Katherine Morrison's List: Gastroenteritis

• norovirus, which is extraordinarily infectious and requires special isolation procedures to avoid transmission
• • Even though absorption is poor and they may be vomited up, drinking fluids is beneficial for the reduction of dehydration. Additionally, some find it less painful to vomit up something (even water) rather than nothing (ie if fluids aren't taken in)
• omplex-carbohydrate-based oral rehydration therapy such as those made from wheat or rice may be superior to simple sugar-based ORS.^[25]
• Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse.
• Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore substantial amounts of soft drinks, juice, and other high simple sugar foods should be avoided
• he BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding

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• they have shown particular promise in the treatment of acute infectious diarrhea and the prevention of antibiotic-associated  diarrhea, associations that have been investigated widely and have been subject to systematic review.^1–4
• Other conditions potentially treatable by probiotics include chronic diarrhea,⁵ inflammatory bowel disease,⁶ irritable bowel syndrome,⁷ and food allergy⁸; potentially preventable conditions range from travelers’ diarrhea⁹ and necrotizing enterocolitis¹⁰ to urogenital infections,¹¹ atopic diseases,¹² and dental caries.¹³ Vanderhoof¹⁴ and other leaders in the field propose future applications in cystic fibrosis, rheumatoid arthritis, and cancers.
• Probiotic therapies, once discussed primarily in the context of “complementary” or “integrative” medicine, are entering the  therapeutic mainstream of pediatric disease.
• Although treatment of bacterial gastroenteritis  and treatment of children with moderate to severe gastroenteritis is not supported conclusively by studies,^29–31 there is strong evidence for the treatment of children with gastroenteritis of viral origin, treatment using Lactobacillus GG, and treatment of children with mild diarrheal illness.^29,32,33

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• group A, receiving oral rehydration solution plus placebo
• group B, receiving the same preparation but with a live preparation of Lactobacillus GG (at least 10(10) CFU/250 ml)
• Duration of diarrhea after enrollment was 71.9 +/- 35.8 hours in group A versus 58.3 +/- 27.6 hours in group B (mean +/- SD; P = 0.03)
• In rotavirus-positive children, diarrhea lasted 76.6 +/- 41.6 hours in group A versus 56.2 +/- 16.9 hours in groups B (P < 0.008)
• Diarrhea lasted longer than 7 days in 10.7% of group A versus 2.7% of group B patients (P < 0.01)
• Hospital stays were significantly shorter in group B than in group A
• oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea, less chance of a protracted course, and faster discharge from the hospital

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• Today, we have a large number of published clinical trials on the role of probiotics in treating sporadic infectious diarrhea in children, and many of them are randomized, blinded, and controlled.
• consistently show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii, but also L. reuteri-in the treatment of acute watery diarrhea, primarily rotaviral, in infants and young children of developed countries.
• uch a beneficial effect seems to result in a reduction of diarrhea duration of little more than 1 day, and to be exerted mostly on diarrhea due to rotavirus.
• The effect is not only strain-dependent, but also dose-dependent, with doses of at least 10 billion/d being necessary.

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• Oral rehydration solution plus Saccharomyces boulardii;
• Oral rehydration therapy plus placebo
• Oral rehydration solution plus a compound containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii
• Median duration of diarrhoea (p = 0.04) in children who received the single species product (58 hours) was shorter than in controls (84.5 hrs).
• Both products decreased the duration of diarrhoea compared to oral rehydration solution alone. This decrease was significant only for the single species product which also decreased the duration of fever. With the multiple species product there was no vomiting subsequent to the initiation of treatment. The quantity of probiotic bacteria needed for optimum treatment of gastroenteritis remains to be determined, particularly when multiple species are included in the product.

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• This investigation showed that L. casei rhamnosus can control bacterial, viral and respiratory infections; a multi-species probiotic reduced gastrointestinal disease significantly. Long-term consumption of L. rhamnosus T cell-1 decreased the incidence of bacterial infection.