Gastroenteritis

Gastroenteritis – is an inflammatory process in the stomach and small intestine caused by bacterial (including Helicobacter), viral or protozoal lesions, chemical and physical factors, allergic reactions. Leading clinical signs – dyspeptic, painful syndrome, in acute infectious gastroenteritis – dehydration. Diagnosis consists in the study of the history of the disease, epidemiological situation, identification of the pathogen, conducting endoscopic and other additional methods of research. Treatment is conservative, determined by the form of pathology.

General information

Gastroenteritis – Inflammatory process localized in the mucous membrane of the stomach and small intestine, leading to disorders of secretory, digestive-transport function, secondary immune and metabolic changes. The disease can occur in two forms – Acute and chronic, which have principal 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 gastroenteritis occurs in more than half of schoolchildren and older persons. Relevance of this pathology is determined by the constant appearance of new strains of pathogens, the development of resistance to antibiotics, the prevalence of such risk factors as irrational nutrition, alcohol consumption and smoking, as well as extremely frequent cases of self-treatment.

Causes of gastroenteritis

The main cause of acute inflammation is infection with bacteria, viruses, protozoa (shigella, salmonellae, Escherichia coli, enterotropic viruses, amebas, etc.), as well as the effect of chemical or physical damaging factors (alcohol, some medications, aggressive chemicals, ionizing radiation, etc.) on the mucosa of the stomach and small intestine.), and the action on the mucous membrane of the stomach and small intestine of chemical or physical damaging factors (alcohol, certain medicines, aggressive chemicals, ionizing radiation). Less frequently, the acute form is the result of an unbalanced diet (eating too spicy, fatty foods) or the individual intolerance of certain foods (allergic form).

The most common form is acute infectious gastroenteritis, in which there is entry of pathogenic flora into the gastrointestinal tract, adhesion and invasion of microorganisms, their production of enterotoxins. These processes are accompanied by an increase in the osmotic pressure of the intestinal contents and the secretion of large quantities of water and electrolytes into its lumen. The likelihood of acute infectious gastroenteritis increases with impaired intestinal microbiocenosis and reduced acidity of gastric juice.

Chronic gastroenteritis can form as a complication and continuation of an acute process that has occurred, but in most cases it is caused by infection with Helicobacter pylori. Helicobacter – are acid-resistant microorganisms, which have a tendency to attack the stomach epithelial tissue and have defense mechanisms that allow them to exist in an aggressive acidic environment.

The development of these bacteria leads to increased acid-forming function, and as a result of the constant action on the mucosa of the small intestine of the acidic contents of the stomach – Metaplasia of the intestinal epithelium, which transforms into gastric. In this case, the mucosa acquires favorable properties for Helicobacter invasion. Chronic inflammatory process leads to insufficient production of digestive juices and inhibition of local immune mechanisms.

According to observations of specialists in the field of practical gastroenterology, the chronic form of pathology is often observed in alcoholism. Atrophic changes in the mucous membrane of the gastrointestinal tract with pronounced disorders of food digestion and absorption of valuable nutrients take place.

Classification

Gastroenteritis is classified according to the form (acute or chronic), the etiological factor and the predominant clinical syndrome. In the course of acute gastroenteritis there are three degrees of severity. The first is characterized by infrequent diarrhea and vomiting, preservation of normal body temperature and absence of symptoms of dehydration. Moderate severity is defined by vomiting and diarrhea up to ten times a day, signs of mild dehydration, and fever up to 38.5ºС. A severe course is accompanied by severe dehydration, fever, impaired consciousness.

Chronic gastroenteritis is classified according to etiological factors (infectious, nutritional, caused by physical or chemical factors, liver and pancreatic diseases), predominant functional changes (disruption of membrane digestion, absorptive or motor function), increased or decreased acidity. Depending on the anatomico-morphological changes, a distinction is made between superficial gastroenteritis with epithelial cell damage, chronic inflammation without atrophy, and chronic atrophic process. In the course of 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 profuse diarrhea and vomiting within a few hours, the patient’s condition can worsen significantly. If the cause of the pathology is an infectious process, the incubation period can last from 3-4 hours to several days. More often than not, the first symptom – Diarrhoea, possibly nausea and vomiting. The severity of symptoms differs depending on the species of the pathogen.

In bacterial gastroenteritis the course is usually more severe than in viral, hyperthermia and intoxication syndrome are characteristic. The peculiarity is the damage of epithelial cells by toxins, so in most cases, bacterial gastroenteritis is accompanied by severe spastic pain along the intestinal tract. Viral lesion is very rarely accompanied by abdominal pain, in young children the disease can quickly lead to significant dehydration. Viral gastroenteritis often has signs of respiratory infection.

In the acute process, the leading clinical syndrome requiring early correction is dehydration. Dehydration may reach a significant degree, when the patient loses 10% of body weight or more of fluid. Seizures, impaired consciousness, marked weakness, tachycardia, decreased blood pressure may occur. Patients feel very thirsty; the skin is dry and turgor is reduced. In case of severe dehydration, the body temperature will drop to 35° C ºC, the amount of urine decreases until anuria.

The chronic form of the disease is accompanied by general symptoms and signs of local mucosal damage. General symptoms are characterized by weakness, asthenicism, weight loss due to impaired absorption of nutrients, irritability, insomnia. Most patients experience trophic changes in the nails (flaky, brittle nails), hair (brittle, split hair), skin, and mucous membranes. Impaired calcium absorption may lead to paresthesias, small muscle cramps.

Pain in chronic gastroenteritis occurs 1-2 hours after a meal, accompanied by nausea, belching, less often – vomiting. Intestinal manifestations of the disease include diarrhea, polyphedema, bloating, rumbling. In the chronic process clinic, periods of exacerbations and remissions alternate. Exacerbations have an autumn-spring seasonality, they are provoked by dietary disorders and concomitant diseases. With adequate therapy, symptoms regress in about ten days.

Diagnosis

In the case of acute gastroenteritis, the leading role in diagnosis is given to the study of complaints and anamnesis of the disease, epidemiological situation in the region, risk factors, as well as methods of identifying the pathogen. The nature of the changes in the stool and the degree of dehydration determine the initiation of treatment. The exact diagnosis is made after identifying the causative agent, but these tests take a long time (7-10 days). Examination reveals dryness of the skin and decreased turgor, painfulness of the abdomen on palpation. The tongue is dry, covered with grayish or white plaque. Hyperthermia, impaired consciousness, with severe dehydration possible – Hypothermia and convulsions.

Coprological examination (coprogram) reveals in the stool admixtures of mucus, pus, blood, undigested fiber, muscle fiber, starch and fat. The clinical blood test reveals leukocytosis and accelerated sedimentation, and in case of dehydration – signs of hemoconcentration (decrease in the liquid component of the blood). Detection of the pathogen is carried out by bacteriological and virological methods. Stool, vomit, blood, and urine are examined. The most informative serological diagnosis is – Quadrupled specific antibody titers in paired sera.

To verify chronic gastroenteritis, additional gastrointestinal examinations are performed. At esophagogastroduodenoscopy the state of the mucous coat of the stomach and initial sections of the small intestine is evaluated, a biopsy of the changed sections of the mucous coat is taken for subsequent histological analysis. This allows to detect atrophy, metaplasia or hyperplasia. Anthroduodenal manometry is used to detect motility disorders. Intragastric pH-metry is mandatory, because decreased and increased acidity require a different approach to treatment. In order to detect Helicobacter pylori, PCR-diagnostics, a respiratory urease test and morphological examination of biopsy specimens are performed. Abdominal ultrasound is performed to assess the condition of the liver and pancreas.

Treatment of gastroenteritis

With an acute process, treatment can be carried out on an outpatient basis or in an infectious hospital, with a chronic – in the department of gastroenterology. The basis of therapy in the acute form is rehydration, diet therapy, in some cases – The use of antibiotics and adjuvants. Any degree of severity of acute infectious gastroenteritis requires an early start of oral rehydration therapy. This is especially true for small children, in whom dehydration develops very quickly. Even if there are no signs of ecstasy, plenty of drinking is required.

If there is thirst, dry skin, reduced urine volume, special oral saline solutions are used. The patient should drink fluids in an amount that exceeds the loss by one and a half times. If thirst decreases and diuresis increases, it means that dehydration is compensated sufficiently. In case of significant losses of water and electrolytes, infusion rehydration with saline solutions is carried out.

Antibiotics in the case of acute gastroenteritis is indicated only in its bacterial etiology (presence of mucus, pus and blood in the stool, marked hyperthermia). Antibacterial therapy is contraindicated in viral lesions. To reduce diarrhea and excretion of toxins, enterosorbents are prescribed: activated charcoal, dioctahedral smectite, polyphepan and others. In order to normalize the intestinal flora, probiotics and eubiotics are used.

Treatment of chronic gastroenteritis is determined by its form. In the case of hyperacidity, antacids, proton pump inhibitors are used. Detection of Helicobacter requires specific therapy: antibiotics, bismuth preparations and proton pump inhibitors are prescribed. With reduced acidity, natural gastric juice, enzyme and reparative preparations are used. Restoration of intestinal microflora is necessarily carried out. With a pronounced pain syndrome, especially with the phenomena of solaritis, physiotherapy is effective: electrophoresis with anesthetics, magnetic therapy.

If you have an acute and chronic form of the disease, you must follow a diet. The food must be chemically and mechanically sparing, avoiding extractive substances, fatty and spicy foods. In order to reduce the risk of relapse, patients are advised to avoid smoking, alcohol, coffee and carbonated drinks. During remission, spa treatment is carried out. Therapy of gastroenteritis should not be performed by patients on their own – Irrational use of symptomatic drugs only reduces symptoms, but does not lead to a cure.

Prognosis and prevention

With timely treatment, compliance with the diet, the prognosis is favorable. At the same time, self-treatment of acute gastroenteritis can lead to chronicity of the process. In the presence of risk factors (age under 6 months and after 65 years of age, associated renal, cardiovascular and neurological diseases, diabetes mellitus, cancer pathology) the acute pathology may be severe with a rather high mortality.

In chronic gastroenteritis obligatory clinical examination and regular check-up. by a gastroenterologist. Preventive measures include personal hygiene (washing hands after visiting the bathroom and before eating), thorough washing of vegetables and herbs eaten raw, sufficient heat treatment of food, detailed examination of food industry workers with suspension from production if an acute infectious process is detected.