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Gastroenteritis in Adults

gastroenteritis-adults

Gastroenteritis is an infection of the gut. It causes diarrhoea, and may also cause vomiting, abdominal pain and other symptoms. In most cases the infection clears over several days, but sometimes takes longer. The main risk is dehydration. The main treatment is to have lots to drink which aims to avoid dehydration.

What is gastroenteritis and how is it caused?

Gastroenteritis is an infection of the gut (intestines). The severity can range from a mild tummy upset for a day or two with some mild diarrhoea, to severe diarrhoea and vomiting for several days or longer. Many viruses, bacteria and other microbes (germs) can cause gastroenteritis.

A virus is the most common cause of gastroenteritis. Viruses are easily spread from one person to another by close contact. This is often because of the virus being present on people's hands after they have been to the toilet. Surfaces or objects touched by the infected person can also allow transmission of the virus. The virus can also be passed on if the infected person prepares food. Outbreaks of a virus causing gastroenteritis in many people can occur - for example, in schools, hospitals or nursing homes.

Food poisoning (eating food infected with microbes) causes some cases of gastroenteritis. Many different types of microbes can cause food poisoning. Common examples are species of bacteria called Campylobacter, Salmonella and Escherichia coli (usually shortened to E. coli). Toxins (poisons) produced by bacteria can also cause food poisoning. Another group of microbes called parasites can also be a cause. Water contaminated by bacteria or other microbes is another common cause, particularly in countries with poor sanitation.

How common is gastroenteritis?

Gastroenteritis is very common. Most people have a mild form of gastroenteritis and do not need to seek medical advice or to visit their doctor.

How does it present?

The main symptom is diarrhoea, often with vomiting as well. Diarrhoea means loose or watery stools (faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with some infections

Crampy pains in your abdomen (tummy) are common. Pains may ease for a while each time you pass some diarrhoea.

A high temperature (fever), headache and aching limbs sometimes occur.

If vomiting occurs, it often lasts only a day or so, but sometimes longer. Diarrhoea often continues after the vomiting stops and commonly lasts for several days or more. Slightly loose stools may persist for a week or so further before a normal pattern returns. Sometimes the symptoms last longer.

Symptoms of dehydration

Diarrhoea and vomiting may cause dehydration (a lack of fluid in the body). Mild dehydration is common and is usually easily reversed by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of your body need a certain amount of fluid to function.

Symptoms of dehydration in adults include: tiredness, dizziness or light-headedness, headache, muscular cramps, sunken eyes, passing little urine, a dry mouth and tongue, weakness, and becoming irritable.

Symptoms of severe dehydration in adults include: weakness, confusion, rapid heart rate, coma, and producing very little urine. Severe dehydration is a medical emergency and immediate medical attention is needed.

Dehydration in adults with gastroenteritis is more likely to occur in:

  • Elderly or frail people.
  • Pregnant women.
  • People with severe diarrhoea and vomiting. In particular, if you are not able to replace the fluid lost with enough drinks.

How is gastroenteritis diagnosed and do I need any tests?

Most people with gastroenteritis recognise this from their typical symptoms and they do not usually need to see a doctor or to seek medical advice. Symptoms are often quite mild and commonly get better within a few days without any medical treatment.

However, in some circumstances, you may need to see a doctor when you have gastroenteritis .The doctor may ask you questions about recent travel abroad, if you have been in contact with someone with similar symptoms, or if you have recently taken antibiotics or been admitted to hospital. This is to look for possible causes of your gastroenteritis. The doctor will also usually check you for signs of dehydration. They may check your temperature, pulse and blood pressure. They may also examine your abdomen to look for any tenderness.

Tests are not usually needed. However, if you are particularly unwell, have bloody stools, have recently travelled abroad, are admitted to hospital, or your symptoms are not getting better, then your doctor may ask you to collect a stool sample. This can then be examined in the laboratory to look for the cause of the infection.

When should a person seek medical advice?

Seek medical advice in any of the following situations, or if any other symptoms occur that you are concerned about:

  • If you suspect that you are becoming dehydrated.
  • If you are vomiting a lot and unable to keep fluids down.
  • If you have blood in your diarrhoea or vomit.
  • If you have severe abdominal pain.
  • If you have severe symptoms, or if you feel that your condition is getting worse.
  • If you have a persisting high fever.
  • If your symptoms are not settling - for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
  • Infections caught abroad.
  • If you are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory bowel disease, kidney disease.
  • If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, HIV infection.
  • If you are pregnant.

How do you treat gastroenteritis in adults?

Symptoms often settle within a few days or so as your immune system usually clears the infection. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop.

The following are commonly advised until symptoms ease.

  • Fluids - have lots to drink to prevent dehydration, or to treat dehydration if it has developed. (Note: if you suspect that you are dehydrated, you should contact a doctor.)

You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.
For most adults, fluids drunk to keep hydrated should mainly be water, also, ideally, include some soup. It is best not to have drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.

Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies. Do not use home-made salt/sugar drinks, as the quantity of salt and sugar has to be exact.

  • Eat as normally as possible, however, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able - but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first.
  • Medication, are not usually necessary. However, you may wish to reduce the number of trips that you need to make to the toilet. You can buy antidiarrhoeal medicines from pharmacies. The safest and most effective is loperamide. The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your gut's activity. You should not take loperamide for longer than five days.
  • Note: do not give antidiarrhoeal medicines to children under 12 years.
  • Paracetamol or ibuprofen is useful to ease a high temperature or headache.

What are the complications that can occur from gastroenteritis?

Complications are common in India. They are more likely in the very young, pregnant women, or the elderly.

Possible complications include the following:

  • Dehydration and salt (electrolyte) imbalance in your body. This is the most common complication. This requires admission to hospital.
  • Reactive complications. Rarely, other parts of the body may react to an infection that occurs in the gut. This can cause symptoms such as arthritis (joint inflammation), skin inflammation and eye inflammation (either conjunctivitis or uveitis). Reactive complications are uncommon when a virus causes gastroenteritis.
  • Spread of infection to other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if gastroenteritis is caused by Salmonella spp. infection.
  • Persistent diarrhoea syndromes may rarely develop.
  • Irritable bowel syndrome is sometimes triggered by a bout of gastroenteritis.
  • Lactose intolerance can sometimes occur for a while after gastroenteritis. This is known as secondary or acquired lactose intolerance. Your gut lining can be damaged by the episode of gastroenteritis. This leads to lack of an enzyme (chemical) called lactase that is needed to help your body digest a sugar called lactose that is in milk. Lactose intolerance leads to bloating, abdominal pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the gut lining heals. It is more common in children.
  • Haemolytic uraemic syndrome is another potential complication. It is rare and is usually associated with gastroenteritis caused by a certain type of E. coli infection. It is a serious condition where there is anaemia, a low platelet count in the blood, and kidney failure. It is more common in children. If recognised and treated, most people recover well.
  • Reduced effectiveness of some medicines. During an episode of gastroenteritis, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or vomiting means that reduced amounts of the medicines are absorbed (taken up) into your body. Examples of such medicines are medicines for epilepsy, diabetes and contraception.

Preventing spread of infection to others

Gastroenteritis can be easily passed on from person to person. If you have gastroenteritis, the following are recommended to prevent the spread of infection to others:

  • Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry properly after washing.
  • Don't share towels and flannels.
  • Don't prepare or serve food for others.
  • Regularly clean the toilets that you use, with disinfectant. Wipe the flush handle, toilet seat, bathroom taps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
  • Stay off work, college, etc, until until at least 48 hours after the last episode of diarrhoea or vomiting.
  • Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations may arise and sometimes longer time off is needed. Specialist advice may be needed for some uncommon causes of gastroenteritis. If in doubt, seek advice from your employer or GP.
  • If the cause of gastroenteritis is known to be (or suspected to be) a microbe called Cryptosporidium spp., you should not swim in swimming pools for two weeks after the last episode of diarrhoea.

How can gastroenteritis be prevented?

The advice given in the previous section is mainly aimed at preventing the spread of infection to other people. However, even when we are not in contact with someone with gastroenteritis, proper storage, preparation and cooking of food, and good hygiene help to prevent gastroenteritis.
In particular, always wash your hands:

  • After you go to the toilet.
  • Before you touch food.
  • Between handling raw meat and food ready to be eaten. (There may be some bacteria on raw meat.)
  • After gardening.
  • After playing with pets (healthy animals can carry certain harmful bacteria).
  • The simple measure of washing hands regularly and properly is known to make a big difference to the chance of developing gastroenteritis.

You should also take extra measures when in countries of poor sanitation. For example, avoid water and other drinks that may not be safe, and avoid food washed in unsafe water.


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