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Acute gastroenteritis — Clinical Guidelines

Overview

Acute gastroenteritis (AGE) involves inflammation of the stomach and intestines, leading to symptoms such as diarrhea, vomiting, and abdominal pain, often due to viral or bacterial pathogens. 2 3

Diagnosis

Clinical Presentation: Diarrhea (typically defined as ≥3 loose stools in 24 hours), vomiting, abdominal pain, fever. 2

Grading Dehydration: Assess using clinical signs (e.g., skin turgor, capillary refill time, urine output). 2

Laboratory Tests: Stool cultures for bacterial pathogens; stool antigen tests for specific pathogens like rotavirus; electrolyte panels for dehydration assessment. 2

Management

Oral Rehydration Therapy (ORT): Primary treatment for mild to moderate dehydration; solutions containing glucose, sodium, and electrolytes. 2 3

Intravenous Fluids: For severe dehydration; isotonic saline or lactated Ringer’s solution. 2

Antiemetics: Use cautiously; ondansetron may be considered for persistent vomiting, though evidence varies. 3

Probiotics: Limited evidence supports use in reducing duration of diarrhea, particularly in children. 3

Nutritional Management: Continue breastfeeding or formula feeding; reintroduce regular diet gradually after rehydration. 2

Special Populations

Pediatrics: Focus on ORT and close monitoring for dehydration; avoid unnecessary antibiotics. 2 3

Elderly: Increased risk of complications; careful hydration management and monitoring for electrolyte imbalances. 2

Key Recommendations

Initiate ORT for children with AGE to prevent and treat dehydration (Evidence: Strong 2).

Use IV fluids for severe dehydration in pediatric patients (Evidence: Strong 2).

Consider probiotics in children to potentially reduce diarrhea duration, though evidence is moderate (Evidence: Moderate 3).

Avoid routine use of antiemetic agents in AGE management due to limited evidence (Evidence: Weak 3).

Continue or initiate appropriate feeding strategies, including breastfeeding or formula, despite AGE (Evidence: Expert opinion 2).

References

1 Baloch M, Tarar S, Taimur S. Sanitary alert: acute gastroenteritis associated with house-fly infestation after heavy rainfall in Karachi, Pakistan. Le infezioni in medicina 2019. link 2 Guarino A, Lo Vecchio A, Dias JA, Berkley JA, Boey C, Bruzzese D et al.. Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children. Journal of pediatric gastroenterology and nutrition 2018. link 3 Freedman SB, Sivabalasundaram V, Bohn V, Powell EC, Johnson DW, Boutis K. The treatment of pediatric gastroenteritis: a comparative analysis of pediatric emergency physicians' practice patterns. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2011. link 4 Paisley J. Acute gastroenteritis syndromes in children. Primary care 1984. link

Acute gastroenteritis