Digestive Diseases I Ohio State Medical Center

Gastroenteritis is often mistaken for stomach flu although it is actually an inflammation of the lining of the intestines caused by a virus, bacteria or parasites.

Symptoms of gastroenteritis include diarrhea, abdominal pain, vomiting, headache, fever and chills. Most people recover with no treatment.

The most common problem with gastroenteritis is dehydration. This happens if you do not drink enough fluids to replace what you lose through vomiting and diarrhea. Dehydration is most common in babies, young children, the elderly and people with weak immune systems.

Bacterial gastroenteritis

Bacterial gastroenteritis can affect one person or a group of people who all ate the same food. It is commonly called food poisoning. It often occurs after eating at picnics, school cafeterias, large social gatherings or restaurants.

Many different types of bacteria can cause bacterial gastroenteritis, including Campylobacter jejuni, E. coli, Salmonella, Shigella, Staphylococcus and Yersinia.

Viral gastroenteritis

Viral gastroenteritis is the second most common illness in the U.S. The cause is often a norovirus infection which spreads through contaminated food or water and/or contact with an infected person. The best prevention is frequent hand washing.

Several different viruses can cause viral gastroenteritis, which is highly contagious and extremely common. Symptoms usually appear within 12-48 hours after exposure to a gastroenteritis-causing virus and last for 1-3 days. Some viruses cause symptoms that last longer.

Viral gastroenteritis is transmitted from person to person. Viruses are present in the stool and vomit of infected people who may contaminate surfaces, objects, food and drinks, especially if they do not wash their hands thoroughly after using the bathroom. When an infected person with unwashed hands touches another person, the virus can spread. When an infected person vomits, the virus can become airborne.

Outbreaks of viral gastroenteritis can occur anyplace where people gather in groups. People who suspect they were exposed to a virus in one of these settings may want to contact a local health department that tracks these outbreaks.

Most cases of viral gastroenteritis are caused by four types of viruses:

• Rotavirus is the leading cause of gastroenteritis among infants and young children 3-15 months old. It can also infect adults in close contact with these children, but their symptoms are milder.
• Caliciviruses cause infection in people of all ages. Norovirus, the most common calicivirus and cause of viral gastroenteritis in adults, is usually responsible for epidemics of viral gastroenteritis. Norovirus outbreaks are more frequent from October-April.
• Adenovirus mainly infects children younger than 2. Of the 49 types of adenoviruses, one strain affects the gastrointestinal tract, causing vomiting and diarrhea. Adenovirus infections occur year-round.
• Astrovirus primarily infects infants and young children, but may also spread to adults. The symptoms are milder than those of norovirus or rotavirus infections. The virus is most active during the winter months.

Diagnosis

Bacterial gastroenteritis

Your health care provider will examine you for signs of food poisoning, including dehydration. Lab tests may be done on the food or a stool sample to find out what germ is causing the symptoms. However, these tests do not always show the cause of the diarrhea. Tests may also be done to look for white blood cells in the stool, which is a sign of infection.

Viral gastroenteritis

Viral gastroenteritis is usually diagnosed based on symptoms alone. People who have symptoms that are severe or last for more than a few days may want to see their doctor for additional tests. A health care provider may ask for a stool sample to test for rotavirus or norovirus or to rule out bacteria or parasites as the cause. During an epidemic of viral gastroenteritis, health care providers or public health officials may test stool samples to find out which virus is responsible for the outbreak.

Treatment

With gastroenteritis, if you have diarrhea and are unable to drink or keep down fluids because of nausea or vomiting, you may need IV fluids. If you take diuretics (water pills), talk to your doctor about stopping them while you have diarrhea. Children, older adults and adults with weak immune systems may need to drink oral rehydration solutions to prevent dehydration. The primary goal of treatment is to reduce symptoms.

Bacterial gastroenteritis

You will usually recover from the most common types of bacterial gastroenteritis in a couple of days. The goal is to make you feel better and avoid dehydration. Drinking enough fluids and learning what to eat will help ease symptoms. Also get plenty of rest.

Viral gastroenteritis

Most cases of viral gastroenteritis resolve over time without specific treatment. Antibiotics are not effective against viral infections. The primary goal of treatment is reduce and manage symptoms.

Viral gastroenteritis (stomach flu) Information | Mount Sinai

Rotavirus infection – gastroenteritis; Norwalk virus; Gastroenteritis – viral; Stomach flu; Diarrhea – viral; Loose stools – viral; Upset stomach – viral

Viral gastroenteritis is present when a virus causes an infection of the stomach and intestine. The infection can lead to diarrhea and vomiting. It is sometimes called the “stomach flu.”

The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

Causes

Gastroenteritis can affect one person or a group of people who all ate the same food or drank the same water. The germs may get into your system in many ways:

• Directly from food or water
• By way of objects such as plates and eating utensils
• Passed from person to person by way of close contact

Many types of viruses can cause gastroenteritis. The most common viruses are:

• Norovirus (Norwalk-like virus) is common among school-age children. It may also cause outbreaks in hospitals and on cruise ships.
• Rotavirus is the leading cause of gastroenteritis in children. It can also infect adults who are exposed to children with the virus and people living in nursing homes.
• Astrovirus.
• Enteric adenovirus.
• COVID-19 may cause stomach flu symptoms, even when breathing problems are not present.

People with the highest risk for a severe infection include young children, older adults, and people who have a suppressed immune system.

Symptoms

Symptoms most often appear within 4 to 48 hours after contact with the virus. Common symptoms include:

• Abdominal pain
• Diarrhea
• Nausea and vomiting

Other symptoms may include:

• Chills, clammy skin, or sweating
• Fever
• Joint stiffness or muscle pain    
• Poor feeding
• Weight loss

Exams and Tests

The health care provider will look for signs of dehydration, including:

• Dry or sticky mouth
• Lethargy or coma (severe dehydration)
• Low blood pressure
• Low or no urine output, concentrated urine that looks dark yellow
• Sunken soft spots (fontanelles) on the top of an infant’s head
• No tears
• Sunken eyes

Tests of stool samples may be used to identify the virus that is causing the sickness. Most of the time, this test is not needed. A stool culture may be done to find out if the problem is being caused by bacteria.

Treatment

The goal of treatment is to make sure the body has enough water and fluids. Fluids and electrolytes (salt and minerals) that are lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

• Older children and adults can drink sports beverages such as Gatorade, but these should not be used for younger children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.
• DO NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), fruit-flavored gelatin, or broth. These liquids do not replace lost minerals and can make diarrhea worse.
• Drink small amounts of fluid (2 to 4 oz. or 60 to 120 mL) every 30 to 60 minutes. Do not try to force down large amounts of fluid at one time, which can cause vomiting. Use a teaspoon (5 milliliters) or syringe for an infant or small child.
• Babies can continue to drink breast milk or formula along with extra fluids. You do NOT need to switch to a soy formula.

Try eating small amounts of food frequently. Foods to try include:

• Cereals, bread, potatoes, lean meats
• Plain yogurt, bananas, fresh apples
• Vegetables

If you have diarrhea and are unable to drink or keep down fluids because of nausea or vomiting, you may need fluids through a vein (IV). Infants and young children are more likely to need IV fluids.

Parents should closely monitor the number of wet diapers an infant or young child has. Fewer wet diapers is a sign that the infant needs more fluids.

People taking water pills (diuretics) who develop diarrhea may be told by their provider to stop taking them until symptoms improve. However, DO NOT stop taking any prescription medicine without first talking to your provider.

Antibiotics do not work for viruses.

You can buy medicines at the drugstore that can help stop or slow diarrhea.

• Do not use these medicines without talking to your provider if you have bloody diarrhea, a fever, or if the diarrhea is severe.
• Do not give these medicines to children.

Outlook (Prognosis)

For most people, the illness goes away in a few days without treatment.

Possible Complications

Severe dehydration can occur in infants and young children.

When to Contact a Medical Professional

Contact your provider if diarrhea lasts for more than several days or if dehydration occurs. You should also contact your provider if you or your child has these symptoms:

• Blood in the stool
• Confusion
• Dizziness
• Dry mouth
• Feeling faint
• Nausea
• No tears when crying
• No urine for 8 hours or more
• Sunken appearance to the eyes
• Sunken soft spot on an infant’s head (fontanelle)

Contact your provider right away if you or your child also have respiratory symptoms, fever or possible exposure to COVID-19.

Prevention

Most viruses and bacteria are passed from person to person by unwashed hands. The best way to prevent stomach flu is to handle food properly and wash your hands thoroughly after using the toilet.

Be sure to observe home isolation and even self-quarantine if COVID-19 is suspected.

A vaccine to prevent rotavirus infection is recommended for infants starting at age 2 months.

Bass DM. Rotaviruses, caliciviruses, and astroviruses. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 292.

DuPont HL, Okhuysen PC. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 267.

Kotloff KL. Acute gastroenteritis in children. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 366.

Melia JMP, Sears CL. Infectious enteritis and proctocolitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 110.

Last reviewed on: 5/4/2022

Reviewed by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Cramping pains in the abdomen – causes

Cramping pains in the abdomen – unpleasant acute, sudden pain in various parts of the abdomen, which can be associated with a large number of diseases, not only of the gastrointestinal tract, but also of other organ systems.

Most often, this condition is associated with spasms in the biliary system, stomach, and intestines.

“Symptoms of anxiety”: if the cramping pain in the abdomen is of high intensity, accompanied by fever, chills, nausea, vomiting, severe bloating in the abdomen, constipation or diarrhea, blood in the stool, tension in the anterior abdominal wall, sharp pain when lightly touching the abdomen or pushing the bed – you should immediately consult a doctor, as an examination of the abdomen, blood tests, ultrasound examination (ultrasound) of the abdominal cavity and, possibly, other studies to rule out acute surgical and other serious pathology.

Causes of cramping pain in the right side of the abdomen:

• acute appendicitis

• diseases of the stomach and duodenum (acute erosive gastroduodenitis, peptic ulcer, stomach cancer)

• diseases of the liver and biliary system (acute cholecystitis, cholelithiasis and biliary colic, biliary dyskinesia with spasm of the gallbladder and bile duct sphincters, abscess, liver cancer)

• bowel diseases (acute infectious enterocolitis, intestinal obstruction, strangulated hernia of the anterior abdominal wall, Crohn’s disease, ulcerative colitis, diverticulitis, intestinal cancer)

• damage to the vessels of the abdominal cavity (dissecting aortic aneurysm, thrombosis and embolism of intestinal vessels, hepatic veins, portal vein, thrombosis of the right renal artery)

• diseases of the urinary system (urolithiasis and renal colic, cancer of the right kidney)

• diseases of the genital organs (acute right-sided adnexitis, ovarian cyst, ectopic pregnancy, dysmenorrhea, acute prostatitis)

• diseases of the nervous system (shingles (herpes zoster), damage to the solar plexus)

• diseases of the chest organs (lower lobe right-sided pneumonia, pleurisy, pneumothorax, acute myocardial infarction, pulmonary embolism)

• diseases of the endocrine system (diabetic ketoacidosis)

• rare diseases (acute intermittent porphyria, lead colic, periodic illness)

Causes of cramping pain in the left side of the abdomen:

• diseases of the pancreas (acute pancreatitis, cancer)

• diseases of the stomach (acute erosive gastritis, peptic ulcer, stomach cancer)

• bowel diseases (acute infectious enterocolitis, intestinal obstruction, strangulated hernia of the anterior abdominal wall, Crohn’s disease, ulcerative colitis, diverticulitis, intestinal cancer, Makelia-Dvorkin-Biehl syndrome (splenic flexure syndrome of the large intestine with severe accumulation of gases)

• diseases of the spleen (splenomegaly in blood diseases, infectious diseases, cirrhosis of the liver; cysts, tumors, abscess, rupture, perisplenitis, impaired blood supply – spleen infarction)

• damage to the vessels of the abdominal cavity (dissecting aneurysm of the aorta, thrombosis and embolism of the intestinal vessels, thrombosis of the splenic vein, left renal artery)

• diseases of the urinary system (urolithiasis and renal colic, cancer of the left kidney)

• diseases of the genital organs (acute left-sided adnexitis, ovarian cyst, ectopic pregnancy, dysmenorrhea, acute prostatitis)

• diseases of the nervous system (shingles (herpes zoster), damage to the solar plexus)

Causes of epigastric cramping pain:

• acute appendicitis (at the beginning of the disease)

• diseases of the stomach (acute gastritis, gastric ulcer, cancer)

• hiatal hernia (strangulation)

• diseases of the pancreas (acute pancreatitis, cysts, cancer)

• diseases of the biliary system (acute cholecystitis, cholelithiasis and biliary colic, biliary dyskinesia with gallbladder spasm)

• bowel diseases (irritable bowel syndrome)

• abdominal vascular disease (dissecting aortic aneurysm, thrombosis and embolism)

• diseases of the nervous system (shingles (herpes zoster), damage to the solar plexus)

• heart disease (acute myocardial infarction)

In our center we are engaged in determining the cause of cramping pain in the abdomen, conducting an examination and differential diagnosis of this condition. Experienced medical specialists (gastroenterologist, surgeon, neurologist, endocrinologist, psychotherapist), as well as the opportunity to be examined using expert-class equipment (ultrasound, videogastroduodenoscopy, colonoscopy) will help to deal with this problem.

Stomach pain is a serious problem

Abdominal pain is a symptom of most gastrointestinal diseases. Together with the specialists of SMC Best Clinic, we will figure out what pain in the gastrointestinal tract can signal and what to do for patients who encounter this problem.

What hurts: the stomach or not the stomach?

If you or your child have a stomach ache in the area of ​​the gastrointestinal tract, you need to contact a gastroenterologist. Unfortunately, pain in the stomach, liver or pancreas appears when the disease has already developed, so such a symptom, even if it does not hurt much, cannot be ignored. Severe pain is a sign of an acute condition, weak pains more often indicate a chronic process or an initial stage.

When, during a consultation, a gastroenterologist asks where it hurts, you should point out as accurately as possible to the place where the maximum pain is noted. Depending on the location of the pain, further diagnostics are prescribed.

Variants of localization of pain in diseases of the gastrointestinal tract:

• Pain in the epigastrium. The epigastrium is called the upper central zone of the abdomen. If the patient suffers from pain in this area, most likely they are associated with diseases of the esophagus and stomach. Most often in this case they talk about the likelihood of gastritis and ulcers. Patients usually describe such pains as cutting and stabbing, but their nature may be different. Both of these diseases are provoked by the bacterium Helicobacter pylori, therefore, to make a diagnosis, you will need to undergo a gastroscopy and be tested for the presence of a bacterium.

• Pain in the right hypochondrium. In this case, first of all, pathologies of the gallbladder or bile ducts should be suspected – biliary dyskinesia, cholecystitis, biliary colic. Also, pain in the right upper abdomen may indicate liver pathology. In this case, the primary diagnosis is ultrasound and blood tests that detect inflammation and rule out hepatitis. Liver tests and other tests are ordered.

• Pain in the left hypochondrium. Such pain is typical for an attack of pancreatitis – inflammation of the pancreas. This organ is also part of the gastrointestinal tract. The doctor will prescribe a general and biochemical blood test, which will show inflammation and the content of trypsin, lipase, amylase enzymes, abdominal ultrasound and other tests.

• Pain in the umbilical region. The midline of the abdomen usually hurts with the development of irritable bowel syndrome (IBS). Other intestinal diseases, such as dysbacteriosis and intestinal infection, can also be the cause. In this case, it is necessary to take blood and stool tests, undergo ultrasound, colonoscopy, etc.

For each person, pain can manifest itself in different ways, so it will definitely not be possible to make a diagnosis on your own. It is best to contact a specialized doctor – a gastroenterologist as soon as possible. And if the stomach hurts very much, you need to immediately call an ambulance, since any inflammation can result in the most dangerous complication – peritonitis – inflammation of the peritoneum.

When the stomach hurts: abdominal pain by time of occurrence

Another important characteristic of stomach pains is the period when they usually appear. Since the vast majority of causes of abdominal pain are associated with a violation of the digestive process, the period is determined depending on the time of the last meal. In accordance with this classification, early, late and hungry pains are distinguished.

In the first case, pain sensations appear within half an hour – an hour after eating. The causes of early stomach pains are inflammation of the middle and lower sections of the stomach, polyposis.

Late pain develops one and a half to three hours after eating. This may be due to gastritis, duodenitis, pancreatitis, or an ulcer. Also, such pain can indicate a very dangerous pathological condition – stomach cancer. If severe pulling pain appears in the abdomen four to five hours after eating, most likely a pre-ulcerative condition will be detected or an ulcer has already developed.

Hungry pains are a symptom of gastritis and stomach and duodenal ulcers.

How the stomach hurts: the nature of the pain and accompanying signs

It is very important to correctly describe the pain syndrome to the doctor. To this end, the patient must determine the nature of the pain – stabbing or cutting, cramping or pulling, pressing or aching, etc. You also need to talk about the accompanying symptoms. Each disease of the gastrointestinal tract has its own face. For example:

• With appendicitis, spasms are first noted in the epigastric region, passing into the right side of the abdomen. The attack is accompanied by vomiting. The pain is sharp, often severe.

• In acute gastritis, the abdomen hurts quite badly, forcing the patient to “bend in half.” In addition, nausea and vomiting may begin. Chronic gastritis is manifested by dull, nagging pains – the stomach “raises”.

• Poisoning almost always causes acute pain in the epigastrium, nausea, vomiting, and diarrhea. The patient is sick. Frequent fever, chills, discoloration of feces.

• A sign of irritable bowel syndrome is unpleasant spasms in the stomach, accompanied by bloating, diarrhea with an admixture of mucus.

• Biliary colic can give in the hypochondrium and “under the spoon.” There are quite a few accompanying symptoms of this pathology: pain radiating to the right shoulder or shoulder blade, vomiting, bitterness in the mouth, belching, etc.

• With a stomach ulcer, the pain is severe, with “sour” belching and heartburn.

• With intestinal colic, the urge to defecate is not uncommon. After the toilet, the pain subsides.

• Nonspecific ulcerative colitis is manifested by pain in the lower abdomen and in the stomach. There is mucus and blood in the stool. Urge to defecate more than 7 times a day.

• Acute pancreatitis gives very severe pain, radiating to the left collarbone, shoulder blade, and back. The patient is nauseated, vomiting and diarrhea are often noted.

• Intestinal infections are always associated with pulling pains in the abdomen, the urge to defecate, nausea, vomiting, and changes in the consistency of feces. It may include blood, mucus, foam, greenery, etc.

Where to go if you have a stomachache?

Gastroenterologists are involved in the diagnosis and treatment of the gastrointestinal tract, so it is pointless to contact a therapist, he will still redirect you to a specialized specialist.