Gastroenteritis disease

Definition

Gastroenteritis is an inflammation of the stomach and intestines.

Description

Gatroenteritis, also called stomach flu, is a common viral or bacterial infection that is not related to the flu caused by the influenza virus. Viral gastroenteritis is highly contagious. Gastroenteritis affects the stomach, the small and large intestines and is primarily characterized by acute abdominal cramps and diarrhea . Symptoms appear within 12 to 48 hours after exposure to the pathogen. Transmission can be indirect, through ingestion of contaminated food, or direct through contact with an infected person or surface. An infected person can transmit the infection to others even when no longer experiencing symptoms.

Demographics

Gastroenteritis is estimated to cause about 5 to 10 million deaths per year worldwide, and about 10,000 deaths per year in the United States. According to the National Digestive Diseases Information Clearinghouse (NDDIC), viral gastroenteritis is the second most common illness in the United States, responsible for millions of cases of diarrhea each year. Most cases are believed to be viral in origin. Nearly half of patients with acute diarrhea must restrict activities, 10% consult physicians, 250,000 require hospitalization, and approximately 3,000 die. The Centers for Disease Control and Prevention (CDC) reports that, each year in the United States, 23 million norovirus infections result in an estimated 50,000 hospitalizations and 310 deaths.

Causes and symptoms

Viral gastroenteritis can be caused by many types of viruses , including noroviruses, rotaviruses, adenoviruses, sapoviruses, and astroviruses. Unlike bacteria, viruses cannot be destroyed by antibiotics . The noroviruses, of which the Norwalk virus is the most well-known, are most commonly responsible for infecting people. Infections are seasonal, occurring more frequently from October to April in the United States. In recent years, noroviruses have been identified as the cause of many gastroenteritis outbreaks in cruise ships, hotels, restaurants, schools, daycare centers, nursing homes , and hospitals.

Bacterial gastroenteritis can be caused by a variety of bacteria. The most common include Escherichia coli, Salmonella typhimurium, Shigella, and Campylobacter jejuni.

Symptoms of gastroenteritis range from mild to severe and may include:

• abdominal pain
• bloating
• diarrhea
• fever, chills
• headache
• muscle cramps
• nausea
• vomiting

Diagnosis

Diagnosis is based on symptoms. Confirmation can be obtained from testing a stool sample to identify the virus or bacterium. Blood tests may be performed to identify antibodies produced against viral infection. These tests are usually only performed when an outbreak is suspected.

Treatment

Diarrhea is the main symptom of gastroenteritis and treatment focuses on preventing the body from losing too much fluid (dehydration ) and the salts and minerals required by the body (electrolytes). Most cases are treated with bed rest and replenishing fluids. Antibiotics are not prescribed, unless the gastroenteritis is confirmed as bacterial in origin, since these medications are ineffective against viral diseases.

QUESTIONS TO ASK YOUR DOCTOR

• Can gastroenteritis be cured?
• Is there a way to prevent it?
• Is it contagious?
• How is diarrhea treated?
• Is drinking water enough to prevent dehydration?
• Are there foods that should be avoided?

Nutrition/Dietetic concerns

People with gastroenteritis should drink plenty of water to avoid dehydration; eat broths and soups that contain sodium ; and drink fruit juices or mineral water and eat soft fruits or vegetables that contain potassium to restore electrolyte levels. Until the diarrhea stops, patients are advised to avoid caffeine , milk products, and foods that are high in fiber, or very high in simple sugars, as they tend to aggravate diarrhea. For example, soft drinks, undiluted apple juice, and sweetened cereals should be avoided. Fried or fatty foods should be avoided because they tend to delay stomach emptying. Carbonated drinks can affect intestinal contractions and make diarrhea worse. A commonly recommended diet is the BRAT diet that includes bananas, plain rice, applesauce, and toast. As the diarrhea improves, soft, bland foods can be added to the diet, supplementing bananas, plain rice, and toast with boiled potatoes, crackers, cooked carrots, and baked chicken without the skin or fat. Other recommended foods include cereals (rice, wheat, and oat cereals), and yogurt. Once the diarrhea has stopped, the patient can usually return to a normal and balanced diet.

Therapy

Health practitioners usually do not recommend anti-diarrheal medications such as loperamide hydrochloride (Immodium) for gastroenteritis because they tend to prolong the infection.

KEY TERMS

Bacteria —Microorganisms found in the environment that can cause disease and foodborne illnesses.

Bacterial infection —Infection caused by a bacterium.

Contagious —Disease transmissible by direct or indirect contact from one person to another.

Contamination —The undesired occurrence of harmful microorganisms or substances in food.

Dehydration —Excessive loss of body fluids through frequent urinating, sweating, diarrhea or vomiting.

Electrolytes —Chemicals such as salts and minerals required for various functions in the body.

Inflammation —A response of body tissues to injury or irritation characterized by pain and swelling and redness and heat.

Influenza —Respiratory illness caused by influenza virus.

Norovirus —A type of virus that can cause food poisoning and acute gastroenteritis with stomach pain, diarrhea, and vomiting in humans.

Outbreak —Classification used in epidemiology to describe a small, localized group of people infected with a disease.

Pathogen —A disease-causing microorganism.

Viral infection —Infection caused by a virus.

Prognosis

Prognosis for gastroenteritis is very good, with most people recovering completely within a day or two. Outcomes depend on the severity of complications and the overall health of the patient.

Prevention

Prevention of gastroenteritis is based on good hygiene. Since viral gastroenteritis is highly contagious, surfaces touched by an infected person, especially by vomit, should be thoroughly cleaned with a bleach solution and rinsed. Contaminated clothes and linens should be washed in hot water. Another important preventive measure is being careful about food contamination, which is often responsible for gastroenteritis. Simple precautions such as washing fruits and vegetables, cooking meat thoroughly, drinking only water from trusted sources, and basic hygiene can prevent gastroenteritis due to food contamination.

Caregiver concerns

The elderly may need medical attention, especially if they have an underlying medical condition. They are more at risk from diarrhea and more vulnerable to complications resulting from dehydration. This age group is more likely to go on cruises, or require hospitalization, which increases their risk of infection.

Resources

BOOKS

Minocha, A. Handbook of Digestive Diseases. Thorofare, NJ: SLACK Incorporated, 2004.

Novartis Foundation. Gastroenteritis Viruses. New York: John Wiley & Sons, 2002.

Viral Gastroenteritis. Edited by U. Desselberger and J. Gray. New York: Springer, 2003.

Wilson, C. L., and S. Droby. Microbial Food Contamination. Boca Raton, FL: CRC Press, 2000.

Zinser, Stephanie. The Good Gut Guide. New York: Thorsons (Harpercollins), 2003.

PERIODICALS

Goller, J. L., et al. “Long-term Features of Norovirus Gastroenteritis in the Elderly.” Journal of Hospital Infection 58, no. 4 (2004): 286–291.

Yee, E. L., et al. “Widespread Outbreak of Norovirus Gastroenteritis Among Evacuees of Hurricane Katrina Residing in a Large Megashelter in Houston, Texas: Lessons Learned for Prevention.” Clinical Infectious Diseases 44, no. 8 (April 2007): 1032–1039.

OTHER

Gastroenteritis. Cleveland Clinic Center for Consumer Health Information. August 18, 2005 [cited April 12, 2008]. http://www.clevelandclinic.org/health/healthinfo/docs/3900/3901.asp?index=12418.

“Gastroenteritis: First Aid.” First Aid Guide. January 9, 2008 [cited April 12, 2008]. MayoClinic.com. http://www.mayoclinic.com/health/first-aid-gastroenteritis/FA00030.

Norovirus: Q & A. Centers for Disease Control and Prevention: Respiratory and Enteric Viruses Branch. August 3, 2006 [cited April 12, 2008]. http://www.cdc.gov/ncidod/dvrd/revb/gastro/norovirus-qa.htm.

Pace, Brian. “Preventing Dehydration from Diarrhea.” JAMA Patient Page. January 17, 2001 [cited April 12, 2008]. http://jama.ama-assn.org/cgi/reprint/285/3/362.pdf.

Viral Gastroenteritis. MayoClinic.com. June 15, 2007 [cited April 12, 2008]. http://www.mayoclinic.com/print/viral-gastroenteritis/DS00085/DSECTION=all&METHOD=print.

ORGANIZATIONS

American Gastroenterological Association, 930 Del Ray Ave., Bethesda, MD, 20814, (301) 654-2055, http://www.gastro.org.

Centers for Disease Control and Prevention (CDC)—National Center for Infectious Diseases, 1600 Clifton Road NE, MS-C14, Atlanta, GA, 30333, (404) 498 1515, (800) 311-3435, http://www.cdc.gov.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD), Building 31, Rm 9A06, 31 Center Drive, MSC 2560, Bethesda, MD, 20892-2560, (301) 496-3583, http://www2.niddk.nih.gov.

Monique Laberge PhD