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Meta-Analysis
. 2015 Jun 15;10(6):e0128754.
doi: 10.1371/journal.pone.0128754. eCollection 2015.

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

Stephen B Freedman  1 , Dion Pasichnyk  2 , Karen J L Black  3 , Eleanor Fitzpatrick  4 , Serge Gouin  5 , Andrea Milne  2 , Lisa Hartling  2 ; Pediatric Emergency Research Canada Gastroenteritis Study Group
Collaborators, Affiliations
Meta-Analysis

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

Stephen B Freedman et al. PLoS One. .

Erratum in

Abstract

Context: Gastroenteritis remains a leading cause of childhood morbidity.

Objective: Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected.

Data sources: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings.

Study selection: Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate.

Data extraction: The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models.

Results: 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92).

Conclusions: There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge.

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Conflict of interest statement

Competing Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Dr. Stephen Freedman acknowledges receiving in-kind study drug/placebo from GlaxoSmithKline, the manufacturer of ondansetron for the conduct of an unrelated study. Dr. Stephen Freedman has received research grant support from Lallemand Health Solutions to study a probiotic agent. All other authors declare no other support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. No individuals employed or contracted by the funders (other than the named authors) played any role in: study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow diagram of study selection.
SR, systematic review; PICO, Population, Intervention, Comparison, Outcome; RCT, randomized controlled trial.
Fig 2
Fig 2. Meta-graph comparing oral rehydration therapy vs. intravenous fluid therapy.
Results from meta-analysis of direct comparisons of oral rehydration therapy vs. intravenous fluid therapy on the outcomes of admission to hospital from the emergency department and revisits to the emergency departments, displayed employing Forest plots.
Fig 3
Fig 3. Meta-graph comparing any antiemetic therapy vs. placebo.
Results from meta-analysis of direct comparisons of therapy with any antiemetic agent vs. placebo on the outcomes of administration of intravenous hydration, admission to hospital from the emergency department and revisits to the emergency departments, displayed employing Forest plots.
Fig 4
Fig 4. Meta-graph comparing any probiotic therapy vs. placebo.
Results from meta-analysis of direct comparisons of therapy with any probiotic agent vs. placebo on the outcomes of administration of revisits to the emergency department, admission to hospital from the emergency department, and intravenous hydration, displayed employing Forest plots.
See this image and copyright information in PMC

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