Efficacy of Ginger as Antiemetic in Children With Acute Gastroenteritis

A Randomised Controlled Trial

Rita Nocerino; Gaetano Cecere; Maria Micillo; Giulio De Marco; Pasqualina Ferri; Mariateresa Russo; Giorgio Bedogni; Roberto Berni Canani

Disclosures

Aliment Pharmacol Ther. 2021;54(1):24-31. 

In This Article

Discussion

To the best of our knowledge, this is the first RCT aimed at evaluating the antiemetic effect of ginger at reducing vomiting in children with AGE. We found that, even under the worst-case scenario ITT, ginger was able to reduce AGE-associated vomiting.

The present study has several strengths. The main strength is that it is a randomised, double-blind, placebo-controlled trial performed by family pediatricians, which is expected to increase its generalizability as compared to trials performed in tertiary care centers. The second strength is that the ARR of vomiting attributable to ginger is clinically relevant,[29] ranging from −15% under worst-case scenario ITT to −20% under equal-case scenario ITT. Of course, the 95% CI of the NNT is wider under the worst-case scenario but even under this extreme and unlikely scenario, ginger preserves a clinically relevant mean effect size. Moreover, ginger is cheap and this increases its attractiveness for the treatment of AGE-associated vomiting in children.

The present study has nonetheless some limitations. First, we did not collect any data on AGE-associated nausea. Second, mostly for ethical reasons, we did not study children with severe dehydration. Third, we tested only a specific preparation of ginger at a fixed dose. Studies using different doses of standardized extracts are needed to determine the best preparation and dose of ginger for children with AGE.

As the primary outcome is concerned, we found that ginger is effective at preventing the occurrence of at least one episode of vomiting. Our finding that ginger is effective at improving vomiting in children with AGE is in line with studies performed in pregnant women and adults receiving chemotherapy.[38,39] Additional insights on the effect of ginger on pediatric AGE can be obtained from the analysis of the secondary and tertiary outcomes, although they must be taken as exploratory. Most importantly, the administration of ginger was associated with a higher intake of ORS, and with a reduction in the number of school days lost by the children.

Besides its general anti-inflammatory effect[40] ginger contains volatile phenolic compounds such as gingerols and shogaol, that may reduce vomiting by different mechanisms.[41] In animal models, 6-, 8-, and 10-gingerols, and 6-shogaol are active on M3 receptors, 5-HT3 receptors (guinea pigs), and 5-HT4 receptors (rats). Gingerols and shogaol may exert their anti-emetic effect by acting on the 5-HT3 receptor ion-channel complex, possibly binding to a modulatory site distinct from the serotonin binding site. This may produce indirect effects on the signal cascade behind the 5-HT3 receptor channel complex through substance P and muscarinic receptors.[41] More recently, it was shown that the antiemetic effect of ginger may be partly dependent upon its modulating effect on the vagal nociceptive receptors of the gastrointestinal tract.[42]

In conclusion, we found that ginger is effective at reducing vomiting in children with AGE. Further clinical trials are warranted to confirm our findings, to define the most effective dose of ginger, and to test whether ginger could be effective at improving vomiting of different etiologies in childhood.

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