The Lagos State Government recently confirmed that the outbreak of Gastroenteritis killed 11 people in the state, while 370 others were treated. Dr Adenike Olainu-Alade, a family physician with the National Health Service and an academic general practitioner with special interest in paediatrics, women’s health, minor surgery and continuing medical education, tells ALEXANDER OKERE about the causes, treatment and prevention of gastroenteritis
What is gastroenteritis?
Gastroenteritis is inflammation (irritation) of the lining of the gastrointestinal tract (stomach and bowel). Gastroenteritis is a very common condition. It occurs commonly in adults, children and babies. It accounts for 1.5 to 2.5 million deaths annually or 12 per cent of all deaths among children less than five years old. It is more common among children and those in developing countries. It is less common in adults because they have developed more immunity over time.
Are there different types?
There are different types and there are several things that can cause gastroenteritis, both infectious and non-infectious. Viral gastroenteritis is the most common, followed by bacterial gastroenteritis. Viruses can cause up to 70 per cent of the gastroenteritis found in children with rotavirus being the most common cause of gastroenteritis in children. Other bugs, like fungus and parasites, can also cause gastroenteritis. Examples of bacteria that cause gastroenteritis include vibrio cholera, campylobacter bacterium, salmonella typhi/paratyphi, E. coli, etc. Viruses such as adenovirus, rotavirus and norovirus are common infective causative agents.
Certain toxins from some bacteria, like staphylococcus, can also contaminate food and cause gastroenteritis. But this bug itself does not cause the illness. But its poisonous toxin does when it comes in contact with food. Other non-infective causes include some medications, such as certain antibiotics which can cause gastroenteritis in susceptible individuals. Chemical poisoning like lead poisoning can also cause gastroenteritis.
Toxins can also be got from improperly preserved food; for example, botulism, which can be fatal in some cases. It is worth mentioning that gastroenteritis could occur under certain circumstances, such as when using a class of medication known as non-steroidal anti-inflammatory drugs, an example of which is Ibuprofen.
Gastroenteritis could also occur as side effects of certain medications; so, always read your medication leaflets. Acid suppressing tablets, like Omeprazole and Ranitidine, can also predispose one to gastroenteritis symptoms.
What are the other causes of this inflammation?
Gastroenteritis is usually caused by an infection but can, sometimes, have non-infectious causes. The inflammation arises as a result of the activity of the particular germ or toxin on the stomach or bowel lining. It is often caused by a stomach bug. However, there is a more severe form of the infection that can last for several days. Also, cases caused by dangerous bugs, like cholera can lead to severe dehydration very fast and could cause shock. Such patients could die if not promptly treated.
How does the infection occur?
The disease can spread by drinking contaminated water or eating contaminated food, eating improperly cooked food or close contact with an infected person. Also exposing food to flies can cause such contamination.
Can it be transmitted from one person to another?
Yes. It can be transmitted from person to person, particularly the infectious causes. Infectious gastroenteritis is caused by bugs like viruses, bacteria, parasites and fungus which are contracted when the bug is ingested usually by eating contaminated food or drinking contaminated water. If infected persons handle food or objects without proper hand washing, they spread the disease.
Infection is caused by person-person contact, such as touching contaminated hands, stool or vomit or by drinking contaminated food or water. Measures that can prevent the transmission include avoiding overcrowding and blocked drainage, which leads to flooding, especially in the rainy season as this will lead to rapid spread of the disease. Also breastfeeding babies, rather than using formula as bottles can easily be contaminated, is advisable.
How is it different from Cholera?
Cholera is a form of gastroenteritis caused by a particular germ called vibrio cholera which leads to a more severe form of gastroenteritis. In the developing world and in Africa and Asia especially, cholera has been found to be a common cause of gastroenteritis. It is usually transmitted by contaminated water or food, which occurs more in these regions due to poor standards of water treatment, sewage disposal and sanitation.
Once cholera spreads into a community, it can be very difficult to control and it is expedient to try to figure out where the source of the infection springs from and contain the source because cholera can cause severe dehydration (loss of water and salts from the body), leading to death in five to 10 per cent of the cases seen.
Lagos State recently recorded some deaths related to gastroenteritis. Are there certain environmental conditions that predispose individuals to the infection?
Yes. There are environmental conditions predisposing individuals to the infection and Lagos is unique in that it is an overcrowded, low-lying megacity; that, compounded by recent floods, can lead to the germs easily getting around. Water quality also worsens during the rainy season and outbreaks are more common at this time. The recent persistent rain led to the flooding of some local government areas like Surulere, Mushin, Ajeromi and Lagos Island.
Some of the samples collected during this outbreak tested positive to a type of cholera in the laboratory. You might have heard of Dr John Snow (not the famous Game of Thrones character), who discovered that the source of the cholera outbreak in London in the 1800s was linked to contaminated food and water from the poor sewer, waste and water management in the city. This led to the improvement of water sanitation and waste management and subsequent eradication of the disease at that time.
You are more likely to contract cholera if you live in areas that are overcrowded and have poor sanitation, lack good clean water supply and adequate sewage and waste disposal methods. That is because the food and water in those areas are easily contaminated and if you eat this food or drink the water, you get the infection.
What are the symptoms of gastroenteritis?
The symptoms of gastroenteritis can include loss of appetite, nausea, bloating, vomiting, abdominal cramps, abdominal pain, diarrhoea, mucous in stool, blood in stool, lethargy, headache, body aches and mild to severe forms of dehydration.
How can it be diagnosed?
Gastroenteritis is usually diagnosed based on the signs and symptoms the person presents with and the tests are usually not required in its management because it hardly alters the treatment given to the person. But in some situations, especially when it is complicated with fever, blood in stool or severe dehydration, a specific cause needs to be established and the diagnostic methods used may include blood and stool tests.
What are the risk factors?
The risk factors include environmental, seasonal and demographic factors such as poor sanitation, overcrowding, flooding as a result of poor drainage system, poor waste management, poor sewage disposal and lack of clean water. People with poor personal hygiene, poor nutritional status, pregnant women, the very old in age and very young children are also more susceptible. Other diseases like measles and immunodeficiencies also put the patient at a higher risk for gastroenteritis infection.
Are there misconceptions about gastroenteritis in Nigeria?
Yes, I believe so, and the most prevalent is the self-medication culture. It is widely believed that anti-diarrhoea and anti-vomiting medication can be used for all forms of gastroenteritis. This practice is reinforced by the availability of over-the-counter anti-diarrhoea medications like Loperamide, which people are made to believe can be used in almost any case of diarrhoea and vomiting. This is made worse by advertising and local unlicensed pharmacies. This practice needs to be discouraged as it can keep infection inside the body which can be deadly in cases caused by germs like cholera.
What are the treatment options?
Treatment in milder form is basically by rehydration – drinking enough fluids or oral rehydration solution. Severe cases will need intravenous fluids (drips) administered in hospital. Antibiotics are usually not recommended straight away except in very young children with bloody diarrhoeal stool and fever. Treatment depends on the cause. Rehydration is the mainstay of treatment in mild to moderate form of the infection; so, patients are advised to drink plenty fluids frequently.
What are the types of drugs to avoid in the treatment of gastroenteritis?
Antibiotics should be avoided because most of the cases are viral. Also to be avoided are anti-vomiting and anti-diarrhoea drugs unless prescribed by a doctor.
Can gastroenteritis cause an infected person to require surgery?
Gastroenteritis can cause complications which may lead to the need for surgery. There are certain helpful bugs that live in our bowels. These bugs exist in harmony with other non-harmful agents. One of such bacterium is clostridium difficile which is known as ‘C.Diff’. C.Diff can cause colitis (inflammation of the colon) when antibiotics used to treat infections elsewhere in the body disrupt the normal equilibrium of the colon and allow C.Diff to overgrow and begin producing toxins.
This is common in people with certain characteristics like age – over 65 years, recent hospital stays, use of acid-suppressing tablets like omeprazole, ranitidine etc, and previous use of antibiotics.
It can lead to a condition called ‘pseudomembranous colitis’ which, when severe, may need to be treated with a surgical procedure in like one per cent of cases to remove the affected part of the bowels and performing an ileostomy (an artificial opening on the skin of the stomach used to empty the bowel into a bag attached on the outside to the stomach wall). Such severe complications of gastroenteritis can be prevented by educating the public to use antibiotics only when recommended by a doctor, careful environmental and hand cleaning, and isolating patients with C.Diff to prevent spread of the disease.
What are the healthy habits that can keep help prevent gastroenteritis in children and adults?
The disease can be prevented by maintaining good personal and community hygiene – washing of hands properly with soap and water, proper sanitation, clean water system and good sewage disposal. Access to uncontaminated water and good sanitation are the bedrock of preventing gastroenteritis.
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