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      Acute gastroenteritis: from guidelines to real life

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          Abstract

          Acute gastroenteritis is a very common disease. It causes significant mortality in developing countries and significant economic burden to developed countries. Viruses are responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus is one of the best studied of these viruses. Oral rehydration therapy is as effective as intravenous therapy in treating mild to moderate dehydration in acute gastroenteritis and is strongly recommended as the first line therapy. However, the oral rehydration solution is described as an underused simple solution. Vomiting is one of the main reasons to explain the underuse of oral rehydration therapy. Antiemetics are not routinely recommended in treating acute gastroenteritis, though they are still commonly prescribed. Ondansetron is one of the best studied antiemetics and its role in enhancing the compliance of oral rehydration therapy and decreasing the rate of hospitalization has been proved recently. The guidelines regarding the recommendation on antiemetics have been changed according to the evidence of these recent studies.

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          Most cited references127

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          Is Open Access

          Global Illness and Deaths Caused by Rotavirus Disease in Children

          To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 60 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, to prevent childhood deaths in developing nations.
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            Rotavirus and Severe Childhood Diarrhea

            Studies published between 1986 and 1999 indicated that rotavirus causes ≈22% (range 17%–28%) of childhood diarrhea hospitalizations. From 2000 to 2004, this proportion increased to 39% (range 29%–45%). Application of this proportion to the recent World Health Organization estimates of diarrhea-related childhood deaths gave an estimated 611,000 (range 454,000–705,000) rotavirus-related deaths.
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              Viruses causing gastroenteritis

              Acute gastroenteritis is one of the most common diseases in humans worldwide. Viruses are recognized as important causes of this disease, particularly in children. Since the Norwalk virus was identified as a cause of gastroenteritis, the number of viral agents associated with diarrheal disease in humans has steadily increased. Rotavirus is the most common cause of severe diarrhea in children under 5 years of age. Astrovirus, calicivirus and enteric adenovirus are also important etiologic agents of acute gastroenteritis. Other viruses, such as toroviruses, coronaviruses, picobirnaviruses and pestiviruses, are increasingly being identified as causative agents of diarrhea. In recent years, the availability of diagnostic tests, mainly immunoassays or molecular biology techniques, has increased our understanding of this group of viruses. The future development of a safe and highly effective vaccine against rotavirus could prevent, at least, cases of severe diarrhea and reduce mortality from this disease.
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                Author and article information

                Journal
                Clin Exp Gastroenterol
                Clinical and experimental gastroenterology
                Dove Medical Press
                1178-7023
                2010
                15 July 2010
                : 3
                : 97-112
                Affiliations
                [1 ]Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, PR China;
                [2 ]Department of Pediatrics, The University of Calgary, Calgary, Alberta, Canada
                Author notes
                Correspondence: Chung M Chow, Department of Paediatrics, 6/F Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, PR China, Tel +852 26322861, Fax +852 26360020, Email ccm250@ 123456ha.org.hk
                Article
                ceg-3-097
                3108653
                21694853
                f33b3b8f-3012-4b46-8da8-a99f97f4ca6a
                © 2010 Chow et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 14 July 2010
                Categories
                Review

                Gastroenterology & Hepatology
                gastroenteritis,vomiting,antiemetic,ondansetron,rotavirus,oral rehydration therapy,intravenous therapy,guideline

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