What is the primary treatment for enteritis vs gastroenteritis?

Treatment of Enteritis vs Gastroenteritis

The primary treatment for both enteritis and gastroenteritis is oral rehydration therapy (ORT) with reduced osmolarity oral rehydration solution (ORS), with intravenous fluids reserved for cases of severe dehydration or inability to tolerate oral intake. 1, 2, 3

Definitions and Differences

• Enteritis: Inflammation specifically of the small intestine, which may present with diarrhea but less commonly with vomiting 1
• Gastroenteritis: Inflammation of both the stomach and intestines, typically presenting with both diarrhea and vomiting 2, 4

Assessment of Dehydration

• Evaluate hydration status through physical examination looking for:

  • Decreased skin turgor
  • Dry mucous membranes
  • Sunken eyes
  • Altered mental status
  • Tachycardia
  • Decreased urine output 2, 3

• Categorize dehydration as:

  • Mild: <4% body weight loss
  • Moderate: 4-6% body weight loss
  • Severe: >6% body weight loss 2, 3

Treatment Approach

Rehydration Therapy

• Mild to Moderate Dehydration:

  • Provide ORS as first-line therapy with dosage of 50-100 mL/kg over 3-4 hours for children and 2-4 L for adults 1, 2
  • Use commercially available low-osmolarity ORS (e.g., Pedialyte, CeraLyte) 2
  • Avoid sports drinks, juices, and soft drinks as primary rehydration solutions 2, 3
  • For children who refuse ORS, nasogastric administration may be considered 1, 2

• Severe Dehydration:

  • Administer isotonic intravenous fluids (lactated Ringer's or normal saline) at 20 mL/kg boluses 1, 2
  • Continue IV rehydration until pulse, perfusion, and mental status normalize 1, 2
  • Transition to oral rehydration once the patient is stabilized 1, 5

Nutritional Management

• Continue breastfeeding throughout the diarrheal episode in infants 1, 2, 3
• Resume age-appropriate diet during or immediately after rehydration 1, 2
• Avoid fasting or withholding food for prolonged periods 2, 3

Pharmacological Management

Antimotility Agents

• For Enteritis and Gastroenteritis in Adults:
  • Loperamide may be given to immunocompetent adults with acute watery diarrhea 1, 2
  • Avoid antimotility drugs in children under 18 years of age 1
  • Contraindicated in cases of bloody diarrhea, high fever, or suspected inflammatory bowel disease 1, 2

Antiemetics

• For Gastroenteritis with Significant Vomiting:
  • Consider ondansetron in children >4 years and adults to facilitate oral rehydration 2, 6
  • Particularly useful in gastroenteritis where vomiting is a prominent feature 6, 4
  • Less commonly needed in pure enteritis where vomiting is less prominent 3

Antimicrobial Therapy

• General Recommendation:

  • Empiric antimicrobial therapy is generally not recommended for either condition in immunocompetent patients 1, 3

• Exceptions where antimicrobials should be considered:

  • Infants <3 months with suspected bacterial etiology
  • Patients with fever, abdominal pain, and bloody diarrhea
  • Immunocompromised patients
  • Suspected Shigella infection 1, 3

• Avoid antimicrobial therapy for STEC O157 and other Shiga toxin-producing organisms as it may increase risk of hemolytic uremic syndrome 1, 3

Special Considerations

• For Persistent Symptoms:

  • If symptoms persist beyond 14 days, empiric antimicrobial therapy should be avoided until specific pathogens are identified 1
  • Further diagnostic evaluation may be warranted to identify specific causes 1

• For Severe Cases:

  • Rapid IV rehydration (20-30 mL/kg over 1-2 hours) can be effective in correcting dehydration and resolving vomiting in the emergency department setting 7
  • Patients with serum bicarbonate ≤13 mEq/L may be less likely to tolerate oral rehydration after IV fluid boluses 7

Prevention Measures

• Practice proper hand hygiene after using toilet, changing diapers, before/after food preparation 2, 3
• Use infection control measures including gloves, gowns, and hand hygiene with soap and water when caring for patients with diarrhea 2, 3
• Rotavirus vaccination is recommended for prevention of severe gastroenteritis in infants 1, 4

Common Pitfalls to Avoid

• Overuse of antimicrobials in viral gastroenteritis, which represents approximately 70% of cases in children 6
• Relying on sports drinks or juices for rehydration instead of proper ORS 2, 3
• Withholding food during episodes, which can worsen nutritional status 2, 3
• Premature discharge of severely dehydrated patients before adequate rehydration 7