We've all been there. Whether it's your head stuck in the sink, or you stuck on a lavatory (sometimes both), we've all known the misery of an upset stomach. Worse still this invariably happens with particularly annoying timing - on holiday for example! Your GP can be helpful for these symptoms, but you often don't need to see them in person to get the help you need.
Medically, we tend to divide these symptoms into three areas:
- gastritis (the nausea and vomiting)
- enteritis (watery, loose diarrhoea)
- gastroenteritis (both of the above)
It's relatively common to have just one or the other, and not necessarily both together.
Firstly, I'll quickly talk about gastritis, which essentially means "inflammation of the stomach". Broadly speaking there are two types we commonly see, and these are either caused by too much acid, or by a bug that you've picked up. Both can cause nausea and vomiting, but there are some key ways to tell them apart.
Your stomach is full of acid normally, which it uses to break down food. Too much acid though can be triggered in some people by certain foods, or stress. This can give that characteristic gnawing/burning sensation that starts just below your ribcage, and can travel up through your chest making you feel nauseous. It can even give you a nasty, often metallic taste in the mouth known as “water brash”, or excessive belching. Acid gastritis and reflux such as this affects 60% of the public at some point in their life. The medication we often use for it - a proton pump inhibitor (PPI) reduces the amount of acid produced by up to 70% and is one of the most commonly prescribed drugs in the UK, reflecting the prevalence of the disease. If this is the underlying problem, this medication normally helps pretty quickly - quite often within hours.
The other type of gastritis is invariably viral in origin. The symptoms can be very similar, but the nausea and vomiting are often more pronounced. The key distinguisher is the presence of added symptoms such as a fever (a temperature over 38°C), rigors and chills. It is these associated symptoms that tend to indicate infection to be the root cause, and as it’s viral in origin, antibiotics are of little use. The body deals with such infections itself (within around 72 hours in most cases) without any necessary intervention. However, a prescription of anti-sickness drugs (anti-emetics) can in some cases entirely eradicate the horrible nausea and vomiting symptoms, allowing you to feel much better whilst your body does the work. Taking regular paracetamol (which you should be able to keep down after the anti-emetics) will also help to reduce your temperature and it’s really important to try and keep adequately hydrated.
Just to make things slightly more complicated, acid reflux can be caused by a bacteria called H. pylori. If the PPI isn’t working quickly and effectively, it may be worth visiting a GP to be tested for this. If this is the cause, then this is one of the few cases where antibiotics CAN help.
Enteritis is the slightly more unsavoury cousin of gastritis. Essentially it is irritated bowel causing profuse, loose, watery stool and lower/generalised abdominal pain. It is usually caused by an infection, which can be bacterial or viral, but mainly the latter in the UK. As it is often infective, people can have a fever and experience cold sweats . The bowel motions are often much more frequent and very loose and watery, associated with very crampy abdominal pain. If you've got a fever, and symptoms like this, you've probably got enteritis. Any recent foreign travel over the last few weeks, or some blood in the stool suggest the possibility that a bacterium is the cause rather than a virus. The destinations you have been too often dictate what antibiotics are used, so it’s important to make sure your GP knows exactly where you’ve been.
Enteritis like this can cause a lot of fluid loss, and with that you lose salts and electrolytes vital to your body's functioning, such as potassium. It's long been known that flat Coca Cola is a great way to replace these, but rehydration sachets work more efficiently to rebalance what your body loses, and each prescription pack contains enough of these to get you through. Furthermore, whilst the old adage “better out than in” is often true for enteritis, we all know this just isn’t always very convenient! So we also include some loperamide in all our packs - the main ingredient in Imodium - which slows the bowels down and gives you a bit of respite.
Gastroenteritis, quite simply, is that rather inconvenient combination of the two together and the treatments noted above are all helpful dependent on which symptoms are most prominent.
It almost goes without saying that there are lots of simple measures for those suffering with these symptoms: plenty of clear fluid to maintain hydration and regular paracetamol will help relieve fever. Make sure to wash your hands thoroughly with soap and warm water to prevent spread of any infection - and if you’ve got a job involving close human contact or food preparation, please please please don’t go to work until 48 hours have passed since your symptoms resolved! Your colleagues and customers will not thank you if you go back sooner!
Often you don't need to see a GP in person to deal with these symptoms, so you may find telephoning easier, and myself or the GPs at Dr Morton's Medical Helpline are on hand to help.