Gastroenteritis

Gastroenteritis Treatment in Dubai

Overview

  • Gastroenteritis ranks with respiratory tract infection as the most common infectious disease syndrome of humans. Approximately five billion episodes of diarrhea occur worldwide annually, accounting for 15 to 30 percent of all deaths in some countries .
  • Bacterial and parasitic gastrointestinal infections have decreased in frequency as a result of improvements in public health infrastructure from the treatment, piping, and proper delivery of drinking water and disposal of sewage. However, viral gastroenteritis has not declined in a comparable fashion from these interventions.
  • The epidemiology, pathogenesis, clinical features, and diagnosis of viral gastroenteritis in children will be reviewed here. Mass immunization with rotavirus vaccines has changed the epidemiology of that infection and of acute infectious gastroenteritis overall

 

Causes of Gastroenteritis

Microbes generally are called “enteritis pathogens” when their infection results in intestinal symptoms. Enteritis pathogens newly recognized since 1970 include viruses ,parasitic agents (eg, Isospora belli Cryptosporidium Giardia ), and bacterial agents (eg, Campylobacter jejuni Campylobacter upsaliensis Clostridium difficile , some Escherichia coli Salmonella strains, Mycobacteria such as Mycobacterium avium complex). The illness caused by enteritis pathogens varies but generally includes a combination of diarrhea, vomiting, and fever, of differing duration and severity.

The viral gastroenteritis pathogens all infect the intestine and induce gastrointestinal symptoms. This shared ability contrasts with so-called “enteric viruses” that may infect the intestine but predominantly produce manifestations at extraintestinal sites. For example, many picornaviruses (echoviruses, coxsackieviruses, and polioviruses) and the SARS coronavirus cause mild gastroenteritis, but the illnesses for which they are recognized are extraintestinal (eg, pleuritis, myocarditis, and neuritis or pneumonia).

The proven pathogens of viral gastroenteritis are

  • Rotaviruses
  • Caliciviruses
  • Astroviruses
  • Enteric adenovirus serotypes 40 and 41 (group F)
  • Some picornaviruses (eg, Aichi virus)

 

Gastroenteritis Symptoms:

  • The clinical manifestations of viral gastroenteritis include diarrhea, vomiting, fever, anorexia, headache, abdominal cramps, and myalgia. None of these symptoms clearly distinguishes among the viral pathogens or viral gastroenteritis from diarrheal illness due to bacterial or parasitic organisms. However, there are some clinical and epidemiologic clues that favor viral over other causes of gastroenteritis
  • The constellation of symptoms varies from day to day and from person to person. Illness usually begins 12 hours to 4 days after exposure and generally lasts for three to seven days
  • Children may have only diarrhea or vomiting at first, but with progression become sufficiently ill to require hospitalization. Other symptoms may develop as the disease evolves; approximately 10 percent of children hospitalized for rotavirus infection have only fever and/or vomiting at the time of admission

Factors associated with severe or prolonged clinical manifestations include:

  • First infection with a particular pathogen
  • Malnutrition or an immunocompromised host
  • Lack of maternally acquired immunity (eg, antibody acquired transplacentally or in human milk)
  • Community change in serotype of the infecting strain
  • Large inoculum size
  • Strain virulence

 

Treatment for Gastroenteritis

  • The evaluation of diarrhea in children requires a careful review of medical history, a physical examination, and, on occasion, diagnostic testing. The clinician will perform a thorough examination because there are some infections unrelated to the bowels (such as an ear infection) that can cause diarrhea.
  • Many tests are available to diagnose the cause of diarrhea and to determine the severity of dehydration, although most children will not require testing.
  • There has been much confusion and folklore about optimal foods for children with diarrhea. Fortunately, a number of studies have examined recommendations that are proven to be effective.
  • Children who are not dehydrated should continue to eat a regular diet and infants who are breastfeeding should continue to do so unless the parent(s) is told otherwise by their clinician. Dehydrated children require rehydration (replacement of lost fluid). After being rehydrated, many children will be able to resume a normal diet.
  • Monitoring for dehydration — Mild dehydration is common in children with diarrhea. Signs and symptoms of mild dehydration include a slightly dry mouth, increased thirst, and slightly decreased urine output (one wet diaper or void in six hours). Parents should monitor for signs of moderate to severe dehydration. Common findings with moderate or severe dehydration include markedly decreased urination (less than one wet diaper or void in six hours), lack of tears when crying, dry mouth, and sunken eyes ( table 1 ).
  • Oral rehydration therapy — Oral rehydration therapy (ORT) was developed as a safer, less expensive, and easier alternative to intravenous fluids. Oral rehydration solution (ORS) is a liquid solution that contains glucose (a sugar) and electrolytes (sodium, potassium, chloride) that are lost in children with vomiting and diarrhea. Various forms of rehydration solution are available. Parents should check with a healthcare provider to determine which solution is preferred. A child who is moderately or severely dehydrated needs to be evaluated by a healthcare provider. A parent may offer ORS, but such children are often too ill and require professional evaluation and treatment.
  • ORT does not cure diarrhea, but it does help to treat the dehydration that often accompanies it.
  • Medications — Medications such as antibiotics and antidiarrheal agents are generally not necessary and could be harmful for infants or children with diarrhea. Rarely, antibiotics may be used in cases of bacterial infection when a specific cause of the diarrhea has been found or is strongly suspected, particularly after recent travel.
  • Probiotics — There are “healthy” bacteria (called probiotics) that may help reduce the duration of diarrhea (by about 12 to 30 hours)
  • Hygiene measures — Hand washing is an essential and very effective way to prevent the spread of infection. Hands should ideally be wet with water and plain or antimicrobial soap, and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly and dried with a single-use towel.
  • Preventing spread — Parents with children who have diarrhea should be cautious to avoid spreading infection to themselves, their family, and friends. Care with hand washing, diapering, and keeping sick children out of school or day care until the diarrhea is gone are a few ways to limit the number of people exposed to the infection

 

Alarming signs:

The following is a list of signs and symptoms that are worrisome and require immediate medical attention:

  • Bloody diarrhea
  • If an infant refuses to eat or drink anything for more than a few hours
  • Moderate to severe dehydration
  • Abdominal pain that comes and goes or is severe
  • Behavior changes, including lethargy or decreased responsiveness

To know more about the various gastroenteritis treatment options available for children, contact the Pediatrician at SHAMMA Clinic

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