Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis and enteritis) and resulting in acute diarrhea. The inflammation is caused most often by an infection from certain viruses or less often by bacteria, their toxins, parasites, or an adverse reaction to something in the diet or medication. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year, and is a leading cause of death among infants and children under 5.
At least 50% of cases of gastroenteritis due to foodborne illness are caused by norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus
Gastroenteritis Classification
Infectious gastroenteritis is caused by a wide variety of bacteria and viruses.
It is important to consider infectious gastroenteritis as a diagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia, septicemia, urinary tract infection and even meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the clinician. Endocrine disorders (e.g. thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities. Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs. These children are routinely tested also for norovirus, which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients. Other methods, electron microscopy and polyacrylamide gel electrophoresis, are used in research laboratories.
Gastroenteritis Symptoms
Gastroenteritis often involves stomach pain or spasms, diarrhea and/or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.
The condition is usually of acute onset, normally lasting 1–6 days, and is self-limiting.
- Nausea and vomiting
- Diarrhea
- Loss of appetite
- Headaches
- Abnormal flatulence
- Abdominal pain
- Abdominal cramps
- Bloody stools (dysentery - suggesting infection by amoeba, ''Campylobacter'', ''Salmonella'', ''Shigella'' or some pathogenic strains of ''Escherichia coli'')
- Fainting and Weakness
The main contributing factors include poor feeding in infants. Diarrhea is common, and may be followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited up.
A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs of dehydration (which include dry mucous membranes), tachycardia, reduced skin turgor, skin color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion and ultimately shock.
Gastroenteritis Diagnosis
No specific diagnostic tests are required in most patients with simple gastroenteritis. If symptoms including fever, bloody stool and diarrhea persist for two weeks or more, examination of stool for Clostridium difficile may be advisable along with cultures for bacteria including Salmonella, Shigella, Campylobacter and Enterotoxic Escherichia coli. Microscopy for parasites, ova and cysts may also be helpful.
Gastroenteritis Prevention
A rotavirus vaccine has between 2000 and 2009 decreased the number of cases of diarrhea due to rotavirus in the United States.
Gastroenteritis Management
The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration.
Rehydration
The primary treatment of gastroenteritis in both children and adults is rehydration, i.e., replenishment of water and electrolytes lost in the stools. Depending on the degree of dehydration, this can be done by giving the person oral rehydration therapy (ORT) or through intravenous delivery. Complex-carbohydrate-based Oral Rehydration Salts (ORS) such as those made from wheat or rice have been found to be superior to simple sugar-based ORS.
Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in children under 5 years of age as they may make the diarrhea worse. Plain water may be used if specific ORS are unavailable or not palatable.
Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore, soft drinks (carbonated or flat), juice, gelatin desserts, and other high simple sugar foods should be avoided.
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.
Pharmacologic therapy
Gastroenteritis is usually an acute and self-limited disease that does not require pharmacologic therapy. Metoclopramide also might be helpful.
Alternative medications
- Probiotics
Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis.
- Zinc
The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to two weeks after onset of gastroenteritis. A 2009 trial however did not find any benefit from supplementation.
Gastroenteritis Complications
Dehydration is a common complication of diarrhea. It can be made worse with the withholding fluids or the administration of juice / soft drinks. Malabsorption of lactose, the principal sugar in milk, may occur. It may increase the diarrhea, however, is not a reason to discontinue breastfeeding.
Gastroenteritis Epidemiology
Every year worldwide rotavirus in children under 5 causes 111 million cases of gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the world's poorest nations.
In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of these occurring in the third world.
The incidence in the developed world is as high as 1-2.5 cases per child per year and is a major cause of hospitalization in this age group.
Age, living conditions, hygiene and cultural habits are important factors. Aetiological agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics. Historians, genealogists, and other researchers should keep in mind that gastroenteritis was not considered a discrete diagnosis until fairly recently.
U.S. President Zachary Taylor died of gastroenteritis on July 9, 1850.
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