Leaderboard ad

Friday, January 18, 2013

The Stomach Bug/Flu in Children: What Works & What Doesn’t

You know of it as the stomach bug or the stomach flu (even though it is technically not related to the actual flu). Medical doctors refer to it as gastroenteritis because it involves inflammation (which is what “itis” means in Greek) of the stomach (gastro) and small intestines (entero). The small intestine is the part of the intestine that takes in all of the nutrients the body needs.

Regardless of what you call this condition, it is not something you want to have. Common signs and symptoms include diarrhea, stomach pain, stomach cramps, and vomiting.  It is a common reason for visits to the doctor, urgent care centers, and emergency rooms.

The stomach bug can occur in adults but it is very common in children. When it occurs in children, it is usually caused by a virus known as rotavirus.  By age five, nearly every child in the world has been infected by rotavirus at least once.

In a new review study published in Europe, researchers presented a summary of the best evidence for treatment of acute gastroenteritis in children. The authors found that oral rehydration (drinking fluids by mouth) is central to treatment.  Specific hypotonic solutions (composed of salt, sugar, and water) are used for this rehydration.  Although effective, oral rehydration is not always used because it does not decrease the amount of bowel movements, does not decrease the length of the illness, and the liquid is not something children enjoy due to the strong salty taste. There are continuing efforts to improve the taste and effectiveness of these liquids for children.

The authors found that the anti-diarrhea medication, Racecadotril  (acetorphan) can be an effective additional treatment along with oral rehydration. The authors also noted that a natural clay known as smectite can be an effective additional treatment to oral rehydration. However, neither smectite nor Racecadotril are available for use in the U.S.

When oral rehydration is not feasible, another option is nasogastric rehydration. In this technique, fluid is directed to the stomach through a tube placed in the nose that connects it to the stomach. This technique is sometimes used over a 24 hour period but newer evidence shows that doing this rapidly over 4 hours is also effective. The authors found that nasogastric hydration can be an effective or better than intravenous hydration, which is when a needle is inserted through the vein and liquid enters the body.  For cases of intravenous hydration, evidence on the amount of fluid to administer was not consistent. The authors considered 20 ml/kg to be appropriate, which is standard intravenous rehydration.

Medications used to stop vomiting are known as anti-emetics. A common medicine used for this purpose is Ondansetron (Zofran). The authors noted that this medication does reduce vomiting in young children with the stomach bug but that there was no evidence that other medications were useful for this purpose. It was noted that the Food and Drug Administration (FDA) recommends heart monitoring in patients receiving Zofran who have potential electrolyte abnormalities (which someone with the stomach bug would) because it can lead to abnormal and potentially deadly heart rhythms. Electrolytes are chemical substances that are able to conduct electricity after they are melted or dissolved in water.

The authors reported on one European study that did not show that the element, zinc, was useful in treating gastroenteritis. Lastly, the authors found that some probiotics are helpful in managing diarrhea gastroenteritis. Probiotics are live microorganisms that provide health benefits to the host. Specific probiotics found to be helpful were Lactobacillus GG and S. boulardii but that others may prove helpful in the future as well as synbiotics. Synbiotics are combinations of probiotics and prebiotics. Prebiotics are undigestible food ingredients that promote growth and/or activity in the digestive system in ways claimed to be beneficial to health.

Suggested reading: Viral Gastroenteritis

Related blog entry: Preventing Rotavirus with Vaccines: Do They Work?

Reference: PieĊ›cik-Lech M, Shamir R, Guarino A, Szajewska H. (2013). Review article: the management of acute gastroenteritis in children. Aliment Pharmacol Ther. 37(3): 289-303.

1 comment:

Your comments are welcome.