Gastroenteritis is an inflammatory process in the stomach and small intestine, the cause of which may be bacterial (including helicobacter), viral or protozoal lesion, the action of chemical and physical factors, the development of allergic reactions. The leading clinical signs are dyspeptic, pain syndrome, and dehydration in acute infectious gastroenteritis. Diagnosis consists in studying the anamnesis of the disease, the epidemiological situation, identifying the pathogen, conducting endoscopic and other additional research methods. Treatment is conservative, determined by the form of pathology.
Meaning
Gastroenteritis is an inflammatory process localized in the mucous membrane of the stomach and small intestine, leading to disruption of secretory, digestive and transport functions, secondary immune and metabolic changes. The disease can occur in two forms – acute and chronic, which have fundamental differences in etiology, manifestations and methods of treatment.
The prevalence is very high: in the structure of infectious diseases, acute gastroenteritis ranks second after respiratory infections, and chronic occurs in more than half of schoolchildren and older age groups. The relevance of this pathology is due to the constant appearance of new strains of pathogens, the development of antibiotic resistance, the prevalence of risk factors such as poor nutrition, alcohol consumption and smoking, as well as extremely frequent cases of self-medication.
Causes of gastroenteritis
The main cause of the development of acute inflammation is infection with bacteria, viruses, protozoa (shigella, salmonella, E. coli, enterotropic viruses, amoebas, etc.), as well as the effect on the mucous membrane of the stomach and small intestine of chemical or physical damaging factors (alcohol, certain medications, aggressive chemicals, ionizing radiation). Less often, the acute form occurs as a result of an unbalanced diet (eating too spicy, fatty foods) or individual intolerance to certain foods (allergic form).
The most common is acute infectious gastroenteritis, in which pathogenic flora enters the gastrointestinal tract, adhesion and invasion of microorganisms, and their production of enterotoxins. These processes are accompanied by an increase in the osmotic pressure of the intestinal contents and the secretion of a large amount of water and electrolytes into its lumen. The probability of acute infectious gastroenteritis increases with violation of intestinal microbiocenosis and low acidity of gastric juice.
Chronic gastroenteritis can form as a complication and continuation of the acute process, but in most cases its cause is infection with Helicobacter pylori. Helicobacteria are acid–resistant microorganisms that have a tropicity to the epithelial tissue of the stomach and have protective mechanisms that allow them to exist in an aggressive acidic environment.
The development of these bacteria leads to an increase in acid–forming function, and as a result of the constant action of acidic stomach contents on the mucous membrane of the small intestine, metaplasia of the intestinal epithelium, which is transformed into gastric. At the same time, the mucosa acquires favorable properties for the settlement of helicobacteria. Chronic inflammatory process leads to insufficient production of digestive juices and suppression of local immune mechanisms.
According to the observations of specialists in the field of practical gastroenterology, a chronic form of pathology is often observed in alcoholism. At the same time, there are atrophic changes in the mucous membrane of the gastrointestinal tract with pronounced disorders of food digestion and absorption of valuable nutrients.
Classification
Gastroenteritis is classified depending on the form (acute or chronic), etiological factor and prevailing clinical syndrome. During acute gastroenteritis, there are three degrees of severity. The first is characterized by infrequent diarrhea and vomiting, maintaining a normal body temperature and the absence of symptoms of dehydration. The average severity is determined by vomiting and diarrhea up to ten times a day, signs of mild dehydration and an increase in temperature to 38.5 ° C. Severe course is accompanied by severe dehydration, fever, impaired consciousness.
Chronic gastroenteritis is classified according to etiological factors (infectious, alimentary, caused by physical or chemical factors, liver and pancreatic diseases), predominant functional changes (violation of membrane digestion, suction or motor function), increased or decreased acidity. Depending on anatomical and morphological changes, superficial gastroenteritis with damage to epithelial cells, chronic inflammation without atrophy, and chronic atrophic process are distinguished. During the chronic form, exacerbations and remissions are distinguished.
Symptoms of gastroenteritis
The clinical picture depends on the form of the disease. The acute process develops rapidly, due to frequent and copious diarrhea and vomiting, the patient’s condition may deteriorate significantly within a few hours. If the cause of the pathology is an infectious process, the incubation period can last from 3-4 hours to several days. Most often, the first symptom is diarrhea, nausea and vomiting are possible. The severity of the manifestations differs depending on the species of the pathogen.
With bacterial gastroenteritis, the course is usually more severe than with viral, hyperthermia and intoxication syndrome are characteristic. A feature is damage to epithelial cells by toxins, so in most cases bacterial gastroenteritis is accompanied by pronounced spastic pains along the course of the intestine. Viral damage is extremely rarely accompanied by abdominal pain, in young children the disease can quickly lead to significant dehydration. Viral gastroenteritis often occurs with signs of respiratory infection.
In the acute process, the leading clinical syndrome requiring early correction is dehydration. Dehydration can reach a significant degree when the patient loses fluid in the amount of 10% of body weight or more. At the same time, seizures, impaired consciousness, pronounced weakness, tachycardia, and a decrease in blood pressure are possible. Patients feel very thirsty; the skin is dry, turgor is reduced. With significant dehydration, the body temperature drops to 35 ° C, the amount of urine excreted decreases up to anuria.
The chronic form of the disease is accompanied by general symptoms and signs of local mucosal damage. General manifestations are characterized by weakness, asthenization, weight loss due to impaired absorption of nutrients, irritability, insomnia. Most patients have trophic changes in nails (flaky, brittle nails), hair (brittle, split hairs), skin and mucous membranes. Violation of calcium absorption can lead to paresthesia, cramps of small muscles.
Pain in chronic gastroenteritis occurs 1-2 hours after eating, accompanied by nausea, belching, less often – vomiting. Intestinal manifestations of the disease include diarrhea, polyphaly, bloating, rumbling. In the clinic of the chronic process, periods of exacerbations and remissions are replaced. Exacerbations have an autumn-spring seasonality, they are provoked by diet disorders and concomitant diseases. With adequate therapy, symptoms regress in about ten days.
Diagnostics
In the case of acute gastroenteritis, the leading role in the diagnosis is given to the study of complaints and anamnesis of the disease, the epidemiological situation in the region, risk factors, as well as methods for detecting the pathogen. The nature of changes in bowel movements and the degree of dehydration make it possible to determine the beginning of treatment. An accurate diagnosis is made after the pathogen is detected, but these studies require a long time (7-10 days). The examination determines the dryness of the skin and a decrease in their turgor, abdominal pain during palpation. The tongue is dry, overlaid with a grayish or white coating. Possible hyperthermia, impaired consciousness, with severe dehydration – hypothermia and convulsions.
Coprological examination (coprogram) reveals impurities of mucus, pus, blood, undigested fiber, muscle fibers, starch and fats in the stool. In a clinical blood test, leukocytosis and acceleration of ESR are determined, and in the case of dehydration, signs of hemoconcentration (reduction of the liquid component of the blood). Detection of the pathogen is carried out by bacteriological and virological methods. Feces, vomit, blood and urine are examined. The most informative serological diagnosis is a fourfold increase in the titer of specific antibodies in paired serums.
Additional studies of the gastrointestinal tract are conducted to verify chronic gastroenteritis. During esophagogastroduodenoscopy, the condition of the gastric mucosa and the initial parts of the small intestine is assessed, a biopsy of the altered mucosal areas is performed for subsequent histological analysis. This makes it possible to detect atrophy, metaplasia or hyperplasia. Antroduodenal manometry is used to detect motor disorders. Intragastric pH-metry is mandatory, since low and high acidity require a different approach to treatment. In order to detect Helicobacter pylori, PCR diagnostics, respiratory urease test and morphological examination of biopsies are carried out. To assess the condition of the liver and pancreas, ultrasound of the abdominal organs is performed.
Treatment for gastroenteritis
In acute cases, treatment can be carried out on an outpatient basis or in an infectious hospital, in chronic cases – in the department of gastroenterology. The basis of therapy in acute form is rehydration, diet therapy, in some cases – the use of antibiotics and auxiliary agents. Any severity of acute infectious gastroenteritis requires early initiation of oral rehydration therapy. This is especially true for young children, whose dehydration develops very quickly. Even if there are no signs of exicosis, copious drinking is required.
In the presence of thirst, dry skin, decreased urine volume, special oral saline solutions are used. The patient should drink the liquid in a volume exceeding the loss by one and a half times. If thirst decreases and diuresis increases, then dehydration is compensated sufficiently. With significant losses of water and electrolytes, infusion rehydration with saline solutions is carried out.
Antibiotics in the case of acute gastroenteritis are indicated only with its bacterial etiology (the presence of mucus, pus and blood in the stool, severe hyperthermia). In case of viral infection, antibacterial therapy is contraindicated. To reduce diarrhea and eliminate toxins, enterosorbents are prescribed: activated carbon, dioctahedral smectite, polyphepan and others. Probiotics and eubiotics are used to normalize the intestinal flora.
Treatment of chronic gastroenteritis is determined by its form. In case of increased acidity, antacids, proton pump inhibitors are used. The detection of helicobacteria requires mandatory specific therapy: antibiotics, bismuth preparations and proton pump inhibitors are prescribed. With reduced acidity, natural gastric juice, enzymatic and reparative preparations are used. The intestinal microflora must be restored. With severe pain syndrome, especially with the phenomena of solaritis, physiotherapy is effective: electrophoresis with anesthetics, magnetic therapy.
In the acute and chronic form of the disease, it is mandatory to follow a diet. The food should be chemically and mechanically gentle, extractive substances, fatty and spicy dishes are excluded. In order to reduce the risk of relapse, patients are advised to exclude smoking, alcohol, coffee and carbonated drinks. During the period of remission, sanatorium treatment is carried out. Gastroenteritis therapy should not be carried out by patients on their own – the irrational use of symptomatic agents only reduces the manifestations, but does not lead to a cure.
Prognosis and prevention
With timely treatment, adherence to a diet, the prognosis is favorable. At the same time, self-treatment of acute gastroenteritis can lead to chronization of the process. In the presence of risk factors (age up to 6 months and after 65 years, concomitant renal, cardiovascular and neurological diseases, diabetes mellitus, oncological pathology), acute pathology can occur in severe form, while the mortality rate is quite high.
In case of chronic gastroenteritis, medical examination and regular examination are mandatory. a gastroenterologist. Preventive measures include personal hygiene (washing hands after visiting bathrooms and before eating), thorough washing of raw vegetables and herbs, sufficient heat treatment of products, a detailed examination of food industry workers with suspension from production when an acute infectious process is detected.
Liteature
- Craig S, Zich DK. Gastroenteritis. In: Marx JA, editor. Rosen’s emergency medicine. 7th edition. 2009; p. 1200.
- Mead P.S., Slutsker L., Dietz V. Food-related illness and death in the United States. Emerg Infect Dis. 1999;5:607. link
- Scharff RL. Health-related costs from foodborne illness and death in the United States. The Produce Safety Project at Georgetown University. Accessed March, 2013.
- CDC Division of News and Electronic Media. Deaths from gastroenteritis double.
- Guerrant R.L., Van Gilder T., Steiner T.S. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001;32:337–338. – link