CRD Summary: This review concluded that there was limited evidence in favour of using racecadotril compared with placebo or no intervention for the reduction of stool output and duration of diarrhoea in children with acute gastroenteritis. The authors’ cautious conclusions appear to reflect the limitations of the evidence presented.

CRD Commentary: Inclusion criteria were clearly defined in terms of the participants, intervention, outcomes and study design. Several relevant sources were searched, although a formal assessment of publication bias was not conducted because of the small number of included studies. Several reviewers independently selected studies, assessed validity and extracted the data, thus reducing the potential for reviewer bias and error. The analyses seemed appropriate and statistical heterogeneity was assessed. However, there is the potential for clinical heterogeneity given the variation in participants, settings and administration of the intervention, as well as differences in the assessment of outcomes. The results also primarily apply to hospitalised patients; the authors advise caution when extending their findings to other patient groups. The authors also noted that at least 2 studies were funded by pharmaceutical company sponsorship.  Overall, the authors’ cautious conclusions appear to reflect the limitations of the evidence presented.