Gastroenteritis

Symptoms of Gastroenteritis

Gastroenteritis is an acute illness that usually lasts between 1-2 days. However, symptoms may take 1-3 days to develop depending upon the causative agent and may range from slight discomfort to severe dehydration which can be fatal especially in children. The typical symptoms of the infection, irrespective of the cause include: 

• Diarrhea

• Vomiting

• Nausea

• Abdominal cramps

• Abdominal pain

• Headache

• Body ache

• Chills

• Bloating

• Loss of appetite 

Gastroenteritis caused by bacteria also includes bloody diarrhea which is called dysentery. It occurs due to the damage of the intestinal wall by the bacteria.

Signs of dehydration

• Decreased urine output

• Dark-colored urine

• Dry skin

• Thirst

• Dizziness

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Signs of dehydration in infants and toddlers

Vomiting is more commonly seen in young children and infants which can even lead to severe dehydration. It is very important to notice the signs of dehydration which include:

• Thirst

• Dry diapers

• Less urination

• Lack of urination 

• Dry mouth

• Lack of tears

• Drowsiness

• Lack of energy

• Sunken fontanel (the soft spot on the top of an infant’s head)

• Sunken eyes and cheeks 

• Fever

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Causes of Gastroenteritis

1. Infectious gastroenteritis

Infections causing gastroenteritis can be viral, bacterial, or parasitic in origin. 

Viruses: The most common viruses responsible for gastroenteritis are: 

• Norovirus: It is the most common cause and is responsible for most cases of viral gastroenteritis. The virus is mostly responsible for outbreaks within closed communities such as nursing homes, schools, military populations, athletic teams, and cruise ships.

• Rotavirus: The virus is mostly responsible for severe vomiting in young children and infants. The infection of rotavirus in children and infants may require hospitalization. 

Less common viruses that can cause gastroenteritis include astrovirus and adenovirus. 

How does viral gastroenteritis spread? 

Viral gastroenteritis is highly infectious. Viruses are present in the vomit and stool of the infected person and can live outside the human body for a long time. It can spread through: 

• Direct contact with vomit or stool of infected person

• Shaking hands with infected person

• Touching contaminated surfaces and objects such as handrails, elevator buttons, utensils, doors etc. 

• Sharing food and beverages with the infected person

Bacteria: Although not common, several species of bacteria can also cause gastroenteritis. They include:

• Campylobacter: This bacteria spreads through contaminated milk and poultry products. 

• Staphylococcus: It is most commonly found in undercooked meats, eggs, and dairy products. 

• E. coli: This bacteria is mostly present in undercooked beef, and unwashed fruits and vegetables. 

• Shigella: This bacteria usually grows in raw food and contaminated water such as swimming pools. 

How does bacterial gastroenteritis spread?

Improper storage and unhygienic handling of food can allow the bacteria to grow. Bacterial gastroenteritis spreads very quickly by: 

• Eating contaminated food and beverages

• Handling stool of infected person

Parasite: Parasites refer to the organism that requires a host to grow and multiply. These organisms usually live in the intestine of the patient. The parasites that can cause gastroenteritis include:  

• Entamoeba histolytica

• Giardia lamblia

• Cryptosporidium

How does parasitic gastroenteritis spread?

The parasites are usually present in the bowel of infected humans and animals and can spread through: 

• Swimming in a contaminated pool and accidentally swallowing water, or through contact with infected animals

• Handling infected animals 

• Changing the nappy of an infected baby and not washing your hands afterwards

2. Chemicals

Gastroenteritis can also be caused by foods contaminated with chemicals such as lead, mercury, cadmium, and arsenic or by directly consuming a heavy metal or chemical. 

3. Medications

Gastroenteritis can be a side effect of some medications such as :

• Antacids containing magnesium as a major ingredient

• Antibiotics

• Chemotherapy drugs

• Colchicine

• Digoxin 

• Laxatives

Confirming the drug as a cause of gastroenteritis is difficult. To recognize this, doctors are usually asked to discontinue the therapy and observe the clinical changes.

Types of Gastroenteritis

Depending upon the duration of illness, gastroenteritis can be:

• Acute: The disease is considered as acute if the duration is 14 days or less than that.

• Persistent: If the symptoms persist for 14-30 days, gastroenteritis is considered as persistent.

• Chronic: The duration of more than 30 days makes the disease chronic in nature.

• Recurrent:  Gastroenteritis is considered chronic in nature if it recurs after 7 days without diarrhea.

Risk Factors For Gastroenteritis

1. Age

Infants and young children are more prone to gastroenteritis because they have low immunity. 

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2. Malnutrition

It is also seen that people having certain nutritional deficiencies such as Vitamin A or zinc deficiency are more prone to gastroenteritis. 

3. Poor hygiene

People living in poor hygienic conditions with improper sanitation are also at higher risk of catching bacteria and parasites that are responsible for causing gastroenteritis. 

4. Weak immune system

People with weak immunity are more prone to bacterial, viral infections that can cause gastroenteritis. This includes patients undergoing chemotherapy, infected with HIV infections etc. 

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5. Poverty 

Poor people living in crowded areas having less access to a balanced diet are at higher risk of gastroenteritis infection.

6. Season

It is also seen that viral infections such as rotavirus and norovirus are more prevalent in winter. 

7. Traveling

People who frequently travel especially to the gastroenteritis endemic areas are at higher risk of catching the infection.  

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Diagnosis of Gastroenteritis

Gastroenteritis is diagnosed by observing the symptoms of the patients. Laboratory examination is necessary to determine the cause that helps in initiating the right treatment plan. 

Medical history and physical examination

In most cases, the doctor will ask about your medical history to rule out the possibility of other diseases that may present with the same set of symptoms. However, if the patient has consistent fever, bloody stool, and severe dehydration, tests are required. 

A. Stool tests

The examination of the stool sample is done to diagnose bacteria and parasites in the stool. The test does not diagnose specific viral causes of gastroenteritis. Patients with bloody stool, high fever, severe abdominal pain, and chronic dehydration are usually recommended for stool tests due to their high specificity for bacterial gastroenteritis.

1. Examining the stool for blood

Blood in the stool can be a sign of infectious gastroenteritis. The stool sample is checked for the presence of hidden blood. 

2. Stool culture

The culturing of the stool is done to identify the disease causing bacteria. For a stool culture, loose and fresh stool samples are taken. Sometimes, more than one stool samples are collected for the culture. The identification of the virus through stool culture can also be done, however it takes longer.  

3. Testing the stool for parasites and ova

The presence of parasites and ova (the egg stage of the parasite) can also be detected in a stool sample. The identification is done by examining the stool smear under the microscope. 

B. Blood tests

The complete blood count (CBC) is performed to check the infection. The infection can cause mild leukocytosis (high white blood cell count). In case of severe dehydration, electrolytes levels are also measured by blood tests.

Sometimes, serum inflammatory markers are also examined through blood tests. 

C. Urine test

Dehydration can be due to acute kidney injury. Blood urea nitrogen and creatinine tests are also recommended to rule out the possibility of kidney disease. 

D. Imaging tests

The imaging tests are rarely done for gastroenteritis. In some cases, imaging studies such as CT scans, ultrasound, and X-ray are done to diagnose the condition of the intestine. CT scans may show thickened walls of the colon or other inflammatory changes of the bowel. Imaging studies are mostly done to rule out other major causes of the symptoms. 

Specialist To Visit

In most of the cases, gastroenteritis does not lead to severe complications. However, patients with severe dehydration should consult the doctor immediately as it may cause hypoglycemia and electrolyte imbalance. 

Diarrhea should not be ignored in newborns and infants as it can lead to severe dehydration and can prove to be fatal. The immediate medical attention is also advised in case of: 

• Old age

• Pregnancy

• Low immunity

The following doctors can be consulted for diagnosis and treatment:

• General physician

• Infectious disease specialist

• Gastroenterologist

• Pediatrician (in case of children)

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Prevention of Gastroenteritis

Vaccination

Immunization for rotavirus is recommended for young children and infants to prevent the risk of gastroenteritis, hospitalization, and death from rotavirus infection. 

There are currently 2 vaccines available that are given two or three doses as per the type of vaccine. The first dose is given before the child is 15 weeks of age. Children should receive all doses of rotavirus vaccine before they turn 8 months of age. 

Hand washing

Most viral gastroenteritis can be prevented by washing of hands with soap and water for at least 10 seconds after going to the toilet, before preparing or handling food, before eating food, after handling vomiting of an infected patient, and after changing diapers of the child. The hand washing facilities should be available for staff, residents, children, and visitors in child care centers and hospitals.

There is also evidence that alcohol-based hand sanitizers in addition to handwashing reduces the chances of gastroenteritis in offices and daycares. Reduction in school absenteeism is also observed.

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Education

People, especially children, should be educated about the importance of hand washing and maintaining good hygiene as the most effective way of preventing gastroenteritis. There should be signs of hand washing in toilets and eating areas to constantly remind the same.

Hygiene measures

Infectious gastroenteritis spreads through contaminated surfaces. Practicing good hygiene is the best way to prevent infection. The following measures can be taken to ensure the cleanliness:

• Keep the nails short and avoid wearing false fingernails, nail extenders and nail polish, and jewelry as they restrict adequate cleaning of hands.

• Clean the surfaces or objects that have been exposed to vomits or feces.

• Wear disposable gloves and masks while handling feces or vomit of infected individuals. 

• Use disposable paper towels to dry your hands. Clothes towels should be avoided as bacteria can survive on objects. 

• Keep kitchen tops, toys, toilet seats, nappy change tables clean to avoid the growth of bacteria and viruses. 

Isolation

As gastroenteritis is highly contagious, isolation of the patient prevents the spread of the infection.  Children who have experienced diarrhea should not return to childcare until 24 hours after symptoms have resolved. Anyone with diarrhea should not swim for at least 2 weeks after complete recovery.

Dietary modifications

As contaminated food and beverages are the most important source of infection, some dietary modification can help prevent the infection. 

• Cook the foods thoroughly

• Avoid consuming uncooked and unpasteurized milk

• Drink only bottled water while traveling. 

• Avoid food buffets, uncooked foods or peeled fruits and vegetables, and ice in drinks.

• Studies also suggest that daily administration of probiotics especially in children reduces the occurrence of acute gastroenteritis.  

• The intake of zinc supplements also has a preventive effect on diarrhea associated with gastroenteritis. 

Breastfeeding

Antibodies in human milk enhance the infant’s immunity and play a major role in the prevention of certain diseases. The complete breastfeeding for the initial four months of life lowers the risk of acute gastroenteritis and it also decreases the rate of hospitalization due to diarrhea. 

Treatment of Gastroenteritis

The treatment of gastroenteritis is based upon the cause and symptoms. The most important goal of the therapy is to maintain hydration and electrolyte balance that is disturbed due to vomiting and persistent diarrhea.

In some cases such as severe dehydration, uncontrolled vomiting, severe electrolyte disturbances, significant renal failure, continuous abdominal pain, and pregnancy, hospital admission is required. The treatment protocols may include: 

Fluid therapy

Most cases of mild dehydration can easily be managed at home through fluid therapy.

• It is advised to drink plenty of fluids to compensate for water loss and prevent dehydration.  

• Oral rehydration solutions are preferred over other clear fluids for managing  diarrhea.

• Fluids high in sugar (such as cola, apple juice, and sports drink) should be avoided as they may aggravate dehydration and diarrhea.

• Patients having severe dehydration and persistent vomiting may require hospital admission for continuous monitoring of electrolyte level. 

• Enteral (oral or nasogastric) and intravenous fluids (Saline solution and lactate Ringer’s solutions) are given to patients facing difficulty in taking fluids due to nausea, vomiting, and to correct electrolyte levels. 

Zinc supplementation

Zinc is a metal that is found in a variety of foods such as meat, fish, almonds, and cereals. Diarrhea, the most common symptom of gastroenteritis, is associated with severe zinc deficiency. 

Zinc supplementation is a very safe and effective way for reducing complications due to gastroenteritis in children. WHO recommends the intake of 10 to 20 mg of zinc for 10 to 14 days for the management of diarrhea in children. It is given in the form of zinc sulfate, zinc acetate, or zinc gluconate.

Probiotics

Probiotics are effective in the treatment of diarrhea, especially for diseases with an infectious origin. The use of probiotics is associated with the reduction in the duration of the diarrhea, if started immediately after the onset of symptoms. 

Antibiotics

They are mostly used to treat gastroenteritis caused by bacteria. Some of the commonly used antibiotics in gastroenteritis include metronidazole, ceftriaxone, and azithromycin. 

Antiemetics 

Antiemetic medications are the drugs that are used to control nausea and vomiting. The commonly used antiemetic medications are ondansetron and metoclopramide. 

Antidiarrheal medications

Antidiarrheal medications are used only in those patients who are not able to maintain a well-hydrated status. Medications such as diphenoxylate, atropine are used.

Home-care For Gastroenteritis

Keep a watch on fluid intake

It is advised to have plenty of fluids like fresh fruit juices, coconut water, clear soups etc. In case of severe vomiting, take small sips of fluids at regular intervals. The mothers of the infected infants should make sure that their babies are getting enough breast milk. 

Have ice chips

If you are facing difficulty in digesting fluids, try to suck ice chips. This also helps in rehydration. The ice chips should not be given to small children. 

Add these foods to your diet

• B.R.A.T stands for bananas, rice, applesauce, and toast. These food items should be included in the diet as it helps in making the stool smooth and helps in compensating the nutrient loss from vomiting and diarrhea.

• Foods like chicken or other lean meats, whole grains and potatoes help in reducing the symptoms of gastroenteritis

It is also advised to consume smaller easy to digest meals at regular intervals.

Avoid certain foods

Certain food items should be avoided as they can make the stomach upset and can cause indigestion. The impaired digestion can aggravate diarrhea and vomiting. These include:

• Greasy and spicy food containing chilly, black pepper, and garlic 

• Drinks with caffeine, such as coffee and tea, and some soft drinks.

• Fatty junk foods such as fried foods, pizza, and fast foods.

• Foods and drinks containing large amounts of simple sugars, such as sweetened beverages and packaged fruit juices.

• Milk and milk products, containing the sugar lactose which can cause some people to develop lactose intolerance 

Take proper rest

People with gastroenteritis should take proper rest even after the completion of therapy. This will lead to complete recovery and healing of the digestive system. 

Try heating pad 

Some patients of gastroenteritis suffer from severe abdominal pain. Such patients can use a heating pad to relieve cramps.  

Say no to alcohol

Alcohol can cause inflammation in the stomach. This can increase the secretion of gastric acid. So, alcohol should be avoided as it can increase the feeling of vomiting (nausea). 

Complications Of Gastroenteritis

In most of the cases, gastroenteritis is resolved through fluid therapy and medications. However, persistent diarrhea and vomiting can lead to: 

1. Dehydration

2. Metabolic acidosis

3. Electrolyte imbalance 

• Hypernatraemia (high levels of sodium)

• Hyponatraemia (low levels of sodium)

• Hypokalaemia (high levels of potassium)

Development of intolerance to food such as lactose, glucose, cow’s milk, and soy protein

4. Increase susceptibility to infection

5. Dehydration can lead to more serious problems, such as:

• Heat stroke: Lack of fluids could lead to heatstroke. This is more common in physically active patients. 

• Kidney disorders: The long episode of dehydration can develop or trigger kidney stones, urinary tract infections (UTIs), or even kidney failure. 

• Seizures: The electrolyte imbalance can also develop seizures in the long run.

• Hypovolemic shock: This can develop due to low blood volume and a drop in blood pressure. 

Alternative Therapies For Gastroenteritis

Home remedies

Tea: Caffeine-free teas are proven to be beneficial in nausea and vomiting. Peppermint and lemon can be added to improve the taste.

Ginger (Adrak): It possesses anti-inflammatory, anti-viral, and anti-bacterial properties. It also eases nausea. It can be taken in raw form or can be boiled in water or tea. 

Apple cider vinegar: It can soothe an irritated stomach and thereby reduce nausea, vomiting, and abdominal cramps.

Add 1 teaspoon of apple cider vinegar to a glass of warm water and drink 30 minutes before eating a meal. 

Yogurt: It contains a lot of good bacteria that help in maintaining the overall good health of the gut. It also helps in reducing watery diarrhea. It should be added to every meal of the patient suffering from gastroenteritis.

Cinnamon (Dalchini): It has antibacterial and antiviral properties which can be used for combating gastroenteritis. It also helps in reducing stomach pain and bloating. 

Turmeric (Haldi): Curcumin, present in turmeric, possesses anti-inflammatory properties. It can be consumed by adding in a glass of warm water or milk. 

Basil (Tulsi): It possesses antispasmodic properties and helps in reducing spasms in gastroenteritis. It also has gastroprotective properties which aid in relieving symptoms of gastroenteritis. 

Peppermint: It soothes the stomach and helps in treating bloating and gas. The most effective way to use it is to consume it in the form of tea. 

Triphala: It is known to improve digestive health and also helps in the absorption of nutrients. 

Coriander (dhania): It possesses healing properties and it is known to alleviate the symptoms of upset stomach and diarrhea.

Asafoetida (hing): It is known for years to strengthen the digestive system. It possesses antiviral and antibacterial properties. It can be added in meals or can be consumed with lukewarm water. 

Licorice (mulethi): It also promotes the healing of an inflamed stomach and treats indigestion. 

Rice water: It is used especially in infants to reduce diarrhea. 

Chamomile tea: It is used as a digestive relaxant and can help in the treatment of many gastrointestinal disturbances, like diarrhea and vomiting, which is most commonly observed in gastroenteritis. 

Acupressure

Patients suffering from excessive nausea and vomiting can also try acupuncture finger pressure techniques as it is shown to stimulate trigger points that may help in reducing nausea and vomiting.