Bowel rest in acute gastroenteritis
Acute infectious gastroenteritis, stomach flu, is caused by viruses, bacteria or parasites. Bowel rest, when patients with infectious diarrhoea are prescribed a restricted diet or fasting, is sometimes used to reduce stool output and protect the small intestine.
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Question
What systematic reviews are there on use of bowel rest in acute gastroenteritis?
Identified literature
Included studies | Population/Intervention | Outcome |
Gregorio et al 2011. (1) | ||
12 RCTs | Population: 1 283 participants included, 1 226 participants used in analysis. Children less than 5 years old with acute diarrhoea (three or more loose stools in 24 hours, for 14 days or less). Intervention: Early refeeding, feeding reintroduced within 12 hours from start of rehydration. Control: Late refeeding, feeding reintroduced more than 12 hours after start of rehydration. |
Effect: Primary: Duration of diarrhoea (hours) from admission to cessation of diarrhoea. Secondary: Total stool output (ml/kg) during the first 24 hours and 48 hours after start of rehydration. Percentage weight gain 24 hours after start of rehydration and at resolution of diarrhoea. Unscheduled intravenous fluid therapy. Cases of vomiting. Adverse effect: Development of persistent diarrhoea. Development of hyponatremia. |
Authors' conclusion: “Up to the present time, some physicians still recommend variable periods of fasting during acute diarrhoea to allow ‘bowel rest’ followed by gradual reintroduction of food. The proponents of this practice contend that early refeeding may increase the stool output and lead to more complications, such as unscheduled use of IV fluids, episodes of vomiting and persistent diarrhoea. Our results suggest that the number of patients who develop these complications are similar whether early or late refeeding is practiced. However, early refeeding is advocated in order to counteract the transient malabsorption of nutrients that can occur during an episode of acute diarrhoea.” |
References
- Gregorio GV, Dans LF, Silvestre MA. Early versus Delayed Refeeding for Children with Acute Diarrhoea. Cochrane Database Syst Rev 2011;7.
Literature search
Search terms | Items found | |
The search result, usually found at the end of the documentation, forms the list of abstracts.; .ab. = Abstract; .ti. = Title; .ab,ti. = Abstract or title; .kw. = Keyword; exp = Term from the MedLine controlled vocabulary, including terms found below this term in the MeSH hierarchy; / = Term from the MedLine controlled vocabulary.; * or $ = Truncation (if found at the end of a free text term) | ||
Population: | ||
1. | Gastroenteritis/ | |
2. | Exp Diarrhea/ | |
3. | gastroenteritis.ab,kw,ti | |
4. | ((acute or viral or infect*) adj3 (diarrhea or diarrhoea)).ab,kw,ti | |
5. | or/1-4 | 79 485 |
Intervention: | ||
6. | exp Patenteral Nutrition/ | |
7. | Diet Therapy/ | |
8. | Fasting/ | |
9. | (bowel rest or parenteral nutrition or fasting or diet or refeeding or reintroduction).ab,kw,ti | |
10. | ((early or sustain*) adj3 feeding).ab,kw,ti | |
11. | or/6-10 | 456 918 |
Combined sets: | ||
12. | 5 AND 11 | 2 784 |
Study types: | ||
13. | systematic review/ | |
14. | meta-analysis/ | |
15. | ((systematic adj2 (review* or overview*)) or meta analy* or meta-analy*).ab.kw.ti | |
16. | or/13-15 | 259 620 |
Final | 12 AND 16 | 36 |
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase | ||
Search terms | Items found | |
Population: | ||
1. | ‘gastroenteritis’/exp OR ‘acute gastroenteritis’/exp OR ‘viral gastroenteritis’/exp | |
2. | ‘acute diarrhea’/exp OR ‘infectious diarrhea’/exp OR ‘traveller diarrhea’/exp | |
3. | gastroenteritis:ab,ti | |
4. | (acute OR infectious OR viral) NEXT/3 (diarrhea OR diarrhoea) | |
5. | 1 OR 2 OR 3 OR 4 | 50 000 |
Intervention: | ||
6. | ‘bowel rest’/exp | |
7. | ‘parenteral nutrition’/exp | |
8. | ‘diet restriction’/exp OR ‘diet therapy’/exp OR ‘refeeding’/exp | |
9. | ‘bowel rest’:ab,ti | |
10. | ‘parenteral nutrition’:ab,ti | |
11. | fasting:ab,ti OR diet:ab,ti OR refeeding:ab,ti OR reintroduction:ab,ti | |
12. | (early OR sustained) NEXT/3 feeding | |
13. | 6 OR 7 OR … 12 | 788 230 |
Combined sets: | ||
14. | 5 AND 13 | 2 110 |
Study types: | ||
15. | ‘systematic review’/exp OR ‘systematic review (topic)’/exp | |
16. | ‘meta analysis’/exp OR ‘meta analysis (topic)/exp | |
17. | (systematic* NEXT/3 review*):ab,ti OR ‘meta analy*’:ab,ti OR metaanaly*:ab,ti | |
18. | 15 OR 16 OR 17 | 403 744 |
Final | 14 AND 18 | 86 |
The search result, usually found at the end of the documentation, forms the list of abstracts. AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase | ||
Search terms | Items found | |
Population: | ||
1. | MH “Gastroenteritis” | |
2. | MH “Diarrhea” | |
3. | TI (gastroenteritis OR ((acute OR viral OR infect*) N3 (diarrhea OR diarrhoea))) | |
4. | AB (gastroenteritis OR ((acute OR viral OR infect*) N3 (diarrhea OR diarrhoea))) | |
5. | SU (gastroenteritis OR ((acute OR viral OR infect*) N3 (diarrhea OR diarrhoea))) | |
6. | 1 OR 2 OR … 5 | 12 901 |
Intervention: | ||
7. | MH “Parenteral Nutrition+” | |
8. | MH “Diet Therapy” | |
9. | MH “Fasting” | |
10 | TI (“bowel rest” OR parenteral nutrition” OR fasting OR diet OR refeeding OR reintroduction OR ((early OR sustain*) N3 feeding)) | |
11. | AB (“bowel rest” OR parenteral nutrition” OR fasting OR diet OR refeeding OR reintroduction OR ((early OR sustain*) N3 feeding)) | |
12. | SU (“bowel rest” OR parenteral nutrition” OR fasting OR diet OR refeeding OR reintroduction OR ((early OR sustain*) N3 feeding)) | |
13. | 7 OR 8 OR … 12 | 147 040 |
Combined sets: | ||
14. | 6 AND 13 | 751 |
Study types: | ||
15. | MH ”Systematic Review” OR PT “Systematic Review” | |
16. | MH “Meta Analysis” OR PT “Meta Analysis” | |
17. | TI (systematic N2 (review* OR overview*)) OR "meta analys*" OR meta-analy* ) | |
18. | AB (systematic N2 (review* OR overview*)) OR "meta analys*" OR meta-analy* ) | |
19. | SU (systematic N2 (review* OR overview*)) OR "meta analys*" OR meta-analy* ) | |
20. | 15 OR 16 OR …19 | 154 569 |
Final | 14 AND 20 | 37 |
The search result, usually found at the end of the documentation, forms the list of abstracts.; TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review | ||
Search terms | Items found | |
Population: | ||
1. | TITLE-ABS-KEY(gastroenteritis OR ((acute OR infectious OR viral) W/3 (diarrhea OR diarrhoea))) | 52 269 |
Intervention: | ||
2. | TITLE-ABS-KEY(“bowel rest” OR “parenteral nutrition” OR fasting OR diet OR refeeding OR reintroduction OR ((early OR sustained) W/3 feeding)) | 933 453 |
Combined sets: | ||
3. | 1 AND 2 | 2 295 |
Study types: | ||
4. | TITLE-ABS-KEY(metaanalysis OR “meta analy*” OR (systematic W/3 (review OR overview))) | 403 509 |
Final | 3 AND 4 | 99 |
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