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User:Doc James/Gastro

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Template:Infobox disease

Gastroenteritis (also known as gastric flu, stomach flu, gastro and stomach virus, although unrelated to influenza) is marked by inflammation of the gastrointestinal tract involving both the stomach and small intestine resulting in diarrhea, vomiting and abdominal cramps.

The majority of cases in children globally are caused by rotavirus while in adults norovirus is more common at least in the United States. Less common causes include bacteria or their toxins, and parasites. Transmission may occur due to improperly prepared foods, contaminated water or close contact with those who are infectious.

The foundation of management is adequate hydration. For mild or moderate cases this can typically be achieved via oral rehydration solution. For more severe cases intravenous fluids may be needed. Gastroenteritis primarily affects children and those in the developing world.

Symptoms and signs

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Gastroenteritis typically involves diarrhea, vomiting, and abdominal cramps.[1] These symptoms usually begin 12–72 hours after contracting the infectious agent[2] and if due to viral agent usually lasts less than one week.[1] Some viral causes may also be associated with fever, fatigue, headaches, and muscle pains.[1] If the stool is bloody the cause is less likely to be viral[1] and more likely to be bacterial.[3] Some bacterial infections may be associated with severe abdominal pain and may last for weeks without treatment.[3]

Complications

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Children infected with rotavirus usually make a full recovery after a few days.[4] Dehydration is a common complication of diarrhea[5] and a child with mild or moderate dehydration may have a prolonged capillary refill, poor skin turgor and abnormal breathing.[6] In areas with poor sanitation repeat infections may lead to malnutrition[2] stunted growth and delayed development.[7]

Reactive arthritis occurs in 1% of people follow campylobacter infection and Guillian Barre syndrome (HUS) occurs in 0.1%.[3] Hemolytic uremic syndrome may occur secondary to infections with Shiga toxin producing E. Coli or Shigella resulting in low platelets, poor kidney function, and low red blood cells due to their breakdown.[8] Children are more predisposed to getting HUS.[7]

Cause

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Viruses particularly rotavirus, and the bacteria E. coli, and Campylobacter are the primary causes of gastroenteritis.[9][2] There are however many other infectious agents that that can cause this syndrome.[7]

Viral

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The viruses that cause gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus.[1][10] Rotavirus is the most common cause of gastroenteritis in children both in the developed and developing world[9] and viruses cause about 70% of episodes of infectious diarrhea in this age group.[11] Rotavirus is a less common cause in adults due to acquired immunity.[12]

Norovirus is a leading cause of gastroenteritis among United States adults being behind greater than 90% of outbreaks.[1] These outbreaks typically occur when groups of people spend time in close proximity such as on cruise ships.[1] People may remain infectious even after the diarrhea has ended.[1]

Bacterial

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In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis with half of these cases associated with poultry.[3] In children bacteria are the cause of about 15% of cases with the most common including: Salmonella, Shigella, Escherichia coli, and Campylobacter.[11]

Clostridium difficile is an important cause of diarrhea and occurs more commonly in the elderly.[7] Infants can carry C. dif without developing symptoms.[7] Traveler's diarrhea, which is diarrhea that occurs with travel is usually a type of bacterial gastroenteritis.

Acid suppressing medication appear to increase the risk of infections by a number of organisms including Clostridium difficile, Salmonella, and Campylobacter.[13] The risk is greater with proton pump inhibitors than with H2 antagonists.[13]

Protozoal

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A number of protozoa can cause gastroenteritis, most commonly Giardia lamblia but also cryptosporidium and Entamoeba histolytica[11] These as a group make up about 10% of cases in children.[8]

Transmission

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Transmission may occur among via contaminated water or people sharing personal objects.[2] In places with a wet and dry seasons water quality typically worsen during the wet season and this is usually the time of outbreaks.[2] In areas of the world with seasons infections are more common in the winter.[7] Bottle-feeding using improperly sanitized bottles is a significant cause globally.[2] Transmission may also be related to poor hygiene especially among children[1] and is increased in those with a poor preexisting nutritional status.[7] Adults after developing tolerance may carry certain organisms without symtoms and thus act as a natural reservoirs.[7] While some agents only occur in primates such as Shigella others may occur in a wide variety of animals such as Giardia.[7]

Pathophysiology

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Gastroenteritis is defined as vomiting or diarrhea due to either an infection of the small or large bowel.[7] The changes in the small bowel are typically noninflammatory while the ones in the large bowel are inflammatory.[7]

Diagnosis

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Gastroenteritis is typically diagnosed based on a person's symptoms.[1] Determining the exact cause is usually not needed as it does not alter management.[2] As hypoglycemia may occur in ~10% of children measuring serum glucose is recommended.[6] Diagnostic testing may be done for surveillance.[1] Electrolytes and kidney function should be check in those with severe dehydration.[11] Stool cultures should be performed in those with blood in the stool, who might have been exposed to food poisoning, and those who have recently traveled to the developing world.[11]

Differential

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Other potential causes of these symptoms may need considering such as: appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus.[11] Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.[14]

Prevention

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Percentage of rotavirus tests with positive results, by surveillance week, United States, July 2000—June 2009.

Lifestyle

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Good hand washing has been found to decrease the rates of gastroenteritis in both the developing and developed world by about 30%.[6] Alcohol based gels may also be effective.[6] Breastfeeding is important especially in places with poor hygiene as is improvement of hygiene generally.[2] Avoiding contaminated food or drink may also be effective.[15]

Vaccination

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It is recommended that the rotavirus vaccine be offered to all children globally due to both its effectiveness and safety.[9] Since 2000, the implementation of a program in the United States has substancially decreased the number of cases of diarrhea.[16][17] The first dose should be given to infants between the ages 6 and 15 weeks.[9] The oral cholera vaccine has been found to be 50–60% effective over 2 years.[18]

Management

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Gastroenteritis is usually an acute and self-limited disease that does not require medication.[19] The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT).[8] Metoclopramide and ondansetron however may be helpful in some children,[20] and butylscopolamine is useful in treating crampy abdominal pain.[21]

Rehydration

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The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by oral rehydration therapy although intravenous delivery may be required if a there is a decreased level of consciousness or dehydration is severe.[22][23] Complex-carbohydrate-based ORT such as those made from wheat or rice may be superior to simple sugar-based ORT.[24] Sugary drinks such as soft drinks and fruit juice are not recommended in children under 5 years of age as they may make the increase diarrhea.[19] Plain water may be used if specific ORT are unavailable or not palatable.[19] A nasogastric tube can be used in young children to administer fluids.[11]

Dietary

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It is recommended that breastfed infants continue to be nursed per usual and that formula-fed infants continue their formula immediately after rehydration with ORT.[25] Lactose-free or lactose-reduced formulas usually are not necessary.[25] Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided.[25] The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.[26] Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools.[27] Fermented milk products (such as yogurt) may also be beneficial.[28] Zinc supplementation appear to be effective in both treating and preventing diarrhea among children in the developing world.[29]

Antiemetics

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Antiemetic medications may be helpful for vomiting in children. Ondansetron has some utility with a single dose associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.[30][31][32] Metoclopramide might also be helpful.[32] However there was an increased number of children who returned and were subsequently admitted in those treated with ondansetron.[33] The intravenous preparation of ondansetron may be given orally.[34]

Antibiotics

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Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are severe[35] or a susceptible bacterial cause is isolated or suspected.[36] If antibiotics are decided on, a macrolide such as azithromycin is preferred over a fluoroquinolones due to the higher rates of resistance to the latter.[3] Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the causative agent and treating with either metronidazole or vancomycin.[37]

Antimotility agents

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Antimotility medication have a theoretical risk of causing complications; clinical experience, however, has shown this to be unlikely.[14] They are thus discouraged in people with bloody diarrhea or diarrhea complicated by a fever.[38] Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.[39] Loperamide is not recommended in children as it may cross the immature blood brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases.[14]

Epidemiology

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Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004. Template:Multicol Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Multicol-break Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Multicol-end

Globally it is estimated that three to five billion cases of gastroenteritis occur yearly[40] primarily affecting children and those in the developing world.[2] It results in about 1.8 million deaths in children a year with most of these in the world's poorest nations.[7] About half a million of those are due to rotavirus in those under 5 years of age.[41] In the developing world children less than two frequently get six or more infections a year.[7] It is less common in adults partly due to the development of immunity.[1]

In 1980 gastroenteritis from all causes caused 4.6 million deaths in children with most of these occurring in the developing world.[37] 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.[42]

In the United States it is the second most common infection after the common cold causing 200-375 million cases (~0.7 per person) of acute diarrhea yearly[1][7] and resulting in ten thousand deaths.[7]

History

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The first usage of "gastroenteritis" is from 1825.[43] Before this time it was more specifically known as typhoid fever 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.[44]

U.S. President Zachary Taylor died of "cholera morbus", equivalent to a diagnosis of gastroenteritis, on July 9, 1850.[45]

Society and culture

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Gastroenteritis is associated with many colloquial names including: "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint" among others.[7] It has played a role in many military campaigns and is believed to be the origin of the term "no guts and glory".[7]

References

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Notes
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Template:Gastroenterology Template:Viral diseases Template:Inflammation

ar:التهاب معدي معوي bg:Гастроентерит ca:Gastroenteritis cs:Gastroenteritida de:Gastroenteritis el:Γαστρεντερίτιδα es:Gastroenteritis eu:Gastroenteritis fa:گاستروآنتریت fr:Gastro-entérite ko:장염 id:Gastroenteritis it:Gastroenterite nl:Buikgriep ja:胃腸炎 pl:Wirusowe zakażenia przewodu pokarmowego pt:Gastroenterite ru:Гастроэнтерит simple:Stomach flu sr:Гастроентеритис fi:Gastroenteriitti sv:Mag-tarmkatarr ta:இரையகக்குடலிய அழற்சி zh:腸胃炎

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Template:Cite journal
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Template:Cite book
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Template:Cite journal
  4. ↑ Template:Cite journal
  5. ↑ Template:Cite web
  6. ↑ 6.0 6.1 6.2 6.3 Template:Cite book
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13 7.14 7.15 7.16 Mandell 2010 Chp. 93
  8. ↑ 8.0 8.1 8.2 Template:Cite journal
  9. ↑ 9.0 9.1 9.2 9.3 Template:Cite journal
  10. ↑ Template:Cite journal
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Template:Cite journal
  12. ↑ Template:Cite journal
  13. ↑ 13.0 13.1 Template:Cite journal
  14. ↑ 14.0 14.1 14.2 Template:Cite book
  15. ↑ Template:Cite web
  16. ↑ Template:Cite journal
  17. ↑ Template:Cite journal
  18. ↑ Template:Cite journal
  19. ↑ 19.0 19.1 19.2 Template:Cite web
  20. ↑ Template:Cite journal
  21. ↑ Template:Cite journal
  22. ↑ Template:Cite web
  23. ↑ Template:Cite journal
  24. ↑ Template:Cite journal
  25. ↑ 25.0 25.1 25.2 Template:Cite web
  26. ↑ Template:Cite journal
  27. ↑ Template:Cite journal
  28. ↑ Template:Cite web
  29. ↑ Template:Cite journal
  30. ↑ Template:Cite journal
  31. ↑ Template:Cite journal
  32. ↑ 32.0 32.1 Template:Cite journal
  33. ↑ Template:Cite journal
  34. ↑ Template:Cite web
  35. ↑ Template:Cite journal
  36. ↑ Template:Cite journal
  37. ↑ 37.0 37.1 Template:Cite book
  38. ↑ Template:Cite book
  39. ↑ Template:Cite book
  40. ↑ Template:Cite journal
  41. ↑ Template:Cite journal
  42. ↑ Template:Cite journal
  43. ↑ Template:Cite web
  44. ↑ Rudy's List of Archaic Medical Terms
  45. ↑ "Biography of Zachary Taylor" from The White House
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