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gastroenteritis
Etiology:
- viral infection
a) Rotavirus
b) Adenovirus serotypes 40 & 41
c) Caliciviruses
- norovirus (Norwalk virus)
d) Astrovirus
- bacterial infection
- Salmonella
- radiation
Epidemiology:
1) Rotavirus
a) major cause in children 3 to 15 months old
b) most children have been exposed to the virus by age 2
c) adults who are in close contact with infected children
d) November to April
2) Adenovirus serotypes 40 & 41
a) children younger than 2 years old
b) infections occur all year round
3) Caliciviruses cause infection in persons of all ages
- norovirus
- Norwalk virus cause epidemic outbreaks
b) sapovirus (Sapporo virus)
4) Astrovirus infects primarily infants, young children, & the elderly
a) most active during the winter months
Clinical manifestations:
1) vomiting
2) watery diarrhea
3) abdominal pain
4) dehydration
5) fever
6) headache
7) generally 1-2 days in duration, but may last up to 10 days
Complications:
- postinfectious irritable bowel syndrome 14.5%, most IBS-D
- postinfectious functional dyspepsia 12.7% [6]
Management:
1) see diarrhea, gastritis
2) dilute apple juice for initial hydration followed by fluids of child's choice [3]
3) ondansetron (Zofran) may stop vomiting & prevent dehydration in children & adolescents [2]
4) fiber may be of benefit
- Isomil DF (IDF) infant formula
5) probiotics for children presenting to the emergency department not helpful [4,5]
Related
diarrhea
enteritis
gastritis
Specific
bacterial gastroenteritis
enterocolitis
eosinophilic gastroenteritis
viral gastroenteritis
General
gastrointestinal disease
inflammation
References
- Journal Watch 21(23):185, 2001
- The NNT: Ondansetron (Zofran) for Pediatric and Adolescent
Gastroenteritis
http://www.thennt.com/nnt/ondansetron-for-pediatric-gastroenteritis/
- Fedorowicz Z, Jagannath VA, Carter B.
Antiemetics for reducing vomiting related to acute
gastroenteritis in children and adolescents.
Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005506
PMID: 21901699
- Carter B, Fedorowicz Z
Antiemetic treatment for acute gastroenteritis in children:
an updated Cochrane systematic review with meta-analysis and
mixed treatment comparison in a Bayesian framework.
BMJ Open 2012;2:e000622
http://bmjopen.bmj.com/content/2/4/e000622.long
- Freedman SB et al
Effect of Dilute Apple Juice and Preferred Fluids vs
Electrolyte Maintenance Solution on Treatment Failure Among
Children With Mild Gastroenteritis. A Randomized Clinical Trial.
JAMA. Published online April 30, 2016
http://jama.jamanetwork.com/article.aspx?articleid=2518402
- Schnadower D, Tarr PI, Casper TC et al.
Lactobacillus rhamnosus GG versus placebo for acute
gastroenteritis in children.
N Engl J Med 2018 Nov 22; 379:2002.
PMID: 30462938
https://www.nejm.org/doi/10.1056/NEJMoa1802598
- Freedman SB, Williamson-Urquhart S, Farion KJ et al.
Multicenter trial of a combination probiotic for children with
gastroenteritis.
N Engl J Med 2018 Nov 22; 379:2015.
PMID: 30462939
https://www.nejm.org/doi/10.1056/NEJMoa1802597
- LaMont JT.
Probiotics for children with gastroenteritis.
N Engl J Med 2018 Nov 22; 379:2076.
PMID: 30462932
https://www.nejm.org/doi/10.1056/NEJMe1814089
- Orciari Herman A. Fairchild DG, Di Francesco L
Physician's First Watch, June 9, 2020
David G. Fairchild, MD, MPH, Editor-in-Chief
Massachusetts Medical Society (subscription needed)
http://www.jwatch.org
Szymanski H, Szajewska H.
Lack of efficacy of Lactobacillus reuteri DSM 17938 for the treatment
of acute gastroenteritis: A randomized controlled trial.
Pediatr Infect Dis J 2019 Apr 25; [e-pub]
PMID: 28060791
https://journals.lww.com/pidj/Abstract/2019/10000/Lack_of_Efficacy_of_Lactobacillus_reuteri_DSM.1.aspx
- Porcari S, Ingrosso MR, Maida M et al.
Prevalence of irritable bowel syndrome and functional dyspepsia after acute
gastroenteritis: Systematic review and meta-analysis.
Gut 2024 Aug 8; 73:1431-1440
PMID: 39013599
https://gut.bmj.com/content/73/9/1431
- Viral Gastroenteritis ("Stomach Flu")
https://www.niddk.nih.gov/health-information/digestive-diseases/viral-gastroenteritis