Gastroenterology

Gastroenteritis

2008-12-11T14:05:00.000-08:00

Gastroenteritis
From Wikipedia, the free encyclopedia

Classification and external resources
ICD-10 A09., J10.8, K52.
ICD-9 009.0, 009.1, 558
DiseasesDB 30726
eMedicine emerg/213
MeSH D005759

Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis and enteritis) and resulting in acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or adverse reaction to something in the diet or medication. Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year,[1] and is a leading cause of death among infants and children under 5.[2]

At least 50% of cases of gastroenteritis as foodborne illness are due to norovirus.[3] Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus[4] and astrovirus.

Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni, Clostridium, Escherichia coli, Yersinia, and others. Some sources of the infection are improperly prepared food, reheated meat dishes, seafood, dairy, and bakery products. Each organism causes slightly different symptoms but all result in diarrhea. Colitis, inflammation of the large intestine, may also be present.

Risk factors are consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor sanitation. The incidence is 1 in 1,000 people.

Classification
Gastroenteritis can be classified as either viral or bacterial.

Symptoms and signs
Gastroenteritis often involves stomach pain or spasms (sometimes to the point of being crippled), diarrhea and/or vomiting, with noninflammatory infection of the upper small bowel, or inflammatory infections of the colon.[5][6][1][7]

It usually is of acute onset, normally lasting fewer than 10 days and self-limiting.

Nausea and vomiting
Diarrhea
Loss of appetite
Abdominal pain
Abdominal cramps
Bloody stools (dysentery - suggesting infection by amoeba, Campylobacter, Salmonella,
Shigella or some pathogenic strains of Escherichia coli[4])
Fainting and Weakness

The main contributing factors include poor feeding in infants. Diarrhea is common, and may be (but not always) followed by vomiting. Viral diarrhea usually causes frequent watery stools, whereas blood stained diarrhea may be indicative of bacterial colitis. In some cases, even when the stomach is empty, bile can be vomited up.

A child with gastroenteritis may be lethargic, suffer lack of sleep, run a low fever, have signs of dehydration (which include dry mucous membranes), tachycardia, reduced skin turgor, skin color discoloration, sunken fontanelles, sunken eyeballs, darkened eye circles, glassy eyes, poor perfusion and ultimately shock.

Symptoms occur for up to 6 days on average. Given appropriate treatment, bowel movements will return to normal within a week after that.

Signs and Tests

Stool culture positive for the organism that causes the infection
White blood cells in the stool
Examination of food for toxin and bacteria

This disease may also alter the results of the following tests:

Stool gram stain
Fecal smear

Differential diagnosis

Gastroenteritis viruses: A = rotavirus, B = adenovirus, C = Norovirus and D = Astrovirus. The virus particles are shown at the same magnification to allow size comparison.

It is important to consider infectious gastroenteritis as a diagnosis per exclusionem. A few loose stools and vomiting may be the result of systemic infection such as pneumonia, septicemia, urinary tract infection and even meningitis. Surgical conditions such as appendicitis, intussusception and, rarely, even Hirschsprung's disease may mislead the clinician.

Non-infectious causes to consider are poisoning with heavy metals (e.g. arsenic, cadmium), seafood (e.g. ciguatera, scombroid, toxic encephalopathic shellfish poisoning) or mushrooms (e.g. Amanita phalloides). Secretory tumours (e.g. carcinoid, medullary tumour of the thyroid, vasoactive intestinal peptide-secreting adenomas) and endocrine disorders (e.g. thyrotoxicosis and Addison's disease) are disorders that can cause diarrhea. Also, pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should be excluded as possibilities.[7] Infectious gastroenteritis is caused by a wide variety of bacteria and viruses. For a list of bacteria causing gastroenteritis, see above. Pseudomembranous colitis is an important cause of diarrhea in patients often recently treated with antibiotics. Viruses causing gastroenteritis include rotavirus, norovirus, adenovirus and astrovirus.

If gastroenteritis in a child is severe enough to require admission to a hospital, then it is important to distinguish between bacterial and viral infections. Bacteria, Shigella and Campylobacter, for example, and parasites like Giardia can be treated with antibiotics, but viruses do not respond to antibiotics and infected children usually make a full recovery after a few days.[8] Children admitted to hospital with gastroenteritis routinely are tested for rotavirus A to gather surveillance data relevant to the epidemiological effects of rotavirus vaccination programs.[9][10] These children are routinely tested also for norovirus, which is extraordinarily infectious and requires special isolation procedures to avoid transmission to other patients. Other methods, electron microscopy and polyacrylamide gel electrophoresis, are used in research laboratories.[11][12]

Management
The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is the preferred treatment of fluid and electrolyte losses caused by diarrhea in children with mild to moderate dehydration [13].

Rehydration
Regardless of cause, the principal treatment of gastroenteritis (and of all other diarrheal illnesses) in both children and adults is rehydration, i.e. replenishment of water lost in the stools. Depending on the degree of dehydration, this can be done by giving the person oral rehydration therapy (ORT) or through intravenous delivery. ORT can begin before dehydration occurs, and continue until the person's urine and stool output return to normal.

People taking diuretics ("water pills") need to be cautious with diarrhea and may need to stop taking the medication during an acute episode, as directed by the health care provider.

Dietary therapy
Centers for Disease Control and Prevention[14] recommendations for infants and children include: Breastfed infants should continue to be nursed on demand. Formula-fed infants should continue their usual formula immediately upon rehydration in amounts sufficient to satisfy energy and nutrient requirements, and at the usual concentration. Lactose-free or lactose-reduced formulas usually are unnecessary. Children receiving semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea. Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea; therefore, substantial amounts of soft drinks (carbonated or flat), juice, gelatin desserts, and other highly sugared liquids should be avoided. Fatty foods should not be avoided, because maintaining adequate calories without fat is difficult, and fat might have an added benefit of reducing intestinal motility. The practice of withholding food for more than 24 hours is inappropriate.[15]

The BRAT diet (Bananas, Rice, Applesauce, Toast and Tea) was recommended in the past however as it contains insufficient nutrients it is no longer recommended.[16]

Probiotics
Some Probiotics have been shown to be beneficial in preventing and treating various forms of gastroenteritis.[16]

Zinc
The World Health Organization recommends that infants and children receive a dietary supplement of zinc for up to 2 weeks after onset of gastroenteritis.[17]

Pharmacologic therapy
Viral gastroenteritis is usually an acute and self-limited disease which does not require pharmacologic therapy.[18]

Antibiotics
Antibiotics may however sometimes be used if symptoms are severe and a bacterial cause is either isolated or suspected.[citation needed] If antibiotics are decided on a fluoroquinolone is often used.[5] Pseudomembranous colitis is treated by discontinuing the causative agent and starting with metronidazole or vancomycin.[5][6][1][7]

Antibiotics usually are not given for gastroenteritis, although they may be given due to some bacteria.

Antidiarrheal agents
This article may require cleanup to meet Wikipedia's quality standards.
Please improve this article if you can. (January 2008)

Loperamide is an opioid analogue commonly used for symptomatic treatment of diarrhea. It slows down gut motility, but does not cross the mature blood-brain barrier[5] to cause the central nervous effect of other opioids. In too high doses, loperamide may cause constipation and significant slowing down of passage of feces, but an appropriate single dose will not slow down the duration of the disease.[19] Although antimotility drugs have the risk of exacerbating the condition, this fear is not supported by clinical experience.[5][7] Nevertheless, others discourage the use of antiperistaltic agents and opiates in febrile dysentery, since they may mask, or exacerbate the symptoms.[1] All these sources agree that in severe colitis antimotility drugs should not be used.

Loperamide prevents the body from flushing toxins from the gut, and should not be used when an active fever is present or there is a suspicion that the diarrhea is associated with organisms that can penetrate the intestinal walls, such as E. coli O157:H7 or Salmonella.

Loperamide is also not recommended in children, especially in children younger than 2 years of age, as it may cause systemic toxicity due to an immature blood brain barrier, and oral rehydration therapy remains the main stay treatment for children.

Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth and salicylate, is another drug that can be used in mild-moderate cases.[5][7]

Combining an antimicrobial drug and an antimotility drug, seems to be effective more rapidly.[5][7]

Antiemetic drugs
If vomiting is severe, antiemetic drugs may be helpful. Ondansetron has some clinical utility in this condition with a single dose associated with reduced use of intravenous fluids, fewer hospitalizations, and decreasing nausea and vomiting.[20][21]

Complications
The most serious complication is dehydration, usually due to severe diarrhea but sometimes made worse due to improper treatment such as withholding fluids until diarrhea stops. Severe dehydration can be lethal and requires prompt medical care. The most common complication, especially in infants, is malabsorption of certain sugars in the diet, and consequent food intolerances. This complication may persist for weeks, during which time it causes mild diarrhea to return when the patient resumes their normal diet. Malabsorption of lactose, the principal sugar in milk, is the most common. Its consequent milk intolerance is caused by lactase deficiency, and the diarrhea is caused by bacterial fermentation of excess lactose in the gut.[22] However, this is not reason to discontinue breastfeeding. In children with viral gastroenteritis (usually rotavirus), the viral infection also can cause a high fever, which in turn can cause febrile convulsion. Gastroenteritis sometimes is followed by pneumonia.

Epidemiology
Globally, gastroenteritis caused 4.6 million deaths in children in 1980 alone, most of these in the third world,[6] where the lack of adequate safe water and sewage treatment capacity contribute to the spread of infectious gastroenteritis. Harrison's Principles of Internal Medicine estimates the current total figure to be 2.4 to 2.9 million per year.[1] The global death rate has now come down significantly to approximately 1.5 million deaths annually, largely due to global introduction of proper oral rehydration therapy.[23]

The incidence in the developed countries is as high as 1-2.5 cases per child per year[citation needed] and a major cause of hospitalisation in this age group.

Age, living conditions, hygiene and cultural habits are important factors. [EtiologyAetiological]] agents vary depending on the climate. Furthermore, most cases of gastroenteritis are seen during the winter in temperate climates and during summer in the tropics.[6]

History
Before the 20th century, the term "gastroenteritis" was not commonly used. What would now be diagnosed as gastroenteritis may have instead been diagnosed more specifically 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 a number of other archaic names for acute diarrhea.[24] Historians, genealogists, and other researchers should keep in mind that gastroenteritis was not considered a discrete diagnosis until fairly recently.

See also

References

^ a b c d e Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
^ King CK, Glass R, Bresee JS, Duggan C (2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm.
^ "Norovirus: Technical Fact Sheet". National Center for Infectious Diseases, CDC.
^ a b Murray PR, Pfaller MA, Rosenthal KS. Medical Microbiology. Mosby, 2005. ISBN 0323033032.
^ a b c d e f g Sleisenger & Fordtran's Gastrointestinal and Liver Disease 7th edition, by Mark Feldman; Lawrence S. Friedman; and Marvin H. Sleisenger, ISBN 0-7216-8973-6, Hardback, Saunders, Published July 2002
^ a b c d Mandell's Principles and Practices of Infection Diseases 6th Edition (2004) by Gerald L. Mandell MD, MACP, John E. Bennett MD, Raphael Dolin MD, ISBN 0-443-06643-4 · Hardback · 4016 Pages Churchill Livingstone
^ a b c d e f The Oxford Textbook of Medicine. Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0
^ Haffejee IE (1991). "The pathophysiology, clinical features and management of rotavirus diarrhoea". Q. J. Med. 79 (288): 289–99. PMID 1649479.
^ Patel MM, Tate JE, Selvarangan R, et al (2007). "Routine laboratory testing data for surveillance of rotavirus hospitalizations to evaluate the impact of vaccination". Pediatr. Infect. Dis. J. 26 (10): 914–9. doi:10.1097/INF.0b013e31812e52fd (inactive 21 June 2008). PMID 17901797.
^ "The paediatric burden of rotavirus disease in Europe". Epidemiol. Infect. 134 (5): 908–16. 2006. doi:10.1017/S0950268806006091. PMID 16650331.
^ Beards GM (1988). "Laboratory diagnosis of viral gastroenteritis". Eur. J. Clin. Microbiol. Infect. Dis. 7 (1): 11–3. doi:10.1007/BF01962164. PMID 3132369.
^ Steel HM, Garnham S, Beards GM, Brown DW (1992). "Investigation of an outbreak of rotavirus infection in geriatric patients by serotyping and polyacrylamide gel electrophoresis (PAGE)". J. Med. Virol. 37 (2): 132–6. doi:10.1002/jmv.1890370211. PMID 1321223.
^ "Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis". Pediatrics 97 (3): 424–35. 1996. PMID 8604285.
^ Managing Acute Gastroenteritis Among Children: Oral Rehydration, Maintenance, and Nutritional Therapy
^ "BestBets: Gradual introduction of feeding is no better than immediate normal feeding in children with gastro-enteritis". Retrieved on December 6,2008.
^ a b King CK, Glass R, Bresee JS, Duggan C (November 2003). "Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy". MMWR Recomm Rep 52 (RR-16): 1–16. PMID 14627948. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm.
^ Rehydrate.org: Zinc Supplementation
^ "Merck - Error Page".
^ Wingate D, Phillips SF, Lewis SJ, et al (2001). "Guidelines for adults on self-medication for the treatment of acute diarrhoea". Aliment. Pharmacol. Ther. 15 (6): 773–82. doi:10.1046/j.1365-2036.2001.00993.x. PMID 11380315. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0269-2813&date=2001&volume=15&issue=6&spage=773.
^ DeCamp LR, Byerley JS, Doshi N, Steiner MJ (September 2008). "Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis". Arch Pediatr Adolesc Med 162 (9): 858–65. doi:10.1001/archpedi.162.9.858. PMID 18762604.
^ Mehta S, Goldman RD (2006). "Ondansetron for acute gastroenteritis in children". Can Fam Physician 52 (11): 1397–8. PMID 17279195. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195.
^ Arya SC (1984). "Rotaviral infection and intestinal lactase level". J. Infect. Dis. 150 (5): 791. PMID 6436397.
^ Victora CG, Bryce J, Fontaine O, Monasch R (2000). "Reducing deaths from diarrhoea through oral rehydration therapy". Bull. World Health Organ. 78 (10): 1246–55. PMID 11100619.
^ Rudy's List of Archaic Medical Terms

External links

"NHS Direct: Gastroenteritis". Retrieved on 2007-04-12.
"eMedicine Health:Gastroenteritis". Retrieved on 2007-04-12.
"The World Health Organisation: Diarrhoea". Retrieved on 2007-04-12.
Gastroenteritis: First aid from the Mayo Clinic
"About.com: Seasonal Flu vs. Stomach Flu". Retrieved on 2007-04-12

For information on another disease, click here .

Gastroenterology

2007-04-19T15:15:00.000-07:00

History

Galen

Drawings of Bozzini's Lichtleiter 1

Drawings of Bozzini's Lichtleiter 2

Citing from Egyptian papyri, Nunn identified significant knowledge of gastrointestinal diseases among practising doctors in Pharaoh periods. Irynakhty, of the tenth dynasty c. 2125 BC was a court physician specialising in gastroenterology and proctology.[1]

Among ancient Greeks, Hippocrates attributed digestion to concoction. Galen's concept of the stomach having four faculties was widely accepted up to modernity.

18th century:

Italian Lazzaro Spallanzani (1729–99) was among early physicians to disregard Galen's theories, and in 1780 he gave experimental proof on the action of gastric juice on foodstuffs.
In 1767, German Johann Zimmermann wrote an important work on dysentery.
In 1777 Maximilian de Stoll of Vienna described cancer of the gallbladder.[2][3]

19th century:

In 1805 Philip Bozzini made first attempt to observe living human body through a tube he named Lichtleiter (light guiding instrument) to examine the urinary tract, the rectum and the pharynx. This is the earliest description of endoscopy.[4][5]
Charles Emile Troisier described enlargement of lymph node in abdominal cancer.[6]
In 1868 Adolf Kussmaul, a well known German physician, developed the gastroscope. He perfected the technique on sword swallower.
In 1871, at the society of physicians in Vienna, Carl Stoerk demonstrated an esophagoscope made of two telescopic metal tubes, initially devised by Waldenburg in 1870.
In 1876 Karl Wilhelm von Kupffer described the properties of some liver cells now called Kupffer cell.
In 1884 Kronecker and Meltzern studied oesophageal manometry in man.

20th century:

Rudolph Schindler described many important diseases involving digestive system during World War I in his illustrated textbook and is portrayed by some as the "father of gastroscopy". He and Wolf developed a semiflexible gastroscope in 1932.
In 1932 Burrill Bernard Crohn described Crohn's disease.
In 1957 Basil Hirschowitz introduced the first prototype fibreoptic gastroscope.
In 2005 Barry Marshall and Robin Warren of Australia were awarded the Nobel Prize in Physiology or Medicine for their discovery of Helicobacter pylori (1982/1983) and its role in peptic ulcer disease.

Disease classification
1. International Classification of Disease(ICD 2007)/WHO classification:

Chapter XI,Diseases of the digestive system,(K00-K93)[3]

2. MeSH Medical Subject Headings) subject Heading:

Gastroenterology (G02.403.776.409.405)[4]
Gastroenterological diseases(C06.405)[5]

3.National Library of Medicine Catalogue(NLM classification 2006):

Digestive system(W1)[6]

Gastroenterological societies

References

01. Nunn JF. Ancient Egyptian Medicine. 2002. ISBN 0-80613-504-2.
02. Edgardo Rivera, MD James L. Abbruzzese, MD; Pancreatic, Hepatic, and Biliary Carcinomas, MEDICAL ONCOLOGY: A COMPREHENSIVE REVIEW[1]
03. DeStoll M: Rationis Mendendi, in Nosocomio Practico vendobonensi. Part 1 Lugduni Batavarum, Haak et Socios et A et J Honkoop 1788, OCLC: 23625746
04. Gilger, Mark A. MD,Gastroenterologic endoscopy in children: past, present, and future. Gastroenterology and nutrition Current Opinion in Pediatrics. 13(5):429-434, October 2001.
05. The Origin of Endoscopes, Olympus history
06. Anton Sebastian, A Dictionary of the History of Medicine, ISBN 1850700214

Publications
Open access to full text

BMC
Gastroenterology
Internet
journal of gastroenterology
World journal of Gastro
Enterology
Medscape
gastroenterology
Gastroenterology
and endoscopy news
Indian
Journal of Gastroenterology
Arquivos
de Gastroenterologia(Portuguese, English)
Revista
Espanola de Enfermedades Digestivas(Spanish, English)
Comparative Hepatology (From
Biomed Central)
Hepatitis Monthly
JOP Journal of the Pancreas

Open access to abstract and some full text

American Journal Of Gastroenterology
The Canadian Journal of Gastroenterology
Gut
Gastroenterology
Journal of Gastroenterology
Best practice and research: Clinical gastroenterology
Clinical Gastroenterology and Hepatology
Current Opinion in Gastroenterology
European Journal of Gastroenterology and Hepatology(Official Journal of the European Association for Gastroenterology and Endoscopy)
Journal of Gastroenterology and Hepatology
Gastrointestinal Endoscopy
Nature Clinical Practice

Information for patients Practice guidelines

Gastroclub patient support
patientplus from patient UK
first principle in gastroenterology
Patient information from american college of gastroenterology
Patient guide from NLH
Gut and liver disease support group
American liver foundation
Canadian society of intestinal research
Canadian Digestive Health Foundation

Practice Guidelines

Related links

Virtual Gastro Centre
On-Line Gastroenterology Journal Club (via
JournalReview.org)
GastroHep.com - Gastrohep
The Digital Atlas of Video Education - Gastroenterology

v • d • e Health science - Medicine - Gastroenterology (primarily K)

Esophagus: Halitosis - Nausea - Vomiting - Heartburn - GERD - Achalasia - Esophageal cancer - Esophageal varices

Stomach: Peptic ulcer - Abdominal pain - Stomach cancer - Non-ulcer dyspepsia - Gastroparesis - Abdominal angina - Malabsorption (e.g. celiac disease, giardiasis) - Pyloric stenosis

Small intestine: Peptic ulcer - Intussusception - Malabsorption (e.g. coeliac, lactose intolerance, fructose malabsorption, Whipple's) - Lymphoma

Colon: Diarrhea - Appendicitis - Diverticulitis - Diverticulosis - IBD (Crohn's Disease, Ulcerative colitis) - IBS - Constipation - Colorectal cancer - Hirschsprung's - Pseudomembranous colitis

Hernia: Inguinal - Femoral - Umbilical - Incisional - Diaphragmatic

Liver: Alcoholic liver disease - Hepatitis - Liver failure - Cirrhosis - NASH - PBC - Budd-Chiari - Hepatocellular carcinoma

Accessory digestive:

Gallbladder/Biliary tree (Gallstones, Cholecystitis, PSC, Ascending
cholangitis) -
Pancreas: (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst,
Hereditary pancreatitis, Pancreatic cancer)

v • d • e Health science > medicine

Advance practice nursing - Audiology - Dentistry - Dietetics - Emergency medical services - Epidemiology - Medical technology - Midwifery - Nursing - Occupational therapy - Optometry - Osteopathic medicine - Pharmacy - Physical therapy (Physiotherapy) - Physician - Physician assistant - Podiatry - Psychology - Public health - Respiratory therapy - Speech and language pathology

Physician specialties: Anesthesiology - Dermatology - Emergency medicine - General practice (Family medicine) - Internal medicine - Neurology - Nuclear medicine - Obstetrics and gynecology - Occupational medicine - Ophthalmology - Pathology - Pediatrics - Physical medicine and rehabilitation (Physiatry) - Preventive medicine - Psychiatry - Radiation oncology - Radiology - Surgery

Medical subspecialties: Allergy and immunology - Cardiology - Endocrinology - Gastroenterology - Hematology - Infectious disease - Intensive care medicine (Critical care medicine) - Medical genetics - Nephrology - Oncology - Pulmonology - Rheumatology

Surgical subspecialties: Cardiac surgery - General surgery - Hand surgery - Neurosurgery - Oral and maxillofacial surgery - Orthopaedic surgery - Otolaryngology (ENT) - Pediatric surgery - Plastic surgery - Surgical oncology - Thoracic surgery - Transplant surgery - Trauma surgery - Urology - Vascular surgery

Retrieved from "http://en.wikipedia.org/wiki/Gastroenterology"

This page was last modified 13:40, 22 April 2007. All text is available under the terms of the GNU Free Documentation License.

To view information on other digestive disease, click on Digestive Diseases Library.

Digestive Diseases Library