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Gastroenteritis

The stomach and intestines are known collectively as the gastrointestinal tract - or gut. Gastroenteritis is an infection of the gut. Children can get infected from eating or drinking food that is contaminated with bacteria, viruses or parasites, or from other infected people (see "Causes" below).

Some of these germs can damage the cells lining the inner surface of the gut and interfere with its normal functions.

Certain bacteria or viruses may also produce toxins that irritate the gut and cause it to produce excess amounts of fluid. This can lead to the various symptoms of gastroenteritis such as diarrhea.

Also called intestinal flu, traveler's diarrhea, viral enteritis, and food poisoning, gastroenteritis is a self-limiting disorder characterized by diarrhea, nausea, vomiting, and abdominal cramping. It occurs in all age-groups and is a major cause of morbidity and mortality in underdeveloped nations.

In the United States, gastroenteritis ranks second to the common cold as a cause of lost work time and fifth as the cause of death among young children. It also can be life-threatening in elderly and debilitated people.

Causes

Many different viruses can cause gastroenteritis, including rotaviruses, adenoviruses, caliciviruses, astroviruses, Norwalk virus, and a group of Noroviruses. Viral gastroenteritis is not caused by bacteria (such as Salmonella or Escherichia coli ) or parasites (such as Giardia ), or by medications or other medical conditions, although the symptoms may be similar. Your doctor can determine if the diarrhea is caused by a virus or by something else.

Signs and symptoms

Clinical manifestations vary, depending on the pathologic organism and the level of GI tract involved. Gastroenteritis in adults is usually a self-limiting, nonfatal disease that produces diarrhea, abdominal discomfort (ranging from cramping to pain), nausea, and vomiting. Other possible symptoms include fever, malaise, and borborygmi.

In children and elderly and debilitated people, gastroenteritis produces the same symptoms, but the inability of these patients to tolerate electrolyte and fluid losses leads to a higher mortality.

Diagnosis

Patient history can aid diagnosis of gastroenteritis. A stool culture should be obtained. Blood cultures are indicated in febrile patients.

Treatment

Usually supportive, treatment consists of nutritional support and increased fluid intake.

An episode of acute gastroenteritis is self-limiting. When an episode is severe and produces symptoms for more than 3 or 4 days and the patient is a young child or an elderly or debilitated person, hospitalization may be necessary. Treatment may include fluid and electrolyte replacement, antibiotic therapy, and anti emetics.

Prevention

The best way to prevent the spread of intestinal infections is to follow these common-sense precautions:

• Wash your hands and your children's hands thoroughly.
• Educate regarding good hygiene to prevent recurrence. Instruct patients to thoroughly cook foods, especially pork; to refrigerate perishable foods, such as milk, mayonnaise, potato salad, and cream-filled pastry; and to always wash their hands with warm water and soap before handling food, especially after using the bathroom.
• Make sure child care centers have separate rooms for changing diapers and preparing or serving food.
• Teach patients to clean utensils thoroughly, to avoid drinking water or eating raw fruit or vegetables when visiting a foreign country, and to eliminate flies and roaches in their home.