Gastroenteritis

Gastroenteritis Overview
Gastroenteritis is a condition that causes irritation and inflammation of the stomach and intestines (the gastrointestinal tract). An infection may be caused by bacteria or parasites in spoiled food or unclean water. Some foods may irritate your stomach and cause gastroenteritis. Lactose intolerance to dairy products is one example. Many people who experience the vomiting and diarrhea that develop from these types of infections or irritations think they have "food poisoning," which they may, or call it "stomach flu," although influenza has nothing to do with it. Travelers to foreign countries may experience "traveler's diarrhea" from contaminated food and unclean water.

The severity of infectious gastroenteritis depends on your immune systems 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 babies 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 Causes
Gastroenteritis has many causes. Viruses and bacteria are the most common. The infectious agents can come from outside your body or internally from some abnormal condition. For example, both normal and disease-causing intestinal bacteria may grow when antacids or other medication alter the stomach acidity. Viruses and bacteria are very contagious and can spread through contaminated food or water. In up to 50% of diarrheal outbreaks, no specific agent is found. Improper handwashing following a bowel movement or handling a diaper can spread the disease from person to person. Gastroenteritis caused by viruses may last 1-2 days. On the other hand, bacterial cases can last a week or more.

Bacteria: These are the most common bacterial causes:

Escherichia coli - Travelers diarrhea, food poisoning, dysentery, colitis, or uremic syndrome

Salmonella - Typhoid fever; handling poultry or reptiles such as turtles that carry the germs

Campylobacter - Undercooked meat, unpasteurized milk

Shigella - Dysentery

Viruses: Viral outbreaks (30-40% of cases in children) can spread rapidly through close contact among children in day care and schools. Poor handwashing habits can spread viruses. Common viral causes include the following:
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Adenoviruses

Rotaviruses

Caliciviruses

Astroviruses

Norovirus (formerly called Norwalk-like virus or NLV) and Norwalk virus

Norovirus was attributed to 9 out of the 21 outbreaks of acute gastroenteritis on cruise ships reported to the CDCs Vessel Sanitation Program from January 1, 2002, to December 2, 2002.

Noroviruses cause about 23 million cases of acute gastroenteritis each year and are the leading cause of outbreaks.

Parasites and protozoans: These tiny organisms are less frequently responsible for intestinal irritation. You may pick up one of these by drinking contaminated water. Swimming pools are common places to come in contact with these parasites. Common parasites include these:
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Giardia - The most frequent cause of waterborne diarrhea causing giardiasis

Cryptosporidium - Affects mostly people with weakened immune systems, causes watery diarrhea

Other common causes: Chemical toxins most often found in seafood, food allergies, heavy metals, antibiotics, and other medications also may be responsible for bouts of gastroenteritis that are not infectious to others.
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Medications Aspirin Nonsteroidal anti-inflammatory medicines (such as Motrin or Advil) Antibiotics Caffeine Steroids - Excessive use or a sudden change in frequency or dosage Laxatives

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Inability to tolerate the sugar lactose in milk and milk products such as cheese and ice cream

Exposure to heavy metals sometimes present in drinking water

Arsenic Lead Mercury

Gastroenteritis Symptoms

Gastroenteritis may affect both the stomach and the intestines, resulting in one or more of the following symptoms:

Common symptoms
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Low grade fever (99F) Nausea with or without vomiting Mild-to-moderate diarrhea: May range from 2-4 loose stools per day for adolescents and adults to stools that run out of the diaper in infants. Crampy painful bloating Vomiting: May or may not accompany diarrhea. If you do vomit, your dehydration rate will increase. Either together or alone, diarrhea and vomiting result not only in loss of significant amounts of fluid, leading to dehydration and possibly shock, but also loss of potassium, sodium, and bicarbonate.

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More serious symptoms

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Blood in vomit or stool Vomiting more than 48 hours Fever higher than 101F Swollen abdomen or abdominal pain coming from the right lower side Dehydration - Little to no urination, extreme thirst, lack of tears, and dry mouth (dry diapers in infants)

When to Seek Medical Care

If you or someone appears weak and dizzy while standing, dehydration is possible. If you cannot drink fluids, but continue to lose fluids through fever, vomiting, and diarrhea, you should call your doctor. If you appear sleepy or unaware, you should definitely be taken to a doctor or hospital's emergency department.

If you have any questions or uncertainty, call or see your doctor.

If you have any of the following symptoms, go to a hospital's Emergency Department:

Blood in the vomit or stool

Vomiting that lasts more than 48 hours

Fever higher than 101F

Swollen abdomen or abdominal pain in the right lower part of the abdomen

Dehydration (check for little to no urination, extreme thirst, lack of tears, and dry mouth)

Exams and Tests

Symptoms of diarrhea and vomiting often indicate gastroenteritis. Finding the cause is another matter. If others around you have similar symptoms, you may be able to trace the illness to a food source or foreign travel. A doctor first will determine if your symptoms are acute (lasting less than 2 weeks) or chronic (longer lasting).

A long-lasting illness suggests an inflammation or immune disorder, which should be checked after infection has been ruled out. Sudden onset of illness may indicate changes in diet or medication. Rapidly developing fever, abdominal pain, bloody stool and presence of white blood cells (leukocytes) may mean an inflammation or diarrhea caused by bacteria. Watery stools without blood or leukocytes are more typical of viral- or toxin-induced diarrhea.

You will be asked if other family or friends have similar exposure or symptoms. The doctor will want to know about the duration, frequency, and description of your bowel movements and whether you are vomiting. You will be asked how often and the amount you are urinating to help the doctor determine if your fluid loss is causing dehydration. Have you lost any weight?

You will be given a physical exam to find any specific or localized tenderness in your abdomen. The doctor will want to determine if you have appendicitis, inflammation of the gallbladder or pancreas, or other noninfectious gastrointestinal disease. The doctor also will feel your abdomen for masses and possibly your rectum. The doctor may perform other lab tests, checking your electrolytes, blood, and stool. The doctor may examine a stool sample for blood, mucus, or abnormal odor. The sample may be inspected under a microscopic to look for parasites and their eggs. The doctor also will take your medical history including the following:
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Travel history: Travel (especially to Mexico) may suggest E coli bacteria or other infection from a parasite in something you ate or drank. Exposure to poisons or other irritants: Swimming in contaminated water or drinking from suspicious fresh water such as mountain streams or wells may indicate infection from Giardiaan organism in the water that causes diarrhea. Diet change, food preparation habits and storage: When the disease occurs following exposure to undercooked, improperly stored or prepared food such as potato salad at a picnic, food poisoning must be considered. In general, symptoms caused by bacteria or their toxins will become apparent after the following amount of time:

Staphylococcus aureus in 3-6 hours Clostridium 8-10 hours Salmonella in 12-72 hours

Medications: If you have used broad-spectrum or multiple antibiotics recently, you may have antibiotic-associated irritation.

Gastroenteritis Treatment
From the history of your gastroenteritis and the physical exam, the doctor will assess how dehydrated you are. Self-care at home by drinking fluids may help relieve your symptoms and avoid dehydration.

Self-Care at Home
The mainstay of home treatment of gastroenteritis is to drink fluids. Fluid intake helps correct electrolyte imbalance, which may stop vomiting.

Dehydration in children: Children should be given oral rehydration solutions such as Pedialyte, Rehydrate, Resol, and Rice-Lyte.

Cola, tea, fruit juice, and sports drinks will not correctly replace fluid or electrolytes lost from diarrhea or vomiting. Nor will plain water. The intestines irritated by gastroenteritis do not absorb plain water as well. In addition, plain water will not replace electrolytes and may dilute electrolytes to the point of seizures. After each loose stool, children younger than 2 years should be given 1-3 ounces of any of the rehydration solutions. Older children should be asked to drink 3-8 ounces. Adults should drink as much as possible. This guideline serves only to replace fluid loss due to diarrhea. Drink additional fluid equal to the amount you normally drink. In underdeveloped nations or regions without available commercial pediatric drinks, the World Health Organization has established a field recipe for fluid rehydration: Mix 2 tablespoons of sugar (or honey) with teaspoon of table salt and teaspoon of baking soda. (Baking soda may be substituted with teaspoon of table salt.) Mix in 1 liter (1 qt) of clean or previously boiled water. You will need solid foods eventually to help end the diarrhea. After 24 hours, begin to offer bland foods with the BRAT dietbananas, rice, applesauce without sugar, toast, pasta, or potatoes.

Dehydration in adults: Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea. Severe symptoms and dehydration usually develop as complications of medication use or chronic diseases such as diabetes or kidney failure. But symptoms may occur in healthy people.
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Initially, adults should eat ice chips and clear, noncaffeinated, nondairy liquids such as Gatorade, ginger ale, fruit juices, and Kool-Aid or other commercial drink mixes. After 24 hours of fluid diet without vomiting, begin a soft-bland solid diet such as the BRAT diet.

Medical Treatment
Upon seeking medical attention, if you cannot take fluids by mouth because of vomiting, the doctor may insert an IV to put fluid back into your body (rehydration). With severe symptoms, a surgeon, toxicologist, gastroenterologist, or other specialist may see you.

Medications

Doctors usually dont give antibiotics until bacteria have been identified. Antibiotics may be given for certain bacteria, specifically Campylobacter, Shigella, and Vibrio cholerae, if properly identified through laboratory testing. Otherwise, using any antibiotic or the wrong antibiotic can worsen some infections or make them last longer.

Medications continued...
For adults, the doctor may give medications to stop vomiting (these are called antiemetics) such as promethazine (Phenergan, Anergan), prochlorperazine (Compazine), or ondansetron (Zofran). Sometimes these medications are given as a suppository. Doctors usually do not recommend antiemetics for children. A single dose of Compazine may be prescribed, however, for children older than 2 years. Doctors generally avoid antidiarrheal medications for all age groups if they suspect the infection is caused by a toxin. The most common antidiarrheal agent for people older than 3 years are over-the-counter medications such as diphenoxylate atropine (Lomotil, Lofene, Lonox) or loperamide hydrochloride (Imodium). Learn more about medications like promethazine (Phenergan, Anergan), and prochlorperazine (Compazine), and ondansetron (Zofran) on RxList.com.

Next Steps
Diarrhea is one of the leading causes of infant sickness. Worldwide, diarrhea accounts for 3-5 million deaths for all age groups. In general, most adults and children recover after they are appropriately rehydrated.

Follow-up
After an infection or irritation of the digestive tract, you may not be able to eat a regular diet. Some people may be unable to tolerate dairy products for several weeks after the disease has gone.

You should continue to advance slowly from bland nondairy soups and grain products to a solid diet. If your symptoms continue or worsen, call your doctor.

Prevention
With most infectious germs, 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. But doctors base their use on your medical and foreign travel history. For lactose intolerance, supplementary enzymes are available over-the-counter for adolescents and adults to aid digestion of milk sugars. Soy formulas and other lactosefree products are available from most grocery stores for formula-feeding infants.