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Cited by 37Viral gastroenteritis research and epidemiologyLiterature Analysis and CriticismGastrointestinal disorders and treatments

The DOI matches its Crossref record; 109 of the 112 references it cites were found in a registry or an index; none of the 110 sources its claims cite is checked for support yet.

Paediatrics: how to manage viral gastroenteritis

Open access
Leung, Alexander KC, Hon, Kam Lun·2021·Drugs in Context
DOI 10.7573/dic.2020-11-7PMC PMC8007205
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Abstract

BACKGROUND: Viral gastroenteritis is the most common diarrhoeal disorder seen in general practice and emergency departments. This article aims to provide a narrative updated review on the evaluation and management of viral gastroenteritis in children. METHODS: A PubMed search was performed with Clinical Queries using the key term 'viral gastroenteritis'. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to the English literature and the paediatric population. RESULTS: Acute viral gastroenteritis is usually self-limiting. However, it can lead to dehydration and electrolyte imbalance if not properly treated. Adequate fluids containing physiological concentrations of glucose and electrolytes should be provided to compensate for gastrointestinal losses and cover maintenance needs. Oral rehydration therapy is as effective as intravenous (IV) fluid therapy for rehydration for children with mild-to-moderate dehydration. Measurements of serum electrolytes, creatinine and glucose are usually not necessary and should only be considered in a subset of children with severe dehydration who require hospitalization and IV therapy. Judicious use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization. CONCLUSION: Acute viral gastroenteritis is associated with substantial morbidity in developed countries and significant mortality in developing countries. Physicians should educate caregivers on proper personal hygiene and handwashing to prevent faecal to oral transmission of the pathogen as well as the importance of rotavirus vaccine in the prevention of rotavirus gastroenteritis. Several norovirus vaccines are currently undergoing clinical trials with promising results. It is hoped that development of an effective norovirus vaccine will further reduce the incidence of viral gastroenteritis.

Overview

Integrity signals

Registry

Crossref · 10.7573/dic.2020-11-7

Cites

109 of 109 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 110 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Acute viral gastroenteritis can lead to dehydration and electrolyte imbalance if not properly treated.

    “However, it can lead to dehydration and electrolyte imbalance if not properly treated.”
    • Also stated in: § Results · plain
      “Acute viral gastroenteritis is usually self-limiting. However, it can lead to dehydration and electrolyte imbalance if not properly treated.”
    • Also stated in: § Introduction · hedged
      “Dehydration, which may be associated with electrolyte imbalance and metabolic acidosis, is the most frequent and dangerous complication.6”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Acute viral gastroenteritis is usually self-limiting.
  • Premisecitation

    The main clinical features of acute viral gastroenteritis include vomiting and diarrhoea, often accompanied by malaise, nausea, abdominal cramps, and fever.

    “The main clinical features of acute viral gastroenteritis include vomiting and diarrhoea, often accompanied by malaise, nausea, abdominal cramps, and fever.”
    • Also stated in: § Clinical manifestations · plain
      “The main clinical features of acute viral gastroenteritis include vomiting and diarrhoea, often accompanied by malaise, nausea, abdominal cramps, and fever.1,4”
    Quote in the paperNot a substantial claim0 of 2 sources checked
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  • Premisecitation

    The most common viral pathogens of childhood acute gastroenteritis are norovirus and rotavirus, followed by sapovirus, enteric adenovirus and astrovirus.

    “The most common viral pathogens are norovirus and rotavirus, followed by sapovirus, enteric adenovirus and astrovirus.4,5,8–16”
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  • Premisecitation

    Measurements of serum electrolytes, creatinine and glucose are usually not necessary in most immune-competent children with typical acute viral gastroenteritis.

    “Measurements of serum electrolytes, creatinine and glucose are usually not necessary and should only be considered in a subset of children with severe dehydration who require hospitalization and IV therapy.”
    • Also stated in: § Laboratory evaluation · plain
      “Measurements of serum electrolytes, creatinine and glucose are usually not necessary in most immune-competent children with typical findings of acute viral gastroenteritis as the results do not change the management.33,37”
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  • Premisecitation

    Oral rehydration therapy is as effective as intravenous fluid therapy for rehydration for children with mild-to-moderate dehydration.

    “Oral rehydration therapy is as effective as intravenous (IV) fluid therapy for rehydration for children with mild-to-moderate dehydration.”
    • Also stated in: § Rehydration therapy · boosted
      “It has been shown that oral rehydration therapy (ORT) is as effective as, if not better than, IV fluid therapy for rehydration for children with mild-to-moderate dehydration.52–55”
    Quote in the paperSubstantial claim0 of 4 sources checked
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  • Probably not a substantial claim. 7
  • It may state two separate claims as one. 18

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    Premisecitation

    The majority of viral pathogens are transmitted via the faecal-oral route through person-to-person contact and contaminated food and water.

    “The majority of viral pathogens are transmitted via the faecal–oral route through person-to-person contact and contaminated food and water.”
    • Also stated in: § Epidemiology · plain
      “The majority of viral pathogens are transmitted via the faecal–oral route through person-to-person contact and contaminated food and water.27,29,30”
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  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Worldwide, viruses account for approximately 75-90% of childhood acute gastroenteritis.

    “Worldwide, viruses account for approximately 75–90% of childhood acute gastroenteritis.”
    • Also stated in: § Aetiology · plain
      “Worldwide, viruses account for approximately 75–90% of childhood acute gastroenteritis.7”
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  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Acute viral gastroenteritis is most common in children 5 years of age and younger.

    “Acute viral gastroenteritis is most common in children 5 years of age and younger.”
    • Also stated in: § Epidemiology · plain
      “Acute viral gastroenteritis is most common in children 5 years of age and younger.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26]

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  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Viral gastroenteritis is one of the most common causes of morbidity and mortality worldwide, especially in young children in developing countries.

    “Viral gastroenteritis is one of the most common causes of morbidity and mortality worldwide, especially in young children in developing countries.1–5”
    Quote in the paperNot a substantial claim0 of 5 sources checked
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  • It may state two separate claims as one.

    Premisecitation

    Judicious use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization.

    “Judicious use of ondansetron can increase the success rate of oral rehydration therapy and minimize the need for IV therapy and hospitalization.”
    • Also stated in: § Antiemetic medications · plain
      “Judicious use of ondansetron can increase the success rate of ORT and decrease the need for IV therapy and hospitalization.58,64,66–68”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [58]

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    Premisecitation

    Acute viral gastroenteritis is associated with substantial morbidity in developed countries and significant mortality in developing countries.

    “Acute viral gastroenteritis is associated with substantial morbidity in developed countries and significant mortality in developing countries.”
    • Also stated in: § Conclusion · plain
      “Acute viral gastroenteritis is associated with substantial morbidity in developed countries and has a significant mortality in developing countries.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
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    Premisecitation

    Shock and acute renal failure may result from severe dehydration.

    “Shock and acute renal failure may result from severe dehydration.39”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39]

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  • It may state two separate claims as one.

    Premisecitation

    Nasogastric rehydration provides the physiological benefits of enteral rehydration and avoids the potential complications of IV therapy.

    “Nasogastric rehydration provides the physiological benefits of enteral rehydration and avoids the potential complications of IV therapy.61”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61]

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  • It may state two separate claims as one.

    Premisecitation

    Fluids containing non-physiological concentrations of glucose and electrolytes, such as carbonated drinks and sweetened fruit juices, have a high carbohydrate content, very low electrolyte content, and high osmolarity.

    “Fluids containing non-physiological concentrations of glucose and electrolytes, such as carbonated drinks and sweetened fruit juices, are discouraged because these drinks have a high carbohydrate content, very low electrolyte content, and high osmolarity.6,36”
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  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Worldwide, acute viral gastroenteritis accounts for over 200,000 child deaths per year, primarily in developing countries.

    “Worldwide, acute viral gastroenteritis accounts for over 200,000 child deaths per year, primarily in developing countries.27”
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    Premisecitation

    Diarrhoea in acute viral gastroenteritis usually lasts less than 7 days, most often improving after 1-3 days, and does not last longer than 14 days.

    “Diarrhoea usually lasts less than 7 days, most often improving after 1–3 days, and does not last longer than 14 days.24”
    • Also stated in: § Conclusion · plain
      “Diarrhoea usually lasts <7 days, improving after 1–3 days, and does not last >14 days; diarrhoea that lasts >14 days is considered chronic.”
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  • It may state two separate claims as one.

    Premisecitation

    Early refeeding with an age-appropriate diet has been shown to induce digestive enzymes, promote the recovery of disaccharidases, improve the absorption of nutrients, enhance enterocyte regeneration, decrease the intestinal permeability changes induced by infection, reduce the duration of diarrhoea, improve nutritional outcomes and maintain growth.

    “Early refeeding with an age-appropriate diet has been shown to induce digestive enzymes, promote the recovery of disaccharidases, improve the absorption of nutrients, enhance enterocyte regeneration, decrease the intestinal permeability changes induced by infection, reduce the duration of diarrhoea, improve nutritional outcomes and maintain growth.64,65”
    Quote in the paperSubstantial claim0 of 2 sources checked
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  • It may state two separate claims as one.

    Premisecitation

    It is not necessary to dilute formula or to give lactose-free formula in refeeding non-breastfed infants.

    “It is not necessary to dilute formula or to give lactose-free formula in refeeding non-breastfed infants.34”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • It may state two separate claims as one.

    Premisecitation

    Gross blood or mucus in the stool are unusual in viral gastroenteritis, and their presence should prompt consideration of other aetiologies.

    “Gross blood or mucus in the stool are unusual in viral gastroenteritis, the presence of which should prompt consideration of other aetiologies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: Stools in acute viral gastroenteritis are typically loose to watery, and mucous and gross blood are uncommon.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The incubation period of acute viral gastroenteritis is usually 12-72 hours, depending on the causative viral pathogen.

    “The incubation period is usually 12–72 hours, depending on the causative viral pathogen.1”
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  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Prior to routine rotavirus vaccination, rotavirus was the most common cause of gastroenteritis in the paediatric age group.

    “Prior to routine rotavirus vaccination, rotavirus was the most common cause of gastroenteritis in the paediatric age group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
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  • It may state two separate claims as one.

    Premisecitation

    Compared to placebo, ondansetron increased the proportion of children with cessation of vomiting (OR 0.28; 95% CI 0.16-0.46; high quality of evidence) and decreased the proportion of children with the need for hospitalization (OR 0.93; 95% CI 1.69-6.18; moderate quality of evidence).

    “Compared to placebo, ondansetron increased the proportion of children with cessation of vomiting (OR 0.28; 95% CI 0.16–0.46; high quality of evidence) and decreased the proportion of children with the need for hospitalization (OR 0.93; 95% CI 1.69–6.18; moderate quality of evidence).69”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • It may state two separate claims as one.

    Premisecitation

    Compared with IV therapy, oral rehydration therapy is less traumatic, easier to administer, cheaper and can be administered in a variety of settings, including the home.

    “Compared with IV therapy, ORT is less traumatic, easier to administer, cheaper and can be administered in a variety of settings, including the home.2,50,53,54”
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  • It may state two separate claims as one.

    Premisecitation

    Extraintestinal manifestations, such as respiratory symptoms, may occur with rotavirus infection and headache and myalgia may occur with norovirus infection.

    “Extraintestinal manifestations, such as respiratory symptoms, may occur with rotavirus infection and headache and myalgia may occur with norovirus infection.1”
    • Also stated in: § Conclusion · hedged
      “Respiratory symptoms may occur with rotavirus infection; headache and myalgia may occur with norovirus infection.”
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    Premisecitation

    A 2018 Cochrane systematic review of 18 randomized and quasi-randomized trials showed that smectite reduced the duration of diarrhoea by approximately 24 hours, increased clinical resolution at day 3, and reduced the output of stools.

    “A 2018 Cochrane systematic review of 18 randomized and quasi-randomized trials (n=2616 children) showed that smectite reduced the duration of diarrhoea by approximately 24 hours (mean difference −24.38 hours; 95% CI −30.91 to −17.85; 2,209 children, 14 studies; low-certainty evidence), increased clinical resolution at day 3 (RR 2.01; 95% CI 1.30–3.39; 312 children, 5 trials; low-certainty evidence”
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  • It may state two separate claims as one.

    Premisecitation

    Human milk may reduce the incidence of gastroenteritis and shorten the duration of diarrhoea.

    “Human milk may reduce the incidence of gastroenteritis and shorten the duration of diarrhoea.7”
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  • It may state two separate claims as one.

    Premisecitation

    In a recent study conducted in India and Tanzania, 4500 children aged 6-59 months with acute diarrhoea were randomized to receive 5 mg, 10 mg and 20 mg of zinc sulphate orally for 14 days; lower doses of zinc have non-inferiority efficacy for the treatment of children with acute diarrhoea and have less vomiting than the standard 20-mg dose.

    “In a recent study conducted in India and Tanzania, 4500 children aged 6–59 months with acute diarrhoea were randomized to receive 5 mg, 10 mg and 20 mg of zinc sulphate orally for 14 days.94 The mean number of diarrhoeal stool was 10.7, 10.9 and 10.8 in the 20-mg, 10-mg and 5-mg groups, respectively. Vomiting within 30 minutes after administration of zinc sulphate occurred in 19.3%, 15.6% and 13.7”
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  • It may state two separate claims as one.

    Premisecitation

    Studies have shown that rotavirus vaccination is both efficacious and effective in the prevention of rotavirus-related diarrhoea and rotavirus-related hospitalizations as well as in the reduction of diarrhoea-associated healthcare utilization and costs.

    “Studies have shown that rotavirus vaccination is both efficacious and effective in the prevention of rotavirus-related diarrhoea and rotavirus-related hospitalizations as well as in the reduction of diarrhoea-associated healthcare utilization and costs.97–100”
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  • It may state two separate claims as one.

    Premisecitation

    A 2020 systematic review and meta-analysis showed that, in patients with acute viral gastroenteritis, probiotics can shorten the duration of diarrhoea (mean difference 0.7 day; 95% CI 0.31-1.09 days; n=740, 10 trials) and the duration of hospitalization (mean difference 0.76 day; 95% CI 0.61-0.92 day; n=329, 4 trials).

    “A 2020 systematic review and meta-analysis showed that, in patients with acute viral gastroenteritis, probiotics can shorten the duration of diarrhoea (mean difference 0.7 day; 95% CI 0.31–1.09 days; n=740, 10 trials) and the duration of hospitalization (mean difference 0.76 day; 95% CI 0.61–0.92 day; n=329, 4 trials).87”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [87]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

24 of 24

  • The paper relies on this without support.

    Acute viral gastroenteritis is usually self-limiting.

    “Acute viral gastroenteritis is usually self-limiting.”
    “In most cases, acute viral gastroenteritis is self-limited.”

  • The paper relies on this without support.

    Good personal hygiene and handwashing prevent the faecal-oral transmission of viral gastroenteritis pathogens.

    “Good personal hygiene is of utmost importance to prevent the spread of pathogens.”
    “Proper personal hygiene and handwashing to prevent faecal to oral transmission of the pathogen is required.”

  • The paper relies on this without support.

    The diagnosis of acute gastroenteritis is clinical, based on the presence of diarrhoea, often accompanied by vomiting, fever and abdominal pain.

    “The diagnosis of acute gastroenteritis is a clinical one based on the presence of diarrhoea (usually no blood in the stools), often accompanied by vomiting, fever and abdominal pain.”

  • The paper relies on this without support.

    Differentiation of viral gastroenteritis from bacterial gastroenteritis based on clinical manifestations alone is often difficult.

    “However, the differentiation of viral gastroenteritis from bacterial gastroenteritis based on clinical manifestations alone is often difficult.”

  • The paper relies on this without support.

    Routine aetiologic testing of viral pathogens is typically not necessary.

    “Routine aetiologic testing of viral pathogens is typically not necessary but may be employed during outbreaks for epidemiological purposes.”

  • The paper relies on this without support.

    In viral gastroenteritis, the incubation period is usually longer than 12 hours, vomiting is prominent, fever is usually low grade, stools usually do not contain blood, and the entire illness usually lasts less than 7 days.

    “In viral gastroenteritis, the incubation period is usually longer than 12 hours, vomiting is prominent, fever is usually low grade, stools usually do not contain blood, and the entire illness usually lasts less than 7 days.”

  • The paper relies on this without support.

    Stools in acute viral gastroenteritis are typically loose to watery, and mucous and gross blood are uncommon.

    “Stools are typically loose to watery. Mucous and gross blood are uncommon.”

  • The paper relies on this without support.

    Children with gastroenteritis caused by norovirus or sapovirus may present with isolated vomiting in the absence of diarrhoea.

    “It is interesting to note that children with gastroenteritis caused by norovirus or sapovirus may present with isolated vomiting in the absence of diarrhoea.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Ondansetron hospitalisation effect is reported with incompatible odds ratio and confidence interval

    Major

    The text says ondansetron decreased hospitalisation, but the confidence interval shown is entirely above 1. That interval would indicate an increased, not decreased, odds of the outcome if it is an odds ratio.

  • Hospitalization odds ratio lies outside its confidence interval

    Major

    The reported odds ratio for hospitalization is 0.93, but its stated 95% confidence interval runs from 1.69 to 6.18. An estimate cannot lie outside its own confidence interval; the interval also points toward increased, rather than decreased, odds of hospitalization.

2 of 2

Citations

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Metadata

Authors
Leung, A. K., & Hon, K. L.
Affiliations
  • University of Calgary (CA)
  • Chinese University of Hong Kong (HK)
Corresponding author
Leung, Alexander KC
ORCID
Venue
Drugs in Context
Publisher
BioExcel
Published
2021-03-26
Volume
10
Pages
1-11
ISSN
1740-4398 (ISSN-L)
DOI
10.7573/dic.2020-11-7
PMC
PMC8007205
OpenAlex
W3134418564
Cited by
37
References
112
Citations by year
2026: 4 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 2
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Drugs in Context (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Literature Analysis and Criticism
  • Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
Keywords
viral gastroenteritis, paediatric diarrhoea, dehydration, oral rehydration therapy, intravenous fluid therapy, ondansetron, electrolyte imbalance, rotavirus vaccine, norovirus vaccine, hand hygiene, fecal-oral transmission

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (prompt extract-v3).

A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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