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Diarrhea nausea headache chills: What Is Norovirus Infection? Symptoms, Contagious Period & Treatment


Syndrome – About GI Motility

Dietary and Nutritional Recommendations for Patients with Dumping Syndrome (Rapid Gastric Emptying)
Dumping syndrome describes a collection of symptoms that occurs when food is emptied too quickly from the stomach. When this happens, the small intestine is filled with undigested food that is not adequately prepared to permit efficient absorption of nutrients.

Dumping syndrome is most commonly seen after a gastrectomy – the surgical removal of all or part of the stomach, usually for ulcer disease. It is now recognized that other types of patients, including those with symptoms suggestive of functional dyspepsia, may have rapid gastric emptying.

The symptoms of dumping syndrome include:

  • Nausea
  • Abdominal cramps
  • Diarrhea
  • Dizzy spells
  • Weakness
  • Cold sweats

Symptoms occur either with or after eating. The symptoms are often divided into “early” or “late” symptoms.

  • Early symptoms begin during or right after a meal. These include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue.
  • Late dumping symptoms occur 1-3 hours after eating and include hypoglycemia, weakness, sweating, and dizziness.

People with dumping syndrome often have both types of symptoms.

The diagnosis of dumping syndrome is based primarily on the development of symptoms in a person with a history of stomach surgery. Tests may be needed to exclude other conditions that have similar symptoms.

These tests may include blood tests, upper endoscopy, and/or gastric emptying test. Gastric emptying demonstrates rapid stomach emptying, especially in early scans taken one half and one hour after eating the test meal which shows nearly complete stomach emptying.

Medical management of dumping symptoms involves dietary changes, and at times, the use of medications.

A change in diet is tried in most cases as the initial treatment. In moderate to severe cases, medications are taken to slow the stomach emptying and movement of food in the gastrointestinal (GI) tract. Rarely, doctors recommend surgery.

The following suggestions may help guide your eating to maximize your nutrition status and minimize symptoms of dumping:

Basic Dietary Guidelines for Dumping Syndrome

  • Eat smaller, more frequent meals. Eating 5 or 6 small meals more often will allow you to eat the equivalent of 3 regular meals without feeling full too fast. Eat slowly and chew all foods thoroughly. Sit upright while eating.
  • Solid foods account for most episodes of dumping. Symptoms are triggered more by solid food that requires breakdown in the stomach such as a piece of steak or pork chop rather than ground meat that is already broken down by the butcher.
  • Limit fluid consumption during meals. Drink liquids 30-60 minutes before or after meals instead of with meals.
  • Avoid nutrient-rich drinks since dumping syndrome is easily triggered by any rich emulsions such as a liquid nutritional supplement or a milk shake.
  • Eat fewer simple sugars. Foods high in simple sugar should be avoided because they pass through your stomach quickly and may cause diarrhea and cramping. Avoid or limit high sugary foods and beverages including the following examples: Kool-Aid, fruit juices/drinks, soda, cakes, pies, candy, doughnuts, cookies.
  • Eat more complex carbohydrates such as whole grains, pastas, potatoes, rice, breads, bagels, unsweetened cereals, etc.
  • Eat more foods high in soluble fiber. Foods high in soluble fiber slow stomach emptying and prevent sugars from being absorbed too quickly. The following examples are foods high in soluble fiber: apples, beets, Brussels sprouts, carrots, oats, spinach, pears.
  • Try increasing the amount of fats in your diet. Fats slow the stomach emptying and may help to prevent dumping syndrome from developing. Butter, margarine, mayonnaise, gravy, vegetable oils, salad dressings, and cream cheese are good choices; use some at all meals and snacks (for those trying to lose weight, an individual meal plan can be designed with a registered dietitian).
  • Increase the protein in your diet. Eat a protein containing food with each meal. Examples of high protein foods include the following: Eggs, meat, poultry, fish, milk, yogurt, cottage cheese, cheese, peanut butter.
  • If milk causes distress, try lactose-free milk. Milk and milk products are often not tolerated; reduce or avoid consumption if this it true for you. It will be important to ensure that adequate calcium and vitamin D are eaten in the diet.

If you have difficulty maintaining your weight, ask to meet with a registered dietitian (RD) to help you with a meal plan. One possibility is to drink a nutritional supplement for extra calories; unfortunately, some of these may worsen symptoms. If tried, drink slowly to prevent symptoms.

Most people with dumping syndrome have relatively mild symptoms and respond well to dietary changes. In people with low blood pressure after meals (feeling lightheaded or sweaty), lying down for 30 minutes may help.

For persons that do not respond to the above dietary treatment, medications are sometimes given. The drug acarbose delays carbohydrate absorption and has been shown to help patients with late dumping. Another drug, octreotide, has been used with some success also. Octreotide is a synthetic form of somatostatin, a naturally occurring hormone in the body. Octreotide and somatostatin delay stomach emptying and exert a strong inhibitory effect on the release of insulin and several gut-derived hormones. Octreotide is a therapy used sparingly since this treatment significantly impairs digestion.

There are several newer agents that are also beginning to be used in attempt to slow gastric emptying (many of these are also used to treat patients with diabetes). In people who do not respond to medical treatment, surgery is sometimes considered.

More dietary information may be found at:

Adapted from IFFGD Publication: Dietary and Nutritional Recommendations for Patients with Dumping Syndrome (Rapid Gastric Emptying) by Carol Rees Parrish, RD, MS, Nutrition Support Specialist, University of Virginia Health System; Henry C. Lin, MD, Chief, Gastroenterology Section, New Mexico VA Health Care System and Professor of Internal Medicine, University of New Mexico; and Henry Parkman, MD, Professor of Medicine, Temple University School of Medicine, Philadelphia, PA.

Highly contagious delta variant could prove tougher to diagnose, experts say

by: Delaney Hall, Nexstar Media Wire

Posted: / Updated:

RICHMOND, Va. (WRIC) — The highly contagious delta variant is now the most dominant COVID-19 strain in the United States, but some health experts warn it could be harder to diagnose.

Dr. David Priest, an infectious disease specialist with Novant Health, said many who are sick with the delta variant are presenting more vague symptoms, such as a sore throat or runny nose.

Quickly differentiating those symptoms from similar patient complaints due to other illnesses, such as respiratory syncytial virus (RSV), which is spiking in parts of the U.S., is a challenge for doctors. Depending on what happens between now and the cold and flu season this fall, a quick diagnosis of the delta variant could become even more difficult.

According to the Centers for Disease Control and Prevention, common symptoms of COVID-19 include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.

CDC: Delta variant now the dominant strain of coronavirus in US

Experts are urging anyone who has any of the COVID-19 symptoms to get tested, even if they feel like it’s the common cold.

The CDC said the delta variant, a version of the coronavirus first identified in India, was first detected in the U.S. in January. It’s now spreading in more than 90 countries.

“These variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19,” the CDC stated. “An increase in the number of cases will put more strain on healthcare resources, lead to more hospitalizations, and potentially more deaths.”

Experts say the delta variant spreads more easily because of mutations that make it better at latching onto cells in our bodies. It’s not clear yet whether the variant makes people sicker since more data needs to be collected, said Dr. Jacob John, who studies viruses at the Christian Medical College at Vellore in southern India.

All three COVID-19 vaccines — Pfizer, Moderna and Johnson & Johnson — appear to stand up to the variant, but experts say the chance of getting the virus is much lower in someone who is fully vaccinated.

Delta variant: What if I’m vaccinated?

Currently, only about 48% of the U.S. population is fully vaccinated. Some parts of the country have far lower immunization rates, and in those places, the delta variant is surging. Dr. Rochelle Walensky, the CDC director, has said that’s leading to “two truths” — highly immunized swaths of America are getting back to normal while hospitalizations are rising in other places.

Dr. Anthony Fauci, America’s top infectious disease expert, said it was inexplicable that some Americans are so resistant to getting a vaccine when scientific data show how effective it is in staving off COVID-19 infections and hospitalizations.

He said last week that 99.2% of recent COVID-19 deaths in the United States involved unvaccinated people.

For COVID-19 testing, there are a number of options, including:

  • Search for locations near you here.
  • Contact your local health department.
  • Call ahead to your local pharmacy, healthcare provider or insurance company for information.

The Associated Press contributed to this report.

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Is It Stomach Bug, Stomach Flu, or Food Poisoning?

Your stomach is in knots as another wave of nausea strikes, sending you to the bathroom for the third time in an hour. But what’s the cause? Two likely culprits are stomach bug (also called stomach flu) and food poisoning. But how does stomach flu differ from food poisoning? Understanding the difference may lead to feeling better sooner and even prevent the illness from occurring in the first place.

Stomach Flu and Food Poisoning Defined

Stomach flu and stomach bug are informal terms for viral gastroenteritis, a sickness in which a viral infection causes inflammation in the stomach and intestines. “The term ‘stomach flu’ can be misleading,” says UH internal medicine specialist Christopher Thomas, DO, “because the illness in not caused by influenza, which attacks the respiratory system.

Though it shares a number of symptoms with viral gastroenteritis, food poisoning is a condition caused by the consumption of contaminated food or water. In fact, food poisoning is an umbrella term for any of the more than 250 foodborne/waterborne illnesses researchers have identified to date.

Comparison of Symptoms

Common symptoms of viral gastroenteritis include:

  • Nausea and/or vomiting
  • Diarrhea
  • Stomach cramps, muscle aches or weakness
  • Loss of appetite
  • Low-grade fever
  • Headaches
  • Light-headedness or dizziness

Common symptoms of food poisoning include:

  • Stomach or intestinal cramping
  • Diarrhea
  • Fatigue
  • Fever
  • Chills and muscle aches
  • Headaches
  • Sweating
  • Thirst

Most people develop viral gastroenteritis symptoms within 24 to 72 hours of exposure to a virus, while food poisoning symptoms can appear anytime within a few hours to weeks following exposure to a foodborne or waterborne pathogen.

Different Causes

Several viruses are the cause of viral gastroenteritis, among them norovirus, rotavirus, adenovirus and astroviruses.

“The most common way to contract stomach flu is through direct contact with someone who is already sick,” Dr. Thomas says. “You can also get a stomach bug by touching any surface that has been in contact with the stool, saliva or vomit of someone infected with the virus.”

By contrast, the cause of food poisoning is consumption of food or water contaminated by bacteria, certain viruses, and less commonly, parasites.


“In the case of viral gastroenteritis,” Dr. Thomas says, “we usually can make a diagnosis based on the presenting symptoms alone.” Also, although not readily available in all clinical settings, a rapid stool test is available for the detection of rotavirus and norovirus.

If food poisoning is suspected, your doctor can often make a diagnosis based on your symptoms, how long you’ve been sick and the specific foods you’ve eaten recently. Depending on your symptoms, your doctor may order certain diagnostic tests.


If the cause of your stomach illness is viral, the treatment is to increase fluids, replenish electrolytes, get rest, and take over-the-counter medicines to reduce fever while the virus runs its course. Most cases of the stomach flu resolve within a few days, though people can feel sick for as many as 10 days or more.

Treatment for food poisoning typically depends on the specific pathogen involved and the severity of symptoms. In most cases, food poisoning resolves without treatment after just a few days, though it can persist longer. Treatment can include replacement of lost fluids and electrolytes and taking doctor-prescribed antibiotics. Also, anti-parasitic medications are available to treat certain foodborne parasites.

A few simple things that you can do at home to speed your recovery from both viral gastroenteritis and food poisoning are:

  • Eat a bland diet to allow your stomach to settle by avoiding solid foods until you feel better
  • Drink plenty of liquids
  • Gradually ease back into eating solid foods, starting with bland, easy-to-digest foods
  • If your illness was severe, avoid dairy products, caffeine, alcohol, sugar, and fatty or highly seasoned foods for a few days to a week following the resolution of your symptoms

When to Call Your Doctor

Food poisoning and viral gastroenteritis can become severe enough to require medical attention. “However,” Dr. Thomas says, “in most cases, people can effectively manage either condition with proper rest, hydration and at-home medical treatment. But call your doctor if you’re unsure what’s causing your symptoms or if you’re having high or persistent fevers.”

Also keep in mind that other health issues can mimic the symptoms of viral gastroenteritis or food poisoning. Call your doctor if your symptoms worsen or if you experience any of the following:

  • Bloody stool or bloody vomit
  • Inability to keep any fluids down
  • Diarrhea lasting more than three days
  • Fever above 104 degrees 
  • Severe abdominal pain

Related Links

Looking for a primary care physician? UH offers online appointment scheduling for select UH physicians and specialties, including primary care. Or find a doctor with our online tool, which allows you to search by location.


Nausea, vomiting are COVID-19 symptoms

Coronavirus symptoms versus flu symptoms

We answer the often searched question: “What are the symptoms of coronavirus versus the flu?”


Corrections & clarifications: This story, originally published March 27, has been updated to reflect new CDC guidance published on March 30 that includes nausea, vomiting and diarrhea as coronavirus symptoms. That guidance changes the fact check of the claim to be “true.”

The claim: COVID-19 has new, expanded symptoms 

As cities and countries across the world scramble to adapt to challenges presented by the coronavirus, viral posts containing misinformation about at-home tests, treatments and virus symptoms have been shared by thousands of users across various social media platforms. 

One Facebook post provides a list of “expanded” symptoms of the virus, including diarrhea, vomiting and loss of appetite. 

When do symptoms show? What are they?

According to the CDC, symptoms of the virus appear between two to 14 days after exposure. However, some cases of asymptotic infection have been reported.

The coronavirus typically causes flulike symptoms, but those who are more vulnerable and susceptible to the disease can develop a severe form of pneumonia. 

According to the World Health Organization, common symptoms of the coronavirus include fever, tiredness and a dry cough.

Additional, less common symptoms include shortness of breath, aches and pains and a sore throat, with very few cases reporting nausea (the feeling of being sick), runny nose or diarrhea.

On March 30, the CDC updated its COVID-19 guidelines with new information on symptoms of the virus. The guidelines now say most people with the virus will experience a fever, cough, fatigue, shortness of breath, loss of appetite, thick mucus production and muscle pain.

The guidelines also state that some cases of COVID-19 have experienced gastrointestinal symptoms including diarrhea and nausea prior to developing the more common symptoms.

WHO has also updated its guidelines with matching symptoms, though it is unclear when the website was changed. 

The WHO recommends people with mild symptoms self-isolate and contact a medical provider or reach out to a COVID-19 line for information on testing, when necessary. Those with a fever, cough or difficulty breathing should seek medical attention.  

Both the CDC and the WHO have released guidelines on how to stay safe, practice social distancing and ultimately flatten the curve. 

How does the virus spread?

COVID-19 is highly contagious, allowing it to spread easily from person to person. The virus is carried on respiratory droplets when we sneeze, cough or talk. The droplets can travel up to 6 feet, meaning that being within 6 feet of an infected person could result in exposure. 

The virus has the potential to live on surfaces for a few hours, which is why proper hygiene, including washing hands and disinfecting surfaces, is critically important in stopping the spread. 

More: How long does the coronavirus live on surfaces?

Current guidelines from the White House, including advisories from the CDC, recommend that all Americans follow the direction of their local authorities, stay indoors as much as possible and practice social distancing to help stop the spread of the virus.

Our ruling: True

We rate the claim of new coronavirus symptoms true because it is supported by updated information, based on our research.

Our fact-check sources:

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or electronic newspaper replica here.

Health department warning residents of norovirus outbreaks in region

Officials with the Health Department of Northwest Michigan are warning residents of several norovirus outbreaks occurring in the area, and in conjunction are offering precautionary measures to keep summer dining experiences safe.

Noroviruses are a group of viruses that cause gastroenteritis in people. The most common way to become infected with norovirus — also known as the “stomach flu” — is through contact with an infected person or by ingesting contaminated food or water. Norovirus illness usually begins 24-28 hours after exposure, but can appear as early as 10 hours after exposure.

The illness is usually brief, with symptoms lasting only 1-2 days. Common symptoms include nausea, vomiting, diarrhea, stomach cramping, low-grade fever, chills, headache, muscle aches and a general sense of tiredness.

It should be noted a norovirus infection is not related to influenza (flu), which is a respiratory viral illness that can cause fever, cough, chills, headache, muscle aches, runny nose and sore throat.

“The flu is where you’re in bed, aching for several days,” said Dr. Joshua Meyerson, medical director for the Health Department of Northwest Michigan regarding a previous norovirus outbreak in 2019.  “Viral gastroenteritis, or the stomach flu, is more of a 24- to 48-hour virus. The flu vaccine will protect you from the respiratory flu, but it won’t do anything for the stomach flu.”

Noroviruses are very contagious and spread easily from person to person. The virus is found in the stool and vomit of infected people.

People can become infected in several way, including eating food or drinking liquids that are contaminated by infected food handlers, touching surfaces or objects contaminated with norovirus and then touching their mouth before hand washing, or having direct contact with another person who is infected and then touching their mouth before hand washing.

According to the Michigan Department of Community Health Communicable Disease Division, while norovirus disease is usually not serious, people may feel very sick, but have no long-term health effects from the illness.

“Sometimes people are unable to drink enough liquids to replace what they lose from vomiting and diarrhea, and they can become dehydrated and need to see a doctor,” reads a statement regarding norovirus from the Michigan Department of Community Health Communicable Disease Division. “This problem usually occurs only among the very young, the elderly, and persons with weakened immune systems.”

The health department said outbreaks also have occurred from eating undercooked oysters harvested from contaminated waters; cooking kills the virus. Drinking water contaminated by sewage can also be a source of illness.

In general, you can protect yourself and others from norovirus by washing your hands thoroughly with soap and water. 

You should also avoid preparing food for others, working in a day care center, health care facility or food service establishment if you have gastrointestinal symptoms including vomiting, diarrhea, nausea or a low-grade fever.

If those symptoms become severe, health experts recommend seeking medical attention.

The Michigan Department of Community Health Communicable Disease Division said people infected with norovirus are contagious from the moment they begin feeling ill to at least three days after recovery. Some people may be contagious for as long as two weeks after recovery.

“Therefore, good hand washing is important,” a statement from the division read. “Persons infected with norovirus should not prepare food while they have symptoms and for three days after they recover. Infected people do not become long-term carriers of norovirus.”

While there is no specific medication or vaccine for norovirus and cannot be treated with antibiotics, it is recommended drinking fluids such as juice or water can reduce people’s chance of becoming dehydrated.

Sports drinks do not replace the nutrients and minerals lost during the illness, the Michigan Department of Community Health Communicable Disease Division noted.

For more information, visit www.nwhealth.org.

Causes, Diagnosis, When to Seek ER Treatment

Diarrhea is when stools are loose and watery. You have diarrhea if you have watery stools or bowel movement three or more times a day. Diarrhea is often accompanied by nausea, vomiting, and abdominal cramps, but it is usually not serious unless it lasts for several days. If vomiting and diarrhea are chronic and occur for an extended period of time, they can be life threatening or be symptoms of an underlying health condition.

When to Visit Emergency Room (ER) for Vomiting and Diarrhea

Visit an emergency room (ER) if you observe the following symptoms of diarrhea and vomiting.

  • Black or tarry stool
  • Stool that contains blood
  • Fever – 102 degrees or higher
  • Abdominal pain or pain in your rectum
  • Diarrhea that lasts longer than two days for adults or longer than one day for children
  • Signs of dehydration

If you are experiencing above symptoms of vomiting and diarrhea, it is time to visit a nearby emergency room (ER) for treatment.

Come in to SignatureCare Emergency Center to make sure you are not dehydrated. Our emergency room staff can assess what is causing the vomiting /and diarrhea. Our board-certified physicians will diagnose the issues causing you to vomit and have diarrhea, and recommend treatment. Schedule an appointment to see one of our 24-hour ER doctors in Houston, Sugar Land, Stafford, Austin or College Station today.

Causes of Vomiting and Diarrhea

Vomiting and diarrhea are very common, and they usually disappear on their own. They are caused by a variety of factors, including:

Medications – Some medications can cause vomiting and diarrhea. These include blood pressure medications, antibiotics, cancer medications and antacids that contain magnesium. If medication is the cause of vomiting or diarrhea, your doctor may be able to suggest a different prescription or offer suggestions that will minimize the effects of the medication.

Food poisoning – Food poisoning is one of the leading causes of vomiting and diarrhea, and it occurs when food contains salmonella, campylobacter or E. coli bacteria. Food poisoning is usually temporary and mild, but it can be serious if the patient is under the age of 1, is elderly or has a weakened immune system.

Viral gastroenteritis – Norovirus and rotavirus are the two main viruses that cause vomiting and diarrhea. They are accompanied by fever, abdominal pain and cramping.

Food intolerances – Food intolerances may lead to bloating, gas, diarrhea and vomiting.

Traveling – Traveler’s diarrhea occurs when water and food that have been contaminated by bacteria are consumed while traveling.

Parasites – An infection caused by parasites may be the source of diarrhea and vomiting. Amoebic dysentery is a condition that develops over time and can persist for months if left untreated. Giardiasis is another parasitic infection that is spread through contaminated water supplies. Symptoms of giardiasis may persist even after the parasites have left the body.

Types of Diarrhea

Vomiting and Diarrhea are very common, and they usually may disappear on their its own. There are two types of diarrhea – Acute and Chronic Diarrhea.

Acute diarrhea is diarrhea that lasts a short time, usually one or two days but it may last longer and will usually go away on its own. Chronic diarrhea is diarrhea that lasts longer – up to four weeks and could be a symptom of a more serious chronic disease. Symptoms of chronic diarrhea may appear continuously or they may come and go.

Who Gets Diarrhea?

Everyone gets diarrhea. People of all ages, races, ethnicities and nationalities get diarrhea. On average, adult Americans get diarrhea at least once a year while children get it twice a year. People who frequently travel outside United States on average, get traveler’s diarrhea from consuming contaminated food or water.

What is Vomiting?

Vomiting or throwing up happens when you forcefully discharge the contents of your stomach. Vomiting can be a one-time event caused by eating something that disagrees with your stomach. Frequently vomiting could be a symptom of an underlying illness and may require a visit to the emergency room for treatment.

Frequent vomiting could also lead to dehydration which left untreated, could lead to serious medical conditions and death.

Diarrheal Diseases – Acute and Chronic


Acute diarrhea is one of the most commonly reported illnesses in the United States, second only to respiratory infections. Worldwide, it is a leading cause of mortality in children younger than four years old, especially in the developing world. Diarrhea that lasts less than 2 weeks is termed acute diarrhea. Persistent diarrhea lasts between 2 and 4 weeks. Chronic diarrhea lasts longer than 4 weeks.


Diarrheal stools are those that take shape of the container, so they are often described as loose or watery. Some people consider diarrhea as an increase in the number of stools, but stool consistency is really the hallmark. Associated symptoms can include abdominal cramps fever, nausea, vomiting, fatigue and urgency. Chronic diarrhea can be accompanied by weight loss, malnutrition, abdominal pain or other symptoms of the underling illness. Clues for organic disease are weight loss, diarrhea that wakes you up at night, or blood in the stools. These are signs that your doctor will want to do a thorough evaluation to determine the cause of your symptoms. Also tell your doctor if you have a family history of celiac disease, inflammatory bowel disease (IBD), have unintentional weight loss, fever, abdominal cramping or decreased appetite. Tell your doctor if you experience bulky, greasy or very bad smelling stools.

Causes – Acute Diarrhea

Most cases of acute, watery diarrhea are caused by viruses (viral gastroenteritis). The most common ones in children are rotavirus and in adults are norovirus (this is sometimes called “cruise ship diarrhea” due to well publicized epidemics). Bacteria are a common cause of traveler’s diarrhea.

Causes – Chronic Diarrhea

Chronic diarrhea is classified as fatty or malabsorption, inflammatory or most commonly watery. Chronic bloody diarrhea may be due to inflammatory bowel disease (IBD), which is ulcerative colitis or Crohn’s disease. Other less common causes include ischemia of the gut, infections, radiation therapy and colon cancer or polyps. Infections leading to chronic diarrhea are uncommon, with the exception of parasites.

The two major causes of fatty or malabsorptive diarrhea are impaired digestion of fats due to low pancreatic enzyme levels and impaired absorption of fats due to small bowel disease. These conditions interfere with the normal processing of fats in the diet. The former is usually due to chronic pancreatitis which is a result of chronic injury to the pancreas. Alcohol damage to the pancreas is the most common cause of chronic pancreatitis in the United States. Other causes of chronic pancreatitis include cystic fibrosis, hereditary pancreatitis, trauma to the pancreas and pancreatic cancer.

The most common small bowel disease in the U.S. is celiac disease, also called celiac sprue. Crohn’s disease can also involve the small bowel. Whipple’s disease, tropical sprue, and eosinophilic gastroenteritis are some of the rare conditions that can lead to malabsorption diarrhea.

There are many causes of watery diarrhea, including carbohydrate malabsorption such as lactose, sorbitol, and fructose intolerance. Symptoms of abdominal bloating and excessive gas after consuming dairy products suggests lactose intolerance. This condition is more common in African-Americans and Asian-Americans. Certain soft drinks, juices, dried fruits and gums contain sorbitol and fructose, which can lead to watery diarrhea in people with sorbitol and fructose intolerance. Diarrhea is a frequent side effect of antibiotics. Certain other medications such as NSAIDs, antacids, antihypertensives, antibiotics and antiarrhythmics can have side effects leading to diarrhea.

Parasitic intestinal infections such as giardiasis can cause chronic diarrhea. Diabetes mellitus may be associated with diarrhea due to nerve damage and bacterial overgrowth; this occurs mainly in patients with long-standing, poorly-controlled diabetes.

Irritable bowel syndrome (IBS) is a condition often associated with diarrhea, constipation or more frequently alternating diarrhea and constipation. Other common symptoms are bloating, abdominal pain relieved with defecation and a sense of incomplete evacuation.

Risk Factors

Exposure to infectious agents is the major risk factor for acute diarrhea. Bacteria and viruses are often transmitted by the fecal-oral route, so hand washing and hygiene are important to prevent infection. Soap and water are better because alcohol-based hand sanitizers may not kill viruses. Medications such as antibiotics and drugs that contain magnesium products are also common offenders. Recent dietary changes can also lead to acute diarrhea. These including intake of coffee, tea, colas, dietetic foods, gums or mints that contain poorly absorbable sugars. Acute bloody diarrhea suggests a bacterial cause like Campylobacter, Salmonella or Shigella or Shiga-toxin E. coli. Traveler’s diarrhea is common in those who travel to developing countries and results from exposure to bacterial pathogens most commonly enterotoxigenic E. coli. The best method of prevention is to avoid eating and drinking contaminated or raw foods and beverages.


Most episodes of acute diarrhea resolve quickly without antibiotic therapy and with simple dietary modifications. See a doctor if you feel ill, have bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours. In patients with mild acute diarrhea, no laboratory evaluation is needed because the illness generally resolves quickly. Your doctor may perform stool tests for bacteria and parasites if your diarrhea is severe or bloody or if you traveled to an area where infections are common. If you have severe diarrhea, blood tests will be helpful to guide replacement of fluid and electrolytes and minerals such as magnesium, potassium and zinc that can become depleted.

If you have chronic diarrhea, your doctor will want to further assess etiologic factors or complications of diarrhea by obtaining several tests. These can include a blood count to look for anemia and infections, an electrolyte and kidney function panel to assess for electrolyte abnormalities and renal insufficiency, and albumin to assess your nutritional status.

A stool sample may help define the type of diarrhea. The presence of fat, microscopic amounts of blood, and white blood cells will help determine if a fatty, inflammatory, or watery diarrhea is present. A bacterial culture and ova/parasite studies of a stool specimen will also help determine if an infectious etiology is present.

Endoscopic examination of the colon with flexible sigmoidoscopy or colonoscopy and upper endoscopy are helpful in detecting the etiology of chronic diarrhea, as this allows direct examination of the bowel mucosa and the ability to obtain biopsies for microscopic evaluation. Double-balloon enteroscopy and capsule endoscopy are sometimes used to examine the mucosa of the small intestine that lies beyond the reach of conventional endoscopes.

Radiographic studies such as an upper GI series or barium enema are not routinely performed in the evaluation of chronic diarrhea, and have largely been replaced by cross-sectional imaging. Ultrasound and CT scan of the abdomen can be helpful to evaluate the bowel, pancreas and other intra-abdominal organs.

Treating Acute Diarrhea

It is important to take plenty of fluid with sugar and salt to avoid dehydration. Salt and sugar together in a beverage help your intestine absorb fluids. Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices when refeeding should begin with soups and broth.

Anti-diarrheal drug therapy can be helpful to control severe symptoms, and includes bismuth subsalicylate and antimotility agents such as loperamide. These, however, should be avoided in people with high fever or bloody diarrhea as they can worsen severe colon infections and in children because the use of anti-diarrheals can lead to complications of hemolytic uremic syndrome in cases of Shiga-toxin E. coli (E. coli 0157:H7).

Your doctor may prescribe antibiotics if you have high fever, dysentery, or moderate to severe traveler’s diarrhea. Some infections such as Shigella always require antibiotic therapy.

Treatment of chronic diarrhea depends on the etiology of the chronic diarrhea. Often, empiric treatment can be provided for symptomatic relief, when a specific diagnosis is not reached, or when a diagnosis that is not specifically treatable is reached.

Antimotility agents such as loperamide are the most effective agents for the treatment of chronic diarrhea. They reduce symptoms as well as stool weight. Attention should be paid to replacing any mineral and vitamin deficiencies, especially calcium, potassium, magnesium and zinc.

Author(s) and Publication Date(s)

Blanca Ochoa, MD and Christina M. Surawicz, MD, MACG, University of Washington School of Medicine, Seattle, WA – Published October 2002. Updated April 2007. Updated December 2012.

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Enterovirus infection | uzalo48.lipetsk

Enterovirus infection (EVI) is a disease caused by enteroviruses, which are very resistant to the environment.

Enteroviruses tolerate low temperatures well : in a frozen state, the activity of enteroviruses persists for many years, in a refrigerator they persist for several weeks, in tap water they survive up to 18 days, in river water – about a month, in treated wastewater – up to two months.

The source of the disease is a sick person or host. You can get infected through contaminated food, water, objects that surround a person, dirty hands, as well as through the air when sneezing, coughing, talking. Risk factors are also bathing in reservoirs contaminated with viruses, the use of unwashed vegetables and fruits, and drinking water of dubious quality.

Viruses enter the human body through the mouth or upper respiratory tract. The period from the entry of the virus into the human body until the first clinical signs appear in all EVIs is the same – from 2 to 10 days, more often 2-5 days.The disease begins acutely – with an increase in body temperature to 38-39 º C, which most often lasts 3-5 days, then decreases to normal values. Very often the temperature has an undulating current. When the temperature rises, a person, especially a child, feels weakness, drowsiness, headache, nausea, and vomiting may occur.

Enteroviruses can affect different body systems – the central and peripheral nervous systems, oropharyngeal mucosa, eye mucosa, skin, muscles, heart, intestinal mucosa, liver, therefore, several forms of enterovirus infection are distinguished.

The most severe diseases are with damage to the nervous system , when serous meningitis and encephalitis develop. These diseases are characterized by an acute onset, the patients experience severe headache, nausea, vomiting, an increase in body temperature to 39-40 0 C, convulsions, paresis and paralysis, loss of consciousness.

With damage to the mucous membrane of the oropharynx , enterovirus herpangina develops, when there is an increase in body temperature, general intoxication (weakness, headache, drowsiness) and a rash in the form of bubbles filled with fluid on the mucous membrane of the oropharynx and tonsils.The bubbles burst, and in their place sores are formed, filled with white bloom. After recovery, no traces remain at the site of the ulcers.

With skin lesions , exanthema may appear – reddening of the skin, most often on the upper half of the body (head, chest, arms) and the appearance of a rash of various types, similar to a rash with rubella, measles, which usually appears on 1-2 days of illness and disappears after 4-6 days.

With the defeat of the intestinal mucosa , loose stools are observed.Symptoms of the disease are similar to those of an intestinal infection. Stool of normal color (yellow or brown), liquid, without various (mucus, blood) impurities. The appearance of loose stools can be either against the background of an increase in temperature, or without it.

With eye damage , conjunctivitis develops, which manifests itself in the form of photophobia, lacrimation, redness and swelling of the eyes. The presence of hemorrhages in the conjunctiva of the eye is possible.

With muscle damage , myositis develops – pain in the muscles.Pain appears against the background of an increase in temperature. Soreness is observed in the chest, arms and legs. With a decrease in body temperature, pain decreases or disappears altogether.

Enterovirus infections can affect various parts of the heart with the development of myocarditis and pericarditis, and with liver damage, acute hepatitis develops.

For the diagnosis of enterovirus infection in patients, depending on the clinical manifestations, the lavage from the nose, throat or feces, cerebrospinal fluid are taken to study.Research is carried out in a virological laboratory.

There is no specific treatment for enterovirus infection. Treatment is carried out symptomatically, depending on the manifestations of the infection – angina, conjunctivitis, myositis, loose stools, heart damage, encephalitis, meningitis, hepatitis, exanthema. If necessary, prophylaxis of bacterial complications is carried out. If symptoms of enterovirus infection appear, you should consult a doctor.

Prevention of enterovirus infection

Personal hygiene rules must be observed.Wash your hands thoroughly with soap and water before preparing food, before eating, and after coming home from the street and using the toilet.

Keep children’s hands clean, teach them to observe personal hygiene measures from childhood. Wash doorknobs, taps, toilet flush handles. Wash and keep children’s toys regularly.

Do not swim yourself and do not allow children to swim in bodies of water where it is not recommended or prohibited. Swim only in approved places, teach children not to swallow water when bathing.

Water from open reservoirs must not be used for drinking and household needs (in exceptional cases, only after boiling for 5-7 minutes), water from a well must be boiled. Drink only boiled or bottled water.

Wash fruits, berries, vegetables thoroughly under running tap water, and for small children it is advisable to wash fruits with boiled water or scald with hot boiled water after washing.

When buying, be sure to read the expiration dates and storage conditions of foodstuffs indicated on the packaging, strictly follow them in everyday life.Watch out for placing food in the refrigerator. Pack each product in a separate, clean package to protect food from contamination. Avoid contact between uncooked and cooked foods. Set aside kitchen utensils (knives, cutting boards) separately for raw and cooked foods.

If you are going to rest in the near or far abroad, be sure to ask the tour operator about the epidemiological situation in the host country, about measures to prevent infectious diseases.

Remember, disease is easier to prevent than to cure! Be healthy!

90,000 Adverse events in people taking macrolide antibiotics

Review Question

We wanted to find out if people taking macrolide antibiotics experience more adverse events than those taking placebo.


Macrolide antibiotics are a group of antibiotics that are commonly used to treat acute and chronic infections.The four most commonly used macrolides are azithromycin, clarithromycin, erythromycin, and roxithromycin. People taking macrolide antibiotics are at risk of adverse events such as nausea, diarrhea, and rash.

Search Date

We searched the literature up to May 2018.

Research characteristics

We included 183 studies with 252,886 participants. Most of the studies were conducted in a hospital setting.Azithromycin and erythromycin have been studied to a greater extent than clarithromycin and roxithromycin. Most of the studies (89%) reported some adverse event, or at least stated that there were no adverse events.

Sources of research funding

Pharmaceutical companies supplied investigational drugs or funded research, or both, in 91 studies. Funding sources were unclear in 59 studies.

Key Findings

People treated with macrolide antibiotics experienced gastrointestinal adverse events such as nausea, vomiting, abdominal pain and diarrhea more often than those treated with placebo.

Taste disturbance was reported more often by people taking macrolides than people taking placebo. However, since few studies have reported these adverse events, these results should be interpreted with caution.

Hearing loss was reported more frequently by people taking macrolide antibiotics, but only four studies reported this outcome.

Macrolides caused less cough and fewer respiratory tract infections than placebo.

We found no evidence that macrolides cause more heart problems, liver problems, blood infections, skin and soft tissue infections, liver enzyme changes, loss of appetite, dizziness, headache, respiratory symptoms, itching, or rash than placebo.

We did not find more deaths in people treated with macrolides than those treated with placebo.

Very limited information was available on whether people treated with macrolides have a greater risk of developing resistant bacteria than those treated with placebo. However, bacteria resistant to macrolide antibiotics were more likely to be detected immediately after initiation of treatment in people taking macrolides than in those taking placebo, but the difference in resistance after treatment was controversial.

Quality of evidence

The quality of the evidence ranged from very low (heart disorders, liver enzyme changes, liver problems) to low (abdominal pain, death, diarrhea, dizziness, hearing loss, skin and soft tissue infections, taste disturbances, wheezing), to moderate (loss of appetite, blood infections, cough, fever, headache, itching, nausea, rash, respiratory symptoms, respiratory infections, vomiting).

Gastritis. Full description: causes, symptoms, diagnosis, treatment

Gastritis is an inflammation of the stomach lining in response to irritation and damage.

There are two forms of gastritis – acute and chronic gastritis.

Causes of acute gastritis

Acute gastritis develops as a result of chemical irritants entering the stomach, eating poor-quality food contaminated with pathogens, and taking high doses of certain medicinal substances, such as aspirin.In this case, there is a sharp burning pain in the upper abdomen, nausea, vomiting, dizziness and weakness.

Acute gastritis requires urgent medical attention and, in severe cases, hospitalization.

After treatment, acute gastritis can turn into chronic, however, more often chronic gastritis is an independent disease.The main symptoms of acute gastritis are acute epigastric pain, nausea, increased salivation and an unpleasant taste in the mouth, as well as headache, combined with general weakness and lethargy , sometimes dizziness, vomiting and diarrhea.

Causes of chronic gastritis

One of the causes of chronic gastritis is acute gastritis, which has not been treated. But there are other reasons for the appearance of chronic gastritis – infection of the gastric mucosa with the bacterium Helicobacter pylori, less often, chronic gastritis appears due to autoimmune processes in the body. There are also a number of reasons that contribute to the acquisition of chronic gastritis:

  • persistent eating disorders;
  • love of spicy food;
  • the habit of chewing food poorly;
  • quick bites
  • frequent meals in fast foods;
  • addiction to alcohol and carbonated drinks;
  • uncontrolled medication intake;
  • work in difficult conditions.
  • infection of the stomach with Helicobacter pylori infection;
    chronic stress;
  • long-term use of drugs that irritate the gastric mucosa;
  • smoking;
  • genetic predisposition.
Can I get gastritis?

Can. Helicobacter pylori is transmitted through saliva through kissing.

An experienced gastroenterologist at the Health Clinic will help you with any form of gastritis.

Symptoms of gastritis

  • aching or sharp burning pain under the “spoon”, appearing or worsening during eating or shortly after eating;

  • heartburn;

  • nausea, at the height of severe nausea there may be vomiting;

  • flatulence;

  • constant belching and heaviness in the abdomen;

  • unreasonable weight loss.

  • unpleasant taste in the mouth;

  • heaviness, feeling of pressure;