Gastroenteritis: Difference between revisions

Latest revision as of 22:33, 22 October 2025

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Gastroenteritis, also known as infectious diarrhea, is an inflammation of the gastrointestinal tract including the stomach and intestine.^[1] Symptoms may include diarrhea, vomiting, and abdominal pain.^[2] Fever, lack of energy, and dehydration may also occur.^[3]^[4] This typically lasts less than two weeks.^[1] Although it is not related to influenza, in Canada and the United States it is often referred to as "stomach flu".^[5]

Gastroenteritis is usually caused by viruses;^[6] however, gut bacteria, parasites, and fungi can also cause gastroenteritis.^[3]^[6] In children, rotavirus is the most common cause of severe disease.^[7] In adults, norovirus and Campylobacter are common causes.^[8]^[9] Eating improperly prepared food, drinking contaminated water or close contact with a person who is infected can spread the disease.^[3] Treatment is generally the same with or without a definitive diagnosis, so testing to confirm is usually not needed.^[3]

For young children in impoverished countries, prevention includes hand washing with soap, drinking clean water, breastfeeding babies instead of using formula,^[3] and proper disposal of human waste. The rotavirus vaccine is recommended as a prevention for children.^[3]^[7] Treatment involves getting enough fluids.^[3] For mild or moderate cases, this can typically be achieved by drinking oral rehydration solution (a combination of water, salts and sugar).^[3] In those who are breastfed, continued breastfeeding is recommended.^[3] For more severe cases, intravenous fluids may be needed.^[3] Fluids may also be given by a nasogastric tube.^[10] Zinc supplementation is recommended in children.^[3] Antibiotics are generally not needed.^[11] However, antibiotics are recommended for young children with a fever and bloody diarrhea.^[2]

In 2015, there were two billion cases of gastroenteritis, resulting in 1.3 million deaths globally.^[12]^[13] Children and those in the developing world are affected the most.^[14] In 2011, there were about 1.7 billion cases, resulting in about 700,000 deaths of children under the age of five.^[15] In the developing world, children less than two years of age frequently get six or more infections a year.^[16] It is less common in adults, partly due to the development of immunity.^[17]

Signs and symptoms

File:BristolStoolChart.png

Bristol stool chart

Gastroenteritis usually involves both diarrhea and vomiting.^[17] Sometimes, only one or the other is present.^[2] This may be accompanied by abdominal cramps.^[2] Signs and symptoms usually begin 12–72 hours after contracting the infectious agent.^[14] If due to a virus, the condition usually resolves within one week.^[17] Some viral infections also involve fever, fatigue, headache and muscle pain.^[17] If the stool is bloody, the cause is less likely to be viral^[17] and more likely to be bacterial.^[18] Some bacterial infections cause severe abdominal pain and may persist for several weeks.^[18]

Children infected with rotavirus usually make a full recovery within three to eight days.^[19] However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common.^[20] Dehydration is a common complication of diarrhea.^[21] Severe dehydration in children may be recognized if the skin color and position returns slowly when pressed.^[22] This is called "prolonged capillary refill" and "poor skin turgor".^[22] Abnormal breathing is another sign of severe dehydration.^[22] Repeat infections are typically seen in areas with poor sanitation, and malnutrition.^[14] Stunted growth and long-term cognitive delays can result.^[16]

Reactive arthritis occurs in 1% of people following infections with Campylobacter species.^[18] Guillain–Barré syndrome occurs in 0.1%.^[18] Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species.^[23] HUS causes low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown).^[23] Children are more predisposed to getting HUS than adults.^[16] Some viral infections may produce benign infantile seizures.^[2]

Cause

Viruses (particularly rotavirus (in children) and norovirus (in adults)) and the bacteria Escherichia coli and Campylobacter species are the primary causes of gastroenteritis.^[14]^[24] There are, however, many other infectious agents that can cause this syndrome including parasites and fungi.^[16]^[6] Non-infectious causes are seen on occasion, but they are less likely than a viral or bacterial cause.^[2] Risk of infection is higher in children due to their lack of immunity.^[2] Children are also at higher risk because they are less likely to practice good hygiene habits.^[2] Children living in areas without easy access to water and soap are especially vulnerable.^[2]

Viral

Rotaviruses, noroviruses, adenoviruses, and astroviruses are known to cause viral gastroenteritis.^[25] Rotavirus is the most common cause of gastroenteritis in children,^[24] and produces similar rates in both the developed and developing world.^[19] Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group.^[10] Rotavirus is a less common cause in adults due to acquired immunity.^[26] Norovirus is the cause in about 18% of all cases.^[27] Generally speaking, viral gastroenteritis accounts for 21–40% of the cases of infectious diarrhea in developed countries.^[28]

Norovirus is the leading cause of gastroenteritis among adults in America accounting for about 90% of viral gastroenteritis outbreaks.^[17] These localized epidemics typically occur when groups of people spend time proximate to each other, such as on cruise ships,^[17] in hospitals, or in restaurants.^[2] People may remain infectious even after their diarrhea has ended.^[17] Norovirus is the cause of about 10% of cases in children.^[2]

Bacterial

File:Salmonella Typhimurium Gram.jpg

Salmonella enterica serovar Typhimurium (ATCC 14028) as seen with a microscope at 1000 fold magnification and following Gram staining

In some countries, Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry.^[18] In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacter species.^[10] If food becomes contaminated with bacteria and remains at room temperature for several hours, the bacteria multiply and increase the risk of infection in those who consume the food.^[16] Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices.^[29] In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.^[30]

Toxigenic Clostridioides difficile is an important cause of diarrhea that occurs more often in the elderly.^[16] Infants can carry these bacteria without developing symptoms.^[16] It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use.^[31] Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics.^[32] Acute "traveler's diarrhea" is usually a type of bacterial gastroenteritis, while the persistent form is usually parasitic.^[33] Acid-suppressing medication appears to increase the risk of significant infection after exposure to several organisms, including Clostridioides difficile, Salmonella, and Campylobacter species.^[34] The risk is greater in those taking proton pump inhibitors than with H₂ antagonists.^[34]

Parasitic

A number of parasites can cause gastroenteritis.^[10] Giardia lamblia is most common, but Entamoeba histolytica, Cryptosporidium spp., and other species have also been implicated.^[10]^[33] As a group, these agents comprise about 10% of cases in children.^[23]^[33] Giardia occurs more commonly in the developing world, but this type of illness can occur nearly everywhere.^[35] It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.^[35]

Transmission

Transmission may occur from drinking contaminated water or when people share personal objects.^[14] Water quality typically worsens during the rainy season and outbreaks are more common at this time.^[14] In areas with four seasons, infections are more common in the winter.^[16] Worldwide, bottle-feeding of babies with improperly sanitized bottles is a significant cause.^[14] Transmission rates are also related to poor hygiene, (especially among children),^[17] in crowded households,^[36] and in those with poor nutritional status.^[16] Adults who have developed immunities might still carry certain organisms without exhibiting symptoms.^[16] Thus, adults can become natural reservoirs of certain diseases.^[16] While some agents (such as Shigella) only occur in primates, others (such as Giardia) may occur in a wide variety of animals.^[16]

Non-infectious

There are a number of non-infectious causes of inflammation of the gastrointestinal tract.^[2] Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-infectious cause of (often severe) gastroenteritis.^[2] Disease secondary to toxins may also occur. Some food-related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.^[37]

In the United States, rates of emergency department use for noninfectious gastroenteritis dropped 30% from 2006 until 2011. Of the twenty most common conditions seen in the emergency department, rates of noninfectious gastroenteritis had the largest decrease in visits in that time period.^[38]

Pathophysiology

Gastroenteritis is defined as vomiting or diarrhea due to inflammation of the small or large bowel, often due to infection.^[16] The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory.^[16] The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 10⁸ (for Vibrio cholerae).^[16]

Diagnosis

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms.^[17] Determining the exact cause is usually not needed as it does not alter the management of the condition.^[14]

However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world.^[10] It may also be appropriate in children younger than 5, old people, and those with poor immune function.^[39] Diagnostic testing may also be done for surveillance.^[17] As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended.^[22] Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.^[10]

Dehydration

A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (≥10%) cases.^[2] In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing.^[22]^[40] Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth.^[2] A normal urinary output and oral fluid intake is reassuring.^[22] Laboratory testing is of little clinical benefit in determining the degree of dehydration.^[2] Thus the use of urine testing or ultrasounds is generally not needed.^[41]

Differential diagnosis

Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus.^[10] Pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should also be considered.^[42] The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather than both).^[2]

Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases.^[2] This is in contrast to the large amount of diarrhea that is typical of gastroenteritis.^[2] Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea.^[2] Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea.^[2] One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.^[2]

Prevention

File:RotavirusV2009.gif

Percentage of rotavirus tests with positive results, by surveillance week, United States, July 2000 – June 2009

Water, sanitation, hygiene

Script error: No such module "labelled list hatnote". A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis.^[16] Personal hygiene measures (such as hand washing with soap) have been found to decrease rates of gastroenteritis in both the developing and developed world by as much as 30%.^[22] Alcohol-based gels may also be effective.^[22] Food or drink that is thought to be contaminated should be avoided.^[43] Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally.^[14] Breast milk reduces both the frequency of infections and their duration.^[2]

Vaccination

Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccine be offered to all children globally.^[24]^[44] Two commercial rotavirus vaccines exist and several more are in development.^[44] In Africa and Asia these vaccines reduced severe disease among infants^[44] and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.^[45]^[46] This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.^[47] Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.^[48]^[49]^[50] The first dose of vaccine should be given to infants between 6 and 15 weeks of age.^[24] The oral cholera vaccine has been found to be 50–60% effective over two years.^[51]

There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), which are two of the leading bacterial causes of gastroenteritis worldwide.^[52]^[53]

Management

Gastroenteritis is usually an acute and self-limiting disease that does not require medication.^[21] The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT).^[23] For children at risk of dehydration from vomiting, taking a single dose of the anti vomiting medication metoclopramide or ondansetron, may be helpful,^[54] and butylscopolamine is useful in treating abdominal pain.^[55]

Rehydration

The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by drinking rehydration solution, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe.^[56]^[57] Drinking replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.^[58] Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under five years of age as they may increase diarrhea.^[21] Plain water may be used if more specific ORT preparations are unavailable or the person is not willing to drink them.^[21] A nasogastric tube can be used in young children to administer fluids if warranted.^[10] In those who require intravenous fluids, one to four hours' worth is often sufficient.^[59]

Dietary

It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT.^[60] Lactose-free or lactose-reduced formulas usually are not necessary.^[60] Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided.^[60] The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.^[60]

A Cochrane Review from 2020 concludes that probiotics make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.^[61] They may be useful in preventing and treating antibiotic associated diarrhea.^[62] Fermented milk products (such as yogurt) are similarly beneficial.^[63] Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.^[64]

Antiemetics

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.^[54]^[65]^[66]^[67] Metoclopramide might also be helpful.^[67] However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.^[68] The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.^[69] Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.^[2]

Antibiotics

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe^[70] or if a susceptible bacterial cause is isolated or suspected.^[71] If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter.^[18] Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin.^[72] Bacteria and protozoans that are amenable to treatment include Shigella^[73] Salmonella typhi,^[74] and Giardia species.^[35] In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole.^[35]^[75] The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.^[2]

Antimotility agents

Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely,^[42] these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by fever.^[76] Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.^[77] Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases,^[42] but salicylate toxicity is theoretically possible.^[2]

Epidemiology

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Deaths due to diarrhoeal diseases per million persons in 2012 <templatestyles src="Div col/styles.css"/>

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0–2

3–10

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1500–2000

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3000–3500

3500–4000

4000–4500

4500–5000

5000–6000

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It is estimated that there were two billion cases of gastroenteritis that resulted in 1.3 million deaths globally in 2015.^[12]^[13] Children and those in the developing world are most commonly affected.^[14] As of 2011, in those younger than five, there were about 1.7 billion cases resulting in 0.7 million deaths,^[15] with most of these occurring in the world's poorest nations.^[16] More than 450,000 of these fatalities are due to rotavirus in children under five years of age.^[7]^[78] Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly.^[30] In the developing world, children less than two years of age frequently get six or more infections a year that result in significant gastroenteritis.^[16] It is less common in adults, partly due to the development of acquired immunity.^[17]

In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world.^[72] Death rates were reduced significantly (to approximately 1.5 million deaths annually) by 2000, largely due to the introduction and widespread use of oral rehydration therapy.^[79] In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea^[16]^[17] and approximately ten thousand deaths annually,^[16] with 150 to 300 of these deaths in children less than five years of age.^[2]

Society and culture

Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others.^[16] It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".^[16]

Gastroenteritis is the main reason for 3.7 million visits to physicians a year in the United States^[2] and 3 million visits in France.^[80] In the United States gastroenteritis as a whole is believed to result in costs of US$23 billion per year,^[81] with rotavirus alone resulting in estimated costs of US$1 billion a year.^[2]

Terminology

Script error: No such module "anchor". The first usage of "gastroenteritis" was in 1825.^[82] Before this time it was commonly known as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of several other archaic names for acute diarrhea.^[83] Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.^[84]

Animals

Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are Campylobacter, Clostridioides difficile, Clostridium perfringens, and Salmonella.^[85] A large number of toxic plants may also cause symptoms.^[86]

Some agents are more specific to a certain species. Transmissible gastroenteritis coronavirus (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration.^[87] It is believed to be introduced to pigs by wild birds and there is no specific treatment available.^[88] It is not transmissible to humans.^[89]

References

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Notes

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External links

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Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years – NICE Clinical Guidelines, No. 84.
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 }}
-'''Gastroenteritis''', also known as '''infectious diarrhea''', is an [[inflammation]] of the [[Human gastrointestinal tract|gastrointestinal tract]] including the [[stomach]] and [[intestine]].<ref name="Sch2015">{{cite book|last1=Schlossberg|first1=David|title=Clinical infectious disease|date=2015|isbn=978-1-107-03891-2|page=334|publisher=Cambridge University Press |edition=Second|url=https://books.google.com/books?id=meFwBwAAQBAJ&pg=PA334|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=meFwBwAAQBAJ&pg=PA334|archive-date=2017-09-08}}</ref> Symptoms may include [[diarrhea]], [[vomiting]], and [[abdominal pain]].<ref name="EBMED2010">{{cite journal|last=Singh|first=Amandeep|title=Pediatric Emergency Medicine Practice Acute Gastroenteritis — An Update|journal=Pediatric Emergency Medicine Practice|date=July 2010|volume=7|issue=7|url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=229}}</ref> [[Fever]], lack of energy, and [[dehydration]] may also occur.<ref name=Ci2013/><ref name="Fer2015">{{cite book|title=Ferri's Clinical Advisor 2015: 5 Books in 1|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-08430-7|page=479|url=https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA479|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA479|archive-date=2017-09-08}}</ref> This typically lasts less than two weeks.<ref name=Sch2015/> Although it is not related to [[influenza]], in the U.S it is sometimes called the "'''stomach flu'''".<ref>{{cite book|last1=Shors|first1=Teri|title=The microbial challenge: a public health perspective|date=2013|publisher=Jones & Bartlett Learning|location=Burlington, MA|isbn=978-1-4496-7333-8|page=457|edition=3rd|url=https://books.google.com/books?id=TDcvAqyx7AIC&pg=PA457|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=TDcvAqyx7AIC&pg=PA457|archive-date=2017-09-08}}</ref>
+'''Gastroenteritis''', also known as '''infectious diarrhea''', is an [[inflammation]] of the [[Human gastrointestinal tract|gastrointestinal tract]] including the [[stomach]] and [[intestine]].<ref name="Sch2015">{{cite book|last1=Schlossberg|first1=David|title=Clinical infectious disease|date=2015|isbn=978-1-107-03891-2|page=334|publisher=Cambridge University Press |edition=Second|url=https://books.google.com/books?id=meFwBwAAQBAJ&pg=PA334|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=meFwBwAAQBAJ&pg=PA334|archive-date=2017-09-08}}</ref> Symptoms may include [[diarrhea]], [[vomiting]], and [[abdominal pain]].<ref name="EBMED2010">{{cite journal|last=Singh|first=Amandeep|title=Pediatric Emergency Medicine Practice Acute Gastroenteritis — An Update|journal=Pediatric Emergency Medicine Practice|date=July 2010|volume=7|issue=7|url=http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=229}}</ref> [[Fever]], lack of energy, and [[dehydration]] may also occur.<ref name=Ci2013/><ref name="Fer2015">{{cite book|title=Ferri's Clinical Advisor 2015: 5 Books in 1|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-08430-7|page=479|url=https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA479|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=icTsAwAAQBAJ&pg=PA479|archive-date=2017-09-08}}</ref> This typically lasts less than two weeks.<ref name=Sch2015/> Although it is not related to [[influenza]], in Canada and the United States it is often referred to as "'''stomach flu'''".<ref>{{cite book|last1=Shors|first1=Teri|title=The microbial challenge: a public health perspective|date=2013|publisher=Jones & Bartlett Learning|location=Burlington, MA|isbn=978-1-4496-7333-8|page=457|edition=3rd|url=https://books.google.com/books?id=TDcvAqyx7AIC&pg=PA457|url-status=live|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=TDcvAqyx7AIC&pg=PA457|archive-date=2017-09-08}}</ref>
 Gastroenteritis is usually caused by [[viruses]];<ref name="Helm2006" /> however, gut [[bacteria]], [[parasites]], and [[fungus|fungi]] can also cause gastroenteritis.<ref name="Ci2013" /><ref name="Helm2006">{{cite book|url=https://books.google.com/books?id=aVmRWrknaWgC&pg=PA2003|title=Textbook of therapeutics: drug and disease management|last1=A. Helms|first1=Richard|date=2006|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-5734-8|edition=8|location=Philadelphia [u.a.]|page=2003|archive-url=https://web.archive.org/web/20170908184604/https://books.google.com/books?id=aVmRWrknaWgC&pg=PA2003|archive-date=2017-09-08|url-status=live}}</ref> In children, [[rotavirus]] is the most common cause of severe disease.<ref name="Rota2012">{{cite journal |vauthors=Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD |title=2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis |journal=The Lancet Infectious Diseases |volume=12 |issue=2 |pages=136–41 |date=February 2012 |pmid=22030330 |doi=10.1016/S1473-3099(11)70253-5 |url=https://zenodo.org/record/1260248 }}</ref> In adults, [[norovirus]] and ''[[Campylobacter]]'' are common causes.<ref name="pmid21695033">{{cite journal |vauthors=Marshall JA, Bruggink LD |title=The dynamics of norovirus outbreak epidemics: recent insights |journal=International Journal of Environmental Research and Public Health |volume=8 |issue=4 |pages=1141–9 |date=April 2011 |pmid=21695033 |pmc=3118882 |doi=10.3390/ijerph8041141|doi-access=free }}</ref><ref name="pmid22025030">{{cite journal |author=Man SM |title=The clinical importance of emerging Campylobacter species |journal=Nature Reviews Gastroenterology & Hepatology |volume=8 |issue=12 |pages=669–85 |date=December 2011 |pmid=22025030 |doi=10.1038/nrgastro.2011.191|s2cid=24103030 }}</ref> Eating improperly prepared food, drinking contaminated water or close contact with a person who is infected can [[#Transmission|spread the disease]].<ref name=Ci2013/> Treatment is generally the same with or without a definitive diagnosis, so testing to confirm is usually not needed.<ref name=Ci2013/>
@@ Line 91: / Line 91: @@
 ===Vaccination===
-Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the [[rotavirus vaccine]] be offered to all children globally.<ref name="Sz2010">{{cite journal|last=Szajewska|first=H|author2=Dziechciarz, P|title=Gastrointestinal infections in the pediatric population|journal=Current Opinion in Gastroenterology|date=January 2010 |volume=26|issue=1|pages=36–44|pmid=19887936|doi=10.1097/MOG.0b013e328333d799|s2cid=5083478}}</ref><ref name="WHORota2009">{{cite journal|last=World Health Organization|title=Rotavirus vaccines: an update|journal=Weekly Epidemiological Record|date=December 2009|volume=84|issue=50|pages=533–540|pmid=20034143|url=https://www.who.int/wer/2009/wer8451_52.pdf|access-date=10 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120709034841/http://www.who.int/wer/2009/wer8451_52.pdf|archive-date=9 July 2012}}</ref> Two commercial rotavirus vaccines exist and several more are in development.<ref name=WHORota2009/> In Africa and Asia these vaccines reduced severe disease among infants<ref name=WHORota2009/> and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.<ref>{{cite journal|vauthors=Giaquinto C, Dominiak-Felden G, Van Damme P, Myint TT, Maldonado YA, Spoulou V, Mast TC, Staat MA|title=Summary of effectiveness and impact of rotavirus vaccination with the oral pentavalent rotavirus vaccine: a systematic review of the experience in industrialized countries|journal=Human Vaccines|date=July 2011|volume=7|pages=734–748|url=http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|access-date=10 May 2012|doi=10.4161/hv.7.7.15511|pmid=21734466|issue=7|s2cid=23996836|url-status=live|archive-url=https://web.archive.org/web/20130217163038/http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|archive-date=17 February 2013|doi-access=free}}</ref><ref>{{cite journal|last=Jiang|first=V|author2=Jiang B|author3=Tate J|author4=Parashar UD|author5=Patel MM|title=Performance of rotavirus vaccines in developed and developing countries|journal=Human Vaccines|date=July 2010|volume=6|issue=7|pages=532–542|url=http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|access-date=10 May 2012|pmid=20622508|pmc=3322519|doi=10.4161/hv.6.7.11278|url-status=dead|archive-url=https://web.archive.org/web/20130217163031/http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|archive-date=17 February 2013}}</ref> This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.<ref>{{cite journal|last=Patel|first=MM|author2=Steele, D |author3=Gentsch, JR |author4=Wecker, J |author5=Glass, RI |author6=Parashar, UD |title=Real-world impact of rotavirus vaccination|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S1–5|pmid=21183833|doi=10.1097/INF.0b013e3181fefa1f|s2cid=1893099 |doi-access=free}}</ref> Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.<ref name="CDC Rota">{{cite journal|last=US Center for Disease Control and Prevention|title=Delayed onset and diminished magnitude of rotavirus activity—United States, November 2007 – May 2008|journal=Morbidity and Mortality Weekly Report|year=2008|volume=57|issue=25|pages=697–700|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|access-date=3 May 2012|pmid=18583958|url-status=live|archive-url=https://web.archive.org/web/20120608073201/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|archive-date=8 June 2012}}</ref><ref>{{cite journal |title=Reduction in rotavirus after vaccine introduction—United States, 2000–2009 |journal=Morbidity and Mortality Weekly Report |volume=58 |issue=41 |pages=1146–9 |date=October 2009 |pmid=19847149 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |url-status=live |archive-url=https://web.archive.org/web/20091031060444/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |archive-date=2009-10-31 |author1=Centers for Disease Control Prevention (CDC) }}</ref><ref>{{cite journal|last=Tate|first=JE |author2=Cortese, MM |author3=Payne, DC |author4=Curns, AT |author5=Yen, C |author6=Esposito, DH |author7=Cortes, JE |author8=Lopman, BA |author9=Patel, MM |author10=Gentsch, JR |author11=Parashar, UD|title=Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S56–60|pmid=21183842|doi=10.1097/INF.0b013e3181fefdc0|s2cid=20940659 |doi-access=free }}</ref> The first dose of vaccine should be given to infants between 6 and 15 weeks of age.<ref name=Sz2010/> The [[Cholera vaccine|oral cholera vaccine]] has been found to be 50–60% effective over two years.<ref>{{cite journal|editor1-last=Sinclair|editor1-first=David|last=Sinclair|first=D|author2=Abba, K |author3=Zaman, K |author4=Qadri, F |author5=Graves, PM |title=Oral vaccines for preventing cholera.|journal=Cochrane Database of Systematic Reviews |date=16 March 2011 |volume=2011 |issue=3|pages=CD008603|pmid=21412922|doi=10.1002/14651858.CD008603.pub2|pmc=6532691}}</ref>
+Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the [[rotavirus vaccine]] be offered to all children globally.<ref name="Sz2010">{{cite journal|last=Szajewska|first=H|author2=Dziechciarz, P|title=Gastrointestinal infections in the pediatric population|journal=Current Opinion in Gastroenterology|date=January 2010 |volume=26|issue=1|pages=36–44|pmid=19887936|doi=10.1097/MOG.0b013e328333d799|s2cid=5083478}}</ref><ref name="WHORota2009">{{cite journal|last=World Health Organization|title=Rotavirus vaccines: an update|journal=Weekly Epidemiological Record|date=December 2009|volume=84|issue=50|pages=533–540|pmid=20034143|url=https://www.who.int/wer/2009/wer8451_52.pdf|access-date=10 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120709034841/http://www.who.int/wer/2009/wer8451_52.pdf|archive-date=9 July 2012}}</ref> Two commercial rotavirus vaccines exist and several more are in development.<ref name=WHORota2009/> In Africa and Asia these vaccines reduced severe disease among infants<ref name=WHORota2009/> and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.<ref>{{cite journal|vauthors=Giaquinto C, Dominiak-Felden G, Van Damme P, Myint TT, Maldonado YA, Spoulou V, Mast TC, Staat MA|title=Summary of effectiveness and impact of rotavirus vaccination with the oral pentavalent rotavirus vaccine: a systematic review of the experience in industrialized countries|journal=Human Vaccines|date=July 2011|volume=7|pages=734–748|url=http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|access-date=10 May 2012|doi=10.4161/hv.7.7.15511|pmid=21734466|issue=7|s2cid=23996836|url-status=live|archive-url=https://web.archive.org/web/20130217163038/http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|archive-date=17 February 2013|doi-access=free}}</ref><ref>{{cite journal|last=Jiang|first=V|author2=Jiang B|author3=Tate J|author4=Parashar UD|author5=Patel MM|title=Performance of rotavirus vaccines in developed and developing countries|journal=Human Vaccines|date=July 2010|volume=6|issue=7|pages=532–542|url=http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|access-date=10 May 2012|pmid=20622508|pmc=3322519|doi=10.4161/hv.6.7.11278|url-status=dead|archive-url=https://web.archive.org/web/20130217163031/http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|archive-date=17 February 2013}}</ref> This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.<ref>{{cite journal|last=Patel|first=MM|author2=Steele, D |author3=Gentsch, JR |author4=Wecker, J |author5=Glass, RI |author6=Parashar, UD |title=Real-world impact of rotavirus vaccination|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S1–5|pmid=21183833|doi=10.1097/INF.0b013e3181fefa1f|s2cid=1893099 |doi-access=free}}</ref> Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.<ref name="CDC Rota">{{cite journal|last=US Center for Disease Control and Prevention|title=Delayed onset and diminished magnitude of rotavirus activity—United States, November 2007 – May 2008|journal=Morbidity and Mortality Weekly Report|year=2008|volume=57|issue=25|pages=697–700|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|access-date=3 May 2012|pmid=18583958|url-status=live|archive-url=https://web.archive.org/web/20120608073201/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|archive-date=8 June 2012}}</ref><ref>{{cite journal |title=Reduction in rotavirus after vaccine introduction—United States, 2000–2009 |journal=Morbidity and Mortality Weekly Report |volume=58 |issue=41 |pages=1146–9 |date=October 2009 |pmid=19847149 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |url-status=live |archive-url=https://web.archive.org/web/20091031060444/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |archive-date=2009-10-31 |author1=Centers for Disease Control Prevention (CDC) }}</ref><ref>{{cite journal|last=Tate|first=JE |author2=Cortese, MM |author3=Payne, DC |author4=Curns, AT |author5=Yen, C |author6=Esposito, DH |author7=Cortes, JE |author8=Lopman, BA |author9=Patel, MM |author10=Gentsch, JR |author11=Parashar, UD|title=Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S56–60|pmid=21183842|doi=10.1097/INF.0b013e3181fefdc0|s2cid=20940659 |doi-access=free }}</ref> The first dose of vaccine should be given to infants between 6 and 15 weeks of age.<ref name=Sz2010/> The [[Cholera vaccine|oral cholera vaccine]] has been found to be 50–60% effective over two years.<ref>{{cite journal|editor1-last=Sinclair|editor1-first=David|last=Sinclair|first=D|author2=Abba, K |author3=Zaman, K |author4=Qadri, F |author5=Graves, PM |title=Oral vaccines for preventing cholera.|journal=Cochrane Database of Systematic Reviews |date=16 March 2011 |volume=2011 |issue=3|article-number=CD008603|pmid=21412922|doi=10.1002/14651858.CD008603.pub2|pmc=6532691}}</ref>
 There are a number of vaccines against gastroenteritis in development. For example, vaccines against ''Shigella'' and enterotoxigenic ''Escherichia coli'' (ETEC), which are two of the leading bacterial causes of gastroenteritis worldwide.<ref name="WHO ETEC">{{cite web|author=World Health Organization|title=Enterotoxigenic Escherichia coli (ETEC)|url=https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index4.html|url-status=dead|archive-url=https://web.archive.org/web/20120515142857/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index4.html|archive-date=15 May 2012|access-date=3 May 2012|work=Diarrhoeal Diseases}}</ref><ref name="WHO Shig">{{cite web|author=World Health Organization|title=Shigellosis|url=https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html|url-status=dead|archive-url=https://web.archive.org/web/20081215123745/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html|archive-date=15 December 2008|access-date=3 May 2012|work=Diarrhoeal Diseases}}</ref>
 ==Management==
-Gastroenteritis is usually an acute and self-limiting disease that does not require medication.<ref name=NICE2009/> The preferred treatment in those with mild to moderate [[dehydration]] is [[oral rehydration therapy]] (ORT).<ref name=BMJ2007 /> For children at risk of dehydration from vomiting, taking a single dose of the [[antiemetic|anti vomiting]] medication [[metoclopramide]] or [[ondansetron]], may be helpful,<ref name="Fedorowicz2011">{{Cite journal|last1=Fedorowicz|first1=Zbys|last2=Jagannath|first2=Vanitha A.|last3=Carter|first3=Ben|date=2011-09-07|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews|volume=130|issue=9|pages=270|doi=10.1002/14651858.CD005506.pub5|issn=1469-493X|pmid=21901699|pmc=6768985}}</ref> and [[butylscopolamine]] is useful in treating [[abdominal pain]].<ref>{{cite journal |author=Tytgat GN |title=Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain |journal=Drugs |volume=67 |issue=9 |pages=1343–57 |year=2007 |pmid=17547475 |doi=10.2165/00003495-200767090-00007|s2cid=46971321 }}</ref>
+Gastroenteritis is usually an acute and self-limiting disease that does not require medication.<ref name=NICE2009/> The preferred treatment in those with mild to moderate [[dehydration]] is [[oral rehydration therapy]] (ORT).<ref name=BMJ2007 /> For children at risk of dehydration from vomiting, taking a single dose of the [[antiemetic|anti vomiting]] medication [[metoclopramide]] or [[ondansetron]], may be helpful,<ref name="Fedorowicz2011">{{Cite journal|last1=Fedorowicz|first1=Zbys|last2=Jagannath|first2=Vanitha A.|last3=Carter|first3=Ben|date=2011-09-07|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews|volume=130|issue=9|page=270|doi=10.1002/14651858.CD005506.pub5|issn=1469-493X|pmid=21901699|pmc=6768985}}</ref> and [[butylscopolamine]] is useful in treating [[abdominal pain]].<ref>{{cite journal |author=Tytgat GN |title=Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain |journal=Drugs |volume=67 |issue=9 |pages=1343–57 |year=2007 |pmid=17547475 |doi=10.2165/00003495-200767090-00007|s2cid=46971321 }}</ref>
 ===Rehydration===
-The primary treatment of gastroenteritis in both children and adults is [[Fluid replacement|rehydration]]. This is preferably achieved by drinking rehydration solution, although [[intravenous therapy|intravenous]] delivery may be required if there is a [[decreased level of consciousness]] or if dehydration is severe.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1039 |title=BestBets: Fluid Treatment of Gastroenteritis in Adults |url-status=live |archive-url=https://web.archive.org/web/20090212164231/http://www.bestbets.org/bets/bet.php?id=1039 |archive-date=2009-02-12 }}</ref><ref>{{cite journal |vauthors=Canavan A, Arant BS |title=Diagnosis and management of dehydration in children |journal=American Family Physician |volume=80 |issue=7 |pages=692–6 |date=October 2009 |pmid=19817339 }}</ref> Drinking replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.<ref>{{cite journal|last1=Gregorio|first1=GV|last2=Gonzales|first2=ML|last3=Dans|first3=LF|last4=Martinez|first4=EG|title=Polymer-based oral rehydration solution for treating acute watery diarrhoea|journal=Cochrane Database of Systematic Reviews|date=13 December 2016|volume=2016|issue=12 |pages=CD006519|pmid=27959472|doi=10.1002/14651858.CD006519.pub3|pmc=5450881}}</ref> Drinks especially high in simple sugars, such as [[soft drinks]] and fruit juices, are not recommended in children under five years of age as they may ''increase'' diarrhea.<ref name=NICE2009/> Plain water may be used if more specific ORT preparations are unavailable or the person is not willing to drink them.<ref name=NICE2009/> A [[nasogastric tube]] can be used in young children to administer fluids if warranted.<ref name=Webb2005/> In those who require intravenous fluids, one to four hours' worth is often sufficient.<ref>{{cite journal |last1=Toaimah|first1=FH|last2=Mohammad|first2=HM|s2cid=20509810|title=Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review|journal=Pediatric Emergency Care |date=February 2016|volume=32|issue=2|pages=131–5|pmid=26835574|doi=10.1097/pec.0000000000000708}}</ref>
+The primary treatment of gastroenteritis in both children and adults is [[Fluid replacement|rehydration]]. This is preferably achieved by drinking rehydration solution, although [[intravenous therapy|intravenous]] delivery may be required if there is a [[decreased level of consciousness]] or if dehydration is severe.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1039 |title=BestBets: Fluid Treatment of Gastroenteritis in Adults |url-status=live |archive-url=https://web.archive.org/web/20090212164231/http://www.bestbets.org/bets/bet.php?id=1039 |archive-date=2009-02-12 }}</ref><ref>{{cite journal |vauthors=Canavan A, Arant BS |title=Diagnosis and management of dehydration in children |journal=American Family Physician |volume=80 |issue=7 |pages=692–6 |date=October 2009 |pmid=19817339 }}</ref> Drinking replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.<ref>{{cite journal|last1=Gregorio|first1=GV|last2=Gonzales|first2=ML|last3=Dans|first3=LF|last4=Martinez|first4=EG|title=Polymer-based oral rehydration solution for treating acute watery diarrhoea|journal=Cochrane Database of Systematic Reviews|date=13 December 2016|volume=2016|issue=12 |article-number=CD006519|pmid=27959472|doi=10.1002/14651858.CD006519.pub3|pmc=5450881}}</ref> Drinks especially high in simple sugars, such as [[soft drinks]] and fruit juices, are not recommended in children under five years of age as they may ''increase'' diarrhea.<ref name=NICE2009/> Plain water may be used if more specific ORT preparations are unavailable or the person is not willing to drink them.<ref name=NICE2009/> A [[nasogastric tube]] can be used in young children to administer fluids if warranted.<ref name=Webb2005/> In those who require intravenous fluids, one to four hours' worth is often sufficient.<ref>{{cite journal |last1=Toaimah|first1=FH|last2=Mohammad|first2=HM|s2cid=20509810|title=Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review|journal=Pediatric Emergency Care |date=February 2016|volume=32|issue=2|pages=131–5|pmid=26835574|doi=10.1097/pec.0000000000000708}}</ref>
 ===Dietary===
 It is recommended that breast-fed infants continue to be nursed in the usual fashion,  and that formula-fed infants continue their formula immediately after rehydration with ORT.<ref name="MMWR2003">{{cite journal |vauthors=King CK, Glass R, Bresee JS, Duggan C |title=Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy |journal= MMWR. Recommendations and Reports |volume=52 |issue=RR-16 |pages=1–16 |date=November 2003 |pmid=14627948 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm |url-status=live |archive-url=https://web.archive.org/web/20141028174056/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm |archive-date=2014-10-28 }}</ref> Lactose-free or lactose-reduced formulas usually are not necessary.<ref name=MMWR2003/> Children should continue their usual diet during episodes of diarrhea with the exception that foods high in [[simple sugar]]s should be avoided.<ref name=MMWR2003/> The [[BRAT diet]] (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.<ref name=MMWR2003/>
-A Cochrane Review from 2020 concludes that [[probiotic]]s make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.<ref>{{cite journal | vauthors = Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ | title = Probiotics for treating acute infectious diarrhoea | journal = Cochrane Database Syst Rev | volume = 2020 | issue = 12 | pages = CD003048 | date = December 2020 | pmid = 33295643 | pmc = 8166250 | doi = 10.1002/14651858.CD003048.pub4 }}</ref> They may be useful in preventing and treating [[antibiotic associated diarrhea]].<ref>{{cite journal|last=Hempel|first=S|author2=Newberry, SJ |author3=Maher, AR |author4=Wang, Z |author5=Miles, JN |author6=Shanman, R |author7=Johnsen, B |author8= Shekelle, PG |title=Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis|journal=JAMA: The Journal of the American Medical Association|date=9 May 2012 |volume=307|issue=18|pages=1959–69|pmid=22570464|doi=10.1001/jama.2012.3507|doi-access=}}</ref> Fermented milk products (such as [[yogurt]]) are similarly beneficial.<ref>{{cite web|last=Mackway-Jones|first=Kevin|title=Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis?|url=http://www.bestbets.org/bets/bet.php?id=1000|work=BestBets|date=June 2007|url-status=live|archive-url=https://web.archive.org/web/20090212163443/http://www.bestbets.org/bets/bet.php?id=1000|archive-date=2009-02-12}}</ref> [[Zinc]] supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.<ref>{{cite journal|last=Telmesani|first=AM|title=Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea.|journal=Journal of Family and Community Medicine|date=May 2010 |volume=17|issue=2|pages=79–82|pmid=21359029|doi=10.4103/1319-1683.71988|pmc=3045093 |doi-access=free }}</ref>
+A Cochrane Review from 2020 concludes that [[probiotic]]s make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.<ref>{{cite journal | vauthors = Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ | title = Probiotics for treating acute infectious diarrhoea | journal = Cochrane Database Syst Rev | volume = 2020 | issue = 12 | article-number = CD003048 | date = December 2020 | pmid = 33295643 | pmc = 8166250 | doi = 10.1002/14651858.CD003048.pub4 }}</ref> They may be useful in preventing and treating [[antibiotic associated diarrhea]].<ref>{{cite journal|last=Hempel|first=S|author2=Newberry, SJ |author3=Maher, AR |author4=Wang, Z |author5=Miles, JN |author6=Shanman, R |author7=Johnsen, B |author8= Shekelle, PG |title=Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis|journal=JAMA: The Journal of the American Medical Association|date=9 May 2012 |volume=307|issue=18|pages=1959–69|pmid=22570464|doi=10.1001/jama.2012.3507|doi-access=}}</ref> Fermented milk products (such as [[yogurt]]) are similarly beneficial.<ref>{{cite web|last=Mackway-Jones|first=Kevin|title=Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis?|url=http://www.bestbets.org/bets/bet.php?id=1000|work=BestBets|date=June 2007|url-status=live|archive-url=https://web.archive.org/web/20090212163443/http://www.bestbets.org/bets/bet.php?id=1000|archive-date=2009-02-12}}</ref> [[Zinc]] supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.<ref>{{cite journal|last=Telmesani|first=AM|title=Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea.|journal=Journal of Family and Community Medicine|date=May 2010 |volume=17|issue=2|pages=79–82|pmid=21359029|doi=10.4103/1319-1683.71988|pmc=3045093 |doi-access=free }}</ref>
 ===Antiemetics===
-[[Antiemetic]] medications may be helpful for treating vomiting in children. [[Ondansetron]] has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.<ref name=Fedorowicz2011 /><ref>{{cite journal |vauthors=DeCamp LR, Byerley JS, Doshi N, Steiner MJ |title=Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis |journal=Archives of Pediatrics & Adolescent Medicine |volume=162 |issue=9 |pages=858–65 |date=September 2008 |pmid=18762604|doi=10.1001/archpedi.162.9.858 |doi-access=free }}</ref><ref name="pmid17279195">{{cite journal|vauthors=Mehta S, Goldman RD | title = Ondansetron for acute gastroenteritis in children| journal = Canadian Family Physician| volume = 52| issue = 11| pages = 1397–8| year = 2006| pmid = 17279195 | url =http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195 | pmc = 1783696 }}</ref><ref name=Cochrane2011/> [[Metoclopramide]] might also be helpful.<ref name="Cochrane2011">{{cite journal|editor1-last=Fedorowicz|editor1-first=Zbys|last=Fedorowicz|first=Z |author2=Jagannath, VA |author3=Carter, B|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews |date=7 September 2011 |volume=9|issue=9|pages=CD005506|pmid=21901699|pmc=6768985|doi=10.1002/14651858.CD005506.pub5}}</ref> However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.<ref>{{cite journal |vauthors=Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK |title=Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? |journal=Annals of Emergency Medicine |volume=55 |issue=5 |pages=415–22 |date=May 2010 |pmid=20031265 |doi=10.1016/j.annemergmed.2009.11.011 }}</ref> The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.<ref>{{cite web|title=Ondansetron|url=http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|work=Lexi-Comp|date=May 2011|url-status=live|archive-url=https://web.archive.org/web/20120606132320/http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|archive-date=2012-06-06}}</ref> [[Dimenhydrinate]], while reducing vomiting, does not appear to have a significant clinical benefit.<ref name=EBMED2010/>
+[[Antiemetic]] medications may be helpful for treating vomiting in children. [[Ondansetron]] has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.<ref name=Fedorowicz2011 /><ref>{{cite journal |vauthors=DeCamp LR, Byerley JS, Doshi N, Steiner MJ |title=Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis |journal=Archives of Pediatrics & Adolescent Medicine |volume=162 |issue=9 |pages=858–65 |date=September 2008 |pmid=18762604|doi=10.1001/archpedi.162.9.858 |doi-access=free }}</ref><ref name="pmid17279195">{{cite journal|vauthors=Mehta S, Goldman RD | title = Ondansetron for acute gastroenteritis in children| journal = Canadian Family Physician| volume = 52| issue = 11| pages = 1397–8| year = 2006| pmid = 17279195 | url =http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195 | pmc = 1783696 }}</ref><ref name=Cochrane2011/> [[Metoclopramide]] might also be helpful.<ref name="Cochrane2011">{{cite journal|editor1-last=Fedorowicz|editor1-first=Zbys|last=Fedorowicz|first=Z |author2=Jagannath, VA |author3=Carter, B|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews |date=7 September 2011 |volume=9|issue=9|article-number=CD005506|pmid=21901699|pmc=6768985|doi=10.1002/14651858.CD005506.pub5}}</ref> However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.<ref>{{cite journal |vauthors=Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK |title=Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? |journal=Annals of Emergency Medicine |volume=55 |issue=5 |pages=415–22 |date=May 2010 |pmid=20031265 |doi=10.1016/j.annemergmed.2009.11.011 }}</ref> The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.<ref>{{cite web|title=Ondansetron|url=http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|work=Lexi-Comp|date=May 2011|url-status=live|archive-url=https://web.archive.org/web/20120606132320/http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|archive-date=2012-06-06}}</ref> [[Dimenhydrinate]], while reducing vomiting, does not appear to have a significant clinical benefit.<ref name=EBMED2010/>
 ===Antibiotics===
-Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe<ref>{{cite journal |vauthors=Traa BS, Walker CL, Munos M, Black RE |title=Antibiotics for the treatment of dysentery in children |journal=International Journal of Epidemiology |volume=39 |issue=Suppl 1 |pages=i70–4 |date=April 2010 |pmid=20348130 |pmc=2845863 |doi=10.1093/ije/dyq024 }}</ref> or if a susceptible bacterial cause is isolated or suspected.<ref>{{cite journal |vauthors=Grimwood K, Forbes DA |title=Acute and persistent diarrhea |journal=Pediatric Clinics of North America |volume=56 |issue=6 |pages=1343–61 |date=December 2009 |pmid=19962025 |doi=10.1016/j.pcl.2009.09.004 }}</ref> If antibiotics are to be employed, a [[macrolide]] (such as [[azithromycin]]) is preferred over a [[fluoroquinolone]] due to higher rates of resistance to the latter.<ref name=Bact2007/> [[Pseudomembranous colitis]], usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either [[metronidazole]] or [[vancomycin]].<ref name="Mandell"/> Bacteria and protozoans that are amenable to treatment include ''[[shigellosis|Shigella]]''<ref>{{cite journal|editor1-last=Christopher|editor1-first=Prince RH|last=Christopher|first=PR |author2=David, KV |author3=John, SM |author4=Sankarapandian, V|title=Antibiotic therapy for Shigella dysentery.|journal=Cochrane Database of Systematic Reviews |date=4 August 2010 |volume=2010 |issue=8|pages=CD006784|pmid=20687081|doi=10.1002/14651858.CD006784.pub4|pmc=6532574}}</ref> ''[[Salmonellosis|Salmonella typhi]]'',<ref>{{cite journal|editor1-last=Bhutta|editor1-first=Zulfiqar A|last=Effa|first=EE |author2=Lassi, ZS |author3=Critchley, JA |author4=Garner, P |author5=Sinclair, D |author6=Olliaro, PL |author7=Bhutta, ZA|title=Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever).|journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |volume=2011 |issue=10|pages=CD004530|pmid=21975746|pmc=6532575|doi=10.1002/14651858.CD004530.pub4|url=https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1078&context=pakistan_fhs_mc_women_childhealth_paediatr}}</ref> and ''Giardia'' species.<ref name=Giar2010/> In those with ''[[Giardia]]'' species or ''Entamoeba histolytica'', [[tinidazole]] treatment is recommended and superior to metronidazole.<ref name=Giar2010/><ref>{{Cite journal|last1=Gonzales|first1=Maria Liza M.|last2=Dans|first2=Leonila F.|last3=Sio-Aguilar|first3=Juliet|date=9 January 2019|title=Antiamoebic drugs for treating amoebic colitis|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD006085|doi=10.1002/14651858.CD006085.pub3|issn=1469-493X|pmc=6326239|pmid=30624763}}</ref> The [[World Health Organization]] (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.<ref name=EBMED2010/>
+Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe<ref>{{cite journal |vauthors=Traa BS, Walker CL, Munos M, Black RE |title=Antibiotics for the treatment of dysentery in children |journal=International Journal of Epidemiology |volume=39 |issue=Suppl 1 |pages=i70–4 |date=April 2010 |pmid=20348130 |pmc=2845863 |doi=10.1093/ije/dyq024 }}</ref> or if a susceptible bacterial cause is isolated or suspected.<ref>{{cite journal |vauthors=Grimwood K, Forbes DA |title=Acute and persistent diarrhea |journal=Pediatric Clinics of North America |volume=56 |issue=6 |pages=1343–61 |date=December 2009 |pmid=19962025 |doi=10.1016/j.pcl.2009.09.004 }}</ref> If antibiotics are to be employed, a [[macrolide]] (such as [[azithromycin]]) is preferred over a [[fluoroquinolone]] due to higher rates of resistance to the latter.<ref name=Bact2007/> [[Pseudomembranous colitis]], usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either [[metronidazole]] or [[vancomycin]].<ref name="Mandell"/> Bacteria and protozoans that are amenable to treatment include ''[[shigellosis|Shigella]]''<ref>{{cite journal|editor1-last=Christopher|editor1-first=Prince RH|last=Christopher|first=PR |author2=David, KV |author3=John, SM |author4=Sankarapandian, V|title=Antibiotic therapy for Shigella dysentery.|journal=Cochrane Database of Systematic Reviews |date=4 August 2010 |volume=2010 |issue=8|article-number=CD006784|pmid=20687081|doi=10.1002/14651858.CD006784.pub4|pmc=6532574}}</ref> ''[[Salmonellosis|Salmonella typhi]]'',<ref>{{cite journal|editor1-last=Bhutta|editor1-first=Zulfiqar A|last=Effa|first=EE |author2=Lassi, ZS |author3=Critchley, JA |author4=Garner, P |author5=Sinclair, D |author6=Olliaro, PL |author7=Bhutta, ZA|title=Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever).|journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |volume=2011 |issue=10|article-number=CD004530|pmid=21975746|pmc=6532575|doi=10.1002/14651858.CD004530.pub4|url=https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1078&context=pakistan_fhs_mc_women_childhealth_paediatr}}</ref> and ''Giardia'' species.<ref name=Giar2010/> In those with ''[[Giardia]]'' species or ''Entamoeba histolytica'', [[tinidazole]] treatment is recommended and superior to metronidazole.<ref name=Giar2010/><ref>{{Cite journal|last1=Gonzales|first1=Maria Liza M.|last2=Dans|first2=Leonila F.|last3=Sio-Aguilar|first3=Juliet|date=9 January 2019|title=Antiamoebic drugs for treating amoebic colitis|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |article-number=CD006085|doi=10.1002/14651858.CD006085.pub3|issn=1469-493X|pmc=6326239|pmid=30624763}}</ref> The [[World Health Organization]] (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.<ref name=EBMED2010/>
 ===Antimotility agents===
@@ Line 142: / Line 142: @@
 Gastroenteritis is associated with many colloquial names, including "[[Montezuma's revenge]]", "Delhi belly", "la turista", and "back door sprint", among others.<ref name=M93/> It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".<ref name=M93/>
-Gastroenteritis is the main reason for 3.7&nbsp;million visits to physicians a year in the United States<ref name=EBMED2010/> and 3&nbsp;million visits in France.<ref>{{cite journal|last=Flahault|first=A|author2=Hanslik, T|title=[Epidemiology of viral gastroenteritis in France and Europe].|journal=Bulletin de l'Académie Nationale de Médecine|date=November 2010 |volume=194|issue=8|pages=1415–24; discussion 1424–5|pmid=22046706|doi=10.1016/S0001-4079(19)32172-7|url=http://archive-ouverte.unige.ch/unige:47039|doi-access=free}}</ref> In the United States gastroenteritis as a whole is believed to result in costs of US$23&nbsp;billion per year,<ref>{{cite book |editor1-last=Skolnik |editor1-first=Neil S. |editor2-last=Albert |editor2-first=Ross H. |title=Essential infectious disease topics for primary care|year=2008|publisher=Humana Press|location=Totowa, NJ|isbn=978-1-58829-520-0|pages=66|url=https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|url-status=live|archive-url=https://web.archive.org/web/20151128094307/https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|archive-date=2015-11-28}}</ref> with rotavirus alone resulting in estimated costs of US$1&nbsp;billion a year.<ref name=EBMED2010/>
+Gastroenteritis is the main reason for 3.7&nbsp;million visits to physicians a year in the United States<ref name=EBMED2010/> and 3&nbsp;million visits in France.<ref>{{cite journal|last=Flahault|first=A|author2=Hanslik, T|title=[Epidemiology of viral gastroenteritis in France and Europe].|journal=Bulletin de l'Académie Nationale de Médecine|date=November 2010 |volume=194|issue=8|pages=1415–24; discussion 1424–5|pmid=22046706|doi=10.1016/S0001-4079(19)32172-7|url=http://archive-ouverte.unige.ch/unige:47039|doi-access=free}}</ref> In the United States gastroenteritis as a whole is believed to result in costs of US$23&nbsp;billion per year,<ref>{{cite book |editor1-last=Skolnik |editor1-first=Neil S. |editor2-last=Albert |editor2-first=Ross H. |title=Essential infectious disease topics for primary care|year=2008|publisher=Humana Press|location=Totowa, NJ|isbn=978-1-58829-520-0|page=66|url=https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|url-status=live|archive-url=https://web.archive.org/web/20151128094307/https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|archive-date=2015-11-28}}</ref> with rotavirus alone resulting in estimated costs of US$1&nbsp;billion a year.<ref name=EBMED2010/>
 == Terminology ==
@@ Line 149: / Line 149: @@
 ==Animals==
-Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are ''Campylobacter'', ''Clostridioides difficile'', ''Clostridium perfringens'', and ''Salmonella''.<ref>{{cite journal|last=Weese |first=JS |title=Bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential|journal=Veterinary Clinics of North America: Small Animal Practice|date=March 2011 |volume=41|issue=2|pages=287–309|pmid=21486637 |doi=10.1016/j.cvsm.2010.12.005}}</ref> A large number of toxic plants may also cause symptoms.<ref>{{cite book |last=Rousseaux |first=Wanda Haschek, Matthew Wallig, Colin |title=Fundamentals of toxicologic pathology |year=2009 |publisher=Academic |location=London |isbn=978-0-12-370469-6 |page=182 |url=https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |edition=2nd |url-status=live |archive-url=https://web.archive.org/web/20160507004136/https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |archive-date=2016-05-07 }}</ref>
+Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are ''Campylobacter'', ''Clostridioides difficile'', ''Clostridium perfringens'', and ''Salmonella''.<ref>{{cite journal|last=Weese |first=JS |title=Bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential|journal=Veterinary Clinics of North America: Small Animal Practice|date=March 2011 |volume=41|issue=2|pages=287–309|pmid=21486637 |doi=10.1016/j.cvsm.2010.12.005}}</ref> A large number of toxic plants may also cause symptoms.<ref>{{cite book |last1=Wallig |first1=Matthew A. |last2=Haschek |first2=Wanda M. |last3=Rousseaux |first3=Colin G. |title=Fundamentals of toxicologic pathology |year=2009 |publisher=Academic |location=London |isbn=978-0-12-370469-6 |page=182 |url=https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |edition=2nd |url-status=live |archive-url=https://web.archive.org/web/20160507004136/https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |archive-date=2016-05-07 }}</ref>
 Some agents are more specific to a certain species. [[Transmissible gastroenteritis coronavirus]] (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration.<ref>{{cite book |editor1-last=MacLachlan |editor1-first=N. James |editor2-last=Dubovi |editor2-first=Edward J. |year=2009 |title=Fenner's veterinary virology|publisher=Elsevier Academic Press|location=Amsterdam|page=399|isbn=978-0-12-375158-4|edition=4th |url=https://books.google.com/books?id=TYFqlYO9eE4C&pg=PA399|url-status=live|archive-url=https://web.archive.org/web/20151125122358/https://books.google.com/books?id=TYFqlYO9eE4C&pg=PA399|archive-date=2015-11-25}}</ref> It is believed to be introduced to pigs by wild birds and there is no specific treatment available.<ref>{{cite book |editor1-first=James G. |editor1-last=Fox |title=Laboratory animal medicine |year=2002 |publisher=Academic Press |location=Amsterdam |isbn=978-0-12-263951-7 |page=649 |url=https://books.google.com/books?id=m2ftfPMJnMMC&pg=PA649 |edition=2nd |display-editors=etal |url-status=live |archive-url=https://web.archive.org/web/20151128151809/https://books.google.com/books?id=m2ftfPMJnMMC&pg=PA649 |archive-date=2015-11-28 }}</ref> It is not transmissible to humans.<ref name="ZimmermanKarriker2012">{{cite book|last1=Zimmerman|first1=Jeffrey|last2=Karriker|first2=Locke|last3=Ramirez|first3=Alejandro|author4=Kent Schwartz|author5=Gregory Stevenson|title=Diseases of Swine|url=https://books.google.com/books?id=jVaemau17J4C&pg=PA504|date=15 May 2012|publisher=John Wiley & Sons|location=Chichester, West Sussex|edition=10th|isbn=978-0-8138-2267-9|page=504|url-status=live|archive-url=https://web.archive.org/web/20151128142144/https://books.google.com/books?id=jVaemau17J4C&pg=PA504|archive-date=28 November 2015}}</ref>

Gastroenteritis: Difference between revisions

Latest revision as of 22:33, 22 October 2025

Contents

Signs and symptoms

Cause

Viral

Bacterial

Parasitic

Transmission

Non-infectious

Pathophysiology

Diagnosis

Dehydration

Differential diagnosis

Prevention

Water, sanitation, hygiene

Vaccination

Management

Rehydration

Dietary

Antiemetics

Antibiotics

Antimotility agents

Epidemiology

Society and culture

Terminology

Animals

See also

References

Notes

External links

Navigation menu

Gastroenteritis: Difference between revisions

Latest revision as of 22:33, 22 October 2025

Signs and symptoms

Cause

Viral

Bacterial

Parasitic

Transmission

Non-infectious

Pathophysiology

Diagnosis

Dehydration

Differential diagnosis

Prevention

Water, sanitation, hygiene

Vaccination

Management

Rehydration

Dietary

Antiemetics

Antibiotics

Antimotility agents

Epidemiology

Society and culture

Terminology

Animals

See also

References

Notes

External links

Navigation menu

Search