Acute gastroenteritis results from infection of the gastrointestinal tract, most commonly with a virus. It is characterised by rapid onset of diarrhoea with or without vomiting, nausea, fever, and abdominal pain. Diarrhoea is defined as the frequent passage of unformed, liquid stools. Regardless of the cause, the mainstay of management of acute gastroenteritis is provision of adequate fluids to prevent and treat dehydration.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent acute gastroenteritis in children? What are the effects of treatments for acute gastroenteritis in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 42 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of: rotavirus vaccines for the prevention of gastroenteritis; enteral rehydration solutions (oral or gastric), lactose-free feeds, loperamide, probiotics, and zinc for the treatment of gastroenteritis; and ondansetron for the treatment of vomiting.
Gastroenteritis in children worldwide is usually caused by rotavirus, which leads to considerable morbidity and mortality.
Bacterial causes of gastroenteritis are more common in developing countries.
Rotavirus vaccines are both safe and effective in preventing and minimising harm from gastroenteritis caused by rotavirus, particularly in preventing severe disease.
Enteral rehydration solutions containing sugar or food plus electrolytes are as effective as intravenous fluids at correcting dehydration and reducing the duration of hospital stay, and may have fewer major adverse effects.
Lactose-free feeds may reduce the duration of diarrhoea in children with mild to severe dehydration compared with feeds containing lactose, but studies have shown conflicting results.
Loperamide can reduce the prevalence of acute diarrhoea in children in the first 48 hours after initiation of treatment, but there is an increased risk of adverse effects compared with placebo.
Ondansetron reduces vomiting but increases diarrhoea in children with gastroenteritis compared with placebo.
Zinc may reduce the duration of diarrhoea compared with placebo but may also increase the risk of vomiting; most studies were conducted in developing countries, with little evidence from developed countries.
Probiotics may reduce the duration of diarrhoea and may reduce hospital stay, with most evidence for Lactobacillus species.