Acute Gastroenteritis: The Do’s and Don’ts of Diarrhea

We’ve all felt it— that wiggling, cramping feeling in your stomach that hints, “Today may not be a great day.” Then the confirmation arrives in the form of sudden onset diarrhea, abdominal pain, nausea and vomiting. It’s official: You have acute gastroenteritis or AGE.

AGE is defined by the symptoms of sudden onset diarrhea, nausea, and vomiting, and remains one of the most common illnesses in the United States, affecting over 179 million Americans annually. It costs the US over 1 billion dollars in treatment fees alone, not to mention the hit we take from lost days of work. Plus, AGE symptoms are miserable. However, as a gastroenterologist, I know we can actually do quite a bit to help ourselves feel better. Here’s how.

Despite the frequency and discomfort of this disease, AGE remains undertreated in the United States, and misconceptions abound.  To set the record straight, let’s start at the cause. AGE is caused by a broad range of pathogens—from viruses to bacteria to parasites. But 78% of all global AGE stems from the same six culprits: Shigella, Rotavirus, Adenovirus, some subspecies of E. Coli, Cryptosporidium, and Campylobacter.  In the US, we also see big bursts of Norovirus, which causes the epidemic form of gastroenteritis (aka the cruise ship horror stories).

With three of the top six causes being bacterial, you’d think the answer to AGE would be antibiotics.  Well, so did the medical community, but it turns out we were wrong.  In the vast majority of cases, antibiotic use actually prolongs the course of illness, and can even worsen symptoms (although in certain rare cases antibiotics are necessary). Since the most common side effects of antibiotics are upset stomach and diarrhea, maybe this isn’t such a surprise.

Even though Cipro isn’t going to be of much use, we do have other medicines and approaches that can be literal life savers, or at the least can get you back to normal faster and help avoid ER visits and hospitalizations for diarrhea.

First, it is worth asking your doctor about prescription Zofran to help with nausea and vomiting, as well as improving your appetite. Zofran works by blocking a specific receptor in your brain that’s tied to nausea. Then, an over-the-counter H2 blocking medication like Zantac or Pepcid will improve abdominal pain by acutely decreasing acid production.  Stronger medications like omeprazole (a PPI) don’t work as quickly, so aren’t ideal.

Once you’ve fixed your stomach, focus on your intestines. Oral rehydration with a fluid containing sugar and salt (like Gatorade or Pedialyte) is key. This activates the sodium/glucose cotransporter in your intestines and helps replenish electrolytes and fluids.  Rehydration also helps with nausea by blocking the part of your metabolism that generates ketone bodies, which at high concentrations can make you want to vomit and suppress your appetite.

After you’re rehydrated, it’s time to start eating again.  Eat anything you like that wouldn’t give you an upset stomach on a normal day. Many physicians still recommend the BRAT (Banana, Rice, Applesauce, Toast) diet, but since there’s no definitive data behind this protocol, if you don’t like it, don’t worry. Just getting any food in you is helpful because a rapid return to eating has been proven to improve recovery time – possibly by providing the nutrition your intestine needs to heal itself.

Finally, starting a probiotic containing Lactobacillus GG has been shown to be very helpful, with people recovering about a day faster.

You might notice I didn’t put Loperamide (aka Immodium) on my list.  Immodium works by decreasing the movement in your intestines. While this can decrease the total volume of diarrhea, it will likely worsen cramping and bloating, and in kids has been associated with severe complications.  We highly recommend avoiding these medications if at all possible.

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