Gastroenteritis - a cause of diarrhoea and vomiting

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This just means inflammation of the gut. In the upper gut it is called gastritis, in the lower gut colitis. However it is usually taken to mean an acute inflammation of the gut caused by acute infection.

The commonest bugs causing acute infection are viruses and bacterial food poisoning. Not unsurprisingly the viruses causing gastroenteritis are called the enteroviruses (from Greek enteron, intestine). Not all viral infections cause obvious symptoms of gastroenteritis (diarrhoea and vomiting) - some are acquired through the gut and also cause swelling of the lymph nodes (glandular fever from Epstein Barr virus) or neurological damage (polio).

There are an important group of viruses which include Epstein Barr virus (glandular fever), ECHO viruses, cocksackie B and polio viruses simply because they are one of the most common triggers for a post viral syndrome. This is another reason why gastroenteritis should be treated properly - to minimise the possibility of developing a post viral syndrome.

A tendency to gastroenteritis and other infections may be a symptom of hypochlorhydria. The reason is that bugs enter the body largely by inhalation or swallowing. Those which are inhaled get stuck on the mucus lining the respiratory tract, swept up by the cilia and then swallowed. Ideally they then drop into an acid stomach which kills them and prevents infection. In patients with recurrent infections and post infectious chronic fatigue syndrome there does appear to be a very high instance of hypochlorhydria, ie this may well be a risk factor for acquiring such problems - see Hypochlorhydria.

Symptoms

These are caused by inflammation of the gut such as diarrhoea, vomiting, loss of appetite, wind, gas and bloating, general aching and colic. Generalised inflammation causes fever, malaise (feeling ill), fatigue (physical and mental) and muscle aching - see Inflammation. 90% of the immune system is gut associated, it is not the bug that makes you ill but the immune system's reaction to it - no wonder people feel so ghastly with gastroenteritis!

Usually the history suggests a viral origin - i.e. it follows a runny nose, other members of the family similarly affected, other member of the community affected.

Diagnosis

Usually this is a clinical diagnosis. However I like to send off stool cultures to look for food poisoning (salmonella, shigella, campylobacter, rarely parasites) just in case the Environmental Health need to be called in and just in case the patient does not get better - in which case I have at least narrowed the diagnosis down.

It is also important to exclude an The acute abdomen - a surgical emergency.

In acute abdominal pain always think of appendicitis, ectopic pregnancy, bowel obstruction (cancer, after an operation), perforation (ulcer, diverticulitis, cancer), testicular torsion, gall bladder disease (cholecystitis, gall stones), pancreatitis, ischaemia, inflammatory bowel disease, pelvic inflammatory disease, renal stones, kidney infection etc. Usually gastroenteritis presents with a colicky pain felt in the mid-line, - ie the pain builds up in a spasm and then passes away. Labour pains are an example of colicky pain.

In contrast peritonitis results in a constant severe pain which makes even movement extremely uncomfortable. Some acute abdomens if not diagnosed early will progress to peritonitis.

Treatment

See Viral infections. Whilst vitamin C in high doses can cause diarrhoea, it is still indicated in gastroenteritis - indeed the requirements for vitamin C are higher during infections. In high doses, i.e. sufficient to cause diarrhoea, vitamin C essentially sterilises the whole gut and kills off all viruses, bacteria, probiotics and probably parasites as well. This is called taking vitamin C to bowel tolerance. So treatment is as follows:

1. The gut must be rested and so no food should be given for at least 24 hours, or until the diarrhoea stops.

2. Dehydration must be prevented by drinking plenty of clear fluids, taking salt and glucose (not fructose ie fruit sugar) to keep energy levels up. There are proprietary preparations on the market for this such as Diorylate. The risk of DIY measures is that there have been very rare instances of babies being given too much salt and dying as a result when a tablespoon of salt per pint of water was used instead of a teaspoonful.

My recipe for rehydration is one litre (2 pints) of water with a half teaspoon of salt (ie 2 grams), 1 scoop of my Mineral Mix (ie 1 grams) and 4 grams of ascorbic acid (2 scoops) taken ad lib. Drink at least 2-3 litres (4 or 6 pints) over the 24 hours, more if diarrhoea is severe.

If there is projectile vomiting, then dehydration can occur very quickly and the patient needs to be hospitalised for i.v. fluids.

3. Do not use a "stopper upper" such as imodium. The way in which the gut gets rid of infection is through diarrhoea and vomiting.

4. With all cases of gastroenteritis a temporary lactose intolerance often develops. Milk sugar (fresh milk and cream) should be avoided for one week after the symptoms have settled. Sometimes the gastroenteritis continues because of this temporary lactose intolerance. Of course the evolutionary correct diet is the Stone Age Diet

5. Once the acute symptoms have settled down recolonise the gut with the good bugs. See Probiotics

(NOTE: article below on Digestive Enzymes is included because it discusses lactose intolerance)

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