Gastroenteritis

From Wikipedia, the free encyclopedia
  (Redirected from Acute gastroenteritis)
Jump to: navigation, search
Gastroenteritis
Classification and external resources

Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = Norovirus and D = Astrovirus. The virus particles are shown at the same magnification to allow size comparison.
ICD-10 A02.0, A08, A09, J10.8, J11.8, K52
ICD-9 008.8 009.0, 009.1, 558
DiseasesDB 30726
eMedicine emerg/213
MeSH D005759

Gastroenteritis (also known as gastric flu, stomach bug, 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.

Contents

[edit] Symptoms and signs

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]

[edit] Complications

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]

[edit] Cause

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 can cause this syndrome.[7]

[edit] Viral

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]

[edit] Bacterial

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.[11] The most common types are: Salmonella, Shigella, Escherichia coli, and Campylobacter.[11] If food becomes contaminated with bacteria and remains at room temperatures for a period of hours, the bacteria can multiply and increase the risk of infection in those who eat the food.[7]

Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly.[7] Infants can carry these bacteria without developing symptoms.[7] Traveler's diarrhea is usually a type of bacterial gastroenteritis.

Acid suppressing medication appears 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]

[edit] Protozoal

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]

[edit] Transmission

Transmission may occur via contaminated water or people sharing personal objects.[2] In places with wet and dry seasons, water quality typically worsens 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 symptoms and thus act as 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]

[edit] Pathophysiology

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] The number of pathogens required to cause an infection is variable from as few as one for crytosporidium to as many as 108 for cholera.[7]

[edit] Diagnosis

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 also be checked when there is a concern for 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]

[edit] Differential

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]

[edit] Prevention

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

[edit] Lifestyle

A supply of easily accessible, uncontaminated water and good sanitation is important for reducing rates of infection.[7] Personal measures such as hand washing have 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]

[edit] Vaccination

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 substantially 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]

[edit] Management

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 abdominal pain.[21]

[edit] Rehydration

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 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]

[edit] Dietary

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]

[edit] Antiemetics

Antiemetic medications may be helpful for treating 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]

[edit] Antibiotics

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]

[edit] Antimotility agents

Antimotility medication has 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]

[edit] Epidemiology

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.
  no data
  ≤less 500
  500–1000
  1000–1500
  1500–2000
  2000–2500
  2500–3000
  3000–3500
  3500–4000
  4000–4500
  4500–5000
  5000–6000
  ≥6000

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 years of age 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]

[edit] History

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]

[edit] Society and culture

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]


[edit] References

  1. ^ a b c d e f g h i j k l m Eckardt AJ, Baumgart DC (January 2011). "Viral gastroenteritis in adults". Recent Patents on Anti-infective Drug Discovery 6 (1): 54–63. PMID 21210762. 
  2. ^ a b c d e f g h i Webber, Roger (2009). Communicable disease epidemiology and control : a global perspective (3rd ed.). Wallingford, Oxfordshire: Cabi. p. 79. ISBN 9781845935047. http://books.google.ca/books?id=pZ9fpHtvOGYC&pg=PA79. 
  3. ^ a b c d e Galanis, E (2007 Sep 11). "Campylobacter and bacterial gastroenteritis.". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 177 (6): 570–1. PMID 17846438. 
  4. ^ Haffejee IE (1991). "The pathophysiology, clinical features and management of rotavirus diarrhoea". Q. J. Med. 79 (288): 289–99. PMID 1649479. 
  5. ^ "Diarrhoea and vomiting in children under 5". http://guidance.nice.org.uk/CG84. 
  6. ^ a b c d Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. pp. 830–839. ISBN 0-07-148480-9. 
  7. ^ a b c d e f g h i j k l m n o p q r s t Mandell 2010 Chp. 93
  8. ^ a b c Elliott, EJ (2007 Jan 6). "Acute gastroenteritis in children.". BMJ (Clinical research ed.) 334 (7583): 35–40. PMID 17204802. 
  9. ^ a b c d Szajewska, H; Dziechciarz, P (2010 Jan). "Gastrointestinal infections in the pediatric population.". Current opinion in gastroenterology 26 (1): 36–44. doi:10.1097/MOG.0b013e328333d799. PMID 19887936. 
  10. ^ Dennehy PH (January 2011). "Viral gastroenteritis in children". The Pediatric Infectious Disease Journal 30 (1): 63–4. doi:10.1097/INF.0b013e3182059102. PMID 21173676. 
  11. ^ a b c d e f g h Webb, A; Starr, M (2005 Apr). "Acute gastroenteritis in children.". Australian family physician 34 (4): 227–31. PMID 15861741. 
  12. ^ Desselberger U, Huppertz HI (January 2011). "Immune responses to rotavirus infection and vaccination and associated correlates of protection". The Journal of Infectious Diseases 203 (2): 188–95. doi:10.1093/infdis/jiq031. PMC 3071058. PMID 21288818. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3071058. 
  13. ^ a b Leonard, J; Marshall, JK, Moayyedi, P (2007 Sep). "Systematic review of the risk of enteric infection in patients taking acid suppression.". The American journal of gastroenterology 102 (9): 2047–56; quiz 2057. PMID 17509031. 
  14. ^ a b c Warrell D.A., Cox T.M., Firth J.D., Benz E.J., ed. (2003). The Oxford Textbook of Medicine (4th ed.). Oxford University Press. ISBN 0-19-262922-0. http://otm.oxfordmedicine.com/. 
  15. ^ "Viral Gastroenteritis". http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm. Retrieved 2010-04-05. 
  16. ^ "Reduction in rotavirus after vaccine introduction—United States, 2000–2009". MMWR Morb. Mortal. Wkly. Rep. 58 (41): 1146–9. October 2009. PMID 19847149. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm. 
  17. ^ Tate, JE; Cortese, MM, Payne, DC, Curns, AT, Yen, C, Esposito, DH, Cortes, JE, Lopman, BA, Patel, MM, Gentsch, JR, Parashar, UD (2011 Jan). "Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data.". The Pediatric infectious disease journal 30 (1 Suppl): S56-60. doi:10.1097/INF.0b013e3181fefdc0. PMID 21183842. 
  18. ^ Sinclair, D; Abba, K, Zaman, K, Qadri, F, Graves, PM (2011 Mar 16). "Oral vaccines for preventing cholera.". Cochrane database of systematic reviews (Online) (3): CD008603. doi:10.1002/14651858.CD008603.pub2. PMID 21412922. 
  19. ^ a b c "Diarrhoea and vomiting in children under 5". http://www.nice.org.uk/Guidance/CG84#summary. 
  20. ^ Alhashimi D, Al-Hashimi H, Fedorowicz Z (2009). Alhashimi, Dunia. ed. "Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents". Cochrane Database Syst Rev (2): CD005506. doi:10.1002/14651858.CD005506.pub4. PMID 19370620. 
  21. ^ Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain". Drugs 67 (9): 1343–57. PMID 17547475. 
  22. ^ "BestBets: Fluid Treatment of Gastroenteritis in Adults". http://www.bestbets.org/bets/bet.php?id=1039. 
  23. ^ Canavan A, Arant BS (October 2009). "Diagnosis and management of dehydration in children". Am Fam Physician 80 (7): 692–6. PMID 19817339. 
  24. ^ Gregorio GV, Gonzales ML, Dans LF, Martinez EG (2009). Gregorio, Germana V. ed. "Polymer-based oral rehydration solution for treating acute watery diarrhoea". Cochrane Database Syst Rev (2): CD006519. doi:10.1002/14651858.CD006519.pub2. PMID 19370638. 
  25. ^ a b c "Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy". http://www.cdc.gov/mmwR/preview/mmwrhtml/rr5216a1.htm. 
  26. ^ King CK, Glass R, Bresee JS, Duggan C (November 2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm. 
  27. ^ Allen SJ, Martinez EG, Gregorio GV, Dans LF (2010). Allen, Stephen J. ed. "Probiotics for treating acute infectious diarrhoea". Cochrane Database Syst Rev 11 (11): CD003048. doi:10.1002/14651858.CD003048.pub3. PMID 21069673. 
  28. ^ "Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis". http://www.bestbets.org/bets/bet.php?id=1000. 
  29. ^ Telmesani, AM (2010 May). "Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea.". Journal of family and community medicine 17 (2): 79–82. PMID 21359029. 
  30. ^ DeCamp LR, Byerley JS, Doshi N, Steiner MJ (September 2008). "Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis". Arch Pediatr Adolesc Med 162 (9): 858–65. doi:10.1001/archpedi.162.9.858. PMID 18762604. 
  31. ^ Mehta S, Goldman RD (2006). "Ondansetron for acute gastroenteritis in children". Can Fam Physician 52 (11): 1397–8. PMC 1783696. PMID 17279195. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195. 
  32. ^ a b Fedorowicz, Z; Jagannath, VA, Carter, B (2011 Sep 7). "Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.". Cochrane database of systematic reviews (Online) 9: CD005506. PMID 21901699. 
  33. ^ Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK (May 2010). "Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses?". Ann Emerg Med 55 (5): 415–22. doi:10.1016/j.annemergmed.2009.11.011. PMID 20031265. 
  34. ^ "Ondansetron: Drug Information Provided by Lexi-Comp: Merck Manual Professional". http://www.merck.com/mmpe/print/lexicomp/ondansetron.html. 
  35. ^ Traa BS, Walker CL, Munos M, Black RE (April 2010). "Antibiotics for the treatment of dysentery in children". Int J Epidemiol 39 (Suppl 1): i70–4. doi:10.1093/ije/dyq024. PMC 2845863. PMID 20348130. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2845863. 
  36. ^ Grimwood K, Forbes DA (December 2009). "Acute and persistent diarrhea". Pediatr. Clin. North Am. 56 (6): 1343–61. doi:10.1016/j.pcl.2009.09.004. PMID 19962025. 
  37. ^ a b Mandell, Gerald L.; Bennett, John E.; Dolin, Raphael (2004). Mandell's Principles and Practices of Infection Diseases (6th ed.). Churchill Livingstone. ISBN 0-443-06643-4. http://www.ppidonline.com/. 
  38. ^ Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill. ISBN 0-07-140235-7. http://books.mcgraw-hill.com/medical/harrisons/. 
  39. ^ Feldman, Mark; Friedman, Lawrence S.; Sleisenger, Marvin H. (2002). Sleisenger & Fordtran's Gastrointestinal and Liver Disease (7th ed.). Saunders. ISBN 0-7216-8973-6. http://www.elsevier-international.com/catalogue/title.cfm?ISBN=0721689736. 
  40. ^ Elliott, EJ (2007 Jan 6). "Acute gastroenteritis in children.". BMJ (Clinical research ed.) 334 (7583): 35–40. PMID 17204802. 
  41. ^ Parashar, UD; Burton, A, Lanata, C, Boschi-Pinto, C, Shibuya, K, Steele, D, Birmingham, M, Glass, RI (2009 Nov 1). "Global mortality associated with rotavirus disease among children in 2004.". The Journal of infectious diseases 200 Suppl 1: S9-S15. PMID 19817620. 
  42. ^ Victora CG, Bryce J, Fontaine O, Monasch R (2000). "Reducing deaths from diarrhoea through oral rehydration therapy". Bull. World Health Organ. 78 (10): 1246–55. PMC 2560623. PMID 11100619. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2560623. 
  43. ^ "Gastroenteritis". Oxford English Dictionary 2011. http://www.oed.com/. Retrieved January 15, 2012. 
  44. ^ Rudy's List of Archaic Medical Terms
  45. ^ "Biography of Zachary Taylor" from The White House
Notes
  • Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed. ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399. 

[edit] External links

Find more about Gastroenteritis on Wikipedia's sister projects:
Definitions and translations from Wiktionary
Images and media from Commons
Learning resources from Wikiversity
News stories from Wikinews
Quotations from Wikiquote
Source texts from Wikisource
Textbooks from Wikibooks
Oncovirus
Immune disorders
Central
nervous system
Cardiovascular
Respiratory system/
acute viral nasopharyngitis/
viral pneumonia
Digestive system
DNA virus: HBV (B)
RNA virus: CBV · HAV (A) · HCV (C) · HDV (D) · HEV (E) · HGV (G)
Urogenital
Acute
Chronic
Processes
Specific locations
Retrieved from "http://en.wikipedia.org/w/index.php?title=Gastroenteritis&oldid=477422974"
Personal tools
Namespaces

Variants
Actions
Navigation
Interaction
Toolbox
Print/export
Languages