ACUTE GASTROENTERITIS IN ADULTS: EPIDEMIOLOGY, GUIDELINES, AND HEALTH COSTS

Acute gastroenteritis is a common cause of illness resulting in visits to the emergency department and outpatient clinics, hospitalizations and lost quality of life occurring in both domestic settings and among those traveling abroad. In addition, it is cause of outbreaks in closed communities such as schools, nursing homes and cruise ships. It is estimated that 1 in 6 people in the United States is subject to gastroenteritis each year with an estimated annual burden of 179 million outpatient visits, nearly 500,000 hospitalizations, and more than 5,000 deaths at an estimated cost upwards of US$150 million to the health-care economy. In Europe and Canada, the estimated annual incidence is between 0.1 to 3.5 episodes per person-year while in resource-limited countries the incidence of acute gastroenteritis is often not evaluated nor included in any specific review. It usually occurs at a baseline frequency, superimposed with epidemic cases of diarrhea, either dysentery or watery diarrhea.Acute gastroenteritis is considered a major public health issue against which control efforts are needed. Several societies and government-sponsored guidelines for the diagnosis and management of acute gastroenteritis in adults are updated periodically, globally the most used and updated are those provided by the World Gastroenterology Organization (WGO), the Infectious Diseases Society of America (IDSA) and the American College of Gastroenterology (ACG). Illness and death from clinical conditions caused by gastroenteritis, especially those related to contaminated food, are a constant threat to public health and a significant obstacle to socio-economic development worldwide. In 2010 a specific Reference Group (FERG) established by World Health Organization (WHO) found that the global burden of acute gastroenteritis is comparable to those of the major infectious diseases, HIV/AIDS, malaria and tuberculosis. The diagnosis of acute gastroenteritis is mainly clinical with evidence diarrhea of rapid onset that lasts less than two weeks and may be accompanied by nausea, vomiting, fever, or abdominal pain. Stool examination and culture to determine etiology should be performed on patients at high risk of severe illness and for whom identification of a pathogen would be important both for the patient and for public health. The treatment of the acute disease is based on: Fluid maintenance and repletion; adaptation of diet; use of probiotics and antibiotics depending on the etiology; use of non-specific anti-diarrheal drugs.