The gastroenteritis is an inflammation of the lining of the stomach and intestines, mainly of infectious nature : why, in everyday language, is often called ” stomach flu ,” although there are no infectious viral gastroenteritis but bacterial or parasitic . Among these, the most famous is the so-called traveler’s diarrhea , a disorder that usually affects those who travel in areas of the world characterized by poor hygiene conditions, with a high risk of contamination of food and water.
Gastroenteritis is manifested by diarrhea, vomiting, abdominal pain and cramps, sometimes fever and, generally, it heals within a week without leaving particular aftermath . But it is still not a disorder to be underestimated , because in the most serious cases it can cause dehydration and also have serious complications.
Read our study to find out everything about gastroenteritis, its causes, how to cure it, the right nutrition in the acute phase and during recovery and how to prevent it by adopting the correct rules of hygiene.
What is Gastroenteritis
Gastroenteritis is an inflammation of the gastrointestinal tract that can involve the stomach, small intestine and colon.
Each year, there are 2 billion cases of gastroenteritis worldwide. Often considered a benign disease, acute gastroenteritis is actually a major cause of morbidity and mortality in children worldwide , with 1.34 million deaths per year under the age of 5, corresponding to about 15% of all infant deaths.
In most cases, gastroenteritis is infectious in nature, but it can also occur from non-infectious causes. Let’s see the difference.
Some diseases involving the gastrointestinal tract can present themselves with similar symptoms : chronic inflammatory bowel diseases , Ulcerative Rectocolitis and Crohn’s disease , food intolerances , for example lactose and gluten. Unlike acute infectious gastroenteritis, they are diseases that have a chronic course and are not “self-limiting” , therefore they require specific diagnostic tests to make the correct diagnosis and set the most appropriate therapy.
The virus infections are responsible for 70% of gastroenteritis in children . The main cause is Rotavirus infection , which is equally common in industrialized and developing western countries: it is recognized today as the main cause of infectious gastroenteritis in the world , it is common in children and most cases affect children under 5 years. With the introduction of the vaccine, there has been a drastic reduction in cases and mortality linked to this infection, both in developed and developing countries. Norovirus and Adenovirus infections are also quite common.
The pathogenic bacteria that cause acute gastroenteritis are: Vibrio cholerae, Escherichia Coli, Campylobacter Jejuni, Salmonella, Yersinia, Shigella and Clostridium Difficile . With the exception of Vibrio cholerae infection and some E. Coli species, which occur with watery diarrhea, other bacterial infections can occur with bloody diarrhea. They almost always need diagnostic tests (e.g. co-cultural examination of the stool) to set up the most appropriate antibiotic therapy.
In western industrialized countries, Campylobacter Jejuni infection is the most common cause of bacterial gastroenteritis in adults. In developing countries, especially in Africa and Asia, cholera is one of the common causes of gastroenteritis.
Other common pathogens are Escherichia coli (in particular the serotype O157: H7, which falls under the enterohemorrhagic Escherichia coli subtype), Salmonella, Shigella and Yersenia.
Bacterial infections account for about 15% of gastroenteritis in children . Elderly and hospitalized people can become infected with Clostridium difficile , often as a result of prolonged or repeated antibiotic therapies. This is because these therapies, by changing the variety of species of the gut bacteria, favor the growth of species such as Clostridium Difficile.
The gastroenteritis caused mainly by bacteria also includes the so-called traveler’s diarrhea.The main causes are attributable to a subgroup of Escherichia coli, called ETEC (Escherichia coli enterotoxigen) , which represents 20-40% of the causes of traveler’s diarrhea.
Gastroenteritis can also be caused by various types of parasites . Common pathogens are Giardia Lambia, Entamoeba histolytica and Cryptosporidium . Together they account for about 10% of the causes of gastroenteritis in children . Parasitic diseases are more common in developing countries or in people living in areas at risk.
How infectious gastroenteritis is transmitted
The main vehicle of transmission of infectious gastroenteritis is the ingestion of contaminated food and water or of food washed with contaminated water, but especially in the case of parasitic gastroenteritis, transmission can also occur from person to person and is often associated with poor situations personal hygiene.
In infants , gastroenteritis can also be transmitted through contact with contaminated objects, such as pacifiers or bottles .
Then there may be specific transmission modalities for certain forms of gastroenteritis , both viral and bacterial.
- The viral gastroenteritis Rotavirus and Adenovirus is transmitted for fecal-oral route : infection in adults can occur in case of close contact with an infected infant.
- Salmonella infection can be contracted through the consumption of eggs, vegetables and raw fruits, contact with reptiles, birds and amphibians , while the Shigella is transmitted from person to person , even if they occur from food outbreaks.
- The gastroenteritis caused by Escherichia coli O157: H 7 can be transmitted through the consumption of undercooked ground beef, unpasteurized milk, juice and contaminated water , although outbreaks have been reported associated with exposure to water in recreational areas such as swimming pools, lakes, water parks.
The main symptoms of gastroenteritis are diarrhea (with or without blood and mucus), vomiting, nausea, abdominal pain and cramps. Fever, malaise, myalgias and severe dehydration can also occur. When fluid loss is very serious, hypotension and tachycardia may appear.
Most gastroenteritis are harmless, with a self-limiting course, and heal within 7 days without specific therapy. Usually children are more at risk of dehydration than adults.
However, the character and severity of the symptoms may vary, also depending on the type of gastroenteritis.
Inflammatory and non-inflammatory gastroenteritis
On the basis of certain characteristics of diarrhea , it is possible to distinguish the gastroenteritis “noninflammatory” from that inflammatory : such a distinction provides a guide in the diagnosis and therapeutic management of acute gastroenteritis.
- “Non-inflammatory” diarrhea is watery and is often associated with symptoms such as nausea, vomiting and widespread cramp-like abdominal pain.
- “Inflammatory” diarrhea can present with blood, abdominal pain in the lower quadrants and is often associated with fever and / or other systemic symptoms.
The “non-inflammatory” forms , which are generally self-limiting and at most require rehydration , are almost always caused by viruses, less frequently by bacteria and parasites (most common enterotoxigenic E. coli, Giardia lambia).
The “inflammatory” forms , however, are commonly caused by bacteria: these pathogens have the ability to invade the intestinal mucosa, inducing, among other consequences, an inflammatory response by our body. Inflammatory gastroenteritis may require specific diagnostic tests to set the most appropriate therapy (culture and parasitological examination of the stool). In addition, the “inflammatory” forms, precisely for their characteristics, must be distinguished from other diseases of the gastrointestinal system, the “chronic inflammatory bowel diseases”, which can have a similar onset.
Let’s see in more detail the specific symptoms of the different infectious gastroenteritis.
In viral infections, the most frequent symptom is watery diarrhea: stools rarely contain mucus or blood.
- The rotavirus gastroenteritis is manifested by vomiting in 90% of cases, followed by diarrhea acquos a. Fever, even very high (above 39 ° C), occurs in 30% of cases. In infants and young children, the symptoms can last up to 5-7 days .
- The Norovirus can strike at any age and usually cause vomiting, abdominal pain, cramps and diarrhea . In children, vomiting is more important than diarrhea, while in adults diarrhea is usually more frequent. Other symptoms that can be associated are fever, headache and myalgias. The disease generally lasts 1 to 3 days .
- The typical symptom of Adenovirus is instead a diarrhea that lasts 1-2 weeks . It generally affects children, especially under the age of two, while infection is rare in adults. Infants and young children may also have modest episodes of vomiting. Respiratory symptoms and fever may also be present. This virus causes generally mild ailments but which can last longer than other viral causes of gastroenteritis .
Gastroenteritis caused by bacteria is characterized by symptoms and signs due to the ability of pathogens to trigger an inflammatory response by our body.
- Bacteria such as Salmonella, Shigella and Escherichia coli O157: H7 generally cause fever, abdominal pain and diarrhea, initially watery, then bloody .
- The symptoms of Clostridium difficile gastroenteritis may instead range from mild abdominal pain with diarrhea mixed with mucus to severe hemorrhagic colitis. These symptoms are similar to other forms of inflammation involving the gastrointestinal tract: for this reason, in the presence of this symptomatology, it is necessary to carry out diagnostic tests that allow you to set the most appropriate therapy.
The typical symptom of parasitic gastroenteritis is diarrhea (without blood), which if persistent can lead to weight loss and fatigue.
Some cases, such as Giardia Lambia infection, can lead to chronic diarrhea. Also in this case it is necessary to perform specific diagnostic tests (seriate stool exam) to make a certain diagnosis and set the most appropriate therapy.
Infectious gastroenteritis, especially viral forms, resolves in a few days without particular consequences.
In developing countries, however, it remains a plague that causes dehydration, malnutrition, growth retardation and death, especially in children. Seizures and epilepsy episodes can occur in febrile cases, generally following the electrolyte imbalances induced by the loss of fluids with diarrhea and vomiting.
Rare complications are Reiter’s syndrome (acute reactive arthritis), which can occur secondary to infection with Yersinia, Salmonella and Campylobacter Jejuni and Guillain-Barré’s syndrome (distal-proximal paralysis triggered by an autoimmune reaction), mainly a consequence of Campylobacter Jejuni infection.
Hemolytic uremic syndrome (SEU)
Among the rare complications (5-10% of cases ) of enterohemorrhagic Escherichia coli gastroenteritis is hemolytic-uremic syndrome (SEU), a disease that presents with severe renal failure, low platelets and severe anemia , which usually they appear after a few days of diarrhea with mucus and blood in the stool. SEU is the most important cause of acute renal failure in children , particularly in the early years of life.
Post-infectious irritable bowel syndrome
Another possible complication, which can develop even after the acute episode of infectious gastroenteritis , is the “post-infectious irritable bowel syndrome”. Following an episode of acute gastroenteritis, certain disorders such as abdominal pain and changes in the way of evacuation may persist . These disorders can take place after an episode of acute gastroenteritis: a possible change in the intestinal bacterial flora has been found as a consequence of the acute infectious insult.
The diagnosis is made through the clinical evaluation of the symptoms and the patient ‘s history , both to identify potential risk factors (for example, the ingestion of potentially contaminated food or water or a recent trip), and to exclude other gastrointestinal diseases that cause similar symptoms (appendicitis, cholecystitis, ulcerative colitis).
In some cases, when the clinical examination and the patient’s history suggest it, blood and stool tests may be scheduled . In patients most critical of dehydration , it is important to monitor electrolytes, kidney function with azotemia and creatinine, possibly glycaemia to evaluate the degree of hydration and the electrolyte and acid-base balance.
Usually for infectious gastroenteritis, especially for viral forms, there is no need to use drugs: the disease, in fact, tends to resolve spontaneously within a week.
In case of vomiting or fever , it is possible to resort to symptomatic therapy with antiemetics or antipyretics , as well as it is possible to take antispasmodics or painkillers in the presence of severe abdominal pain . In the most severe forms, where there is a significant loss of fluids , an intravenous supportive therapy may be necessary in order to restore the balance of water and electrolytes in the blood. Even probiotics may help reduce diarrhea .
Antibiotics and antidiarrheal drugs, on the other hand, are not usually recommended in mild and self-limiting cases.
Of course, if the situation does not improve within a couple of days, it is advisable to seek medical attention. In non-self-limiting bacterial forms, targeted antibiotic therapy must often be resorted to.
Especially in the acute phase of gastroenteritis , especially in the presence of vomiting and diarrhea , it is advisable to eat small and light meals : very heavy, spicy, fatty or high-sugar foods are not tolerated by the body and can sharpen the symptoms, in addition to worsening the dehydration. In the acute phase it is also recommended to avoid foods and drinks containing lactose, caffeine and alcohol . If, however, the ailments are mild and do not compromise your appetite, you can eat whatever you want, to maintain strength. Usually, however, the acute phase lasts a few days, so if you are unable to eat there are no risks :if necessary, medications or natural remedies can be used to reduce nausea and vomiting and improve appetite .
It is very important to try to rehydrate the body with water, if possible by mouth, otherwise by nasogastric or intravenous tube .
If you want to know more about the most suitable diet in case of gastroenteritis, read our article ” Intestinal virus: the nutritionist’s advice to get better and what to eat in the recovery phase “.
Some natural remedies can help alleviate certain symptoms of gastroenteritis, such as diarrhea, abdominal pain and cramps, nausea and vomiting . Alessia Onorati, herbalist , suggests what they are, when and how to take them, in which cases it is advisable not to use them. In any case, taking in children is always not recommended because it has too many contraindications.
Ginger herbal tea
In herbal medicine, ginger is recommended for the treatment of dyspeptic disorders such as heartburn, flatulence and nausea . The antiemetic action (reduction of nausea and vomiting) is attributed to gingerol and shogaol which stimulate salivation and gastric secretions.
- Method of preparation : pour about 200 ml of water and a tablespoon of ginger root into a container, bring to the boil and boil for 10 minutes. Turn off and leave to infuse for 10 minutes (stirring occasionally), filter and drink one to two cups a day, preferably before main meals.
- Warnings : it is important to take ginger with caution in case of gallstones and not to associate it with anticoagulants and platelet aggregation inhibitors.
Dried bay leaves help calm stomach pains .
Method of preparation : pour about 200 ml of water into a container, add three chopped bay leaves, bring to the boil and boil for 10 minutes. Turn off and leave to infuse for 10 minutes (stirring occasionally), filter and drink one to two cups a day, preferably after main meals.
Agrimony herbal tea
Agrimony is a plant with astringent properties, useful for the treatment of diarrhea .
- Method of preparation : bring about 200 ml of water to a boil, pour a spoonful of agrimony, turn off and leave to infuse for 10 minutes (stirring occasionally). Filter and drink one to three cups a day away from main meals.
- Drug interactions : agrimony can interact with the absorption of some drugs in relation to the high tannin content of the plant: before taking it, it is important to seek advice from your doctor.
Fennel, star anise, licorice and carnation herbal tea
An excellent remedy to combat abdominal pain and cramps is a herbal tea made up of star anise (fruits), fennel (fruits), licorice (root), cloves. For the percentage of herbal tea, ask your trusted herbalist for advice.
Method of preparation : pour about 200 ml of water and a spoonful of herbal tea into a container and boil for 3/5 minutes. Turn off and leave to infuse for 10/15 minutes (stirring occasionally). Filter and drink one to three cups a day, preferably after main meals.
To prevent infectious gastroenteritis, two live attenuated vaccines against Rotaviruses are available , safe and effective against most of the strains responsible for the disease. Immunization for Rotavirus is part of the childhood vaccinations recommended by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists: the vaccine must be done within 6 months and it is very effective .
For infants, breastfeeding also provides a form of protection .
The other weapon of prevention is hygiene , given the ease with which many agents, especially viruses, are transmitted from person to person. It is also essential to follow the correct procedures for handling and preparing food and avoid potentially contaminated food and drinks , especially when traveling .
Especially in developing countries , it is important to wash your hands, use pocket disinfectants, do not drink tap water if not drinkable . If you buy fruit on the counters on the streets , it is advisable to prefer the one with the peel, to eat after peeling it, rather than the one already sold in pieces and washed . Also beware of smoothies and soups, which are often mixed with tap water : in general, it is good to consume only foods that have been boiled or prepared with bottle or filter water .
As a precaution, children with diarrhea should not attend kindergarten as long as symptoms are present. In case of enterohemorrhagic Escherichia coli or Shigella infection, two negative tests are required for readmission to the classroom.
Extrnal Link : Gastroenteritis