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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.

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]

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.

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

• Diseases and Infestations - gastroenteritis: inflammation of stomach and intestine, due to virus, bacteria, or food poisoning, that causes vomiting

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 (also known as gastric flu, stomach flu, gastro and stomach virus, although unrelated to influenza) is marked by inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in diarrhea, vomiting and abdominal cramps.

The majority of cases in children globally are caused by rotavirus, while in adults norovirus is more common, at least in the United States. Less common causes include bacteria or their toxins, and parasites. Transmission may occur due to improperly prepared foods, contaminated water or close contact with those 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 1 Symptoms and signs 1.1 Complications 2 Cause 2.1 Viral 2.2 Bacterial 2.3 Protozoal 2.4 Transmission 3 Pathophysiology 4 Diagnosis 4.1 Differential 5 Prevention 5.1 Lifestyle 5.2 Vaccination 6 Management 6.1 Rehydration 6.2 Dietary 6.3 Antiemetics 6.4 Antibiotics 6.5 Antimotility agents 7 Epidemiology 8 History 9 Society and culture 10 References 11 External links

Symptoms and signs

Gastroenteritis typically involves diarrhea, vomiting, and abdominal cramps.^[1] These symptoms usually begin 12–72 hours after contracting the infectious agent^[2] and if due to viral agent usually lasts less than one week.^[1] Some viral causes may also be associated with fever, fatigue, headaches, and muscle pains.^[1] If the stool is bloody the cause is less likely to be viral^[1] and more likely to be bacterial.^[3] Some bacterial infections may be associated with severe abdominal pain and may last for weeks without treatment.^[3]

Complications

Children infected with rotavirus usually make a full recovery after a few days.^[4] Dehydration is a common complication of diarrhea^[5] and a child with mild or moderate dehydration may have a prolonged capillary refill, poor skin turgor and abnormal breathing.^[6] In areas with poor sanitation repeat infections may lead to malnutrition^[2] stunted growth and delayed development.^[7]

Reactive arthritis occurs in 1% of people follow campylobacter infection and Guillian Barre syndrome (HUS) occurs in 0.1%.^[3] Hemolytic uremic syndrome may occur secondary to infections with Shiga toxin producing E. Coli or Shigella resulting in low platelets, poor kidney function, and low red blood cells due to their breakdown.^[8] Children are more predisposed to getting HUS.^[7]

Cause

Viruses particularly rotavirus, and the bacteria E. coli, and Campylobacter are the primary causes of gastroenteritis.^[9][2] There are however many other infectious agents that can cause this syndrome.^[7]

Viral

The viruses that cause gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus.^[1][10] Rotavirus is the most common cause of gastroenteritis in children both in the developed and developing world^[9] and viruses cause about 70% of episodes of infectious diarrhea in this age group.^[11] Rotavirus is a less common cause in adults due to acquired immunity.^[12]

Norovirus is a leading cause of gastroenteritis among United States adults being behind greater than 90% of outbreaks.^[1] These outbreaks typically occur when groups of people spend time in close proximity such as on cruise ships.^[1] People may remain infectious even after the diarrhea has ended.^[1]

Bacterial

In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis with half of these cases associated with poultry.^[3] In children bacteria are the cause of about 15% of cases.^[11] The most common types are: Salmonella, Shigella, Escherichia coli, and Campylobacter.^[11] If food becomes contaminated with bacteria and remains at room temperatures for a period of hours, the bacteria can multiply and increase the risk of infection in those who eat the food.^[7]

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly.^[7] Infants can carry these bacteria without developing symptoms.^[7] Traveler's diarrhea is usually a type of bacterial gastroenteritis.

Acid suppressing medication appears to increase the risk of infections by a number of organisms including Clostridium difficile, Salmonella, and Campylobacter.^[13] The risk is greater with proton pump inhibitors than with H2 antagonists.^[13]

Protozoal

A number of protozoa can cause gastroenteritis, most commonly Giardia lamblia but also cryptosporidium and Entamoeba histolytica^[11] These as a group make up about 10% of cases in children.^[8]

Transmission

Transmission may occur among via contaminated water or people sharing personal objects.^[2] In places with a wet and dry seasons water quality typically worsen during the wet season and this is usually the time of outbreaks.^[2] In areas of the world with seasons infections are more common in the winter.^[7] Bottle-feeding using improperly sanitized bottles is a significant cause globally.^[2] Transmission may also be related to poor hygiene especially among children^[1] and is increased in those with a poor preexisting nutritional status.^[7] Adults after developing tolerance may carry certain organisms without symptoms and thus act as natural reservoirs.^[7] While some agents only occur in primates such as Shigella others may occur in a wide variety of animals such as Giardia.^[7]

Pathophysiology

Gastroenteritis is defined as vomiting or diarrhea due to either an infection of the small or large bowel.^[7] The changes in the small bowel are typically noninflammatory while the ones in the large bowel are inflammatory.^[7] The number of pathogens required to cause an infection is variable from as few as one for crytosporidium to as many as 10⁸ for cholera.^[7]

Diagnosis

Gastroenteritis is typically diagnosed based on a person's symptoms.^[1] Determining the exact cause is usually not needed as it does not alter management.^[2] As hypoglycemia may occur in ~10% of children measuring serum glucose is recommended.^[6] Diagnostic testing may be done for surveillance.^[1] Electrolytes and kidney function should also be checked when there is a concern for severe dehydration.^[11] Stool cultures should be performed in those with blood in the stool, who might have been exposed to food poisoning, and those who have recently traveled to the developing world.^[11]

Differential

Other potential causes of these symptoms may need considering such as: appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus.^[11] Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.^[14]

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 is important for reducing rates of infection.^[7] Personal measures such as hand washing have been found to decrease the rates of gastroenteritis in both the developing and developed world by about 30%.^[6] Alcohol based gels may also be effective.^[6] Breastfeeding is important especially in places with poor hygiene as is improvement of hygiene generally.^[2] Avoiding contaminated food or drink may also be effective.^[15]

Vaccination

It is recommended that the rotavirus vaccine be offered to all children globally due to both its effectiveness and safety.^[9] Since 2000, the implementation of a program in the United States has substantially decreased the number of cases of diarrhea.^[16][17] The first dose should be given to infants between the ages 6 and 15 weeks.^[9] The oral cholera vaccine has been found to be 50–60% effective over 2 years.^[18]

Management

Gastroenteritis is usually an acute and self-limited disease that does not require medication.^[19] The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT).^[8] Metoclopramide and ondansetron however may be helpful in some children,^[20] and butylscopolamine is useful in treating abdominal pain.^[21]

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 dehydration is severe.^[22][23] Complex-carbohydrate-based ORT such as those made from wheat or rice may be superior to simple sugar-based ORT.^[24] Sugary drinks such as soft drinks and fruit juice are not recommended in children under 5 years of age as they may increase diarrhea.^[19] Plain water may be used if specific ORT are unavailable or not palatable.^[19] A nasogastric tube can be used in young children to administer fluids.^[11]

Dietary

It is recommended that breastfed infants continue to be nursed per usual and that formula-fed infants continue their formula immediately after rehydration with ORT.^[25] Lactose-free or lactose-reduced formulas usually are not necessary.^[25] Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided.^[25] 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.^[26] Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools.^[27] Fermented milk products (such as yogurt) may also be beneficial.^[28] Zinc supplementation appear to be effective in both treating and preventing diarrhea among children in the developing world.^[29]

Antiemetics

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility with a single dose associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.^[30][31][32] Metoclopramide might also be helpful.^[32] However there was an increased number of children who returned and were subsequently admitted in those treated with ondansetron.^[33] The intravenous preparation of ondansetron may be given orally.^[34]

Antibiotics

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are severe^[35] or a susceptible bacterial cause is isolated or suspected.^[36] If antibiotics are decided on, a macrolide such as azithromycin is preferred over a fluoroquinolones due to the higher rates of resistance to the latter.^[3] Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin.^[37]

Antimotility agents

Antimotility medication has a theoretical risk of causing complications; clinical experience, however, has shown this to be unlikely.^[14] They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.^[38] Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.^[39] Loperamide is not recommended in children 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.^[14]

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

Globally it is estimated that three to five billion cases of gastroenteritis occur yearly^[40] primarily affecting children and those in the developing world.^[2] It results in about 1.8 million deaths in children a year with most of these in the world's poorest nations.^[7] About half a million of those are due to rotavirus in those under 5 years of age.^[41] In the developing world children less than two years of age frequently get six or more infections a year.^[7] It is less common in adults partly due to the development of immunity.^[1]

In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of these occurring in the developing world.^[37] Current death rates have come down significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the global introduction of oral rehydration therapy.^[42]

In the United States it is the second most common infection after the common cold causing 200-375 million cases (~0.7 per person) of acute diarrhea yearly^[1][7] and resulting in ten thousand deaths.^[7]

History

The first usage of "gastroenteritis" is from 1825.^[43] 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.^[44]

U.S. President Zachary Taylor died of "cholera morbus", equivalent to a diagnosis of gastroenteritis, on July 9, 1850.^[45]

Society and culture

Gastroenteritis is associated with many colloquial names including: "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint" among others.^[7] It has played a role in many military campaigns and is believed to be the origin of the term "no guts and glory".^[7]

References

1. ^ ^{a b c d e f g h i j k l m} Eckardt AJ, Baumgart DC (January 2011). "Viral gastroenteritis in adults". Recent Patents on Anti-infective Drug Discovery 6 (1): 54–63. PMID 21210762. 
2. ^ ^{a b c d e f g h i} Webber, Roger (2009). Communicable disease epidemiology and control : a global perspective (3rd ed.). Wallingford, Oxfordshire: Cabi. p. 79. ISBN 9781845935047. http://books.google.ca/books?id=pZ9fpHtvOGYC&pg=PA79. 
3. ^ ^{a b c d e} Galanis, E (2007 Sep 11). "Campylobacter and bacterial gastroenteritis.". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 177 (6): 570–1. PMID 17846438. 
4. ^ Haffejee IE (1991). "The pathophysiology, clinical features and management of rotavirus diarrhoea". Q. J. Med. 79 (288): 289–99. PMID 1649479. 
5. ^ "Diarrhoea and vomiting in children under 5". http://guidance.nice.org.uk/CG84. 
6. ^ ^{a b c d} Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 830–839. ISBN 0-07-148480-9. 
7. ^ ^{a b c d e f g h i j k l m n o p q r s t} Mandell 2010 Chp. 93
8. ^ ^{a b c} Elliott, EJ (2007 Jan 6). "Acute gastroenteritis in children.". BMJ (Clinical research ed.) 334 (7583): 35–40. PMID 17204802. 
9. ^ ^{a b c d} Szajewska, H; Dziechciarz, P (2010 Jan). "Gastrointestinal infections in the pediatric population.". Current opinion in gastroenterology 26 (1): 36–44. doi:10.1097/MOG.0b013e328333d799. PMID 19887936. 
10. ^ Dennehy PH (January 2011). "Viral gastroenteritis in children". The Pediatric Infectious Disease Journal 30 (1): 63–4. doi:10.1097/INF.0b013e3182059102. PMID 21173676. 
11. ^ ^{a b c d e f g h} Webb, A; Starr, M (2005 Apr). "Acute gastroenteritis in children.". Australian family physician 34 (4): 227–31. PMID 15861741. 
12. ^ Desselberger U, Huppertz HI (January 2011). "Immune responses to rotavirus infection and vaccination and associated correlates of protection". The Journal of Infectious Diseases 203 (2): 188–95. doi:10.1093/infdis/jiq031. PMC 3071058. PMID 21288818. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3071058. 
13. ^ ^{a b} Leonard, J; Marshall, JK, Moayyedi, P (2007 Sep). "Systematic review of the risk of enteric infection in patients taking acid suppression.". The American journal of gastroenterology 102 (9): 2047–56; quiz 2057. PMID 17509031. 
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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 0443068399. 

External links

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• "NHS Direct: Gastroenteritis". http://www.nhsdirect.nhs.uk/checksymptoms/topics/gastroenteritis. Retrieved 2007-04-12. 
• "The World Health Organisation: Diarrhoea". http://www.who.int/topics/diarrhoea/en/. Retrieved 2007-04-12. 
• Gastroenteritis: First aid from the Mayo Clinic

v d e Digestive system · Digestive disease · Gastroenterology (primarily K20–K93, 530–579) Upper GI tract Esophagus Esophagitis (Candidal, Herpetiform) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, Gastroesophageal reflux disease (GERD)) · Laryngopharyngeal reflux (LPR) · Esophageal stricture · Megaesophagus Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus Lower GI tract: Intestinal/ enteropathy Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · small bowel bacterial overgrowth syndrome  · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease · bile acid malabsorption Large intestine (appendix/colon) Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis Large and/or small Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) · Intestinal adhesions Rectum Proctitis (Radiation proctitis) · Proctalgia fugax · Rectal prolapse · Anismus Anal canal Anal fissure/Anal fistula · Anal abscess  · Anal dysplasia  · Pruritus ani GI bleeding/BIS Upper (Hematemesis, Melena) · Lower (Hematochezia) Accessory Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Budd-Chiari syndrome, Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis Gallbladder Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome · Porcelain gallbladder Bile duct/ other biliary tree Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia) · Sphincter of Oddi dysfunction Pancreatic Pancreatitis (Acute, Chronic, Hereditary, Pancreatic abscess) · Pancreatic pseudocyst · Exocrine pancreatic insufficiency · Pancreatic fistula Abdominopelvic Hernia Diaphragmatic (Congenital) · Hiatus Inguinal (Indirect, Direct) · Umbilical · Femoral · Obturator · Spigelian lumbar (Petit's, Grynfeltt-Lesshaft) undefined location (Incisional · Internal hernia) Peritoneal Peritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum M: DIG anat(t, g, p)/phys/devp/enzy noco/cong/tumr, sysi/epon proc, drug(A2A/2B/3/4/5/6/7/14/16), blte

v d e Infectious diseases · Viral systemic diseases (A80–B34, 042–079) Oncovirus DNA virus: HBV (Hepatocellular carcinoma) · HPV (Cervical cancer, Anal cancer) · Kaposi's sarcoma-associated herpesvirus (Kaposi's sarcoma) · Epstein-Barr virus (Nasopharyngeal carcinoma, Burkitt's lymphoma, Primary central nervous system lymphoma) · MCPyV (Merkel cell cancer) · SV40 RNA virus: HCV (Hepatocellular carcinoma) · HTLV-I (Adult T-cell leukemia/lymphoma) Immune disorders HIV (AIDS) Central nervous system Encephalitis/ meningitis DNA virus: JCV (Progressive multifocal leukoencephalopathy) RNA virus: MeV (Subacute sclerosing panencephalitis) · LCV (Lymphocytic choriomeningitis) · Arbovirus encephalitis · Orthomyxoviridae (probable) (Encephalitis lethargica) · RV (Rabies) · Chandipura virus  · Herpesviral meningitis · Ramsay Hunt syndrome type II Myelitis Poliovirus (Poliomyelitis, Post-polio syndrome) · HTLV-I (Tropical spastic paraparesis) Eye Cytomegalovirus (Cytomegalovirus retinitis) · HSV (Herpetic keratitis) Cardiovascular CBV (Pericarditis, Myocarditis) Respiratory system/ acute viral nasopharyngitis/ viral pneumonia DNA virus Epstein-Barr virus (EBV infection/Infectious mononucleosis) · Cytomegalovirus RNA virus IV: SARS coronavirus (Severe acute respiratory syndrome) V, Orthomyxoviridae: Influenzavirus A/B/C (Influenza/Avian influenza) V, Paramyxovirus: Human parainfluenza viruses (Parainfluenza) · RSV · hMPV Digestive system Oropharynx/Esophagus MuV (Mumps) · Cytomegalovirus (Cytomegalovirus esophagitis) Gastroenteritis/ diarrhea DNA virus: Adenovirus (Adenovirus infection) RNA virus: Rotavirus · Norovirus · Astrovirus · Coronavirus Hepatitis DNA virus: HBV (B) RNA virus: CBV · HAV (A) · HCV (C) · HDV (D) · HEV (E) · HGV (G) Pancreatitis CBV Urogenital BK virus · MuV (Mumps) M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc)

v d e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific locations Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Cellulitis · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis Lymphatic Lymphangitis · Lymphadenitis

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