What is the treatment for viral gastritis?

Treatment of Viral Gastroenteritis

Oral rehydration therapy (ORS) is the primary treatment for viral gastroenteritis, with supportive care focused on preventing and treating dehydration while maintaining nutrition. 1

First-Line Management

Rehydration

• Oral rehydration solution (ORS) is the cornerstone of treatment for viral gastroenteritis 1, 2
• For patients with mild to moderate dehydration:
  • ORS is as effective as intravenous fluid therapy 3
  • Continue oral rehydration even if vomiting persists, offering small frequent sips
• For severe dehydration or inability to tolerate oral fluids:
  • Intravenous rehydration may be necessary
  • Transition to oral rehydration once the patient stabilizes 1

Nutrition

• Continue normal feeding during illness to maintain gut integrity 1
• Resume age-appropriate usual diet during or immediately after rehydration
• Easily digestible foods (BRAT diet - bananas, rice, applesauce, toast) may be better tolerated 1
• Breastfeeding should continue for infants, as breast milk may have protective effects against viral enteric infections 1

Symptomatic Treatment

Anti-emetics

• Ondansetron may be considered when vomiting is severe and preventing adequate oral rehydration, particularly in children >4 years 1
• Ondansetron (0.15 mg/kg IV) significantly improves oral hydration tolerance and reduces hospital admission rates compared to placebo 4

Anti-diarrheals

• Antimotility drugs (e.g., loperamide) should NOT be given to children <18 years with acute diarrhea 1
• In adults, loperamide may be considered only after adequate hydration is achieved
• Avoid antimotility agents in cases with fever or inflammatory diarrhea 1

Other Medications

• Bismuth subsalicylate may reduce the duration of Norwalk virus infection (from 27 to 20 hours) 1
• No specific antiviral therapy is currently recommended for viral gastroenteritis 5

Special Populations

Children

• Require close monitoring for dehydration
• Ondansetron is particularly effective in reducing hospitalization rates in children 4
• Dexamethasone is less effective than ondansetron for treating vomiting in viral gastritis 4

Elderly

• Higher risk for dehydration and electrolyte imbalances
• May experience prolonged constitutional symptoms
• May develop mild lactose intolerance after rotavirus infection (typically 10-14 days) 1
• Require closer monitoring for complications 1

Immunocompromised Individuals

• Experience prolonged viral shedding and illness duration
• At risk for more severe disease, particularly with cytomegalovirus or adenovirus
• Require more aggressive supportive care and monitoring 1

Prevention of Transmission

• Vigorous handwashing with soap for at least 10 seconds after each contact with ill persons 1
• Clean soiled surfaces promptly with appropriate disinfectants 1
• Isolate affected individuals for at least 2 days after symptom resolution 1
• For nosocomial rotavirus, isolation should continue until stool is negative by antigen detection (may be ≥1 week) 1
• Food handlers should not prepare food for at least 2 days after resolution of illness 1

Common Pitfalls to Avoid

1. Unnecessary laboratory testing: Measurements of serum electrolytes, creatinine, and glucose are usually not necessary except in severe dehydration requiring hospitalization 3

2. Premature use of antimotility agents: These can prolong viral shedding and worsen outcomes, especially in children 1

3. Withholding food: Continuing nutrition during illness is important for gut integrity and recovery 1

4. Inadequate isolation: Remember that viral shedding can continue for up to 3 weeks with norovirus, with only 10-100 viral particles needed for transmission 1

5. Insufficient hand hygiene: Regular soap is effective; special handwashing products are not necessary but thorough technique is essential 1