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Gastroenteritis

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Gastroenteritis is a condition commonly known as “stomach flu.” However, the term is a misnomer because the flu virus does not cause the disease. It affects the stomach and intestines and is characterised by loose, watery stools, abdominal cramps, vomiting, fever, and body aches.

The inflammation of the intestinal lining also occurs, which destroys the cells of the intestine, further leading to a decrease in the absorption of nutrients and water and causing diarrhoea.

Rotavirus, norovirus, and other common infective agents cause gastroenteritis in adults and children. Infectious gastroenteritis is extremely contagious and spreads from person to person via the faecal-oral route through contaminated food and water.

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Certain species of bacteria and parasites cause gastroenteritis. The incidence of gastroenteritis is higher in developing nations compared to developed nations because of the lack of access to clean drinking water.

The onset of symptoms occurs within 1–2 days of infection; however, this primarily depends on the type of infectious agent or toxin ingested. For staphylococcal toxins, the symptoms may appear within an hour; however, in Listeria infections, symptoms may take about two months to develop.

The diagnosis of the condition is made by assessing symptoms. For mild infections lasting for a short duration, additional tests may not be considered important. However, the doctor may recommend a stool test or perform a physical exam if required in certain instances. The doctor may require a brief medical history of the patient.

The management of gastroenteritis involves fluid replenishment to combat dehydration, which may be fatal because it may cause severe complications such as electrolyte disturbances and metabolic acidosis in certain individuals if not correctly managed. It is not advisable to take antibiotics, anti-diarrhoeal, or antiemetic drugs unless prescribed because they can cause additional problems in certain patients. Gastroenteritis is a condition commonly known as “stomach flu.” However, the term is a misnomer because the flu virus does not cause the disease. It affects the stomach and intestines and is characterised by loose, watery stools, abdominal cramps, vomiting, fever, and body aches.

The inflammation of the intestinal lining also occurs, which destroys the cells of the intestine, further leading to a decrease in the absorption of nutrients and water and causing diarrhoea.

Rotavirus, norovirus, and other common infective agents cause gastroenteritis in adults and children. Infectious gastroenteritis is extremely contagious and spreads from person to person via the faecal-oral route through contaminated food and water.

Certain species of bacteria and parasites cause gastroenteritis. The incidence of gastroenteritis is higher in developing nations compared to developed nations because of the lack of access to clean drinking water.

The onset of symptoms occurs within 1–2 days of infection; however, this primarily depends on the type of infectious agent or toxin ingested. For staphylococcal toxins, the symptoms may appear within an hour; however, in Listeria infections, symptoms may take about two months to develop.

The diagnosis of the condition is made by assessing symptoms. For mild infections lasting for a short duration, additional tests may not be considered important. However, the doctor may recommend a stool test or perform a physical exam if required in certain instances. The doctor may require a brief medical history of the patient.

The management of gastroenteritis involves fluid replenishment to combat dehydration, which may be fatal because it may cause severe complications such as electrolyte disturbances and metabolic acidosis in certain individuals if not correctly managed. It is not advisable to take antibiotics, anti-diarrhoeal, or antiemetic drugs unless prescribed because they can cause additional problems in certain patients.

Types

Depending on the causative agent, gastroenteritis may be classified as follows:

Viral gastroenteritis


Most known cases of gastroenteritis can be attributed to viral infections. Rotavirus A is responsible for most known cases, closely followed by rotavirus B, responsible for endemic outbreaks. Generally, Group C rotaviruses cause sporadic outbursts of infections. They may cause infection alone or along with Group A rotaviruses.

Norovirus infections are equally common and generally affect adults but may affect young children. Norovirus infections have been on the rise and are the primary infective agents among adults and children. Moreover, this virus causes gastroenteritis epidemics and sporadic cases.

Noroviruses belonging to groups I, II and IV are primarily known to infect human beings, whereas group III noroviruses primarily affect cattle and do not cause gastroenteritis in human beings.

Astroviruses are less common but have been known to cause infections that are perhaps more severe than Norovirus infections. The primary category of astroviruses responsible for causing gastroenteritis in human beings belongs to category 1. However, the mixed infection of astrovirus with rotavirus may occur in certain individuals.

Bacterial gastroenteritis


Campylobacter, Escherichia coli, Salmonella, and Shigella are the most common bacterial species responsible for causing gastroenteritis or traveller’s diarrhoea. These bacteria spread primarily via contaminated water and raw, contaminated food such as fruits and vegetables that were not thoroughly washed using clean water.

Campylobacter infections have a higher occurrence rate compared to infections caused by Shigella, E. coli and Salmonella. However, complications are rarely seen in Campylobacter infections, and most patients do not require antibiotic therapy.

Parasitic gastroenteritis


Protozoan parasites such as Giardia, Cryptosporidium, and Cyclospora species may cause similar infections. These protozoan parasites primarily cause long-term infections, although acute infections may occur in certain cases.

Non-infectious gastroenteritis


Bacterial endotoxins are primarily responsible for causing non-infectious gastroenteritis. Toxins from bacteria such as Staphylococcus aureus and Bacillus cereus may cause the appearance of typical symptoms as early as 4–6 h after ingestion. Another example of non-infectious gastroenteritis is eosinophilic gastroenteritis; however, this form of gastroenteritis has been observed in very few individuals. The commonly occurring symptoms include abdominal cramps, diarrhoea, vomiting, and weight loss.

Depending on the duration of illness, gastroenteritis can be classified as follows:

Acute gastroenteritis


Acute gastroenteritis generally lasts for fewer than two weeks; however, persistent gastroenteritis may last between 14 and 30 days. Acute gastroenteritis is a commonly known infection characterised by the typical symptoms of gastroenteritis. The management of this disease usually involves rehydration therapy.

Chronic gastroenteritis


Chronic gastroenteritis generally lasts for over a month and can usually be attributed to viral or protozoan infections. An infection, if left untreated in adults and children, may inevitably progress to a chronic case. Moreover, individuals with compromised immune systems and comorbidities may be more susceptible to chronic infections.

Causes

The significant causes of gastroenteritis include:


  • Infection by viruses or bacteria.

  • Infection by parasites such as Entamoeba histolytica, Giardia lamblia and Cryptosporidium.

  • Ingestion of food and water contaminated with the toxic by-products of certain bacteria.

  • Ingestion of poisonous chemicals such as Pb.

  • Ingestion of antibiotics.

Symptoms

Most individuals experience symptoms of gastroenteritis within 1–2 days of being infected. The commonly observed symptoms of gastroenteritis include:


  • Diarrhoea

  • Vomiting

  • Nausea

  • Abdominal pain or cramps

  • Fever


Diarrhoea and vomiting are the most common symptom associated with gastroenteritis and may lead to severe dehydration and electrolyte disturbance in the body if not attended to quickly. The symptoms of dehydration primarily include extreme thirst, weakness, dizziness, sunken eyes, decreased urination, and the appearance of dark-hued urine. Most patients experience fever as a reaction to the presence of an infection in the body.

Risk Factors

Gastroenteritis primarily spreads via food and water contaminated with viruses, bacteria and other pathogens. Major risk factors for gastroenteritis include environmental factors, including indoor environment, seasonal factors and demographic factors such as age. Studies show that infants and children are more susceptible to the disease than adults. Moreover, it has been observed that individuals suffering from other diseases and those with a weakened immune system are at a greater risk of contracting gastroenteritis.

Diagnosis

The primary diagnosis of gastroenteritis is made based on the symptoms. For mild infections, additional tests are generally not conducted. The doctor may suggest routine blood and stool tests to determine the causative agent and other infection signs. Furthermore, a physical examination would help look for signs of rectal bleeding and dehydration. A record of the patient’s medical history regarding the types of symptoms experienced and their duration and frequency of occurrence, present or past illnesses, current medication history, and a history of travel or contact with possibly infected persons are required to assess the patient’s condition

Treatment

Generally, the treatment regimens for gastroenteritis depend on various factors such as the severity of illness and causative agent. The mild cases of gastroenteritis do not typically require medication and may resolve on their own with sufficient care. The treatment options for gastroenteritis include the following:


  • Providing plenty of water and replenishing fluids such as oral rehydration solutions. Consuming foods that are nutritious but easy to digest is recommended.

  • Severe cases of gastroenteritis associated with dehydration may require hospitalisation and administration of intravenous fluids and electrolytes.

  • The doctors may prescribe specific antimicrobial drugs to kill the target organism such as bacteria or parasites.

  • Generally, medicines to counteract vomiting or diarrhoea are not prescribed unless specifically recommended because they prevent the elimination of the infectious agent from the body.

Prevention

Proper precautions must be in place to prevent transmission or the occurrence of gastroenteritis. However, the primary focus lies in maintaining safe hygiene practices to avoid the occurrence and spread of the infection. The commonly followed preventive measures include:


  • Avoid going outside while ill. Please visit a doctor if symptoms of gastroenteritis such as diarrhoea and vomiting persist or worsen.

  • Hand washing from time to time with soap and water, particularly after going to the toilet, preparing or handling food, eating, changing diapers, and coming in contact with pets.

  • Do not eat raw fruits and vegetables because they could be contaminated with pathogens.

  • Carrying bottled water when travelling to avoid drinking water that may be contaminated.

  • Thoroughly clean toilets and bathrooms regularly using suitable disinfectants.

  • Clean and disinfect common surfaces at home to prevent the spread of the infection to other family members.

  • Thoroughly washing kitchen utensils and using different utensils for handling raw and cooked food. All kitchen surfaces must be regularly cleaned and thoroughly disinfected.

  • Keep cold food refrigerated and heat food to a temperature of >60℃ to prevent the growth of harmful bacteria.

  • Do not consume spoiled food.


References:

  1. Stomach Flu (gastroenteritis). Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/12418-gastroenteritis. (https://my.clevelandclinic.org/health/diseases/12418-gastroenteritis)

  2. Clark B, et al. Curr Opin Infect Dis. 2004;17(5):461-9.

  3. Gastroenteritis. Healthy WA. Available at: https://www.healthywa.wa.gov.au/Articles/F_I/Gastroenteritis. (https://www.healthywa.wa.gov.au/Articles/F_I/Gastroenteritis)

  4. Viral gastroenteritis (“stomach flu”). NIH. Available at https://www.niddk.nih.gov/health-information/digestive-diseases/viral-gastroenteritis#:~:text=Definition%20%26%20Facts,term%20is%20not%20medically%20correct. (https://www.niddk.nih.gov/health-information/digestive-diseases/viral-gastroenteritis#:~:text=Definition%20%26%20Facts,term%20is%20not%20medically%20correct)

  5. Elliott EJ, et al. BMJ. 2007;334(7583):35-40.

  6. Allos BM, et al. Clin Infect Dis. 2001;32(8):1201-6.

  7. McGregor AC, et al. Clin Med (Lond). 2015;15(1):93-5.

  8. Mori et al. Gastroenterol 2013;7(2):293-298.

  9. Graves NS. Prim Care. 2013;40(3):727-41.

  10. Gastroenteritis. Better Health Channel. Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastroenteritis#treatment-for-gastroenteritis. Accessed on April 8, 2021. (https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastroenteritis#treatment-for-gastroenteritis)

  11. Rivera-Dominguez G, et al. Pediatric gastroenteritis. NIH. Available at: https://www.ncbi.nlm.nih.gov/books/NBK499939/#:%20~:text=The%20main%20risk%20factors%20for,a%20gastrointestinal%20(GI)%20infection.

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