From the Guidelines
Gastroenteritis symptoms can be effectively managed by preventing dehydration through adequate fluid and electrolyte intake, and treatment should focus on replacing lost fluids and electrolytes, as stated in the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
Symptoms and Presentation
Gastroenteritis typically presents with nausea, vomiting, diarrhea, abdominal cramps, and sometimes fever and body aches. These symptoms occur when the stomach and intestines become inflamed, usually due to a viral infection (like norovirus or rotavirus), bacterial infection (such as E. coli or Salmonella), or parasites. According to the 2017 IDSA guidelines, the WHO defines diarrhea as the passage of 3 or more loose or liquid stools per 24 hours, or more frequently than is normal for an individual person 1.
Treatment and Management
Treatment focuses on preventing dehydration by drinking clear fluids like water, diluted fruit juices, or oral rehydration solutions (such as Pedialyte). Adults can take small sips of 2-4 ounces every 30-60 minutes, while children should receive smaller, more frequent amounts. Over-the-counter medications like loperamide (Imodium) can help control diarrhea in adults, but should be avoided in children and cases with high fever or bloody stools. Bismuth subsalicylate (Pepto-Bismol) may help relieve multiple symptoms. Rest is important, and diet should progress gradually from bland, easy-to-digest foods (bananas, rice, applesauce, toast) to a normal diet as symptoms improve.
Prevention and Complications
Seek medical attention if symptoms are severe, include bloody diarrhea, persist beyond 3 days, or if dehydration signs develop (extreme thirst, dry mouth, decreased urination, dizziness). Handwashing and food safety practices help prevent gastroenteritis spread. The 2017 IDSA guidelines also emphasize the importance of general measures, including use of hand hygiene, proper food preparation and storage, avoidance of high-risk foods, and appropriate use of antimicrobial agents to reduce the burden of acute infectious diarrhea 1. Some key points to consider in the management of gastroenteritis include:
- The risk of death from diarrhea is increased among certain populations, such as African Americans and those with prematurity, low birth weight, less maternal education, and low income 1.
- The implementation of rotavirus vaccines has reduced the burden of acute gastroenteritis, and specific preventive measures, such as typhoid and cholera vaccines for travelers, can also be effective 1.
- Laboratory investigation is generally not warranted for most acute diarrhea episodes in previously healthy, immunocompetent people, but may be justified in certain cases, such as immunocompromised individuals or those with noninfectious and extraintestinal manifestations associated with enteric pathogens 1.
From the Research
Gastroenteritis Symptoms
- Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, or abdominal pain 2
- Symptoms of gastroenteritis include diarrhea, vomiting, nausea, fever, and abdominal pain 2, 3
Diagnosis and Evaluation
- Evaluation of a child with acute gastroenteritis should include a recent history of fluid intake and output 2
- The physical examination is the best way to evaluate hydration status 2
- The four-item Clinical Dehydration Scale can be used to determine severity of dehydration based on physical examination findings 2
Treatment and Management
- Oral rehydration therapy is the mainstay of treatment for mild dehydration and is as effective as intravenous rehydration for preventing hospitalization and return to the emergency department 2, 4
- Oral rehydration solutions are recommended for moderate dehydration 2, 4
- Ondansetron may be prescribed if needed to prevent vomiting and improve tolerance of oral rehydration solutions 2, 3
- Hospitalization and intravenous fluids are recommended for children who do not respond to oral rehydration therapy plus an antiemetic and patients with severe dehydration 2, 4