Category Archives: Gastroenteritis

Travellers Diarrhea (Turista)

Travellers diarrhea is a type of gastroenteritis which usually develops during travels to places with inadequately treated water supply. The illness, characterized by diarrhea, nausea, and vomiting, is also known as turista.

  • Nausea and vomiting, as well as diarrhea accompanied by abdominal pain and cramping, are the usual symptoms, but the severity of the symptoms may vary.
  • Traveler’s diarrhea may be caused by viral or bacterial infection. Parasites also may be responsible.
  • The infection originates from food or drink consumed on a visit to developing countries with inadequate water purification measures.
  • The illness can be prevented by certain precautions such as using only carbonated drinks and bottled water for drinking purposes as well as for brushing teeth.
  • The gastroenteritis is treated with rehydration therapy and drugs to control diarrhea. Sometimes antibiotics are also used for the treatment of travellers diarrhea.

The occurrence of Traveler’s diarrhea is common in people who visit developing countries which do not have a water supply system of purified water. Lack of immunity to local microorganisms, due to lack of previous exposure, is the main reason for this type of gastroenteritis affecting visitors. Bacterial infection by Escherichia coli, or viral infection by norovirus, is the usual cause of the disease. Avoiding drinking water from local sources is not sufficient to prevent this disease. If ice cubes made from ordinary water is added to bottled water, it may get contaminated. Brushing the teeth with tap water or eating from dishes rinsed in ordinary water may lead to infection. Eating fresh fruits with skin, even after washing them, can result in infection. Occasionally, certain parasitic infestations also cause travellers diarrhea.

Symptoms and Diagnosis

Nausea and vomiting as well as diarrhea are the usual symptoms. Abdominal pain and cramping are usually present.  Rumbling of the intestines may be audible. Severity of the symptoms may vary and they usually start within 12 hours to three days after the consumption of contaminated water or food. Travellers diarrhea due to noro virus infection typically has symptoms such as headache and muscular pain in addition to vomiting. Diagnostic tests are not usually done, and the illness is often mild, with the patient recovering in about 3-5 days without any treatment.

Prevention

Travellers diarrhea may be prevented by taking a number of precautionary measures on traveling to susceptible areas:

  • Eating in reputed restaurants following proper food hygiene practices
  • Drinking only bottled water and carbonated drinks
  • Eating only freshly cooked hot food
  • Eating fruits only after peeling the skin
  • Using bottled water to wash food items, cutlery, and toothbrush, and for rinsing the mouth
  • Avoiding food and drinks at roadside eateries
  • Avoiding fresh vegetables and fruits in salads
  • Not participating in buffets, open air food fests and feasts

As a preventive measure, an antibiotic drug may be taken by people with lower immunity when they visit areas known to cause travellers diarrhea. Ciprofloxacin is the antibiotic of choice in such situations.

Treatment

When gastroenteritis develops, plenty of water and other liquids should be taken to compensate for the fluid loss due to diarrhea. An antidiarrheal drug like loperamide may be taken to control diarrhea. However, loperamide should not be taken if fever is present or if stools are bloody. Children below 2 years are also not treated with antidiarrheal drugs. Travelers developing fever or passing bloody stools should get medical care as soon as possible.

Antibiotic therapy is started if diarrhea persists with more than 3 bowel movements in an 8 hour period. Azithromycin, ciprofloxacin, rifaximin, or levofloxacin are given to adult patients, while children above 2 years of age are usually treated with azithromycin

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Clostridium perfringens Food Poisoning

Clostridium perfringens food poisoning is caused by the consumption of food containing a high concentration of Clostridium perfringens bacteria. The bacterial toxin responsible for the symptoms is produced inside the small intestine.

In most cases, the food poisoning due to Clostridium perfringens causes mild or moderate illness which resolve without any treatment. However, certain strains cause severe illness, causing damage to the small intestine called necrotic enteritis, which may become fatal due to septicemia. Meat and meat products are the usual foods contaminated by Clostridium perfringens bacteria. Thorough cooking of the food items may destroy some strains of the bacteria but not all.

Symptoms

Severe watery diarrhea accompanied by abdominal pain and cramping is the usual symptom which appear within 6 hours to a day of eating food containing a large number of Clostridium perfringens bacteria. Distention of the abdomen due to gas accumulation may be present. Though the illness is often mild, severe dehydration resulting from frequent watery stools can lead to complications such as very low blood pressure, leading to shock. Usually the symptoms subside after 24 hours, without any treatment.

Diagnosis and Treatment

The diagnosis of Clostridium perfringens food poisoning follows the news of an outbreak in the local area. Testing of the stool samples and the suspected food samples may help in confirming the diagnosis.

Treatment involves rehydration therapy and rest. Antibiotics are not usually used to treat the illness. Clostridium perfringens food poisoning can be prevented by proper handling of cooked meat which is not consumed immediately. It should be refrigerated without delay and should be thoroughly reheated before consumption.

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Staphylococcal Food Poisoning

Staphylococcal food poisoning is caused by the toxins produced in the food contaminated by staphylococcal bacteria. It results in nausea, vomiting, and diarrhea, accompanied by abdominal cramps.

The staphylococci bacteria are commonly found in the nose, mouth as well as the throat of people. They are present in the skin too, occasionally causing boils and other infections. They may grow in food, especially in milk, custard, fish and meat. Rather than the bacteria; it is the toxins made by the organism which are responsible for food poisoning. The contamination usually starts with unhygienic handling of food, especially by those with skin infections harboring staphylococcal bacteria. The bacteria multiply rapidly in undercooked food, and in cooked food remaining long at room temperature, producing the toxins which cause food poisoning.

Symptoms and Diagnosis

Nausea and severe vomiting are the usual symptoms of staphylococcal food poisoning and they usually appear within 2-8 hours of consuming food contaminated by staphylococcal bacteria. Abdominal pain and cramping as well as diarrhea are often present. Some people may develop symptoms such as fever and headache too. Dehydration due to severe vomiting may lead to low blood pressure, and eventually shock, if the water and electrolytes lost are not replenished effectively. In some cases, especially in very young children and among those who are already weak from illnesses and old age, staphylococcal food poisoning may have fatal consequences. But otherwise, people completely recover from the illness within 12 hours of the onset of symptoms.

The typical symptoms of gastroenteritis alert the doctor to the possibility of Staphylococcal food poisoning. A lab test can detect staphylococci in the food suspected to have caused the food poisoning, but it is not often necessary. If other people who have consumed the same food have developed similar symptoms, it may be considered as confirmation of staphylococcal food poisoning. Large scale infections originating from public sources such as restaurants are investigated further for public safety.

Prevention and Treatment

Staphylococcal food poisoning can be avoided by practicing good hygiene measures while preparing and preserving food. People who have skin lesions or infected sores should refrain from handling food till the infection clears off completely. Prepared food should not be left at room temperature for long. If prepared food is not consumed immediately, it should be cooled down fast, and refrigerated, to avoid the growth of staphylococcus.

Treatment involves rehydrating the body by plenty of fluid consumption. Since bacterial infection is not the cause of illness, but the ingestion of toxins produced by the bacteria, antibiotics are not needed. If nausea and vomiting are severe, the doctor may prescribe a suppository or give an injection to reduce them. Intravenous administration of fluids may be necessary to combat severe fluid loss.

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Hemorrhagic Colitis

Hemorrhagic colitis is an acute form of gastroenteritis resulting from a bacterial infection in the large intestine caused by a specific strain of Escherichia coli. It is a self limiting disease characterized by bloody diarrhea accompanied by abdominal cramps, and occasionally low grade fever.

This illness mostly affects children below 5 years as well as older people, but it may occur at any age. The strain E. coli O157:H7 is the usual cause of Hemorrhagic colitis in North America. Cattle are natural reservoirs of these bacteria and the infection does not produce any symptoms in them. The bacteria infect people when they consume under cooked beef, especially ground meat, or unpasteurized milk. Water and juice contaminated by the infective organism also can cause infection. An infected individual can transmit the disease through person to person contact and often an infection leads to an outbreak of hemorrhagic colitis. It usually spreads rapidly among young children who are in diapers.

Damage to the intestinal lining caused by the toxins produced by E. coli is the cause of the diarrhea. If the toxins reach the blood, other organs may be affected, mainly the kidneys.

Symptoms Of Hemorrhagic colitis

The onset of the disease is marked by sudden diarrhea accompanied by severe abdominal pain and cramping. Low grade fever may be present, but in many cases it is absent. Temperatures above 1020 F are rare.   The stools are watery but traces of blood may not be seen in the first one or two days. But by the third day, the stools may have become bloody and it may remain like that for up to 8 days after which it resolves by itself.

Hemolytic-uremic syndrome is a serious complication which arises in 2% to 7% of patients who have developed hemorrhagic colitis. The symptoms of developing hemolytic-uremic syndrome are thrombocytopenia or low platelet count, excessive breakdown of red blood cells called hemolytic anemia as well as the usual symptoms of anemia such as weakness, giddiness and fatigue. It may lead to sudden kidney failure.    Hemolytic-uremic syndrome in some cases may lead to further complications such as strokes or seizures due to nerve damage or damage to the brain. An increase in fever as the illness enters the second week may be an indication of complications developing. Complications like hemolytic-uremic syndrome usually develop in young children below the age of 5 years. It is frequent in older people also. Hemorrhagic colitis can have a fatal outcome in older people even when they have not developed hemolytic-uremic syndrome or other complications arising from it.

Diagnosis

Diarrhea with bloody stools is the typical symptom which alerts the doctor to the possibility of hemorrhagic colitis. Stool samples are tested for the presence of E. coli bacteria. The stool may be tested for the specific toxin (shiga toxin) which the E. coli bacteria produce. If any other reason for bloody diarrhea is suspected, a viewing test called colonoscopy may be done to examine the interiors of the large intestine.

Treatment

Keeping the patient rehydrated is the most crucial part of the treatment. The fluid lost through frequent watery bowel movements should be replenished as much as possible. In case of severe dehydration, intravenous administration of electrolyte solution may be necessary. Antibiotic therapy to treat the infection is not advisable as the chances of developing complications like hemolytic-uremic syndrome may be increase by those drugs. Intensive care treatment and kidney dialysis may be necessary for patients developing this complication.

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What Is Gastroenteritis

Gastroenteritis is the inflammation affecting the lining of the gastrointestinal tract, including both the intestines, and the stomach. Microbial infections and exposure to certain drugs and chemical substances are the usual causes for this condition.

  • Diarrhea accompanied by pain in the abdomen, as well as nausea and vomiting is the usual symptom.
  • Gastrointestinal infections are the usual reason for gastroenteritis, but it can also result from drug use and exposure to toxins.
  • Recent travel involving change in the source of food and water, and close contact with those who are having the disease, are the usual reasons for contracting this disease. Certain diagnostic tests using toxic chemicals, and antibiotic therapy, are the less common reasons for gastroenteritis.
  • Maintaining good hygiene, including frequent washing of hands, especially after bowel movements, and before handling food, help in avoiding microbial infections.
  • Infections caused by certain bacteria can be treated by antibiotic therapy.

Diarrhea is usually the most common, as well as the first sign of gastroenteritis. It can be severe diarrhea or a milder one. Nausea and vomiting, pain, and uneasiness in the stomach, abdominal cramps and loss of appetite are some of the accompanying symptoms. The disease is not usually longstanding and the difficulties caused by it are manageable in healthy people. However, frequent passage of watery stools may result in severe dehydration especially in patients who are very young. In older and weaker people also, gastroenteritis can lead to life threatening complications due to loss of electrolytes and complications developing from dehydration.

Gastroenteritis, due to food contamination, affects one out of every six people each year in the United States alone. The world over, one and a half million deaths occur due to epidemics of gastroenteritis among children. The death toll is highest in less developed countries due to lack of awareness about hygiene and non-availability of medical care.

Causes

Gastroenteritis due to microbial infections can spread quickly among people when good hygiene practices are lacking. A person with the disease has the potential to contaminate every object handled, if the hands are not washed thoroughly after every bowel movement. All those who touch contaminated surfaces and then accidentally touch their mouth or handle food with unwashed hands may contract the disease. Any object, which may have traces of stool on it, such as toys and diapers, are potential agents of spreading the disease. This kind of disease transmission is termed as fecal-oral transmission. Water can also be contaminated with fecal matter which may lead to large-scale spread of the disease, usually termed as an outbreak of epidemic. This is very common among people who live in crowded communities. Every time a person consumes uncooked food and water in an area having an outbreak, is at risk of contracting the disease.

Swimming in ponds and pools contaminated by fecal matter from an infected person using it, or from contaminated water entering it, may lead to gastroenteritis. Animals also can be carriers of infectious microbes.  Close interaction with animals or contamination with animal feces also can result in gastroenteritis. The infection causing gastroenteritis may be either bacterial or viral. Parasitic infestation, ingestion of toxic materials and certain drugs are some other causes precipitating gastroenteritis.

Viral Gastroenteritis: Gastroenteritis is often caused by viruses which attack the intestinal lining. They cause severe watery diarrhea accompanied by fever and vomiting. Viral gastroenteritis is a frequent occurrence in the United States.

Mainly there are four kinds of viruses which are responsible for almost all the cases of viral gastroenteritis: They include:

  • Rotavirus
  • Norovirus
  • Astrovirus
  • Enteric adenovirus

Rotavirus infection results in severe diarrhea in very small children aged 3-15 months. It is a highly contagious infection which spreads through the fecal-oral route and causes severe dehydration in the affected children. The infection can be contracted by adults also, but often a mild form of disease results. Rotavirus infections are prevalent in temperate climatic regions, appearing during winter. The infection causes symptoms severe enough to necessitate hospitalization of young children and infants. In the United States, the disease has assumed a recurrent pattern, appearing in the month of November in the Southwest regions, and travelling across the country, ending in March in the Northeast.

Norovirus infections are found in adults and older children, starting mainly from the month of November and lasting till April, even though they may occur at any time of the year. The infection usually spreads through contaminated water and food, but since it is highly infectious, people can directly get it from others on casual interaction.

Astrovirus is spread by the fecal-oral route, mostly affecting young children and infants. Adults also are prone to astrovirus infection, which normally strikes in winter.

Adenovirus is also transmitted via the fecal-oral route. Infants and toddlers below 2 years of age are most prone to this infection. Adenovirus infection can occur at any time of the year but higher incidence is observed in the summer months.

Enterovirus and cytomegalovirus are certain other infective agents generally affecting those who have immune deficiency conditions.

Bacterial Gastroenteritis: Gastroenteritis may be caused by bacterial infections too, but it is less frequent when compared to gastroenteritis due to viral infections. Different bacteria cause diarrhea by different means. Vibrio cholera, Clostridium difficile and certain types of Escherichia coli do not invade the intestinal lining but they attach to it, producing certain chemicals called enterotoxins. These toxic substances trigger the intestinal lining into secreting water as well as minerals precipitating watery diarrhea.

On the other hand, certain other bacteria infiltrate the lining of the intestines, causing damage to the cells. It results in the formation of ulcerations which bleed and leak fluid into the intestines, resulting in diarrhea. The stool may contain red and white blood cells and even traces of blood. Shigella, E. coliSalmonella, and Campylobacter are some of the bacteria of this type.

Diarrhea resulting from Salmonella infection is the most frequent and most dangerous bacterial gastroenteritis prevalent in the United States. Campylobacter bacterial infection also is as frequent. Undercooked meat products, especially poultry, and milk which is not pasteurized, are the major sources of Salmonella and Campylobacter infections. Stools of cats and dogs having diarrhea may spread Campylobacter infections. Salmonella is present in amphibians like salamanders and frogs, reptiles like lizards and turtles, as well as birds. Handling of these animals and raw eggs may result in Salmonella infection.

Another bacterium called Shigella is also responsible for bacterial gastroenteritis in the United States. Person-to-person transmission is the most common route of spreading Shigella infection. Daycare centers are often implicated in the spread of the disease. Occasionally, infection is spread through food.

There are a number of subtypes of E. coli which cause diarrhea. Enterohemorrhagic E. coli which are otherwise called Shiga toxin-producing E. coli results in hemorrhagic colitis. Another condition caused by them is hemolytic-uremic syndrome. E. coliO157:H7 is the most prevalent subtype affecting people in the United States. The source of the infection is usually unpasteurized milk or undercooked ground meat.

 Day care centers are major hubs of E. coli infections. Recreational water illnesses are also large scale infections of E. coli affecting people frequenting open water bodies like lakes, pools, oceans, as well as water parks. Enterotoxigenic E. coli, as the name suggests, produces toxins which result in thin watery stools. Traveler’s diarrhea, affecting visitors to developing countries especially in the tropics, are usually caused by these. Other types of E. coli prevalent in the developing countries may cause bloody diarrhea or nonbloody diarrhea, but it is rare case in the United States.

Certain bacteria, namely, Clostridium perfringens Bacillus cereus,Staphylococcus aureus etc., contaminate the food with a toxin produced by them. Consumption of such foods alone is capable of producing symptoms of gastroenteritis, even in the absence of infection. Symptoms such as nausea and vomiting, accompanied by severe diarrhea, usually start appearing within 12 hours of exposure to the toxin. They may eventually subside within a day or two.

Bacterial Gastroentertis may be caused by many other bacteria but they are not very common in the United States. Appendicitis-like symptoms are precipitated by the infection of Yersinia enterocolitica which may cause gastroenteritis too. The infection usually results from consuming unpasteurized milk, undercooked pork or from water contaminated with the bacteria. Undercooked seafood is the usual source of Vibrio parahaemolyticus infection. Another vibrio bacterium called Vibrio cholera is the cause of cholera epidemics in developing countries. It is characterized watery stools which results in the rapid dehydration of the patient, especially children, many of whom succumb to the infection. This infection quickly spreads in crowded areas like refugee camps. Food contaminated by Listeria can cause gastroenteritis. Plesiomonas shigelloides infection results from the consumption of raw shellfish. People who visit developing countries in the tropical region also contract this infection. Swimming in brackish water and accidentally swallowing the water is the usual reason for the Aeromonas infection.

Parasites: Giardia intestinalis is a parasite inhabiting the intestines and when they bore into the lining, it results in nausea and vomiting, and sometimes diarrhea too. This disease condition known as giardiasis is prevalent in colder regions of the world.  In chronic disease, absorption of nutrients may be impaired, resulting in deficiency diseases due to malabsorption. Contaminated drinking water is the usual channel of transmission, but children in day care centers seem to be getting the infection by contact.

Cryptosporidium parvum is a parasite found in the intestines causing watery stools and other symptoms such as nausea and vomiting as well as abdominal pain. This disease condition known as cryptosporidiosis is usually harmless in normal healthy individuals, but it can be an extremely dangerous and potentially fatal condition in immune-deficient people. Contaminated water is the channel by which Cryptosporidium parvum spreads. It is identified as the culprit of recreational water illness common in the United States, especially since chlorination of water does not affect this organism.

Cyclospora cayetanensis  and Isospora belli  also cause symptoms like that of cryptosporidiosis, especially in people with weakened immune system. Microsporidia is another group of organisms which too cause these symptoms.

 Amebiasis caused by Entamoeba histolytica usually affects the large intestine. Occasionally, it may affect the other organ too including the liver. Though amebiasis is not common in the United States, it is prevalent in many developing countries where bloody diarrhea resulting from it is a common form of gastroenteritis.

Chemical Gastroenteritis: When certain toxic chemicals are ingested it may result in gastroenteritis. The toxins may be biological in origin as in the case of mushroom poisoning and food poisoning from certain seafood. Since chemical gastroenteritis is not caused by any infection, it is not infectious. Toxic chemicals include lead, cadmium, arsenic and mercury. Nausea and vomiting, accompanied by stomach pain as well as diarrhea are the usual symptoms. Excessive consumption of certain food items like tomatoes and citrus fruits may cause gastroenteritis in some people.

Symptoms of Gastroenteritis

Symptoms are typically watery diarrhea as well as nausea and vomiting. But the severity of the symptoms varies from person to person. It usually depends on the causative organism and the toxins produced by them. The immune reaction of the body also determines the severity. Loud stomach sounds, pain and cramping in the abdomen and loss of appetite are other usual symptoms appearing. Blood as well as mucus may be present in the stool. Abdomen may become distended with gas. Fever may be present in some cases. Muscle aches and lethargy may be frequent.

Dehydration developing due to frequent diarrhea and vomiting is a complication of gastroenteritis. Decrease in urine output, dryness of mouth, listlessness and tiredness are some of the indications of dehydration. In infants, signs of dehydration include absence of tears while crying. Loss of minerals and salts may lead to abnormally low potassium levels in the blood called hypokalemia. Dehydration results in the development of low blood pressure due to lowered blood volume. Abnormally fast heart rate may develop. Hyponatremia or lowering of blood sodium levels is a complication if the salts, lost in the stool and vomit, are not replaced by the rehydration therapy. If plain water or light tea is the only liquids used for rehydration there is a high chance of developing low sodium and potassium levels which can become dangerous.  Using ORS solution for rehydration may help prevent this complication, which can otherwise lead to even kidney failure or shock.

Diagnosis Of Gastroenteritis

Gastroenteritis is diagnosed from the typical symptom of frequent watery stool, but the cause of the disease may not be apparent. If it is known that other people in the office or at home have been ill with similar symptoms, the possibility of contracting the same infection is very high. Consuming food contaminated with infectious agents is a major cause of infection. Improperly cooked food, unpasteurized dairy products; raw egg or egg based preparations like mayonnaise, carry the risk of infection with Salmonella. Antibiotic use is another cause of diarrhea; so is travel to other places and countries.

If diarrhea does not resolve in a day or two, a sample of the stool should be tested to identify the organism causing the disease such as bacteria or parasites.

A sigmoidoscopy is usually done if the diarrhea continues for more than a few days. With a viewing tube called sigmoidoscope, the large bowel is checked for abnormalities as well as for the presence of ulcerative colitis.

Prevention of Gastroenteritis

Oral vaccines available against rotavirus are effective against the most common strains of virus. These vaccinations help prevent viral gastroenteritis in young children, especially in those who spend time in daycare centers. Hygiene measures are important while changing diapers and feeding children. Diapers should be changed in designated areas and the areas should be cleaned with a bleach solution. Hands should be thoroughly scrubbed with soap and water after every diaper change. The soiled diapers and cleaning tissues should be disposed off promptly. When children have diarrhea, they should be kept away from daycare centers till the symptoms are resolved. Infections with Shigella, as well as E. coli infection resulting in bloody diarrhea, should be treated with care. Children affected should test negative twice, before returning to the day care.

To avoid contracting Salmonella infection, children should be kept away from amphibian and reptilian animals which are likely to carry the bacteria. Older individuals with lower immunity level also should avoid contact with animals.

Frequent washing of hands with soap and water will reduce the chances of contracting the disease to a great extent. Contact with people who are infected is the most common method of transmission. People who have diarrhea should wash their hands thoroughly after every bowel movement. Clothes contaminated with stool should not be mixed with other washing load. Soiled clothes should be washed separately. To avoid contaminating food, hand washing before meals as well as before touching any instruments such as knives, cutting boards, cooking vessels, spoons etc., associated with cooking and serving food should be strictly practiced. Instruments and vessels which have come in contact with raw meat and eggs should be washed separately. Meat should be cooked properly and should be quickly cooled down and refrigerated before microbes get chance to grow and multiply. Milk should be consumed after boiling thoroughly or pasteurized milk should be used. Raw egg products such as mayonnaise should also be pasteurized. Eating street foods should be avoided especially while traveling.

When a person is having diarrhea, swimming in a community pool should be strictly avoided to prevent the spread of recreational water illness. The diapers of toddlers and infants should be checked and changed away from the pool. Ingesting water during swimming should be avoided.

Treatment Of Gastroenteritis

Rehydration therapy is the most essential and effective treatment for gastroenteritis. With sufficient intake of fluids and a good rest the body may overcome the infection in a few days without any further treatment. Rehydration therapy should be tailored to the condition of the patient and the symptoms of the disease. If vomiting is present, the patient may not be able to tolerate oral intake of fluids. Very small quantities of liquids, mostly one sip at a time, may be administered frequently. If it is not sufficient to maintain satisfactory hydration, intravenous administration should be initiated without delay.

 A home-made salt sugar mixture advised for oral dehydration is found to be as effective as the commercially available oral rehydration (ORS) mixtures in saving lives, especially among children in underdeveloped countries. Breast feeding of younger babies should be continued during the disease in addition to spoon feeding of small quantities of ORS. Tea, coffee, colas, fruit juices, energy drinks, alcohol etc., should be avoided. A drug to reduce vomiting is often given to adult patients but it is not given to younger children and babies. The antiemetic drug can be given in the form of a suppository or it can be injected as oral administration may not be ideal in severe cases of vomiting.

Normal diet can be resumed as and when the disease is under control but new foods should be added with gradually depending on the patient’s reception. People generally limit their choice to bland and mild food items like rice, toast, bananas and cooked apple, though diet restrictions are unnecessary. Some people may not tolerate certain foods, especially milk, immediately following a bout of diarrhea. Use of lactobacillus culture, available in powder form also, often help people get over the intolerance of milk.

The stool is tested to identify the causative organism and for the presence of blood. Traces of blood in the stool may indicate a serious infection which should be tackled first. If blood is not detected, the patient may be given antidiarrheal drug if the watery stools do not stop in a day or two. diphenoxylate is an antidiarrheal drug often prescribed. Loperamide is another drug which is available over the counter. These antidiarrheal drugs are effective in controlling diarrhea, but children below five years should not use them.

The use of antibiotics in the treatment has certain problems. It may result in drug -induced diarrhea as the antibiotics destroy beneficial bacteria in the intestine making way for the proliferation of certain harmful bacteria like Clostridium difficile. During stool testing, if the cause is found to be certain organisms such as Shigella, Campylobacter and Vibrio, antibiotic therapy is initiated. Traveler’s diarrhea is another instance in which antibiotic therapy is used to treat gastroenteritis.

Intestinal parasites can be eradicated by the use of drugs metronidazole as well as nitazoxanide which are antiparasitic medication.

Some beneficial bacteria found in the gastrointestinal tract are useful in creating a favorable environment for the growth of good microbes while suppressing the proliferation of harmful organisms. Such bacterial cultures called probiotics are useful in managing the diarrhea and reducing the duration of the disease. An example of probiotics is yogurt containing the beneficial bacteria lactobacillus. In severe cases of gastroenteritis probiotics may not have much effect. To control fluid and electrolyte loss which may lead to severe complications, the patient with acute gastroenteritis should be hospitalized for intravenous dehydration therapy.

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