Your Medical Moment: Stomach Bug In Town?

19 Jul Your Medical Moment: Stomach Bug In Town?

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Dr. Diana Koelliker answers this week’s question: Hey Doc, is there a stomach bug going around?

My answer is always YES. That’s because gastroenteritis occurs in all age groups, at all times throughout the year, it is highly contagious and therefore it gets around.

Dr. Diana Koelliker, Medical Director of Emergency Services & Telluride EMS Director

What is the Stomach Bug?

Gastroenteritis is an inflammation of the stomach and intestines that results in some combination of nausea, vomiting, diarrhea, abdominal cramps and sometimes fever. It may be referred to as a “stomach bug”, “an intestinal/stomach virus” or “the stomach flu”, although it has no association with influenza (the real flu that we see in winter with high fever, cough and body aches for which there is a flu shot…that I recommend…but we’ll talk about that in another Medical Moment).

Gastroenteritis is usually self-limited, meaning that it gets better on its own without medication, and the mainstay of therapy is adequate hydration. For severe cases, IV fluids may be necessary. Those most at risk for dehydration are the very young, the very old and those with underlying medical conditions that cause a weakened immune system.

Causes:

Most cases of gastroenteritis are infectious and most of the infections are caused by viruses. There are dozens of different viruses (norovirus, rotovirus, adenovirus, etc.) that can cause gastroenteritis. All are extremely contagious and that is why these episodes can be so widespread in a community.

Children are most at risk for these types of infections because of weak immune systems and poor hygiene….ie, a kid thinks nothing of eating a french fry off the ground in front of the port-a-potties at Bluegrass. While these infections can cause a lot of vomiting and copious diarrhea, there is no specific treatment other than rehydration.

“Food poisoning” is often blamed for gastrointestinal illness, but it is actually a minority of the cases. Food borne illness can result from raw or undercooked meat, poultry, seafood, eggs, raw sprouts or unpasteurized milk or cheese to name a few. This frequently results in a bacterial infection when contaminated food is left at room temperature for several hours and the bacteria multiply and then cause illness in those who eat the food. This can also occur with ingestion of contaminated water (like in underdeveloped countries without appropriate water purification systems). Examples of these types of infection are E. coli, Salmonella, Shigella and Campylobacter among others. Some of these infections can be treated with antibiotics, but that is the minority of gastroenteritis cases. Bacterial infections usually result in severe illness with bloody diarrhea and high fever. If you have these symptoms, you should see your doctor.

Treatment:

First of all, good hygiene is paramount. Wash your hands particularly after using the restroom or prior to eating and definitely don’t share cups or utensils with sick contacts. Some viruses can be transmitted even days after diarrhea or fevers have subsided.

Oral Rehydration Therapy (ORT) is the mainstay of treatment. Children and adults can go days without eating, as long as a person stays hydrated. In kids dehydration can be seen as no tear production with crying or no wet diapers over a significant period of time. Small amounts of clear liquids like water, Gatorade, Sprite, ginger ale, pedialyte, etc. can be helpful in the process. Popsicles are a good way to encourage kids to take fluids a little at a time. Vomiting can cause a person to become very thirsty, but chugging 12 ounces of fluids can cause distention of the stomach and can encourage more vomiting….so small sips are better.

I usually recommend holding off on food for at least 12 hours after vomiting has subsided. Dairy products like milk are harder to digest and are not recommended at first. In the past, the BRAT diet (bananas, rice, applesauce, tea and toast) was touted as the solution. However, this has been shown to have insufficient nutrients and has no benefit over normal but bland feeding. I usually advise patients to begin to eat things that are appealing while staying away from spicy, fried or heavily processed foods.

Anti-emetics like ondansetron (Zofran) are well-tolerated by children and adults with few side effects and frequently can help nausea and vomiting. Your doctor can prescribe this or other medications.

Ginger root is a natural anti-emetic, and probiotics or yogurt with live cultures can be helpful to repopulate the intestines with good bacteria.

Treat fever with acetaminophen or ibuprofen. I usually do not recommend the use of anti-motility agents (like Immodium) because in some circumstances this can actually make the illness worse.

Seek medical attention if lethargy or signs of dehydration develop. If you have high fever, bloody diarrhea or persistent abdominal pain, you should see your doctor. Luckily, that is not the typical presentation for most people with gastroenteritis.

And in case you are wondering, there have been a lot of people with the “stomach bug” in town recently….

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