Published online Sep 7, 2019. doi: 10.3748/wjg.v25.i33.4999
Peer-review started: April 28, 2019
First decision: May 30, 2019
Revised: July 4, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: September 7, 2019
Diarrhea is a major infectious cause of childhood morbidity and mortality worldwide. Preventing or correcting dehydration through treatment with zinc or 0.9% saline solution is the main approach for diarrhea management; however, during diarrhea episodes, infectious symptoms are not fully alleviated by rehydration measures. Probiotics restore the gut microbiota and have been reported to reduce the duration of diarrhea.
Although previous studies have reported that Lactobacillus rhamnosus GG (LGG) is an effective therapeutic agent for acute diarrhea in children, a recent large, high-quality RCT found no adequate evidence of a beneficial effect of LGG treatment.
To evaluate the efficacy of LGG in treating acute diarrhea in children and provide some reference for future trials of treatments for diarrhea.
The EMBASE, MEDLINE, PubMed, Web of Science databases, and the Cochrane Central Register of Controlled Trials were searched up to April 2019 for meta-analyses and randomized controlled trials (RCTs). Cochrane Review Manager was used to analyze the relevant data and primary outcomes, including the duration of diarrhea and diarrhea lasting ≥ 3 and ≥ 4 d. Secondary outcomes included the hospital stay duration, stool frequency, and improvement in stool consistency and vomiting.
The systematic review identified 19 RCTs that met the inclusion criteria and indicated that compared with the control group, LGG administration notably reduced the diarrhea duration [mean difference (MD) -24.02 h, 95% confidence interval (CI) (-36.58, -11.45)]. Greater reductions were detected at a high dose of ≥ 1010 CFU per day [MD -22.56 h, 95%CI (-36.41, -8.72)] and in LGG participants with diarrhea for less than 3 days at study enrollment [MD -15.83 h, 95%CI (-20.68, -10.98)]. The study locations contributed to differences in the reduction in the diarrhea duration in Asia and Europe [MD -24.42 h, 95%CI (-47.01, -1.82); MD -32.02 h, 95%CI (-49.26, -14.79), respectively]. High-dose LGG treatment was confirmed to effectively reduce the duration of rotavirus-induced diarrhea [MD -31.05 h, 95%CI (-50.31, -11.80)] and stool number [MD -1.08, 95%CI (-1.87, -0.28)].
The following conclusions were cautiously established: compared to control children, children who received a course of LGG had better outcomes, including a markedly reduced duration of diarrhea, especially those with rotavirus-positive diarrhea, those who received no less than 1010 CFU per day, and those treated at the early stage. Furthermore, studies conducted in Asia and Europe reported greater treatment efficacy. The therapeutic effect of LGG supplementation on the stool number per day and hospital stay duration associated with rotavirus-induced diarrhea was high.
Our study found better outcomes among children with acute diarrhea who were treated by LGG supplementation. Limited identification of pathogens, small sample sizes, and a lack of a standard clinical parameter format precluded further analyses across studies, thus weakening the evidence required to guide clinical practice. Investigations are required to assess the cost-effectiveness of treating diarrhea with probiotics.