Clinical Evidence Concise

A Publication of BMJ Publishing Group

Gastroenteritis in Children

Am Fam Physician. 2008 Feb 1;77(3):353-354.

This clinical content conforms to AAFP criteria for evidence-based continuing medical education (EB CME). See Clinical Quiz on page 289.

What are the effects of treatments for acute gastroenteritis?

BENEFICIAL

Enteral (Oral or Nasogastric) Rehydration Solutions (As Effective As Intravenous Fluids). One systematic review, which included studies in children with mild to severe dehydration, found that enteral (oral or nasogastric) rehydration reduced hospital stay compared with intravenous rehydration, and found no significant difference between treatments in weight gain or duration of diarrhea. Enteral rehydration reduced major adverse events (death or seizure) compared with intravenous rehydration; this was largely based on the results of one large randomized controlled trial (RCT) in children with severe gastroenteritis. A second systematic review found that oral rehydration failed in one out of 25 children treated (failure was defined as the need for intravenous fluids), but this was minimized by the use of low osmolarity solutions. There were no significant differences in weight gain, electrolyte disturbance, or duration of diarrhea between the enteral and intravenous groups. Hospital stay and phlebitis were significantly less common, and paralytic ileus was more common in children treated with oral rehydration.

LIKELY TO BE BENEFICIAL

Lactose-Free Feeds (May Reduce Duration of Diarrhea). One systematic review of weak RCTs and three of five subsequent RCTs found that lactose-free feeds reduced the duration of diarrhea in children with mild to severe dehydration compared with lactose-containing feeds. The two remaining subsequent RCTs found no significant difference between lactose-free and lactose-containing feeds in duration of diarrhea.

Loperamide (Reduces Duration of Diarrhea, but There Is Risk of Adverse Effects). Two RCTs found that, in children with mild to moderate dehydration, loperamide reduced the duration of diarrhea compared with placebo. Another RCT found no significant difference between loperamide and placebo in the duration of diarrhea. We found insufficient evidence to assess the risk of adverse effects.

UNKNOWN EFFECTIVENESS

Clear Fluids (Other Than Oral Rehydration Solutions). We found no systematic reviews or RCTs comparing clear fluids (water, carbonated drinks, and translucent fruit juices) with oral rehydration solutions for treatment of acute gastroenteritis.

Definition

Acute gastroenteritis is caused by infection of the gastrointestinal tract, most commonly with a virus. It is characterized by rapid onset of diarrhea with or without vomiting, nausea, fever, or abdominal pain.1 In children, the symptoms and signs can be nonspecific.2 Diarrhea is defined as frequent, unformed, liquid stools.3 Regardless of the cause, the mainstay of management of acute gastroenteritis is provision of adequate fluids to prevent and treat dehydration. In this review, we examine the benefits and harms of different treatments for gastroenteritis, irrespective of its cause.

Incidence and Prevalence

Worldwide, about 3 to 5 billion cases of acute gastroenteritis occur each year in children younger than five years, resulting in nearly 2 million deaths.4,5 In the United Kingdom, acute gastroenteritis accounts for 204 out of 1,000 general physician consultations in children younger than five years.6 Gastroenteritis leads to hospital admission in seven out of 1,000 children younger than five years each year in the United Kingdom,6 and 13 out of 1,000 in the United States.7 In Australia, gastroenteritis accounts for 6 percent of all hospital admissions in children younger than 15 years.8

Etiology

In resource-rich countries, acute gastroenteritis is caused predominantly by viruses (87 percent), of which rotavirus is the most common.812 Bacteria, predominantly Campylobacter, Salmonella, Shigella, and Escherichia coli, cause most of the remaining cases. In resource-poor countries, where bacterial pathogens are more frequent, rotavirus is also a major cause of gastroenteritis.

Prognosis

Acute gastroenteritis is usually self-limiting, but if untreated it can lead to morbidity and mortality secondary to water loss and electrolyte and acid-base disturbance. Acute diarrhea causes 4 million deaths each year in children younger than five years in Asia (excluding China), Africa, and Latin America; more than 80 percent of deaths occur in children younger than two years.13 Although death is uncommon in developed countries, dehydration secondary to gastroenteritis is a significant cause of morbidity and hospital admission.79

Author disclosure: Nothing to disclose.

search date: August 2006

Adapted with permission from Dalby-Payne J, Elliott E. Gastroenteritis in children. Clin Evid Handbook. Dec 2007:91–92.

 

REFERENCES

1. Armon K, Elliott EJ. Acute gastroenteritis. In: Moyer VA, Elliott EJ, Davis RL, eds. Evidence Based Pediatrics and Child Health. 2nd ed. London: BMJ Books; 2004:377–392.

2. American Academy of Pediatrics. Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics. 1996;97:424–435.

3. Critchley M. Butterworths Medical Dictionary. 2nd ed. London: Butterworths; 1986.

4. World Health Organization. Child and adolescent health and development: child health epidemiology. http://www.who.int/child-adolescent-health/overview/childhealth/childepidemiology.htm. Accessed September 4, 2006.

5. World Health Organization. Children's environmental health. http://www.who.int/ceh/en/. Accessed September 4, 2006.

6. OPCS. Morbidity statistics from general practice. Fourth national study, 1991–1992. London: HMSO; 1993.

7. Glass RI, Lew JF, Gangarosa RE, et al. Estimates of morbidity and mortality rates for diarrheal diseases in American children. J Pediatr. 1991;118:S27–S33.

8. Elliott EJ, Backhouse JA, Leach JW. Pre-admission management of acute gastroenteritis. J Paediatr Child Health. 1996;32:18–21.

9. Conway SP, Phillips RR, Panday S. Admission to hospital with gastroenteritis. Arch Dis Child. 1990;65:579–584.

10. Finkelstein JA, Schwartz JS, Torrey S, et al. Common clinical features as predictors of bacterial diarrhea in infants. Am J Emerg Med. 1989;7:469–473.

11. DeWitt TG, Humphrey KF, McCarthy P. Clinical predictors of acute bacterial diarrhea in young children. Pediatrics. 1985;76:551–556.

12. Ferson MJ. Hospitalisations for rotavirus gastroenteritis among children under five years of age in New South Wales. Med J Aust. 1996;164:273–276.

13. Anonymous. A manual for the treatment of diarrhoea. Programme for the control of diarrhoeal diseases. Geneva: WHO; 1990.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.com (subscription required). Those who receive a complimentary print copy of the Clinical Evidence Handbook from United Health Foundation can gain complimentary online access by registering on the Web site using the ISBN number of their book.


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