Gastroenteritis

By Ronald Steriti, ND, PhD

© 2013

Gastroenteritis is characterized by inflammation ("-itis") of the gastrointestinal tract that involves both the stomach ("gastro"-) and the small intestine ("entero"-), resulting in some combination of diarrhea, vomiting, and abdominal pain and cramping.

Gastroenteritis has also been referred to as gastro, stomach bug, and stomach virus. Although unrelated to influenza, it has also been called stomach flu and gastric flu.

Eosinophilic gastroenteritis (EG) typically presents with a combination of chronic nonspecific gastrointestinal symptoms that include abdominal pain, nausea, vomiting, diarrhea, weight loss, and abdominal distension. Approximately 80% of the patients have symptoms for several years. (Agrawal, Rani et al. 2012)

Causes

Norovirus is and the leading cause of gastroenteritis worldwide, and the leading cause of adult gastroenteritis in the United States. (Koo, Ajami et al. 2010)

Rotavirus is the leading cause in children. (Elliott 2007)

Non-infectious gastroenteritis can be caused by medications (i.e. NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-infection source of (often severe) gastroenteritis.

In bacterium-induced diarrhoea, rapid loss of fluids and electrolytes results from inhibition of the normal absorptive function of the intestine as well as the activation of secretory processes. (Viswanathan, Hodges et al. 2009)

Differential Diagnosis

Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include:

Appendicitis,

Volvulus, a bowel obstruction with a loop of bowel whose nose has abnormally twisted on itself.

Inflammatory bowel disease,

Urinary tract infections,

Diabetes mellitus: diabetic ketoacidosis

Pancreatic insufficiency,

Short bowel syndrome,

Whipple's disease,

Celiac disease,

Laxative abuse should also be considered.

There is an association between acid suppression (with proton pump inhibitors and H2 receptor antagonists) and an increased risk of enteric infection. (Leonard, Marshall et al. 2007)

Conventional Treatment

Gastroenteritis is usually an acute and self-limiting disease that does not require medication.

Oral Rehydration Therapy

The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). (Chow, Leung et al. 2010) (Hartling, Bellemare et al. 2006)

Antiemetics

Ondansetron is a serotonin 5-HT3 receptor antagonist used mainly as an antiemetic to treat nausea and vomiting. (Carter and Fedorowicz 2012)

The use of antiemetics is a controversial topic in treatment of pediatric gastroenteritis. Although not recommended by the American Academy of Pediatrics, antiemetics are commonly prescribed by physicians. A review of the literature shows side effects of promethazine, prochlorperazine, and metoclopramide are common and potentially dangerous. Ondansetron has recently been studied as an adjunct to oral rehydration therapy in treatment of acute gastroenteritis with mild to moderate dehydration. Although studies are limited, early research suggests the medication is safe when used in a single dose and can be effective to prevent vomiting, the need for intravenous fluids, and hospital admission. (Manteuffel 2009)

Natural Therapies

Diet

The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding. (King, Glass et al. 2003)

Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under 5 years of age as they may increase diarrhea. (King, Glass et al. 2003)

Bee Honey

Bee honey added to oral rehydration therapy promoted rehydration of the body and sped recovery from vomiting and diarrhea. (Abdulrhman, Mekawy et al. 2010)

Coconut Water

Young coconut water may be helpful for home rehydration in children with mild gastroenteritis, but osmolality values showed great variation throughout maturation. (Adams and Bratt 1992)

Zinc

Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world. (Lazzerini and Ronfani 2012) (Salvatore, Hauser et al. 2007) (Patel, Mamtani et al. 2011) (Patel, Mamtani et al. 2010)

Probiotics

Probiotics have been shown to be beneficial in reducing both the duration of illness and the frequency of stools. They may also be useful in preventing and treating antibiotic associated diarrhea. (Allen, Martinez et al. 2010) (Johnston, Goldenberg et al. 2011) (Hempel, Newberry et al. 2012) (Erdogan, Tanyeri et al. 2012)

The vast majority of the published trials show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii-in the treatment of acute watery diarrhea, and particularly those due to rotavirus. (Guandalini 2011)

The cost/benefit ratio of probiotics in the ambulatory treatment of acute infectious gastro-enteritis with or without a synbiotic food supplement (containing fructo-oligosaccharides and probiotic strains of Streptoccoccus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis) has been studied in 111 children. Although use of the synbiotic supplementation increased cost, add-on medication and extra consultations were reduced, resulting in a reduction of health care cost of 25%. (Vandenplas and De Hert 2012) (Passariello, Terrin et al. 2012) (Vandenplas and De Hert 2011)

The use of Lactobacillus GG is associated with moderate clinical benefits in the treatment of acute diarrhoea in children. (Szajewska, Skorka et al. 2007) (Piescik-Lech, Urbanska et al. 2013) (Ventola, Lehtoranta et al. 2012)

Tannins

A recent study investigated the anti-viral effects of tannins on 12 different viruses including both enveloped viruses (influenza virus H3N2, H5N3, herpes simplex virus-1, vesicular stomatitis virus, Sendai virus and Newcastle disease virus) and non-enveloped viruses (poliovirus, coxsachievirus, adenovirus, rotavirus, feline calicivirus and mouse norovirus). We found that extracts from persimmon (Diospyros kaki), which contains ca. 22% of persimmon tannin, reduced viral infectivity in more than 4-log scale against all of the viruses tested, showing strong anti-viral effects against a broad range of viruses. Other tannins derived from green tea, acacia and gallnuts were effective for some of the viruses, while the coffee extracts were not effective for any of the virus. (Ueda, Kawabata et al. 2013)

Tannic acid inhibited norovirus binding to HBGA receptors. (Zhang, Dai et al. 2012) (Su and D'Souza 2012)

Grape Seed Extract

A recent study evaluated the effect of commercial GSE, Gravinol-S, on the infectivity of human enteric virus surrogates (feline calicivirus, FCV-F9; murine norovirus, MNV-1; and bacteriophage MS2) and hepatitis A virus (HAV; strain HM175). GSE caused significant reduction of the four virus titers. (Johnston, Goldenberg et al. 2011)

Cranberry

Cranberry juice (CJ) and cranberry proanthocyanidins (PAC) are widely known for their antibacterial, antiviral, and pharmacological activities. CJ and PAC show promise as natural antivirals that could potentially be exploited for foodborne viral illness treatment and prevention. (Su, Howell et al. 2010) (Su, Howell et al. 2010)

Citrate

Human noroviruses bind with their capsid-protruding domains to histo-blood-group antigens (HBGAs), an interaction thought to direct their entry into cells. Citrate and other glycomimetics have the potential to block human noroviruses from binding to HBGAs. (Hansman, Shahzad-Ul-Hussan et al. 2012)

Chitosan

Plaque reduction of human enteric virus surrogates by chitosan treatment show promise for its potential application in the food environment. (Su, Zivanovic et al. 2009)

L-Glutamine

L-glutamine may be helpful in mucositis: intestinal mucosal damage of the gastrointestinal tract. (Noe 2009)

Butyrate

An NIH study found that adjunct therapy with butyrate enema during shigellosis led to early reduction of inflammation and enhanced LL-37 expression in the rectal epithelia with prolonged release of LL-37 in the stool. (Raqib, Sarker et al. 2012)

Butyrate exerts potent effects on a variety of colonic mucosal functions such as inhibition of inflammation and carcinogenesis, reinforcing various components of the colonic defence barrier and decreasing oxidative stress. (Hamer, Jonkers et al. 2008)

Butyrate enema therapy stimulated colonic repair, as evidenced by clinical recovery, decreased inflammation, and restoration of SCFA stimulated electrolyte absorption in experimental colitis in the rat. (Butzner, Parmar et al. 1996)


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