Guarino Alfredo, Ashkenazi Shai, Gendrel Dominique, Lo Vecchio Andrea, Shamir Raanan, Szajewska Hania
*Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy †Schneider Children's Medical Center, Tel-Aviv University, Tel-Aviv, Israel ‡University Paris 5 and Necker-Enfants-Malades, Paris, France §Medical University of Warsaw, Department of Pediatrics, Warsaw, Poland.
J Pediatr Gastroenterol Nutr. 2014 Jul;59(1):132-52. doi: 10.1097/MPG.0000000000000375.
These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe.
The guideline development group formulated questions, identified data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system.
Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates.
Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.
本指南更新并扩展了欧洲儿童急性胃肠炎管理的循证指征。
指南制定小组提出问题、识别数据并制定建议。建议采用缪尔·格雷系统分级，同时采用推荐分级、评估、制定与评价系统分级。
胃肠炎的严重程度与病因相关，轮状病毒是最严重的感染病原体，常与脱水相关。脱水反映了疾病的严重程度，应通过既定的评分系统进行监测。一般无需进行检查。使用低渗溶液口服补液是主要治疗方法，应尽早开始。不应中断母乳喂养。应继续正常喂养，饮食无需改变，包括牛奶。数据表明，在医院环境中，对于非母乳喂养的婴幼儿，在胃肠炎管理中可考虑使用无乳糖配方奶。积极治疗可缩短腹泻持续时间并减轻严重程度。有效的干预措施包括给予特定益生菌，如鼠李糖乳杆菌GG或布拉酵母菌、蒙脱石或消旋卡多曲。仅在特殊情况下使用抗感染药物。昂丹司琼对呕吐有效，但鉴于其严重心脏效应的警告，其常规使用需要安全许可。一般应将住院治疗保留给需要肠内/肠外补液的儿童；大多数病例可在门诊处理。肠内补液优于静脉补液。超快速静脉补液方案并不优于标准方案，且可能与更高的再入院率相关。
急性胃肠炎采用一些简单、明确的医学干预措施管理效果最佳。
