The dreaded stomach flu (gastroenteritis)

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The dreaded stomach flu (gastroenteritis)

Healthylife Pharmacy16 June 2021|4 min read

Hearing someone say they feel nauseous and may be getting a stomach virus can make you want to turn and run. The dreaded stomach bug will often start with fever and chills before progressing to vomiting and diarrhoea, be accompanied by stomach pain, appetite loss, body aches, fatigue and, in some cases, dehydration. Stomach flu is not caused by the influenza virus, as the common name suggest, but different viruses, such as norovirus and rotavirus, bacteria, parasites, toxins (such as from plants or medication). Some illness can also be associated with gastritis such as bowel disease. Gastroenteritis (stomach flu), also known as infectious diarrhea or “gastro”, is inflammation of the gastrointestinal tract (the stomach and intestines).

Common culprits include:

  • Viral common causes - norovirus, rotavirus, astrovirus and adenovirus
  • Bacteria – such as the Campylobacter bacterium
  • Parasites – such as Entamoeba histolytica, Giardia lamblia and Cryptosporidium, Entamoeba histolytica
  • Medications – antibiotics
  • Health disorders – bowel disease, lowered immunity
  • Poisons – lead for example

Catching a stomach flu

Eating improperly prepared food, drinking contaminated water, poor hygiene practices or close contact with a person who is infected can spread the disease-causing gastroenteritis.

Viral gastroenteritis is spread from one person to another and is highly contagious. The virus is found in vomit and faeces of a contaminated person and spread through contact (such as handshakes, touching etc), touching a contaminated object (coffee cup, pen, door handle for example) or from food and beverages. Rotavirus infections are a major cause of severe gastroenteritis in children causing malabsorption and dehydration.

Drug and Chemical-Related Gastroenteritis

Some medications can cause vomiting and diarrhea - such as antacids containing magnesium, antibiotics (leading to clostridium difficile), anthelminthics (to remove parasites and worms for example), cytotoxic (used in cancer therapy), colchicine (used to treat gout) and laxatives for example.

Diagnosing the cause 

Diagnosis is generally clinical assessment based on symptoms or a stool culture (bowel motion culture) and medication evaluation.

Treatment for gastroenteritis

In most cases gastroenteritis will resolve on its own without any treatment needed, unless the cause is bacterial or parasitic, in which case anti-infective treatment may be needed. The doctor may also prescribe anti-diarrheal and nausea medication in some conditions of gastroenteritis.

There are some natural remedies to help with uncomfortable symptoms and avoidance of spread of infection. The most important aspect is avoiding dehydration, particularly in the elderly, infants and those with compromised immunity. Dehydration can be serious.

Fluids to avoid Dehydration

It is important to keep up fluid intake to avoid dehydration.

  • Clear liquid (water or broths)
  • Small sips of fluids taken often or ice chips to suck. Avoid consuming large amounts in one go
  • Electrolyte formulas are available for all age groups – discuss options with pharmacist 
  • Ginger tea (ginger offers an antinausea action), peppermint or chamomile tea (calming on the stomach)

Rest as much as possible and avoid stimulating drinks such as caffeinated drinks (strong tea, coffee, cocoa), and alcohol which will make dehydration worse.

Ginger

Ginger is perfect for helping with symptoms of stomach flu. Its action includes carminative (relieving digestive discomfort), anti-emetic (reducing vomiting), spasmolytic (relief of spasmodic pain), diaphoretic (promoting perspiration and fever reduction) and anti-inflammatory.
Ginger can be taken in a number of different ways such of as a supplement, ginger lollies, ginger tea and essential oil of ginger in an oil burner as aromatherapy.

Andrographis 

Andrographis (Andrographis paniculata) herb offers antioxidant, anti-inflammatory, antimicrobial and parasitic actions amongst its many activities and may help in prevention of viruses causing diarrhoea. Handy for travellers.

Essential oils

Many essential oils show activity against pathogenic viruses. Some well-known essential oils include:

Melaleuca alternifolia (tea tree) possess antiviral, antibacterial, anti-inflammatory and antifungal properties making it valuable against a wide variety of infections. Use in vaporizer or it to wipe over surfaces to aid in the elimination of pathogens.

Eucalyptus oil offers antimicrobial action against many pathogens. Use it around the house to help prevent the spread of virus and bacteria.

Oregano oil and its primary component, carvacrol - has been shown effective against norovirus, causing the breakdown of viral defences.

Probiotics and prebiotics

Does the use of Probiotics and prebiotics help? Evidence suggests that probiotics -

  • may prevent diarrhoea - suggested probiotics Bifidobacterium lactis Bb12; Lactobacillus rhamnosus GG
  • may reduce the duration of diarrhoea -suggested probiotics Lactobacillus rhamnosus GG; Lactobacillus reuteri MM53
  • may offer a moderate protective effect for preventing antibiotic associated diarrhoea - suggested probiotics Lactobacillus rhamnosus GGSaccharomyces cerevisiae var boulardii, lactobacillus plantarum 299v, Lactobacillus reuteri MM53lactobacillus acidophilus LA5 and Bifidobacterium lactis Bb12
  • showed statistically significant efficacy in the prevention of travellers’ diarrhoea -suggested probiotics Lactobacillus acidophilus and Bifidobacterium lactis Bb12Lactobacillus rhamnosus GGSaccharomyces cerevisiae var boulardii
  • help tolerance for lactose – suggested probiotics Lactobacillus acidophilus LA5; Lactobacillus acidophilus NCFM
  • helped with Amoebiasis (amoebic dysentery) and Crohn’s disease - suggested probiotic Saccharomyces cerevisiae var boulardii Biocodex
  • helped with HIV/AIDS associated diarrhoea – suggested probiotics Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
  • helped with radiation-induced diarrhoea – suggested probiotic (VSL#3)

Prebiotics may improve the efficacy of probiotics. A prebiotic is a non-digestible dietary fibre which provide food for healthy probiotic growth. They are often found in with probiotic formulas or can be added to food. Suggestions are inulin, beta glucan, oligosaccharides, pectin, garlic, unripe (green) bananas (inulin), barley (beta glucan) and apples (pectin). Prebiotics help improve digestive health.

Zinc

Zinc supplementation improves oral hydration and is recommended by the world health organisation (WHO)in cases of acute gastroenteritis. Zinc is supports immune system function. Adequate zinc levels in the body help protect from invading pathogens.

Reintroduction of food back into the diet

Food might be the last thing on your mind in the initial stage of the gastro (when vomiting and diarrhea are at its worse), but when the appetite returns it is beneficial to start slow and small.

When there is a tolerance to fluid without vomiting, food can slowly be reintroduced. Lactose can sometimes be a problem so avoidance of lactose containing products is suggested (dairy-free diet).

Bland food is often advised – such as bananas, apples, rice and toast.

Avoiding contamination

  • Frequent washing of hands is the most effective way of avoiding contamination
  • Avoidance of contaminated people
  • Wipe over or spray surfaces
  • Children with diarrhea should not return to child care and recreational facilities till symptoms have discontinued completely
  • People who prepare food for others should not do this until 48hours after vomiting and diarrhoea has ceased
  • Immunocompromised people should take extra care
  • Travellers should avoid potentially contaminated food and beverages

Washing hands regularly and thoroughly with soap and running water especially before preparing foods and eating, after using the toilet or changing nappies. Dry hands on a clean towel.

References

  1. https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/gastroenteritis/gastroenteritis
  2. Therapeutics and Immunoprophylaxis Against Noroviruses and Rotaviruses: The Past, Present, and Future https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971199/
  3. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/viral-gastroenteritis.aspx
  4. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastroenteritis
  5. Experimental and Clinical Pharmacology of Andrographis paniculata and Its Major Bioactive Phytoconstituent Andrographolide https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619690/
  6. Phytochemistry, Pharmacology and Clinical Use of Andrographis paniculata R. Perumal Samy, M.M. Thwin and P. Gopalakrishnakone* Venom and Toxin Research Programme, Department of Anatomy, Yong Loo Lin School https://journals.sagepub.com/doi/pdf/10.1177/1934578X0700200519
  7. Antimicrobial Properties of Plant Essential Oils against Human Pathogens and Their Mode of Action: An Updated Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206475/
  8. Essential Oils as Antiviral Agents, Potential of Essential Oils to Treat SARS-CoV-2 Infection: An In-Silico Investigation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279430/
  9. Melaleuca alternifolia (tea tree) oil and its monoterpene constituents in treating protozoan and helminthic infections https://pubmed.ncbi.nlm.nih.gov/33503761/
  10. Antiviral efficacy and mechanisms of action of oregano essential oil and its primary component carvacrol against murine norovirus https://sfamjournals.onlinelibrary.wiley.com/doi/full/10.1111/jam.12453
  11. https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/gastroenteritis/drug-related-gastroenteritis-and-chemical-related-gastroenteritis
  12. https://www.msdmanuals.com/en-au/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea
  13. Probiotics for the prevention of pediatric antibiotic-associated diarrhea https://pubmed.ncbi.nlm.nih.gov/31039287/
  14. Use of probiotics in gastrointestinal disorders: what to recommend? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002586/
  15. Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232657/
  16. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children https://pubmed.ncbi.nlm.nih.gov/29257353/
  17. Study on prebiotic effectiveness of neutral garlic fructan in vitro https://www.sciencedirect.com/science/article/pii/S2213453013000311
  18. Health Effects and Sources of Prebiotic Dietary Fibre https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041804/
  19. Modulation of rotavirus severe gastroenteritis by the combination of probiotics and prebiotics https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548957/
  20. Zinc as a Gatekeeper of Immune Function https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748737/
  21. Sarris, Jerome and Wardle, Jon; 2014, Clinical Naturopathy 2e, Elsevier, NSW Australia