BMJ. 2007 Jan 6; 334[7583]: 35–40. Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. In developed countries it is a common reason for presentation to general practice or emergency departments and for admission to hospital. Dehydration, which may be associated with electrolyte disturbance and metabolic acidosis, is the
most frequent and dangerous complication. Optimal management with oral or intravenous fluids minimises the risk of dehydration and its adverse outcomes. Routine use of antibiotics, antidiarrhoeal agents, and antiemetics is not recommended and may cause harm. Prevention is the key to controlling gastroenteritis, and recently licensed, highly effective rotavirus vaccines will have a major effect on public health. I
searched the Cochrane Library database using the keywords “acute gastroenteritis” [all text], “acute disease”, “gastroenteritis”, and “child”. I searched Medline via PubMed clinical queries using the keywords “gastroenteritis” together with “oral rehydration”, “antidiarrheal”, “antiemetic”, “probiotic”, and “zinc” with the options “find systematic reviews” and “search by study category—therapy.” The options of “aetiology” and “diagnosis” were also applied using the term “gastroenteritis”. I also
searched the child health section of Clinical Evidence and reviewed the reference lists of publications found during searches for other relevant manuscripts Acute gastroenteritis—diarrhoea or vomiting [or both] of more than seven days duration—may be accompanied by fever, abdominal pain, and anorexia. Diarrhoea is the passage of excessively liquid or frequent stools
with increased water content. Patterns of stooling vary widely in young children, and diarrhoea represents a change from the norm.1 Worldwide, 3-5 billion cases of acute gastroenteritis and nearly 2 million deaths occur each year in children under 5
years.2 In the United States, gastroenteritis accounts for about ∼10% [220 000] of admissions to hospital, more than 1.5 million outpatient visits, and around 300 deaths in children under 5 annually, with a cost of around $1bn [£0.5bn;
€0.8bn].2 In the same age group in Australia, about 10 000 hospital admissions, 22 000 visits to emergency departments, and 115 000 general practice consultations occur annually for rotavirus alone, with an estimated cost of $A30m [£12m; €18m;
$23m].3 In the United Kingdom, 204 of 1000 consultations with general practitioners in children under 5 are for gastroenteritis, and the annual hospital admission rate in this group is about seven per 1000 children.4 Children in childcare settings are often
infected but asymptomatic and may unwittingly transmit infection. Sources and selection criteria
What is the epidemiology and impact of gastroenteritis?
Children with poor nutrition are at increased risk of complications. In the north end of Australia, Aboriginal and Torres Strait Islander children have increased rates of admission for gastroenteritis, malnutrition, comorbidity, and electrolyte disturbance [especially hypokalaemia] and a longer hospital stay than their non-indigenous counterparts.5 The cost of gastroenteritis to the community is huge but often underestimated if costs to the family, including lost time at work, are not considered.
Summary points
Rotavirus is the most common cause of acute gastroenteritis worldwide and vaccination will have a major impact on disease rates, morbidity, and mortality
Most children are not dehydrated and can be managed at home
Dehydration, metabolic acidosis, and electrolyte disturbance can be prevented and treated by fluid therapy
Most children with mild-moderate dehydration can be treated with oral or enteral rehydration using low osmolality oral rehydration solutions
Severely dehydrated or shocked children usually need intravenous fluids and hospital admission
-
Drugs are usually unnecessary and may do harm
General practitioners have an important role in prevention, through encouraging breastfeeding, recommending and advocating free access to rotavirus vaccination, and educating carers about personal and food hygiene
What are the causes and clinical characteristics?
Box 1 lists some causes of acute gastroenteritis in children. Worldwide, most cases are due to viral infection [fig 1; box 2], with rotaviruses and noroviruses being most common. Viral infections damage small bowel enterocytes and cause low grade fever and watery diarrhoea without blood. Rotavirus infection is seasonal in temperate climates, peaking in late winter, but occurs throughout the year in the tropics. Rotavirus strains vary by season and geographically within countries.6 The peak age for infection is between 6 months and 2 years, and the mode of spread is by the faecal-oral or respiratory route.
Fig 1 Rotavirus particles seen under the electron microscope. Courtesy of Alan Philips
Box 1 Causes of acute gastroenteritis in children
Viruses [∼70%]
Rotaviruses
Noroviruses [Norwalk-like viruses]
Enteric adenoviruses
Caliciviruses
Astroviruses
Enteroviruses