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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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What systematic reviews are there on use of bowel rest in acute gastroenteritis?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
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

  1. Gregorio GV, Dans LF, Silvestre MA. Early versus Delayed Refeeding for Children with Acute Diarrhoea. Cochrane Database Syst Rev 2011;7.
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Published: Report no: ut201931 Registration no: SBU 2019/401
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Literature search

MEDLINE via Ovid 190924 
Bowel rest in gastrotenteritis
  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

 

Embase via embase.com 190924 
Bowel rest for acute gastroenteritis
/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

 

Cinahl via ebsco.com 190924 
Bowel rest in acute gastroenteritis
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

 

Scopus via scopus.com 190924 
Bowel rest in acute gastroenteritis
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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