You’re hunkered over the toilet praying you’re not gonna throw up again or you’re curled up on the couch waiting for the next rush of cramps sending you speeding back to the bathroom. Most of us have been there and it’s no fun. Sometimes you just tough it out at home and sometimes it gets so bad you have to see the doctor.
Gastroenteritis goes by several names; belly flu, traveler’s diarrhea, food poisoning and infectious diarrhea. Whatever you call it, it is a significant problem for people around the world. It is caused when the lining of your intestines is irritated or inflamed and is caused by both viruses and bacteria.
Rotavirus is the most common cause in kids and the Norovirus is the most common cause in adults. But you may have heard of the Norwalk virus recently causing horrible outbreaks of gastroenteritis on some cruises. The Norwalk virus is a strain of the Norovirus and sometimes people use the names interchangeably.
Bacteria can cause it too. We often think of E-coli or salmonella but C-jejuni is the most common offender in the bacteria world. Parasites like giardia and cryptosporidium cause diarrhea from contaminated water sources and I always worry about them in anyone that tells me they have been swimming or drinking from ponds, lakes or streams.
How do you get gastroenteritis? The list is short: food, people and contaminated water. Seafood and products with eggs and mayonnaise are especially common causes. Undercooked chicken (C-jejuni) and beef (E-coli) are also causes – which is why I don’t order my steak rare – and coming into direct contact with infected people or touching things they’ve touched like door handles or sink handles. Contaminated water is the most common cause worldwide.
What are the symptoms of gastroenteritis? Diarrhea and vomiting are obviously the most well known. Other symptoms include abdominal pain or cramping, nausea, fever, dehydration, incontinence, muscle cramps, poor feeding (esp in children) or decreased wet diapers in babies. Rarely you may have bleeding in your diarrhea, and if you do go to your doctor immediately.
How do we diagnosis gastroenteritis? Usually, a doctor takes a history and does a physical examination. Rarely do we need to do stool studies. Most people have a viral cause, which usually resolves with time and so stool studies rarely aid in the diagnosis. If you have been out of the country or camping or there is a local outbreak of food poisoning then stool studies are possibly helpful. There is a new community-acquired bacterial cause that is making its way around, C-dificile, and can be severe. We used to worry about it in nursing homes and hospitals mostly, but it has made its way out into the community now and is a nasty little germ. There is a stool test specifically designed for diagnosing C-dificile and takes about a day to get results back.
How do we treat this? Hydration, hydration and more hydration. We want you to drink fluids with electrolytes if you can. Drink water too but also add in drinks that have electrolytes to replace what you’re losing through diarrhea and vomiting.
Avoid milk while you have diarrhea as your intestines are temporarily unable to digest it and it will worsen your symptoms. Some people swear by probiotics. The studies on probiotics aren’t conclusive but I like to recommend them to my patients. Sometimes adding in a fiber supplement helps bulk your stool up.
Medicines like Zofran and Phenergan are helpful for the vomiting. I especially like the new sublingual Zofran tablets which have helped people, especially kids, avoid having to get an IV. Antibiotics are rarely helpful and in some cases even dangerous. That's not saying you never need an antibiotic but the cases are rare and your doctor can determine if you are one of the rare patients that needs them.
What about anti-diarrheal medicines like Imodium? Most doctors don’t recommend using them and they can actually prolong your symptoms but if you’re just absolutely miserable, you can use them sparingly. I like prescribing anti-cramping medicines like bentyl too. Now, none of these medicines will just stop the symptoms completely but they help. Time is what you need most; time and hydration. If you feel like the symptoms are just uncontrollable at home, then see your doctor or consider an urgent care or an ER.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
