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Wednesday, 4 December 2013

Enteritis - The Complications

Acute Enteritis, in most cases is defined as a condition of inflammation of the small intestine as a result of eating and drinking contaminated water and foods infected by virus and bacteria. But according to the study by the University Hospital Aintree, chronic radiation enteritis is an increasing problem, as more patients receive radiotherapy as part of their cancer therapy and as the long-term survival of these patients improves(a). Other study indicated that acute radiation enteritis is almost inevitable in the curative treatment of malignant tumors of the abdomen and pelvic area. It is frequently a self-limiting disorder of intestinal function associated with reversible mucosal changes of the intestine(b). The prevalence of the disease although is decreasing, it still affects millions (approx 1 in 83 or 1.20% or 3.3 million people in USA ) of people in the U.S alone, according to the statistic. Chronic enteritis is a condition of inflammation caused by other health conditions, such as Crohn's or celiac disease.
Complications
1. Chronic fatigue syndrome
A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. In the study to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection, showed that in a total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis(22).

2. Irritable bowel syndrome and chronic fatigue
Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications. In the study to estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis, indicated that Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness.This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic(23).

3. Arthritis symptoms
According to the London Kidney Research Unit, Division of Nephrology, London Health Sciences Centre, Acute bacterial gastroenteritis necessitating medical attention was associated with a higher risk of arthritic symptoms, but not arthritic medications, up to 4 yrs afterwards(24).

4. Risk of pregnancy-related hypertension
In the study to  evaluate the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water, by the University of Western Ontario, London, indicated that of 148 eligible pregnancies, antenatal audits with blood pressure data were available for 135. PRH was detected in 20.7% pregnancies, of which 6.7% were chronic hypertension and 14.1% gestational hypertension. Although nonsignificant, we observed a consistent trend toward higher rates of PRH and mean arterial pressure, particularly prior to 20 weeks gestation, among women who reported symptomatic gastroenteritis compared to asymptomatic women. BP should be monitored closely in women after exposure to contaminated water(25).

5. Diabetes mellitus
Ingestion of Escherichia coli O157:H7 can cause a spectrum of acute illness, ranging from overt hemolytic-uremic syndrome (HUS), to gastroenteritis with bloody diarrhea, to no symptoms. According to the study by the University of Western Ontario, survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection. However, less severe forms of infection, such as E. coli O157:H7 gastroenteritis without overt HUS, do not appear to result in an increased risk of type 2 diabetes(26).

6. Hypertension, Renal impairment, and Self reported cardiovascular disease
In the study to evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter, showed that Gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter was associated with an increased risk for hypertension, renal impairment, and self reported cardiovascular disease. Annual monitoring of blood pressure and periodic monitoring of renal function may be warranted for individuals who experience E coli O157:H7 gastroenteritis(27).
Other study also indicated that acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection(28).


7. Celiac disease
According to the study by the McMaster University Medical Centre, CD should be considered in the differential diagnosis of persistent IBS-like symptoms after an episode of infectious gastroenteritis(29).

8. Seizures and even GE encephalopathy
In the study to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections of a data of a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009, found that Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode(29a).

9. Dehydration
According to the Department of Pediatrics, CHU Sainte-Justine, From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001)(29b).

10. Etc.
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/19897345
(b) http://www.ncbi.nlm.nih.gov/pubmed/3310287  
(22) http://www.ncbi.nlm.nih.gov/pubmed/22316329
(23) http://www.ncbi.nlm.nih.gov/pubmed/21911849
(24) http://www.ncbi.nlm.nih.gov/pubmed/15923490
(25) http://www.ncbi.nlm.nih.gov/pubmed/19180135
(26) http://www.ncbi.nlm.nih.gov/pubmed/19180134
(27) http://www.ncbi.nlm.nih.gov/pubmed/21084368
(28) http://www.ncbi.nlm.nih.gov/pubmed/15923490
(29) http://www.ncbi.nlm.nih.gov/pubmed/17637949
(29a) http://www.ncbi.nlm.nih.gov/pubmed/21309881
(29b) http://www.ncbi.nlm.nih.gov/pubmed/20624137