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Foreword: ESPGHAN/ESPID Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe

Guarino, Alfredo

Journal of Pediatric Gastroenterology and Nutrition: May 2008 - Volume 46 - Issue - p vii–viii
doi: 10.1097/01.mpg.0000319064.93905.44
Original Articles

Naples, Italy

It is widely recognized that rotavirus is the main cause of acute gastroenteritis (AGE) in children in the world and, of course, in Europe. In fact, all children in Europe are expected to experience episodes of gastroenteritis in the first 3 years of life. Thus, pediatricians continue to see numerous cases in their daily practice. The overall burden of AGE in human terms and in terms of costs is overwhelming.

One of the aims of scientific societies is to give guidance and support to their members regarding unsettled or controversial issues. It was in this context that the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) and the European Society for Paediatric Infectious Diseases (ESPID) joined forces to draw up guidelines for pediatricians who must deal with AGE practically on a daily basis.

This joint venture was prompted by the excellent collaboration between ESPGHAN and ESPID in drawing up the ESPID/ESPGHAN Evidence-Based Recommendations for Rotavirus Vaccination in Europe, our sister paper that is included in this supplement. The 2 societies agreed to collaborate on this ambitious enterprise to produce recommendations for both the prevention and management of gastroenteritis. Consequently, the vaccination recommendations and the AGE management guidelines represent an example of 2 authoritative societies joining together to promote good-quality health care for children in Europe.

We wanted these guidelines to be a tool to meet 2 needs: first, as a guide in day-to-day practice (in some cases, demolishing entrenched myths; for example, the notion that feeding should be modified or delayed in children with AGE), and second, to reduce the financial burden of AGE as regards unnecessary treatment and hospitalization. We hope that, ultimately, these guidelines will improve the quality of health care of children with AGE in Europe and beyond.

Over the years, various guidelines have been produced for the management of AGE in childhood; however, the defining feature of our guidelines is that the recommendations made stem from state-of-the-art evidence obtained through a thorough process of identifying and examining the literature on this topic. The results of this analysis are reported in the tables of evidence contained in Appendix II of these guidelines.

Our idea was to give pediatricians a comprehensive instrument that covers virtually all aspects of the topic. Therefore, the guidelines are divided into sections, from definition to management (oral rehydration solutions, nutritional management and drugs), in which we discuss the evidence for or against diagnostic and therapeutic approaches. Also, such daily problems as the option of dealing with patients over the telephone rather than by a medical visit are critically discussed.

The working group, constituted by Fabio Albano, Hans Hoekstra, Raanan Shamir, Hania Szajewska, and myself, representing ESPGHAN, and Shai Ashkenazi and Dominque Gendrel representing ESPID, is very pleased with the results. We are also pleased with the support received from ESPGHAN and ESPID, not only in promoting and endorsing these guidelines but also for the useful suggestions we received from the 2 councils during the peer-review process. Thus, these guidelines are unique in that they were examined in detail by the most eminent experts in Europe from both an “infectious” and a gastrointestinal point of view. These guidelines would not have been so complete without the contribution of the ESPGHAN and ESPID councils.

The guidelines also underwent open peer review in that the preliminary conclusions and draft recommendations were presented at 2 international scientific meetings (the 40th Annual Meeting of ESPGHAN, Barcelona, Spain, 2007, and the 25th Annual Meeting of ESPID, Porto, Portugal, 2007). On those 2 occasions, the guidelines development group obtained valuable feedback, suggestions for additional evidence, and possible alternative interpretations of some evidence.

On a personal note, I am sure that publication of the guidelines as a supplement in JPGN will ensure wide circulation of the 2 documents, and I am also pleased that the electronic version of the guidelines will be available open access on the societies' web sites, thereby increasing the circulation even further.

I wish to thank the sponsors, GlaxoSmithKline Biologicals and Sanofi Pasteur MSD, for their support during the long and complex process underlying the production of evidence-based guidelines and for the enthusiasm with which they supported the project of a joint ESPGHAN/ESPID working group.

Finally, I want to acknowledge the fundamental contribution of our collaborators, Anna Chmielewska, Corina Hartman, Liat Hoffnung, Andrea Lo Vecchio, Bernadeta Patro, Marek Ruszczyński, and Naama Tirosh, to data searching, data analysis, and preparation of the tables of evidence. I am also grateful to Jean Ann Gilder Scientific Communication (Naples, Italy) for coordinating the production of the guidelines and for editing the text.

© 2008 Lippincott Williams & Wilkins, Inc.