Am Fam Physician. 2008;77(3):353-354
Author disclosure: Nothing to disclose.
What are the effects of treatments for acute gastroenteritis?
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.
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.
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
In resource-rich countries, acute gastroenteritis is caused predominantly by viruses (87 percent), of which rotavirus is the most common.8–12 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.
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.7–9