Gastroenterocolitis is a combined inflammation of the stomach, small and large intestines. The disease often has an infectious nature (viral bacterial or parasitic pathogens), less often begins under the influence of allergens, exogenous toxins, some medications. Pathology is manifested by nausea, vomiting, various abdominal pains, stool disorders. Diagnosis requires stool tests, blood tests, ultrasound of the abdominal cavity and other instrumental techniques. Treatment includes elimination of the etiological factor (if possible), restoration of the functions of the digestive system, elimination of dehydration.
ICD 10
A00-A09 K52
Meaning
Gastroenterocolitis is one of the most common pathological conditions in medicine faced by family doctors, as well as narrow—profile specialists: infectious disease specialists, gastroenterologists, toxicologists. Acute forms of the disease are in second place in frequency of occurrence after respiratory infections. The relevance of gastrointestinal inflammation is due to a wide variety of etiological factors, serious disorders of the digestive processes, the tendency of patients to carry out treatment independently without consulting specialists, which often leads to complications.
Causes of gastroenterocolitis
Total inflammation of the stomach and intestines is a nonspecific syndrome, has a polyethological nature, which is determined by the patient’s age, eating habits, the presence of chronic concomitant diseases and other features. The causes of gastroenterocolitis are grouped into several categories, such as:
- Bacterial infections. Such an inflammatory process in the gastrointestinal tract is the result of many intestinal infections: salmonellosis, shigellosis (dysentery), escherichiosis, campylobacteriosis. Pathology often occurs with food toxicoinfections caused by staphylococci, streptococci, enterococci.
- Viral infections. Infectious lesions of the stomach and intestines are often observed when infected with viruses: rotavirus, adenovirus, norovirus. Such forms of the disease are more typical for children. Gastroenterocolitis is also possible with influenza, polio, reovirus infection and other infectious processes.
- Parasitic infestations. The defeat of the digestive tract is characteristic of protozoal infections: amoebiasis, balantidiasis, giardiasis. Involvement in the pathological process of most parts of the gastrointestinal tract is possible with a long course of helminthiasis.
- Toxic effects. The disease occurs when accidentally swallowing solutions of household chemicals, cosmetics, industrial alkaline or acidic liquids. Less often, pathology is formed by the use of poisonous mushrooms, exotic seafood, and some plants.
- Allergens. Allergic gastrointestinal inflammation is a common pathology that occurs both when using sensitizing products specific to a particular person, and due to food intolerance to dyes, flavors, and other low—quality food components.
- Iatrogenic factors. Prolonged treatment with antibiotics, cytostatics, corticosteroids provokes intestinal dysbiosis, against which gastroenterocolitis develops. Acute damage is possible as a result of radiation exposure during radiotherapy of oncopathology, with accidental or intentional use of a large dose of medications.
Risk factors
The main predisposing factor is errors in nutrition. The manifestation of symptoms is observed with unhealthy snacks and the absence of full meals, abuse of spicy or smoked dishes, simultaneous intake of a large number of sweets. Refusal of hot dishes in the context of the causes of the disease remains a debatable issue, however, in many patients, when eating dry, signs of gastrointestinal tract damage worsen.
Risk factors include the presence of somatic pathology: chronic pancreatitis, cholecystitis, hepatitis, especially if timely treatment is not carried out. The likelihood of developing the disease increases in patients with achilia due to the absence of the disinfecting function of hydrochloric acid of the stomach. Violations of the immune status are fraught with the rapid spread of intestinal infections with the total involvement of all parts of the gastrointestinal tract in the process.
Pathogenesis
The mechanism of development of the disease differs depending on the main etiological factor, the initial state of the gastrointestinal tract. With an invasive type of intestinal infection, pathogens colonize on the intestinal wall, their introduction into the mucosa with the development of inflammation, ulcerative-necrotic changes. In the secretory type, the biochemical mechanisms of absorption of water and electrolytes in the intestine are disrupted, and in the osmotic type, the hyperosmolarity of the chyme is at the heart of the disease.
With toxic and iatrogenic gastroenterocolitis, there is direct damage to the walls of all parts of the gastrointestinal tract with the formation of erosions, ulcers, burns (under the action of acids or alkalis). A special mechanism for the formation of allergic lesions of the gastrointestinal tract: most often it occurs according to the immediate (reagin) type associated with hyperproduction of immunoglobulins E, occasionally delayed sensitivity reactions (cellular type) are diagnosed.
Regardless of the mechanism of damage to the stomach and intestines, serious violations of digestive function occur in gastrointestinal inflammation. Due to a decrease in the production of hydrochloric acid and pepsin, protein food is not digested in the stomach, a deficiency of pancreatic and intestinal enzymes causes maldigestion. As a result, a person develops malabsorption, the body does not receive the main macronutrients, vitamins and minerals, which is manifested by a variety of deficient conditions.
Symptoms of gastroenterocolitis
Pathology is characterized by a combination of symptoms that are typical of gastritis, enteritis and colitis. Gastritic signs of the disease include pain and pain in the upper abdomen, nausea, repeated vomiting. Enteritis is characterized by soreness in all parts of the abdomen, rumbling in the intestines, frequent loose stools. Colitis is manifested by spastic pains in the left lower abdomen, impurities of mucus and blood in the feces, painful urge to defecate.
To determine the type of intestinal lesion, the nature of fecal masses is taken into account. For secretory diarrhea, an abundant watery stool without foreign impurities in an amount of more than 1 liter per day is pathognomonic. Osmotic diarrhea is manifested by fetid “fatty” feces, in which undigested food particles are present. Invasive diarrhea, which is typical of extensive lesions of the large intestine, is characterized by a liquid muco-fecal stool with streaks of blood.
In the acute form of the disease, severe intoxication syndrome occurs. In patients, body temperature rises to subfebrile or febrile values, severe weakness and adynamia are bothering, in some cases moderate depression of consciousness occurs, requiring urgent treatment. When exposed to exogenous toxins, joint and muscle pain, impaired reflex activity, tremor of the fingers are possible.
The above-described clinical picture is typical for the acute variant of gastroenterocolitis, whereas the chronic form of the disease proceeds with scant symptoms. Patients complain of moderate abdominal pain, stool disorders, decreased appetite. With nutritional insufficiency, fatigue, deterioration of working capacity, headaches worry. Symptoms have a wave-like course with periods of exacerbations, partial or complete remissions.
Complications
Local complications of pathology include perforation of the intestinal wall, rapidly progressing colitis, toxic megacolon. With deep damage to the intestinal wall, there is a risk of profuse bleeding, which, in the absence of timely treatment, ends with the death of the patient. Prolonged inflammatory process in the chronic variant of the disease is fraught with the development of stomach or intestinal cancer.
Acute complications of toxic/drug gastroenterocolitis include damage to other organs: the urinary system, heart, brain. The negative effect of exogenous substances is manifested by acute renal failure, heart failure, toxic encephalopathy. With a massive bacterial invasion, there is a risk of developing an infectious and toxic shock.
The longer the disease is not treated, the more the digestive function is suppressed. Insufficiency of oral and/or parietal digestion of nutrients is accompanied by impaired absorption of amino acids, monosaccharides, lipids, trace elements. The body is in a state of nutritional deficiency, polyhypovitaminosis occurs. Against this background, the condition of the skin and hair deteriorates, functional disorders of internal organs occur.
With gastroenterocolitis of any etiology, dysbiosis inevitably manifests itself, characterized by the predominance of pathogenic intestinal microflora. If dysbiosis treatment has not been prescribed, patients experience heaviness and bloating, have unstable fetid stools, besides these signs are aggravated by the use of fatty foods, fast food dishes, alcohol. Against the background of a violation of the synthesis of vitamins in the colon without appropriate treatment with vitamin preparations, the symptoms of vitamin deficiency are aggravated.
Diagnostics
Examination of patients with signs of acute gastroenterocolitis is the responsibility of the infectious disease specialist, and chronic variants of the disease are mainly dealt with by gastroenterologists. During the initial examination, great importance is paid to collecting anamnesis of the disease: when symptoms appeared, what events the patient associates with the deterioration of health, whether treatment was carried out at home. To clarify the cause of gastrointestinal tract damage , the following methods are used:
- Physical examination. Superficial and deep palpation of the abdomen is required to identify areas of maximum pain, to exclude acute surgical pathology. An examination of the tongue, skin, and mucous membranes is also performed — additional symptoms provide valuable information for guessing the cause of the disease.
- Ultrasound of the abdominal organs. Ultrasound diagnostics is necessary to localize the inflammatory process in the gastrointestinal tract, exclude other diseases that may have a similar clinical picture, and quickly assess the condition of the entire abdominal cavity.
- Additional instrumental methods. To clarify the anatomical and functional features of the digestive tract, radiography with barium passage, EGD, colonoscopy is prescribed. A modern and comfortable research option for patients is videocapsular endoscopy — informative visualization of all parts of the intestine without the introduction of a probe.
- The coprogram. Disorders of digestive function are determined by the content in the feces of a large amount of undigested fiber, striated muscle fibers, drops of neutral fat. The inflammatory process is indicated by mucus, a significant number of white blood cells, the presence of red blood cells.
- Microbiological diagnostics. Bacteriological fecal culture is an informative method for detecting most types of bacterial intestinal infections. Fecal microscopy is performed to diagnose helminth eggs, protozoan cysts. Of the modern methods, ELISA and PCR of feces are used.
- Blood test. Changes in the hemogram indicate a nonspecific inflammatory process (leukocytosis or leukopenia, increased ESR). Deviations in the biochemical analysis of blood occur in chronic gastroenterocolitis. If necessary, serological reactions to antibodies to intestinal infections are performed.
Gastroenterocolitis treatment
In gastroenterocolitic inflammation, treatment includes two main directions: non-drug measures of correction of the condition (diet therapy, therapeutic and protective regime), drug therapy — etiotropic, pathogenetic, symptomatic, restorative. Treatment of uncomplicated forms of the disease in patients without additional risk factors and epidemiological danger is possible at home, in other cases hospitalization in a specialized hospital is required.
Therapeutic nutrition is prescribed taking into account the intensity of the diarrheal syndrome, the general condition of the patient. After normalization of the stool, the diet is gradually expanded. With chronic gastroenterocolitis, constant adherence to a sparing diet with a predominance of easily digestible food is required. Oral or parenteral rehydration is performed to correct the water balance. Medical treatment may include the following drugs:
- Antibiotics. Medications are used with proven bacterial etiology of gastroenterocolitis for the rapid elimination of the etiological factor. In the case of parasitic infestations, specific antiprotozoal or anthelmintic agents are indicated for treatment.
- Enterosorbents. The drugs bind and remove toxic substances from the gastrointestinal tract, so they are used as pathogenetic treatment for various forms of gastroenterocolitis.
- Immunomodulators. Medications are prescribed for the treatment of severe bacterial or viral infections, especially in immunocompromised patients.
- Probiotics. Medicines containing beneficial lacto- and bifidobacteria are necessary for the restoration of intestinal microflora after the inflammatory process, antibiotic therapy. To enhance the effectiveness of probiotics, they are combined with prebiotics.
- Enzymes. With reduced activity of digestive enzymes, it is advisable to medically correct the function of oral digestion, which makes it possible to eliminate nutritional insufficiency, normalize stools in the chronic form of the disease.
Prognosis and prevention
Most cases of acute gastroenterocolitis can be successfully eliminated with the help of complex drug therapy. If the treatment is carried out in a timely manner, the prognosis is favorable, long-term consequences do not arise. Patients with chronic somatic pathology, reduced immune status, as well as people who self-medicate have an increased risk of complications.
Measures of personal prevention of gastroenterocolitis include rational nutrition, quitting smoking, minimizing alcohol consumption. It is also recommended to observe the rules of personal hygiene not to buy products “from hand”, not to visit suspicious catering establishments. At the state level, it is necessary to ensure quality control of food, drinking water, and prevent contamination of reservoirs with sewage.
