consistency of stoll in chronic non-specific diarrhoea partly partly due to prolongation of colonic transit time

Study on efficacy of WHO-ORS in malnourished children with acute dehydrating diarrhoea.

Twenty-five well nourished children (group A) and 25 malnourished children (group B) of acute diarrhoea with some dehydration were taken up for the study. Both the groups were given World Health Organisation-oral rehydration solution (WHO-ORS) as per WHO guidelines. In both the groups, isonatraemic dehydration was the commonest (group A 64%, group B 56%). Hypokalaemia was noted in 32% cases in group A and 60% cases in group B. Oral rehydration therapy (ORT) was successful in 92% cases in well nourished group A cases and in 80% in group B cases. The mean time in hours required for hydration (group A 8.1+/-1.6; group B 9.1+/-1.4; p<0.05) and hospital stay in days (group A 1.6+/-0.9; group B 3.2+/-3.3; p<0.05) were longer in group B.

Management of diarrhoea in practice.

Diarrhoea, a major cause of morbidity and mortality can be produced by a variety of etiological factors. Management protocol includes assessment of the child, physical examination, lab-evaluation, assessment of severity of dehydration and rehydration therapy using either of the following - WHO - ORS, Home available fluids (HAF), sugar salt solution (SSS), improve WHO-ORS, Amino acid fortified ORS, rice based ORS, low osmolarity ORS. Intravenous fluids are required if patients can't accept orally. Commonly observed electrolyte disturbances are hypernatremia, hyponatremia and hypokalemia. Concussion is a common problem and can result due to electrolyte imbalance, cavernous sinus thrombosis, associated meningitis, shigella encephalopathy and hypoglycemia in undernourished children. Treatment includes i.v. diazepam and i.v. glucose and correction of electrolyte imbalance. Additional treatment interventions include antimicrobial drugs including antibiotics, antimotility drugs, absorbents, nutritional and micro and macro nutrient supplementation.

Studies of the small bowel surface by scanning electron microscopy in infants with persistent diarrhea

We describe the ultrastructural abnormalities of the small bowel surface in 16 infants with persistent diarrhea. The age range of the patients was 2 to 10 months, mean 4.8 months. All patients had diarrhea lasting 14 or more days. Bacterial overgrowth of the colonic microflora in the jejunal secretion, at concentrations above 10(4) colonies/ml, was present in 11 (68.7 percent) patients. The stool culture was positive for an enteropathogenic agent in 8 (50.0 percent) patients: for EPEC O111 in 2, EPEC O119 in 1, EAEC in 1, and Shigella flexneri in 1; mixed infections due to EPEC O111 and EAEC in 1 patient, EPEC O119 and EAEC in 1 and EPEC O55, EPEC O111, EAEC and Shigella sonnei in 1. Morphological abnormalities in the small bowel mucosa were observed in all 16 patients, varying in intensity from moderate 9 (56.3 percent) to severe 7 (43.7 percent). The scanning electron microscopic study of small bowel biopsies from these subjects showed several surface abnormalities. At low magnification (100X) most of the villi showed mild to moderate stunting, but on several occasions there was subtotal villus atrophy. At higher magnification (7,500X) photomicrographs showed derangement of the enterocytes; on several occasions the cell borders were not clearly defined and very often microvilli were decreased in number and height; in some areas there was a total disappearance of the microvilli. In half of the patients a mucus-fibrinoid pseudomembrane was seen partially coating the enterocytes, a finding that provides additional information on the pathophysiology of persistent diarrhea