Association between glycerin enema use and 14-day unplanned revisits in children with acute viral gastroenteritis: a dual-center retrospective cohort study
This dual-center retrospective cohort study found that administering a glycerin enema within 12 hours of presentation to children with acute viral gastroenteritis was significantly associated with a reduced 14-day unplanned revisit rate, lower antibiotic use, and shorter symptom duration compared to controls, even after propensity score matching and sensitivity analyses.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of young children around the world fall ill with a stomach bug that causes vomiting, fever, and diarrhea. This condition, known as acute viral gastroenteritis, is usually caused by two specific viruses, rotavirus and norovirus. While most cases resolve on their own with fluids and rest, a significant number of children end up returning to the hospital or clinic within two weeks because their symptoms do not improve or get worse. Doctors have long relied on rehydration to treat these children, but there is no specific medicine that kills the virus itself. In some cases, children do not even have diarrhea as their main symptom; instead, they suffer from severe vomiting, belly pain, and a feeling of fullness or blockage in their lower intestine. For these children, doctors sometimes use a glycerin enema, a simple procedure where a small amount of lubricating liquid is gently introduced into the rectum to stimulate a bowel movement and clear out hardened stool. However, until now, there has been very little solid evidence to show whether using this enema early in the illness actually helps prevent children from needing to come back for more care.
A team of researchers from two hospitals in China set out to answer this question by looking back at medical records from over 2,000 children treated between 2021 and 2025. They focused specifically on children who tested positive for rotavirus or norovirus. The researchers wanted to know if giving a glycerin enema within twelve hours of a child's first visit changed the likelihood of that child returning to the hospital within fourteen days. To make a fair comparison, they had to account for the fact that doctors do not give enemas to every child; they usually choose to do so for children who appear to have a blockage or specific symptoms like vomiting without diarrhea. To handle this, the researchers used a statistical method to pair each child who received an enema with a child who did not, matching them closely based on age, gender, whether they had a fever, whether they received intravenous fluids, and whether their main complaint was diarrhea or something else. This created two groups of 178 children each that were nearly identical in every way except for the treatment they received.
The results showed a striking difference between the two groups. Among the children who received the glycerin enema within twelve hours of their first visit, only three out of 178 returned to the hospital unexpectedly within two weeks. In contrast, among the matched children who did not receive the enema, twenty-two out of 178 returned for unplanned care. This means the revisit rate was just under two percent for the treated group compared to nearly twelve and a half percent for the untreated group. The researchers also found that children who received the enema were less likely to be prescribed antibiotics and were less likely to have symptoms that lasted for three days or longer. The time it took for children to return, if they did return, was concentrated within the first three days for both groups, with no significant difference in the timing of these returns between the treated and untreated children.
The study suggests that clearing the lower intestine early in the course of the illness might break a cycle where the virus stays in contact with the gut lining for too long, potentially causing more damage and prolonging the sickness. By helping the body move contents through the digestive tract, the enema may reduce the time the virus has to interact with the intestinal wall. The researchers noted that the benefit was seen in children who presented without diarrhea, where the effect appeared strongest. While the revisit rate was also lower in the subgroup of children with diarrhea, the number of cases in this group was too small to statistically confirm the size of the effect, though the direction of the result was consistent with the non-diarrhea group. They also checked to see if the results could be explained by some other hidden factor, such as the severity of the illness, and found that it would take an extremely powerful unknown factor to explain away the difference they observed.
Despite these promising findings, the researchers are careful to state that this was a look-back study, not a new experiment where they assigned treatments randomly. Because of this, they cannot say for certain that the enema caused the improvement, only that the two events were strongly linked. The data came from two hospitals that share the same medical records and protocols, which helps consistency but means the results might look different in other parts of the world or in different hospital systems. The authors conclude that while the glycerin enema is a simple, low-cost procedure that appears to be associated with fewer return visits and shorter illness durations, the next step is to run a large, controlled trial where children are randomly assigned to receive the treatment or not. Such a study would confirm whether this simple intervention is truly the key to helping more children recover faster and stay out of the hospital.
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