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American Heritage Dictionary:

gas·tro·en·ter·i·tis

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(găs'trō-ĕn'tə-rī'tĭs) pronunciation
n.
Inflammation of the mucous membrane of the stomach and intestines.


Britannica Concise Encyclopedia:

gastroenteritis

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Acute infectious syndrome of the stomach lining and intestines. Symptoms include diarrhea, vomiting, and abdominal cramps. Severity varies from transient diarrhea to life-threatening dehydration, children and the very old being more at risk for the latter. Many microorganisms produce it, either by secreting toxins or by invading the gut walls. Forms of gastroenteritis include food poisoning, cholera, and traveler's diarrhea. Depending on cause and severity, treatment includes antibiotics or simply supportive care.

For more information on gastroenteritis, visit Britannica.com.

Oxford Food & Fitness Dictionary:

gastroenteritis

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Inflammation of the stomach and intestines. It is usually caused by a bacterial or viral infection associated with food poisoning. Symptoms include nausea, vomiting, and diarrhoea. Gastroenteritis may cause dehydration, which precludes vigorous physical activity. Victims of gastroenteritis should drink plenty of fluids and maintain a good salt balance. Infants are at particular risk of dehydration and may require intravenous fluid replacement.

Gale Encyclopedia of Children's Health:

Gastroenteritis

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Definition

Gastroenteritis is an inflammation of the digestive tract, particularly the stomach, and large and small intestines. Viral and bacterial gastroenteritis are intestinal infections associated with symptoms of diarrhea, abdominal cramps, nausea, and vomiting.

Description

Gastroenteritis is an uncomfortable and inconvenient ailment, but is rarely life-threatening in the United States and other developed nations. Viral gastroenteritis is frequently referred to as the stomach or intestinal flu, although the influenza virus is not associated with this illness.

Demographics

Viral gastroenteritis is one of the most common acute (sudden-onset) illnesses in the United States, with millions of cases reported annually. Each year, an estimated 220,000 children younger than age five are hospitalized with gastroenteritis symptoms. Of these children, 300 die as a result of severe diarrhea and dehydration. In developing nations, diarrheal illnesses are a major source of mortality.

Causes and Symptoms

Causes

Gastroenteritis is caused by the ingestion of viruses, certain bacteria, or parasites. Food that has spoiled may also cause illness. Young children may develop signs and symptoms of gastroenteritis as a reaction to a new food.

VIRAL INFECTION. Viral infection is the most common cause of gastroenteritis. Viral gastroenteritis is highly contagious and can be spread through close contact with an infected person. Exposure also can occur through the fecal-oral route, such as by consuming foods or beverages contaminated by fecal material related to poor sanitation or poor hygiene, or by touching contaminated surfaces and then touching the mouth and ingesting the germs. The four types of viruses that cause most viral gastroenteritis include rotavirus, adenovirus, calicivirus, and astrovirus.

Typically, children ages three to 15 months are more vulnerable to rotaviruses, the most significant cause of acute watery diarrhea. Outbreaks of diarrhea caused by rotaviruses are common during the winter and early spring months, especially in child care centers. Symptoms in children last for three to eight days, and occur one to two days after exposure to the virus. Worldwide, rotaviruses are estimated to cause 800,000 deaths annually in children under five years of age. 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 under age two are more susceptible to adenovirus serotypes 40 and 41. Vomiting and diarrhea symptoms occur about one week after exposure to the virus.

Calciviruses cause infection in people of all ages. This family of viruses includes the noroviruses (such as the Norwalk virus) and the sapoviruses (such as the sapporo virus). Calciviruses are transmitted from person-to-person contact, as well as through contaminated water or food. These viruses are the most likely to produce vomiting as a major symptom. Muscle aches also are common symptoms. The symptoms usually appear within one to three days after exposure to the virus.

Astrovirus primarily infects infants, young children, and the elderly. This virus is most active during the winter months. Symptoms of vomiting and diarrhea appear within one to three days after exposure to the virus.

BACTERIAL AND PARASITIC INFECTIONS. 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 worsen underlying problems in sanitation and food safety.

In developed nations, including the United States, bacterial gastroenteritis may result from contaminated water supplies, improperly processed or preserved foods, or person-to-person contact in places such as child-care centers. 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 (E. coli) 0157:H7 and Listeria monocytogenes, bacterial causes of food borne illnesses, have caused 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. Shigella bacteria are dangerous because they attack the intestinal wall and cause bleeding ulcers.

Parasitic infections that cause gastroenteritis are most commonly caused by Giardia, which is easily spread through contaminated water and human contact. Cryptosporidium is another common parasitic organism that causes the symptoms of gastroenteritis.

Symptoms

Gastroenteritis symptoms include nausea and vomiting, watery diarrhea, and abdominal pain and cramps. These symptoms are sometimes accompanied by bloating, low fever, chills, headache, and overall tiredness or weakness. Gastroenteritis symptoms typically last two to three days, but some viruses may last up to a week.

Infants, young children, the elderly, and anyone with an underlying disease are more vulnerable to complications of gastroenteritis. 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 become prolonged. Untreated, severe dehydration can be life threatening. Dehydration should be suspected if symptoms of a dry mouth, increased or excessive thirst, or decreased urination are experienced.

When to Call the Doctor

If symptoms do not resolve within one week, an infection or disorder more serious than gastroenteritis may be involved. Prompt medical attention is required if the child has any of these symptoms:

  • a high fever of 102°F (38.9°C) or above
  • blood or mucus in the diarrhea
  • blood in the vomit
  • bloody stools or black stools
  • confusion
  • severe abdominal pain or swelling
  • inability to keep liquids down

If a child has the following symptoms, the parent should contact the child's pediatrician:

  • diarrhea or vomiting that wakes the child during the night
  • persistent or severe diarrhea or vomiting
  • dehydration symptoms, including dry mouth, increased or excessive thirst, few or no tears when crying, decreased urination, dark yellow urine, irritability, low energy, lightheadedness or fainting, severe weakness, and sunken abdomen, eyes, and cheeks
  • no improvement in symptoms after 36 hours

Diagnosis

A usual bout of gastroenteritis should not require a visit to the doctor. However, medical treatment is essential if symptoms worsen or if the child has any symptoms of dehydration.

A physician makes the diagnosis of gastroenteritis based on the presence of symptoms and after performing a medical examination. 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 rotavirus, disease-causing (pathogenic) bacteria, or parasites.

When symptoms continue even after treatment or to rule out the presence of other illnesses with similar symptoms, the diagnostic evaluation may include blood tests, a hydrogen breath test, or an x ray of the bowel, called a barium enema. Endoscopic tests such as a colonoscopy or sigmoidoscopy may be performed. An endoscopic test is an internal examination of the colon using a flexible instrument (sigmoidoscope or colonoscope) inserted through the anus. When symptoms persist, a nutritional assessment, performed by a registered dietitian, may be included in the child's diagnostic evaluation.

Treatment

Gastroenteritis is a self-limiting illness that will resolve by itself. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) should be used sparingly for relief of discomfort. Parents should ask the child's doctor for specific guidelines. Should pathogenic bacteria or parasites be identified in the patient's stool sample, medications such as antibiotics will be prescribed. Over-the-counter antidiarrheal medications such as Imodium should not be given to the child unless advised by the child's doctor, as these drugs may make it more difficult for the child's body to eliminate the virus.

An adequate intake of liquids and oral rehydrating solutions may be enough to treat mild dehydration. More severe dehydration requires medical treatment with intravenous (IV) fluids and may require hospitalization. IV therapy can be followed with oral rehydration as the patient's condition improves. Once normal hydration is achieved and symptoms have cleared, the patient can resume a regular diet.

Nutritional Concerns

It is important for the child to stay hydrated and nourished during a bout of gastroenteritis. Formula feeding and breastfeeding should continue as normal. If dehydration is absent, drinking generous amounts of fluids, such as water or juice, is adequate. Caffeine should be avoided since it increases urine output and can contribute to or worsen dehydration. Dairy products, sugary beverages and foods, highly seasoned foods, and fatty or fried foods should be avoided until symptoms have cleared.

When diarrhea and vomiting symptoms have subsided, plain foods can be given. The traditional BRAT diet—bananas, rice, applesauce, and toast—is tolerated by the tender gastrointestinal system. Other foods can be gradually reintroduced into the diet once the child is symptom-free.

Minimal to moderate dehydration can be treated by giving the child generous amounts of fluids, including water, clear liquids, and oral rehydrating solutions containing glucose and electrolytes. Oral rehydrating solutions—including brands such as Pedialyte, Infalyte, Ceralyte, and Oralyte—are available at most grocery and drug stores. They are essential for replacing fluids, minerals, and salts lost from diarrhea or vomiting, and should be given when diarrhea or vomiting first occur.

Small sips of water, clear liquids, or ice chips are usually tolerated better than a large glass of liquid given all at once.

If the water supply is thought to be contaminated because of a recent storm or other reason, the water should be boiled or bottled water should be given.

The Centers for Disease Control and Prevention (CDC) recommends that families with infants and young children keep a supply of oral rehydration solution (two bottles or packages) at home at all times. However, it is important to make sure that the product has not expired before giving it to the child. Parents and caregivers should follow usage directions on the package.

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.

Alternative Treatment

Alternative and complementary therapies include approaches that are considered to be outside the mainstream of traditional health care. Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet and homeopathy.

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 has some support in the medical literature. Castor oil packs applied to the abdomen can reduce inflammation and also lessen spasms or discomfort.

Before using any alternative remedy, it is important for the parent/caregiver and child to learn about the therapy, its safety and effectiveness, and potential side effects. Although some remedies are beneficial, others may be harmful to certain patients. Dietary supplements should not be used as a substitute for medical therapies prescribed by a doctor. Parents should discuss these alternative treatments with the child's doctor to determine the techniques and remedies that may be beneficial for the child.

Prognosis

For most people, gastroenteritis is not a serious illness. It typically resolves within two to three days and there are usually no long-term effects. If dehydration occurs, recovery is extended by a few days. Gastroenteritis is not an anatomical or structural defect, nor is it an identifiable physical or chemical disorder.

Prevention

A few steps can be taken to avoid gastroenteritis. Thorough hand washing is the most effective way to prevent the fecal-oral transmission of certain viruses, especially rotaviruses. People should wash their hands frequently, especially after using the bathroom and before eating. Child-care providers and caregivers should wash their hands after diapering a child and before preparing, serving, or eating, food. The child's hands also should be washed after every diaper change. Separate towels or disposable paper towels should be used to dry hands. Clean bathroom surfaces, disinfected toys, and prompt washing of soiled clothes in hot water also help prevent the spread of infectious germs.

Ensuring that food is prepared safely well-cooked and unspoiled can prevent bacterial gastroenteritis, but may not be effective against viral gastroenteritis. All kitchen utensils, counters, or cutting boards that come in contact with raw meat, especially poultry, should be washed with hot water and a chlorine bleach-based cleaner to prevent the spread of harmful bacteria. Meats should be refrigerated as soon as possible after bringing them home from the grocery store, and cooked leftovers should be refrigerated as soon as possible after a meal to prevent spoilage.

Consuming contaminated food or water can cause gastroenteritis when traveling to other countries. To reduce the risk, travelers should use bottled water for drinking and brushing teeth, and avoid ice (it may be made with contaminated water) and raw foods, including peeled fruit, raw vegetables, and salads.

Research is underway involving vaccines that will decrease the risk of rotavirus infection, especially among infants and young children.

Parental Concerns

Parents should reinforce with the child that gastroenteritis is not a serious condition and that symptoms usually subside in a few days. It is most important to prevent dehydration by following the recommendations listed previously. Parents should assure that the child gets adequate rest; the child should be kept home from school or day care until the symptoms have cleared. The child may be contagious before the onset of diarrhea and a few days after the diarrhea has ended. To prevent the spread of infection among family members, soiled clothing or bedding should be washed in hot water immediately, hands must be washed frequently, there should be no sharing of utensils or cups used by the child, and toys and bathroom surfaces should be cleaned with a chlorine-based cleaner.

See also Food poisoning.

Resources

Periodicals

DeWit, Matty A.S., et. al. "Risk Factors for Nororvirus, Sappporo-like Virus, and Group A Rotavirus Gastroenteritis." Emerging Infectious Diseases 9, no. 12 (December, 2003): 1563–70. Available online at: www.cdc.gov/eid.

Organizations

American College of Gastroenterology (ACG). P.O. Box 3099, Alexandria, VA 22302. (703) 820-7400. Web site: www.acg.gi.org/patientinfo.

American Gastroenterological Association. 4930 Del Ray Ave., Bethesda, MD 20814. (301) 654-2055. Patient Information Resources. Web site: www.gastro.org/generalPublic.html.

Centers for Disease Control and Prevention. 1600 Clifton Rd., Atlanta, GA 30333. (800) 311-3435 or (404) 639-3534. Web site: www.cdc.gov.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389. Web site: www.niddk.nih.gov.

Web Sites

"Gastroenteritis." September 24, 2003. Mayo Clinic. Available online at: www.mayoclinic.com/invoke.cfm?id=DS00085.

"Gastrointestinal Infections and Diarrhea." KidsHealth. Nemours Foundation, February 2002. Available online at: www.kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&os=107&cat_id=137&article_id=22887.

"Viral Gastroenteritis." [cited August 20, 2001]. Centers for Disease Control. Available online at: www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm.

[Article by: Julia Barrett Angela M. Costello]


Saunders Veterinary Dictionary:

gastroenteritis

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Inflammation of the lining of the stomach and intestine. The clinical manifestations are vomiting and diarrhea. See also gastritis.

  • canine hemorrhagic g. — an acute syndrome of vomiting and bloody diarrhea with dehydration and marked hemoconcentration. If not treated vigorously, it may lead to circulatory failure and death in a short time. The cause is unknown.
  • eosinophilic g. — a chronic segmental disease of the alimentary tract characterized by a variety of signs depending on the location of the lesion but including vomiting, or diarrhea or melena or hematochezia. Occurs in dogs, particularly German shepherd dogs, rarely in cats, and in horses. Diarrhea, weight loss and a protein-losing enteropathy result. A hypersensitivity to ingested allergens is the suggested cause. The diagnostic lesion is the aggregation of eosinophils in the intestinal wall. See also eosinophilic gastritis.
  • transmissible viral g. of pigs — see transmissible gastroenteritis.
Mosby's Dental Dictionary:

gastroenteritis

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n

An inflammation of the stomach and intestines accompanying numerous gastrointestinal (GI) disorders. Symptoms are anorexia, nausea, vomiting, abdominal discomfort, and diarrhea.

Random House Word Menu:

categories related to 'gastroenteritis'

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Random House Word Menu by Stephen Glazier
For a list of words related to gastroenteritis, see:
  • Diseases and Infestations - gastroenteritis: inflammation of stomach and intestine, due to virus, bacteria, or food poisoning, that causes vomiting

Wikipedia on Answers.com:

Gastroenteritis

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Gastroenteritis
Classification and external resources

Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = Norovirus and D = Astrovirus. The virus particles are shown at the same magnification to allow size comparison.
ICD-10 A02.0, A08, A09, J10.8, J11.8, K52
ICD-9 008.8 009.0, 009.1, 558
DiseasesDB 30726
eMedicine emerg/213
MeSH D005759

Gastroenteritis is a medical condition characterized by inflammation ("-itis") of the gastrointestinal tract that involves both the stomach ("gastro"-) and the small intestine ("entero"-), resulting in some combination of diarrhea, vomiting, and abdominal pain and cramping.[1] Gastroenteritis has also been referred to as gastro, stomach bug, and stomach virus. Although unrelated to influenza, it has also been called stomach flu and gastric flu.[2]

Globally, most cases in children are caused by rotavirus.[3] In adults, norovirus[4] and campylobacter[5] are more common. Less common causes include other bacteria (or their toxins) and parasites. Transmission may occur due to consumption of improperly prepared foods, contaminated water, or via close contact with individuals who are infectious.

The foundation of management is adequate hydration. For mild or moderate cases, this can typically be achieved via oral rehydration solution. For more severe cases, intravenous fluids may be needed. Gastroenteritis primarily affects children and those in the developing world.

Contents

Symptoms and signs

Types 7 on the Bristol Stool Chart indicate diarrhea

Gastroenteritis typically involves both diarrhea and vomiting,[6] or less commonly, presents with only one or the other.[1] Abdominal cramping may also be present.[1] Signs and symptoms usually begin 12–72 hours after contracting the infectious agent.[7] If due to a viral agent, the condition usually resolves within one week.[6] Some viral causes may also be associated with fever, fatigue, headache, and muscle pain.[6] If the stool is bloody, the cause is less likely to be viral[6] and more likely to be bacterial.[8] Some bacterial infections may be associated with severe abdominal pain and may persist for several weeks.[8]

Children infected with rotavirus usually make a full recovery after within three to eight days.[9] However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common.[10] Dehydration is a common complication of diarrhea,[11] and a child with a significant degree of dehydration may have a prolonged capillary refill, poor skin turgor, and abnormal breathing.[12] Repeat infections are typically seen in areas with poor sanitation, and malnutrition,[7] stunted growth, and long-term cognitive delays can result.[13]

Reactive arthritis occurs in 1% of people following infections with Campylobacter species, and Guillian-Barre syndrome occurs in 0.1%.[8] Hemolytic uremic syndrome (HUS) may occur as a result of infection with Shiga toxin-producing Escherichia coli or Shigella species, resulting in low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown).[14] Children are more predisposed to getting HUS than adults.[13] Some viral infections may produce benign infantile seizures.[1]

Cause

Viruses (particularly rotavirus) and the bacteria E. coli and Campylobacter species are the primary causes of gastroenteritis.[15][7] There are, however, many other infectious agents that can cause this syndrome.[13] Non-infectious causes are seen on occasion, but they less likely than a viral or bacterial etiology.[1] Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene.[1]

Viral

Viruses that are known to cause gastroenteritis include rotavirus, norovirus, adenovirus, and astrovirus.[6][16] Rotavirus is the most common cause of gastroenteritis in children,[15] and produces similar incidence rates in both the developed and developing world.[9] Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group.[17] Rotavirus is a less common cause in adults due to acquired immunity.[18]

Norovirus is the leading cause of gastroenteritis among adults in America, causing greater than 90% of outbreaks.[6] These localized epidemics typically occur when groups of people spend time in close physical proximity to each other, such as on cruise ships,[6] in hospitals, or in restaurants.[1] People may remain infectious even after their diarrhea has ended.[6] Norovirus is the cause of about 10% of cases in children.[1]

Bacterial

Salmonella enterica serovar Typhimurium (ATCC 14028) as seen with a microscope at 1000 fold magnification and following Gram staining.

In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry.[8] In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacter species.[17] If food becomes contaminated with bacteria and remains at room temperature for a period of several hours, the bacteria multiply and increase the risk of infection in those who consume the food.[13] Some foods commonly associated with illness include: raw or undercooked meat, chicken, seafood and eggs; raw sprouts; unpasteurized milk, soft cheeses, fruit and vegetable juices.[19] In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.[20]

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly.[13] Infants can carry these bacteria without developing symptoms.[13] It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use.[21] Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics.[22] "Traveler's diarrhea" is usually a type of bacterial gastroenteritis. Acid-suppressing medication appears to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile, and Salmonella and Campylobacter species.[23] The risk is greater in those taking proton pump inhibitors than with H2 antagonists.[23]

Parasitic

A number of protozoans can cause gastroenteritis – most commonly Giardia lamblia – but Entamoeba histolytica and Cryptosporidium species have also been implicated.[17] As a group, these agents comprise about 10% of cases in children.[14] Giardia occurs more commonly in the developing world, but this etiologic agent causes this type of illness to some degree nearly everywhere.[24] It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.[24]

Transmission

Transmission may occur via consumption of contaminated water, or when people share personal objects.[7] In places with wet and dry seasons, water quality typically worsens during the wet season, and this correlates with the time of outbreaks.[7] In areas of the world with seasons, infections are more common in the winter.[13] Bottle-feeding of babies with improperly sanitized bottles is a significant cause on a global scale.[7] Transmission rates are also related to poor hygiene, especially among children,[6] in crowded households,[25] and in those with pre-existing poor nutritional status.[13] After developing tolerance, adults may carry certain organisms without exhibiting signs or symptoms, and thus act as natural reservoirs of contagion.[13] While some agents (such as Shigella) only occur in primates, others may occur in a wide variety of animals (such as Giardia).[13]

Non-infectious

There are a number of non-infectious causes of inflammation of the gastrointestinal tract.[1] Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-infection source of (often severe) gastroenteritis.[1] Disease secondary to toxins may also occur. Some food related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.[26]

Pathophysiology

Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large bowel.[13] The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory.[13] The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 108 (for Vibrio cholera).[13]

Diagnosis

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms.[6] Determining the exact cause is usually not needed as it does not alter management of the condition.[7] However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world.[17] Diagnostic testing may also be done for surveillance.[6] As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended.[12] Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.[17]

Dehydration

A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (≥10%) cases.[1] In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing.[12][27] Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth.[1] A normal urinary output and oral fluid intake is reassuring.[12] Laboratory testing is of little clinical benefit in determining the degree of dehydration.[1]

Differential diagnosis

Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus.[17] Pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should also be considered.[28] The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather than both).[1]

Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases.[1] This is in contrast to the large amount of diarrhea that is typical of gastroenteritis.[1] Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea.[1] Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea.[1] One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.[1]

Prevention

Percentage of rotavirus tests with positive results, by surveillance week, United States, July 2000 – June 2009.

Lifestyle

A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis.[13] Personal measures (such as hand washing) have been found to decrease incidence and prevalence rates of gastroenteritis in both the developing and developed world by as much as 30%.[12] Alcohol-based gels may also be effective.[12] Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally.[7] Breast milk reduces both the frequency of infections and their duration.[1] Avoiding contaminated food or drink should also be effective.[29]

Vaccination

Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccine be offered to all children globally.[30][15] Two commercial rotavirus vaccines exist and several more are in development.[30] In Africa and Asia these vaccines reduced severe disease among infants[30] and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.[31][32] This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.[33] Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.[34][35][36] The first dose of vaccine should be given to infants between 6 and 15 weeks of age.[15] The oral cholera vaccine has been found to be 50–60% effective over 2 years.[37]

Management

Gastroenteritis is usually an acute and self-limiting disease that does not require medication.[11] The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT).[14] Metoclopramide and/or ondansetron, however, may be helpful in some children,[38] and butylscopolamine is useful in treating abdominal pain.[39]

Rehydration

The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy, although intravenous delivery may be required if a there is a decreased level of consciousness or if dehydration is severe.[40][41] Oral replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.[42] Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea.[11] Plain water may be used if more specific and effective ORT preparations are unavailable or are not palatable.[11] A nasogastric tube can be used in young children to administer fluids if warranted.[17]

Dietary

It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT.[43] Lactose-free or lactose-reduced formulas usually are not necessary.[43] Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided.[43] The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.[43] Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools.[44] Fermented milk products (such as yogurt) may also be beneficial.[45] Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.[46]

Antiemetics

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.[47][48][49] Metoclopramide might also be helpful.[49] However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.[50] The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.[51] Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.[1]

Antibiotics

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe[52] or if a susceptible bacterial cause is isolated or suspected.[53] If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter.[8] Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin.[54] Bacteria and protozoans that are amenable to treatment include Shigella[55] Salmonella typhi,[56] and Giardia species.[24] In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole.[57][24] The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.[1]

Antimotility agents

Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely,[28] these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by fever.[58] Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.[59] Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases,[28] but salicylate toxicity is theoretically possible.[1]

Epidemiology

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.
  no data
  ≤less 500
  500–1000
  1000–1500
  1500–2000
  2000–2500
  2500–3000
  3000–3500
  3500–4000
  4000–4500
  4500–5000
  5000–6000
  ≥6000

It is estimated that three to five billion cases of gastroenteritis occur globally on an annual basis,[60] primarily affecting children and those in the developing world.[7] It resulted in about 1.3 million deaths in children less than five as of 2008,[61] with most of these occurring in the world's poorest nations.[13] More than 450,000 of these fatalities are due to rotavirus in children under 5 years of age.[62][63] Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly.[20] In the developing world children less than two years of age frequently get six or more infections a year that result in clinically significant gastroenteritis.[13] It is less common in adults, partly due to the development of acquired immunity.[6]

In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world.[54] Death rates were reduced significantly (to approximately 1.5 million deaths annually) by the year 2000, largely due to the introduction and widespread use of oral rehydration therapy.[64] In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea[6][13] and approximately ten thousand deaths annually,[13] with 150 to 300 of these deaths in children less than five years of age.[1]

History

The first usage of "gastroenteritis" was in 1825.[65] Before this time it was more specifically known as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of a number of other archaic names for acute diarrhea.[66]

Society and culture

Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others.[13] It has played a role in many military campaigns and is believed to be the origin of the term "no guts and glory".[13]

Gastroenteritis is the main reason for 3.7 million visits to physicians a year in the United States[1] and 3 million visits in France.[67] In the United States gastroenteritis as a whole is believed to result in costs of 23 billion USD per year[68] with that due to rotavirus alone resulting in estimated costs of 1 billion USD a year.[1]

Research

There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), two of the leading bacterial causes of gastroenteritis worldwide.[69][70]

In other animals

Gastroenteritis in cats and dogs is caused by many of the same agents as in humans. The most common organisms are: Campylobacter, Clostridium difficile, Clostridium perfringens, and Salmonella.[71] A large number of toxic plants may also cause symptoms.[72] Some agents are more specific to a certain species. Transmissible gastroenteritis coronavirus (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration.[73] It is believed to be introduced to pigs by wild bird and there is no specific treatment available.[74] It is not transmissible to humans.[75]

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Notes
  • Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed. ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9. 
Oncovirus
Immune disorders
Central
nervous system
Cardiovascular
Respiratory system/
acute viral nasopharyngitis/
viral pneumonia
Digestive system
DNA virus: HBV (B)
RNA virus: CBV · HAV (A) · HCV (C) · HDV (D) · HEV (E) · HGV (G)
Urogenital
Acute
Chronic
Processes
Specific locations

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