GASTROENTERITIS - Full extract 

Gastroenteritis, or "gastro" for short, is a common stomach and bowel infection that is usually associated with vomiting and diarrhoea. In most cases it runs its own course over several days. However, it can be a serious condition if the fluid loss is severe enough to cause dehydration; this is more likely to occur in the elderly and the very young. 

Most cases of gastroenteritis are due to viral infections. About a half are caused by the rotavirus, first discovered and described at the Royal Children's Hospital/ University of Melbourne in the early 1970's. Various other viruses may cause the same symptoms, as may bacteria like Campylobacter. In most cases the precise infective agent is not identified. It is only when symptoms are persisting that stools are sent for microscopy and culture in the laboratory. 

On a global scale, gastroenteritis is a massive health problem. About 5 million people die each year, mainly young children in underdeveloped countries. Most deaths are due to dehydration, inadequate fluid replacement and circulatory collapse. In Australia an occasional fatality still occurs with gastroenteritis, again mainly due to complications of severe dehydration. A rotavirus vaccine has been developed in Australia and may eventually have extensive world-wide application.

Gastroenteritis is a major cause of illness in our own community. There are about 5000 cases seen annually at the Royal Children's Hospital in Melbourne. Of these about 500 require admission. There are many more cases treated elsewhere, and an unknown number that just recover without medical attention. 

The main symptoms of are vomiting, diarrhoea and cramping abdominal pain. Sometimes a fever will also be present. In more severe cases, signs of dehydration may appear; a young child may look floppy and pale and the urine output may be reduced. These signs mean that urgent medical assessment and treatment are required. 

Usually gastroenteritis settles without specific treatment over a few days, although the diarrhoea may last several days longer. Because of the transient intolerance to sugars that often accompanies gastro, dairy products and fatty foods are best avoided for the first day or two. Dry biscuits, toast, clear soups, and foods like boiled rice and potato may be tried. However, adequate fluid intake is the main concern. 

In babies replacement of fluid losses is vitally important. Whilst it is preferable to continue with breastfeeding and bottlefeeding, top-ups with oral rehydration fluid are often required. Gastrolyte is one of several excellent oral rehydration fluids available from the chemist. An alternative fluid supplement can be prepared using flat lemonade diluted to one fifth strength with boiled water. Undiluted lemonade, cordials and fruit juices should never be used because they can aggravate diarrhoea and cause dehydration. Medications to stop vomiting and diarrhoea should not be used in children; their absorption is unpredictable and they may make matters worse. 

Other conditions can mimic gastroenteritis. Food poisoning is caused by bacterial contamination of food and it may cause severe vomiting and diarrhoea. Often several people who have eaten the same food are affected. If diarrhoea is not settling, stools are sent for culture. Most of these cases clear without treatment. Early appendicitis and other acute abdominal conditions can also look like gastroenteritis. Persistent pain and localized tenderness should suggest that something more than gastroenteritis may be responsible. 

Health Tips:
* Gastroenteritis is highly contagious. Take special care to wash hands after changing nappies or going to the toilet.

* Watch closely the young child with gastroenteritis; a drowsy, floppy child with dry nappies may be seriously dehydrated and require urgent medical care.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001