gastroenteritis

Definition

Gastroenteritis is a catchall term for infection or irritation of the digestive tract, particularly the
stomach and intestine. It is frequently referred to as the stomach or intestinal flu, although the
influenza virus is not associated with this illness. Major symptoms include nausea and vomiting,
diarrhea, and abdominal cramps. These symptoms are sometimes also accompanied by fever and
overall weakness. Gastroenteritis typically lasts about three days. Adults usually recover without
problem, but children, the elderly, and anyone with an underlying disease are more vulnerable to
complications such as dehydration.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but it is rarely life-threatening in

the United States and other developed nations. However, an estimated 220,000 children younger
than age five are hospitalized with gastroenteritis symptoms in the United States annually. Of
these children, 300 die as a result of severe diarrhea and dehydration. In developing nations,
diarrheal illnesses are a major source of mortality. In 1990, approximately three million deaths
occurred worldwide as a result of diarrheal illness.
The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus,
adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all
over the world. Exposure typically occurs through the fecal-oral route, such as by consuming
foods contaminated by fecal material related to poor sanitation. However, the infective dose can
be very low (approximately 100 virus particles), so other routes of transmission are quite
probable.
Typically, children are more vulnerable to rotaviruses, the most significant cause of acute watery
diarrhea. Annually, worldwide, rotaviruses are estimated to cause 800,000 deaths in children
below age five. For this reason, much research has gone into developing a vaccine to protect
children from this virus. Adults can be infected with rotaviruses, but these infections typically
have minimal or no symptoms.
Children are also susceptible to adenoviruses and astroviruses, which are minor causes of
childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major
causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause
illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton,
and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major
symptom.
Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking water,
or contaminated food-conditions common in developing nations. Natural or man-made disasters
can make underlying problems in sanitation and food safety worse. In developed nations, the
modern food production system potentially exposes millions of people to disease-causing
bacteria through its intensive production and distribution methods. Common types of bacterial
gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however, Escherichia
coli 0157 and Listeria monocytogenes are creating increased concern in developed nations.
Cholera and Shigella remain two diseases of great concern in developing countries, and research
to develop long-term vaccines against them is underway.
Causes and symptoms

Gastroenteritis arises from ingestion of viruses, certain bacteria, or parasites. Food that has
spoiled may also cause illness. Certain medications and excessive alcohol can irritate the
digestive tract to the point of inducing gastroenteritis. Regardless of the cause, the symptoms of
gastroenteritis include diarrhea, nausea and vomiting, and abdominal pain and cramps. Sufferers
may also experience bloating, low fever, and overall tiredness. Typically, the symptoms last only
two to three days, but some viruses may last up to a week.
A usual bout of gastroenteritis shouldn't require a visit to the doctor. However, medical treatment
is essential if symptoms worsen or if there are complications. Infants, young children, the
elderly, and persons with underlying disease require special attention in this regard.
The greatest danger presented by gastroenteritis is dehydration. The loss of fluids through
diarrhea and vomiting can upset the body's electrolyte balance, leading to potentially life-
threatening problems such as heart beat abnormalities (arrhythmia). The risk of dehydration
increases as symptoms are prolonged. Dehydration should be suspected if a dry mouth, increased
or excessive thirst, or scanty urination is experienced.
If symptoms do not resolve within a week, an infection or disorder more serious than
gastroenteritis may be involved. Symptoms of great concern include a high fever (102 ° F [38.9
°C] or above), blood or mucus in the diarrhea, blood in the vomit, and severe abdominal pain or
swelling. These symptoms require prompt medical attention.

Diagnosis

The symptoms of gastroenteritis are usually enough to identify the illness. Unless there is an
outbreak affecting several people or complications are encountered in a particular case,
identifying the specific cause of the illness is not a priority. However, if identification of the
infectious agent is required, a stool sample will be collected and analyzed for the presence of
viruses, disease-causing (pathogenic) bacteria, or parasites.

Treatment

Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort and
convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve the
symptoms. These medications work by altering the ability of the intestine to move or secrete
spontaneously, absorbing toxins and water, or altering intestinal microflora. Some over-the-
counter medicines use more than one element to treat symptoms.
If over-the-counter medications are ineffective and medical treatment is sought, a doctor may
prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. Should pathogenic
bacteria or parasites be identified in the patient's stool sample, medications such as antibiotics
will be prescribed.
It is important to stay hydrated and nourished during a bout of gastroenteritis. If dehydration is
absent, the drinking of generous amounts of nonalcoholic fluids, such as water or juice, is
adequate. Caffeine, since it increases urine output, should be avoided. The traditional BRAT
diet-bananas, rice, applesauce, and toast-is tolerated by the tender gastrointestinal system, but it
is not particularly nutritious. Many, but not all, medical researchers recommend a diet that
includes complex carbohydrates (e.g., rice, wheat, potatoes, bread, and cereal), lean meats,
yogurt, fruit, and vegetables. Milk and other dairy products shouldn't create problems if they are
part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These
recommendations are based on clinical experience and controlled trials, but are not universally
accepted.
Minimal to moderate dehydration is treated with oral rehydrating solutions that contain glucose
and electrolytes. These solutions are commercially available under names such as Naturalyte,
Pedialyte, Infalyte, and Rehydralyte. Oral rehydrating solutions are formulated based on
physiological properties. Fluids that are not based on these properties-such as cola, apple juice,
broth, and sports beverages-are not recommended to treat dehydration. If vomiting interferes
with oral rehydration, small frequent fluid intake may be better tolerated. Should oral rehydration
fail or severe dehydration occur, medical treatment in the form of intravenous (IV) therapy is
required. IV therapy can be followed with oral rehydration as the patient's condition improves.
Once normal hydration is achieved, the patient can return to a regular diet.

Alternative treatment

Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet, herbal

remedies, and homeopathy. An infusion of meadowsweet (Filipendula ulmaria) may be effective
in reducing nausea and stomach acidity. Once the worst symptoms are relieved, slippery elm
(Ulmus fulva) can help calm the digestive tract. Of the homeopathic remedies available,
Arsenicum album, ipecac, or Nux vomica are three said to relieve the symptoms of
gastroenteritis.
Probiotics, bacteria that are beneficial to a person's health, are recommended during the recovery
phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said to be
effective in soothing the digestive tract and returning the intestinal flora to normal. L.
acidophilus is found in live-culture yogurt, as well as in capsule or powder form at health food
stores. The use of probiotics is found in folk remedies and has some support in the medical
literature. Castor oil packs to the abdomen can reduce inflammation and also reduce spasms or
discomfort.

Prognosis

Gastroenteritis is usually resolved within two to three days and there are no long-term effects. If
dehydration occurs, recovery is extended by a few days.

Prevention

There are few steps that can be taken to avoid gastroenteritis. Ensuring that food is well-cooked
and unspoiled can prevent bacterial gastroenteritis, but may not be effective against viral
gastroenteritis.
Gastroenteritis Overview

Gastroenteritis is a condition that causes irritation and inflammation of the stomach and
intestines (the gastrointestinal tract). Diarrhea, crampy abdominal pain, nausea, and vomiting are
the most common symptoms.

Viral infection is the most common cause of gastroenteritis but bacteria, parasites, and food-
borne illness (such as shellfish) can be the offending agent.

Many people who experience the vomiting and diarrhea that develop from these types of
infections or irritations think they have "food poisoning," and they may indeed have a food-
borne illness. Many people also refer to gastroenteritis as "stomach flu," although influenza has
nothing to do with the condition.

Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food and
unclean water.

• The severity of infectious gastroenteritis depends on the immune system's ability to resist
the infection. Electrolytes (these include essential elements of sodium and potassium)
may be lost as you vomit and experience diarrhea.

• Most people recover easily from a short bout with vomiting and diarrhea by drinking
fluids and easing back into a normal diet. But for others, such as infants and the elderly,
loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening
illness unless the condition is treated and fluids restored.

Gastroenteritis Symptoms

By definition, gastroenteritis affects both the stomach and the intestines, resulting in both
vomiting and diarrhea.

Common symptoms may include:

• Low grade fever to 100°F (37.7°C)

• Nausea with or without vomiting

• Mild-to-moderate diarrhea:

• Crampy painful abdominal bloating

More serious symptoms

• Blood in vomit or stool

• Vomiting more than 48 hours

 • Fever higher than 101°F (40°C)

• Swollen abdomen or abdominal pain

• Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and
lack of sweat and tears are characteristic findings.

Prevention

With most infections, the key is to block the spread of the organism.

• Always wash your hands.

• Eat properly prepared and stored food.

• Bleach soiled laundry.

• Vaccinations for Salmonella typhi, Vibrio cholerae, and rotavirus have been developed.
Rotavirus vaccination is recommended for infants in the U.S. Vaccines for S. typhi and V.
cholerae may be administered to individuals traveling in at-risk areas.