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Not just a stomach bug

By: Gwen Y. Reyes-Amurao, M.D.Not just a stomach bug

Gastroenteritis is a common illness, which affects individuals of all ages at any time. The Mayo Clinic defines gastroenteritis as the inflammation of the lining of the stomach and small and large intestines. According to the British Medical Journal, there are 3.5 billion reported cases of acute gastroenteritis worldwide, with nearly two million deaths occurring in children under five years old.  Given that the numbers have increased dramatically over the past few years, it’s about time to know and find out more about it.

Gastroenteritis usually presents as diarrhea and vomiting and may be accompanied by nausea, abdominal pain or discomfort, and loss of appetite. Although these symptoms may not be considered as life-threatening, its consequences and complications can be very serious if not addressed early.

Causes

Infection is the most common cause of gastroenteritis and may either be viral, bacterial, or parasitic in origin. The most common viral agents known are the norovirus, rotavirus, and adenovirus. The rotavirus usually lasts 5 to 7 days in infants and young children and may be accompanied by fever. The norovirus, on the other hand, causes more vomiting than diarrhea and does not last longer than two days. The adenovirus, which is also fairly common, can cause mild vomiting a few days after diarrhea starts. Because the rotavirus is the most common viral cause of severe diarrhea among children worldwide, routine immunization against it is now part of the Childhood Immunization Schedule.

When it comes to bacteria, common causative agents include Vibrio cholerae, Salmonella, and Escherichia coli or E.coli. Once these bacteria attach themselves to the lining of the intestines, they produce toxins that can cause watery diarrhea and vomiting. In severe cases, it can lead to ulcerations within the intestinal walls that may lead to bleeding and bloody diarrhea. Other common bacterial causes include Staphylococcusaureus and Clostridium species leading to gastroenteritis without necessarily leading to a bacterial infection. Toxins coming from these bacterial strains can also manifest as severe nausea, vomiting, and diarrhea, with symptoms emerging within 12 hours of ingesting contaminated food, resolving within the next 36 hours.

Parasites can also be a cause of gastroenteritis once they invade the lining of the gastrointestinal tract. Nausea, vomiting, and watery diarrhea are common manifestations and can lead to decreased absorption of nutrients. A common parasitic cause of gastroenteritis is the Entamoeba histolytica and leads to a condition known as amoebiasis. This is marked with severe abdominal pain and bloody diarrhea.

Aside from microorganisms, chemical toxins and certain conditions can also lead to gastroenteritis. These toxins can be found in mushrooms and seafood, but can also be associated with food or water with high levels of lead or mercury. Nausea, vomiting, and diarrhea can also be a common side effect of certain drugs. These include antibiotics, drugs used in chemo and radiation, and laxatives. Since it may be difficult to determine if certain substances lead to this effect on the gastrointestinal system, the symptoms will often immediately resolve once the offending agent is removed. If this occurs after taking a particular medication, it is best not to take the same one in the future and consult with a physician as soon as possible.

Although causes may vary from one individual to another, a common complication one would always want to avoid is dehydration. By definition, dehydration is the severe loss of water and electrolytes, which in gastroenteritis can be a consequence of vomiting and diarrhea. Water loss is almost always a problem unless there is an adequate replacement of fluids at the onset of these symptoms.

Treatment

Since there are different causes of gastroenteritis, treatment may also vary. Viral cases are often self-limiting and will resolve spontaneously after a few days. With bacterial and parasitic infections, appropriate medications may be given such as anti-bacterial and anti-parasitic agents. Antibiotics are often not indicated unless severe since some studies suggest that resistance develops with the intake of anti-bacterial agents.

To avoid dehydration, oral rehydration salts or ORS solutions are best given to prevent water and electrolyte loss. Sports rehydration drinks are different from ORS solutions, and they often contain sugar or citric acid, which can lead to further vomiting and diarrhea. Carbonated and caffeinated drinks, including fruit juices, are also not appropriate in these cases. If oral intake cannot be tolerated or if there is severe and persistent vomiting or diarrhea, hospital admission may be advised for intravenous rehydration.

The doctor may also advise lessening the intake of oily or fatty food, as well as dairy products, which can lead to further diarrhea. Breast milk should not be discontinued since these contain important antibodies, which can help boost the immune system.

Through research and advancements in technology, new studies indicate that pre and probiotics play an important role in the management and prevention of gastrointestinal conditions or illnesses in both children and adults. According to the Journal of Microbes and Infection, certain Lactobacilli strains inhibit the growth of intestinal pathogens or harmful bacteria that can invade the gut and lead to gastroenteritis. The Lactobacillus GG strain has been studied widely and has been shown to prevent and treat gastroenteritis caused by the rotavirus and other bacteria.

Medications

In severe cases of diarrhea, medications to control it may be given but are not always advised. At times it is best to allow the virus or bacteria to be completely eliminated by the system, just as long as there are no signs or no risk of dehydration. Medications for abdominal pain, when severe, may also be given for temporary relief. For mild to moderate vomiting, anti-nausea drugs may be given to prevent further episodes and to avoid dehydration. When severe and persistent, these medications may be given intramuscularly or intravenously especially if the child or adult cannot tolerate anything taken orally or through ingestion. 

At the time when symptoms are marked, it is best to withhold any food intake. Once there are fewer episodes of vomiting or diarrhea and the stomach has settled, soft food may be introduced slowly back into the diet. Soups and clear broths are best while on a soft diet. Once these are tolerated, easy-to-digest food such as crackers, toast, gelatin, and bananas can be given.

Prevention

Viruses and bacteria can easily spread from one person to another through close contact with someone who has the infection. Gastroenteritis can also be caused by ingestion of contaminated water or food. Being careful with what you eat or drink and making sure food is prepared well can help prevent contamination. 

Although most people neglect it, proper hand washing is one hygienic practice that can prevent a lot of illnesses. According to the World Health Organization (WHO), it is best to use warm water and soap while rubbing hands together for at least twenty seconds, with special attention to the creases of the hands and under the fingernails. If soap and water are not available, alcohol-based sanitizers are advised to properly disinfect the hands especially prior to eating. Since infection can easily be transmitted from one person to another, isolating utensils, glasses, plates, and other things used for eating of the person with the infection will prevent further spread.

In a study conducted in daycare centers all over the United States where adenovirus, rotavirus, Giardia lamblia and E. coli were found in the stools of the children, a few schools were advised to diligently practice proper hand washing techniques, while case-control centers were not. After 35 weeks, the incidence of diarrhea was reduced by approximately half in schools that practiced hand washing as compared to those that did not.

Ingesting contaminated water and food when traveling is best avoided by taking the necessary precautions. Bringing along medications that can help address diarrhea, vomiting and taking anti-nausea medications can help temporarily relieve symptoms of gastroenteritis. More so, taking probiotics and having oral rehydration solutions can come in handy in cases like these.

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