Review Article: The Management of Acute Gastroenteritis in Children

Alimentary Pharmacology & Therapeutics

M. Pieścik-Lech, R. Shamir, A. Guarino, H. Szajewska

Aliment Pharmacol Ther. 2013;37(3):289-303

Introduction

Acute gastroenteritis (AGE), characterised by the sudden onset of diarrhoea with or without vomiting, is one of the most common infectious diseases of childhood. In Europe, it is estimated that the incidence of diarrhoea ranges from 0.5 to 1.9 episodes per child per year in children up to 3 years of age.[1] In low- and middle-income countries, while the incidence of acute diarrhoea has declined from 3.4 episodes/child year in 1990 to 2.9 episodes/child year in 2010, the incidence of AGE remains high, especially in infants aged 6–11 months (4.5 episodes/child year).^[2] Moreover, worldwide diarrhoea remains one of the leading causes of mortality among children younger than 5 years.^[3]

In 2008, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society of Paediatric Infectious Diseases (ESPID) developed evidence-based guidelines for the management of AGE for practitioners at all levels of health care – primary care physicians, paediatricians and family physicians – practising in Europe.^[1] In addition, a number of national guidelines have been developed, although their quality varies.^[4] Perhaps the best known among them are those developed by the National Institute for Health and Clinical Excellence (NICE).^[5]

Both ESPGHAN/ESPID and the NICE guidelines largely agree on key issues in the management of AGE. Oral rehydration therapy with a hypotonic solution remains central to the management of AGE. Fast oral rehydration with rapid return to regular food is recommended. 

The routine use of special or diluted formulas is unjustified. Continuation of breastfeeding is strongly recommended. 

The guidelines recommend against the routine use of antibiotics in otherwise healthy children presenting with AGE. 

Regarding drugs, both sets of guidelines recommend against the use of antiemetics, but they strongly emphasise the need for further research. Compared with the NICE guidelines, the ESPGHAN/ESPID guidelines make a stronger recommendation for the use of probiotics for the management of AGE, particularly those with documented efficacy such as Lactobacillus GG and Saccharomyces boulardii. 

The ESPGHAN/ESPID guidelines state that treatment with racecadotril (an enkephalinase inhibitor) may be considered in the management of AGE. Both sets of guidelines state that there is evidence suggesting that smectite (a natural hydrated aluminomagnesium silicate that binds to digestive mucus and has the ability to bind endotoxins and exotoxins, bacteria and rotavirus) is an effective antidiarrhoeal agent, but only the ESPGHAN/ESPID guidelines recommend that the use of smectite may be considered in the management of AGE.