Gastroenteritis, symptoms and treatment in adults at home

Having a bacterial or viral nature, gastroenteritis during pregnancy manifests itself as inflammation of the mucous membrane of the stomach and intestines. Symptoms of the disease include vomiting, diarrhea, and fever. Being a common disease, this disease carries the threat of dehydration. If the doctor's instructions are not followed, it becomes chronic.

Gastroenteritis: causes of occurrence during pregnancy

Bacteria, viruses and allergens in food contribute to the appearance of inflammatory processes in the gastrointestinal tract. Gastroenteritis mainly affects susceptible categories of people - children, pregnant women, and the elderly. Chemicals and pathogenic microorganisms irritate the mucous membrane of the digestive organ and disrupt the normal functioning of the stomach. Among the causes of the disease in pregnant women are:

• rotavirus infection;
• allergens in food;
• medications (antibiotics);
• helminth infections;
• toxic processes;
• lack of personal hygiene;
• contact with the carrier.

The disease occurs when consuming rough food, alcoholic and cold drinks. Spicy seasonings in food have a negative effect on the general condition of the mucous membrane. A lack of vitamins in the body weakens the immune system, especially during pregnancy, which also contributes to the onset of the disease. The expectant mother should avoid hypothermia, which leads to a weakening of the body's protective properties and, as a result, to gastroenteritis.

Causes

The etiological factor is viruses of different groups:

• rotaviruses (they account for up to 50% of diseases, while viral gastroenteritis in children is much more severe than in adults);
• parvoviruses;
• noroviruses;
• astroviruses;
• caliciviruses;
• adenoviruses;
• coronaviruses;
• caliciviruses (Norfolk);
• enteroviruses.

An acute viral infection breaks out suddenly and infects people from the same group. It is much easier and ends faster than bacterial damage to the intestines. In the case of group diarrhea, they first suspect the worst and try to detect pathogenic microflora, protozoa or helminths in a person.

The diagnosis of viral gastroenteritis in practice is usually made by exclusion.

You can become infected from a sick person or a virus carrier (one in whom the foreign particle persists in the body - lives, and does not cause any clinical symptoms). Patients with gastroenteritis of this etiology are contagious from the first day of infection. They can distribute the virus to others for an average of 3-7 days, sometimes this ability lasts up to several weeks (that is, after the end of the acute period).

How does infection occur?

1. By nutritional route:
   absorption of food products that have not been subjected to heat treatment;
2. drinking raw water.
3. By airborne droplets:
   while talking, coughing or sneezing of an infected interlocutor;
4. such infection is typical only for adeno- and enteroviruses.
5. By contact and household means:
   when using one utensil;
6. if all family members use the same towel;
7. through children's toys.

Features of viral gastroenteritis:

• the incidence of this pathology is recorded year-round;
• occur in an acute form;
• particularly large outbreaks are observed in winter and autumn (since during the cold season people tend to stay indoors, and the risk of contact with an infected person increases);
• the most frequently affected group of the population is children under 6 years of age (due to the lack of developed hygiene skills and visiting closed groups - kindergartens, they have the greatest risk of becoming infected);
• gastroenteritis in adults occurs with a less severe intoxication syndrome than a bacterial intestinal infection.

How to recognize: main symptoms

With this pathology, a person may develop a dry cough.
Inflammation of the mucous membrane is bacterial and viral in nature. With a long-term pathological condition, the disease becomes chronic. General symptoms manifest themselves as:

• acute pain that intensifies before defecation;
• nausea;
• increased sweating;
• vomiting - single and multiple, leading to dehydration;
• accelerated bowel movement (diarrhea);
• increased body temperature;
• chills and fever;
• dry cough;
• sore throat.

Depending on the form, gastroenteritis in pregnant women can be acute or chronic. Having different stages of manifestation, it is characterized by general fatigue, weakness, irritability. Sleep disturbances often occur. Depending on the factor that caused the inflammation, there are different forms of gastroenteritis. The table shows the features of their manifestations during pregnancy:

Viral gastroenteritis in children: symptoms, diagnosis, treatment, prevention

Rotaviruses

• Globally, approximately 30–72% of young children hospitalized with diarrhea were reported to be infected with rotavirus. At the community level, rotavirus infection accounts for approximately 4 to 24% of gastroenteritis cases. During outbreaks, gastroenteritis in children attending kindergartens is associated with rotaviruses in 20–40% of cases.
• Rotavirus is a non-enveloped double-stranded RNA virus of the Reoviridae family. The virus is so named because of its characteristic appearance under electron microscopy, resembling a wheel with spokes. The outer viral capsid consists of 2 structural proteins, VP4 and VP7; the inner capsid consists of VP6; the core consists of VP1, VP2 and VP3. VP6 is the main group-specific antigen. Rotaviruses are divided into 7 groups (A to G) based on differences in VP6. Group A is the most common rotavirus that causes human disease. Serotype specificity is determined by VP4 and VP7 according to their ability to respond to neutralizing antibodies. Rotaviruses are generally species specific, but cross-specificity may occur. Rotavirus is widespread, and by the age of 3 years, almost all children are infected with it.

Caliciviruses

• Caliciviruses are non-enveloped, positive-sense, single-stranded RNA viruses of the Caliciviridae family. They are so named because of the characteristic cup-shaped depressions above the surface of the virion. Caliciviruses are divided into 4 genera: Norovirus, Sapovirus, Vesivirus and Lagovirus. Only Norovirus and Sapovirus cause gastroenteritis in humans; they are called human caliciviruses. Noroviruses can be further divided into at least 20 genetic clusters, of which the Norwalk virus is an exemplar. Human caliciviruses can cause large outbreaks of gastroenteritis through contaminated food or water in all age groups.

Astroviruses

• Astroviruses are non-enveloped, positive-sense, single-stranded RNA viruses of the family Astroviridae. They are so named because they resemble a star in appearance under electron microscopy. Gastroenteritis caused by astroviruses is associated with outbreaks of mild gastroenteritis in kindergartens, schools, and pediatric departments, as well as in care homes. Astroviral gastroenteritis occurs more commonly in children <7 years of age and the elderly.

Adenoviruses

• Intestinal adenoviruses relatively often cause gastroenteritis in children and can cause outbreaks in kindergartens, orphanages and pediatric wards. Asymptomatic shedding of the virus can cause outbreaks.

Pathophysiology

Among all the viruses that can cause gastroenteritis in children, rotavirus is the most studied. Rotavirus selectively infects enterocytes of the mature small intestinal mucosa after it is activated by cleavage of VP4 by trypsin-like proteases. The infectious process begins in the proximal parts of the small intestine and spreads distally, but is mainly limited to the mucosa. Reproduction of viral particles in mature enterocytes leads to the destruction of these cells. The villi are most affected, but the crypts are preserved. The cells of the intestinal crypts begin to rapidly divide.

Mechanisms of excess secretion

• The loss of villi and the filling of the crypts with rapidly proliferating cells ultimately leads to a reduction in the surface area in the intestinal lumen.
• Villous loss and dysfunction during infection leads to an imbalance between absorption and secretion and excess secretion.
• Accelerated renewal of enterocytes leads to the appearance of a large number of immature cells incapable of absorption.
• The virus destroys disaccharidases in the small intestine.
• Rotavirus enterotoxin (NSP4) can cause calcium release from the endoplasmic reticulum, leading to increased secretion from villous cells.
• Stimulation of the intestinal nervous system by NSP4 and villous ischemia may further increase diarrhea.

Significant loss of fluid and electrolytes leads to dehydration, electrolyte imbalance and metabolic acidosis. If this condition is not corrected, it can lead to circulatory collapse, shock, target organ hypoperfusion, and tissue damage.

Risk factors

• Under 5 years of age Acute gastroenteritis often develops in children under 5 years of age.
• Rotavirus gastroenteritis, the most common cause of gastroenteritis, is most common in children aged 6 to 24 months and is most severe. Infections in the first months of life are usually mild or asymptomatic, possibly due to maternal antibodies.

Diagnostic criteria

Mild (<5%)

• The patient is conscious
• Slightly reduced volume of urine output
• Slightly expressed feeling of thirst
• Mild dry mucous membranes
• Slight increase in heart rate
• Normal capillary refill
• Normal skin turgor
• Eyes unchanged
• The anterior fontanel is unchanged.

Moderate (5 - 10%)

• Conscious, tired or irritable
• Decreased urine output
• Moderate thirst
• Dry mucous membranes
• Increased heart rate
• Delayed capillary refill
• Decreased skin turgor
• Sunken eyes
• Sunken anterior fontanel

Severe (>10%)

• Apathy or lethargy
• Significantly reduced urine output or no urine output at all
• Severe thirst
• Very dry mucous membranes
• Significant increase in heart rate
• Extended period or minimal capillary refill
• Decreased skin turgor
• Severely sunken eyes
• Severely sunken anterior fontanel
• Cold extremities
• Hypotension
• Coma.

Diagnostics

A detailed history and thorough physical examination will enable evaluation of other cases of vomiting and/or diarrhea and assessment of the level of dehydration. However, it is difficult to clinically distinguish viral from bacterial gastroenteritis.

Anamnesis

It is necessary to find out the duration of the disease; number of episodes, quality and nature of vomiting (presence of bile) and diarrhea (presence of blood and mucus); approximate volume of fluid consumption and volume of losses.

It should also be noted the child's weight before the onset of the disease; associated symptoms such as fever, abdominal cramps and tenesmus; general activity level; consumption of contaminated foods or liquids; contact with people with gastroenteritis; outbreaks of gastroenteritis in the community; simultaneous illness of family members; visiting kindergarten; history of past illnesses; recent travel to a region associated with possible development of diarrhea; recent infection; recent use of antibiotics; duration of breastfeeding and immunization status.

Physical examination

It is necessary to assess the general condition of the patient and the severity of dehydration. This includes mental status assessment; heart rate; capillary refilling; skin turgor; conditions of the mucous membranes, eyes and fontanel.

• Signs of mild dehydration include : feeling tense; slight decrease in urine volume; moderate increase in thirst; moderate dryness of the mucous membrane; slightly increased heart rate; normal capillary refill; normal skin turgor; normal condition of the eyes and normal condition of the anterior fontanel.
• Signs of moderate dehydration include : feeling tense, tired or irritable; decreased volume of urine excreted; moderately expressed feeling of thirst; dry mucous membranes; increased heart rate; delayed capillary refill; decreased skin turgor; sunken eyes and sunken anterior fontanel.
• Signs of severe dehydration include : apathetic or lethargic state; markedly reduced volume of urine produced or complete absence of urine; strong feeling of thirst; very dry mucous membranes; significant increase in heart rate; prolonged or minimal capillary refill; decreased skin turgor; severely sunken eyes; strongly sunken anterior fontanel; cold extremities; hypotension and coma.

Although body weight loss is a useful indicator of dehydration, it should always be confirmed by changes in clinical signs because weight measurement is subject to many potential errors (eg, use of different scales or nonstandard measurement methods). Thus, weight change is highly dependent on how long ago the child ate, whether he urinated, and whether he had bowel movements before the measurement.

With viral gastroenteritis, the fever is usually mild, the abdomen is soft and not tense, and intestinal motility can be heard well. If findings differ from these, an alternative cause of vomiting and/or diarrhea should be considered and sought.

Diagnostic tests

Differential diagnosis

Treatment

The mainstay of therapy is the use of oral rehydration therapy (ORT) with appropriate oral rehydration solutions (ORS) in combination with an age-appropriate diet. Oral rehydration therapy (ORT) is as effective, if not more effective, than intravenous fluids for rehydration for moderate dehydration in children. Compared with intravenous therapy, ORT is less traumatic, less expensive, easier to administer, and can be used in a variety of settings, including the home.

There are many commercial RPR formulations available that are safe. Liquids containing nonphysiological concentrations of glucose and electrolytes, such as carbonated drinks and sweetened fruit juices, are not used because they have a high carbohydrate content, very low electrolyte content, and high osmolarity. The use of these hyperosmolar solutions may cause osmotic diarrhea if they are administered in very large quantities. Parents should also be specifically instructed not to offer plain water to children with acute gastroenteritis because drinking water can lead to hyponatremia and hypoglycemia.

Early replacement has both clinical and nutritional benefits. It stimulates digestive enzymes, improves nutrient absorption, enhances enterocyte regeneration, helps restore disaccharidases, reduces changes in intestinal permeability caused by infection, reduces the duration of diarrhea, supports growth and improves nutritional outcomes.

Foods high in complex carbohydrates (rice, cereals, bread, wheat and potatoes), lean meats, fruits and vegetables are well tolerated. With the exception of a subgroup of children with secondary disaccharidase deficiency, most children with acute gastroenteritis are able to tolerate milk and lactose-containing diets. Foods high in simple sugars and fatty foods should be avoided.

Standard therapeutic recommendations

In addition to fluid replacement associated with dehydration, patients with viral gastroenteritis should be treated as follows.

• The daily fluid requirement is 100 ml/kg for the first 10 kg of body weight, 50 ml/kg for the next 10 kg and 20 ml/kg for each subsequent 1 kg over 20 kg. This is usually achieved through an age-appropriate diet.
• For infants, breastfeeding should be continued.
• There is no need to dilute the formula or give lactose-free formula when re-feeding to non-breastfed infants.
• Infants should be offered bottle feeding or breastfeeding more frequently.
• Children should continue to be fed an age-appropriate diet.

Ondansetron

Ondansetron should be used when vomiting interferes with oral rehydration therapy. A single dose of ondansetron should be given orally instead of intravenously when possible. The medicine can be used for both inpatients and outpatients, but only after the patient has been clinically evaluated.

• Ondasetron: children 8–15 kg: 2 mg orally as a single dose; children 16–30 kg: 4 mg orally once; children >30 kg: 8 mg orally as a single dose; children: 0.1––0.15 mg/kg intravenously as a single dose, maximum single dose 4 mg

The drug should be used with caution in children in whom diarrhea is a serious problem, as use of the drug may worsen the diarrhea.

Children who are not dehydrated

Treatment consists of providing adequate volumes of fluid to compensate for losses through the gastrointestinal tract and cover current needs.

Children weighing less than 10 kg should receive 60 to 120 ml PRT to compensate for an episode of vomiting or diarrhea, while those weighing > 10 kg should receive 120 to 240 ml PRT to compensate for an episode of vomiting or diarrhea in addition to their normal daily requirements. Standard therapeutic recommendations should be followed.

Children with mild dehydration

Signs of mild dehydration include: feeling tense; slight decrease in urine volume; moderate increase in thirst; moderate dryness of the mucous membrane; slightly increased heart rate; normal capillary refill; normal skin turgor; normal condition of the eyes and normal condition of the anterior fontanel.

Children with mild dehydration should receive 50 ml/kg over 4 hours during PRT. Current losses must be replaced by PRT. Children weighing less than 10 kg should receive 60 to 120 ml of PRT to compensate for an episode of vomiting or diarrhea, while those weighing > 10 kg should receive 120 to 240 ml of PRT to compensate for an episode of vomiting or diarrhea.

Children with moderate dehydration

Signs of moderate dehydration include: feeling tense, tired or irritable; decreased volume of urine excreted; moderately expressed feeling of thirst; dry mucous membranes; increased heart rate; delayed capillary refill; decreased skin turgor; sunken eyes and sunken anterior fontanel. Children with moderate dehydration should receive 100 ml/kg over 4 hours during PRT.

Current losses must be replaced by PRT. Children weighing less than 10 kg should receive 60 to 120 ml of PRT to compensate for an episode of vomiting or diarrhea, while those weighing > 10 kg should receive 120 to 240 ml of PRT to compensate for an episode of vomiting or diarrhea.

Children with severe dehydration

Signs of severe dehydration include: feeling lethargic or lethargic; markedly reduced volume of urine produced or complete absence of urine; strong feeling of thirst; very dry mucous membranes; significant increase in heart rate; prolonged or minimal capillary refill; decreased skin turgor; severely sunken eyes; strongly sunken anterior fontanel; cold extremities; hypotension and coma. Severe dehydration is a medical emergency requiring immediate fluid resuscitation and hospitalization.

Normal saline or lactated Ringer's solution, 20 ml/kg, should be administered intravenously over 1 hour. Vital signs should be monitored and the patient's condition should be assessed regularly. A bolus of intravenous fluid is given until pulse, perfusion, and mental status return to normal. In children with gastroenteritis, non-osmotic stimuli for antidiuretic secretion are common. Hypotonic saline solutions are not suitable for intravenous rehydration because non-osmotic activity of antidiuretic hormone during intravenous fluid administration can lead to hyponatremia.

PRT should be started when the child is able to tolerate it. Current losses should be replaced with oral or nasogastric rehydration therapy. Children weighing less than 10 kg should receive 60 to 120 ml of PRT to compensate for an episode of vomiting or diarrhea, while those weighing > 10 kg should receive 120 to 240 ml of PRT to compensate for an episode of vomiting or diarrhea.

Lack of tolerance to or refusal of PRT

The principle approach is to give small amounts of fluid at frequent intervals, and the volume should be gradually increased until the child can drink the fluid. Using a spoon or IV for very young children can significantly increase fluid retention during PRT. A child who refuses to drink may be helped by administering liquid into the mouth with a syringe.

Flavored or candy-type liquids may also be used and may be more acceptable to some children. Liquids simply added with apple or orange juice do not taste any better than liquids with commercial flavor enhancers. Additionally, only very small amounts of apple or orange juice can be added without significantly changing the electrolyte composition and PRT osmolarity.

If children refuse to drink, despite all of the above measures, then a gastric tube is first inserted before attempting intravenous rehydration. Rehydration via a nasogastric tube provides the physiological benefits of enteral rehydration and avoids the potential complications of intravenous therapy. Hydration by nasogastric tube is particularly useful in the emergency department, where rapid correction of dehydration may prevent hospitalization. A nasogastric tube is also useful in patients with normal mental status who are unable to drink adequate fluids.

Children with contraindications to the use of PRT

Contraindications to the use of PRT are prolonged vomiting that does not go away despite small and frequent feedings, severe dehydration with the development of shock, impaired consciousness, paralytic ileus and malabsorption of monosaccharides. Ongoing diarrhea of ​​>10 mL/kg body weight per hour is no longer considered a contraindication to ORT, as most children will still respond to ORT.

Children with contraindications to ORT are given intravenous therapy to replace calculated deficits, ongoing losses, and daily fluid requirements. Either full-strength saline or lactated Ringer's may be used for severe dehydration with or without shock. A mixture of equal parts normal saline and 5% glucose is indicated for children with mild to moderate dehydration, or for those who are not dehydrated but require fluid replacement/maintenance.

For children with mild to moderate dehydration, the deficit should be replenished over 4 hours and the remaining requirement uniformly over 24 hours. For children with severe dehydration, refer to the section above. PRT and early refeeding should be started as soon as the patient's physical condition allows.

Prevention

Good personal hygiene is of utmost importance in preventing the spread of the virus. This includes frequent hand washing with soap, careful disposal of diapers, and proper preparation and storage of food and drinking water.

Infants should be exclusively breastfed for the first 6 months if possible. Breastfeeding should be continued with additional foods for at least the first 12 months. Subsequent breastfeeding should be encouraged and continued as long as mother and baby mutually desire it.

Universal immunization of infants up to 6 weeks of age and completion of the schedule at 8 months and 0 days with rotavirus vaccine is recommended. Rotavirus vaccines are safe and effective against rotavirus disease and reduce mortality.

Danger during pregnancy

Thickening of the blood is a consequence of a lack of fluid in the body.
The main negative factor of gastroenteritis for expectant mothers is the possibility of transmitting the disease to the child. Dehydration of the mother’s body negatively affects the fetus, even leading to death if symptoms are ignored and measures are not taken. Dehydration contributes to blood thickening, disrupting the blood supply to organs, leading to the appearance of blood clots and varicose veins. An imbalance in brain activity appears. There is a possibility of the disease becoming chronic. Dysbacteriosis develops.

What is gastroenteritis

Gastroenteritis is the same as catarrh of the stomach and intestines - an inflammatory disease of the stomach and small intestine. The acute form is usually characteristic; the chronic form is much less common. Caused by viruses, usually rotavirus and E. coli.

Non-viral forms of the disease are much less common. They can develop under the influence of certain medications, or as a result of eating food to which the patient’s body is particularly sensitive. Children are more susceptible to this disease and it is often more severe.

Conventionally, this disease can be called a disease of dirty hands, since bacteria first enter the body due to basic lack of hygiene, as well as through water and food.

Gastroenteritis is also called stomach flu - because it is transmitted from person to person. Moreover, the infected person himself is dangerous to others literally for the first few days, then the risk of transmitting the disease to others decreases sharply.

Gastroenteritis is also called stomach flu - because it is transmitted from person to person. Moreover, the infected person himself is dangerous to others literally for the first few days, then the risk of transmitting the disease to others decreases sharply.

Diagnostic methods

Diagnosis of gastroenteritis during pregnancy is carried out only by a specialist.

The first thing to do when symptoms of the disease appear is to contact a gastroenterologist or infectious disease specialist. During pregnancy, it is especially important to diagnose the disease in a timely manner so as not to put the fetus at risk. The examination begins with receiving complaints and describing the symptoms of the disease. Further diagnosis includes visual examination of the patient and palpation. Pregnant women need to donate blood and stool for analysis to prescribe precise treatment that will take into account the fact of pregnancy. An abdominal ultrasound is also done to confirm the diagnosis.

All in your hands

Gastroenteritis is one of those diseases that can be easily prevented. For specific prevention of rotavirus infection, there are two vaccines that have undergone clinical trials. Both contain a weakened live virus and are taken orally.

You can also avoid infection by following basic hygiene rules:

• wash your hands before eating;
• pay attention to the expiration date of food products and monitor their storage temperature;
• drink only filtered or bottled water, exclude all drinks with ice;
• prepare cuts on clean cutting boards;
• wash vegetables, fruits and herbs thoroughly;
• do not eat raw eggs;
• buy food and drinking water only in supermarkets;
• Carry alcohol or wet wipes with you to disinfect your hands.

Safe treatment for pregnant women

The ban on certain medications during pregnancy precludes their use. Among the effective methods of combating gastroenteritis are diet. Eliminating animal fats and high-fiber foods from your diet will promote recovery. Drinking enough fluids will help prevent dehydration. Dehydration leads to loss of nutrients, vitamins, and minerals, so it is important to ensure their supply. Treatment of gastroenteritis in pregnant women includes taking medications only as prescribed by a doctor. The exact dosage is important so as not to harm the child. Adequate rest promotes a speedy recovery.

Prevention

In order not to become infected with viral gastroenteritis, you need to accustom yourself and your family members to maintain a culture of personal hygiene:

• wash your hands when coming from outside, before eating and after visiting the bathroom;
• do wet cleaning in the house;
• allow sunlight to penetrate into the rooms;
• boil drinking water and milk;
• thoroughly, using a washcloth, wash purchased vegetables and fruits, rinse them with boiling water;
• eat only from clean dishes;
• change into clean clothes at home.

If one of the family members develops symptoms of viral gastroenteritis, he (if possible) should be transferred to an isolated room (not a walk-through room), provided with separate dishes and towels.

Antiviral vaccines have been developed for specific prevention: Rotarix and Rotatek. They are intended to prevent the development of rotavirus infection. It is necessary to administer the drug twice with an interval of a month. The protection is enough for 2-3 years. Children are vaccinated up to six months of age; it is not advisable to carry out the procedure later. Vaccines for other viruses are still under development.

Folk remedies

Alternative medicine recipes have long been used to eliminate pathologies of the digestive system.

Read also Food poisoning: symptoms, causes and treatment of the disease

A decoction of mint leaves will help relieve spasms of the smooth muscles of the stomach and intestines, have a bactericidal effect, and facilitate the process of digesting food. It’s easy to prepare: you need a teaspoon of fresh or dry leaves for a glass of boiling water. Boil the mixture for a few minutes, leave for 20 minutes, and take warm. The recommended daily intake is 3 glasses.

Cranberry decoction will have an anti-inflammatory, antimicrobial and general strengthening effect on the body. To obtain it, you need to boil 100 g of berries in 500 ml of water for 15 minutes, leave for 1 hour, take throughout the day, dividing into 2 doses. Continue taking until the symptoms of the disease disappear completely, as well as during the recovery period.

A decoction based on St. John's wort has bactericidal, astringent, and anti-inflammatory properties. It relieves spasms and stimulates the secretion of digestive enzymes. To prepare it, boil 80 g of dry raw material in a liter of water for 30 minutes. After this, the composition is infused and taken during the day in three doses. The duration of the therapeutic course is 4 weeks.

Traditional medicine will help restore strength after a long illness. They are allowed to be used only after consulting a specialist.

Ways to prevent disease

All age groups are susceptible to the pathological condition. In order to prevent the development of the disease, you must follow simple rules:

• 
  Strictly adhere to the rules of personal hygiene.

• Prepare meat and fish dishes according to technology, adhere to recommendations for proper heat treatment.
• Do not eat food that has expired.
• Do not drink tap water, use only purified or bottled water.

If you notice the first signs of infection, it is recommended to immediately seek medical help.

Acute gastroenteritis is a serious disease that can lead to many complications: gastroenteropathy, dehydration, transition to the chronic stage, and death. Do not delay visiting a doctor. This will help avoid health problems.