From the Guidelines
Gastroenteritis is typically diagnosed based on clinical presentation and history, and treatment focuses on preventing dehydration and managing symptoms.
Diagnosis
- The World Health Organization (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.
- Acute gastroenteritis is characterized by acute onset, nonbloody diarrhea, vomiting, nausea, and abdominal cramps, with an incubation period of 12–48 hours 1.
- Laboratory investigation is generally not warranted for previously healthy, immunocompetent individuals with acute diarrhea, but may be justified in certain cases, such as immunocompromised individuals or those with noninfectious and extraintestinal manifestations associated with enteric pathogens 1.
Treatment
- The mainstay of treatment for gastroenteritis is preventing dehydration by ensuring adequate fluid and electrolyte intake for replacement and maintenance 1.
- Probiotics, such as L. rhamnosus ATCC 53103, E. faecium SF68, and S. boulardii, have been shown to reduce the duration and severity of diarrhea in some studies, although the evidence is not yet conclusive 1.
- Antimicrobial agents and antimotility drugs should be used judiciously, as they can contribute to antibiotic resistance and worsen illness 1.
- Vaccination against rotavirus is recommended for infants, and has been shown to reduce the incidence of severe rotavirus gastroenteritis and hospitalizations 1.
Prevention
- General measures to prevent gastroenteritis include hand hygiene, proper food preparation and storage, avoidance of high-risk foods, and use of infection prevention and control measures in hospitals and other settings 1.
- Specific preventive measures, such as typhoid and cholera vaccines, may be recommended for travelers to certain areas 1.
From the Research
Diagnosis of Gastroenteritis
- The diagnosis of gastroenteritis is often based on clinical symptoms, with the vast majority of cases being of viral etiology, self-limited, and requiring only supportive care 2.
- Viral causes of acute gastroenteritis include rotaviruses, human caliciviruses, astroviruses, and enteric adenoviruses, with clinical symptoms ranging from mild diarrhea to life-threatening dehydration 3.
- Enteric viruses, particularly rotaviruses and noroviruses, are a leading cause of gastroenteritis worldwide, with rotaviruses primarily affecting young children and noroviruses affecting people of all ages 4.
Treatment of Gastroenteritis
- The treatment of viral gastroenteritis is based primarily on replacement of fluid and electrolytes, with oral rehydration therapy being as effective as intravenous therapy in treating mild to moderate dehydration 4, 5.
- Antiemetics, such as ondansetron, can be used to enhance the compliance of oral rehydration therapy and decrease the rate of hospitalization, although they are not routinely recommended in treating acute gastroenteritis 5, 6.
- The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution, with antiemetics allowing for improved tolerance of oral rehydration solution 6.
- Prevention of norovirus infection relies on frequent hand hygiene, limiting contact with people who are infected with the virus, and disinfection of contaminated environmental surfaces, with norovirus vaccine candidates being in clinical trials 4.