Gastroenteritis

Gastroenteritis - An unpleasant upset

Gastroenteritis is a general term for inflammation and infection of the digestive tract. This unpleasant condition produces such symptoms as chills, fever, loss of appetite, nausea and vomiting, cramps, and mild to severe diarrhea. Electrolytes, particularly sodium, potassium and bicarbonate, are lost along with body fluids, causing an imbalance that can result in life-threatening dehydration in the very young, the very ill, and the elderly.

Synonyms

  • Diarrhea (acute or chronic)
  • Acute gastroenteritis
  • Bacterial gastroenteritis
  • Cytomegalovirus (CMV) gastroenteritis
  • Gastrointestinal infection
  • Infectious diarrhea
  • Norwalk virus
  • Rotavirus infection
  • Viral gastroenteritis

Detailed Description

Gastroenteritis is an irritation or infection of the digestive tract that can accompany dysentery, typhoid fever, cholera, food poisoning, and "traveler's diarrhea." This condition can be caused by a number of unsavory things, including the following:

  • Micro-organisms in contaminated water or food
  • Bacteria that invade the lining of the intestine (E. coli and salmonella, for example)
  • Viruses that affect the lungs as well as the stomach and intestine
  • Intestinal parasites, particularly Giardia lamblia, that live in contaminated water

Gastroenteritis may also result from ingesting chemical toxins or heavy metals found in food and water supplies.

Characteristics of Gastroenteritis

While gastroenteritis can have many causes, the symptoms are similar:

How Common Is Gastroenteritis?

All ages are susceptible to this disease. Both males and females are equally likely to develop gastroenteritis.

What You Can Expect

Gastroenteritis is usually self-limiting, with recovery in 24 to 36 hours. Persistent and untreated, however, it can cause complications that include severe dehydration and crucial electrolyte losses, which can lead to shock, vascular collapse, and renal failure. Infants, the elderly, and debilitated people are particularly at risk.

Established Causes

Several microorganisms have been established as causes of gastroenteritis. They usually fall within one of these three classes:

  • Viral sources such as rotavirus (especially in children) and Norwalk virus. Both are commonly found in drinking water and food.
  • CMV or cytomegalovirus, another virus that causes gastroenteritis, is usually found in people with impaired immune systems (HIV-positive people, people undergoing chemotherapy).
  • Bacterial sources such as E. coli, salmonella, shigella, staphylococcus, and others. Typically found in improperly prepared foods.

Risk Factors

Since most sources of gastroenteritis are waterborne or food-based, precautions should be taken to prevent acquiring this condition. Risk factors include the following:

  • Drinking water from unknown or potentially contaminated sources
  • Visiting developing countries (or areas with poor sanitation)
  • Eating undercooked seafood
  • Eating reheated meat dishes
  • Poor hygiene
  • Ingesting certain antibiotics and other drugs

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.


Symptoms

Since untreated gastroenteritis can cause severe dehydration and discomfort, watch out for its symptoms, which include the following:

Conditions That May Be Mistaken for Gastroenteritis

Gastroenteritis is often confused with other, more serious conditions, including the following:

If your symptoms last for more than a week or seem to be chronic, call your doctor.

How Is Gastroenteritis Diagnosed?

Gastroenteritis symptoms will usually subside after about five days. If you don't feel better at this point, call your doctor, as the condition causing your symptoms may be serious. A stool sample and/or blood tests may be taken to determine if a bacterial or parasitic condition exists. Your doctor may want to perform further tests, which could include X-rays and internal examinations of your stomach and colon.

Lab tests

The following tests may be used to determine the cause of gastroenteritis:

  • Stool sample
  • Serum electrolyte tests
  • Complete blood count
  • Blood cultures

Physical examination

  • Examination for signs of dehydration-- dry mouth or mucous membranes
  • Esophagogastroduodenoscopy -- a flexible tube is used to visualize your stomach and duodenum
  • Colonoscopy -- a flexible tube is used to visualize your large intestine

Imaging

  • Abdominal X-rays may be performed to rule out other, more serious conditions
  • CT scan (computed tomography, a type of cross-sectional X-ray)


Goals of Treatment

Gastroenteritis usually resolves itself within 24 to 36 hours-- five days at most. Replacing lost water and electrolytes to avoid dehydration are important at this point. Medication is normally not necessary, although it may be used to help relieve symptoms. If the gastroenteritis is a symptom of a more serious condition, identifying, diagnosing, and treating the condition is critical.

Treatment Overview

Because gastroenteritis typically passes within a few days, avoiding dehydration is usually the main goal of treatment. When trying to replenish lost electrolytes (sodium and potassium), remember that water and soda do not contain these necessary elements. Special electrolyte solutions (such as Gatorade and Pedialyte) are available, and liquids like bouillon and vegetable juices will also do the trick.

Drugs

While in the past doctors have often recommended immediately turning to an antidiarrheal medicine to alleviate this condition, many now recommend letting it run its course. Diarrhea is the body's natural way of ridding itself of toxins, and inhibiting this process may cause prolonged suffering. However, if you would like to stop the problem temporarily for personal reasons (important meetings, travel, or so on), antidiarrheal medicines include Imodium, Kaopectate II, and Lomotil. They are safe to use unless there's a fever, or blood present in the diarrhea.

If symptoms persist for more than five days, or a bacterial or parasitic organism has been identified as the cause, your doctor may prescribe antibiotics. They may include the following:

  • Flagyl (metronidazole) treats giardia and C. difficile
  • Cipro (ciprofloxacin) treats shigella, salmonella, and E. coli
  • Vibramycin or Doryx (doxycycline) and other antibiotics may also be prescribed

Appropriate Healthcare Setting

Outpatient care is usually sufficient unless severe dehydration has occurred, in which case hospitalization may be necessary.

Healthcare Professionals Who May Be Involved in Treatment

Unless severe dehydration results in your hospitalization, your primary care provider should be able to treat this condition. Gastroenterologists may be involved in making the diagnosis.

Activity & Diet Recommendations

  • Drink plenty of fluids. An electrolyte replenisher or rehydration liquid may be helpful.
  • After diarrhea and vomiting stop, drink small amounts of clear liquid such as tea, broth, and flat ginger ale or lemon/lime soda.
  • After tolerating liquids for 12 hours, eat small amounts of soft food such as cooked cereal, rice, eggs, custard, baked potato, yogurt, bananas, apple sauce, and toast.
  • After tolerating soft food for two or three days, gradually return to a normal diet. However, for several more days, avoid alcohol, spicy foods (that includes pizza!), gravy, raw vegetables and fruits, salad dressing, coffee, and milk.

Quality of Life

You don't want to get sick at home or abroad, so be careful what you eat and drink and observe the rules of safe food preparation and storage. Don't overdo alcohol. Wash your hands after going to the bathroom and before eating. Finally, be aware of any side effects your medications may have.

Considerations for Women

Pregnancy

Some research has shown that ciprofloxacin and metronidazole (antibiotics used to treat gastroenteritis) given in early stages of pregnancy may lead to birth defects. Discuss the use of these drugs with your doctor.

Be sure to keep well hydrated.

Nursing mothers

Metronidazole and ciprofloxacin are excreted in breast milk. If these antibiotics are prescribed, discontinue breast-feeding for approximately 24 hours. Discuss this with your doctor first.

Considerations for Children and Adolescents

Infants are particularly susceptible to dehydration and electrolyte imbalance as a result of gastroenteritis. If your child has severe or persistent vomiting or diarrhea, see your doctor immediately.

Considerations for Older People

Like the young, elderly people are at higher risk for gastric disorders than healthy adults. With age comes decreased effectiveness of the immune system, opening the way for infections like gastroenteritis. Many elderly people don't drink enough water on a daily basis and so risk dehydration, a condition seriously exacerbated by gastroenteritis. An improperly balanced diet and the use of such drugs as aspirin, nonsteroidal anti-inflammatories (NSAIDs), antibiotics, cortisone, and laxatives can cause intestinal problems.


Supplements

Vitamin C: If you are taking it, cut back until you're better. Large doses of vitamin C can cause diarrhea. The triggering dose varies, but if you take more than a 2,000 mg of vitamin C a day, take less or stop taking it until you're better.

Herbs

  • Chamomile: Tea made from this herb gently soothes the digestive tract.
  • Herbal teas: Tea made with raspberry, blackberry, or blueberry leaves can help treat diarrhea. They contain astringent compounds (tannins) that soothe the digestive tract.

Homeopathy

Homeopathic medicine is based on the idea that some conditions can be cured by administering tiny amounts of drugs or substances that, in a healthy person, would produce symptoms like that of the disease -- thereby working with, not against, the body's natural defense systems.

Purchase commercially prepared homeopathic medicines, or visit a professional; do not attempt to mix your own, as many of the substances are dangerous in more than tiny amounts.

In a study of infectious diarrhea, a condition very similar to gastroenteritis, University of Washington researchers compared administering just rehydration fluid versus administering rehydration fluid plus homeopathic medicine. The combination treatment worked better. The medicines included the following: Arsenicum (arsenic), Chamomilla (chamomile), Mercurius (mercury), Sulphur (sulphur), or Podophyllum (mayapple). [1]



Sources

[1] Jacobs, J., et al. "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Trial in Nicaragua," Pediatrics (1994) 93:719.

Preventing Gastroenteritis

In general, careful scrutiny of the food and beverages you consume is the key to avoiding this condition. Be especially careful in foreign countries not to overlook small details like the water you brush your teeth with and the manner in which food is cooked. Be sure to wash your hands frequently and thoroughly. If possible, use an antibacterial soap like Softsoap or a liquid hand sanitizer like Purell.

Self-Care Measures

If you contract gastroenteritis, treat the digestive tract with care until you recover. You can help your stomach and digestive tract on the road to recovery in the following ways:

  • Drink more fluids. The diarrhea associated with gastroenteritis depletes the body of fluids and electrolytes (sodium and potassium). Water is a good start, but to replace lost electrolytes it's better to drink bouillon, Gatorade, or vegetable juices, which contain sodium and potassium. For infants, use special rehydration fluids like Pedialyte and Kao Lectrolyte.
  • Eat BRAT foods. BRAT is an acronym for bananas, rice, applesauce, and toast. They're binding and help treat the diarrhea associated with gastroenteritis.
  • Steer clear of caffeine. Coffee, tea, and sodas make matters worse.
  • Eat live-culture yogurt. Gastroenteritis can kill the good bacteria that normally live in your digestive tract. Yogurt helps re-establish these bacteria.


Websites & Organizations

AHCPR Center for Health Information Dissemination
2101 East Jefferson Street, Suite 501
Rockville, MD 20852
Phone: 301-594-1364

Australian Gastroenterology Institute

Digestive Disease National Coalition
507 Capitol Court, Suite 200
Washington DC 20002
Phone: 202-544-7497

Dr. Reddy's Pediatric Office on the Web

Health Answers

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 301-468-6344
Email: nddic@info.niddk.nih.gov

Neonatal Infections

Sources for This Article

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Hardman, Joel G. and Limbird, Lee E. Goodman and Gilman's The Pharmacological Basis of Therapeutics eds. New York: McGraw Hill, 1996.

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Tyler, Varro. Herbs of Choice. New York: Pharmaceutical Products Press, 1994.


Articles

Baert, D, De Man, M, Oosterbosch, L, Duyck, MC, Van der Spek, P, Lepoutre, L. "Infectious Gastroenteritis: Are They All the Same?" Acta Clin Belg. 269-72. 1995.

Chakravarti, A, Kumar, S, Mittal, SK, Broor, S. "Clinical and Epidemiological Features of Acute Gastroenteritis Caused By Human Rotavirus Subgroups." J Diarrhoeal Dis Res. 21-4. Mar 1992.

Cunningham, R, Parry, CM, Harries, AD, Beeching, NJ. "Acute Gastroenteritis: Effect on Nutritional Status." Br J Clin Pract. 180-1. Autumn 1992.

Gangarosa, RE, Glass, RI, Lew, JF, Boring, JR. "Hospitalizations Involving Gastroenteritis in the United States, 1985: The Special Burden of the Disease Among the Elderly." American Journal of Epidemiology. 281-90. Feb 1, 1992.

Jacobs, J. et al. "Treatment of Acute Childhood Diarrhea With Homeopathic Medicine: A Randomized Trial in Nicaragua," Pediatrics (1994) 93:719.

Jenkins, HR, Ansari, BM. "Management of Gastroenteritis." Arch Dis Child. 939-41. Sep 1990.

Kapikian, AZ. "Overview of viral gastroenteritis." Arch Virol Suppl. 7-19. 1996.

Merrick, N, Davidson, B, Fox, S. "Treatment of Acute Gastroenteritis: Too Much and Too Little Care." Clin Pediatr. 429-35. Sep 1996.

O'Loughlin, EV. "Acute Gastroenteritis in Children." Aust Fam Physician. 1115-20. Aug 1992.

Urasawa, S. "Viral Gastroenteritis. Introduction." Arch Virol Suppl. 1-6. 1996.

Walker-Smith, JA. "Advances in the Management of Gastroenteritis in Children." Br J Hosp Med. 582-5. Nov 4-17, 1992.

 

 

 

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