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Gastroenteritis



 
 
Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and stomach flu, although unrelated to influenza
Influenza

Influenza, commonly known as the flu, is an infectious disease that affects birds and mammals caused by RNA viruses of the biological family Orthomyxoviridae ....
) is inflammation
Inflammation

Inflammation is the complex biological response of Blood vessel tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue....
 of the gastrointestinal tract
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
, involving both the stomach
Stomach

In most mammals, the stomach is a hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication....
 and the small intestine
Small intestine

In vertebrates, including mammals, reptiles, birds, and bony fish, the small intestine is the part of the gastrointestinal tract following the stomach, and is where the vast majority of digestion takes place....
 (see also gastritis
Gastritis

Gastritis is an inflammation of the lining of the stomach, and has many possible causes. The main acute causes are excessive alcohol consumption or prolonged use of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen....
 and enteritis
Enteritis

In medicine, enteritis refers to inflammation of the small intestine. See also inflammation of related organs of the gastrointestinal system: gastritis , gastroenteritis , colitis , and enterocolitis ....
) and resulting in acute
Acute (medicine)

In medicine, an acute disease is a disease with either or both of:# a rapid onset;# a short course .This adjective is part of the definition of several diseases and is, therefore, incorporated in their name, for instance, severe acute respiratory syndrome, acute leukemia....
 diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
. The inflammation is caused most often by infection
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
 with certain virus
Virus

A virus is a Optical microscope#Limitations of light microscopes infectious agent that is unable to grow or reproduce outside a host cell . Viruses infect all cellular life....
es, less often by bacteria
Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
 or their toxin
Toxin

A toxin is a poisonous substance produced by living cells or organisms. For a toxic substance not produced by living organisms, "toxicant" is the more appropriate term, and "toxics" is an acceptable plural....
s, parasites, or adverse reaction to something in the diet or medication.






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Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and stomach flu, although unrelated to influenza
Influenza

Influenza, commonly known as the flu, is an infectious disease that affects birds and mammals caused by RNA viruses of the biological family Orthomyxoviridae ....
) is inflammation
Inflammation

Inflammation is the complex biological response of Blood vessel tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue....
 of the gastrointestinal tract
Gastrointestinal tract

The digestive tract is the system of Organ s within multicellular animals that takes in food, digestion it to extract energy and nutrients, and expels the remaining waste....
, involving both the stomach
Stomach

In most mammals, the stomach is a hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication....
 and the small intestine
Small intestine

In vertebrates, including mammals, reptiles, birds, and bony fish, the small intestine is the part of the gastrointestinal tract following the stomach, and is where the vast majority of digestion takes place....
 (see also gastritis
Gastritis

Gastritis is an inflammation of the lining of the stomach, and has many possible causes. The main acute causes are excessive alcohol consumption or prolonged use of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen....
 and enteritis
Enteritis

In medicine, enteritis refers to inflammation of the small intestine. See also inflammation of related organs of the gastrointestinal system: gastritis , gastroenteritis , colitis , and enterocolitis ....
) and resulting in acute
Acute (medicine)

In medicine, an acute disease is a disease with either or both of:# a rapid onset;# a short course .This adjective is part of the definition of several diseases and is, therefore, incorporated in their name, for instance, severe acute respiratory syndrome, acute leukemia....
 diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
. The inflammation is caused most often by infection
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
 with certain virus
Virus

A virus is a Optical microscope#Limitations of light microscopes infectious agent that is unable to grow or reproduce outside a host cell . Viruses infect all cellular life....
es, less often by bacteria
Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
 or their toxin
Toxin

A toxin is a poisonous substance produced by living cells or organisms. For a toxic substance not produced by living organisms, "toxicant" is the more appropriate term, and "toxics" is an acceptable plural....
s, parasites, or 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 infant
Infant

An infant or baby is the term used to refer to the young offspring of humans....
s and child
Child

A child is a human being between the stages of birth and puberty. The legal definition of "child" generally refers to a minor , otherwise known as a person younger than the age of majority....
ren under 5.

At least 50% of cases of gastroenteritis as foodborne illness
Foodborne illness

Foodborne illness is any illness resulting from the consumption of food.There are two types of food poisoning: food infection and food intoxication....
 are due to norovirus. Another 20% of cases, and the majority of severe cases in children, are due to rotavirus
Rotavirus

Rotavirus is a genus of double-stranded RNA virus in the family Reoviridae. It is the leading single cause of Diarrhea among infants and young children....
. Other significant viral agents include adenovirus and astrovirus
Astrovirus

Astrovirus is a type of virus that infects mammals and birds. Astroviruses belong to the virus family Astroviridae. They were first described in the year 1975 using electron microscopes during an outbreak of diarrhoea....
.

Different species of bacteria can cause gastroenteritis, including Salmonella
Salmonella

Salmonella is a genus of rod-shaped Gram-negative enterobacteriaceae that causes typhoid fever, paratyphoid fever, and the foodborne illness salmonellosis....
, Shigella
Shigella

Shigella is a genus of Gram-negative, Endospore rod-shaped bacterium closely related to Escherichia coli and Salmonella. The causative agent of human shigellosis, Shigella cause disease in primates, but not in other mammals....
, Staphylococcus
Staphylococcus

Staphylococcus is a genus of Gram-positive Bacterium. Under the microscope they appear round , and form in grape-like clusters.The Staphylococcus genus include just thirty-three species....
, Campylobacter jejuni
Campylobacter jejuni

Campylobacter jejuni is a species of curved, rod-shaped, non-spore forming, Gram-negative microaerophilic, bacteria commonly found in animal feces....
, Clostridium
Clostridium

Clostridium is a genus of Gram-positive bacteria, belonging to the Firmicutes. They are obligate anaerobes capable of producing endospores....
, Escherichia coli
Escherichia coli

'Escherichia coli' , is a Gram negative bacterium that is commonly found in the lower gastrointestinal tract of warm-blooded animals. Most E....
, Yersinia
Yersinia

Yersinia is a genus of bacterium in the family Enterobacteriaceae. Yersinia are Gram-negative rod shaped bacteria, a few micrometers long and fractions of a micrometer in diameter, and are facultative anaerobes....
, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis
Colitis

Colitis is a Chronic digestive diseases characterized by inflammation of the colon .Colitis is one of a group of conditions which are inflammatory and auto-immune, affecting the tissue that lines the gastrointestinal system ....
, inflammation of the large intestine, may also be present.

Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water. The incidence is 1 in 1,000 people.

Gastroenteritis can be classified as either viral or bacterial.

Symptoms and signs

Gastroenteritis often involves stomach pain or spasms (sometimes to the point of being crippled), diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
 and/or vomiting
Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure....
, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon
Colon (anatomy)

The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
.

It usually is of acute onset, normally lasting 1-6 days (fewer than 10 days) and self-limiting
Self-limiting (biology)

In biology, a self-limiting organism or colony of organisms limits its own growth by its actions. For example, a single organism may have a maximum size determined by genetics, or a colony of organisms may release waste which is ultimately toxic to the colony once it exceeds a certain population....
.

  • Nausea
    Nausea

    Nausea is the sensation of unease and discomfort in the stomach with an urge to vomit....
     and vomiting
    Vomiting

    Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Undesired vomiting may result from many causes, ranging from gastritis or poisoning to brain tumors, or elevated intracranial pressure....
  • Diarrhea
    Diarrhea

    In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
  • Loss of appetite
  • Abdominal pain
  • Abdominal cramps
  • Bloody stools (dysentery
    Dysentery

    Dysentery is a disorder of the digestive system that results in severe diarrhea containing mucus and/or blood in the feces. If untreated, Dysentery can be fatal....
     - 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
Colitis

Colitis is a Chronic digestive diseases characterized by inflammation of the colon .Colitis is one of a group of conditions which are inflammatory and auto-immune, affecting the tissue that lines the gastrointestinal system ....
. In some cases, even when the stomach is empty, bile
Bile

Bile or gall is a bitter yellow or green fluid secreted by hepatocytes from the liver of most vertebrates. In many species, bile is stored in the gallbladder between meals and upon eating is discharged into the duodenum where the bile aids the process of digestion of lipids....
 can be vomited up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs of dehydration
Dehydration

Dehydration is the removal of water from an object. In Physiology terms, it entails a relative deficiency of water molecules in relation to other dissolved solutes....
 (which include dry mucous membranes), tachycardia
Tachycardia

The word tachycardia comes from the Greek words tachys and kardia .Tachycardia typically refers to a heartrate that exceeds the range of the normal resting heartrate, based upon age:...
, reduced skin turgor, skin color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion
Perfusion

In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."...
 and ultimately shock.

Symptoms occur for up to 6 days on average. Given appropriate treatment, bowel movements will return to normal within a week after that.

Laboratory tests

  • Examination of stool for toxins, (e.g. Clostridium difficile toxin
    Clostridium difficile

    Clostridium difficile , also known as "CDF/cdf", or "C. diff", is a species of Gram-positive bacteria of the genus Clostridium. Clostridia are Anaerobic organism, endospore-forming rods ....
    )
  • Stool cultures for the organisms that causes the disease, (e.g. Salmonella
    Salmonella

    Salmonella is a genus of rod-shaped Gram-negative enterobacteriaceae that causes typhoid fever, paratyphoid fever, and the foodborne illness salmonellosis....
    , Shigella
    Shigella

    Shigella is a genus of Gram-negative, Endospore rod-shaped bacterium closely related to Escherichia coli and Salmonella. The causative agent of human shigellosis, Shigella cause disease in primates, but not in other mammals....
    , Campylobacter
    Campylobacter

    The genus Campylobacter, first discovered in 1963, describes Gram-negative, spiral, microaerophilic bacterium. Motile, with either uni- or bi-polar flagella, the organisms have a characteristic spiral/corkscrew appearance and are oxidase-positive....
     and enterotoxic Escherichia coli)
  • Microscopy for parasites and their ova and cysts
  • ELISA
    ELISA

    Enzyme-Linked ImmunoSorbent Assay, also called ELISA, Enzyme ImmunoAssay or EIA, is a biochemistry technique used mainly in immunology to detect the presence of an antibody or an antigen in a sample....
     for viruses


Differential diagnosis


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
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
 such as pneumonia
Pneumonia

Pneumonia is an Inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolus inflammation and abnormal alveolar filling with fluid ....
, septicemia, urinary tract infection
Urinary tract infection

A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it....
 and even meningitis
Meningitis

Meningitis is a medical condition caused by inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges....
. Surgical conditions such as appendicitis
Appendicitis

Appendicitis is a condition characterized by inflammation of the Vermiform appendix. It is a medical emergency. All cases require removal of the inflamed appendix, either by laparotomy or laparoscopy....
, intussusception
Intussusception

Intussusception may refer to:* Intussusception * Intussusception ...
 and, rarely, even Hirschsprung's disease
Hirschsprung's disease

Hirschsprung's disease, or congenital aganglionic megacolon, involves an enlargement of the colon , caused by bowel obstruction resulting from an ganglion section of bowel that starts at the anus and progresses upwards....
 may mislead the clinician.

Noninfectious

Non-infectious causes to consider are poisoning with heavy metals (e.g. arsenic
Arsenic

Arsenic is a well-known chemical element that has the symbol As and atomic number 33. Arsenic was first documented by Albertus Magnus in 1250....
, cadmium
Cadmium

Cadmium is a chemical element with the symbol Cd and atomic number 48. A relatively abundant , soft, bluish-white, transition metal, cadmium is known to cause cancer and occurs with zinc ores....
), seafood (e.g. ciguatera
Ciguatera

Ciguatera is a foodborne illness poisoning in humans caused by eating marine species whose flesh is contaminated with a toxin known as ciguatoxin, which is present in many microorganisms living in tropical waters....
, scombroid
Scombroid

Scombridae food poisoning is a foodborne illness that results from eating spoiled fish. It is the second most common type of seafood poisoning, second only to ciguatera....
, toxic encephalopathic shellfish poisoning) or mushrooms (e.g. Amanita phalloides). Secretory tumours (e.g. carcinoid
Carcinoid

Carcinoid is a slow-growing but malignant type of neuroendocrine tumour, originating in the cells of the neuroendocrine system.In 2000, the World Health Organization redefined "carcinoid", but this new definition has not been accepted by all practitioners....
, medullary tumour of the thyroid, vasoactive intestinal peptide-secreting adenomas
VIPoma

A VIPoma is a rare endocrine tumor, usually originating in the pancreas, which produces vasoactive intestinal peptide .A syndrome caused by non-? islet cell tumors....
) and endocrine disorders (e.g. thyrotoxicosis and Addison's disease
Addison's disease

Addison's disease is a rare endocrine disorder in which the adrenal gland doesn't produce enough steroid hormones . It may develop in children and adults, and may occur as the result many underlying causes....
) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome
Short bowel syndrome

Short bowel syndrome is a malabsorption disorder caused by the surgery removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel....
, Whipple's disease
Whipple's disease

Whipple's disease is a rare disease, systemic infectious disease caused by the bacterium Tropheryma whipplei. First described by George Hoyt Whipple in 1907 and commonly considered a gastrointestinal disorder, Whipple's disease primarily causes malabsorption but may affect any part of the body including the heart, lungs, brain, joints, an...
, coeliac disease
Coeliac disease

C?liac disease , also spelled celiac disease, is an Autoimmunity disorder of the small intestine that occurs in Genetic predisposition people of all ages from middle infancy on up....
, and laxative abuse should be excluded as possibilities.

Infectious

Infectious gastroenteritis is caused by a wide variety of bacteria
Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
 and virus
Virus

A virus is a Optical microscope#Limitations of light microscopes infectious agent that is unable to grow or reproduce outside a host cell . Viruses infect all cellular life....
es.

Bacterial
For a list of bacteria causing gastroenteritis, see above. Pseudomembranous colitis
Pseudomembranous colitis

Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression "C....
 is an important cause of diarrhea in patients often recently treated with antibiotics. Viruses causing gastroenteritis include rotavirus
Rotavirus

Rotavirus is a genus of double-stranded RNA virus in the family Reoviridae. It is the leading single cause of Diarrhea among infants and young children....
, norovirus, adenovirus and astrovirus
Astrovirus

Astrovirus is a type of virus that infects mammals and birds. Astroviruses belong to the virus family Astroviridae. They were first described in the year 1975 using electron microscopes during an outbreak of diarrhoea....
.

If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, Shigella
Shigella

Shigella is a genus of Gram-negative, Endospore rod-shaped bacterium closely related to Escherichia coli and Salmonella. The causative agent of human shigellosis, Shigella cause disease in primates, but not in other mammals....
 and Campylobacter
Campylobacter

The genus Campylobacter, first discovered in 1963, describes Gram-negative, spiral, microaerophilic bacterium. Motile, with either uni- or bi-polar flagella, the organisms have a characteristic spiral/corkscrew appearance and are oxidase-positive....
, for example, and parasites like Giardia
Giardia

Giardia is a genus of anaerobic flagellated protozoan parasites that colonise and reproduce in the small intestines of several vertebrates, causing giardiasis....
 can be treated with antibiotic
Antibiotic

In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics belong to the group of antimicrobial compounds used to treat infections caused by microorganisms, including fungus and protozoa....
s.

Viral
Viruses do not respond to antibiotics and infected children usually make a full recovery after a few days. 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.

Management

The objective of treatment is to replace lost fluid
Fluid

A fluid is defined as a substance that continually deforms under an applied shear stress. All liquids and all gases are fluids. Fluids are a subset of the Phase and include liquids, gas, Plasma physics and, to some extent, plasticity ....
s and electrolyte
Electrolyte

An electrolyte is any substance containing free ions that behaves as an electrical conductor medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutions, but molten electrolytes and solid electrolytes are also possible....
s. Oral rehydration
Oral rehydration therapy

Oral rehydration therapy is a simple, cheap, and effective treatment for dehydration associated with diarrhea, particularly gastroenteritis, such as that caused by cholera or rotavirus....
 is the preferred treatment of fluid
Fluid

A fluid is defined as a substance that continually deforms under an applied shear stress. All liquids and all gases are fluids. Fluids are a subset of the Phase and include liquids, gas, Plasma physics and, to some extent, plasticity ....
 and electrolyte
Electrolyte

An electrolyte is any substance containing free ions that behaves as an electrical conductor medium. Because they generally consist of ions in solution, electrolytes are also known as ionic solutions, but molten electrolytes and solid electrolytes are also possible....
 losses caused by diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
 in children with mild to moderate dehydration.

Rehydration

The principal treatment of gastroenteritis in both children and adults is rehydration
Rehydration

Rehydration is the replenishment of water, or water and electrolytes, lost through dehydration.In humans, methods of rehydration include oral rehydration therapy or intravenous therapy....
, i.e., replenishment of water lost in the stools. Depending on the degree of dehydration
Dehydration

Dehydration is the removal of water from an object. In Physiology terms, it entails a relative deficiency of water molecules in relation to other dissolved solutes....
, this can be done by giving the person oral rehydration therapy
Oral rehydration therapy

Oral rehydration therapy is a simple, cheap, and effective treatment for dehydration associated with diarrhea, particularly gastroenteritis, such as that caused by cholera or rotavirus....
 (ORT) or through intravenous
Vein

In the circulatory system, veins are blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary vein and umbilical veins, both of which carry oxygenated blood....
 delivery.

People taking diuretics ("water pills") need to be cautious with diarrhea and may need to stop taking the medication during an acute episode, as directed by the health care provider.

Dietary therapy

Centers for Disease Control and Prevention
Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention is an agency of the United States United States Department of Health and Human Services based in Atlanta, Georgia, United States adjacent to the campus of Emory University and northeast of downtown Atlanta....
 recommendations for infants and children include:
  • Breastfed infants should continue to be nursed on demand.
  • Formula-fed infants should continue their usual formula immediately upon rehydration in amounts sufficient to satisfy energy and nutrient requirements and at the usual concentration. Lactose-free or lactose-reduced formulas usually are unnecessary.


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
Osmosis

Osmosis is the diffusion of a solvent through a Semipermeable membrane, from a solution of low solute concentration to a solution with high solute concentration , up a solute concentration gradient....
 might worsen diarrhea; therefore, substantial amounts of soft drinks (carbonated or flat), juice, gelatin desserts, and other highly sugared liquids should be avoided. Fatty foods should not be avoided, because maintaining adequate calorie
Calorie

The calorie is a pre-SI metric system unit of energy. The unit was first defined by Professor Nicolas Cl?ment in 1824 as a unit of heat. This definition entered French and English dictionaries between 1841 and 1867....
s without fat is difficult, and fat might have an added benefit of reducing intestinal motility
Motility

Motility is a biology term which refers to the ability to move spontaneously and actively, consuming energy in the process. It can apply to either single-celled or multicellular organisms....
. The practice of withholding food for more than 24 hours is yet to be proven more effective.

The BRAT diet
BRAT diet

The BRAT diet was, historically, a prescribed treatment for patients with gastrointestinal distress such as diarrhea, dyspepsia, and/or gastroenteritis....
 (bananas, rice, applesauce, toast and tea) was recommended in the past. It is no longer recommended, as it contains insufficient nutrients.

Probiotics

Some probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis. Fermented milk products (such as yogurt) also reduce the duration of symptoms.

Zinc

The World Health Organization
World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health....
 recommends that infants and children receive a dietary supplement
Dietary supplement

A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to provide nutrients, such as vitamins, Dietary minerals, fatty acids or amino acids, that are missing or are not consumed in sufficient quantity in a person's diet ....
 of zinc
Zinc

Zinc is a metallic chemical element with the symbol Zn and atomic number 30. It is a first-row transition metal of the group 12 element of the periodic table....
 for up to two weeks after onset of gastroenteritis.

Pharmacologic therapy

Viral gastroenteritis is usually an acute and self-limited disease that does not require pharmacologic therapy.

Antibiotics
Antibiotics may sometimes be used if symptoms are severe and a bacterial cause is either isolated or suspected. If antibiotics are decided on, a fluoroquinolone is often used. Pseudomembranous colitis
Pseudomembranous colitis

Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. Still, the expression "C....
 is treated by discontinuing the causative agent and starting with metronidazole
Metronidazole

Metronidazole is a nitroimidazole antibiotic medication used mainly in the treatment of infections caused by susceptible organisms, particularly anaerobe bacterium and protozoa....
 or vancomycin
Vancomycin

Vancomycin is a glycopeptide antibiotic used in the prophylaxis and treatment of infections caused by Gram-positive bacterium. It has traditionally been reserved as a drug of last resort, used only after treatment with other antibiotics had failed, although the emergence of vancomycin-resistant organisms means that it is increasingly being...
.

Antibiotics usually are not given for gastroenteritis, although they may be given due to some bacteria.

Antidiarrheal agents
Loperamide
Loperamide

Loperamide, a synthetic piperidine derivative, is a medication effective against diarrhea resulting from gastroenteritis or inflammatory bowel disease....
 is an opioid
Opioid

An opioid is a chemical substance that has a morphine-like action in the body. The main use is for analgesia. These agents work by binding to opioid receptors, which are found principally in the central nervous system and the gastrointestinal tract....
 analogue commonly used for symptomatic treatment of diarrhea. It slows down gut motility
Peristalsis

Peristalsis is the rhythmic contraction of smooth muscles to propel contents through the digestive tract. The word is derived from New Latin and comes from the Greek language peristaltikos, peristaltic, from peristellein, "to wrap around," and stellein, "to place."...
 but does not cross the mature blood-brain barrier
Blood-brain barrier

The blood-brain barrier is a metabolic or cellular structure in the central nervous system that restricts the passage of various chemical substances and microscopic objects between the bloodstream and the neural tissue itself, while still allowing the passage of substances essential to metabolism function ....
  to cause the central nervous effect of other opioids. In excessive doses, loperamide may cause constipation and significantly slow down of passage of feces, but an appropriate single dose will not slow down the duration of the disease. Although antimotility drugs have the risk of exacerbating the condition, clinical experience shows this is unlikely. Nevertheless, others discourage the use of antiperistaltic agents and opiates in febrile dysentery
Dysentery

Dysentery is a disorder of the digestive system that results in severe diarrhea containing mucus and/or blood in the feces. If untreated, Dysentery can be fatal....
, since they may mask or exacerbate the symptoms. All these sources agree that in severe colitis
Colitis

Colitis is a Chronic digestive diseases characterized by inflammation of the colon .Colitis is one of a group of conditions which are inflammatory and auto-immune, affecting the tissue that lines the gastrointestinal system ....
 antimotility drugs should not be used.

Loperamide prevents the body from flushing toxins from the gut and should not be used when an active fever is present or there is a suspicion that the diarrhea is associated with organisms that can penetrate the intestinal walls, such as E. coli O157:H7 or Salmonella
Salmonella

Salmonella is a genus of rod-shaped Gram-negative enterobacteriaceae that causes typhoid fever, paratyphoid fever, and the foodborne illness salmonellosis....
.

Loperamide is not recommended in children, especially in children younger than 2 years of age, as it may cause systemic toxicity due to an immature blood brain barrier. Oral rehydration therapy remains the mainstay treatment for children.

Bismuth subsalicylate
Bismuth subsalicylate

Bismuth subsalicylate, with a chemical formula C7H5BiO4, is a drug used to treat nausea, heartburn, indigestion, diarrhea, and other temporary discomforts of the stomach and gastrointestinal tract....
 (BSS), an insoluble complex of trivalent bismuth and salicylate, is drug that can be used in mild-moderate cases.

Combining an antimicrobial drug and an antimotility drug seems to be more rapidly effective.

Antiemetic drugs
If vomiting is severe, antiemetic
Antiemetic

An antiemetic is a medication that is effective against vomiting and nausea. Anti-emetics are typically used to treat motion sickness and the Adverse effect of opioid analgesics, general anaesthetics and chemotherapy directed against cancer....
 drugs may be helpful. Ondansetron
Ondansetron

Ondansetron or GlaxoSmithKline's Zofran is a serotonin 5-HT3 antagonist used mainly as an antiemetic to treat nausea and vomiting following chemotherapy....
 has some clinical utility in this condition with a single dose associated with reduced use of intravenous fluids, fewer hospitalizations, and decreasing nausea and vomiting. Metoclopramide
Metoclopramide

Metoclopramide is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. Thus it is primarily used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis....
 however has not been found to be helpful.

Complications

The most serious complication is dehydration
Dehydration

Dehydration is the removal of water from an object. In Physiology terms, it entails a relative deficiency of water molecules in relation to other dissolved solutes....
, usually due to severe diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
 but sometimes made worse due to improper treatment such as withholding fluids until diarrhea stops. Severe dehydration can be lethal and requires prompt medical care.

The most common complication, especially in infants, is malabsorption
Malabsorption

Malabsorption is a state arising from abnormality in digestion or absorption of Nutrient across the gastrointestinal tract.Impairment can be of single or multiple nutrients depending on the abnormality....
 of certain sugars in the diet and consequent food intolerance
Food intolerance

Food intolerance or food sensitivity is a delayed negative reaction to a food, beverage or food additive; a true food allergy occurs within minutes of ingesting the triggering item....
s. This complication may persist for weeks, during which it causes mild diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
 to return when the patient resumes a normal diet. Malabsorption of lactose
Lactose

Lactose is a sugar that is found most notably in milk. Lactose makes up around 2?8% of milk . The name comes from the Latin word for milk, plus the -ose ending used to name sugars....
, the principal sugar in milk
Milk

Milk is an opaque white liquid produced by the mammary glands of female mammals . It provides the primary source of nutrition for newborn mammals before they are able to digestion other types of food....
, is the most common. Its consequent milk intolerance is caused by lactase
Lactase

Lactase , a part of the ?-galactosidase family of enzymes, is a glycoside hydrolase involved in the hydrolysis of the disaccharide lactose into constituent galactose and glucose monomers....
 deficiency, and the diarrhea is caused by bacterial fermentation of excess lactose in the gut. However, this is not reason to discontinue breastfeeding
Breastfeeding

Breastfeeding is the feeding of an infant or young child with breast milk directly from human breasts rather than from a baby bottle or other container....
. In children with viral gastroenteritis (usually rotavirus
Rotavirus

Rotavirus is a genus of double-stranded RNA virus in the family Reoviridae. It is the leading single cause of Diarrhea among infants and young children....
), the viral infection also can cause a high fever
Fever

Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
, which in turn can cause febrile convulsion. Gastroenteritis sometimes is followed by pneumonia
Pneumonia

Pneumonia is an Inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolus inflammation and abnormal alveolar filling with fluid ....
.

Epidemiology

Globally, gastroenteritis caused 4.6 million deaths in children in 1980 alone, most of these in the third world
Third World

Third World is a categorical label used to describe states that are considered to be developed in terms of their economy or level of industrialization, globalization, standard of living, health, education or other criteria for 'advancements'....
, where the lack of adequate safe water and sewage treatment
Sewage treatment

Sewage treatment, or domestic wastewater treatment, is the process of removing contaminants from wastewater and household sewage, both runoff and domestic....
 capacity contribute to the spread of infectious gastroenteritis. Harrison's Principles of Internal Medicine
Harrison's Principles of Internal Medicine

Harrison's Principles of Internal Medicine is an United States textbook of internal medicine. First published in 1950, it is presently in its seventeenth edition ....
 estimates the current total figure to be 2.4 to 2.9 million per year. The global death rate has now come down significantly to approximately 1.5 million deaths annually, largely due to global introduction of proper oral rehydration therapy
Oral rehydration therapy

Oral rehydration therapy is a simple, cheap, and effective treatment for dehydration associated with diarrhea, particularly gastroenteritis, such as that caused by cholera or rotavirus....
.

The incidence in the developed countries is as high as 1-2.5 cases per child per year and a major cause of hospitalisation in this age group.

Age, living conditions, hygiene and cultural habits are important factors. Aetiological
Etiology

Etiology is the study of Causality. The word is derived from the Ancient Greek , aitiologia, "giving a reason for" .The word is most commonly used in medical and philosophical theories, where it is used to refer to the study of why things occur, or even the reasons behind the way that things act, and is used in philosophy, physics, psy...
 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.

History

Before the 20th century, the term "gastroenteritis" was not commonly used. What would now be diagnosed as gastroenteritis may have instead been diagnosed more specifically as typhoid fever
Typhoid fever

Typhoid fever, also known as enteric fever, or commonly just typhoid, is an illness caused by the bacterium Salmonella typhi. Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person....
 or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of a number of other archaic names for acute diarrhea. 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
Zachary Taylor

Zachary Taylor was an Military of the United States and the List of Presidents of the United States President of the United States.Known as "Old Rough and Ready", Taylor had a 40-year military career in the United States Army, serving in the War of 1812, Black Hawk War, and Seminole Wars before achieving fame leading U.S....
 died of gastroenteritis on July 9, 1850.

See also


External links