|Synonyms||gastro, stomach bug, stomach virus, stomach flu, gastric flu|
|Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = norovirus and D = astrovirus. The virus particles are shown at the same magnification to allow size comparison.|
|Classification and external resources|
|ICD-10||A02.0, A08, A09, J10.8, J11.8, K52|
|ICD-9-CM||008.8 009.0, 009.1, 558|
Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract that involves the stomach and small intestine. Signs and symptoms include some combination of diarrhea, vomiting, and abdominal pain. Fever, lack of energy, and dehydration may also occur. This typically lasts less than two weeks. It is unrelated to influenza though it has been called the stomach flu.
Gastroenteritis can be due to infections by viruses, bacteria, parasites, and fungus. The most common cause is viruses. In children rotavirus is the most common cause of severe disease. In adults, norovirus and Campylobacter are common. Transmission may occur due to eating improperly prepared foods, drinking contaminated water, or through close contact with an individual who is infected. Testing to confirm the diagnosis is typically not needed.
Prevention includes hand washing with soap, drinking clean water, proper disposal of human waste, and breastfeeding babies instead of using formula. The rotavirus vaccine is recommended in children. Treatment involves getting enough fluids. For mild or moderate cases, this can typically be achieved by drinking oral rehydration solution (a combination of water, salts, and sugar). In those who are breast fed, continued breastfeeding is recommended. For more severe cases, intravenous fluids may be needed. Fluids may also be given by a nasogastric tube. Zinc supplementation is recommended in children. Antibiotics are generally not needed.
It is estimated that three to five billion cases of gastroenteritis resulting in 1.4 million deaths occur globally each year. Children and those in the developing world are most commonly affected. As of 2011, in those below age five, there were about 1.7 billion cases resulting in 0.7 million deaths. In the developing world children less than two years of age frequently get six or more infections a year. It is less common in adults, partly due to the development of immunity.
- 1 Signs and symptoms
- 2 Cause
- 3 Pathophysiology
- 4 Diagnosis
- 5 Prevention
- 6 Management
- 7 Epidemiology
- 8 History
- 9 Society and culture
- 10 Research
- 11 Other animals
- 12 References
- 13 External links
Signs and symptoms
Gastroenteritis typically involves both diarrhea and vomiting, or less commonly, presents with only one or the other. Abdominal cramping may also be present. Signs and symptoms usually begin 12–72 hours after contracting the infectious agent. If due to a viral agent, the condition usually resolves within one week. Some viral causes may also be associated with fever, fatigue, headache, and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections may be associated with severe abdominal pain and may persist for several weeks.
Children infected with rotavirus usually make a full recovery within three to eight days. However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common. Dehydration is a common complication of diarrhea, and a child with a significant degree of dehydration may have a prolonged capillary refill, poor skin turgor, and abnormal breathing. Repeat infections are typically seen in areas with poor sanitation, and malnutrition, stunted growth, and long-term cognitive delays can result.
Reactive arthritis occurs in 1% of people following infections with Campylobacter species, and Guillain–Barré syndrome occurs in 0.1%. Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species, causing low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown). Children are more predisposed to getting HUS than adults. Some viral infections may produce benign infantile seizures.
Viruses (particularly rotavirus) and the bacteria Escherichia coli and Campylobacter species are the primary causes of gastroenteritis. There are, however, many other infectious agents that can cause this syndrome. Non-infectious causes are seen on occasion, but they are less likely than a viral or bacterial cause. Risk of infection is higher in children due to their lack of immunity and relatively poor hygiene.
Rotavirus, norovirus, adenovirus, and astrovirus are known to cause viral gastroenteritis. Rotavirus is the most common cause of gastroenteritis in children, and produces similar rates in both the developed and developing world. Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group. Rotavirus is a less common cause in adults due to acquired immunity. Norovirus is the cause in about 18% of all cases.
Norovirus is the leading cause of gastroenteritis among adults in America, causing greater than 90% of outbreaks. These localized epidemics typically occur when groups of people spend time in close physical proximity to each other, such as on cruise ships, in hospitals, or in restaurants. People may remain infectious even after their diarrhea has ended. Norovirus is the cause of about 10% of cases in children.
In the developed world Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry. In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacter species. If food becomes contaminated with bacteria and remains at room temperature for a period of several hours, the bacteria multiply and increase the risk of infection in those who consume the food. Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices. In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.
Toxigenic Clostridium difficile is an important cause of diarrhea that occurs more often in the elderly. Infants can carry these bacteria without developing symptoms. It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use. Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics. Acute "traveler's diarrhea" is usually a type of bacterial gastroenteritis, while the persistent form is usually parasitic. Acid-suppressing medication appears to increase the risk of significant infection after exposure to a number of organisms, including Clostridium difficile, Salmonella, and Campylobacter species. The risk is greater in those taking proton pump inhibitors than with H2 antagonists.
A number of protozoa can cause gastroenteritis – most commonly Giardia lamblia – but Entamoeba histolytica, Cryptosporidium spp., and other species have also been implicated. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in the developing world, but this etiologic agent causes this type of illness to some degree nearly everywhere. It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.
Transmission may occur via consumption of contaminated water, or when people share personal objects. In places with wet and dry seasons, water quality typically worsens during the wet season, and this correlates with the time of outbreaks. In areas of the world with four seasons, infections are more common in the winter. Bottle-feeding of babies with improperly sanitized bottles is a significant cause on a global scale. Transmission rates are also related to poor hygiene, especially among children, in crowded households, and in those with pre-existing poor nutritional status. After developing tolerance, adults may carry certain organisms without exhibiting signs or symptoms, and thus act as natural reservoirs of contagion. While some agents (such as Shigella) only occur in primates, others may occur in a wide variety of animals (such as Giardia).
There are a number of non-infectious causes of inflammation of the gastrointestinal tract. Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-infectious source of (often severe) gastroenteritis. Disease secondary to toxins may also occur. Some food-related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.
In the United States, rates of emergency department use for noninfectious gastroenteritis dropped 30% from 2006 until 2011. Of the twenty most common conditions seen in the emergency department, rates of noninfectious gastroenteritis had the largest decrease in visits in that time period.
Gastroenteritis is defined as vomiting or diarrhea due to infection of the small or large bowel. The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory. The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 108 (for Vibrio cholerae).
Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms. Determining the exact cause is usually not needed as it does not alter management of the condition. However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world. Diagnostic testing may also be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.
A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (≥10%) cases. In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing. Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the degree of dehydration. Thus the use of urine testing or ultrasounds is generally not needed.
Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus. Pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should also be considered. The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather than both).
Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases. This is in contrast to the large amount of diarrhea that is typical of gastroenteritis. Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea. Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea. One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.
A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis. Personal measures (such as hand washing with soap) have been found to decrease rates of gastroenteritis in both the developing and developed world by as much as 30%. Alcohol-based gels may also be effective. Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally. Breast milk reduces both the frequency of infections and their duration. Avoiding contaminated food or drink should also be effective.
Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccine be offered to all children globally. Two commercial rotavirus vaccines exist and several more are in development. In Africa and Asia these vaccines reduced severe disease among infants and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease. This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections. Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent. The first dose of vaccine should be given to infants between 6 and 15 weeks of age. The oral cholera vaccine has been found to be 50–60% effective over 2 years.
Gastroenteritis is usually an acute and self-limiting disease that does not require medication. The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). For children at risk of dehydration from vomiting, taking a single dose of the anti vomiting medication metoclopramide or ondansetron, may be helpful, and butylscopolamine is useful in treating abdominal pain.
The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by drinking rehydration solution, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe. Drinking replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars. Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea. Plain water may be used if more specific ORT preparations are unavailable or the person is not willing to drink them. A nasogastric tube can be used in young children to administer fluids if warranted. In those who require intravenous fluids, one to four hours' worth is often sufficient.
It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT. Lactose-free or lactose-reduced formulas usually are not necessary. Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided. 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.
Some probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools. They may also be useful in preventing and treating antibiotic associated diarrhea. Fermented milk products (such as yogurt) are similarly beneficial. Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.
Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting. Metoclopramide might also be helpful. However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children. The intravenous preparation of ondansetron may be given orally if clinical judgment warrants. Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.
Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe or if a susceptible bacterial cause is isolated or suspected. If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin. Bacteria and protozoans that are amenable to treatment include Shigella Salmonella typhi, and Giardia species. In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole. The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.
Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely, these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by fever. Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea. Loperamide is not recommended in children, however, 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, but salicylate toxicity is theoretically possible.
It is estimated that three to five billion cases of gastroenteritis resulting in 1.4 million deaths occur globally on an annual basis. Children and those in the developing world are most commonly affected. As of 2011, in those less than five, there were about 1.7 billion cases resulting in 0.7 million deaths, with most of these occurring in the world's poorest nations. More than 450,000 of these fatalities are due to rotavirus in children under 5 years of age. Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly. In the developing world, children less than two years of age frequently get six or more infections a year that result in significant gastroenteritis. It is less common in adults, partly due to the development of acquired immunity.
In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world. Death rates were reduced significantly (to approximately 1.5 million deaths annually) by the year 2000, largely due to the introduction and widespread use of oral rehydration therapy. In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea and approximately ten thousand deaths annually, with 150 to 300 of these deaths in children less than five years of age.
The first usage of "gastroenteritis" was in 1825. Before this time it was commonly 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. Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.
Society and culture
Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others. It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".
Gastroenteritis is the main reason for 3.7 million visits to physicians a year in the United States and 3 million visits in France. In the United States gastroenteritis as a whole is believed to result in costs of 23 billion USD per year with that due to rotavirus alone resulting in estimated costs of 1 billion USD a year.
There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), two of the leading bacterial causes of gastroenteritis worldwide.
Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are Campylobacter, Clostridium difficile, Clostridium perfringens, and Salmonella. A large number of toxic plants may also cause symptoms.
Some agents are more specific to a certain species. Transmissible gastroenteritis coronavirus (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration. It is believed to be introduced to pigs by wild birds and there is no specific treatment available. It is not transmissible to humans.
- Schlossberg, David (2015). Clinical infectious disease (Second ed.). p. 334. ISBN 9781107038912.
- Singh, Amandeep (July 2010). "Pediatric Emergency Medicine Practice Acute Gastroenteritis — An Update". Emergency Medicine Practice. 7 (7).
- Ciccarelli, S; Stolfi, I; Caramia, G (29 October 2013). "Management strategies in the treatment of neonatal and pediatric gastroenteritis.". Infection and drug resistance. 6: 133–61. doi:10.2147/IDR.S12718. PMC . PMID 24194646.
- Ferri's Clinical Advisor 2015: 5 Books in 1. Elsevier Health Sciences. 2014. p. 479. ISBN 9780323084307.
- Shors, Teri (2013). The microbial challenge : a public health perspective (3rd ed.). Burlington, Mass.: Jones & Bartlett Learning. p. 457. ISBN 9781449673338.
- A. Helms, Richard (2006). Textbook of therapeutics : drug and disease management (8. ed.). Philadelphia, Pa. [u.a.]: Lippincott Williams & Wilkins. p. 2003. ISBN 9780781757348.
- Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD (February 2012). "2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis". The Lancet Infectious Diseases. 12 (2): 136–41. doi:10.1016/S1473-3099(11)70253-5. PMID 22030330.
- Marshall JA, Bruggink LD (April 2011). "The dynamics of norovirus outbreak epidemics: recent insights". International Journal of Environmental Research and Public Health. 8 (4): 1141–9. doi:10.3390/ijerph8041141. PMC . PMID 21695033.
- Man SM (December 2011). "The clinical importance of emerging Campylobacter species". Nature Reviews Gastroenterology & Hepatology. 8 (12): 669–85. doi:10.1038/nrgastro.2011.191. PMID 22025030.
- Webb, A; Starr, M (April 2005). "Acute gastroenteritis in children.". Australian family physician. 34 (4): 227–31. PMID 15861741.
- Zollner-Schwetz, I; Krause, R (August 2015). "Therapy of acute gastroenteritis: role of antibiotics.". Clinical Microbiology and Infection. 21 (8): 744–9. doi:10.1016/j.cmi.2015.03.002. PMID 25769427.
- Elliott, EJ (6 January 2007). "Acute gastroenteritis in children.". BMJ (Clinical research ed.). 334 (7583): 35–40. doi:10.1136/bmj.39036.406169.80. PMC . PMID 17204802.
- Lozano, R (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.
- Webber, Roger (2009). Communicable disease epidemiology and control : a global perspective (3rd ed.). Wallingford, Oxfordshire: Cabi. p. 79. ISBN 978-1-84593-504-7.
- Walker, CL; Rudan, I; Liu, L; Nair, H; Theodoratou, E; Bhutta, ZA; O'Brien, KL; Campbell, H; Black, RE (Apr 20, 2013). "Global burden of childhood pneumonia and diarrhoea.". Lancet. 381 (9875): 1405–16. doi:10.1016/S0140-6736(13)60222-6. PMID 23582727.
- Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). "93". Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- Eckardt AJ, Baumgart DC (January 2011). "Viral gastroenteritis in adults". Recent Patents on Anti-infective Drug Discovery. 6 (1): 54–63. doi:10.2174/157489111794407877. PMID 21210762.
- Galanis, E (11 September 2007). "Campylobacter and bacterial gastroenteritis.". CMAJ : Canadian Medical Association. 177 (6): 570–1. doi:10.1503/cmaj.070660. PMC . PMID 17846438.
- Meloni, A; Locci, D; Frau, G; Masia, G; Nurchi, AM; Coppola, RC (October 2011). "Epidemiology and prevention of rotavirus infection: an underestimated issue?". The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 24 (Suppl 2): 48–51. doi:10.3109/14767058.2011.601920. PMID 21749188.
- "Toolkit". DefeatDD. Retrieved 3 May 2012.
- "Management of acute diarrhoea and vomiting due to gastoenteritis in children under 5". National Institute of Clinical Excellence. April 2009.
- 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.
- Szajewska, H; Dziechciarz, P (January 2010). "Gastrointestinal infections in the pediatric population.". Current Opinion in Gastroenterology. 26 (1): 36–44. doi:10.1097/MOG.0b013e328333d799. PMID 19887936.
- Dennehy PH (January 2011). "Viral gastroenteritis in children". The Pediatric Infectious Disease Journal. 30 (1): 63–4. doi:10.1097/INF.0b013e3182059102. PMID 21173676.
- 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 . PMID 21288818.
- Ahmed, Sharia M; Hall, Aron J; Robinson, Anne E; Verhoef, Linda; Premkumar, Prasanna; Parashar, Umesh D; Koopmans, Marion; Lopman, Benjamin A (Aug 2014). "Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis". The Lancet Infectious Diseases. 14 (8): 725–30. doi:10.1016/S1473-3099(14)70767-4. PMID 24981041.
- Nyachuba, DG (May 2010). "Foodborne illness: is it on the rise?". Nutrition Reviews. 68 (5): 257–69. doi:10.1111/j.1753-4887.2010.00286.x. PMID 20500787.
- Charles, RC; Ryan, ET (October 2011). "Cholera in the 21st century.". Current Opinion in Infectious Diseases. 24 (5): 472–7. doi:10.1097/QCO.0b013e32834a88af. PMID 21799407.
- Moudgal, V; Sobel, JD (February 2012). "Clostridium difficile colitis: a review.". Hospital practice (1995). 40 (1): 139–48. doi:10.3810/hp.2012.02.954. PMID 22406889.
- Lin, Z; Kotler, DP; Schlievert, PM; Sordillo, EM (May 2010). "Staphylococcal enterocolitis: forgotten but not gone?". Digestive diseases and sciences. 55 (5): 1200–7. doi:10.1007/s10620-009-0886-1. PMID 19609675.
- "Persistent Travelers' Diarrhea". United States Centers for Disease Control and Prevention. 10 July 2015. Retrieved 9 January 2016.
Although most cases of travelers' diarrhea are acute and self-limited, a certain percentage of travelers will develop persistent (>14 days) gastrointestinal symptoms ... Parasites as a group are the pathogens most likely to be isolated from patients with persistent diarrhea
- Leonard, J; Marshall, JK; Moayyedi, P (September 2007). "Systematic review of the risk of enteric infection in patients taking acid suppression.". The American journal of gastroenterology. 102 (9): 2047–56; quiz 2057. doi:10.1111/j.1572-0241.2007.01275.x. PMID 17509031.
- Escobedo, AA; Almirall, P; Robertson, LJ; Franco, RM; Hanevik, K; Mørch, K; Cimerman, S (October 2010). "Giardiasis: the ever-present threat of a neglected disease.". Infectious disorders drug targets. 10 (5): 329–48. doi:10.2174/187152610793180821. PMID 20701575.
- Grimwood, K; Forbes, DA (December 2009). "Acute and persistent diarrhea.". Pediatric clinics of North America. 56 (6): 1343–61. doi:10.1016/j.pcl.2009.09.004. PMID 19962025.
- Lawrence, DT; Dobmeier, SG; Bechtel, LK; Holstege, CP (May 2007). "Food poisoning.". Emergency medicine clinics of North America. 25 (2): 357–73; abstract ix. doi:10.1016/j.emc.2007.02.014. PMID 17482025.
- Skiner HG, Blanchard J, Elixhauser A (September 2014). "Trends in Emergency Department Visits, 2006-2011". HCUP Statistical Brief #179. Rockville, MD: Agency for Healthcare Research and Quality.
- Steiner, MJ; DeWalt, DA; Byerley JS (9 June 2004). "Is this child dehydrated?". JAMA: the Journal of the American Medical Association. 291 (22): 2746–54. doi:10.1001/jama.291.22.2746. PMID 15187057.
- Freedman, SB; Vandermeer, B; Milne, A; Hartling, L; Pediatric Emergency Research Canada Gastroenteritis Study, Group (April 2015). "Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis.". The Journal of Pediatrics. 166 (4): 908–916.e6. doi:10.1016/j.jpeds.2014.12.029. PMID 25641247.
- Warrell D.A.; Cox T.M.; Firth J.D.; Benz E.J., eds. (2003). The Oxford Textbook of Medicine (4th ed.). Oxford University Press. ISBN 0-19-262922-0.
- "Viral Gastroenteritis". Center for Disease Control and Prevention. February 2011. Retrieved 16 April 2012.
- World Health Organization (December 2009). "Rotavirus vaccines: an update" (PDF). Weekly epidemiological record. 51–52 (84): 533–540. PMID 20034143. Retrieved 10 May 2012.
- Giaquinto C, Dominiak-Felden G, Van Damme P, Myint TT, Maldonado YA, Spoulou V, Mast TC, Staat MA (July 2011). "Summary of effectiveness and impact of rotavirus vaccination with the oral pentavalent rotavirus vaccine: a systematic review of the experience in industrialized countries". Human Vaccines. 7 (7): 734–748. doi:10.4161/hv.7.7.15511. PMID 21734466. Retrieved 10 May 2012.
- Jiang, V; Jiang B; Tate J; Parashar UD; Patel MM (July 2010). "Performance of rotavirus vaccines in developed and developing countries". Human Vaccines. 6 (7): 532–542. doi:10.4161/hv.6.7.11278. PMC . PMID 20622508. Retrieved 10 May 2012.
- Patel, MM; Steele, D; Gentsch, JR; Wecker, J; Glass, RI; Parashar, UD (January 2011). "Real-world impact of rotavirus vaccination.". The Pediatric Infectious Disease Journal. 30 (1 Suppl): S1–5. doi:10.1097/INF.0b013e3181fefa1f. PMID 21183833.
- US Center for Disease Control and Prevention (2008). "Delayed onset and diminished magnitude of rotavirus activity—United States, November 2007–May 2008". Morbidity and Mortality Weekly Report. 57 (25): 697–700. PMID 18583958. Retrieved 3 May 2012.
- "Reduction in rotavirus after vaccine introduction—United States, 2000–2009". MMWR Morb. Mortal. Wkly. Rep. 58 (41): 1146–9. October 2009. PMID 19847149.
- Tate, JE; Cortese, MM; Payne, DC; Curns, AT; Yen, C; Esposito, DH; Cortes, JE; Lopman, BA; Patel, MM; Gentsch, JR; Parashar, UD (January 2011). "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.
- Sinclair, D; Abba, K; Zaman, K; Qadri, F; Graves, PM (16 March 2011). Sinclair, David, ed. "Oral vaccines for preventing cholera.". Cochrane Database of Systematic Reviews (3): CD008603. doi:10.1002/14651858.CD008603.pub2. PMID 21412922.
- Fedorowicz, Zbys; Jagannath, Vanitha A.; Carter, Ben (2011-09-07). "Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents". The Cochrane Database of Systematic Reviews (9): CD005506. doi:10.1002/14651858.CD005506.pub5. ISSN 1469-493X. PMID 21901699.
- Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain". Drugs. 67 (9): 1343–57. doi:10.2165/00003495-200767090-00007. PMID 17547475.
- "BestBets: Fluid Treatment of Gastroenteritis in Adults".
- Canavan A, Arant BS (October 2009). "Diagnosis and management of dehydration in children". Am Fam Physician. 80 (7): 692–6. PMID 19817339.
- Gregorio GV, Gonzales ML, Dans LF, Martinez EG (2009). Gregorio GV, 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.
- Toaimah, FH; Mohammad, HM (February 2016). "Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review.". Pediatric emergency care. 32 (2): 131–5. doi:10.1097/pec.0000000000000708. PMID 26835574.
- 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.
- Allen SJ, Martinez EG, Gregorio GV, Dans LF (2010). Allen SJ, ed. "Probiotics for treating acute infectious diarrhoea". Cochrane Database Syst Rev. 11 (11): CD003048. doi:10.1002/14651858.CD003048.pub3. PMID 21069673.
- Feizizadeh, S; Salehi-Abargouei, A; Akbari, V (Jul 2014). "Efficacy and safety of Saccharomyces boulardii for acute diarrhea.". Pediatrics. 134 (1): e176–91. doi:10.1542/peds.2013-3950. PMID 24958586.
- Hempel, S; Newberry, SJ; Maher, AR; Wang, Z; Miles, JN; Shanman, R; Johnsen, B; Shekelle, PG (9 May 2012). "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.". JAMA: the Journal of the American Medical Association. 307 (18): 1959–69. doi:10.1001/jama.2012.3507. PMID 22570464.
- Mackway-Jones, Kevin (June 2007). "Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis?". BestBets.
- Telmesani, AM (May 2010). "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. doi:10.4103/1319-1683.71988. PMC . PMID 21359029.
- 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.
- Mehta S, Goldman RD (2006). "Ondansetron for acute gastroenteritis in children". Can Fam Physician. 52 (11): 1397–8. PMC . PMID 17279195.
- Fedorowicz, Z; Jagannath, VA; Carter, B (7 September 2011). Fedorowicz, Zbys, ed. "Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.". Cochrane Database of Systematic Reviews. 9 (9): CD005506. doi:10.1002/14651858.CD005506.pub5. PMID 21901699.
- 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?". Annals of Emergency Medicine. 55 (5): 415–22. doi:10.1016/j.annemergmed.2009.11.011. PMID 20031265.
- "Ondansetron". Lexi-Comp. May 2011.
- 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 . PMID 20348130.
- 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.
- 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.
- Christopher, PR; David, KV; John, SM; Sankarapandian, V (4 August 2010). Christopher, Prince RH, ed. "Antibiotic therapy for Shigella dysentery.". Cochrane Database of Systematic Reviews (8): CD006784. doi:10.1002/14651858.CD006784.pub4. PMID 20687081.
- Effa, EE; Lassi, ZS; Critchley, JA; Garner, P; Sinclair, D; Olliaro, PL; Bhutta, ZA (5 October 2011). Bhutta, Zulfiqar A, ed. "Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever).". Cochrane Database of Systematic Reviews (10): CD004530. doi:10.1002/14651858.CD004530.pub4. PMID 21975746.
- Gonzales, ML; Dans, LF; Martinez, EG (15 April 2009). Gonzales, Maria Liza M, ed. "Antiamoebic drugs for treating amoebic colitis.". Cochrane Database of Systematic Reviews (2): CD006085. doi:10.1002/14651858.CD006085.pub2. PMID 19370624.
- Harrison's Principles of Internal Medicine (16th ed.). McGraw-Hill. ISBN 0-07-140235-7.
- Feldman, Mark; Friedman, Lawrence S.; Sleisenger, Marvin H. (2002). Sleisenger & Fordtran's Gastrointestinal and Liver Disease (7th ed.). Saunders. ISBN 0-7216-8973-6.
- World Health Organization (November 2008). "Global networks for surveillance of rotavirus gastroenteritis, 2001–2008" (PDF). Weekly Epidemiological Record. 47 (83): 421–428. PMID 19024780. Retrieved 10 May 2012.
- 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 . PMID 11100619.
- "Gastroenteritis". Oxford English Dictionary 2011. Retrieved January 15, 2012.
- Rudy's List of Archaic Medical Terms
- Charles E. Rosenberg (2009). The Cholera Years the United States in 1832, 1849, and 1866. Chicago: University of Chicago Press. p. 74. ISBN 9780226726762.
- Flahault, A; Hanslik, T (November 2010). "[Epidemiology of viral gastroenteritis in France and Europe].". Bulletin de l'Academie nationale de medecine. 194 (8): 1415–24; discussion 1424–5. PMID 22046706.
- Albert, edited by Neil S. Skolnik ; associate editor, Ross H. (2008). Essential infectious disease topics for primary care. Totowa, NJ: Humana Press. p. 66. ISBN 978-1-58829-520-0.
- World Health Organization. "Enterotoxigenic Escherichia coli (ETEC)". Diarrhoeal Diseases. Retrieved 3 May 2012.
- World Health Organization. "Shigellosis". Diarrhoeal Diseases. Retrieved 3 May 2012.
- Weese, JS (March 2011). "Bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential.". The Veterinary Clinics of North America. Small Animal Practice. 41 (2): 287–309. doi:10.1016/j.cvsm.2010.12.005. PMID 21486637.
- Rousseaux, Wanda Haschek, Matthew Wallig, Colin (2009). Fundamentals of toxicologic pathology (2nd ed.). London: Academic. p. 182. ISBN 9780123704696.
- MacLachlan, edited by N. James; Dubovi, Edward J. (2009). Fenner's veterinary virology (4th ed.). Amsterdam: Elsevier Academic Press. p. 399. ISBN 9780123751584.
- Fox, James G.; et al., eds. (2002). Laboratory animal medicine (2nd ed.). Amsterdam: Academic Press. p. 649. ISBN 9780122639517.
- Zimmerman, Jeffrey; Karriker, Locke; Ramirez, Alejandro; Kent Schwartz; Gregory Stevenson (15 May 2012). Diseases of Swine (10th ed.). Chichester, West Sussex: John Wiley & Sons. p. 504. ISBN 978-0-8138-2267-9.
- Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
- Gastroenteritis at DMOZ
- Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years – NICE Clinical Guidelines, No. 84.