Management of Gastroenteritis in Primary Care – A Review

Gastroenteritis is one the most common diseases worldwide, and it’s more dangerous in children, although in most time it’s self-limited, it can be fatal in case of children, the most dangerous side of GE is diarrhea and the dehydration that follows it. Since dehydration is the most dangerous symptom of the Gastroenteritis Oral rehydration solutions and even intravenous solution intake (in case of severe dehydration) is the main treatment, followed by symptomatic treatment such anti-emetics or antidiarrheal drugs, although caution should be considered for drugs used in children. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. During the last few years, the role of primary care physicians in the diagnosis and management of gastroenteritis has been recognized as very important, and it has been suggested that they have all the available resources in order to ensure high standard of care for their patients. In particular, clearly articulated clinical practice guidelines, effective medications, accurate noninvasive investigations, and evidence-based primary care management plans are available to support PCPs who want to raise their threshold for referring patients with GI symptoms.

Differential diagnosis of infectious watery diarrhea (view from time immemorial to the present). Modern approaches to rehydration

Today, as in ancient times, diarrhea (loss of water and electrolytes along with stool) accompanies many pathological conditions in humans. The pathophysiology of various types of diarrhea has been studied, which made it possible to optimize therapeutic approaches and save the lives of many people. The most dangerous conditions occur in young patients with osmotic and exudative types of diarrhea, as they result in exicosis within a short time. In arriving at a diagnosis, rehydration therapy should be started as soon as possible. The article presents the historical aspects associated with the global pandemics of cholera. The history of the creation of solutions for intravenous and oral rehydration is covered. The authors presented tables for calculating fluid losses and the required volume of solutions for oral or parenteral administration. The modern requirements for rehydration solutions and the principles of rehydration in children are presented. Oral rehydration is particularly problematic for young children due to the limited range of drugs and requirements for the composition of solutions used in pediatrics. According to the recommendations of the World Health Organization and ESPGHAN, clinical recommendations of the Russian Federation, low-osmolar solutions should be used. When complex solutions containing probiotic and zinc are used, the therapy compliance increases. A rehydration solution, which contains a weighted amount of salt for the preparation of a low-osmolar solution, as well as the probiotic L. reuteri DSM 17938 at least 1 billion of viable bacteria and zinc sulphate 0.004 g is one of the latest solutions. The results of studies of this solution are provided.

Comparative analysis and evaluation of current antidiarrheal prescribing trends with representative brand in pediatric population of Pakistan

Background: Prevalence of carpal tunnel syndrome (CTS) among pregnant women is very much common among the Background: Inappropriate management of diarrhea is the main cause of morbidity and mortality in the pediatric population worldwide, more especially in developing countries including Pakistan. Method: The sample size was calculated using World Health Organization (WHO) and Expanded Program on Immunization (EPI) info calculator. 240 prescriptions were collected from eight hospitals including four public hospitals (Pakistan Institute of Medical Sciences, Polyclinic Hospital, Holy family Hospital and Benazir Hospital) and four private hospitals (Hearts International Hospital, Maroof Hospital, Railway hospital, Bilal Hospital) of twin cities of Pakistan (Islamabad and Rawalpindi). Objectives: The purpose of this study was to analyze current prescribing trends of diarrheal management followed by comparative pharmaceutical evaluation of representative brands Parameters recorded from prescriptions were demographics (age and gender), presenting complaints and medications prescribed. Prescriptions were evaluated by their comparison with standard treatment guidelines. Results: Data were evaluated using a statistical package for social sciences (SPSS version 16.0) for descriptive statistics and cross-tabulations along with Chi square test. Diarrhea was presenting complaint in 106 (44%) of peads among age group 0-2 years. Out of 106 (44%) cases of diarrhea, 52 (20%) cases have prescribed an antibiotic in combination with other medications, which was not indicated according to standard guidelines. The use of oral rehydration solutions (ORS) was also limited. Zinc supplementation with ORS is indicated treatment for diarrhea and was prescribed to 21 (9%) cases. Conclusion: Hence, it has been concluded that standard treatment guidelines were not followed thoroughly which leads to increased morbidity, complications and cost.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol

Background: Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea (≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial is the first step in reappraising current recommendations. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. Methods An open Phase II trial, with a partial factorial design, enrolling Ugandan and Kenyan children aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is urine output (mls/kg/hour at 8 hours post-randomisation), and for oral rehydration a change in sodium levels at 24 hours post-randomisation. This trial will also generate feasibility, safety and preliminary data on survival to 28 days. Discussion. If current rehydration strategies for non-malnourished children are safe in SAM this could prompt future evaluation in Phase III trials.

Are oral rehydration solutions optimized for treating diarrhea?

Background: A historical turning point occurred in the treatment of diarrhea when it was discovered that glucose could enhance intestinal sodium and water absorption. Adding glucose to salt water (oral rehydration solution, ORS) more efficiently replaced intestinal water and salt losses. Aim: Provide a novel hypothesis to explain why mainstream use of ORS has been strongly recommended, but weakly adopted. Methods: Traditional (absorptive) and novel (secretory) physiological functions of glucose in an ORS were reviewed. Results: Small amounts of glucose can stimulate both intestinal absorption and secretion. Glucose can exacerbate a net secretory state and may aggravate pathogen-induced diarrhea, particularly for pathogens that affect glucose transport. Conclusion: A hypothesis is made to explain why glucose-based ORS does not appreciably reduce diarrheal stool volume and why modern food science initiatives should focus on ORS formulations that replace water and electrolytes while also reducing stool volume and duration of diarrhea.

Recent emerging gut Microbiome Management Modalities in Acute Diarrhea in Children: (a comparative study review of different probiotic strains). An Update. !

Aims & Objectives: Acute Diarrhea (AD) is a highly prevalent condition that causes significant morbidity and mortality worldwide. Conventional therapies include oral Rehydration Solutions (ORS), Antibiotics and Zinc Products. Emerging data suggest that Probiotics use in the treatment & control of AD cases in children may help supplement current therapies for further control. Methods Herein, we review the evidence of several Probiotics modalities for AD treatment. We describe the Clinical Impact & prevalence of Acute Diarrhea in children and its complications, provide an overview of current treatments, and finally, discuss recent emergent Gut approaches to AD management. Specifically, we will describe - in a Comparative study - on the utility of different kinds of Probiotics known & used and common natural products in the treatment of Acute cases of AD and focus on recent, high-quality studies. Adverse effects and potential interactions of each therapy will be highlighted where applicable.

Milk consumption monitoring as a farmer friendly indicator for advanced treatment in limited fed calves with neonatal diarrhoea syndrome

The purpose of this study was to investigate whether milk consumption (MC) could be used as a simple farmer-friendly indicator for providing advanced treatment to limited fed diarrhoeic neonatal calves. Complementarily, it was evaluated whether the standard indications for veterinary care (severe dehydration and/or acidosis-septicaemia) are associated with different patterns in MC. The MC and health records of 103 calves with diarrhoeathat were fed a milk replacer at the volume of 10% of their body weight were used in the study. The MC reduction rate (MCRR) was calculated after each feeding (MC_t) during the diarrhoea course, based on the MC prior to the diarrhoea onset for each calf (MC₀) using the formula MCRR = 100 × (MC₀ − MC_t)/MC₀. The calves were assigned into the ST group (n = 58) if they only received the standard treatment (oral rehydration solutions between milk feedings) until recovery, and into the advanced treatment (VT) group (n = 45) if they needed advanced treatment (i.v. fluids ± antibiotics) directly or after the standard treatment. The calves in the VT group that only had dehydration, were further assigned into the DH subgroup (n = 22) and those with signs of acidosis-septicaemia with or without dehydration were assigned into the ASD subgroup (n = 23). The MC was practically stable in the ST group throughout the diarrhoea course. In the VT group, the MC was significantly reduced during the last 36 hours prior to the advanced treatment administration. This reduction was significantly higher in the ASD subgroup than the DH subgroup. The MCRR on the last meal prior to treatment administration was proven to be a very reliable indicator for the detection of diarrhoeic calves needing advanced treatment (cut-off: ≥ 24.5%; sensitivity: 95.6%; specificity: 98.7%) and of those with acidosis-septicaemia (cut-off: ≥ 29.6%; sensitivity: 91.7%; specificity: 99.1%). The results of the study show thatfarmers employing this feeding regimen should seek veterinary assistance when the milk consumption of calves is reduced by ≥ 24.5%.