I.

READINGS

Acute Gastroenteritis is a catchall term for infection or irritation of the digestive tract,

particularly the stomach and intestine. It is frequently referred to as the stomach or intestinal flu,

although the influenza virus is not associated with this illness. Major symptoms include nausea

and vomiting, diarrhea, and abdominal cramps. These symptoms are sometimes also

accompanied by fever and overall weakness. Gastroenteritis typically lasts about three days.

Adults usually recover without problem, but children, the elderly, and anyone with an underlying

disease are more vulnerable to complications such as dehydration.

The most common cause of gastroenteritis is viral infection. Viruses such as rotavirus,

adenovirus, astrovirus, and calicivirus and small round-structured viruses (SRSVs) are found all

over the world. Exposure typically occurs through the fecal-oral route, such as by consuming

foods contaminated by fecal material related to poor sanitation. However, the infective dose can

be very low (approximately 100 virus particles), so other routes of transmission are quite

probable. Typically, children are more vulnerable to rotaviruses, the most significant cause of

acute watery diarrhea.

Colloquially referred to as the "stomach flu," viral gastroenteritis can be passed from one

infected individual to another with relative ease. Sometimes, extremely spicy or unfamiliar food

can cause a short bout of acute gastroenteritis. This happens regularly in young children. Food

contaminated with bacteria can also cause inflammation. Drinking plenty of fluid and avoiding

food for a while can help ease the symptoms.

childhood gastroenteritis. Adults experience illness from astroviruses as well, but the major

causes of adult viral gastroenteritis are the caliciviruses and SRSVs. These viruses also cause

illness in children. The SRSVs are a type of calicivirus and include the Norwalk, Southhampton,

and Lonsdale viruses. These viruses are the most likely to produce vomiting as a major

symptom.

Bacterial gastroenteritis is frequently a result of poor sanitation, the lack of safe drinking

water, or contaminated food-conditions common in developing nations. Natural or man-made

disasters can make underlying problems in sanitation and food safety worse. In developed

nations, the modern food production system potentially exposes millions of people to disease-

causing bacteria through its intensive production and distribution methods. Common types of

bacterial gastroenteritis can be linked to Salmonella and Campylobacter bacteria; however,

Escherichia coli 0157 and Listeria monocytogenes are creating increased concern in developed

nations.

INCIDENCE

Every year worldwide rotavirus in children under 5 causes 111 million cases of

gastroenteritis and nearly half a million deaths. 82% of these deaths occur in the world's poorest

nations.

In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of

these occurring in the third world. Lack of adequate safe water and sewage treatment has

contributed to the spread of infectious gastroenteritis. Current death rates have come down
significantly to approximately 1.5 million deaths annually in the year 2000, largely due to the

global introduction of oral rehydration therapy.

The incidence in the developed world is as high as 1-2.5 cases per child per year and is a

major cause of hospitalization in this age group.

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

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.

Risk factors/Predisposing factors

Gastroenteritis occurs all over the world, affecting people of every age, race and

background. In developing nations, it's a leading cause of death in children.

Children in child care centers and older adults living in nursing homes are especially

vulnerable. That's because children's immune systems aren't mature until about age 6, and adult

immune systems tend to become less efficient later in life.

Intestinal infections can flourish anywhere people congregate — from schools and

dormitories to campgrounds and luxury cruise ships. Adults whose resistance is low — often

because their immune systems are compromised by HIV, AIDS or other medical conditions —

are especially at risk.

Common signs and symptoms may include:

 Low grade fever to 100°F (37.7°C)

 Nausea with or without vomiting

 Crampy painful abdominal bloating

More serious symptoms

 Blood in vomit or stool

 Vomiting more than 48 hours

 Fever higher than 101°F (40°C)

 Swollen abdomen or abdominal pain

 Dehydration - weakness, lightheadedness, decreased urination, dry skin, dry mouth and

lack of sweat and tears are characteristic findings.

Management and Treatment

Gastroenteritis is a self-limiting illness which will resolve by itself. However, for comfort

and convenience, a person may use over-the-counter medications such as Pepto Bismol to relieve

the symptoms. These medications work by altering the ability of the intestine to move or secrete

spontaneously, absorbing toxins and water, or altering intestinal microflora. Some over-the-

counter medicines use more than one element to treat symptoms.

If over-the-counter medications are ineffective and medical treatment is sought, a doctor

may prescribe a more powerful anti-diarrheal drug, such as motofen or lomotil. Should

pathogenic bacteria or parasites be identified in the patient's stool sample, medications such as

antibiotics will be prescribed.

dehydration is absent, the drinking of generous amounts of nonalcoholic fluids, such as water or

juice, is adequate. Caffeine, since it increases urine output, should be avoided. The traditional

BRAT diet-bananas, rice, applesauce, and toast-is tolerated by the tender gastrointestinal system,

but it is not particularly nutritious. Many, but not all, medical researchers recommend a diet that

includes complex carbohydrates (e.g., rice, wheat, potatoes, bread, and cereal), lean meats,

yogurt, fruit, and vegetables. Milk and other dairy products shouldn't create problems if they are

part of the normal diet. Fatty foods or foods with a lot of sugar should be avoided. These

recommendations are based on clinical experience and controlled trials, but are not universally

accepted.

Minimal to moderate dehydration is treated with oral rehydrating solutions that contain

glucose and electrolytes. These solutions are commercially available under names such as

Naturalyte, Pedialyte, Infalyte, and Rehydralyte. Oral rehydrating solutions are formulated based

on physiological properties. Fluids that are not based on these properties-such as cola, apple

juice, broth, and sports beverages-are not recommended treating dehydration. If vomiting

interferes with oral rehydration, small frequent fluid intake may be better tolerated. Should oral

rehydration fail or severe dehydration occur, medical treatment in the form of intravenous (IV)

therapy is required. IV therapy can be followed with oral rehydration as the patient's condition

improves. Once normal hydration is achieved, the patient can return to a regular diet.

Symptoms of uncomplicated gastroenteritis can be relieved with adjustments in diet,

herbal remedies, and homeopathy. An infusion of meadowsweet (Filipendula ulmaria) may be

effective in reducing nausea and stomach acidity. Once the worst symptoms are relieved,
slippery elm (Ulmus fulva) can help calm the digestive tract. Of the homeopathic remedies

available, Arsenicum album, ipecac, or Nux vomica are three said to relieve the symptoms of

gastroenteritis.

Probiotics, bacteria that are beneficial to a person's health, are recommended during the

recovery phase of gastroenteritis. Specifically, live cultures of Lactobacillus acidophilus are said

to be effective in soothing the digestive tract and returning the intestinal flora to normal. L.

acidophilus is found in live-culture yogurt, as well as in capsule or powder form at health food

stores. The use of probiotics is found in folk remedies and has some support in the medical

literature. Castor oil packs to the abdomen can reduce inflammation and also reduce spasms or

discomfort.

Gastroenteritis is usually resolved within two to three days and there are no long-term

effects. If dehydration occurs, recovery is extended by a few days.