Akut Gastroenterit
Özet
Akut gastroenterit, mide ve bağırsak mukozasının ani başlangıçlı inflamasyonu ile karakterize, dünya genelinde yaygın görülen bir klinik tablodur. Karın ağrısı, bulantı, kusma ve diyare ile seyreden bu durum, çoğunlukla enfeksiyöz ajanlara bağlı olarak gelişir. Viral etkenler (özellikle rotavirüs ve norovirüs), bakteriyel etkenler (Escherichia coli, Salmonella, Campylobacter, Shigella) ve paraziter etkenler hastalığın başlıca nedenlerindendir. Hastalık genellikle kendini sınırlayıcı olup 3–5 gün içinde düzelir; ancak ileri yaş grupları, immün yetmezlikli hastalar ve malnütrisyon varlığında ciddi dehidratasyon ve komplikasyon riski artar. Epidemiyolojik açıdan akut gastroenterit, gelişmekte olan ülkelerde ciddi bir morbidite ve mortalite kaynağıdır; gelişmiş ülkelerde ise daha çok hastane başvurusu ve sağlık hizmeti kullanımına yol açan bir halk sağlığı sorunu olarak görülür. Tedavide temel yaklaşım sıvı replasmanı ve elektrolit dengesinin sağlanmasıdır. Semptomatik destek ve uygun diyet önerileri çoğu vakada yeterlidir. Antibiyotik tedavisi, özellikle orta ve ağır şiddette bakteriyel gastroenterit, ateş, kanlı ishal veya immün yetmezlik gibi yüksek riskli olgularda düşünülür. Koruyucu önlemler arasında hijyen, güvenli su ve gıda tüketimi ile aşılar (örneğin rotavirüs aşısı) yer alır. Akut gastroenterit, klinik belirti ve semptomları değişmekle birlikte, erken tanı, riskli grupların belirlenmesi ve uygun tedavi yaklaşımı ile ciddi komplikasyonların önlenebileceği bir hastalıktır.
Acute gastroenteritis is a common clinical condition worldwide, characterized by the sudden onset of inflammation of the gastric and intestinal mucosa. It typically presents with abdominal pain, nausea, vomiting, and diarrhea and is most often caused by infectious agents. Viral pathogens (notably rotavirus and norovirus), bacterial pathogens (Escherichia coli, Salmonella, Campylobacter, Shigella), and parasitic agents represent the primary etiologic factors.The disease is generally self-limiting, resolving within 3–5 days; however, the risk of severe dehydration and complications increases in elderly individuals, immunocompromised patients, and those with malnutrition. From an epidemiological perspective, acute gastroenteritis constitutes a significant cause of morbidity and mortality in developing countries, whereas in developed countries it is primarily a public health concern due to increased healthcare utilization and hospital visits. The mainstay of treatment is fluid replacement and maintenance of electrolyte balance. Symptomatic support and appropriate dietary measures are sufficient in most cases. Antibiotic therapy is considered in high-risk patients, particularly in moderate to severe bacterial gastroenteritis, the presence of fever, bloody diarrhea, or immunodeficiency. Preventive measures include proper hygiene, consumption of safe water and food, and vaccination, such as the rotavirus vaccine. Although the clinical presentation of acute gastroenteritis may vary, early diagnosis, identification of high-risk groups, and timely, appropriate management are essential to prevent serious complications.
Referanslar
Guerrant RL, Walker DH, Weller PF (eds.). Tropical Infectious Diseases: Principles, Pathogens and Practice. 3rd ed. Philadelphia: Elsevier Saunders; 2011.
Koo HL, Ajami N, Atmar RL, et al. Noroviruses: The leading cause of gastroenteritis worldwide. Discovery Medicine. 2010;10(50):61–70.
World Health Organization. Diarrhoeal disease. (05/02/2026 tarihinde https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease adresinden ulaşılmıştır).
Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in U.S. children. New England Journal of Medicine. 2013;368(12):1121–1130. doi:10.1056/NEJMsa1206589
Kotloff KL, Nataro JP, Blackwelder WC, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013;382(9888):209–222. doi:10.1016/S0140-6736(13)60844-2
Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New England Journal of Medicine. 2009;361(18):1776–1785. doi:10.1056/NEJMra0804575
Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases. 2001;32(3):331–351. doi:10.1086/318514
Parashar UD, Burton A, Lanata C, et al. Global mortality associated with rotavirus disease among children. Journal of Infectious Diseases. 2009;200(Suppl 1):S9–S15. doi:10.1086/605025
Parashar UD, Glass RI. Rotavirus vaccines—early success, remaining questions. New England Journal of Medicine. 2009;360:1063–1065. doi:10.1056/NEJMp0810154
Getto L, Zeserson E, Breyer M. Vomiting, diarrhea, constipation and gastroenteritis. Emergency Medicine Clinics of North America. 2011;29:221–234. doi:10.1016/j.emc.2011.01.005
Newell DG, Koopmans M, Verhoef L, et al. Food-borne diseases—the challenges of 20 years ago still persist while new ones continue to emerge. International Journal of Food Microbiology. 2010;139:S3–S15. doi:10.1016/j.ijfoodmicro.2010.01.021
Kotloff KL. The burden and etiology of diarrheal illness in developing countries. Pediatric Clinics of North America. 2017;64(4):799–814. doi:10.1016/j.pcl.2017.03.006
Becker KM, Moe CL, Southwick KL, et al. Transmission of Norwalk virus during a football game. New England Journal of Medicine. 2000;343(17):1223–1227. doi:10.1056/NEJM200010263431704
Troeger C, Khalil IA, Rao PC, et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatrics. 2018;172(10):958–965. doi:10.1001/jamapediatrics.2018.1960
Ramig RF. Pathogenesis of intestinal and systemic rotavirus infection. Journal of Virology. 2004;78(19):10213–10220. doi:10.1128/JVI.78.19.10213-10220.2004
Bok K, Green KY. Norovirus gastroenteritis in immunocompromised patients. New England Journal of Medicine. 2012;367(22):2126–2132. doi:10.1056/NEJMra1207742
Fleckenstein JM, Hardwidge PR, Munson GP, et al. Molecular mechanisms of enterotoxigenic Escherichia coli infection. Microbes and Infection. 2010;12(2):89–98. doi:10.1016/j.micinf.2009.10.002
Beatty ME, Adcock PM, Smith SW, et al. Epidemic diarrhea due to enterotoxigenic Escherichia coli. Clinical Infectious Diseases. 2006;42(3):329–334. doi:10.1086/499246
Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clinical Microbiology Reviews. 2015;28(1):3–31. doi:10.1128/CMR.00073-14
Tolan DJ, Davies HO. Radiology in acute gastroenteritis. Clinical Radiology. 2017;72(8):621–629.
Navidad JF, Griswold DJ, Gradus MS, et al. Evaluation of diarrhea in the emergency department. Emergency Medicine Clinics of North America. 2013;31(1):195–214.
Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of Pediatric Gastroenterology and Nutrition. 2014;59(1):132–152. doi:10.1097/MPG.0000000000000375
Referanslar
Guerrant RL, Walker DH, Weller PF (eds.). Tropical Infectious Diseases: Principles, Pathogens and Practice. 3rd ed. Philadelphia: Elsevier Saunders; 2011.
Koo HL, Ajami N, Atmar RL, et al. Noroviruses: The leading cause of gastroenteritis worldwide. Discovery Medicine. 2010;10(50):61–70.
World Health Organization. Diarrhoeal disease. (05/02/2026 tarihinde https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease adresinden ulaşılmıştır).
Payne DC, Vinjé J, Szilagyi PG, et al. Norovirus and medically attended gastroenteritis in U.S. children. New England Journal of Medicine. 2013;368(12):1121–1130. doi:10.1056/NEJMsa1206589
Kotloff KL, Nataro JP, Blackwelder WC, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013;382(9888):209–222. doi:10.1016/S0140-6736(13)60844-2
Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. New England Journal of Medicine. 2009;361(18):1776–1785. doi:10.1056/NEJMra0804575
Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases. 2001;32(3):331–351. doi:10.1086/318514
Parashar UD, Burton A, Lanata C, et al. Global mortality associated with rotavirus disease among children. Journal of Infectious Diseases. 2009;200(Suppl 1):S9–S15. doi:10.1086/605025
Parashar UD, Glass RI. Rotavirus vaccines—early success, remaining questions. New England Journal of Medicine. 2009;360:1063–1065. doi:10.1056/NEJMp0810154
Getto L, Zeserson E, Breyer M. Vomiting, diarrhea, constipation and gastroenteritis. Emergency Medicine Clinics of North America. 2011;29:221–234. doi:10.1016/j.emc.2011.01.005
Newell DG, Koopmans M, Verhoef L, et al. Food-borne diseases—the challenges of 20 years ago still persist while new ones continue to emerge. International Journal of Food Microbiology. 2010;139:S3–S15. doi:10.1016/j.ijfoodmicro.2010.01.021
Kotloff KL. The burden and etiology of diarrheal illness in developing countries. Pediatric Clinics of North America. 2017;64(4):799–814. doi:10.1016/j.pcl.2017.03.006
Becker KM, Moe CL, Southwick KL, et al. Transmission of Norwalk virus during a football game. New England Journal of Medicine. 2000;343(17):1223–1227. doi:10.1056/NEJM200010263431704
Troeger C, Khalil IA, Rao PC, et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatrics. 2018;172(10):958–965. doi:10.1001/jamapediatrics.2018.1960
Ramig RF. Pathogenesis of intestinal and systemic rotavirus infection. Journal of Virology. 2004;78(19):10213–10220. doi:10.1128/JVI.78.19.10213-10220.2004
Bok K, Green KY. Norovirus gastroenteritis in immunocompromised patients. New England Journal of Medicine. 2012;367(22):2126–2132. doi:10.1056/NEJMra1207742
Fleckenstein JM, Hardwidge PR, Munson GP, et al. Molecular mechanisms of enterotoxigenic Escherichia coli infection. Microbes and Infection. 2010;12(2):89–98. doi:10.1016/j.micinf.2009.10.002
Beatty ME, Adcock PM, Smith SW, et al. Epidemic diarrhea due to enterotoxigenic Escherichia coli. Clinical Infectious Diseases. 2006;42(3):329–334. doi:10.1086/499246
Humphries RM, Linscott AJ. Laboratory diagnosis of bacterial gastroenteritis. Clinical Microbiology Reviews. 2015;28(1):3–31. doi:10.1128/CMR.00073-14
Tolan DJ, Davies HO. Radiology in acute gastroenteritis. Clinical Radiology. 2017;72(8):621–629.
Navidad JF, Griswold DJ, Gradus MS, et al. Evaluation of diarrhea in the emergency department. Emergency Medicine Clinics of North America. 2013;31(1):195–214.
Guarino A, Ashkenazi S, Gendrel D, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. Journal of Pediatric Gastroenterology and Nutrition. 2014;59(1):132–152. doi:10.1097/MPG.0000000000000375
