Abdominal influenza

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Gastrointestinal flu is the colloquial term for gastrointestinal inflammation (medical gastroenteritis) caused by pathogens. The gastrointestinal flu has nothing to do with the real flu. It is usually harmless, but causes unpleasant symptoms such as vomiting and diarrhea. In rare cases, a gastrointestinal infection can be more complicated. Find out more about the causes and treatment of gastrointestinal flu here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A09K52A08J11

Brief overview

What is gastrointestinal flu? An infection-related inflammation of the gastrointestinal tract with vomiting and (later) diarrhea as typical symptoms.
Causes and risk factors: mostly viruses or bacteria. A weakened immune system promotes infection.
Examinations and diagnosis: taking the medical history (anamnesis), physical examination. Further examinations are rarely necessary (such as blood and urine tests, colonoscopy).
Treatment: drink as much as possible, only eat light food, if necessary a glucose-salt solution as a fluid substitute and medication (from the doctor).
Prevent gastrointestinal flu: general hygiene tips (especially washing your hands), vaccinations against certain pathogens
Course and prognosis: Depending on the pathogen, the symptoms can last from 24 hours to several weeks. Most of the time, gastrointestinal flu is over quickly and heals without any consequences. It becomes dangerous when there is a massive loss of fluids and electrolytes.

description

What laypeople call gastrointestinal flu, doctors call "gastroenteritis", i.e. inflammation of the gastrointestinal tract. Strictly speaking, gastrointestinal inflammation of this kind does not have to result exclusively from infection with pathogens such as viruses or bacteria. It can also be the result of cancer treatment, for example. The correct technical term for gastrointestinal flu is therefore "infectious gastroenteritis".

The slang term "gastrointestinal flu" can be misleading in that it includes the word "flu". Infectious gastroenteritis has nothing to do with classic flu - both diseases are caused by different pathogens.

Gastrointestinal flu can occur at any age. Babies and toddlers get sick from it particularly often because their immune system has not yet dealt with many pathogens and is accordingly sensitive. In the first three years of life, children suffer from gastrointestinal infections on average once or twice a year. Three quarters of all sick children are between six and 24 months old.

Older people are also more likely to contract gastrointestinal flu.

What happens with gastrointestinal flu?

The pathogens of gastrointestinal flu attack the mucous membrane in the gastrointestinal tract (either directly or via the toxins they produce): First, the germs enter the stomach via the mouth and then move on through the intestines, where they settle multiply before they leave the body with the feces. The symptoms of gastrointestinal flu usually develop according to this "migration" through the digestive tract and the associated damage to the mucous membranes: symptoms in the initial phase are usually nausea and vomiting, later diarrhea occurs. These symptoms come about as follows:

The damage to the stomach lining caused by the pathogens can trigger nausea in the brain. Vomiting is a protective reflex of the body that tries in this way to get the unwanted intruders out of the body.
The often severe diarrhea in a gastrointestinal infection, on the other hand, occurs because the mucous membrane cells in the small and large intestines are impaired.

Basically, the different pathogens trigger diarrhea in different ways. However, a distinction can be made between three mechanisms which, when combined, often lead to diarrhea in gastrointestinal flu:

Secretory diarrhea: Some pathogens (for example cholera bacteria) increase the water excretion (secretion) in the mucous membrane cells of the intestine, i.e. the intestinal mucosa releases water into the intestine. The food pulp located there becomes very liquefied as a result.
Exudative diarrhea: Some gastrointestinal flu pathogens cause severe inflammation of the mucous membrane. As a result, it secretes more mucus and occasionally even blood, which the affected person excretes in the stool.
Osmotic diarrhea: Broken mucous membrane cells can no longer absorb many food components. Using a physical process called osmosis, these undigested components draw water from the surrounding tissue into the inside of the intestine, which in turn leads to or increases diarrhea.

Diarrhea is a very soft to watery stool consistency, more than three bowel movements per day or at least two more bowel movements per day than usual.

Gastrointestinal flu: contagion

The path of infection in a gastrointestinal infection is usually fecal-oral. This means that the pathogens from the feces (or vomit) of a person suffering from gastrointestinal flu get somehow into the mouth of another. This can happen, for example, if the sick person does not wash their hands sufficiently after using the toilet. If he then touches food (such as bread) or objects (e.g. glass, doorknob), he transfers the pathogen to it. When a healthy person attacks this and then touches his face, he transports the pathogens into his "system". This way of infection is also called contact or smear infection.

Certain gastrointestinal flu pathogens - the noroviruses - can also spread aerogenically. This means that they get from person to person by air and can thus transmit gastrointestinal flu. This contributes to the enormous risk of infection with noroviruses. The pathogens float enclosed in tiny droplets that the sick person excreted when speaking, coughing or sneezing, for example, in the ambient air and can then be inhaled by other people. This transmission path is also called droplet infection.

Some gastrointestinal flu pathogens, such as EHEC (enterohaemorrhagic Escherichia coli) or salmonella, can also pass from animals to humans. Infection occurs mainly through contaminated animal products such as raw eggs (for example in the form of tiramisu or mayonnaise) or milk. Inadequate cooling of the food often contributes to the infection of gastrointestinal flu pathogens.

How big is the risk of infection with gastrointestinal flu?

How contagious gastrointestinal flu is primarily depends on the causative agent. The risk of infection increases, for example, when the germs are relatively robust and can survive outside the human body for a longer period of time. It is also increased if the pathogen can cause gastrointestinal flu even in the smallest quantities thanks to its rapid and powerful ability to multiply. This is the case with noroviruses, for example.

If, on the other hand, the pathogens are more sensitive or can only trigger a disease in large numbers, the risk of infection is lower.

In general, gastrointestinal infections have a high potential for contagion, which is why several family members often get sick and larger outbreaks in community facilities are more common. The more viruses the sick person sheds, the more contagious it is. That is why the risk of a "gastrointestinal infection" is particularly high as long as the typical vomiting diarrhea is present. However, gastrointestinal flu patients are also infectious a few days before and after.

Gastrointestinal flu: duration

How long gastrointestinal flu lasts depends on several factors. The most important thing is which pathogen is responsible for the disease. In the case of a virus-related gastrointestinal flu, vomiting diarrhea is usually over after a few days. In contrast, an infection with certain bacteria (Campylobacter) can cause symptoms for up to two weeks.

You can find out everything you need to know about the duration of gastrointestinal flu and how long it has been contagious under Gastrointestinal flu - duration.

Gastrointestinal flu: symptoms

Nausea and vomiting followed by diarrhea are the typical symptoms of gastrointestinal flu. It is not uncommon for those affected to complain of cramp-like abdominal pain. which usually subside for a short time after every visit to the toilet.

You can read more about the symptoms of infectious gastroenteritis and the possible complications in the article Gastrointestinal flu - symptoms.

Gastrointestinal flu: causes and risk factors

The term "gastrointestinal flu" generally describes a clinical picture in which an infection with a pathogen leads to typical symptoms in the gastrointestinal tract. Depending on the pathogen, the incubation period (= time between infection and onset of the disease) as well as the intensity and duration of the symptoms vary.

In most cases, gastrointestinal flu is caused by viruses, especially noroviruses and rotaviruses. Other viruses are rarely the trigger, for example astro or sapoviruses. There are also a number of bacteria and some parasites that can cause gastrointestinal infections.

Rotaviruses

Rotaviruses are very often responsible for gastrointestinal flu in children. Up to 70 percent of infectious diarrheal diseases in young children are caused by rotaviruses. In developing countries, these infectious agents are also responsible for the high child mortality rates.

In the course of the first few years of life, the body forms more and more antibodies against the pathogens through frequent contact with rotaviruses, which protect against later infections or make them weaker. Therefore, rotaviruses cause gastrointestinal infections less often in adults than in children. But since there are different types of rotavirus, the body can never be completely immune to it. Rotaviruses can also be responsible for traveler's diarrhea, for example.In this case, gastrointestinal flu develops because the person concerned has not yet developed any antibodies against the rotaviruses that are widespread in the travel destination.

Noroviruses

Noroviruses are even more contagious than rotaviruses. They also come in countless variations, so that the immune system is usually unable to counter an infection with effective antibodies. Among other things, noroviruses are the main pathogen responsible for gastrointestinal flu in adults and account for around half of all non-bacterial gastroenteritis cases in this age group. Since noroviruses are also transmitted via the air (airborne) as droplet infection, entire families often suffer from gastrointestinal flu. In hospitals and nursing homes, affected patients are immediately isolated and the doctors and nursing staff wear protective clothing to prevent the disease from spreading.

In the case of an infection with noro- or rotaviruses, the symptoms set in after about ten hours at the earliest and after three days at the latest - depending on the type of virus and the amount of virus.

Salmonella

Salmonella is one of the best-known bacteria that can cause gastrointestinal flu. The infection they cause is called salmonellosis (salmonella poisoning).

Several species belong to the Salmonella genus, with only the Salmonella species "Salmonella Enteritidis" causing classic gastrointestinal flu. Other types of salmonella, on the other hand, cause typhoid or paratyphoid fever. These two diseases can also be associated with diarrhea. However, these are serious general illnesses and not the typical gastrointestinal infection.

If you have salmonellosis, you can infect other people with it. Mostly, however, the infection takes place via animal products that are contaminated with the germs. The main sources of infection include raw eggs and insufficiently heated meat. Be careful with poultry products in particular.

Since salmonella cannot be killed by freezing, they can also be found in the thawing water of poultry products, for example, and cause gastrointestinal flu if consumed. Therefore, you should always pour off the condensed water and, if possible, generally not put frozen goods in warm water to thaw, as salmonella multiply particularly well in this. However, a certain minimum amount of Salmonella is necessary for infection.

Campylobacter

Campylobacter bacteria can also cause gastrointestinal flu. These pathogens enter the human body through contact with animals and the consumption of contaminated food (poultry, raw milk). The Campylobacter enteritis that this can cause is the most common food-borne cause of gastrointestinal flu, ahead of salmonellosis. Symptoms appear around two to five days after being infected.

Escherichia coli (E. coli)

Most representatives of this type of bacteria are completely harmless and even very useful for humans. "Coli" is the genitive of Colon, the Latin word for large intestine. This is exactly where trillions of these bacteria settle in every human being and support digestion.

However, there are also some E. coli strains that are pathogenic to humans, i.e. cause diseases in humans. These include, for example, poison-producing E. coli (enterotoxin-producing E. coli, ETEC for short). In the case of traveler's diarrhea, ETEC is the responsible pathogen in around 40 percent of cases. Other harmful strains are EPEC (enteropathogenic E. coli), EIEC (enteroinvasive E. coli), EAEC (enteroaggregative E. coli) and EHEC (enterohaemorrhagic E. coli).

The public's attention was last drawn to EHEC in spring 2011, when several people in Germany died of the so-called haemolytic uremic syndrome (HUS). This is a disease of the small blood vessels, which in these cases occurred as a complication of a particularly aggressive EHEC infection. Basically, however, EHEC disease rarely leads to HUS.

The transmission of EHEC and other E. coli strains occurs on the one hand faecal-oral, on the other hand, similar to Salmonella, via animal products such as raw meat or unpasteurized milk. The incubation period is around two to ten days.

Shigella

Shigella cause bacterial dysentery, also known as shigellosis. This form of gastrointestinal flu spreads especially when hygiene standards are low, for example in war zones or developing countries. The infection usually takes place via infected water and food. Shigellosis occurs rarely in Germany and when it does, it is mostly as a souvenir from vacation trips from countries such as India, Tunisia or Egypt. The incubation period is one to four days.

Clostridium difficile

Clostridium difficile is a type of bacteria that ultimately occurs everywhere, including soil and dust. To a certain extent, these bacteria are also found naturally in the human intestine. But if they get out of hand there, they can trigger gastrointestinal flu.

This can happen, for example, when taking antibiotics if they disrupt the microbiotic balance in the gastrointestinal tract. The Clostridium difficile bacteria may then multiply too much and cause gastroenteritis. However, it is not the classic gastrointestinal flu, but a serious inflammation of the intestine. What is particularly feared is the severe course of this intestinal inflammation, which is also known as "pseudomembranous colitis".

Yersinia and Cholera Bacteria

Yersinia bacteria are rather rare in Western Europe and only responsible for about one percent of all diarrheal diseases. Cholera caused by bacteria of the Vibrio cholerae type is also a rarity in western countries, but worldwide there are more than six million cases each year. The disease only breaks out in around 15 percent of those infected; However, if the course is severe and medical care is poor, cholera can become very dangerous. Due to the sometimes massive diarrhea ("rice water stool"), those affected - especially children - lose a lot of fluids in a short time.

Food poisoning

Some bacteria damage the mucous membrane cells of the gastrointestinal tract indirectly by producing special poisons (toxins). Such so-called toxin formers include, for example, the bacteria Staphylococcus aureus, Bacillus cereus and Clostridium perfringens. These pathogens can occur in large numbers in spoiled food and, if they reach a certain level, cause symptoms of severe gastrointestinal flu after just a few hours.

Parasites

In addition to viruses and bacteria, there are also certain parasites that can cause gastrointestinal flu. For example, the amoeba species Entamoeba histolytica, which triggers amoebic dysentery. This disease occurs mainly in tropical and subtropical areas. A common parasitic pathogen that mainly causes diarrhea is the single cell Giardia lamblia. The disease it causes is called giardiasis.

Risk factors for gastrointestinal flu

In general, gastrointestinal flu pathogens always have it easier when the immune system is weakened. This is generally the case with children and the elderly. This is why these age groups are particularly susceptible to gastrointestinal flu. They also have a greater risk of a more complicated course. The same also applies to people who have an immune deficiency for other reasons, such as those suffering from AIDS, as well as patients who receive chemotherapy or immunosuppressive (immunosuppressive) drugs.

Gastrointestinal flu: examinations and diagnosis

The right person to contact if you have gastrointestinal flu is your family doctor. A typical gastrointestinal flu is usually straightforward and can be recognized quickly by the doctor based on the symptoms. Exactly questioning the patient about the origin of the disease and medical history (anamnesis) is important, however, in order to differentiate gastrointestinal flu from other diseases with similar symptoms (food intolerance, appendicitis, etc.). In addition, taking a medical history helps the doctor estimate the risk of a more complicated course of gastrointestinal flu. Possible questions in the anamnesis interview are, for example:

Do you have diarrhea in addition to vomiting?
How long have the complaints existed?
Do you suspect a connection with a particular dish?
Have you eaten raw milk, undercooked meat or products with raw eggs?
Are other people in the immediate vicinity (workplace, school, family) affected by gastrointestinal flu?
Do you have fever?
Have you noticed blood in your stool?
Have you been abroad in the last few days or weeks?
Are you taking or have you recently taken any medication (e.g. antibiotics)?

In addition, the doctor asks the patient about known previous illnesses. In the case of gastrointestinal flu in children, the question of a recent change in diet is also useful.

This is followed by the physical examination: The doctor pays particular attention to signs that indicate a lack of fluids (dehydration). Such signs include dry mucous membranes, sunken eyes or standing skin folds. It is very important to notice and treat dehydration in good time, especially in young children and infants. Without appropriate measures against dehydration, the child can lose consciousness or even die in the further course.

Further examinations are usually not necessary if you have gastrointestinal flu. However, they can be useful, for example, if some of the above questions were answered with yes - for example the question about blood in the stool or a recent stay abroad. In such cases, the doctor will determine the pathogen responsible for the symptoms more precisely, for example by means of a stool examination. Blood and urine tests are sometimes also indicated. If necessary, the doctor will also carry out an ultrasound examination of the abdomen or a colonoscopy.

Gastrointestinal flu: treatment

What to do with gastrointestinal flu This is usually the first question that arises after the diagnosis has been made. The main treatment options include:

Drink a lot

In the case of gastrointestinal flu, the main aim is to compensate for the loss of fluids caused by vomiting and diarrhea. In the case of a simple gastrointestinal infection, this specifically means drinking a lot of unsweetened tea or water (preferably non-carbonated). Pure juices or soda are rather unsuitable, because the high sugar content is an additional problem for the already irritated gastrointestinal tract.

The body also loses salts (electrolytes) with the fluid. A severe electrolyte deficiency can be life-threatening, especially for children. In the pharmacy there are electrolyte powders that remedy the electrolyte deficiency. They are particularly useful in children with severe diarrhea and vomiting.

Light food

Electrolyte powders are usually not necessary if those affected manage to ingest small amounts of food. It is true that in the acute phase of gastrointestinal flu it is often difficult to hold anything down without vomiting. But the body still needs a little food - on the one hand to replace lost electrolytes, and on the other hand because the intestines obtain the building blocks for healing the damaged mucous membrane directly from food.

Therefore, if you have gastrointestinal flu, you should try to eat easily digestible food a few hours after the onset of symptoms. Soup broth, for example, is well tolerated in the acute phase; in the further course bread, pasta, rice dishes, porridge or semolina are also a good tip. Too heavy, fatty food, on the other hand, should not be on the menu.

Oral rehydration solutions (ORL)

Especially in the case of prolonged diarrhea and vomiting, it may be necessary to compensate for the loss of fluid and salts with a so-called oral rehydration solution (ORL). This is a special mix of dextrose and salt for drinking, which has an ideally balanced sugar and electrolyte content. Oral rehydration solutions of this kind have been in standard use worldwide for the treatment of gastrointestinal flu and other diarrheal diseases since the 1970s. This has significantly reduced child mortality, especially in crisis countries.

If there is already a severe lack of fluids, the doctor can also give similar preparations directly as an infusion.

Medical therapy

If the gastrointestinal flu is uncomplicated, the patient is usually not given any medication. On the one hand, drugs are usually not necessary, on the other hand, there are no specific drugs against many viral pathogens.

Under certain circumstances, however, drug therapy makes sense. For example, in the case of gastrointestinal flu that has been proven to be bacterial, antibiotics can shorten the duration of the illness. In principle, however, doctors should use antibiotics very cautiously in the case of a gastrointestinal infection and only in the following cases:

in premature babies
in the first trimester of pregnancy
in people with known immunodeficiency
in the case of severe disease
when bloody diarrhea occurs
in the detection of pathogens such as Salmonella typhi, Vibrio cholerae, amoebas and Clostridium difficile

In the case of EHEC infections, antibiotics can be dangerous because, although they destroy large numbers of enterohaemorrhagic E. coli, their decay products can possibly trigger a haemolytic uremic syndrome (HUS). Antibiotics should therefore only be given cautiously in the case of EHEC infections.

In addition to antibiotics, there are other drugs that can be used to relieve symptoms of gastrointestinal flu. These include antiemetics, which help against nausea and vomiting, as well as so-called motility inhibitors (for example loperamide). These can slow down the bowel movement and thus the diarrhea. The active ingredient Racecadotril can also be used against severe diarrhea. The antispasmodic butylscopolamine works against cramp-like abdominal pain.

All of these drugs are not always useful, which is why the treating doctor has to decide on their use individually.

Gastrointestinal flu: home remedies

Various home remedies can help relieve gastrointestinal flu symptoms. An old tip against diarrhea is, for example, the consumption of grated apples (with the skin!). Apples contain so-called pectins. These ingredients can bind bacteria and their toxins in the intestines.

Blueberry tea, for example, is also advisable if you have diarrhea. It contains tannins that have a contracting effect on the intestinal mucosa. They also have anti-inflammatory and antibacterial properties.

You can find out how to use these and other home remedies against gastrointestinal flu correctly under Gastrointestinal flu: Home remedies

Gastrointestinal flu: disease course and prognosis

Depending on the causative agent and the general physical condition of the person affected, the symptoms of gastrointestinal flu may only persist for a few days or longer. For example, a norovirus infection usually lasts for several days, and acute food poisoning can sometimes be completely overcome after just 24 hours. Amoebic dysentery, on the other hand, can last for weeks if left untreated.

However, an acute gastrointestinal flu usually goes away just as quickly as it came. It generally subsides after a short time and heals without any consequences. Correct symptomatic treatment (drinking enough, etc.) can often prevent complications.

However, caution is required in special situations: For example, babies and toddlers can lose massive amounts of fluids and electrolytes due to severe diarrhea. In extreme cases, there is even a risk of death from severe gastrointestinal flu! Pregnancy and breastfeeding are also situations in which close medical care for mother and child is necessary in order to be able to react to possible complications in good time.

Gastrointestinal flu: prevention

The best thing to do is not to get gastrointestinal flu in the first place - and there are a number of things that can be done to prevent illness.

hygiene

A gastrointestinal flu can only be prevented by avoiding close contact with sick people as much as possible and by paying attention to good hygiene. Above all, this includes thorough and regular hand washing. The feces and vomit of people with gastrointestinal flu are particularly highly infectious. Therefore, infection in the toilet is particularly likely if it is used by both sick and healthy people. You should therefore clean and disinfect the toilet before each use. Wash your hands with soap for two to three minutes after each use of the toilet. This significantly reduces the risk of infection with gastrointestinal flu.

However, you should avoid close physical contact with the sick as much as possible. You should also wash the bed linen and clothing of sick people at at least 60 ° C, better at 90 ° C.

Stay at home

By not going to school or work as soon as they notice the signs of gastrointestinal flu, people can reduce the risk of contagion to others. This is the only way to prevent the disease from spreading, especially if highly contagious viruses are responsible for the gastrointestinal flu.

Vaccinations

There is now a standard recommendation for active immunization against rotaviruses in infancy from the sixth week of life (oral vaccination). This rotavirus vaccination does not offer 100% immunity, but has been shown to reduce the number of infections.

There is also a vaccine against the travel sickness cholera, but the Standing Vaccination Commission (STIKO) and the WHO only recommend it for (long-term) trips to regions with an increased risk of infection. These include, for example, crisis areas and countries with generally very poor hygiene conditions. A doctor can give specific recommendations on the travel destination as part of a medical travel consultation.

Prevention of gastrointestinal flu while traveling

Otherwise, travel-related gastrointestinal infections can essentially be avoided by taking the following advice to heart: "Cook it, peel it or leave it". In countries with dubious hygiene standards, you should always boil water before use or sterilize it with special tablets or only use originally sealed water bottles. You should also avoid raw and insufficiently heated food such as seafood, fish and undercooked meat. Only eat fruit that can be peeled off immediately (e.g. bananas). You should generally keep your hands off ice cubes and ice cream - they can also contain gastrointestinal flu pathogens.

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