Viral gastroenteritis: rotavirus, norovirus (Norwalk virus being the only species in properly after using the washroom,
m, or before preparing or handling food, and not
this group), adenovirus and astrovirus. These viruses tend to invade and replicate
within the epithelial layer of the gut wall causing patches of damage that
interferes with absorption, and causes the intestines to secrete water, whereas
usually one of their main functions is to absorb water.
Bacterial gastroenteritis: Campylobacter species, Escherichia coli, Salmonella,
Shigella, Clostridium difficile, and Vibrio cholerae, which causes cholera. Bacteria
adhere to the intestinal wall, multiply, and then further invade the gut lining,
particularly in the colon. In addition to producing toxins that alter the absorption
of water and electrolytes, bacterial infections of this sort often cause intestinal
ulceration and bleeding.
Parasitic gastroenteritis: various unicellular organisms, called protozoans,
including Giardia lamblia, Entamoeba histolytica, and Cryptosporidium species.
These microbes adhere to the intestinal walls causing microabscesses, ulcers,
bleeding, and inflammation.
It’s not only infections that inflame the digestive tract, as some non-infectious
conditions may also do this. For example, some medications, such as non-
steroidal anti-inflammatories that are commonly used to treat pain caused by
inflammatory diseases like arthritis, as well as certain foods; for example, gluten.
Long-term, or over use of nonsteroidal anti-inflammatories may damage the
digestive tract by interfering with mucus secretion, causing ulcers and bleeding.
In contrast, for some people, gluten triggers an autoimmune reaction that
destroys enterocytes, the cells in the inner lining of the intestine that are
responsible for absorbing nutrients, disrupts the structure of the intestinal wall,
and inflames the intestines. With continued exposure to the irritant, you are likely
to experience chronic gastroenteritis with diarrhea and other symptoms lasting
more than four weeks.
Causes and risk factors of gastroenteritis
Many of the risk factors that increase the likelihood you will have gastroenteritis
at one time or another are related to the transmission of disease causing
microbes, which spread through the oral-fecal route; ingesting water or food
contaminated with feces, person-to-person contact, or direct exposure to
contaminated feces. Children are particularly vulnerable to gastroenteritis
because of a lack of immunity. Risk is increased in the developing world where
transmission is increased due to poor hygiene, crowded living conditions, and
poor nutrition. Although adults are less susceptible as a result of acquired
immunity, the risk of gastroenteritis increases again as your immune system
weakens with age. This means elderly people are more susceptible especially if
living close together in nursing homes where infections spread easily.
Behaviors that increase the likelihood of transmission, also increase the risk of
gastroenteritis. These include failing to breastfeed your baby (up to 12 months of
age provides the best protection), using a baby bottle to feed your baby (these
easily become contaminated as they are difficult to clean), storing cooked food at
room temperature for several hours before eating it (this allows the bacteria to
multiply), storing drinking water that could become contaminated before you
drink it, or drinking water that is contaminated at source, not washing your hands
disposing of feces hygienically, particularly baby diapers. In addition you increase
your risk of gastroenteritis, also known as “food poisoning”, by eating certain
higher risk foods including raw or undercooked meat or poultry, unpasteurized
milk or cheese, eggs, fruit, and vegetable juices.
Finally, like the flu virus, the microbes that cause gastroenteritis are seasonal,
which means you are more vulnerable at certain times of the year than others.
Places that have a wet and dry season tend to have outbreaks during the wet
season, while regions with four seasons are more likely to have outbreaks in the
winter.
How likely are you to get gastroenteritis?
Gastroenteritis occurs all over the world and can affect anyone of any age and
any race. Worldwide, an estimated three to five billion children under the age of
five experience acute viral gastroenteritis,and a total of around 1.5 million people
(children and adults) die from this condition,
Rotavirus is the most common cause of gastroenteritis in children, while norovirus
is more common in adults and accounts for the vast majority of outbreaks in
developed countries. Localized epidemics occur due to the ability of some
microbes, including norovirus, to spread rapidly from one person to the next when
groups of people are in close quarters, such as in hospitals and nursing homes,
and because it is possible to be infectious even after the diarrhea has stopped
increasing the chances of spreading it to someone else. Parasitic gastroenteritis is
more common in the developing world, and your chances of getting it are higher
if you travel to regions where it is more prevalent. Other environments where
parasites commonly flourish include daycares and disaster zones.
Can gastroenteritis be prevented?
The best way to prevent gastrointestinal disease is to take simple precautions
that reduce the likelihood you will introduce disease causing microbes into your
mouth. These include washing your hands thoroughly, particularly after using the
toilet, and ensuring your children do too. Avoiding sharing eating utensils, and
using separate personal items like toothbrushes and towels. Disinfecting hard
surfaces around your home, and keeping your distance if you or a family member
has an infection. It is also a good idea to wash all fruit and vegetables, and cook
meat and poultry all the way through, to kill any harmful bacteria that may be
lurking there.
In addition to these hands on strategies, there are currently two rotavirus
vaccines approved by global health agencies. The World Health Organization has
recommended all national vaccination programs offer the rotavirus vaccine to
prevent infection in babies and young children. Many developed countries now
offer this vaccine, but unfortunately developing countries have had more difficulty
making it available, due to the lack of infrastructure and resources that are
needed to offer wide spread access.
Diagnosis and treatment of gastroenteritis
Diagnosis of gastroenteritis is generally based on your symptoms, a physical
exam, and knowledge of outbreaks of infectious disease in your community.
However, if your symptoms are very severe, or if you are showing signs of
dehydration, you may need to provide a stool sample to help rule out other
possible causes of illness.
Most cases of gastroenteritis get better on their own, within a week or so.
Treatment initially consists of self-care measures, such as making sure you stay
hydrated, and avoiding eating or drinking anything that might upset your
stomach even more; for example, spicy food, or alcohol. If your symptoms are
very severe, you may need to take antidiarrheal or antiemetic medications to
reduce diarrhea and vomiting. There are no specific medications for treating viral
gastroenteritis; however, you may be given antibiotics if a specific causative
microbe has been identified. Antibiotics are only effective against bacterial
infections and are often avoided as much as possible in order to prevent the
development of antibiotic resistant strains of bacteria. In very severe cases, you
may need to go to hospital for intravenous fluids and nutrition, and to avoid more
serious complications.