Current issues in the diagnosis, evaluation, and management of gastrointestinal infections

PURPOSE: To provide an overview of common gastrointestinal infections and discuss diagnosis and treatment strategies. EPIDEMIOLOGY: In 1999, noroviruses accounted for two thirds of foodborne disease for which a pathogen was identified. There are more than 200 million cases of diarrheal illness annually in the United States. Infections with Shiga-toxin-producing Escherichia coli cause an estimated 73 000 cases annually in the United States and may cause serious sequelae. Clostridium difficile causes 15% to 20% of cases of nosocomial diarrhea. REVIEW SUMMARY: Gastrointestinal infections are common and cause substantial symptomatic discomfort, but are often self-limiting in nature. Restraint in the use of laboratory tests and antibiotic therapy is a key feature in the management of acute gastroenteritis and acute community-acquired diarrhea. A cautious approach to the use of antibiotic therapy can help minimize problems with antibiotic resistance. Infection with Shiga-toxin-producing E coli poses special considerations, because antibiotic therapy may induce toxin production and increase the severity of the disease. Nosocomial diarrhea is often self-limiting and does not routinely warrant testing except in select high-risk patients. Laboratory evaluation is appropriate whenever C difficile infection is suspected. The management of C difficile colitis begins with cessation of antibiotics and avoidance of peristaltic agents, which can promote retention of the toxin and often involves antibiotic therapy to eradicate the pathogen. TYPE OF AVAILABLE EVIDENCE: National guidelines, observational studies, expert reviews, retrospective studies. GRADE OF AVAILABLE EVIDENCE: Fair. CONCLUSION: Acute gastrointestinal infections are common and have the potential to cause substantial morbidity, which can be limited by prompt diagnosis and appropriate clinical management. In many cases, the illness is self-limiting, emphasizing the need for judicious use of diagnostic tests and antibiotic therapy.