Guide to the nicotine lozenge including pros and cons and instructions on how to use.

What is a nicotine lozenge? The nicotine lozenge is one of the newest forms of nicotine replacement therapy products available on the market nowadays. It comes in the form of a sugar-free hard sweet, that you suck slowly in order to release the nicotine. It is very similar to the nicotine microtab and the nicotine gum, in that the nicotine is absorbed through the lining of the mouth, which means that the nicotine is absorbed quicker into the bloodstream and therefore reaches the brain much faster as well.

The nicotine lozenge is available in two strengths, either 2mg or 4mg. If you smoke your first cigarette of the day within 30 minutes of waking up, then the stronger strength is more suitable for you. The lozenges are available in a variety of flavours and each lozenge, which is the equivalent of one dose, contains 1mg of nicotine in the form of nicotine bitartrate dihydrate, the purest form of nicotine salt or powder. Other ingredients that make up the nicotine lozenges are sodium bicarbonate, sodium carbonate, xanthan gum, peppermint oil and magnesium stearate. The nicotine lozenge is most suitable for smokers with a medium nicotine dependency and is not recommended for those who smoke more than one and a half packets of cigarettes a day.

How do nicotine lozenges work?

A lozenge is placed in the mouth, between the gum and the cheek and sucked slowly until there is a strong taste of nicotine in the mouth. At this point stop sucking until the taste fades, resting the lozenge against the cheek. Continue to suck again when you cannot taste any nicotine in the mouth and suck the lozenge until it has completely dissolved. The lozenge should occasionally be moved from side to side in the mouth and the whole process should take about 20 - 30 minutes.

Upon sucking, small doses of nicotine are released and absorbed into the bloodstream through the lining of the mouth, from where it then travels quickly to the brain.

For this reason, lozenges are particularly efficient at helping with nicotine cravings and withdrawal symptoms as most of the nicotine contained in the lozenge is rapidly absorbed into the bloodstream and not lost. Quantities of nicotine will continue to be absorbed even after the lozenge has dissolved.

Smokers are advised to follow a schedule of 12 weeks when using the lozenges. During the first half of this period, 1 lozenge should be taken every 1 or 2 hours. For the following two weeks, weeks 7 - 9, this amount is reduced to one lozenge every 2 - 4 hours, thus gradually reducing the nicotine intake and finally, for the last two weeks, weeks 10 - 12, 1 lozenge should be taken every 4 - 8 hours.

By this time the nicotine intake is so low that the cravings and withdrawal symptoms should have subsided and you should be ready to stop the treatment altogether.

Is this method safe?

As long as directions on how to take the lozenges are adhered to, they should be perfectly safe to use. Side effects may occur in some people but not necessarily in others.

No more than 20 lozenges should be consumed in one day, not more than five lozenges in six hours and only one lozenge is to be taken at one time. Any of the above may lead to a nicotine overdose where the smoker would experience symptoms such as palpitations and rapid heartbeat, dizziness, headache, nausea, vomiting, diarrhoea or weakness in the body.

The lozenges should be sucked slowly and gently, and not chewed or swallowed, as this may cause heartburn or indigestion.

People with or who have previously had any of the specific medical conditions outlined below should take care if taking any form of NRT and should consult the doctor beforehand:

• Any form of heart disease - angina, heart attack
• Stroke
• Diabetes
• Overactive thyroid
• Stomach ulcer or stomach problems
• High blood pressure
• Any form of cardiovascular and circulatory disease
• Liver or kidney disease
• Any allergic reaction to certain medications
• A low in salt diet
• Pregnancy or breast-feeding
• Tooth or gum disease
• Sore throats or irritations
• Increased appetite

Are there any side effects?

Side effects can occur upon using the nicotine lozenges and may disappear quickly with continuous use. Some of the more common side effects include an irritation of the teeth, gums and throat, indigestion, diarrhoea or constipation, flatulence, insomnia, hiccups, headache, and coughing.

More serious side effects may also take place, although they are less frequent and a doctor should be consulted after stopping usage of the nicotine lozenges. More serious side effects include stomach pain and discomfort, dizziness or fainting, changes in hearing and vision, slight confusion, seizures or chest pains and palpitations.

What are the advantages of using this method?

• They are handy and discreet.
• The amount of nicotine that enters the body is controlled.
• Nicotine is absorbed rapidly and therefore reduces cravings and withdrawal symptoms quicker.
• They have proven to be a highly successful stop smoking tool.
• They are simple and easy to use and control.
• They are available in different doses.
• They have a pleasant taste.
• There are no special chewing techniques.
• You do not have to carefully dispose of the lozenge.
• They are sugar-free, which means that you won't put on weight.

Are there any disadvantages?

• They look like sweets and should therefore be kept away from children.
• They can cause sore throats and other side effects.
• They may stick to dentures.
• Can be costly.
• You can become addicted to the lozenge.

The long-term effects of smoking on our health and illnesses caused by smoking

Whether you smoke 5 cigarettes a day or 50, there is no doubt that smoking is extremely bad for you and will seriously affect your health in some way. Smoking cigarettes can harm almost every organ in your body, from top to bottom and inside and out. Moreover, it is only now that doctors are beginning to discover the true extent of the harm that smoking can cause to a person's health and to the health of those around him. Smoking over a prolonged period of time can cause a number of serious diseases and illnesses, some fatal and others that will not kill you but will leave you with a poorer quality of life in general.

Usually a person takes up smoking when they are young and the effects that smoking may have on their health does not enter their head at the time. Within a short while, they will become addicted to nicotine and it will be too late to give up. The younger a person starts to smoke, the greater the health risks they will face later on in life. Smoking is one of the biggest single causes of preventable disease and premature death in a large number of mainly developed countries around the world. In the UK around 120,000 people die each year from smoking-related diseases. 50% of long-term smokers die prematurely from smoking, a large number of them when they reach middle age. Globally around 2.5 million people die each year from smoking and it has been estimated that some time during the 2020's the number of deaths caused by smoking will hit the 10 million mark. The majority of people who die from smoking will have suffered from one of three main diseases: lung cancer, coronary heart disease or chronic obstructive pulmonary disease (COPD).

Around 90% of all lung cancer deaths are caused from smoking and smoking is also the biggest risk factor for a number of other types of cancer as well. Overall, smoking has been linked to a third of all deaths from cancer. In the US, 1 in every 4 people die of cancer and over half a million people die each year from this disease. To give you a clearer idea, more than 1,500 people a day die from cancer.

People who smoke a lot of cigarettes a day are particularly at risk of developing cancer and if those people have been smoking for a long time, the risk is even higher. For example, a person who has been smoking one packet of cigarettes a day for 30 years is more at risk than a person who has been smoking two packs a day for 15 years.

Smoking also causes a quarter of all deaths from heart disease. Over 70% of smokers between the ages of 35 and 44 who die of coronary heart disease, die prematurely due to smoking. In teenagers who smoke, early signs of heart disease, such as the building up of fatty deposits in the arteries, can be detected.

In the US, coronary heart disease is the leading cause of death and more than 2,600 people die each day from some form of cardiovascular disease, which may have been caused by smoking.

Smoking also causes strokes and heart attacks and doctors say that smokers are twice as likely to suffer a heart attack than non-smokers and three times as likely to suffer a stroke. However, on a more positive note, if a smoker quits smoking, after 5 years, the risk of suffering a heart attack is halved and after 10 years the risk drops to the same as that of a non-smoker who has never smoked.

Another major illness and cause of death from smoking is chronic obstructive pulmonary disease (COPD). This term is used generally and includes a number of lung destroying and respiratory illnesses that are brought on by smoking. The main diseases are emphysema and chronic bronchitis. The airways and tissues of the lungs are destroyed, which will in time make breathing extremely difficult. Sufferers of these diseases may experience shortness of breath, chest pain, constant coughing and tiring after a small amount of exertion.

At the moment, the symptoms can be eased with medical treatment, however as yet no cure exists. If you already have either of these diseases, giving up smoking will stop their progression. If you do not suffer from any of the symptoms associated with either emphysema or chronic bronchitis, then giving up smoking will greatly reduce the risk of developing these seriously debilitating illnesses.

Smoking reduces a person's life expectancy from anything from 7 years to 30 years. Generally smokers are less healthy and less physically fit than non-smokers. In addition, they take more days off work through illness than non-smokers and are more prone to common illnesses such as colds or sore throats. Smokers will get out of breath much quicker after exertion and find it harder to exercise and they will also have a higher risk of infections, as the body's immune system is damaged from smoking.

As well as having long-term negative effects on a person's health, smoking also has immediate effects on the body. After smoking a cigarette your blood pressure will rise and your heart rate will increase by about 20 beats per minute. Carbon monoxide, a poisonous gas, will enter the lungs and begin to replace the oxygen. The tiny hairs in the lungs that filter the air that you breathe will cease to work, as they become paralysed by the poisons that are contained in tobacco smoke. Circulation, especially to the hands and feet becomes less efficient and the temperature of the skin may drop by up to 5°C. Your nervous system will be altered and smoking can cause muscle tension.

In the long-term, smoking causes other diseases apart from those mentioned above. Below is a list of diseases, illnesses and other effects that are caused from smoking:

Lung cancer Cancer of the mouth Cancer of the throat Cancer of the larynx Cancer of the oesophagus Stomach cancer Kidney cancer Cancer of the bladder Cancer of the pancreas Liver cancer Cancer of the penis Cancer of the anus Cervical cancer Prostate cancer

Heart attack Coronary heart disease Cardiovascular disease Congestive heart failure Stroke Atherosclerosis Abdominal aortic aneurysm Peripheral artery disease Ischaemic heart disease Angina Leukaemia Emphysema Chronic bronchitis Pneumonia

Asthma Diabetes Stomach ulcers Cataracts Gum disease High blood pressure Crohn's disease Premature aging of the skin Loss of smell and taste Osteoporosis (women) Gangrene Impotence Reduced fertility

Quitting Smoking Using The Nicotrol Inhaler

The nicotine inhaler is a cigarette-type device made up of a cartridge containing nicotine with menthol, and a mouthpiece. When air is inhaled through the device, it is saturated with nicotine, which is then absorbed through the lining of the mouth and upper esophagus. The absorption of nicotine is slower than from a regular cigarette, with peak nicotine doses occurring 10 to 15 minutes after the end of puffing. Each puff contains about 10 times less nicotine than a puff of a cigarette. The best results have been achieved by frequent puffing for 20 or more minutes. You can use from 6 to 16 cartridges throughout the day to relieve withdrawal symptoms or to control the urge to smoke. The initial use of less than two cartridges a day was associated with a lesser likelihood of success.

The inhaler works on much the same principle as the gum, but they are different in design. Nicotine inhalers are shaped like little cigarettes, and when you suck on them they release a mist of nicotine stuff into your lungs. The nasal spray is like the product you use for nasal congestion; you just pump it into your nostril and it sprays nicotine stuff up there.

The advantages of these are that they work much more quickly than the gum; they can be used in any situation and whenever they are needed (within the constraints set by the package directions); and the inhaler is very much like a cigarette, so it makes a good replacement.

The disadvantages are that they can have many side effects like burning of the nasal tissues or throat, stomach ache, nausea, etc.; they are more expensive than the gum; and, finally, the inhaler might be too good of a replacement, as it's quite a bit like continuing to smoke.

At this time, the nicotine inhaler is available only by prescription, but insurance will cover this medication in New Mexico and Texas. The cost ranges from $40 to $55 per package.

The nicotine inhaler relieves nicotine withdrawal symptoms and is an aid in smoking cessation. It is important to remember that a combination of approaches has been the most successful for smoking cessation, and that the nicotine inhaler is most successful when used in combination with psychological and/or behavioral cessation strategies as well. The inhaler mimics the hand-to-mouth ritual of smoking and as well as the feeling of inhaling from a cigarette. It is not known at this time if the nicotine inhaler has the ability to satisfy a smoker's psychological need for the hand-to-mouth ritual of smoking.

The nicotine inhaler is supplied with 42 cartridges and a plastic storage case. Each cartridge can provide up to 300 to 400 puffs. However, once a cartridge is opened it is only good for one day. A gradual reduction in the dosage is recommended for a period of up to 12 weeks, and the inhaler should not be used more than six months total.

The most common side effects include heartburn, irritation or soreness in the mouth or throat, oral burning, coughing after inhalation, and rhinitis. The inhaler should be used with caution if you have bronchospastic disease, coronary heart disease, cardiac arrhythmias or vasospastic disease. It should not be used during the immediate post-myocardial infarction period, or if you have serious arrhythmias, severe or worsening angina, hyperthyroidism, pheochromocytoma, insulin-dependent diabetes, an active peptic ulcer, or accelerated hypertension.

Be sure to keep opened and unopened cartridges out of the reach of pets and children because they can produce a fatal poisoning. Also, be sure to clean the mouthpiece regularly with soap and warm water. Do not use the nicotine inhaler while you are still smoking.

Cigarette Ads a Powerful Lure for Teen Smoking

Cigarette advertising significantly increases the odds that youngsters who see the ads will start smoking, but exposure to ads for other products does not, The ads for other products such as cell phones and candies fail to trigger the same psychological mechanisms that make children take up the smoking habit.
he initiation of smoking was significantly associated with the number of times each adolescent recalled seeing the cigarette ads.

Nineteen percent of teens in the high cigarette ad recall group started smoking compared to 10% in the low cigarette ad exposure group.

Exposure to ads for other products was not significantly associated with onset of cigarette smoking after adjusting for other factors.

Other predictors of smoking included older age, low socioeconomic level, having friends who smoke, sensation-seeking/rebellion, and low school performance.

“Our results support the notion of a content-related effect of cigarette advertisements and underlines the specificity of the relationship between tobacco marketing and teen smoking,” the authors write. “Exposure to cigarette advertisements but not other advertisements is associated with smoking initiation.”

The researchers say tobacco ads work because companies aim their messages at young people, who are particular susceptible to even subtle meanings, such as hints that smoking is tied to masculinity, in the case of males, and to thinness, sex appeal, and independence for girls.

The other products advertised do not project such mental cues or thoughts, and thus don’t influence youngsters to start smoking.

Going Green: Digesting Tea Defends Against Alzheimer's, Cancer

Drinking, or better yet digestion and the body's ability to absorb key elements of green tea, may play a vital role in aiding the brain to fend off the development of Alzheimer's, and can protect against cancer. Digestion is a vital process which provides our bodies with the nutrients we need to survive. However, just because the food we put into our mouths is generally accepted to contain health-boosting properties, we can't assume these compounds will ever be used by the body. A new study has been published that hints this ancient Chinese remedy could play a vital role in building defenses against key life threatening conditions.
Green tea is tea made solely with the leaves of Camellia sinensis that have undergone minimal oxidation during processing. Green tea originates from China and has become associated with many cultures in Asia from Japan and South Korea to the Middle East. Recently, it has become more widespread in the West, where black tea is traditionally consumed. Many varieties of green tea have been created in countries where they are grown and these varieties can differ substantially due to variable growing conditions, horticulture, production processing, and harvesting time.

Over the last few decades green tea has been subjected to many scientific and medical studies to determine the extent of its long-purported health benefits, with some evidence suggesting that regular green tea drinkers have lower chances of heart disease and developing certain types of cancer. Although green tea does not raise the metabolic rate enough to produce immediate weight loss, a green tea extract containing polyphenols and caffeine has been shown to induce thermogenesis and stimulate fat oxidation, boosting the metabolic rate 4% without increasing the heart rate.

For this particular study, The Newcastle University team deemed it necessary to analyze the protective properties of the products of digestion, so they worked alongside Dr. Gordon McDougall of the Plant Products and Food Quality Group at the Scottish Crop Research Institute in Dundee, who developed technology which simulates the human digestive system.

Two compounds are known to play a significant role in the development of Alzheimer's disease (AD); hydrogen peroxide and a protein known as beta-amyloid. Long considered a key player in the development and progression of AD, beta-amyloid has gradually begun to give up many secrets of its importance. Scientists have learned an enormous amount about how beta-amyloid plaques are formed and the toxic effects that these structures as well as the earlier forms of beta-amyloid have on neurons and synapses. These findings have opened up new avenues of investigation and new possibilities for therapeutic targets.

The Antibiotics Crisis: How Did We Get Here And Where Do We Go Next?

In recent years there has been a lot of news about the impending antibiotics crisis, brought to a head by renewed awareness that we are running out of drugs to treat evolving superbugs, and with the startling revelation following the NDM-1 discovery, that microorganisms are also capable of sharing bits of themselves with each other to thwart even our most powerful last-line antibiotics.

Is this the beginning of the end of antibiotics, as some scientists are predicting, are we about to return to a pre-penicillin world where a common bacterial infection could be a death sentence? Or are we just at the cusp of a new wave of inventions that will spur a new generation of drugs that will keep us ahead of the evolutionary race against harmful microorganisms?

This article does not answer these questions, but attempts to present a digest of key facts and recent developments to illuminate the issues around them.

It starts with a summary of what we mean by antibiotics and what they can and cannot treat. It then goes on to explain how antibiotic resistance arises, including the problem of multiple drug resistance, and why many experts say widespread and misguided use is to blame for the accelerated rate at which resistance has become a global problem, as has the dearth in new drug developments. It then describes some of the things researchers and organizations say we can do to to slow down the development of superbugs, and ends with a round up of some surprising new directions that could offer alternative solutions.

Antibiotics and Microorganisms

Antibiotics are drugs that kill microorganisms like bacteria, fungi and parasites. They do not work against viruses because viruses are not microorganisms. When the press and media talk about antibiotics they generally mean drugs that kill bacteria, because most of the stories that have been hitting the headlines in recent years are about antibiotic-resistant bacteria or "superbugs" like the Methicillin-resistant Staphylococcus aureus (MRSA).

Bacteria are very small creatures of usually only one cell, comprising internal cell structures but no distinct nucleus, surrounded by a cell wall. They can make their own proteins and reproduce themselves as long as they have a source of food.

As far as humans are concerned, some bacteria are friendly and essential to wellbeing, they do helpful things like break down food in our gut, while others are dangerous because they attack our tissue and cells to make their food, or they produce toxins that poison and kill.

Some bacteria cause no harm while they live in one part of the body, but then become potentially deadly once they enter the bloodstream. A good example is Escherichia coli (E. coli), which lives in the human gut and helps break down food, but if it enters the bloodstream (eg through a perforation in the intestines), it can cause severe cramping, diarrhea, and even death from peritonitis if not treated promptly.

Another example is Staphylococcus, which lives harmlessly on human skin or even in our nostrils, but if it enters the bloodstream, it can lead to potentially fatal conditions like toxic shock syndrome.

Our immune system has special cells that recognize bacteria as foreign agents and mobilize existing counter-agents or antibodies, or trigger the production of new antibodies, to attack and destroy the bacteria before they get a chance to seize a foothold and start replicating inside us. However, sometimes we lose the fight and succumb to infection, and in some cases, without treatment, the consequences can be very severe and even deadly.

Antibiotics have made a big difference to mankind's fight against infectious microorganisms and have vastly improved the conditions and chances of success in many fields of medicine all over the world.

They work because they block a life-sustaining function in the unwelcome microorganism. Some stop the microorganism from being able to make or maintain a cell wall, while others target a particular protein that is vital for survival or replication.

An example of the former is penicillin, the first commercially available antibiotic that Alexander Flemming discovered in 1929. Penicillin stops bacteria like Strep (Streptococcus, a bacterium that is commonly found on skin or in the throat) from making strong cell walls. Before the introduction of penicillin in World War II, soldiers were more likely to die of bacterial infections than from their wounds.

Viruses are not microorganisms, and although capable of self-replicating, do not appear to be "alive" at all: they are particles consisting of DNA or RNA, some long molecules, and a protein coat. They are much smaller than bacteria, have none of their internal cell machinery, and no cell wall. To replicate they have to get inside host cells and hijack their resources.

And here lies a clue as to why we have a global problem with antibiotics and antibiotic resistance: too many doctors and healthcare professionals, often encouraged by patient demand, have been prescribing antibiotics to treat viral infections. This leads to imprudent use of antibiotics and greater opportunity for bacteria to mutate into resistant forms

Gastroenteritis
(Stomach Flu)

What is gastroenteritis?

Gastroenteritis is inflammation of the gastrointestinal tract, involving the stomach, intestines, or both; usually resulting in diarrhea, abdominal cramps, nausea and possibly vomiting. Gastroenteritis is frequently termed "stomach flu" or "gastric flu" because the most frequent cause of gastroenteritis is viral. However, this loose terminology confuses some people because influenza viruses (flu viruses) do not cause gastroenteritis.

Gastroenteritis also can be confusing to people because gastroenteritis itself is considered a disease, but gastroenteritis can also be considered a symptom of other diseases. For example, a person who has the symptoms of gastroenteritis and eventually develops bloody diarrhea is usually not diagnosed with gastroenteritis, but with a specific disease such as shigellosis. Unfortunately, there are many specific diseases that manifest with symptoms of gastroenteritis, usually early in the disease process.

To complicate things even more, often confusion is generated when the term gastroenteritis is modified by words like "mild" or "severe." "Severe gastroenteritis" is a non-specific term that usually means different things to different investigators. The meaning is usually implied by the disease process that is being discussed. For example, if the context of an article about a viral cause of gastroenteritis, it often means diarrhea that causes dehydration; while another article about a bacterial cause of gastroenteritis it may mean bloody diarrhea with fever.

The best way to sort out this non-specific terminology associated with gastroenteritis is for authors and health care practitioners to define what they mean by gastroenteritis and its modifying terms. While there may be disagreement about the terms, at least their meaning will be clear to the readers of individual articles. Consequently, for this article, gastroenteritis will mean the short-term (lasting about 2 to 5 days and resolution, sometime over an additional few days) occurrence of symptoms that may include some or all of the following:

• Non-bloody diarrhea
  
  
• Nausea
  
  
• Vomiting (occasional, less than 48 hours)
  
  
• Abdominal cramping (intermittent, usually relieved by a bowel movement)

Other symptoms may develop such as a mild fever (about 100 F, 37.7 C), mild chills, occasionally a headache, and/or muscle aches, and a feeling of being tired. All of the above symptoms may develop into severe gastroenteritis which means for this article, dehydration, which may be life-threatening, especially in children.

People with symptoms of diarrhea, bloody diarrhea, nausea, or vomiting that lasts more than five days, and often may have additional symptoms of fever (greater than 101 F, 38.3 C), malaise, dehydration, and sepsis, for this article, will not be considered to have gastroenteritis. However, people with such problems will be considered to have symptoms of gastroenteritis that are related to a specific disease, for example, shigellosis.

Not all investigators will agree with this designation and consider bloody diarrhea, vomiting more than 48 hours, fever higher than 101 F (38.3 C), dehydration, and relatively constant abdominal pain as severe gastroenteritis. However, these symptoms are not frequently associated with gastroenteritis or stomach flu that does not run a limited course, and does not resolve without professional or medical treatment, and are more often associated with other specific diseases, most of which require medical care.

Most children and adults diagnosed with shigellosis, E. coli 0157:H7 infections, salmonellosis, and other diseases are usually not diagnosed as having severe gastroenteritis or severe stomach flu. Readers may wonder why then, should such pathogens be listed as causes of gastroenteritis. The answer is simple. The pathogens are listed because in many people, the pathogens produce only symptoms of gastroenteritis and do not go on to develop worse symptoms, often because an otherwise healthy person self-limits the infection. Not to list them would not give an accurate summation of the causes of gastroenteritis.

What causes gastroenteritis?

Gastroenteritis, as defined above, has many causes, but the most frequent causes are viral and bacterial. Other causes vary greatly, such as parasites, toxins, food allergies, and medications. Many of the causes of gastroenteritis actually go on to develop additional gastrointestinal symptoms that are considered specific diseases themselves. The following lists the major causes of gastroenteritis, and also lists the diseases that have symptoms of gastroenteritis as part of their specific disease process; this list is not all-inclusive but does include the large majority of causes of gastroenteritis that may be encountered worldwide.

Viruses

• Norovirus: causes about 50% to 70% of all gastroenteritis in adults, the most common cause of gastroenteritis in the US.
  
  
• Rotavirus: common cause of diarrhea in infants, occasionally producing dehydration
  
  
• Adenovirus: usually respiratory, but some strains cause gastroenteritis symptoms
  
  
• Astrovirus: common cause of diarrhea in infants
  
  
• Sapovirus: common cause of mild gastroenteritis in children

Bacteria

• Staphylococcus: - a frequent cause of diarrhea and abdominal cramps; disease - Staphylococcus food poisoning
  
  
• Escherichia coli: food poisoning; diseases - E. coli infections, especially strain 0157:H7 that may cause HUS (hemolytic-uremic syndrome) or TTP (thrombotic thrombocytopenic purpura)
  
  
• Salmonella: food poisoning; disease - salmonellosis
  
  
• Shigella: food poisoning; disease - shigellosis
  
  
• Clostridium difficile: bacterial overgrowth and toxin production due to antibiotic suppression of competing intestinal bacteria; disease - C. difficile toxin production
  
  
• Listeria: usual source is contaminated dairy products; disease - listeriosis
  
  
• Campylobacter: contaminated dairy foods
  
  
• Vibrio: contaminated drinking water and seafood; disease - cholera
  
  
• Bacillus: usual source is contaminated rice
  
  
• Aeromonas: seafood contamination
  
  
• Yersenia: pork meat contamination
  
  
• Plesiomonas: oysters and other seafood

Parasites

• Giardia: common source of diarrhea from contaminated water; disease - giardiasis
  
  
• Cryptosporidium: food, water sources of diarrhea; disease - cryptosporidiosis
  
  
• Entamoeba: contaminated water; disease - amebiasis

Other causes of gastroenteritis

• Food allergies: many types; eggs, nuts, milk, and shellfish are fairly common
  
  
• Antibiotics: many antibiotics allow bacterial/fungal overgrowth (see Clostridium difficile previously mentioned)
  
  
• Toxins: algal toxin in shellfish, heavy metal toxins. (aluminum, cadmium, arsenic, lead, and mercury) and others
  
  
• Medications: side effects of many medications are diarrhea

hat are the symptoms of gastroenteritis?

The symptoms of gastroenteritis are:

• diarrhea,
  
  
• nausea,
  
  
• abdominal cramps, and
  
  
• vomiting.

Not all affected individuals will develop all symptoms. Some people also may develop a mild fever of about 100 F (37.7 C). Most symptoms will resolve in about 2 to 5 days. Gastroenteritis may cause dehydration during this short time period, mainly in children or debilitated adults. In this article, gastroenteritis with dehydration is considered severe gastroenteritis. For videos of how a child may appear with dehydration, see the link in the references section of this article.

People with symptoms of diarrhea, bloody diarrhea, nausea, or vomiting that last longer than 5 days, and often may have additional symptoms of fever (greater than 101 F, 38.3 C), malaise, dehydration, sepsis, or additional symptoms, for this article, will not be considered to have gastroenteritis. Not all investigators or clinicians will agree with this designation and consider bloody diarrhea, vomiting more than 48 hours, fever higher than 101 F, dehydration, and relatively constant abdominal pain as symptoms of severe gastroenteritis. However, since these symptoms are non-specific and are more frequently associated as part of a spectrum of symptoms that occur with a specific disease that needs medical care, often quickly, these symptoms are considered as part of those that may occur with a number of specific diseases.

Is gastroenteritis contagious?

The majority of causes of gastroenteritis are contagious (mainly viral, bacterial, and parasitic). In some instances where the cause of the gastroenteritis is not a pathogen (for example, food allergies, toxins that are ingested), gastroenteritis is not contagious.

Is gastroenteritis a serious illness?

Most adults with gastroenteritis (as defined previously) are uncomfortable but do not have a serious illness. This is not always true for children and infants, or some adults (elderly, immune depressed) because they dehydrate rapidly. If dehydration develops and is not rapidly reversed, this symptom can make an infection that usually resolves on its own without medical treatment into a serious illness.

How does food get contaminated by gastroenteritis viruses?

Food is easily contaminated by people who prepare or handle food, and have viral gastroenteritis. Most often, failure to adequately wash hands or to clean off foods (for example, vegetables and fruits) that may be contaminated with sewage or untreated water, allow viral contamination that causes gastroenteritis. Additionally, the viruses can be viable for hours to days when they contaminate surfaces like handrails, doorknobs, and other items. This situation of contamination is essentially the same for many of the bacterial and other pathogens that can cause bacterial gastroenteritis.

Who is at risk for gastroenteritis?

Gastroenteritis is a very common disease; most people are at some risk to encounter the wide-spread causes (mainly viral and bacterial). This risk is due to poor hygiene of a few people with the disease that may be encountered frequently in daily living (for example, infants, children, or some food handlers). Some people have higher risk for infection; for example, individuals on cruise ships or those that live or work in crowded conditions like child care centers, dorms, or barracks, because of the higher chance that an infected person will come in contact with many other people, and rapidly spread the causative agent.

Infants, children and some adults (elderly, immunodepressed) are at risk for developing dehydration with gastroenteritis because they may lose fluids more rapidly than normal adults. Women who are pregnant are not at a great risk if they stay well hydrated; if they do not, they may put themselves and their baby at risk for complications of dehydration such as kidney failure, electrolyte abnormalities, shock and fetal death.

When should the doctor be called for gastroenteritis?

Because gastroenteritis, as defined above, usually runs a limited course and resolves on its own without professional or medical treatment, and most people will not need to contact a doctor. However, if a person begins to show signs of dehydration, especially if the person is unwilling or unable to adequately rehydrate orally at home, medical care should be sought. Signs and symptoms of dehydration may include:

• decreased or no urine production,
• dry mucus membranes,
• dry mouth or skin,
• inability to produce tears,
• weakness,
• lightheadedness, and
• low blood pressure.

If gastroenteritis symptoms last more than about 5 days, increase in severity (fever of 101 F or higher, bloody diarrhea, dehydration, constant abdominal pain) or other symptoms develop, the affected individual should seek medical care. The person may have had gastroenteritis symptoms, but may have a disease more serious gastroenteritis that does not run a limited course and does not resolve without professional or medical treatment.

How is gastroenteritis diagnosed?

Gastroenteritis is most often presumptively diagnosed simply by the symptoms. Because gastroenteritis is a disease that usually runs a limited course that resolves on its own without medical treatment, the large majority of patients are never seen or diagnosed by a health care practitioner. There are no specific tests for gastroenteritis. However, during outbreaks like those seen on cruise ships, viral and bacterial cultures or PCR and other immunologically-based tests can eventually identify the causative pathogen. However, by the time this identification occurs, most of the patients have begun to recover. When gastroenteritis symptoms become severe, most public health officials and clinicians run such tests to identify the causative agent.

What is the treatment for gastroenteritis?

Although most people with gastroenteritis require no formal treatment, the key to a more rapid and safe recovery is good hydration. Home treatment consists of adequate fluid intake so that dehydration is prevented. The recommended fluids are clear fluids (Pedialyte, especially for young children, Gatorade, Powerade, and other similar drinks) but not fruit juices or milk. If dehydration occurs, the affected individual should be evaluated by a health care practitioner, who is likely to begin IV rehydration, the treatment of choice for rapid rehydration.

Medications may be prescribed to reduce the symptoms of gastroenteritis, for example, promethazine (Phenergan), prochlorperazine (Compazine) or ondansetron (Zofran) may be prescribed to reduce vomiting. Some physicians suggest using these only as a suppository (or IV) since patients frequently just vomit the pills up. Others may prescribe diphenoxylate and atropine (Lomotil) or loperamide (Imodium) to slow diarrhea. Many clinicians simply suggest no treatment for gastroenteritis symptoms as all of the drugs have side effects, and the clinicians figure that if the patient stays well hydrated, the symptoms will soon stop anyway.

Once the gastroenteritis symptoms abate, especially vomiting, clinicians recommend a BRAT diet (bananas, rice, apples and toast) for a day or two before beginning a regular diet.

Individuals that have more serious symptoms, or other symptoms in addition to gastroenteritis need to be evaluated, diagnosed, and treated by a physician because the patient will likely have a specific disease that will need treatment. The treatment will depend on the cause of the illness (for example, salmonellosis or Clostridium difficile toxin). Administration of antibiotics and other treatments may be contraindicated for some of these diseases, so an accurate diagnosis is important.

What are the complications of gastroenteritis?

Most individuals do not experience any complications and make a complete recovery. The major complication for some individuals is dehydration; infants, children, the elderly, and immunodepressed are at higher risk for this complication. In many third world countries, hydration of infants is difficult. Consequently, there are many infant deaths worldwide due to dehydration caused by gastroenteritis.

Can gastroenteritis be prevented?

Because there are so many different causes of gastroenteritis, the ability to prevent the disease is related to the cause. Some causes are easier to prevent than others. For example, although viral causes are very contagious, one major viral pathogen, rotavirus, has a vaccine that has markedly reduced the incidence of rotavirus in the US pediatric population. Unfortunately, vaccines for other viral causes, although being researched, are not currently available. The only vaccine used against bacterial causes is Vibrio cholerae vaccine, but it is not readily available.

However, there are several general steps people can take to prevent or reduce the chance of getting gastroenteritis from almost every cause. These are as follows:

• Hand washing, especially before eating and after any close association with an infected person, or items (clothing, bedding, toys) they have touched
  
  
• Launder items daily that infected persons wear
  
  
• Avoid as much direct contact with infected individuals as possible
  
  
• Do not eat undercooked foods, especially meats like hamburger
  
  
• Do not eat or drink raw foods or untreated water
  
  
• Do not drink any untreated or unpasteurized fluids, especially milk
  
  
• Thoroughly wash any produce before eating
  
  
• While traveling, avoid all raw foods and ice; drink only from sealed bottled products and use bottled water for tooth brushing

These methods can reduce the chance of getting gastroenteritis from most of the known causes, but no method offers complete protection.

What is the prognosis of gastroenteritis?

In most people, the prognosis (outlook) for complete recovery is excellent, as long as the person keeps well hydrated. Because infants, children, and adults who are elderly or immunodepressed, usually dehydrate faster than healthy adults and sometimes are more difficult to rehydrate orally, their prognosis can range from excellent to poor, depending on how dehydrated they become and how effective are the attempts to rehydrate them.

The prognosis for those patients that develop gastroenteritis symptoms as part of a specific disease process (for example, shigellosis) vary from good to poor, depending on the severity of the specific disease process.

Gastroenteritis At A Glance

• Gastroenteritis is inflammation of the stomach, intestines or both.
  
  
• There are many causes of gastroenteritis; the most numerous cases are caused by viruses, followed by bacteria and other agents.
  
  
• The major symptoms of gastroenteritis are diarrhea, nausea, vomiting, and abdominal cramps; symptoms usually self-resolve in 2 to 5 days.
  
  
• The majority of gastroenteritis disease is very contagious, especially those caused by viruses and bacteria; a few causes of gastroenteritis are not contagious.
  
  
• Gastroenteritis usually is not a serious illness unless the affected person becomes dehydrated.
  
  
• Most food, fluids, and other items become contaminated with causative agents of gastroenteritis from direct or indirect contact with a person that has the disease.
  
  
• Most individuals have some risk of encountering gastroenteritis; people that live in close contact with others (for example, live on a ship, in a dorm, or barracks) have a higher risk.
  
  
• People who become dehydrated should seek medical care; if the symptoms become worse or are accompanied with other symptoms and/or last longer than about 5 days, the person should seek medical care as they may have a more serious disease.
  
  
• Gastroenteritis is frequently presumptively diagnosed by the symptoms; infrequently, culture and identification, usually with immunological tests, of the causative agent is done during outbreaks of the disease.
  
  
• Most people self-limit gastroenteritis in about 2 to 5 days and require no treatment as long as they remain well hydrated. IV hydration may be needed by some people. Some clinicians treat the symptoms of nausea, vomiting, and diarrhea with medications, others do not.
  
  
• The major complication of gastroenteritis is dehydration.
  
  
• Hand washing, good hygiene, washing produce, cooking foods adequately, and drinking only treated or pasteurized fluids can help prevent gastroenteritis.
  
  
• The prognosis for gastroenteritis is usually excellent, unless dehydration occurs.