What is the treatment for viral gastritis?

Treatment of Viral Gastroenteritis

Viral gastroenteritis is primarily treated with oral rehydration therapy (ORT), as it is a self-limited illness where the main risk is dehydration and electrolyte imbalance. 1, 2

First-Line Management

Rehydration

• Oral rehydration therapy (ORT) using oral rehydration solution (ORS) is the first-line treatment 2
  • As effective as intravenous therapy for mild to moderate dehydration 3
  • Should be attempted before considering IV fluids
• Reserve intravenous (IV) fluid therapy for patients with:
  • Severe dehydration
  • Inability to tolerate oral fluids
  • Altered mental status
  • Shock 2

Antiemetics

• Ondansetron may be given to facilitate oral rehydration in children >4 years and adolescents with vomiting 2
  • Improves tolerance of oral fluids and reduces hospitalization rates 4
  • Dosage: 0.15 mg/kg IV 4

Nutrition

• Continue normal feeding during illness
• Resume age-appropriate diet during or immediately after rehydration 2
• Breast milk has protective effects against viral enteric infections; infants can usually be "fed through" an episode 1, 2
• Avoid foods high in simple sugars as they can worsen diarrhea through osmotic effects 2

Special Considerations

Antimotility Agents

• Should NOT be given to children <18 years with acute diarrhea 2
• Loperamide may be given to immunocompetent adults with acute watery diarrhea 2
• Avoid antimotility agents in cases of inflammatory diarrhea or diarrhea with fever 2

High-Risk Populations

• Children: Higher risk of dehydration; respond well to ORT 1
• Elderly: At increased risk for severe dehydration and electrolyte imbalances 2
• Immunocompromised: May experience prolonged viral shedding and more severe disease 2
  • In severe cases of adenovirus-associated diarrhea in immunocompromised patients, cidofovir may be considered (5 mg/kg IV weekly) despite its nephrotoxicity 1
  • For CMV enteritis in immunocompromised patients, ganciclovir (5 mg/kg bid IV for 2-3 weeks) followed by maintenance therapy is recommended 1

Duration of Symptoms

• Most viral gastroenteritis is self-limited:
  • Norovirus: 24-72 hours
  • Rotavirus: 4-7 days
  • Adenovirus: ≥1 week 2

Monitoring and Follow-up

• Monitor for signs of dehydration: decreased urine output, dry mucous membranes, decreased skin turgor
• Electrolyte measurements generally not necessary except in severe dehydration requiring hospitalization 5
• Approximately 9% of patients may develop post-infectious irritable bowel syndrome 2

Prevention

• Rigorous handwashing with soap and water for at least 20 seconds
• Rotavirus vaccination for children
• Food handlers should not prepare food for at least 2 days after resolution of illness
• Clean and disinfect contaminated surfaces with chlorine bleach solution 2

Common Pitfalls to Avoid

1. Overreliance on IV fluids when ORT would be sufficient
2. Unnecessary use of antimotility agents in children or with inflammatory diarrhea
3. Premature discontinuation of feeding during illness
4. Failure to recognize dehydration in high-risk populations (young children, elderly)
5. Unnecessary laboratory testing in mild cases

The key to successful management is early recognition and prompt initiation of appropriate rehydration therapy, with special attention to vulnerable populations who may require more aggressive intervention.