Gastroenteritis Overview

Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). The most common symptoms are diarrhea, crampy abdominal pain, nausea, and vomiting. Many people also refer to gastroenteritis as "stomach flu." This can sometimes be confusing because influenza (flu) symptoms include headache, muscle aches and pains, and respiratory symptoms, but influenza does not involve the gastrointestinal tract. The term stomach flu presumes a viral infection, even though there may be other causes of infection. Viral infections are the most common cause of gastroenteritis but bacteria, parasites, and food borne illnesses (such as shellfish) can also be the offending agents. Many people !ho e"perience vomiting and diarrhea that develops from these types of infections or irritations thin# they have "food poisoning," !hen they actually may have a food borne illness. Travelers to foreign countries may e"perience "traveler$s diarrhea" from contaminated food and unclean !ater. The severity of infectious gastroenteritis depends on the immune system$s ability to resist the infection. %lectrolytes (these include essential elements of sodium and potassium) may be lost as the affected individual vomits and e"periences diarrhea. Most people recover easily from a short episode of vomiting and diarrhea by drin#ing fluids and gradually progressing to a normal diet. &ut for others, such as infants and the elderly, loss of bodily fluid !ith gastroenteritis can causedehydration, !hich is a life threatening illness unless the condition is treated and fluids restored.

Gastroenteritis Causes
Gastroenteritis has many causes. Viruses and bacteria are the most common. Viruses and bacteria are very contagious and can spread through contaminated food or !ater. 'n up to ()* of diarrheal outbrea#s, no specific agent is found. The infection can spread from person to person because of improper hand!ashing follo!ing a bo!el movement or handling a soiled diaper.

Gastroenteritis caused by viruses may last one to t!o days. +o!ever, some bacterial cases can continue for a longer period of time.

Viruses
Norovirus ,ifty to seventy percent of cases of gastroenteritis in adults are caused by thenoroviruses (genus Norovirus, familyCaliciviridae. This virus is highly contagious and spreads rapidly. -orovirus is the most common cause of gastroenteritis in the .nited /tates. o o the mouth, o direct contact !ith an infected individual (for e"ample, e"posure to norovirus !hen caring or sharing foods, drin#s, eating utensils !ith an affected individual, and e"posure to infected individuals and ob1ects in daycare centers and nursing homes. -orovirus is often in the ne!s !hen cruise ship passengers contract the virus, !hich causes gastroenteritis. Rotavirus 2ccording to the 343, "5otavirus !as also the leading cause of severe diarrhea in ../. infants and young children before rotavirus vaccine !as introduced for ../. infants in 6))7. 8rior to that, almost all children in the .nited /tates !ere infected !ith rotavirus before their (th birthday. %ach year in the .nited /tates in the pre vaccine period, rotavirus !as responsible for more than 9)),))) doctor visits: more than 6)),))) emergency room visits: ((,))) to ;),))) hospitalizations: and 6) to 7) deaths in children younger than ( years of age." <ther viruses that cause gastrointestinal symptoms include= Adenoviruses This virus most commonly causes respiratory illness: ho!ever, other illnesses may be caused by adenoviruses such as gastroenteritis, bladder infections, and rash illnesses. Parvoviruses - The human bocavirus (+&oV), !hich can cause gastroenteritis belongs to the family 8arvoviridae. Astroviruses 2strovirus infection is the third most fre0uent cause of gastroenteritis in infants. -oroviruses can be transmitted and infect individuals by contaminated food and li0uids, touching ob1ects contaminated !ith norovirus and then placing the hands or fingers in

Bacteria
&acteria may cause gastroenteritis directly by infecting the lining of the stomach and intestine. /ome bacteria such as Staphylococcus aureus produce a to"in that is the cause of the symptoms. /taph is a common type of food poisoning. Escherichia coli infection can cause significant complications. E. coli <>(;=+;(one type of the bacteria) can cause complications in appro"imately >)* of affected individuals (for e"ample, #idney failure in

children ?hemolytic uremic syndrome or +./), bloody diarrhea, and thrombotic thrombocytopenic purpura (TT8) in the elderly. Salmonella, Shigella and Campylobacter Salmonella, Shigella and Campylobacter are also common causes of illness. Salmonella is contracted by ingesting the bacteria in contaminated food or !ater, and by handling poultry or reptiles such as turtles that carry the germs. Campylobacter occurs by the consumption of ra! or undercoo#ed poultry meat and cross contamination of other foods. 'nfants may contract the infection by contact !ith poultry pac#ages in shopping carts. 3ampylobacter is also associated !ith unpasteurized mil# or contaminated !ater. The infection can be spread to humans by contact !ith infected stool of an ill pet (for e"ample, cats or dogs). 't is generally not passed from human to human. Shigella bacteria generally spreads from an infected person to another person. Shigella are in diarrheal stools of infected individuals !hile they are ill, and for up to one to t!o !ee#s after contracting the infection. Shigella infection also may be contracted from eating contaminated food, drin#ing contaminated !ater, or s!imming or playing in contaminated !ater (for e"ample, !ading pools, shallo! play fountains). /higella can also be spread among men !ho have se" !ith men. Clostridium difficile Clostridium difficile (C difficile) bacteria may overgro! in the large intestine after a person has been on antibiotics for an infection. The most common antibiotics that pose a potential ris# factor for C difficile include B5A), penicillins, and cephalosporins. <ther ris# factors for C difficile infection are hospitalization, individuals 7( years of age or greater, and e"isting chronic medical conditions. clindamycin (for e"ample, 3leocin), fluoro0uinolones (for e"ample, levoflo"acin ?@eva0uin$A, ciproflo"acin ?3ipro, 3irpo B5, 8ro0uin

Parasites and Protozoans

These tiny organisms are less fre0uently responsible for intestinal irritation. 2 person may become infected by one of these by drin#ing contaminated !ater. /!imming pools are common places to come in contact !ith these parasites. 3ommon parasites include Giardia is the most fre0uent cause of !aterborne diarrhea, causing giardiasis. <ften, people become infected after s!allo!ing !ater that has been contaminated by animal feces (poop). This may

occur by drin#ing infected !ater from river or la#es but giardia may also be found in s!imming pools, !ells and cisterns. Cryptosporidium (3rypto) is a parasite that lives in the intestine of affected individuals or animals. The infected individual or animal sheds theCryptosporidium parasite in the stool. 3rypto may also be found in food, !ater, soil, or contaminated surfaces (s!allo!ing contaminated recreational !ater, beverages, uncoo#ed food, un!ashed fruits and vegetables, touching contaminated surfaces such as bathroom fi"tures, toys, diaper pails, changing tables, changing diapers, caring for an infected individual or handling an infected co! or calf). Those at ris# for serious disease are individuals !ith !ea#ened immune systems.

Other Common Causes of Gastroenteritis

Gastroenteritis that is not contagious to others can be caused by chemical to"ins, most often found in seafood, food allergies, heavy metals, antibiotics, and other medications.

Gastroenteritis Sym toms

&y definition, gastroenteritis affects both the stomach and the intestines, resulting in both vomiting and diarrhea. Common !astroenteritis sym toms @o! grade fever to >)) , (C;.; 3) -ausea !ith or !ithout vomiting Mild to moderate diarrhea 3rampy painful abdominal bloating (The cramps may come in cycles, increasing in severity until a loose bo!el movement occurs and the pain resolves some!hat.) "ore serious sym toms of !astroenteritis &lood in vomit or stool (&lood in vomit or stool is never normal and the affected individual should call or a visit a health care practitioner.) Vomiting more than 9D hours ,ever higher than >)> , (9) 3) /!ollen abdomen or abdominal pain 4ehydration !ea#ness, lightheadedness, decreased urination, dry s#in, dry mouth and lac# of s!eat and tears are characteristic signs and symptoms.

#hen to See$ "edica% Care

Most often gastroenteritis is self limiting, but it can cause significant problems !ith dehydration. /hould that be a concern, contacting a primary care provider is reasonable. Vomiting blood or having bloody or blac# bo!el movements are not normal, and emergency care should be sought. /ome medications such as iron or bismuth subsalicylate (8epto &ismol) can turn stool blac# in color. ,ever, increasing severity of abdominal pain, and persistent symptoms should not be ignored and see#ing medical care should be considered.