Environmental Enteric Dysfunction: Pathogenesis, Diagnosis, and Clinical Consequences
Environmental Enteric Dysfunction: Pathogenesis, Diagnosis, and Clinical Consequences
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DOI：
10.1093/cid/ciu485
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发表时间：
2014-11-01
影响因子：
11.8
通讯作者：
Brewer, Thomas
中科院分区：
文献类型：
--
作者：
Keusch, Gerald T.;Denno, Donna M.;Brewer, Thomas
发育迟缓在发展中国家的幼儿中很常见，并与发病率、发育迟缓和死亡率的增加有关。其复杂的发病机制可能涉及宫内和产后营养不良，暴露于微生物，以及反复感染的代谢后果。影响肠道结构和功能的获得性肠病可能在这一结果中起着重要作用，特别是在生命的最初几个月，并作为感染和营养不良相互作用的前兆。然而，缺乏有效的临床诊断标准限制了研究其作用，识别致病因素和确定成本效益干预措施的能力。这篇综述通过历史的方法解决了这些问题，并提供了建议，以定义和验证工作的临床诊断，并指导在这一领域的关键研究，以有效地进行。预防早期肠道功能变化和炎症可能会阻止或减轻营养不良和感染的后期不良恶性循环。
Stunting is common in young children in developing countries, and is associated with increased morbidity, developmental delays, and mortality. Its complex pathogenesis likely involves poor intrauterine and postnatal nutrition, exposure to microbes, and the metabolic consequences of repeated infections. Acquired enteropathy affecting both gut structure and function likely plays a significant role in this outcome, especially in the first few months of life, and serve as a precursor to later interactions of infection and malnutrition. However, the lack of validated clinical diagnostic criteria has limited the ability to study its role, identify causative factors, and determine cost-effective interventions. This review addresses these issues through a historical approach, and provides recommendations to define and validate a working clinical diagnosis and to guide critical research in this area to effectively proceed. Prevention of early gut functional changes and inflammation may preclude or mitigate the later adverse vicious cycle of malnutrition and infection.