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Fever followed by diarrhea: Viral gastroenteritis (stomach flu) – Symptoms and causes

Can diarrhea be a symptom of the flu?

Diarrhea and other gastrointestinal (GI) problems are uncommon symptoms of the flu.

While influenza (flu) is a common cause of respiratory illness, it only sometimes causes diarrhea. Researchers do not know why or how this may occur.

According to the Centers for Disease Control and Prevention (CDC), diarrhea during the flu is more common in children than in adults.

This article looks at why influenza may cause diarrhea, stomach flu, and vomiting. It also looks at other flu symptoms and treatments.

The flu virus typically infects people via a respiratory route. However, GI symptoms, including diarrhea, vomiting, and abdominal pain, sometimes occur. GI symptoms can indicate severe flu and represent a secondary infection.

It is common for the flu virus to spread to the GI tract after a respiratory infection. However, researchers do not know how it is spread.

Researchers suggest that a person with the flu may experience diarrhea as a result of taking flu medications, which can irritate the gut, or because of a direct viral effect or secondary bacterial infection.

Researchers that identified flu viruses in feces estimate that these reach and affect the GI tract due to:

  • the flu virus replicating in the intestinal cells
  • a person swallowing the flu virus
  • affected intestinal immune cells

Stomach flu, also known as viral gastroenteritis, is a highly contagious intestinal infection. Symptoms include diarrhea, vomiting, and stomach cramps.

Stomach flu is not the same as influenza, which primarily affects the respiratory system. Stomach flu mainly affects the intestines and stomach.

A person can develop stomach flu from different viruses, including:

  • rotavirus, which is most common between April and December
  • norovirus, which is the most contagious form of stomach flu
  • astrovirus, which typically affects people with weakened immune systems
  • adenovirus, which can cause a wide range of symptoms

A person will usually develop symptoms following contact with someone who has the stomach flu. They may also develop symptoms from food and water containing the virus.

Other symptoms of the flu may include:

  • fever
  • chills
  • headaches
  • stuffy or runny nose
  • cough
  • muscle aches
  • sore throat
  • fatigue

Individuals most commonly treat the flu at home with over-the-counter (OTC) medications, such as painkillers, decongestants, and cough medications.

Resting, ensuring enough fluids, and managing body temperature can also help reduce the severity of symptoms.

In some instances, a doctor may prescribe antiviral drugs that can reduce the severity of flu symptoms. They can also reduce the overall amount of time a person is sick by 1 or 2 days. The drugs work most effectively if a person takes them within 2 days of getting the infection.

People who are at high risk of serious complications from flu viruses might especially benefit from antiviral medication. People at higher risk of complications include:

  • young children
  • people 65 years old and older
  • people with other medical conditions, such as heart disease, asthma, and diabetes

A person can usually treat diarrhea using OTC medications, such as bismuth subsalicylate (Kaopectate or Pepto-Bismol) and loperamide (Imodium).

However, if a person has a fever or notices blood in their stools, it may indicate a different type of infection, such as bacteria or parasites. For instances such as these, a doctor may not recommend OTC medications.

It is important to treat dehydration, which can result from diarrhea. A person should drink plenty of water to replace lost fluids and consider other options to replace electrolytes, including:

  • sports drinks
  • caffeine-free soft drinks
  • broths
  • fruit juices

If diarrhea lasts longer than 2 days, a person should consider contacting a doctor.

There are several ways a person can actively prevent the flu. These include:

  • Flu vaccines: Flu vaccines protect against the most common flu viruses. Anyone 6 months or older should receive a flu vaccine, as it can also help prevent high risk people from serious flu complications and illness.
  • Stopping the spread: Individuals should avoid contact with people who are sick with the flu, if possible. Similarly, if a person has the flu, they should limit their contact with others. Covering the nose and mouth while coughing or sneezing and not touching the face can also limit the spread of the flu.

People should also wash their hands thoroughly and regularly as well as disinfect surfaces.

Some people with the flu may experience diarrhea as a symptom. The flu virus may spread to the GI tract as a secondary virus and cause diarrhea. Researchers are unsure of exactly how and why this occurs.

Stomach flu, or viral gastroenteritis, differs from the flu. Stomach flu primarily affects the intestines and stomach, while the flu primarily affects the respiratory system. The two viruses have different causes.

A person can usually treat the flu and diarrhea at home using OTC medications. However, if complications occur and symptoms become severe, they should seek medical attention.

A person may prevent the flu by avoiding contact with the virus and by receiving a flu vaccine.

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

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Infectious diarrhea in general practice | Ivashkin V.

T., Sheptulin A.A.

Diarrhea of ​​an infectious nature is currently one of the most common diseases and ranks second in frequency after acute inflammatory diseases of the upper respiratory tract. For example, in Africa, Asia (excluding China) and Latin America, every year in children under

For 5 years, more than 750 million cases of acute infectious diarrhea are registered, which leads to death in more than 4.5 million children [1].
The causative agents of infectious diarrhea can be various agents that can determine the originality of the clinical picture of the disease, the features of diagnosis and treatment. The seriousness of the problem is also due to the fact that the diagnosis and treatment of infectious diarrhea is often carried out not by infectious disease specialists, but by general practitioners [2].
Bacterial diarrhea
Etiology and pathogenesis
Significant changes have now occurred in the structure of the etiological factors of bacterial diarrhea. The frequency of infectious diarrhea caused by common pathogens (Shigella, Salmonella) has decreased, and the number of cases of diseases caused by enteropathogenic strains of Escherichia coli and Campylobacter infection has increased [3].
The pathophysiological mechanisms of bacterial diarrhea include the production of enterotoxin, which increases the activity of adenylate cyclase and thus stimulates the secretion of water and electrolytes by enterocytes (for example, in infection with Vibrio cholerae, clostridia, enterotoxin-producing strains of Escherichia coli), or direct invasion of bacteria into mucosal epithelial cells intestines with their subsequent damage and the development of an inflammatory reaction (with shigellosis infection, infection caused by enteroinvasive strains of Escherichia coli, yersiniosis, salmonellosis).
Clinical picture
The incubation period for bacterial diarrhea can last from several hours (with salmonellosis or staphylococcal infection) to 10 days (with yersiniosis). The leading clinical symptoms of bacterial diarrhea, in addition to loose stools, are fever and cramping abdominal pain. In this case, some features of clinical manifestations due to the etiological factor may be noted. For example, the clinical picture in campylobacter ileitis may resemble acute appendicitis, and the surgeon who decides to operate in this situation finds an unchanged appendix and signs of mesenteric lymphadenitis. Yersinia infection sometimes occurs with the development of nodular erythema and joint damage. Salmonella infection can be complicated by bacteremia with the occurrence of pneumonia, meningitis, abscesses of internal organs. Infectious diarrhea caused by enterohemolytic strains of Escherichia coli (0157:H7) can lead to the development of hemolytic-uremic syndrome, manifested by acute renal failure, hemolytic anemia and thrombocytopenic purpura.
Diagnosis of bacterial diarrhea involves a clinical blood test (leukocytosis is detected with a shift of the formula to the left) and sigmoidoscopy (a picture of acute proctosigmoiditis with shigellosis infection), as well as a search for the etiological factor that caused its development. Stool culture with its subsequent microbiological examination gives a positive result in approximately 40–60% of patients with acute diarrhea that occurs with fever and the appearance of leukocytes in the feces [4]. With negative results of crops, immunological diagnostic methods are used. Thus, the use of enzyme immunoassay methods makes it possible to detect antibodies to Campylobacter and Salmonella. Enterotoxins of pathogenic strains of Escherichia coli can be detected using polymerase chain reaction and latex agglutination. With shigellosis, antibodies to antigen 0 can be determined already in the first days of the disease using the hemagglutination method.
Dehydration Control
Treatment of acute infectious diarrhea should primarily include (especially in children) control of dehydration. In mild cases of the disease, rehydration therapy is reduced to sufficient fluid intake (tea, mineral water, etc.) containing glucose and electrolytes. The simplest rehydration solution is prepared as follows: in 1 glass of orange juice (it contains 1. 5 g of potassium chloride), add 1/2 teaspoon of common salt (3.5 g of sodium chloride) and 1 teaspoon of baking soda (2.5 g of bicarbonate). sodium), after which the total volume of the solution is brought to 1 l with boiled water [5].
With more pronounced dehydration, special rehydration solutions are shown that have an electrolyte composition recommended by WHO (Na + –
90 mmol/l, K+ – 20 mmol/l, CI- – 80 mmol/l, HCO-3 – 30 mmol/l, glucose – 110 mmol/l). In pediatric practice, in order to combat dehydration with diarrhea, the drug rehydron is used, containing 3.5 g of sodium chloride, 2.9 g of sodium citrate, 2.5 g of potassium chloride and 10 g of dextrose in 1 sachet. After dissolving the contents of sachet
in 1 liter of warm boiled water, the patient is allowed to drink the resulting solution, based on the expected loss of body weight (with a loss of 5-7.5% of body weight, the volume of fluid administered is 40-50 ml / kg of body weight for 4 hours or up to 150 ml / kg of body weight per day). The total volume of oral fluid for adult patients should be at least 2-3 liters per day. In severe dehydration (loss of more than 10% of body weight within 24 hours), additionally resort to intravenous administration of water and electrolyte solutions. Patients with acute infectious diarrhea are recommended a light diet for a period of 2-3 days with the inclusion of foods such as mucous soups, rice, dried bread, salted crackers, baked potatoes, eggs, etc. Foods rich in vegetable fiber, dairy should be avoided. products, coffee and alcohol.
Antibacterial therapy
Antibacterial drugs, previously widely used in the treatment of bacterial diarrhea, are now prescribed differentially, taking into account the type of pathogen and the severity of the course of the disease. It should be borne in mind that many forms of infectious diarrhea end in self-healing within 5 days on the background of rehydration therapy [5].
In uncomplicated cases of salmonellosis, antibiotics are not indicated, since they do not reduce the duration of the disease and lengthen the period of isolation of the pathogen. Antibiotic therapy is resorted to in cases where the disease occurs with high fever, signs of severe intoxication, bacteremia and damage to other organs. The drugs of choice in this case are ampicillin (at a dose of 4-6 g per day) or chloramphenicol (1 g 3 times a day), which are used for 2 weeks. With severe intoxication, co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole 2 times a day for 1–2 weeks) can be considered an alternative.
Antibiotic therapy, carried out in patients with shigellosis, helps to reduce the duration of fever and shorten the period of carriage of microorganisms. The drug of choice is co-trimoxazole, administered at a dose of 960 mg 2 times a day for 5 days. Given the possible resistance to this drug, nalidixic acid (1 g 4 times a day), norfloxacin (400 mg 2 times a day) or ciprofloxacin (500 mg 2 times a day) can also be used instead. Ampicillin and doxycycline are used only when the susceptibility of cultured bacterial strains to them is confirmed. The use of ceftriaxone (1 g per day intravenously for 5 days) is considered as a backup method of treatment.
In the treatment of uncomplicated campylobacteriosis, antibiotics usually do not play a significant role, since the clinical manifestations of this disease often subside completely in such cases even before the pathogen is identified. Antibacterial agents are usually used in severe cases of the disease, severe intoxication, and the presence of blood in the stool. The main drug for the treatment of campylobacteriosis is erythromycin, which is prescribed at a dose of 1 g per day (in 2 or 4 doses) for 5-7 days. Tetracyclines (eg, doxycycline 200 mg on day 1 and then 100 mg daily) and fluoroquinolones are also effective. With campylobacter septicemia, gentamicin (at a dose of 4–5 mg per 1 kg of body weight), ceftriaxone (1 g per day) or chloramphenicol (3 g per day) is used.
With yersiniosis, antibiotic treatment is carried out only in severe cases of the disease. In this case, gentamicin (5 mg per 1 kg of body weight per day intravenously) or chloramphenicol (50 mg per 1 kg of body weight per day intravenously or orally) should be considered as the drugs of choice. The duration of treatment should be at least 2 weeks.
The use of antibiotics in cholera contributes to the rapid disappearance of cholera vibrio from faeces and a decrease in the duration of diarrhea. Tetracycline (250 mg every 6 hours for 9 months) remains the drug of choice.0005
4 days). Furazolidone can also be used (at a dose of 5 mg per 1 kg of body weight per day, divided by
for 4 doses, for 3 days), chloramphenicol (500 mg
4 times a day for 7 days) and co-trimoxazole
(960 mg 2 times a day for 1 week).
The use of symptomatic antidiarrheals in the treatment of infectious diarrhea caused by enteroinvasive bacteria (Shigella and Salmonella) is not indicated, as they slow down the elimination of microorganisms and prolong the duration of the disease. Their appointment should also be avoided in case of high fever, severe intoxication, as well as in the presence of leukocytes and blood in the feces, because of the risk of developing toxic dilatation of the colon (toxic megacolon).
Viral diarrhea
Among the various variants of viral diarrhea, diarrhea of ​​​​rotavirus etiology (the most common form of infectious diarrhea in children), diarrhea caused by the Norfolk virus, as well as adeno- and astroviruses have the greatest clinical significance. In the clinical picture of viral diarrhea, attention is drawn to the frequent combination of diarrhea and fever with dyspeptic disorders, and often (with rotavirus diarrhea) with damage to the upper respiratory tract. The diagnosis is confirmed by detecting the virus in the feces using electron microscopy or by special immunological studies (for example, with monoclonal antibodies). The course of viral diarrhea is usually favorable. The duration of the disease does not exceed, as a rule, 3-5 days. Treatment is symptomatic and is reduced to the elimination of water and electrolyte disorders.
Diarrhea of ​​parasitic origin
In the group of diarrhea of ​​parasitic origin, amebiasis and giardiasis are of the greatest clinical importance.
The causative agent of amoebiasis is the dysenteric amoeba, which is characterized by an almost ubiquitous prevalence. It is believed that about 10% of the world’s population is infected with these protozoa. At the same time, in 90% of those infected, the colonization of the colon mucosa by parasites is asymptomatic, while in the remaining cases, the classic picture of amoebic colitis develops with abdominal pain, diarrhea, and fever. The stool has an admixture of blood that is clearly visible to the eye. In severe amebiasis, complications are possible in the form of perforation of the intestinal wall with the development of peritonitis, toxic megacolon, abscesses of the liver, lungs, and brain. The diagnosis of amoebiasis is confirmed by the detection of Entamoeba histolytica trophozites or their cysts in the stool. Additional diagnostic value is the determination of specific IgA, IgM and IgG enzyme immunoassay. Treatment includes metronidazole (0.75 g 3 times a day for 5-10 days) or a combination of tetracycline (0. 25 g 4 times) with chloroquine (0.25-0.5 g 3-4 times) in within 15 days.
One of the most common infections that can cause acute or chronic diarrhea is giardiasis. When Giardia enters the intestines, asymptomatic carriage develops in many cases. The picture of giardiasis enteritis occurs only in 25-50% of those infected, and the disease often takes a chronic course. The diagnosis of giardiasis is confirmed by the detection of trophozoites or cysts of Giardia in feces, bile or duodenal contents. It is also possible to determine antibodies of classes IgA, IgM and IgG to G. lamblia. The drug of choice in the treatment of patients with giardiasis is metronidazole, used for 7 days at a dose of 0.25 g 3 times a day.
Special forms of diarrhea
Currently, specific forms of infectious diarrhea have been identified:
• travelers’ diarrhea;
• diarrhea in homosexual men;
• diarrhea in AIDS patients;
• antibiotic-associated diarrhea;
• bacterial overgrowth syndrome.
The need for their separate consideration is dictated by various circumstances: wide prevalence (travelers’ diarrhea), peculiarity of etiological factors (diarrhea in homosexual men, diarrhea in AIDS patients), often uncontrolled use of antibiotics (antibiotic-associated diarrhea).
The risk of developing traveler’s diarrhea is highest (30–70%) when traveling to countries in Asia, Africa and Latin America. In most cases, this form of the disease is caused by enterotoxigenic strains of Escherichia coli (less commonly, Salmonella, Shigella and other microorganisms). Additional importance in its development is a change in the nature of nutrition, climatic features, and nervous stress. Traveler’s diarrhea usually begins suddenly, with cramping abdominal pain and mild fever. Signs of dehydration, as a rule, are not observed and the symptoms of the disease disappear spontaneously within 3-4 days. In most patients, symptomatic treatment is sufficient. Loperamide (Imodium) has proven itself well. The antidiarrheal effect of the drug is associated with a decrease in peristalsis and an increase in the time it takes for the contents to pass through the intestines. The preparation increases the tone of the anal sphincter, contributing to a better retention of feces and reducing the imperative urge to defecate. In adults with acute diarrhea, the first dose of Imodium is 4 mg (in children 2 mg), then after each episode of loose stools – 2 mg. The appointment of antibacterial drugs (furazolidone, fluoroquinolones, co-trimoxazole) is resorted to only with high fever and symptoms of intoxication.
Infectious diarrhea in homosexual men is caused by specific pathogens (gonococci, chlamydia, herpes simplex virus). So, getting into the rectum of gonococci can cause sluggish gonorrheal proctitis with mucopurulent discharge. The diagnosis is confirmed by the detection of gram-negative diplococci in leukocytes obtained with a swab during sigmoidoscopy. Treatment in such cases is carried out with penicillins.
The combination of diarrheal syndrome with severe proctalgia, difficulty urinating, enlarged inguinal lymph nodes and characteristic vesicular rashes on the mucous membrane of the rectum in the anus may indicate that the patient has an infection caused by the herpes simplex virus. The diagnosis is confirmed by examining the contents of the vesicles (using the method of tissue culture), as well as determining the titer of the corresponding antibodies. Treatment is with acyclovir.
Diarrhea in AIDS patients is one of the leading syndromes in the clinical picture of the disease, occurring in 30–40% of patients. The etiological factors of infectious diarrhea in patients are most often protozoa (cryptosporidium and isospores), “opportunistic” viruses (cytomegalovirus, herpes simplex virus), bacterial agents (most often Mycobacterium avium intracellulare). Infectious diarrhea in AIDS patients often takes a life-threatening course (primarily due to significant weight loss) and is difficult to treat.
In addition, diarrhea in AIDS patients can be caused by the direct action of the human immunodeficiency virus itself on the intestinal mucosa with the development of HIV-associated enteropathy and malabsorption syndrome. The ability of the human immunodeficiency virus to enhance secretion processes in the intestine sometimes leads to secretory diarrhea with an increase in fecal volume up to 12-14 liters per day. The only drug effective in such cases is octreotide. Finally, when searching for the causes of diarrhea in AIDS patients, it must be borne in mind that it may be associated with a malignant lesion of the gastrointestinal tract (Kaposi’s sarcoma, malignant lymphoma).
Antibiotic-associated diarrhea is of great clinical importance when it is caused by Clostridium difficile. The frequency of carriage of these microorganisms, which is 3–15% among the adult population, increases significantly (up to 15–40%) when taking antibiotics (primarily clindamycin, ampicillin, cephalosporins), which inhibit the growth of intestinal flora strains that normally suppress the vital activity of Clostridium difficile .
The spectrum of clinical manifestations of this infection ranges from mild loosening of the stool to severe pseudomembranous colitis associated with the damaging effect on colonocytes of enterotoxins A and B produced by these microorganisms. Pseudomembranous colitis occurs, as a rule, with high fever, cramping abdominal pain, loose stools (often with an admixture of blood), and high leukocytosis. The disease can be complicated by electrolyte disturbances, the development of arterial hypotension and toxic megacolon. The diagnosis is confirmed by endoscopic examination (characteristic raids on the colonic mucosa in the form of pseudomembranes) and the detection of Clostridium difficile (using the tissue culture method) or its toxins (enzymatic immunoassay). Treatment of patients with pseudomembranous colitis is carried out with vancomycin (0.125-0.5 g 4 times a day) or metronidazole (0.25 g 4 times a day) for 7-14 days.
Bacterial overgrowth syndrome is a specific variant of infectious diarrhea, which is based on an increase in the content of bacteria in the small intestine (from 104-107 / ml to 1011 / ml). Bacterial overgrowth syndrome occurs when the passage of contents through the small intestine slows down (for example, after operations on the stomach and intestines, with adhesions, intestinal strictures) or the function of the ileocecal valve is disturbed (resection of the caecum and ileum), as a result of which the contents large intestine enters the lumen of the small intestine.
Bacterial overgrowth syndrome is clinically manifested by diarrhea followed by the development of malabsorption syndrome. Diagnosis is based on the results of a breath test performed with labeled lactulose, as well as the detection of an increased number of microorganisms (> 106) in the duodenal aspirate. Treatment of bacterial overgrowth syndrome should be aimed at eliminating the diseases that caused its development (tumor of the small intestine, adhesions, fistulas, etc.).
Thus, the presented data show that in clinical practice, a general practitioner may encounter various forms and variants of infectious diarrhea, often with clinical features due to the causative agent of the disease. Knowledge of these features is essential for correct diagnosis and adequate treatment.

1. Speelman P. Acute gastrointestinal infections and their complications. Current topics in gastroenterology and hepatology (Ed. G.N.J. Tytgat, M. van Blankenstein). Stuttgart-New York, 1990; 81–7.
2. Ivashkin V.T. Infectious diarrhea in the practice of a gastroenterologist. Ross. magazine gastroenterology, hepatology, coloproctology. 1997; 5; 51–7.
3. Slutsker L., Ries A.A., Greene K.D. et al. Escherichia coli 0157 : H7 diarrhea in the United States: clinical and epidemiologic features. Ann. Intern Med. 1997; 126:505–13.
4. Bogomolov B.P. Diarrhea in the differential diagnosis of infectious diseases. Wedge. honey. 1997; 7:8–12.
5. McQuaid K.R. Diarrhea. Current medical diagnosis & treatment (Ed.L.M.Tierney, S.J.McPhee, M.A.Papadakis). 38th Ed. Appleton & Lange. Stamford, 1999; 546–52.

Loperamide –
Imodium (trade name)

Irritable bowel syndrome

Irritable bowel syndrome is not an independent disease, but a complex of disorders that are not associated with a direct lesion of the intestine itself.

In other words, the intestine is only a target, and the disease is caused by completely different factors.

Causes of irritable bowel syndrome:

– neuropsychic psychoemotional disorders,

– stresses

– violation of the habitual diet lack of fiber in food

– sedentary lifestyle

– gynecological diseases (causing reflex disorders of bowel functions)

– endocrine disorders (menopause, dysmenorrhea, premenstrual syndrome, obesity, hypothyroidism, diabetes mellitus, etc.)

transferred acute intestinal infections with subsequent dysbacteriosis.

Under the influence of the above factors, there is a change in the sensitivity of receptors in the intestinal wall, which leads to impaired bowel function.

The manifestations of irritable bowel syndrome are extremely varied:

1. Abdominal pain localized around the navel or in the lower abdomen. This is due to overstretching of the intestinal wall with gases or feces. Reduction of pain occurs after the discharge of gases or bowel movements.

2 . Violation of the stool can manifest itself as both diarrhea and constipation. Diarrhea often occurs after eating, sometimes in the morning. The stool often contains mucus. Some people may have a feeling of incomplete bowel movement. Flatulence usually increases in the evening, decreases after defecation.

3. Neurotic manifestations: headaches, feeling short of breath. Often worried about belching with air, nausea, a feeling of heaviness and overflow in the epigastrium.

There is no reliable data on the incidence of this disease, since only 10% of patients seek help.

More often women get sick at a young age, somewhat less often the primary development of the disease begins after 40 years, but then, to exclude organic pathology, these patients need a particularly thorough examination.

Factors that cause irritation of gut receptors and resulting functional disorders usually include lactose and other sugars, short chain fatty acids, food agents, laxatives, infection due to bacterial overgrowth and dysbacteriosis, etc.

IBS often occurs after acute intestinal infections with the development of dysbacteriosis.

A significant role in the occurrence of some symptoms is played by the peculiarities of the diet, the lack of the necessary physical activity.

A certain place among the factors leading to the development of IBS, obviously, is occupied by gynecological diseases. Symptoms of IBS are often found in women with dysmenorrhea.

The main cause of irritable bowel syndrome is colon dysbacteriosis combined with bacterial overgrowth in the small intestine.

At the same time, hemolyzing flora, Escherichia coli with mild enzymatic properties, enteropathogenic Escherichia coli are detected. The microflora of the colon is dominated by opportunistic microbes or their associations (staphylococci, Proteus, yeast-like fungi, lactose-negative or hemolytic ischerichia, Pseudomonas aeruginosa, Klebsiella, etc.).

As a result of the vital activity of an excess amount of bacteria in the small intestine, free bile acids, fatty acid hydroxides, bacterial toxins, proteases and various metabolites (phenols, biogenic amines, etc.) can be formed and accumulated.

As a result of these processes, the motor, motor and digestive functions of the small intestine are disturbed, the absorption of vitamins, macro- and microelements is reduced. Thus, chyme with aggressive properties enters the colon, which leads to a disorder of the motor-secretory function of the colon and rectum.

Depending on the leading clinical symptom, it is customary to distinguish three main variants of IBS:

First option (irritable bowel syndrome with predominant diarrhea):

Loose stools 2-4 times a day, mainly in the morning after breakfast, sometimes with an admixture of mucus and undigested food residues.

Occasionally false urge to defecate. No diarrhea at night.

Second option (irritable bowel syndrome with constipation predominance):

Absence of stool for 3 days or more. Alternating constipation with diarrhea.

Feeling of incomplete emptying of the bowels, stools like sheep’s feces or ribbon-like.

Third option (irritable bowel syndrome with predominance of abdominal pain and bloating):

Cramping pains throughout the intestines, without a clear localization. Bloating (flatulence). Pain, as a rule, increases before the act of defecation and decreases after bowel movement. The appearance of pain is often provoked by eating.

The above complaints often occur in many other bowel diseases: tumors, diverticulum, Crohn’s disease, ulcerative colitis, ischemic colitis, and others.

In the presence of diarrhea, it is necessary to carry out a differential diagnosis with infectious diseases, celiac disease, pseudomembranous colitis, Whipple’s disease, with an overdose of laxatives.

For this purpose, first of all, it is necessary to determine the volume of bowel movements (for IBS, the presence of frequent stools with a small amount of bowel movements is characteristic).

In the variant of IBS with a predominance of constipation, it is necessary to exclude anorectal dysfunctions, enterocele and rectocele.

In the variant of IBS with a predominance of abdominal pain and bloating, intestinal obstruction, lactase deficiency and organic pathology (polyposis, diverticulosis, tumors) are excluded.

Diagnosis of irritable bowel syndrome.

This requires X-ray and sometimes computerized examination of the abdominal cavity, appropriate endoscopic and scatological studies, including stool culture for bacterial flora.

During the initial examination, the doctor carefully analyzes all the symptoms, pays special attention to the presence or absence of blood in the feces, fever, anemia, unmotivated weight loss, increased ESR and other so-called anxiety symptoms, the presence of which is a reason to suspect an organic pathology.

The initial examination of such patients should include a general clinical and biochemical blood tests, a coprogram, stool culture for bacterial flora (Salmonella, Shigella, Yersinia, etc.), as well as instrumental examination methods (rectosigmoscopy, colonoscopy, ultrasound of the abdominal organs, fibrogastroduodenoscopy, etc. .).

This will rule out diseases such as colon and rectal cancer, ulcerative colitis, Crohn’s disease, ischemic and pseudomembranous colitis, diverticulosis and intestinal polyposis.


Treatment of patients with IBS associated with dysbacteriosis includes:

– elimination of microbial contamination of the small intestine;

– restoration of normal intestinal microflora in the large intestine;

– restoration of disturbed processes of digestion and absorption;

– elimination of hypo- and avitaminosis and deficiency of micro- and macroelements;

– normalization of the motor-evacuation function of the colon and the act of defecation.