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.

Salmonella and Campylobacter bacteria; however, Listeria monocytogenes are creating increased concern in developed nations. 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 toandbacteria; however, Escherichia coli 0157 andare 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

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, Nux vomica are three said to relieve the symptoms of gastroenteritis. Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet, herbal remedies, and homeopathy. An infusion of meadowsweet () may be effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved, slippery elm () can help calm the digestive tract. Of the homeopathic remedies available, ipecac , orare 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.

Resources

Periodicals

Hart, C. Anthony, and Nigel A. Cunliffe. "Viral Gastroenteritis." Current Opinion in Infectious Diseases 10 (1997): 408.

Moss, Peter J., and Michael W. McKendrick. "Bacterial Gastroenteritis." Current Opinion in Infectious Diseases 10 (1997): 402.

Key terms

Dehydration — A condition in which the body lacks the normal level of fluids, potentially impairing normal body functions.

Electrolyte — An ion, or weakly charged element, that conducts reactions and signals in the body. Examples of electrolytes are sodium and potassium ions.

Glucose — A sugar that serves as the body's primary source of fuel.

Influenza — A virus that affects the respiratory system, causing fever, congestion, muscle aches, and headaches.

Microflora — The bacterial population in the intestine.

Probiotics — Bacteria that are beneficial to a person's health, either through protecting the body against pathogenic bacteria or assisting in recovery from an illness.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.