Ginger shows antiemetic potential in kids with acute gastroenteritis

A couple of drops of liquefied ginger can safely prevent at least one episode of vomiting related to acute gastroenteritis (AGE) in children, as shown in a study.

“Our finding … is in line with studies performed in pregnant women and adults receiving chemotherapy. Additional insights on the effect of ginger on paediatric AGE can be obtained from the analysis of the secondary and tertiary outcomes, although they must be taken as exploratory,” according to the investigators. [Crit Rev Food Sci Nutr 2017;57:141-146; J Matern Fetal Neonatal Med 2018;31:2509-2514]

“Most importantly, the administration of ginger was associated with a higher intake of oral rehydration solution (ORS), and with a reduction in the number of school days lost by the children,” they added.

In the present study, 150 children with AGE (intention to treat [ITT]; average age 6 years, 50 percent boys) were randomized to treatment with either ginger (n=75) or placebo (n=75), both of which were in liquid form. Each patient received 20 drops containing 10 mg of product, plus a hypotonic ORS given 30 minutes after the first dose. Twenty additional drops of treatment were administered every 8 hours after the first dose, until the resolution of vomiting.

Of the patients, 70 children in the ginger arm and 71 in the placebo arm (per protocol) completed the study. In the ITT analysis, assuming that all children lost to follow-up had reached the primary outcome, fewer patients in the ginger arm experienced the primary outcome of ≥1 episode of vomiting occurring after the first dose of treatment (67 percent, 95 percent confidence interval [CI], 56–77 vs 87 percent, 95 percent CI, 79–94). [Aliment Pharmacol Ther 2021;doi:10.1111/apt.16404 ]

Ginger substantially reduced the risk of vomiting under equal-case ITT scenario that all children lost to follow-up had reached the primary outcome (absolute risk reduction [ARR], –20 percent, 95 percent CI, −33 to −7; p=0.003), with a number needed to treat of five (95 percent CI, 3–15).

Results followed the same pattern under the worst-case scenario ITT analysis assuming that the four children lost in the placebo arm had not vomited and the five lost in the ginger arm had vomiting (ARR, −0.15 percent, 95 percent CI, −0.29 to −0.006; p=0.038) and in a per-protocol analysis excluding children lost to follow-up (ARR, −22 percent, −35 to −8; p=0.002).

The median volume of ORS consumed in the 4 hours after the first dose of treatment was 30 ml/kg in the ginger arm and 10 ml/kg in the placebo arm. None of the children required intravenous fluid rehydration or hospitalization. Also, fewer children who received ginger skipped school 24 hours (56 percent vs 80 percent), 48 hours (44 percent vs 56 percent), and 72 hours (29 percent vs 30 percent) after the first dose of treatment.

“The intervention was well accepted by the children, as confirmed by an adherence rate of 100 percent,” the investigators noted, adding that there were no reported adverse effects attributable either treatment.

Ginger (Zingiber officinale) is a spice long been used as traditional remedy for nausea and vomiting. It contains volatile phenolic compounds such as gingerols and shogaol that exert antiemetic effects by different mechanisms. [Complement Ther Med 2019;45:114-123; Planta Med 2011;77:973-978]

“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,” according to the investigators. [Neurogastroenterol Motil 2019;31:e13585]

The study was limited by the lack of data on acute gastroenteritis-associated nausea and the exclusion of children with severe dehydration, they acknowledged. “[Additionally], we tested only a specific preparation of ginger at a fixed dose.”

The investigators called for further clinical trials to confirm the present data, to define the most effective dose of ginger, and to test whether ginger could be effective at improving vomiting of different aetiologies in childhood.