Gastroenteritis is an inflammation of gastrointestinal mucosa caused by various factors, mainly manifested as abdominal pain, diarrhea, nausea and vomiting.The disease is divided into acute and chronicAcute gastroenteritisMore common, mostly caused by viruses, bacteria or parasites.The source of disease can also be non infectious factors such as drugs, alcoholism, allergies, autoimmune diseases, etc.Children or people with low immunity are more susceptible to gastroenteritis.
The main symptoms of gastroenteritis include epigastric pain, diarrhea, abdominal distension, fullness after meals and early satietyAnorexia、Belching、Regurgitation, nausea, etc.Severe diarrhea and vomiting may cause dehydration and electrolyte imbalance.The disease is infectious to a certain extent, and is mainly transmitted through excreta mouth or human to human contact.
The treatment of gastroenteritis mainly includes symptomatic treatment, anti infection treatment and adjustment of living habits.Patients with acute gastroenteritis mainly need fluid replacement, and those with severe gastroenteritis need correctionAcidosisandElectrolyte disorder。Usually, chronic gastritis can heal itself. If the symptoms are serious or last for a long time, you need to see a doctor in time.
TCM disease name
gastroenteritis
Visiting department
Department of Gastroenterology, Intestinal Clinic, Pediatrics
According to different pathogens, infectious gastroenteritis can be divided into bacterial, viral, fungal, parasitic, etc.
Non infectious gastroenteritis is found in stressmedicine, alcoholism, food allergy, autoimmune disease, etc.
Pathogenesis
Infectious factors
Pathogenic microorganism infection: includingBacteria、fungus、Viruses、parasiteAll kinds of infectious enteritis caused by.
viral infection
The most common pathogens are rotavirus, norovirus, adenovirus and astrovirus.
Children's infection is mostly viral infection, with rotavirus and norovirus being the most common.The results of the survey of diarrhea in children in China show that the incidence peak is from October to December every year, and the main pathogen is rotavirus.
For adults, the proportion of viral infection leading to infectious gastroenteritis is much higher than that of other pathogens. Norovirus is the main virus leading to adult acute gastroenteritis.
bacterial infection
It can be caused by eating food contaminated by bacteria, that is, food poisoning, contact with the carrier or drinking raw water.
Common bacteria in children include Escherichia coli, Campylobacter, Salmonella and Shigella.
In addition, TB infection can cause tuberculous enteritis, and Helicobacter pylori infection can cause chronic gastritis.
Parasitic infection
Common pathogens include Giardia, amoeba, cryptosporidium, schistosoma, etc.
Non infectious factors
Digestive juice reflux
Bile, pancreatic juice and intestinal fluid flow back into the stomach in large quantities.
Food and medicine
Long term consumption of crude or irritating food, high salt diet, food allergy, alcoholism, long-term use of non steroidal anti-inflammatory drugs (such as aspirin, ibuprofen, etc.) and other drugs.
autoimmune gastritis
Chronic atrophic gastritis caused by autoimmune disorder.
Dysfunction of intestinal flora
Various factors cause potentially harmful bacteria in the intestinal tract to produce toxins, destroy the intestinal mucosa, and induce infection and immune disorders.
Inflammatory enteropathy
Chronic nonspecific intestinal inflammation, including ulcerative colitis and Crohn's disease.
other
It includes radiation enteritis caused by exposure to large amounts of radiation, and ischemic enteritis caused by insufficient blood supply to the intestinal wall.
Predisposing factors
Pediatric predisposing factors
Young age: The younger the age, the more likely the acute gastroenteritis will occur. The severity and duration of diarrhea are related to young age (<6 months).
Feeding mode: The early occurrence of severe diarrhea or prolonged diarrhea in infants may be related to premature weaning.
Potential chronic disease or immune deficiency: children with malnutrition and immune deficiency have a higher risk of severe diarrhea, or even can not recover, and progress to chronic disease.
Environmental/socio-economic factors: nurseries and cities with low socio-economic levels are more likely to cause moderate to severe and persistent diarrhea.
Adult triggers
Unclean diet: eating unclean diet contaminated by flies, carriers or patients, drinking raw water, eating raw meat, eating spoiled food, eating food stored in the refrigerator for a long time or frozen food, etc.
Recent travel or contact with epidemic areas.
Low immunity or malnutrition.
Long term and extensive use of antibiotics.
symptom
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The symptoms of gastroenteritis caused by different causes are different, often showing epigastric pain, diarrhea, abdominal distention, fullness and early satiety after meals, anorexia, belching, acid regurgitation, nausea and other symptoms.
Dehydration and electrolyte imbalance may occur in patients with severe diarrhea and vomiting;Acute gastritis caused by acute stress or drugs can also cause hematemesis, black stool, etc.
Typical symptoms
Infectious gastroenteritis
Most patients have acute onset, such as fatigue, anorexia, nausea, vomiting, abdominal discomfort, and drainage like stool.
Most people with food poisoning get sick within a few hours after eating, and in serious cases, mucus, pus, and bloody stool may appear.The odor of stool caused by amoeba is jam like.Giardia causes explosive watery stools with foul smell, mostly abdominal distention, stink, nausea, vomiting, etc.
Tuberculous enteritis is characterized by chronic abdominal pain and diarrhea, sometimes with diarrhea and constipation alternating.
Non infectious gastroenteritis
Most patients with noninfectious gastroenteritis have no symptoms or no obvious symptoms. Those with symptoms mainly show nonspecific dyspepsia, such as abdominal pain, abdominal distention, fullness after meals and early satiety. Eating can be aggravated or reduced, and appetite can also be decreased, belching, acid regurgitation, nausea, etc.Severe cases may be accompanied by hematemesis and (or) black stool.
Acute gastroenteritis, such as seafood and other food allergies, can cause severe pain around the umbilicus within a few hours of eating. After 2-3 times of watery stool diarrhea, it can heal itself, sometimes accompanied by urticaria.
Autoimmune enteritis is a chronic disease, characterized by long-term abdominal pain, abdominal distention, diarrhea or constipation.
Accompanying symptoms
The common accompanying symptoms of acute gastroenteritis include fever, headache, myalgia, etc.In severe cases, dehydration, electrolyte disorder and even shock may be caused by a large amount of water loss.
Chronic course gastroenteritis may have different systemic manifestations due to different causes, including fever, night sweat, emaciation, anemia, clubbing fingers, etc., as well as extraintestinal manifestations such as arthritis, nodular erythema, ophthalmia, oral ulcer, etc.
Medical treatment
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Patients with acute gastroenteritis often have a history of unclean diet before onset. When severe abdominal pain occurs, the number of stools increases significantly, mucus purulent stool, high fever, dehydration, shock and other symptoms occur, it is recommended to seek medical advice in time. Children or people with low immunity are prone to progress, so they should seek medical advice in time.
Acute gastroenteritis can usually be diagnosed by symptoms, and doctors will conduct corresponding examinations according to the patient's condition, judge the cause and severity according to the examination results, and then select the appropriate treatment scheme.Patients with mild illness can be treated in the outpatient department, and those with severe illness need to be hospitalized.
Visiting department
They mainly went to the department of gastroenterology and the intestinal out-patient clinic;Pediatric patients may seek medical advice from pediatrics.
Relevant inspection
laboratory examination
Blood test
The type of infectious gastroenteritis can be preliminarily determined according to the total number of white blood cells, hemoglobin concentration, erythrocyte sedimentation rate and C-reactive protein in blood routine.
Fecal examination
After infection by different pathogens, the feces may show different characteristics, such as watery stool, meat washing watery stool, purulent stool, bloody stool, mucus stool, etc.
White blood cells and red blood cells can be seen in the stool of some patients.
For chronic diarrhea caused by intestinal tuberculosis and intestinal infection, pathogenic bacteria culture is also required.
Water and electrolyte inspection
Patients with severe symptoms should pay attention to whether they have dehydration symptoms, and improve this examination to monitor the water and electrolyte status of patients.
Special examination of gastrointestinal tract
Gastroscopy and histopathology
Gastroscopy is the first choice when the symptoms of indigestion of unknown causes are manifested, and the tissues are taken under gastroscope for pathological examination.At the same time, rapid urease test is also available to detect whether there is Helicobacter pylori (Hp) infection.
It is of great significance to clarify the cause of chronic gastritis and exclude peptic ulcer and gastric cancer.
Enteroscopy and histopathology
Patients with long-term abdominal pain, diarrhea or constipation are preferred to have colonoscopy. The colonoscopy and histopathological characteristics of gastroenteritis of different causes are different. This examination is of great significance for etiology identification.
C-13 or C-14 urea breath test
The method of detecting Helicobacter pylori (Hp) infection independent of endoscopy has high accuracy.
Imaging examination
X-ray barium enema
This examination is feasible for chronic intestinal diseases. X-ray manifestations of gastroenteritis are different for different causes.
differential diagnosis
Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease, and there is no abnormality in all examinations. There is also a lack of abnormal findings in enteroscopy that can explain the symptoms of patients.
The clinical manifestations are loose stool, watery stool or mucus stool, bloodless stool or pyemia stool.Diarrhea is more common in the daytime and alleviates at night. It is related to mental tension and emotional changes, and may also be related to the intake of certain foods. Language hints can induce or alleviate diarrhea.
Peptic ulcer
It can be manifested as upper abdominal pain, upper abdominal fullness/discomfort, heartburn, acid regurgitation, belching, nausea, vomiting, anorexia and other non-specific symptoms. The identification mainly depends on endoscopy.
Colorectal cancer
It includes colon cancer and rectal cancer, which can be manifested as changes in bowel habits, abdominal pain, abdominal lumps, etc. It can be confirmed by colonoscopy and histopathology.
gastric cancer
Gastric cancer may have no symptoms or only non-specific dyspepsia symptoms in the early stage, and may have bleeding, obstruction, abdominal mass or metastasis symptoms in the late stage.The differentiation mainly depends on endoscopy and histopathology.
treatment
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Acute gastroenteritis can generally heal itself in a short time after fluid infusion, diet and drug treatment. In severe cases, acidosis and electrolyte disorder need to be corrected.
Gastroenteritis of chronic course should be treated on the basis of symptomatic treatment according to the etiology.
Most gastroenteritis diseases do not need to be treated with antibiotics.
Acute treatment
Replenishment is the most important treatment in the acute phase. The doctor will determine the specific method, amount and speed of fluid replacement according to the degree of dehydration.
For mild and moderate dehydration, oral rehydration salts (ORS) can be given. For severe dehydration, intravenous rehydration is required. After the condition is improved, oral rehydration is required.
General treatment
The patient needs adequate rest.
Generally, acute gastroenteritis does not require fasting. It is recommended to eat less and more meals (especially for infants, 6 meals a day is recommended), increase calorie intake as much as possible, and eat mixed foods rich in trace elements and vitamins.
In case of severe vomiting, fasting is required, and fasting patients should be fed with intravenous nutrition.
medication
Patients can be treated with the following drugs under the guidance of doctors.
Symptomatic treatment
Spasmolysis and analgesia
It is suitable for people with severe abdominal pain. Atropine, compound belladonna tablets, anisodamine, etc. can be used to reduce the degree of intestinal spasm.Use with caution in patients with inflammatory bowel disease.
It is suitable for patients with severe vomiting. Metoclopramide can be injected.Oral or intravenous ondansetron may be effective in young children with vomiting.
Intestinal mucosal protective agents and adsorbents, such as montmorillonite powder, pectin, activated carbon, etc;Reduce excessive secretion of water and electrolyte, such as racecadotril;Inhibit intestinal peristalsis, such as loperamide and phenethylpiperidine.
It should be noted that for patients with toxic or infectious gastroenteritis, if they take drugs to reduce intestinal motility, toxins may not be effectively discharged from the body, aggravating the symptoms of poisoning. Therefore, for patients with infectious gastroenteritis, such drugs should be considered under the guidance of doctors.
Most children, adults with mild to moderate diarrhea, do not need anti infection treatment, especially acute gastroenteritis caused by virus.
However, some people with severe illness and low immunity need to use antibiotics under the guidance of doctors. The commonly used antibiotics for adults are fluoroquinolones, such as norfloxacin (norfloxacin), ciprofloxacin, etc. They can also choose sulfonamides, azithromycin, rifaximin, etc.
Some special people should pay attention to the following issues when using antibiotics:
Pregnant women should inform the doctor of the situation to avoid the use of teratogenic drugs or drugs with obvious toxicity to pregnant women or fetuses.
Breastfeeding can be stopped when women in lactation use antibiotics, and they can breastfeed after drug metabolism.
Newborns should avoid choosing antibiotics that are toxic or affect growth and development.
Children patients should pay attention to drug reduction according to the doctor's advice to avoid adverse reactions.
Dysfunction of intestinal flora
Supplement intestinal probiotics, such as Bacillus licheniformis, bifidobacteria, etc.
Aminosalicylic acid preparations, such as sulfasalazine, mesalazine, olsalazine, balsalazide, etc;Hormone;Immunosuppressants and biological agents, such as azathioprine, cyclosporine, infliximab, etc.
Intestinal tuberculosis and tuberculous peritonitis
Some TCM treatments, such as massage, acupuncture, or drugs, can alleviate symptoms. It is recommended to go to a regular medical institution for treatment under the guidance of a doctor.
prognosis
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The prognosis is completely different for different causes.
Acute gastroenteritis, mostly, has a good prognosis, and its course is often related to the patient's age, body immunity, pathogen virulence and other factors.Children, the elderly, people with immunodeficiency or other diseases are seriously ill, and the mortality rate is slightly higher.
Chronic gastritis, intestinal flora imbalance, intestinal tuberculosis and other diseases can be cured.
Ischemic enteritis and inflammatory bowel disease can be alleviated after treatment.
complication
Water and electrolyte disorder
Patients with acute gastroenteritis may be accompanied by dehydration, acidosis and electrolyte disorders.
anemia
Long term bleeding of gastric mucosa and intestinal mucosa, or autoimmune related diseases, or anemia may occur in patients.
Peptic ulcer
15%~20% of Helicobacter pylori (Hp) associated gastritis can cause peptic ulcer.
Most of them are caused by inflammatory bowel disease and infectious colitis, which are characterized by rapid deterioration of the condition, emergence of toxemia, dehydration, electrolyte disorder, intestinal dilatation, etc.The disease has an acute onset and rapid development. If it is not diagnosed and treated in time, the risk of death is high.
Intestinal tuberculosis or inflammatory bowel disease may be accompanied by intestinal obstruction, which may cause obstruction of passage of intestinal contents.
Inflammatory bowel disease is at risk of canceration.
prevention
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Do not eat unclean fruits
During the growth period, fruits and melons should be watered, fertilized, and sprayed with pesticides. During the collection, handling, and sale process, fruits and melons are susceptible to bacterial infection, so many fruits and melons have bacteria, insect eggs, and chemical pesticides on their skins. Therefore, fruits and melons must be washed repeatedly with clean water before eating.All fruits and melons that can be peeled should be peeled before eating, otherwise pesticide accumulation and poisoning may occur.
Avoid eating stimulating food
Stimulating food such as cold food and spicy food should be selected according to personal conditions, original eating habits and seasons, and excessive eating should be avoided, especially alcohol addiction.
Pay attention to food hygiene
Wash your hands frequently, pay attention to the hygiene of tableware, and separate raw food and cooked food.
