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Stomach Flu / Viral Gastroenteritis

Definition :
Yesterday, you were enjoying a tasty meal at your favorite restaurant, and now you're doubled over with pain. These symptoms could be those of viral gastroenteritis — an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever.

You usually develop viral gastroenteritis — often called stomach flu — after contact with an infected person or because you've ingested contaminated food or water. If you're otherwise healthy, you'll likely recover without complications. But for infants, older adults and people with compromised immune systems, viral gastroenteritis can be deadly.

There's no effective treatment for viral gastroenteritis, so prevention is key. In addition to avoiding food and water that may be contaminated, thorough and frequent hand washing is your best defense.

Causes :
You're most likely to contract viral gastroenteritis when you eat or drink contaminated food or water, or if you share utensils, towels or food with someone who's infected.

Some shellfish, especially raw or undercooked oysters, can make you sick. Contaminated drinking water also can cause viral diarrhea. But in many cases, the virus is passed through the fecal-oral route — that is, someone with the virus handles food you eat without washing his or her hands after using the bathroom.

A number of viruses can be the cause of gastroenteritis, including :

  • Rotavirus. This is the most common cause of infectious diarrhea in infants and children worldwide — it's also a leading cause of death among children. Every year, thousands of children are hospitalized with complications of the infection. Your child is likely to have rotavirus at least once before age 5. Children are usually infected when they put their fingers or other objects contaminated with the virus into their mouths.

    Adults who are infected with rotavirus usually don't develop symptoms, but can still spread the illness. Some people, particularly those in institutional settings, may spread the virus even though they don't have any symptoms of illness themselves.

    A vaccine against rotaviral gastroenteritis is available in some countries, including the United States, and appears to be effective in preventing severe symptoms. Talk to your doctor about whether to immunize your child.

  • Noroviruses. There are many different strains of noroviruses, including Norwalk virus, that all cause similar symptoms. In addition to diarrhea, nausea and vomiting, you may experience muscle aches, headache, fatigue and low-grade fever.

    Both children and adults are affected by noroviruses. Norovirus infection can sweep through families and communities. It's especially likely to spread among people in confined spaces. In most cases you pick up the virus from contaminated food or water, although person-to-person transmission also is possible.

    After exposure to the virus, you're likely to feel sick within 18 to 72 hours. Most people feel better in a day or two, but you're still contagious for at least three days — and up to two weeks — after you've recovered.

Risk Factor :
Gastroenteritis occurs all over the world, affecting people of every age, race and background. In developing nations, it's a leading cause of death in children.

Children in child care centers and older adults living in nursing homes are especially vulnerable. That's because children's immune systems aren't mature until about age 6, and adult immune systems tend to become less efficient later in life.

Intestinal infections can flourish anywhere people congregate — from schools and dormitories to campgrounds and luxury cruise ships. Adults whose resistance is low — often because their immune systems are compromised by HIV, AIDS or other medical conditions — are especially at risk.

Each gastrointestinal virus has a season when it's most active. If you live in the Northern Hemisphere, you're more likely to get rotavirus or the Norwalk virus between October and April.

When to seek medical advice :
Stomach cancer is treatable if caught early. Unfortunately, it rarely causes symptoms in the beginning stages. When symptoms do occur, they're often vague and can easily be mistaken for other, more common but less serious problems such as a stomach virus or heartburn. Less than one in five stomach cancers are diagnosed before they have spread outside the stomach.

See your doctor if you have a persistent feeling of discomfort in the upper or middle region of your abdomen, especially if it occurs in conjunction with fatigue and weight loss.

And see your doctor right away if you develop black, tarry stools or if you vomit after meals. Although not always indicators of stomach cancer, these signs may result from other conditions that require medical care.

Symptoms :
One early sign of stomach cancer is microscopic internal bleeding, which is usually only detected by tests that check your stool for blood. You may also feel tired if this bleeding causes the loss of too many healthy red blood cells (anemia). Early stomach cancer may also cause symptoms such as heartburn and abdominal pain, which can be mistaken for other, more common problems.

When the cancer is more advanced, you may experience signs and symptoms such as :

  • Discomfort in the upper or middle region of your abdomen that may not be relieved by food or antacids (In the early stages of stomach cancer, pain is often relieved by food or acid-buffering medications.)
  • Abdominal discomfort aggravated by eating
  • Black, tarry stools
  • Vomiting blood
  • Vomiting after meals
  • Weakness and fatigue
  • Unintended weight loss
  • Full feeling after meals, even when eating less than normal

Having one or more of these signs and symptoms doesn't necessarily mean you have stomach cancer. Other more common conditions, especially peptic ulcers, can cause similar problems.

Diagnosis :
To help diagnose stomach cancer and rule out other possibilities, your doctor may recommend one or more of the following diagnostic tests :

  • Upper endoscopy. This procedure allows your doctor to see abnormalities in your upper gastrointestinal (GI) tract that may not be visible on X-rays. For the test, your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the first part of your small intestine. Your throat is usually numbed before you're asked to swallow the endoscope, and you'll usually receive intravenous medication to ensure that you're comfortable during the procedure.

    If any tissue in your upper intestinal tract looks suspicious, your doctor can remove a small sample (biopsy) using instruments inserted through the endoscope. The sample is then sent to a lab for examination by a pathologist.

    Upper endoscopy takes about 20 to 30 minutes, although you won't be sent home until the medication wears off — usually one to two hours later. Risks of the procedure are rare and include bleeding and perforation of the stomach lining. The most common complication is a slight sore throat from swallowing the endoscope.

  • Stomach X-ray (barium upper GI series). This test uses a series of X-rays to examine your esophagus, your stomach and the first part of your small intestine.

    Before the test, you'll drink a thick liquid (barium) that temporarily coats the lining of your stomach so that it shows up clearly on the X-rays. You may also be asked to swallow a gas-producing liquid or pill, such as sodium bicarbonate, which stretches the stomach and separates its folds, thereby providing a better view of the inner lining.

    After the test you can eat normally and resume your usual activities, although you'll need to drink extra water to help flush the barium from your system. The most common complication of the procedure is temporary constipation.

If you receive a diagnosis of stomach cancer, your doctor is likely to recommend additional tests to help determine the extent of the disease (staging tests) and the best course of treatment. These may include :

  • Endoscopic ultrasound. This test helps determine whether cancer has spread into the walls of your stomach or to nearby tissues and lymph nodes. Endoscopic ultrasound is similar to upper endoscopy, but in this case, the endoscope carries a small ultrasound probe that uses high-frequency sound waves to create images of your stomach and surrounding tissues, including lymph nodes.
  • Computerized tomography (CT) scan. Used to help check for the spread of cancer outside your stomach — especially to organs such as your liver and lungs — this test uses split-second computer processing and X-ray beams to produce detailed cross-sectional images of your internal organs. A CT scan exposes you to more radiation than conventional X-rays do, but in most cases, the benefits outweigh the risks.
  • Magnetic resonance imaging (MRI). This test also looks for the spread of cancer beyond your stomach. But unlike a CT scan, MRI uses a powerful magnetic field and radio waves — not X-rays — to produce cross-sectional images of your body.
  • Chest X-ray. This test checks whether cancer has spread to your lungs but isn't as sensitive as a CT scan.

The kind of treatment you receive for stomach cancer depends on a number of factors, including the location of the cancer, how advanced it is, your overall health and your own preferences. Especially when cancer is advanced, choosing a treatment plan is a major decision, and it's important to take time to evaluate your choices.

You may also want to consider seeking a second opinion. This can provide additional information to help you feel more certain about the option you're considering.

The goal of any treatment is always to eliminate the cancer completely. When that isn't possible, the focus may be on preventing the tumor from growing or causing more harm. In some cases, an approach called palliative care may be best. Palliative care refers to treatment aimed not at removing or slowing the disease, but at helping relieve symptoms and making you as comfortable as possible.

Stomach cancer treatment options include the following :

  • Surgery. This is the most common treatment for stomach cancer. Depending on the extent of the cancer, your doctor may remove part (subtotal, or partial, gastrectomy) or all (total gastrectomy) of your stomach as well as some of the surrounding tissue. Lymph nodes near the tumor also are often removed during surgery. After a subtotal gastrectomy, the remaining part of your stomach is connected to your esophagus and your small intestine. If your entire stomach is removed, your surgeon attaches your esophagus directly to your small intestine. A 2006 study suggested that chemotherapy before and after surgery may improve outcomes for certain people, so discuss this with your doctor.

    When stomach cancer is caught at an early stage and your surgeon is able to remove the entire tumor, a complete recovery is possible. Unfortunately, diagnosis usually doesn't occur until stomach cancer has spread through the stomach wall to nearby lymph nodes or other organs. At this point, it's not possible to remove all the cancer surgically, but your doctor may still recommend an operation to alleviate pain, bleeding or obstruction. In some cases of advanced stomach cancer, a laser beam directed through an endoscope can vaporize most of the tumor and relieve obstruction without an operation.

    After gastrectomy, some people experience leakage or obstruction where the intestinal tract has been reconstructed. More common problems associated with partial or total gastrectomy include diarrhea, vomiting and dumping syndrome, which occurs when the small intestine fills too quickly with undigested food. Signs and symptoms of dumping may occur immediately after eating (early dumping) or several hours after a meal (late dumping) and include nausea, vomiting, diarrhea, cramping and dizziness.

  • Chemotherapy. This treatment uses drugs to help kill cancer cells. Injected into a vein or taken orally, chemotherapy medications travel through your bloodstream and are often used to eliminate cancer cells that may remain after surgery or to treat cancers that have spread to other parts of the body. Chemotherapy may also be used to control cancer growth, prolong life or relieve symptoms of advanced disease. Although it sometimes may be the only treatment needed, doctors most often use chemotherapy in conjunction with other therapies. For example, in locally advanced stomach cancer, which occurs when the tumor affects only the stomach and nearby tissues, chemotherapy and radiation (radiotherapy) may be offered after surgery to help increase survival and improve quality of life.

    A 2006 study found that people whose stomach cancer hadn't spread had better outcomes when chemotherapy was used both before and after surgery to remove the cancer. In the study, people with stomach cancer were randomly assigned to receive surgery alone or to receive three cycles of chemotherapy before surgery and three cycles of chemotherapy after recovering from surgery. People in this study who received surgery combined with chemotherapy lived somewhat longer and had a lower risk of the cancer returning than did people who received surgery only.

    Because anti-cancer drugs affect healthy cells as well as cancerous ones — especially fast-growing cells in your digestive tract and bone marrow — side effects such as nausea and vomiting, fatigue, and an increased risk of infection due to a shortage of white blood cells are common. Although not everyone experiences these side effects, chemotherapy can sometimes feel like another illness and is often the part of treatment about which people are most apprehensive. But newer anti-nausea medications can prevent or reduce most nausea. Sometimes acupuncture or relaxation techniques, such as guided imagery, meditation and deep breathing, also may help control nausea and vomiting. Chemotherapy is normally administered in cycles, with periods of treatment alternating with periods of recovery during which your body can recover. Ask your treatment team about the side effects of any treatment you're considering and the best ways to minimize those effects.

  • Radiation therapy (radiotherapy). This therapy uses high-energy X-rays to kill cancer cells. Unlike chemotherapy, which affects your entire body, radiation affects only those parts of your body through which the radiation beam passes. Because any tissue touched by radiation can be damaged, doctors are careful to aim the beam in a way that's least likely to harm healthy tissue. Radiation that comes from a machine outside your body (external beam radiation) is generally used to treat stomach cancer, especially in conjunction with chemotherapy. It may also help relieve pain and blockages. Side effects may include a burn similar to sunburn on your skin where the radiation enters your body, nausea, vomiting, and fatigue that may increase over the course of treatment.
  • Antibiotics. Carefully selected individuals who have H. pylori-associated gastric lymphomas may be cured by antibiotic therapy that eliminates the bacteria causing this cancer. If you have this type of cancer, your doctor will need to carefully monitor your condition for recurrence or for the presence of more advanced disease that requires more aggressive therapy.

Targeted drug therapy
The Food and Drug Administration has approved the anti-leukemia drug imatinib mesylate (Gleevec) to treat gastrointestinal stromal tumors (GISTs) that contain a specific genetic mutation. Imatinib, which is taken in capsule form once a day, belongs to a class of medications that target a specific genetic mutation within cancer cells but leave healthy tissue relatively untouched. Side effects tend to be milder than with other types of cancer therapy and include fluid retention (edema), nausea, muscle cramps and rash.

Imatinib is effective only for GISTs that have a specific genetic mutation and even then, it isn't for everyone — surgical removal remains the primary therapy for this type of cancer. Despite promising results in some people, imatinib isn't effective in all cases nor are the long-term effects known.

Clinical trials
If you have advanced stomach cancer, you may want to consider participating in a clinical trial. This is a study that's used to test new forms of therapy — typically new drugs, different approaches to surgery or radiation treatments, and novel methods such as gene therapy. If the therapy being tested proves to be safer or more effective than current treatments, it will become the new standard of care.

The treatments used in clinical trials haven't yet proved effective. They may have serious or unexpected side effects, and there's no guarantee you'll benefit from them.

On the other hand, cancer clinical trials are closely monitored by the federal government to ensure they're conducted as safely as possible. And they offer access to treatments that wouldn't otherwise be available to you.

If you're interested in finding out more about clinical trials, talk to your treatment team. You can also call the National Cancer Institute's Cancer Information Service at 800-4-CANCER, or 800-422-6237. The call is free and trained specialists are available to answer your questions.

Although it may not be possible to prevent stomach cancer, the following steps can help reduce your risk :

  • Emphasize fruits and vegetables. A diet rich in fresh fruits and vegetables, especially those high in vitamin C and beta carotene, has been shown to help protect against stomach cancer. Look for deep green and dark yellow or orange fruits and vegetables, such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes. Also try to eat vegetables from the cabbage family, including broccoli, brussels sprouts and cauliflower. Lycopene, a nutrient found in tomatoes and other red fruits and vegetables such as strawberries and red bell peppers, may be a particularly powerful anti-cancer chemical.
  • Avoid nitrites and nitrates. These nitrogen compounds are known to contribute to stomach cancer. They're found primarily in processed meats — bologna, salami and corned beef, for instance — and in cured meats such as ham and bacon.
  • Limit smoked, pickled and heavily salted foods. These have been linked to an increased risk of stomach cancer. Countries where the consumption of smoked, pickled and salted food is high have correspondingly high stomach cancer rates.
  • Don't smoke. Tobacco use greatly increases your risk of stomach cancer, especially cancer that occurs at the junction of the esophagus and stomach.
  • Limit alcohol consumption. Alcohol may cause changes in cells that can lead to cancer.
  • Limit red meat. Eating large amounts of red meat — particularly when it's barbecued or well-done — increases your risk of stomach cancer. Instead, choose fish or poultry.
  • See your doctor if you have symptoms of an ulcer. Infection with H. pylori, the bacterium that causes most cases of gastric ulcers, is one of the leading causes of stomach cancer. Don't ignore symptoms of ulcers, such as a gnawing pain in your abdomen or chest that's worse when your stomach is empty or at night. Other, more severe signs and symptoms of ulcers include nausea, vomiting, bleeding and unintended weight loss.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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