WHAT IS IT?
Gastroenteritis is an irritation and inflammation of the digestive tract. In the United States, it is second only to the common cold in frequency of occurrence. Although often called “stomach flu” it is not caused by the influenza virus and affects the intestines rather than the stomach.
IS IT CONTAGIOUS?
Gastroenteritis caused by viruses, parasites, and bacteria can easily be passed on to others. It is important to wash your hands thoroughly before preparing food and after using the bathroom (or changing a child’s diaper).
WHAT CAUSES IT?
There are many causes of gastroenteritis. The most common causes are infecting organisms such as viruses, bacteria or parasites.
WHAT ARE ITS COMMON SYMPTOMS?
Symptoms can vary greatly from person to person. Most people experience two or more of the following: nausea, vomiting, diarrhea, abdominal discomfort, headache, low-grade fever (99° F) and muscle aches. Viral gastroenteritis may last several hours to several days, with the average episode lasting 24-48 hours. In contrast, bacterial or parasitic infections can last well over a week and may require medication for treatment. In these cases, laboratory tests are necessary before appropriate antibiotics can be prescribed. They may not always be beneficial.
IS IT SERIOUS?
In a normal healthy adult, a case of gastroenteritis is unpleasant, but not dangerous. However, prolonged bouts of vomiting and diarrhea can lead to dehydration and disruption of important body chemistry. Chronic diseases such as diabetes mellitus or kidney problems may put you at additional risk for complications from gastroenteritis.
HOW IS IT TREATED?
Treatment for this problem consists of two important parts: what you can do, and what your health care provider can do.
What Can You Do?
Stay at home and rest until symptoms subside.
Allow your gastrointestinal tract to settle by not eating for a few hours.
Sip small amounts of clear liquids (see below) or suck on ice chips if vomiting is still a problem. Note: these recommendations are not appropriate for children.
After 4-8 hours, if clear liquids (refer to chart on second page) are tolerated, progress to soft, mildly flavored foods, such as toast, broth, apples, bananas, and rice. Gradually increase the amount and types of foods over the next day or so, as tolerated. Bananas are rich in potassium, which is lost in watery stools. Avoid caffeine, fatty foods, and alcohol for at least several days. Caffeine and alcohol can worsen dehydration. Acidic foods such as citrus fruits/juices and tomatoes may irritate the digestive tract. Since lactose intolerance may occur following gastroenteritis, limit dairy (milk) products for 1-2 weeks.
What Can Your Health Care Provider Do?
If appropriate, your health care provider will prescribe medication. If your nausea and diarrhea are relatively mild, your provider will probably advise you to continue the self-help measures recommended (above). If vomiting is severe, an anti-emetic drug may be prescribed in suppository form, or given to you by injection. Persistent diarrhea is sometimes treated with other medications such as narcotic-type drugs, which harden your bowel movements, or antispasmodic drugs that slow down bowel activity. Any such treatment is usually stopped as soon as the bowels begin to function normally. Analysis of bowel movements may be necessary if diarrhea is prolonged (1-4 weeks). Such testing can identify more severe causes of this illness so that specific therapy may be targeted to the cause.
CAN YOU PREVENT IT?
Handwashing can protect you from many types of illness, including gastroenteritis. Avoid eating raw oysters.
WHAT SHOULD YOU EAT?
The following chart illustrates the progressive diet to be used when experiencing episodes of gastroenteritis, and is intended as a guide only. As the diet expands, beverages or foods from preceding columns are included. If symptoms recur or become worse, the diet should regress back to FULL LIQUID or CLEAR LIQUID recommendations and your health care provider contacted.
- Apple, grape or cranberry juice
- Fruit punch
- Ginger ale, 7-up
- Clear bouillon
- Fruit ice
- No coffee or caffeinated beverages
- Carbonated, decaffeinated beverages
- Strained, bland soups
- Cream of wheat or rice cereal
- Vegetable juices
- Strained fruit juices or nectars
- Vanilla, other extracts
- White bread or toast
- Cooked or ready-to-eat cereal (no bran)
- Graham crackers
- Soft, cooked vegetables
- Boiled or mashed potatoes
- Apple sauce
- Bananas or seedless melon
- Cooked or canned fruits
- Mild cheese
- Cottage cheese
- Soft cooked, poached or hard-boiled or scrambled eggs
- Tender meat, fish or poultry
- Soft cake or cookies without nuts or raisins
- Butter, cream or margarine
Notify your health care provider if you have any of the following symptoms:
Not able to keep liquids down after 24 hours
You have been vomiting for more than two days
You are vomiting blood
You are dehydrated. Signs of dehydration include; excessive thirst, dry mouth, deep yellow urine or little or no urine, severe weakness, dizziness or lightheadedness
You notice blood in your bowel movements
You have a fever above 101° F
Pain that is localized, especially in the right lower abdomen
Other symptoms develop that worry you
ReferencesShamansky, S., Cecere, M., & Shellenberger, E. (1984). Primary Health Care Handbook. Little, Brown & Co. Boston, MA.
Kunz, J. & Finkel, A. (Eds.) (1987). The American Medical Association Family Medical Guide. Random House: New York, NY.
Griffith, H.W. (1989). Instructions for patients. W. B. Saunders Co. Philadelphia, PA. Cecil's Text Book of Medicine. 23rd Ed. (2008).
UpToDate web site (online subscription 18.1) http://www.uptodate.com/index