Gastroenteritis

Gastroenteritis (also known as gastro, gastric flu, tummy bug in the United Kingdom, and stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis and enteritis) and resulting in acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or adverse reaction to something in the diet or medication. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year,[1] and is a leading cause of death among infants and children under 5.[2] At least 50% of cases of gastroenteritis as foodborne illness are due to norovirus.[3] Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus[4] and astrovirus. Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present. Risk factors include consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. It is also common for river swimmers to become infected during times of rain as a result of contaminated runoff water. [5] The incidence is 1 in 1,000 people. Gastroenteritis can be classified as either viral or bacterial. Bacterial For a list of bacteria causing gastroenteritis, see above. Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics. Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus. If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, Shigella and Campylobacter, for example, and parasites like Giardia can be treated with antibiotics. Acute gastroenteritis therapy based on degree of dehydration consisting of:

2. 3.

• Rehydration therapy • Replacement of losses • Appropriate nutrition Maintenance dietary therapy Pharmacologic therapy • Antimicrobial agents • Nonantimicrobial drug therapies (considered but not recommended)

Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration

Rehydration The principal treatment of gastroenteritis in both children and adults is rehydration, i.e., replenishment of water lost in the stools. Depending on the degree of dehydration, this can be done by giving the person oral rehydration therapy (ORT) or through intravenous delivery.[15] People taking diuretics ("water pills") need to be cautious with diarrhea and may need to stop taking the medication during an acute episode, as directed by the health care provider. Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore, substantial amounts of soft drinks (carbonated or flat), juice, gelatin desserts, and other highly sugared liquids should be avoided. Diluted fruit juice is ideal. The practice of withholding food for more than 24 hours is yet to be proven more effective