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Acute viral gastroenteritis in adults

Irene Alexandraki, MD, MPH
Gerald W Smetana, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
Howard Libman, MD, FACP


Acute viral gastroenteritis is a common cause of illness resulting in visits to the emergency department and outpatient clinics in the United States. In addition, acute viral gastroenteritis causes outbreaks in certain closed communities, such as nursing homes, schools, and cruise ships. Restaurant and catered meals are another common source of outbreaks.

This topic focuses on the management of acute viral gastroenteritis in adults. The approach to acute nonviral diarrhea in adults, chronic diarrhea in adults, and diarrhea in children are discussed separately:

(See "Norovirus".)

(See "Approach to the adult with acute diarrhea in resource-rich settings".)

(See "Approach to the adult with acute diarrhea in resource-limited countries".)

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Literature review current through: Oct 2017. | This topic last updated: Oct 24, 2017.
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  1. Bresee JS, Marcus R, Venezia RA, et al. The etiology of severe acute gastroenteritis among adults visiting emergency departments in the United States. J Infect Dis 2012; 205:1374.
  2. Scallan E, Griffin PM, Angulo FJ, et al. Foodborne illness acquired in the United States--unspecified agents. Emerg Infect Dis 2011; 17:16.
  3. Hall AJ, Rosenthal M, Gregoricus N, et al. Incidence of acute gastroenteritis and role of norovirus, Georgia, USA, 2004-2005. Emerg Infect Dis 2011; 17:1381.
  4. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States--major pathogens. Emerg Infect Dis 2011; 17:7.
  5. Wikswo ME, Hall AJ, Centers for Disease Control and Prevention. Outbreaks of acute gastroenteritis transmitted by person-to-person contact--United States, 2009-2010. MMWR Surveill Summ 2012; 61:1.
  6. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017.
  7. Flint JA, Van Duynhoven YT, Angulo FJ, et al. Estimating the burden of acute gastroenteritis, foodborne disease, and pathogens commonly transmitted by food: an international review. Clin Infect Dis 2005; 41:698.
  8. Greer AL, Drews SJ, Fisman DN. Why "winter" vomiting disease? Seasonality, hydrology, and Norovirus epidemiology in Toronto, Canada. Ecohealth 2009; 6:192.
  9. Mounts AW, Ando T, Koopmans M, et al. Cold weather seasonality of gastroenteritis associated with Norwalk-like viruses. J Infect Dis 2000; 181 Suppl 2:S284.
  10. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med 2004; 350:38.
  11. Arena C, Amoros JP, Vaillant V, et al. Acute diarrhea in adults consulting a general practitioner in France during winter: incidence, clinical characteristics, management and risk factors. BMC Infect Dis 2014; 14:574.
  12. Kaplan JE, Feldman R, Campbell DS, et al. The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Am J Public Health 1982; 72:1329.
  13. Lopman BA, Reacher MH, Vipond IB, et al. Clinical manifestation of norovirus gastroenteritis in health care settings. Clin Infect Dis 2004; 39:318.
  14. Jones R, Rubin G. Acute diarrhoea in adults. BMJ 2009; 338:b1877.
  15. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Recomm Rep 2011; 60:1.
  16. National Health Services. Gastroenteritis: Making a Diagnosis. Available at: http://www.cks.nhs.uk/gastroenteritis/making_a_diagnosis/differential_diagnosis# (Accessed on August 27, 2012).
  17. Guerrant RL, Carneiro-Filho BA, Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003; 37:398.
  18. Dalby-Payne JR, Elliott EJ. Gastroenteritis in children. BMJ Clin Evid 2009; 2009.
  19. Hartling L, Bellemare S, Wiebe N, et al. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev 2006; :CD004390.
  20. Faruque AS, Mahalanabis D, Hamadani JD, Zetterstrom R. Reduced osmolarity oral rehydration salt in Cholera. Scand J Infect Dis 1996; 28:87.
  21. Rao SS, Summers RW, Rao GR, et al. Oral rehydration for viral gastroenteritis in adults: a randomized, controlled trial of 3 solutions. JPEN J Parenter Enteral Nutr 2006; 30:433.
  22. King CK, Glass R, Bresee JS, et al. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003; 52:1.
  23. DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1997; 92:1962.
  24. de Bruyn G. Diarrhoea in adults (acute). BMJ Clin Evid 2008; 2008.
  25. Oelschlaeger TA. Mechanisms of probiotic actions - A review. Int J Med Microbiol 2010; 300:57.
  26. Kotzampassi K, Giamarellos-Bourboulis EJ. Probiotics for infectious diseases: more drugs, less dietary supplementation. Int J Antimicrob Agents 2012; 40:288.
  27. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev 2010; :CD003048.
  28. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 2002; 109:678.
  29. McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel Med Infect Dis 2007; 5:97.
  30. Szajewska H, Skórka A, Ruszczyński M, Gieruszczak-Białek D. Meta-analysis: Lactobacillus GG for treating acute diarrhoea in children. Aliment Pharmacol Ther 2007; 25:871.
  31. Britton RA, Versalovic J. Probiotics and gastrointestinal infections. Interdiscip Perspect Infect Dis 2008; 2008:290769.
  32. Bernaola Aponte G, Bada Mancilla CA, Carreazo Pariasca NY, Rojas Galarza RA. Probiotics for treating persistent diarrhoea in children. Cochrane Database Syst Rev 2010; :CD007401.
  33. Szajewska H, Skórka A. Saccharomyces boulardii for treating acute gastroenteritis in children: updated meta-analysis of randomized controlled trials. Aliment Pharmacol Ther 2009; 30:960.
  34. Scrimgeour AG, Lukaski HC. Zinc and diarrheal disease: current status and future perspectives. Curr Opin Clin Nutr Metab Care 2008; 11:711.
  35. Nichter M, Acuin CS, Vargas A. Introducing Zinc in a Diarrhoeal Control Programme: Guide to conducting formative research. World Health Organization 2008. Available at: http://whqlibdoc.who.int/publications/2008/9789241596473_eng.pdf (Accessed on September 30, 2012).
  36. Fraker PJ, King LE. Reprogramming of the immune system during zinc deficiency. Annu Rev Nutr 2004; 24:277.
  37. Baker DE. Loperamide: a pharmacological review. Rev Gastroenterol Disord 2007; 7 Suppl 3:S11.
  38. Dettmer A. Loperamide oxide in the treatment of acute diarrhea in adults. Clin Ther 1994; 16:972.
  39. Gallelli L, Colosimo M, Tolotta GA, et al. Prospective randomized double-blind trial of racecadotril compared with loperamide in elderly people with gastroenteritis living in nursing homes. Eur J Clin Pharmacol 2010; 66:137.
  40. Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 2001; 32:331.
  41. Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open 2012; 2.
  42. Chow CM, Leung AK, Hon KL. Acute gastroenteritis: from guidelines to real life. Clin Exp Gastroenterol 2010; 3:97.
  43. Farthing M, Salam M, Lindberg G, et al. Acute diarrhea in adults and children: a global perspective. World Gastoenterology Organisation Global Guidelines 2012. Available at: http://www.worldgastroenterology.org/assets/export/userfiles/Acute%20Diarrhea_long_FINAL_120604.pdf (Accessed on May 22, 2013).
  44. National Health Services. Gastroenteritis: Background information. Available at: http://www.cks.nhs.uk/gastroenteritis/background_information/prognosis# Gastroenteritis /Prognosis (Accessed on August 15, 2012).
  45. Spiller R, Garsed K. Infection, inflammation, and the irritable bowel syndrome. Dig Liver Dis 2009; 41:844.
  46. Fankhauser RL, Monroe SS, Noel JS, et al. Epidemiologic and molecular trends of "Norwalk-like viruses" associated with outbreaks of gastroenteritis in the United States. J Infect Dis 2002; 186:1.
  47. Centers for Disease Control and Prevention (CDC). Norovirus activity--United States, 2006-2007. MMWR Morb Mortal Wkly Rep 2007; 56:842.
  48. Said MA, Perl TM, Sears CL. Healthcare epidemiology: gastrointestinal flu: norovirus in health care and long-term care facilities. Clin Infect Dis 2008; 47:1202.
  49. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 2003; 3:275.
  50. Bresee JS, Widdowson MA, Monroe SS, Glass RI. Foodborne viral gastroenteritis: challenges and opportunities. Clin Infect Dis 2002; 35:748.
  51. Centers for Disease Control and Prevention (CDC). Multisite outbreak of norovirus associated with a franchise restaurant--Kent County, Michigan, May 2005. MMWR Morb Mortal Wkly Rep 2006; 55:395.
  52. Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med 2009; 361:1776.
  53. Centers for Disease Control and Prevention (CDC). Outbreaks of gastroenteritis associated with noroviruses on cruise ships--United States, 2002. MMWR Morb Mortal Wkly Rep 2002; 51:1112.
  54. Parashar U, Quiroz ES, Mounts AW, et al. "Norwalk-like viruses". Public health consequences and outbreak management. MMWR Recomm Rep 2001; 50:1.
  55. Moe CL. Preventing norovirus transmission: how should we handle food handlers? Clin Infect Dis 2009; 48:38.