Secondary Logo

Journal Logo


Brief History of Working Group on Oral Rehydration Solution

Walker-Smith, John

Author Information
Journal of Pediatric Gastroenterology and Nutrition: October 2001 - Volume 33 - Issue - p S1
  • Free

Thirteen years ago on May 20, 1988, at the 21 annual meeting of the European Society of Paediatric Gastroenterology and Nutrition (ESPGAN) in Copenhagen, John Walker-Smith and Stefano Guandalini organized a workshop on the “Role of Oral Rehydration Solutions in Children of Europe”(1). Timo Vesikari gave the global view; Stefano the European perspective, whereas Walker-Smith reviewed the contemporary controversies that centered on the composition of oral rehydration solutions, especially the sodium content of 90 mmol/L.

Michael Farthing moderated a section on the way forward with animal perfusion studies from Bhu Sandhu and Farthing. This was followed by a report from Liz Elliott on human perfusion studies with solutions of differing composition and then by a report of comparative clinical trials from Roque Ferreira, with Amido Rubino opening the discussion on guidelines for Europe. The proceedings of this workshop were subsequently published (1).

Eleven years ago on May 25, 1990, in Amsterdam, the ESPGAN Working Group on Oral Rehydration Solutions in the Children of Europe convened, with Walker-Smith as chair. This group subsequently met in London and published an influential article on its recommendations for the composition of oral rehydration solutions for the children of Europe (2). This was quite a landmark article because it highlighted the case for low-sodium (60 mmol/L), low-osmolality solutions for European children. This approach was subsequently shown to be effective in the developing world as well (see later presentations within).

The Working Group met again at an ESPGAN meeting in Brussels in 1992 and resolved to move on to a new related topic. When it met again in Gothenburg at the ESPGAN meeting in 1993, the Working Group changed its name to Feeding and Acute Diarrhoea. The group subsequently met in London and undertook a Europe-wide study of early feeding in gastroenteritis. The results were presented at the ESPGAN Working Group meeting in Jerusalem in 1995 and later published (3), as was an article on recommendations for early feeding in childhood gastroenteritis (4).

At the Munich ESPGAN meeting in 1996, Stefano Guandalini took over as convenor of the Acute Diarrhoea Working Group and attention was turned to the role of Lactobacillus GG as an addition to oral rehydration solution. This resulted in another successful European multicenter trial, and the results were also published (5).

The working group met again in Thessaloniki in 1997.

In 1999, Bhu Sandhu took over as convenor in Warsaw and has continued since. Another article was published of a study investigating the influence of the earlier recommendations for the management of acute diarrhea in Europe (6).

This working group has had a major influence related to evidence-based medicine by ensuring that the composition of ORS in Europe is based on clear scientific principles.

The group has shown how successful multicenter clinical research can be in Europe, and it has catalyzed international friendships. There are a number of stalwarts who have served the group right from the outset, most notably the convenors Stefano Guandalini and Bhu Sandhu and the new convenor Hans Hoekstra.

The group has had a real influence on improving the health of the children of Europe.


1. Farthing M, Walker-Smith J, eds. Oral rehydration solutions for the children of Europe. Proceedings of a workshop held at XXI Annual Meeting of ESPGAN, Copenhagen, May 20, 1988. Acta Paediatr Scand 1989;suppl 364:1–50.
2. Booth I, Cunha Ferreira R, Desjeux JF, et al. Recommendations for composition of oral rehydration solutions for children of Europe. ESPGAN Working Group on Oral Rehydration. J Pedr Gastroenterol Nutr 1992; 14: 113–5.
3. Sandhu BK, Isolauri E, Walker-Smith J, et al. Early feeding in childhood gastroenteritis. A multicentre study on behalf of the European Society of Paediatric Gastroenterology and Nutrition Working Group on Acute Diarrhoea. J Pediatr Gastroenterol Nutr 1997;24:522–7. Selected for inclusion in the International Book of Paediatrics 1999;564–6.
4. Walker-Smith J, Sandhu BK, Isolauri E, et al. Recommendations for feeding in childhood gastroenteritis. Medical position paper on behalf of ESPGAN. J Pediatr Gastroenterol Nutr 1997; 24: 619–20.
5. Guandalini S, Pensabene L, Abu-Zikri M, et al. Lactobacillus GG administered in oral rehydration solution in children with acute diarrhoea: A multicentre European Trial. J Pediatr Gastroenterol Nutr 2000; 30: 54–60.
6. Szajewska H, Hoekstra H, Sandhu BK, on behalf of Working Group on Acute diarrhoea of European Society of Paediatric Gastroenterology and Nutrition. Management of acute diarrhoea in Europe and the impact of new recommendations. A multi-centre study. J Pediatr Gastroenterol Nutr 2000;30:522–7.
© 2001 Lippincott Williams & Wilkins, Inc.