gastrointestinal disorders
Overview of Gastroenteritis
Treatment of Gastroenteritis
Oral or IV rehydration Consideration of antidiarrheal agents ifC. difficileorE. coliO157:H7 infection is not suspected Antibiotics only in select cases Supportive treatment is all that is needed for most patients. Bed rest with convenient access to a toilet or bedpan is desirable. O157:H7 infection, rehydration with isotonic IV fluids may attenuate the severity of any renal injury should hemolytic-uremic syndrome develop. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration ). Carbonated beverages and sports drinks lack the correct ratio of glucose to sodium and thus are not appropriate, particularly for children When the patient can tolerate fluids without vomiting and the appetite has begun to return, food may be gradually restarted. Although commonly recommended, there is no demonstrated benefit to restricting the diet to bland food (eg, cereal, gelatin, bananas, toast). Some patients have temporary lactose intolerance. Antidiarrheal (antimotility) agentsare not recommended in pediatric cases and therefore should be avoided in children < 18 years of age with acute diarrhea (see also the Infectious Diseases Society of America's2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea). Use of antidiarrheal agents is contraindicated in children < 2 years of age. These agents are generally safe for adult patients with watery diarrhea (as shown by heme-negative stool). However, antidiarrheals may cause deterioration of patients withC. difficileorE. coliO157:H7 infection and thus should not be given to any patient with recent antibiotic use, heme-positive or bloody stool, or diarrhea with fever, pending specific diagnosis. Effective antidiarrheals includeloperamideordiphenoxylate/atropine. Ifvomitingis severe and a surgical condition (eg, small-bowel obstruction) has been excluded, an antiemetic may be beneficial. Medications useful in adults includeondansetron,prochlorperazine, andpromethazine. Do not use antidiarrheal agents in adults with suspectedC. difficileorE. coliO157:H7 infection (eg, with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever) or in children. Children who are still vomiting after 24 hours require reevaluation. appear to briefly shorten the duration of diarrhea, there is insufficient evidence that they affect major clinical outcomes (eg, decrease the need for IV hydration and/or hospitalization) to support their routine use in the treatment or prevention of infectious diarrhea ( Probiotics reference ). 1.Preidis GA, Weizman AV, Kashyap PC, Morgan RL: AGA technical review on the role of probiotics in the management of gastrointestinal disorders.Gastroenterology159(2):708–738.e4, 2020. doi: 10.1053/j.gastro.2020.05.060 Empiric antibiotics are generally not recommended except for certain cases of Treatment or when suspicion of In proven bacterial gastroenteritis, antibiotics are not always required. They do not help withSalmonellaand may prolong the duration of shedding in the stool. Exceptions include patients with immunocompromise, neonates, and patients withSalmonellabacteremia. Antibiotics are also ineffective against toxic gastroenteritis (eg,S. aureus,B. cereus,C. perfringens). Indiscriminate use of antibiotics fosters the emergence of drug-resistant organisms, increases the risk of adverse effects, and increases the potential forC. difficileinfection. However, certain infections do require antibiotics (see table). infection ( Antimicrobials references ). colitis. This treatment generally has been shown to be safe and effective, but there are still issues with quality control, particularly regarding infection transmission (see Treatment of recurrences ) ( For cryptosporidiosis, a course ofnitazoxanidemay be helpful in patients with immunocompromise. Giardiasis is treated withmetronidazoleornitazoxanide. 1.Johnson S, Lavergne V, Skinner AM, et al: Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused update guidelines on management ofClostridioides difficileinfection in adults.Clin Infect Dis73(5):e1029–e1044, 2021. doi: 10.1093/cid/ciab549 2.Perler BK, Chen B, Phelps E, et al: Long-term efficacy and safety offecal microbiotatransplantation for treatment of recurrentClostridioides difficileinfection.J Clin Gastroenterol54(8):701–706, 2020. doi: 10.1097/MCG.0000000000001281 3.Feuerstadt P, Allegretti JR, Khanna S: Practical use of RBX2660 for the prevention of recurrentClostridioides difficileinfection.Am J Gastroenterol2023. doi: 10.14309/ajg.0000000000002195 