Gastroenteritis#Cause

File:BristolStoolChart.png]]

Gastroenteritis usually involves both diarrhea and vomiting. Sometimes, only one or the other is present. This may be accompanied by abdominal cramps. Signs and symptoms usually begin 12–72 hours after contracting the infectious agent. If due to a virus, the condition usually resolves within one week. Some viral infections also involve fever, fatigue, headache and muscle pain. If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial. Some bacterial infections cause severe abdominal pain and may persist for several weeks.

Children infected with rotavirus usually make a full recovery within three to eight days.{{cite journal|last=Meloni|first=A|author2=Locci, D |author3=Frau, G |author4=Masia, G |author5=Nurchi, AM |author6=Coppola, RC |title=Epidemiology and prevention of rotavirus infection: an underestimated issue?|journal=Journal of Maternal-Fetal and Neonatal Medicine|date=October 2011 |volume=24 |issue=Suppl 2|pages=48–51|pmid=21749188|doi=10.3109/14767058.2011.601920|s2cid=44379279}} However, in poor countries treatment for severe infections is often out of reach and persistent diarrhea is common.{{cite web|title=Toolkit |url=http://www.defeatdd.org/understanding-crisis/advocacy-outreach/toolkits |work=DefeatDD |access-date=3 May 2012 |url-status=dead |archive-url=https://web.archive.org/web/20120427053802/http://www.defeatdd.org/understanding-crisis/advocacy-outreach/toolkits |archive-date=27 April 2012 }} Dehydration is a common complication of diarrhea.{{cite web|title=Management of acute diarrhoea and vomiting due to gastoenteritis in children under 5|url=http://guidance.nice.org.uk/CG84|work=National Institute of Clinical Excellence|date=April 2009|url-status=dead|archive-url=https://web.archive.org/web/20090802094158/http://guidance.nice.org.uk/CG84|archive-date=2009-08-02|access-date=2009-06-11}} Severe dehydration in children may be recognized if the skin color and position returns slowly when pressed. This is called "prolonged capillary refill" and "poor skin turgor". Abnormal breathing is another sign of severe dehydration.{{cite book |author=Tintinalli, Judith E. |title=Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli))|publisher=McGraw-Hill Companies |location=New York |year=2010 |pages=830–839 |isbn=978-0-07-148480-0 }} Repeat infections are typically seen in areas with poor sanitation, and malnutrition. Stunted growth and long-term cognitive delays can result.

Reactive arthritis occurs in 1% of people following infections with Campylobacter species. Guillain–Barré syndrome occurs in 0.1%. Hemolytic uremic syndrome (HUS) may occur due to infection with Shiga toxin-producing Escherichia coli or Shigella species. HUS causes low platelet counts, poor kidney function, and low red blood cell count (due to their breakdown).{{cite journal|last=Elliott|first=EJ|title=Acute gastroenteritis in children.|journal=The BMJ|date=6 January 2007 |volume=334|issue=7583|pages=35–40|pmid=17204802|doi=10.1136/bmj.39036.406169.80|pmc=1764079}} Children are more predisposed to getting HUS than adults. Some viral infections may produce benign infantile seizures.

Viruses (particularly rotavirus (in children) and norovirus (in adults)) and the bacteria Escherichia coli and Campylobacter species are the primary causes of gastroenteritis. There are, however, many other infectious agents that can cause this syndrome including parasites and fungi. Non-infectious causes are seen on occasion, but they are less likely than a viral or bacterial cause. Risk of infection is higher in children due to their lack of immunity. Children are also at higher risk because they are less likely to practice good hygiene habits. Children living in areas without easy access to water and soap are especially vulnerable.

Rotaviruses, noroviruses, adenoviruses, and astroviruses are known to cause viral gastroenteritis.{{cite book |last1=Barlow |first1=Gavin |last2=Irving |first2=William L. |last3=Moss |first3=Peter J. |editor1-last=Feather |editor1-first=Adam |editor2-last=Randall |editor2-first=David |editor3-last=Waterhouse |editor3-first=Mona |title=Kumar and Clark's Clinical Medicine |date=2020 |publisher=Elsevier |isbn=978-0-7020-7870-5 |pages=529–530 |edition=10th |chapter-url=https://books.google.com/books?id=sl3sDwAAQBAJ&pg=PA529 |language=en |chapter=20. Infectious disease }} Rotavirus is the most common cause of gastroenteritis in children, and produces similar rates in both the developed and developing world. Viruses cause about 70% of episodes of infectious diarrhea in the pediatric age group. Rotavirus is a less common cause in adults due to acquired immunity.{{cite journal |vauthors=Desselberger U, Huppertz HI |title=Immune responses to rotavirus infection and vaccination and associated correlates of protection |journal=The Journal of Infectious Diseases |volume=203 |issue=2 |pages=188–95 |date=January 2011 |pmid=21288818 |pmc=3071058 |doi=10.1093/infdis/jiq031 }} Norovirus is the cause in about 18% of all cases.{{cite journal|last1=Ahmed|first1=Sharia M|last2=Hall|first2=Aron J|last3=Robinson|first3=Anne E|last4=Verhoef|first4=Linda|last5=Premkumar|first5=Prasanna|last6=Parashar|first6=Umesh D|last7=Koopmans|first7=Marion|last8=Lopman|first8=Benjamin A|title=Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis|journal=The Lancet Infectious Diseases|doi=10.1016/S1473-3099(14)70767-4|pmid=24981041|volume=14|issue=8|date=Aug 2014|pages=725–30|pmc=8006533|url=https://zenodo.org/record/1260252}} Generally speaking, viral gastroenteritis accounts for 21–40% of the cases of infectious diarrhea in developed countries.{{Cite journal|last=Baumgart|first=Alexander J. Eckardt and Daniel C.|date=2010-12-31|title=Viral Gastroenteritis in Adults|url=https://www.eurekaselect.com/76857/article|access-date=2020-12-22|journal=Recent Patents on Anti-Infective Drug Discovery|volume=6|issue=1|pages=54–63|doi=10.2174/157489111794407877|pmid=21210762|language=en|url-access=subscription}}

Norovirus is the leading cause of gastroenteritis among adults in America accounting for about 90% of viral gastroenteritis outbreaks. These localized epidemics typically occur when groups of people spend time proximate to each other, such as on cruise ships, in hospitals, or in restaurants. People may remain infectious even after their diarrhea has ended. Norovirus is the cause of about 10% of cases in children.

File:Salmonella Typhimurium Gram.jpg

In some countries, Campylobacter jejuni is the primary cause of bacterial gastroenteritis, with half of these cases associated with exposure to poultry.{{cite journal|last=Galanis|first=E|title=Campylobacter and bacterial gastroenteritis.|journal=Canadian Medical Association Journal |date=11 September 2007 |volume=177|issue=6|pages=570–1|pmid=17846438|doi=10.1503/cmaj.070660|pmc=1963361}} In children, bacteria are the cause in about 15% of cases, with the most common types being Escherichia coli, Salmonella, Shigella, and Campylobacter species. If food becomes contaminated with bacteria and remains at room temperature for several hours, the bacteria multiply and increase the risk of infection in those who consume the food. Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices.{{cite journal|last=Nyachuba|first=DG|title=Foodborne illness: is it on the rise?|journal=Nutrition Reviews|date=May 2010 |volume=68|issue=5|pages=257–69|pmid=20500787|doi=10.1111/j.1753-4887.2010.00286.x}} In the developing world, especially sub-Saharan Africa and Asia, cholera is a common cause of gastroenteritis. This infection is usually transmitted by contaminated water or food.{{cite journal|last=Charles|first=RC|author2=Ryan, ET|title=Cholera in the 21st century.|journal=Current Opinion in Infectious Diseases|date=October 2011 |volume=24|issue=5|pages=472–7|pmid=21799407|doi=10.1097/QCO.0b013e32834a88af|s2cid=6907842}}

Toxigenic Clostridioides difficile is an important cause of diarrhea that occurs more often in the elderly. Infants can carry these bacteria without developing symptoms. It is a common cause of diarrhea in those who are hospitalized and is frequently associated with antibiotic use.{{cite journal|last=Moudgal|first=V|author2=Sobel, JD|title=Clostridium difficile colitis: a review.|journal=Hospital Practice |date=February 2012 |volume=40|issue=1|pages=139–48|pmid=22406889|doi=10.3810/hp.2012.02.954|s2cid=23015631}} Staphylococcus aureus infectious diarrhea may also occur in those who have used antibiotics.{{cite journal|last=Lin|first=Z|author2=Kotler, DP |author3=Schlievert, PM |author4= Sordillo, EM |title=Staphylococcal enterocolitis: forgotten but not gone?|journal=Digestive Diseases and Sciences|date=May 2010 |volume=55|issue=5|pages=1200–7|pmid=19609675|doi=10.1007/s10620-009-0886-1|s2cid=2023416}} Acute "traveler's diarrhea" is usually a type of bacterial gastroenteritis, while the persistent form is usually parasitic.{{cite web|title=Persistent Travelers' Diarrhea|url=http://wwwnc.cdc.gov/travel/yellowbook/2016/post-travel-evaluation/persistent-travelers-diarrhea|publisher=United States Centers for Disease Control and Prevention|access-date=9 January 2016|date=10 July 2015|quote=Although most cases of travelers' diarrhea are acute and self-limited, a certain percentage of travelers will develop persistent (>14 days) gastrointestinal symptoms ... Parasites as a group are the pathogens most likely to be isolated from patients with persistent diarrhea|url-status=live|archive-url=https://web.archive.org/web/20160103203635/http://wwwnc.cdc.gov/travel/yellowbook/2016/post-travel-evaluation/persistent-travelers-diarrhea|archive-date=3 January 2016}} Acid-suppressing medication appears to increase the risk of significant infection after exposure to several organisms, including Clostridioides difficile, Salmonella, and Campylobacter species.{{cite journal|last=Leonard|first=J |author2=Marshall, JK |author3=Moayyedi, P|title=Systematic review of the risk of enteric infection in patients taking acid suppression.|journal=The American Journal of Gastroenterology|date=September 2007 |volume=102|issue=9|pages=2047–56; quiz 2057|doi=10.1111/j.1572-0241.2007.01275.x |pmid=17509031|s2cid=12326803 }} The risk is greater in those taking proton pump inhibitors than with H₂ antagonists.

A number of parasites can cause gastroenteritis. Giardia lamblia is most common, but Entamoeba histolytica, Cryptosporidium spp., and other species have also been implicated. As a group, these agents comprise about 10% of cases in children. Giardia occurs more commonly in the developing world, but this type of illness can occur nearly everywhere.{{cite journal|last=Escobedo|first=AA|author2=Almirall, P |author3=Robertson, LJ |author4=Franco, RM |author5=Hanevik, K |author6=Mørch, K |author7=Cimerman, S |title=Giardiasis: the ever-present threat of a neglected disease|journal=Infectious Disorders Drug Targets|date=October 2010 |volume=10|issue=5|pages=329–48|pmid=20701575|doi=10.2174/187152610793180821}} It occurs more commonly in persons who have traveled to areas with high prevalence, children who attend day care, men who have sex with men, and following disasters.

Transmission may occur from drinking contaminated water or when people share personal objects. Water quality typically worsens during the rainy season and outbreaks are more common at this time. In areas with four seasons, infections are more common in the winter. Worldwide, bottle-feeding of babies with improperly sanitized bottles is a significant cause. Transmission rates are also related to poor hygiene, (especially among children), in crowded households,{{cite journal|last=Grimwood|first=K|author2=Forbes, DA|title=Acute and persistent diarrhea|journal=Pediatric Clinics of North America|date=December 2009 |volume=56|issue=6|pages=1343–61|pmid=19962025|doi=10.1016/j.pcl.2009.09.004}} and in those with poor nutritional status. Adults who have developed immunities might still carry certain organisms without exhibiting symptoms. Thus, adults can become natural reservoirs of certain diseases. While some agents (such as Shigella) only occur in primates, others (such as Giardia) may occur in a wide variety of animals.

There are a number of non-infectious causes of inflammation of the gastrointestinal tract. Some of the more common include medications (like NSAIDs), certain foods such as lactose (in those who are intolerant), and gluten (in those with celiac disease). Crohn's disease is also a non-infectious cause of (often severe) gastroenteritis. Disease secondary to toxins may also occur. Some food-related conditions associated with nausea, vomiting, and diarrhea include: ciguatera poisoning due to consumption of contaminated predatory fish, scombroid associated with the consumption of certain types of spoiled fish, tetrodotoxin poisoning from the consumption of puffer fish among others, and botulism typically due to improperly preserved food.{{cite journal|last=Lawrence|first=DT|author2=Dobmeier, SG |author3=Bechtel, LK |author4= Holstege, CP |title=Food poisoning|journal=Emergency Medicine Clinics of North America|date=May 2007 |volume=25|issue=2|pages=357–73; abstract ix|pmid=17482025|doi=10.1016/j.emc.2007.02.014}}

In the United States, rates of emergency department use for noninfectious gastroenteritis dropped 30% from 2006 until 2011. Of the twenty most common conditions seen in the emergency department, rates of noninfectious gastroenteritis had the largest decrease in visits in that time period.{{cite journal | vauthors = Skiner HG, Blanchard J, Elixhauser A | title = Trends in Emergency Department Visits, 2006–2011 | journal =HCUP Statistical Brief |issue=179 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = September 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp | url-status=live | archive-url = https://web.archive.org/web/20141224224220/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp | archive-date = 2014-12-24 }}

Gastroenteritis is defined as vomiting or diarrhea due to inflammation of the small or large bowel, often due to infection. The changes in the small bowel are typically noninflammatory, while the ones in the large bowel are inflammatory. The number of pathogens required to cause an infection varies from as few as one (for Cryptosporidium) to as many as 10⁸ (for Vibrio cholerae).

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms. Determining the exact cause is usually not needed as it does not alter the management of the condition.

However, stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world. It may also be appropriate in children younger than 5, old people, and those with poor immune function.{{cite journal|last1=Shane|first1=Andi L|last2=Mody|first2=Rajal K|last3=Crump|first3=John A|last4=Tarr|first4=Phillip I|last5=Steiner|first5=Theodore S|last6=Kotloff|first6=Karen|last7=Langley|first7=Joanne M|last8=Wanke|first8=Christine|last9=Warren|first9=Cirle Alcantara|last10=Cheng|first10=Allen C|last11=Cantey|first11=Joseph|last12=Pickering|first12=Larry K|title=2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea|journal=Clinical Infectious Diseases|date=19 October 2017|doi=10.1093/cid/cix669|pmid=29053792|pmc=5850553|volume=65|issue=12|pages=e45–e80}} Diagnostic testing may also be done for surveillance. As hypoglycemia occurs in approximately 10% of infants and young children, measuring serum glucose in this population is recommended. Electrolytes and kidney function should also be checked when there is a concern about severe dehydration.

A determination of whether or not the person has dehydration is an important part of the assessment, with dehydration typically divided into mild (3–5%), moderate (6–9%), and severe (≥10%) cases. In children, the most accurate signs of moderate or severe dehydration are a prolonged capillary refill, poor skin turgor, and abnormal breathing.{{cite journal|last=Steiner|first=MJ |author2=DeWalt, DA |author3-link=Julie Story Byerley |author3=Byerley JS|title=Is this child dehydrated?|journal=JAMA: The Journal of the American Medical Association|date=9 June 2004 |volume=291|issue=22|pages=2746–54|pmid=15187057|doi=10.1001/jama.291.22.2746}} Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth. A normal urinary output and oral fluid intake is reassuring. Laboratory testing is of little clinical benefit in determining the degree of dehydration. Thus the use of urine testing or ultrasounds is generally not needed.{{cite journal|last1=Freedman|first1=SB|last2=Vandermeer|first2=B|last3=Milne|first3=A|last4=Hartling|first4=L|title=Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis|journal=The Journal of Pediatrics|date=April 2015|volume=166|issue=4|pages=908–916.e6|pmid=25641247|doi=10.1016/j.jpeds.2014.12.029|s2cid=29662891 }}

Other potential causes of signs and symptoms that mimic those seen in gastroenteritis that need to be ruled out include appendicitis, volvulus, inflammatory bowel disease, urinary tract infections, and diabetes mellitus. Pancreatic insufficiency, short bowel syndrome, Whipple's disease, coeliac disease, and laxative abuse should also be considered.{{cite book|editor1=Warrell D.A. |editor2=Cox T.M. |editor3=Firth J.D. |editor4=Benz E.J. |title=The Oxford Textbook of Medicine |publisher=Oxford University Press |year=2003 |isbn=978-0-19-262922-7 |edition=4th |url=http://otm.oxfordmedicine.com/ |url-status=dead |archive-url=https://web.archive.org/web/20120321002102/http://otm.oxfordmedicine.com/ |archive-date=2012-03-21 }} The differential diagnosis can be complicated somewhat if the person exhibits only vomiting or diarrhea (rather than both).

Appendicitis may present with vomiting, abdominal pain, and a small amount of diarrhea in up to 33% of cases. This is in contrast to the large amount of diarrhea that is typical of gastroenteritis. Infections of the lungs or urinary tract in children may also cause vomiting or diarrhea. Classical diabetic ketoacidosis (DKA) presents with abdominal pain, nausea, and vomiting, but without diarrhea. One study found that 17% of children with DKA were initially diagnosed as having gastroenteritis.

File:RotavirusV2009.gif

{{Further|WASH#Health aspects}}

A supply of easily accessible uncontaminated water and good sanitation practices are important for reducing rates of infection and clinically significant gastroenteritis. Personal hygiene measures (such as hand washing with soap) have been found to decrease rates of gastroenteritis in both the developing and developed world by as much as 30%. Alcohol-based gels may also be effective. Food or drink that is thought to be contaminated should be avoided.{{cite web|title=Viral Gastroenteritis |url=https://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm |work=Center for Disease Control and Prevention |access-date=16 April 2012 |date=February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20120424073547/http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm |archive-date=24 April 2012 }}

Breastfeeding is important, especially in places with poor hygiene, as is improvement of hygiene generally. Breast milk reduces both the frequency of infections and their duration.

Due to both its effectiveness and safety, in 2009 the World Health Organization recommended that the rotavirus vaccine be offered to all children globally.{{cite journal|last=Szajewska|first=H|author2=Dziechciarz, P|title=Gastrointestinal infections in the pediatric population|journal=Current Opinion in Gastroenterology|date=January 2010 |volume=26|issue=1|pages=36–44|pmid=19887936|doi=10.1097/MOG.0b013e328333d799|s2cid=5083478}}{{cite journal|last=World Health Organization|title=Rotavirus vaccines: an update|journal=Weekly Epidemiological Record|date=December 2009|volume=84|issue=50|pages=533–540|pmid=20034143|url=https://www.who.int/wer/2009/wer8451_52.pdf|access-date=10 May 2012|url-status=live|archive-url=https://web.archive.org/web/20120709034841/http://www.who.int/wer/2009/wer8451_52.pdf|archive-date=9 July 2012}} Two commercial rotavirus vaccines exist and several more are in development. In Africa and Asia these vaccines reduced severe disease among infants and countries that have put in place national immunization programs have seen a decline in the rates and severity of disease.{{cite journal|vauthors=Giaquinto C, Dominiak-Felden G, Van Damme P, Myint TT, Maldonado YA, Spoulou V, Mast TC, Staat MA|title=Summary of effectiveness and impact of rotavirus vaccination with the oral pentavalent rotavirus vaccine: a systematic review of the experience in industrialized countries|journal=Human Vaccines|date=July 2011|volume=7|pages=734–748|url=http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|access-date=10 May 2012|doi=10.4161/hv.7.7.15511|pmid=21734466|issue=7|s2cid=23996836|url-status=live|archive-url=https://web.archive.org/web/20130217163038/http://www.landesbioscience.com/journals/vaccines/article/15511/?nocache=1111012137|archive-date=17 February 2013|doi-access=free}}{{cite journal|last=Jiang|first=V|author2=Jiang B|author3=Tate J|author4=Parashar UD|author5=Patel MM|title=Performance of rotavirus vaccines in developed and developing countries|journal=Human Vaccines|date=July 2010|volume=6|issue=7|pages=532–542|url=http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|access-date=10 May 2012|pmid=20622508|pmc=3322519|doi=10.4161/hv.6.7.11278|url-status=dead|archive-url=https://web.archive.org/web/20130217163031/http://www.landesbioscience.com/journals/vaccines/article/11278/?nocache=531156378|archive-date=17 February 2013}} This vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections.{{cite journal|last=Patel|first=MM|author2=Steele, D |author3=Gentsch, JR |author4=Wecker, J |author5=Glass, RI |author6=Parashar, UD |title=Real-world impact of rotavirus vaccination|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S1–5|pmid=21183833|doi=10.1097/INF.0b013e3181fefa1f|s2cid=1893099 |doi-access=free}} Since 2000, the implementation of a rotavirus vaccination program in the United States has substantially decreased the number of cases of diarrhea by as much as 80 percent.{{cite journal|last=US Center for Disease Control and Prevention|title=Delayed onset and diminished magnitude of rotavirus activity—United States, November 2007 – May 2008|journal=Morbidity and Mortality Weekly Report|year=2008|volume=57|issue=25|pages=697–700|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|access-date=3 May 2012|pmid=18583958|url-status=live|archive-url=https://web.archive.org/web/20120608073201/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a6.htm|archive-date=8 June 2012}}{{cite journal |title=Reduction in rotavirus after vaccine introduction—United States, 2000–2009 |journal=Morbidity and Mortality Weekly Report |volume=58 |issue=41 |pages=1146–9 |date=October 2009 |pmid=19847149 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |url-status=live |archive-url=https://web.archive.org/web/20091031060444/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5841a2.htm |archive-date=2009-10-31 |author1=Centers for Disease Control Prevention (CDC) }}{{cite journal|last=Tate|first=JE |author2=Cortese, MM |author3=Payne, DC |author4=Curns, AT |author5=Yen, C |author6=Esposito, DH |author7=Cortes, JE |author8=Lopman, BA |author9=Patel, MM |author10=Gentsch, JR |author11=Parashar, UD|title=Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data|journal=The Pediatric Infectious Disease Journal|date=January 2011 |volume=30|issue=1 Suppl|pages=S56–60|pmid=21183842|doi=10.1097/INF.0b013e3181fefdc0|s2cid=20940659 |doi-access=free }} The first dose of vaccine should be given to infants between 6 and 15 weeks of age. The oral cholera vaccine has been found to be 50–60% effective over two years.{{cite journal|editor1-last=Sinclair|editor1-first=David|last=Sinclair|first=D|author2=Abba, K |author3=Zaman, K |author4=Qadri, F |author5=Graves, PM |title=Oral vaccines for preventing cholera.|journal=Cochrane Database of Systematic Reviews |date=16 March 2011 |volume=2011 |issue=3|pages=CD008603|pmid=21412922|doi=10.1002/14651858.CD008603.pub2|pmc=6532691}}

There are a number of vaccines against gastroenteritis in development. For example, vaccines against Shigella and enterotoxigenic Escherichia coli (ETEC), which are two of the leading bacterial causes of gastroenteritis worldwide.{{cite web|author=World Health Organization|title=Enterotoxigenic Escherichia coli (ETEC)|url=https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index4.html|url-status=dead|archive-url=https://web.archive.org/web/20120515142857/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index4.html|archive-date=15 May 2012|access-date=3 May 2012|work=Diarrhoeal Diseases}}{{cite web|author=World Health Organization|title=Shigellosis|url=https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html|url-status=dead|archive-url=https://web.archive.org/web/20081215123745/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index6.html|archive-date=15 December 2008|access-date=3 May 2012|work=Diarrhoeal Diseases}}

Gastroenteritis is usually an acute and self-limiting disease that does not require medication. The preferred treatment in those with mild to moderate dehydration is oral rehydration therapy (ORT). For children at risk of dehydration from vomiting, taking a single dose of the anti vomiting medication metoclopramide or ondansetron, may be helpful,{{Cite journal|last1=Fedorowicz|first1=Zbys|last2=Jagannath|first2=Vanitha A.|last3=Carter|first3=Ben|date=2011-09-07|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews|volume=130|issue=9|pages=270|doi=10.1002/14651858.CD005506.pub5|issn=1469-493X|pmid=21901699|pmc=6768985}} and butylscopolamine is useful in treating abdominal pain.{{cite journal |author=Tytgat GN |title=Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain |journal=Drugs |volume=67 |issue=9 |pages=1343–57 |year=2007 |pmid=17547475 |doi=10.2165/00003495-200767090-00007|s2cid=46971321 }}

The primary treatment of gastroenteritis in both children and adults is rehydration. This is preferably achieved by drinking rehydration solution, although intravenous delivery may be required if there is a decreased level of consciousness or if dehydration is severe.{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1039 |title=BestBets: Fluid Treatment of Gastroenteritis in Adults |url-status=live |archive-url=https://web.archive.org/web/20090212164231/http://www.bestbets.org/bets/bet.php?id=1039 |archive-date=2009-02-12 }}{{cite journal |vauthors=Canavan A, Arant BS |title=Diagnosis and management of dehydration in children |journal=American Family Physician |volume=80 |issue=7 |pages=692–6 |date=October 2009 |pmid=19817339 }} Drinking replacement therapy products made with complex carbohydrates (i.e. those made from wheat or rice) may be superior to those based on simple sugars.{{cite journal|last1=Gregorio|first1=GV|last2=Gonzales|first2=ML|last3=Dans|first3=LF|last4=Martinez|first4=EG|title=Polymer-based oral rehydration solution for treating acute watery diarrhoea|journal=Cochrane Database of Systematic Reviews|date=13 December 2016|volume=2016|issue=12 |pages=CD006519|pmid=27959472|doi=10.1002/14651858.CD006519.pub3|pmc=5450881}} Drinks especially high in simple sugars, such as soft drinks and fruit juices, are not recommended in children under five years of age as they may increase diarrhea. Plain water may be used if more specific ORT preparations are unavailable or the person is not willing to drink them. A nasogastric tube can be used in young children to administer fluids if warranted. In those who require intravenous fluids, one to four hours' worth is often sufficient.{{cite journal |last1=Toaimah|first1=FH|last2=Mohammad|first2=HM|s2cid=20509810|title=Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review|journal=Pediatric Emergency Care |date=February 2016|volume=32|issue=2|pages=131–5|pmid=26835574|doi=10.1097/pec.0000000000000708}}

It is recommended that breast-fed infants continue to be nursed in the usual fashion, and that formula-fed infants continue their formula immediately after rehydration with ORT.{{cite journal |vauthors=King CK, Glass R, Bresee JS, Duggan C |title=Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy |journal= MMWR. Recommendations and Reports |volume=52 |issue=RR-16 |pages=1–16 |date=November 2003 |pmid=14627948 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm |url-status=live |archive-url=https://web.archive.org/web/20141028174056/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm |archive-date=2014-10-28 }} Lactose-free or lactose-reduced formulas usually are not necessary. Children should continue their usual diet during episodes of diarrhea with the exception that foods high in simple sugars should be avoided. The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended, as it contains insufficient nutrients and has no benefit over normal feeding.

A Cochrane Review from 2020 concludes that probiotics make little or no difference to people who have diarrhea lasting 2 days or longer and that there is no proof that they reduce its duration.{{cite journal | vauthors = Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ | title = Probiotics for treating acute infectious diarrhoea | journal = Cochrane Database Syst Rev | volume = 2020 | issue = 12 | pages = CD003048 | date = December 2020 | pmid = 33295643 | pmc = 8166250 | doi = 10.1002/14651858.CD003048.pub4 }} They may be useful in preventing and treating antibiotic associated diarrhea.{{cite journal|last=Hempel|first=S|author2=Newberry, SJ |author3=Maher, AR |author4=Wang, Z |author5=Miles, JN |author6=Shanman, R |author7=Johnsen, B |author8= Shekelle, PG |title=Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis|journal=JAMA: The Journal of the American Medical Association|date=9 May 2012 |volume=307|issue=18|pages=1959–69|pmid=22570464|doi=10.1001/jama.2012.3507|doi-access=}} Fermented milk products (such as yogurt) are similarly beneficial.{{cite web|last=Mackway-Jones|first=Kevin|title=Does yogurt decrease acute diarrhoeal symptoms in children with acute gastroenteritis?|url=http://www.bestbets.org/bets/bet.php?id=1000|work=BestBets|date=June 2007|url-status=live|archive-url=https://web.archive.org/web/20090212163443/http://www.bestbets.org/bets/bet.php?id=1000|archive-date=2009-02-12}} Zinc supplementation appears to be effective in both treating and preventing diarrhea among children in the developing world.{{cite journal|last=Telmesani|first=AM|title=Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea.|journal=Journal of Family and Community Medicine|date=May 2010 |volume=17|issue=2|pages=79–82|pmid=21359029|doi=10.4103/1319-1683.71988|pmc=3045093 |doi-access=free }}

Antiemetic medications may be helpful for treating vomiting in children. Ondansetron has some utility, with a single dose being associated with less need for intravenous fluids, fewer hospitalizations, and decreased vomiting.{{cite journal |vauthors=DeCamp LR, Byerley JS, Doshi N, Steiner MJ |title=Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis |journal=Archives of Pediatrics & Adolescent Medicine |volume=162 |issue=9 |pages=858–65 |date=September 2008 |pmid=18762604|doi=10.1001/archpedi.162.9.858 |doi-access=free }}{{cite journal|vauthors=Mehta S, Goldman RD | title = Ondansetron for acute gastroenteritis in children| journal = Canadian Family Physician| volume = 52| issue = 11| pages = 1397–8| year = 2006| pmid = 17279195 | url =http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17279195 | pmc = 1783696 }} Metoclopramide might also be helpful.{{cite journal|editor1-last=Fedorowicz|editor1-first=Zbys|last=Fedorowicz|first=Z |author2=Jagannath, VA |author3=Carter, B|title=Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents|journal=Cochrane Database of Systematic Reviews |date=7 September 2011 |volume=9|issue=9|pages=CD005506|pmid=21901699|pmc=6768985|doi=10.1002/14651858.CD005506.pub5}} However, the use of ondansetron might possibly be linked to an increased rate of return to hospital in children.{{cite journal |vauthors=Sturm JJ, Hirsh DA, Schweickert A, Massey R, Simon HK |title=Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? |journal=Annals of Emergency Medicine |volume=55 |issue=5 |pages=415–22 |date=May 2010 |pmid=20031265 |doi=10.1016/j.annemergmed.2009.11.011 }} The intravenous preparation of ondansetron may be given orally if clinical judgment warrants.{{cite web|title=Ondansetron|url=http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|work=Lexi-Comp|date=May 2011|url-status=live|archive-url=https://web.archive.org/web/20120606132320/http://www.merckmanuals.com/professional/print/lexicomp/ondansetron.html|archive-date=2012-06-06}} Dimenhydrinate, while reducing vomiting, does not appear to have a significant clinical benefit.

Antibiotics are not usually used for gastroenteritis, although they are sometimes recommended if symptoms are particularly severe{{cite journal |vauthors=Traa BS, Walker CL, Munos M, Black RE |title=Antibiotics for the treatment of dysentery in children |journal=International Journal of Epidemiology |volume=39 |issue=Suppl 1 |pages=i70–4 |date=April 2010 |pmid=20348130 |pmc=2845863 |doi=10.1093/ije/dyq024 }} or if a susceptible bacterial cause is isolated or suspected.{{cite journal |vauthors=Grimwood K, Forbes DA |title=Acute and persistent diarrhea |journal=Pediatric Clinics of North America |volume=56 |issue=6 |pages=1343–61 |date=December 2009 |pmid=19962025 |doi=10.1016/j.pcl.2009.09.004 }} If antibiotics are to be employed, a macrolide (such as azithromycin) is preferred over a fluoroquinolone due to higher rates of resistance to the latter. Pseudomembranous colitis, usually caused by antibiotic use, is managed by discontinuing the causative agent and treating it with either metronidazole or vancomycin. Bacteria and protozoans that are amenable to treatment include Shigella{{cite journal|editor1-last=Christopher|editor1-first=Prince RH|last=Christopher|first=PR |author2=David, KV |author3=John, SM |author4=Sankarapandian, V|title=Antibiotic therapy for Shigella dysentery.|journal=Cochrane Database of Systematic Reviews |date=4 August 2010 |volume=2010 |issue=8|pages=CD006784|pmid=20687081|doi=10.1002/14651858.CD006784.pub4|pmc=6532574}} Salmonella typhi,{{cite journal|editor1-last=Bhutta|editor1-first=Zulfiqar A|last=Effa|first=EE |author2=Lassi, ZS |author3=Critchley, JA |author4=Garner, P |author5=Sinclair, D |author6=Olliaro, PL |author7=Bhutta, ZA|title=Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever).|journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |volume=2011 |issue=10|pages=CD004530|pmid=21975746|pmc=6532575|doi=10.1002/14651858.CD004530.pub4|url=https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1078&context=pakistan_fhs_mc_women_childhealth_paediatr}} and Giardia species. In those with Giardia species or Entamoeba histolytica, tinidazole treatment is recommended and superior to metronidazole.{{Cite journal|last1=Gonzales|first1=Maria Liza M.|last2=Dans|first2=Leonila F.|last3=Sio-Aguilar|first3=Juliet|date=9 January 2019|title=Antiamoebic drugs for treating amoebic colitis|journal=The Cochrane Database of Systematic Reviews|volume=1|issue=1 |pages=CD006085|doi=10.1002/14651858.CD006085.pub3|issn=1469-493X|pmc=6326239|pmid=30624763}} The World Health Organization (WHO) recommends the use of antibiotics in young children who have both bloody diarrhea and fever.

Antimotility medication has a theoretical risk of causing complications, and although clinical experience has shown this to be unlikely, these drugs are discouraged in people with bloody diarrhea or diarrhea that is complicated by fever.{{cite book |title=Harrison's Principles of Internal Medicine |publisher=McGraw-Hill |isbn=978-0-07-140235-4 |edition=16th |url=http://books.mcgraw-hill.com/medical/harrisons/ |url-status=dead |archive-url=https://web.archive.org/web/20120804162006/http://books.mcgraw-hill.com/medical/harrisons/ |archive-date=2012-08-04 |year=2005 |access-date=2006-04-22 }} Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of diarrhea.{{cite book |first1=Mark |last1=Feldman |first2=Lawrence S. |last2=Friedman |first3=Marvin H. |last3=Sleisenger |title=Sleisenger & Fordtran's Gastrointestinal and Liver Disease |publisher=Saunders |year=2002 |isbn=978-0-7216-8973-9 |edition=7th |url=https://archive.org/details/sleisengerfordtr0001unse |url-access=registration }} Loperamide is not recommended in children, however, as it may cross the immature blood–brain barrier and cause toxicity. Bismuth subsalicylate, an insoluble complex of trivalent bismuth and salicylate, can be used in mild to moderate cases, but salicylate toxicity is theoretically possible.

File:Diarrhoeal diseases world map-Deaths per million persons-WHO2012.svg

File:Diarrhoeal diseases world map - DALY - WHO2004.svg for diarrhea per 100,000 inhabitants in 2004

{{Col-begin}}

{{Col-break}}

{{legend|#b3b3b3|no data}}

{{legend|#ffff65|≤500}}

{{legend|#fff200|500–1000}}

{{legend|#ffdc00|1000–1500}}

{{legend|#ffc600|1500–2000}}

{{legend|#ffb000|2000–2500}}

{{legend|#ff9a00|2500–3000}}

{{Col-break}}

{{legend|#ff8400|3000–3500}}

{{legend|#ff6e00|3500–4000}}

{{legend|#ff5800|4000–4500}}

{{legend|#ff4200|4500–5000}}

{{legend|#ff2c00|5000–6000}}

{{legend|#cb0000|≥6000}}

{{col-end}}]]

It is estimated that there were two billion cases of gastroenteritis that resulted in 1.3 million deaths globally in 2015. Children and those in the developing world are most commonly affected. As of 2011, in those younger than five, there were about 1.7 billion cases resulting in 0.7 million deaths, with most of these occurring in the world's poorest nations. More than 450,000 of these fatalities are due to rotavirus in children under five years of age.{{cite journal|last=World Health Organization|title=Global networks for surveillance of rotavirus gastroenteritis, 2001–2008|journal=Weekly Epidemiological Record|date=November 2008|volume=83|issue=47|pages=421–428|url=https://www.who.int/wer/2008/wer8347.pdf|access-date=10 May 2012|pmid=19024780|url-status=live|archive-url=https://web.archive.org/web/20120709014120/http://www.who.int/wer/2008/wer8347.pdf|archive-date=9 July 2012}} Cholera causes about three to five million cases of disease and kills approximately 100,000 people yearly. In the developing world, children less than two years of age frequently get six or more infections a year that result in significant gastroenteritis. It is less common in adults, partly due to the development of acquired immunity.

In 1980, gastroenteritis from all causes caused 4.6 million deaths in children, with the majority occurring in the developing world.{{cite book |first1=Gerald L. |last1=Mandell |first2=John E. |last2=Bennett |first3=Raphael |last3=Dolin |title=Mandell's Principles and Practices of Infection Diseases |publisher=Churchill Livingstone |year=2004 |isbn=978-0-443-06643-6 |edition=6th |url=http://www.ppidonline.com/ |url-status=dead |archive-url=https://web.archive.org/web/20131018175309/http://www.ppidonline.com/ |archive-date=2013-10-18 |access-date=2006-04-22 }} Death rates were reduced significantly (to approximately 1.5 million deaths annually) by 2000, largely due to the introduction and widespread use of oral rehydration therapy.{{cite journal |vauthors=Victora CG, Bryce J, Fontaine O, Monasch R |title=Reducing deaths from diarrhoea through oral rehydration therapy |journal=Bulletin of the World Health Organization |volume=78|issue=10 |pages=1246–55 |year=2000 |pmid=11100619 |pmc=2560623 }} In the US, infections causing gastroenteritis are the second most common infection (after the common cold), and they result in between 200 and 375 million cases of acute diarrhea and approximately ten thousand deaths annually, with 150 to 300 of these deaths in children less than five years of age.

Gastroenteritis is associated with many colloquial names, including "Montezuma's revenge", "Delhi belly", "la turista", and "back door sprint", among others. It has played a role in many military campaigns and is believed to be the origin of the term "no guts no glory".

Gastroenteritis is the main reason for 3.7 million visits to physicians a year in the United States and 3 million visits in France.{{cite journal|last=Flahault|first=A|author2=Hanslik, T|title=[Epidemiology of viral gastroenteritis in France and Europe].|journal=Bulletin de l'Académie Nationale de Médecine|date=November 2010 |volume=194|issue=8|pages=1415–24; discussion 1424–5|pmid=22046706|doi=10.1016/S0001-4079(19)32172-7|url=http://archive-ouverte.unige.ch/unige:47039|doi-access=free}} In the United States gastroenteritis as a whole is believed to result in costs of US$23 billion per year,{{cite book |editor1-last=Skolnik |editor1-first=Neil S. |editor2-last=Albert |editor2-first=Ross H. |title=Essential infectious disease topics for primary care|year=2008|publisher=Humana Press|location=Totowa, NJ|isbn=978-1-58829-520-0|pages=66|url=https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|url-status=live|archive-url=https://web.archive.org/web/20151128094307/https://books.google.com/books?id=iGUKPeO9-ygC&pg=PA66|archive-date=2015-11-28}} with rotavirus alone resulting in estimated costs of US$1 billion a year.

{{Anchor|Cholera morbus}}

The first usage of "gastroenteritis" was in 1825.{{cite web|title=Gastroenteritis|url=http://www.oed.com/|url-status=live|archive-url=https://web.archive.org/web/20080111125659/http://www.oed.com/|archive-date=January 11, 2008|access-date=January 15, 2012|work=Oxford English Dictionary 2011}} Before this time it was commonly known as typhoid fever or "cholera morbus", among others, or less specifically as "griping of the guts", "surfeit", "flux", "colic", "bowel complaint", or any one of several other archaic names for acute diarrhea.[http://www.antiquusmorbus.com/English/English.htm Rudy's List of Archaic Medical Terms] {{webarchive|url=https://web.archive.org/web/20070709111154/http://www.antiquusmorbus.com/English/English.htm|date=2007-07-09}} Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.{{cite book|author1=Charles E. Rosenberg|url=https://books.google.com/books?id=k2pL9c00rl4C&pg=PA74|title=The Cholera Years the United States in 1832, 1849, and 1866|date=2009|publisher=University of Chicago Press|isbn=978-0-226-72676-2|location=Chicago|page=74|archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&pg=PA74|archive-date=2015-11-09|url-status=live}}

Many of the same agents cause gastroenteritis in cats and dogs as in humans. The most common organisms are Campylobacter, Clostridioides difficile, Clostridium perfringens, and Salmonella.{{cite journal|last=Weese |first=JS |title=Bacterial enteritis in dogs and cats: diagnosis, therapy, and zoonotic potential|journal=Veterinary Clinics of North America: Small Animal Practice|date=March 2011 |volume=41|issue=2|pages=287–309|pmid=21486637 |doi=10.1016/j.cvsm.2010.12.005}} A large number of toxic plants may also cause symptoms.{{cite book |last=Rousseaux |first=Wanda Haschek, Matthew Wallig, Colin |title=Fundamentals of toxicologic pathology |year=2009 |publisher=Academic |location=London |isbn=978-0-12-370469-6 |page=182 |url=https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |edition=2nd |url-status=live |archive-url=https://web.archive.org/web/20160507004136/https://books.google.com/books?id=vkox3JS83k8C&pg=PA182 |archive-date=2016-05-07 }}

Some agents are more specific to a certain species. Transmissible gastroenteritis coronavirus (TGEV) occurs in pigs resulting in vomiting, diarrhea, and dehydration.{{cite book |editor1-last=MacLachlan |editor1-first=N. James |editor2-last=Dubovi |editor2-first=Edward J. |year=2009 |title=Fenner's veterinary virology|publisher=Elsevier Academic Press|location=Amsterdam|page=399|isbn=978-0-12-375158-4|edition=4th |url=https://books.google.com/books?id=TYFqlYO9eE4C&pg=PA399|url-status=live|archive-url=https://web.archive.org/web/20151125122358/https://books.google.com/books?id=TYFqlYO9eE4C&pg=PA399|archive-date=2015-11-25}} It is believed to be introduced to pigs by wild birds and there is no specific treatment available.{{cite book |editor1-first=James G. |editor1-last=Fox |title=Laboratory animal medicine |year=2002 |publisher=Academic Press |location=Amsterdam |isbn=978-0-12-263951-7 |page=649 |url=https://books.google.com/books?id=m2ftfPMJnMMC&pg=PA649 |edition=2nd |display-editors=etal |url-status=live |archive-url=https://web.archive.org/web/20151128151809/https://books.google.com/books?id=m2ftfPMJnMMC&pg=PA649 |archive-date=2015-11-28 }} It is not transmissible to humans.{{cite book|last1=Zimmerman|first1=Jeffrey|last2=Karriker|first2=Locke|last3=Ramirez|first3=Alejandro|author4=Kent Schwartz|author5=Gregory Stevenson|title=Diseases of Swine|url=https://books.google.com/books?id=jVaemau17J4C&pg=PA504|date=15 May 2012|publisher=John Wiley & Sons|location=Chichester, West Sussex|edition=10th|isbn=978-0-8138-2267-9|page=504|url-status=live|archive-url=https://web.archive.org/web/20151128142144/https://books.google.com/books?id=jVaemau17J4C&pg=PA504|archive-date=28 November 2015}}

• Enterocolitis

{{Reflist}}

• {{cite book |editor1-last=Dolin |editor1-first=Raphael |editor2-last=Mandell |editor2-first=Gerald L. |editor3-last=Bennett |editor3-first=John E. |year=2010 |title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher=Churchill Livingstone/Elsevier|location=Philadelphia|isbn=978-0-443-06839-3|edition=7th |ref={{harvid|Mandell|2010}}}}

{{commons category}}

• [https://www.ncbi.nlm.nih.gov/books/NBK63841/ Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years] – NICE Clinical Guidelines, No. 84.
• {{cite web | url = https://medlineplus.gov/gastroenteritis.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Gastroenteritis }}

{{Medical condition classification and resources

| DiseasesDB = 30726

| ICD10 = {{ICD10|A|02|0|a|00}}, {{ICD10|A|08||a|00}}, {{ICD10|A|09||a|00}}, {{ICD10|J|10|8|j|09}}, {{ICD10|J|11|8|j|09}}, {{ICD10|K|52||k|50}}

| ICD9 = {{ICD9|008.8}} {{ICD9|009.0}}, {{ICD9|009.1}}, {{ICD9|558}}

| ICDO =

| OMIM =

| MedlinePlus = 000252

| MedlinePlus_mult= {{MedlinePlus2|000254}}

| eMedicineSubj = emerg

| eMedicineTopic = 213

| MeshID = D005759

}}

{{Gastroenterology}}

{{Viral diseases}}

{{Authority control}}

Category:Pediatrics

Category:Foodborne illnesses

Category:Infectious diseases

Category:Abdominal pain

Category:Conditions diagnosed by stool test

Category:Noninfective enteritis and colitis

Category:Diarrhea

Category:Wikipedia medicine articles ready to translate (full)

Category:Sanitation

Category:Wikipedia emergency medicine articles ready to translate