Types of Entertitis
1. Campylobacter enteritis (Campylobacter jejuni)
Campylobacter enteritis is the commonest form of infective diarrhoea in most developed countries of the world. According to the statistic from Wales laboratory, the an annual incidence of about 85/100,000, but the true rate is probably nearer 1100/100,000. Most infections are sporadic and believed to be foodborne; large outbreaks are infrequent and mostly as a result of the consumption of raw milk or unchlorinated water. Raw meats and animal products, notably broiler chickens, are the main source of campylobacters in food(c). Other indicated that Cross-contamination and improper handling and cooking of foods of animal origin account for the majority of disease. Hygienic measures must be applied in order to reduce the incidence of campylobacteriosis in humans(b).
2. E. coli enteritis (E. coli)
In an age cross sectional cohort analysis of 340 0-47 month old children and newborn cohort analysis of 144 newborns to determine the diarrheogenic Escherichia coli incidence in Santa Julia, a low socioeconomic community in Santiago, Chile, between December 1986 and February 1990, showed thatthe age cross sectional cohort had 1178 episodes of diarrhea and the newborn cohort had 674 episodes. No difference in the isolation rate of enteroaggregative E. coli existed between cases and controls. Since most households in Santa Julia have access to potable water (68%) and an indoor toilet (64%), food contamination were likely the vehicles of E. coli transmission because more than 50% of households do not have a refrigerator(e). Other in the review of the outbreak of E. coli O142 K86 H34, the enteritis of adults and children are due to enteroinvasive (EIEC) and enterotoxigenic (ETEC) strains, suggested that routine search for EPEC is suggested in cases of infantile enteritis in hospitals and other institutions(f).
3. Clostridium perfringens enteritis
Clostridium perfringens is an important anaerobic pathogen causing foodborne and non-foodborne gastrointestinal diseases in humans and animals. This pathogen is also the more common Clostridium species associated with bacteraemia. We report on a fatal case of C. perfringens infection in an adult with type 2 diabetes(g).
4. Staphylococcal enteritis (Food poisioning)
The disease is as reslt of eating or drinking substances contaminated with staph enterotoxin. The enterotoxins are fast acting, sometimes causing illness within one to six hours. Patients typically experience nausea, vomiting, stomach cramps, and diarrhea(h).
5. Radiation enteritis
Radiation therapy may damage the lining of the intestines (bowels) and cause inflammation.
The clinicopathologic features of radiation enteritis are reviewed in 44 children receiving whole abdominal radiation therapy between 1961-1972 at the Institut Gustave-Roussy. Five of 14 long-term survivors (36%) developed severe delayed radiation injury with small bowel obstruction, occurring within 2 months after completion of irradiation. All had previously had acute radiation reaction during therapy, according to the study by Dr. Donaldson SS and the research team(i).
6. Salmonella enteritis
Salmonella enterica and Campylobacter spp. cause a considerable number of human illnesses each year, and the vast majority of cases are foodborne(j). Other study indicated thatthe most common disease syndromes caused by Salmonella serotypes in humans, typhoid fever and enteritis, can be modeled using Salmonella enterica serotype Typhimurium infections in mice and calves, respectively(k).
7. Shigella enteritis
Shigella species cause bacillary dysentery in humans by invasion, intracellular multiplication, spread to adjacent cells, and induction of brisk inflammatory responses in the intestinal epithelium(l). According to the study, in August 2002, an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5-6 August 2002. The estimated primary attack rate was 9.97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16.49%)(m).
8. Etc.
I. Symptoms
1. Abdomen Pain, diahrrea and fever
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(1).
2. Post-infectious fatigue and abdominal symptoms
Some patients with Severity of Giardia infection after treatment may be experience Post-infectious fatigue and abdominal symptoms. According to the study by Haukeland University Hospital, Protracted and severe giardiasis seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the Giardia infection(2).
3. Bloating, Iron and vitamin deficiency
Patient with Campylobacter jejuni enteritis may be experioence with symptoms of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies.
There is a report of a young woman with no previous gastrointestinal complaints who was initially diagnosed with postinfective irritable bowel syndrome (IBS) after a confirmed case of Campylobacter jejuni enteritis. However, because of persistent diarrhea, new-onset bloating and the development of iron and vitamin deficiencies(3).
4. Hematochezia
Hematochezia is defined as a condition of passing fresh blood through the anus and in or with stools. In most cases it is caused by the bleeding of lower gastrointestine.
5. Dizziness
Patient with cryptogenic multifocal ulcerous stenosing enteritis, may be experiencerecurrent colicky abdominal pain and dizziness(4).
6. Acute intestinal obstruction or perforation
Although Acute intestinal obstruction or perforationare rare in patient with enteritis. There is a report of a case of a case of eosinophilic enteritis, hitherto unreported, presenting as an ileal obstruction, and followed by jejunal bleeding, which was visualized by capsule endoscopy. A 62-year-old man received a 15 cm single segmental ileal resection at a point 50 cm from the IC valve due to symptoms of obstruction, which were diagnosed as eosinophilic enteritis(5).
7. Constipation
There is a report of a case of mucosal Eosinophilic gastroenteris (EG) presenting as constipation and abdominal pain in a 43 year old female. EG should be considered in the differential diagnosis of patients presenting with constipation and abdominal pain and can easily be diagnosed with mucosal biopsies and treated with steroid therapy(5a).
8. Others
Patients may be also experience to symptoms of loss of appetite, dehydration, vomiting, thirst, change in stool pattern, high CRP and leucocytosisetc, etc(5b).
II. Causes and Risk factors
A. Causes
1. Radiation-induced enteritis
Radiation enteritis is a severe problem in patients receiving irradiation of the abdomen or pelvis in the course of cancer treatment. According to the study by Fovárosi Onkormányzat Uzsoki Utcai Kórház Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145, during the radiotherapy of tumors in the minor pelvis and abdomen intestinal inflammation of different degree may occur even if special attention is paid. Irradiation to the minor pelvis causes in half of the cases radiation induced acute enteritis, whereas in 25% chronic enteritis and colitis will develop(6).
2. Virus
Certain virus can induce entertitis including Cytomegalovirus and Norovirus. The Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries, according to the study to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis by Gazi University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey, indicated that NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%)(7).
3. Bacteria
Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract, according to the study by Universidad de Barcelona, Barcelona, España(8).
4. Crohn's disease
Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology(9). Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel, according to the study by, there is a report of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. Laboratory tests indicated iron-deficiency anemia. There was no evidence of bleeding on esophagogastroduodenoscopic and colonofiberscopic examination. With capsule endoscopy, multiple mucosal ulcers were visualized in the jejunoileal area. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis(10).
5. Medication such as proton pump inhibitors
Gastric acid is a defense mechanism against gastrointestinal infections caused by ingested bacteria. According to the study by Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain, gastric acid suppression induced by proton pump inhibitors (PPIs) but not H2RAs is associated with an increased risk of Campylobacter and Salmonella GE(11).
6. Drugs
There is a report of a 25-year-old woman who was hospitalized repeatedly during a 5-year period due to abdominal pain, change in stool pattern, high CRP and leucocytosis. A thorough interview revealed a recreational use of cocaine, and diary recordings confirmed the association between her abdominal pain and cocaine use(12).
B. Risk Factors
1. Intestinal illness
People who have a family memeber with intestinal illness are at increased risk to develop gastroenteritis.In the study to evaluate risk factors for childhood hemolytic-uremic syndrome (HUS) and gastroenteritis during an epidemic of Escherichia coli O157:H7 infection, showed that Patients with HUS and those with uncomplicated E. coli O157:H7 gastroenteritis differed only on measures of clinical severity. In the 7 days before the onset of gastrointestinal symptoms, children with HUS and those with uncomplicated gastroenteritis were more likely to have been exposed to a family member with diarrhea than were the healthy control subjects (odds ratio = 9 for HUS vs healthy control subjects; 95% confidence interval 2 to 43; p < 0.01)(13).
2. Undercooked ground meat and foods
Undercooked ground meat and foods traditionally consumed by the Inuit were not implicated as risk factors in E. coli O157:H7 infection(14).
3. Environmental risk
Campylobacter is a common cause of bacterial gastro-enteritis characterized by multiple environmental sources and transmission pathways. According to the study, regional characteristics associated with an increased regional risk of campylobacteriosis, for at least some geographical units, were high ruminant density, high poultry density, high population density, and presence of a large poultry slaughterhouse, whereas a reduction in risk was associated with a lower percentage of people with diplomas, a lower level of precipitation, and warmer temperature. Two clusters of elevated residual risk were observed, with different location and size depending on the geographical unit used(15).
4. Biologically plausible risk
In the study to to evaluate whether the increase in incidence of campylobacteriosis observed in humans in Norway from 1995 to 2001 was statistically significant and whether different biologically plausible risk factors were associated with the incidence of campylobacteriosis in the different counties in Norway, found that treated water was a protective factor against Campylobacter infections in humans with an IRR of 0.78 per percentage increase in people supplied. Campylobacter infections did not appear to be clustered in any particular county in Norway(16).
5. Immune dysfunction
Immune system is responsible in fighting against invasion of bacteria and virus. Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS)(17).
6. Aging
Elderly are more susceptible to bacterial and virus infection and inflammation, as a result of weakened immune system.
7. Etc.
II. Diseases associated to Entetitis
1. Functional gastrointestinal disorders (PI-FGID)
A Giardia outbreak was associated with development of post-infectious functional gastrointestinal disorders (PI-FGID) and chronic fatigue syndrome (PI-CFS). According to the study by the University of Bergen, Patients with PI-CFS and/or PI-FGID 5 years after Giardia lamblia infection showed alterations in NK-cell and CD8-cell populations suggesting a possible immunological abnormality in these conditions(18).
2. Small bowel perforation
There is a report of a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum(19).
3. Severe intraluminal hemorrhage
There is a report of 4 9-month-old Simmental male calves were presented with a history of sudden death. The necropsy and microscopic findings allowed a diagnosis of enteritis and severe intraluminal hemorrhage with blood clots in the jejunum, suggestive of jejunal hemorrhage syndrome, according to the study by Institute of Veterinary Medicine Belgrade(20).
4. Chronic and recurrent occlusion events and multiple small intestinal ulcers
Cryptogenic multifocal ulcerous stenosing enteritis is a rare idiopathic disease of the small bowel. According to the study by Seoul Paik Hospital, Inje University, College of Medicine Seoul, there is a case of a 44-year-old man complained of recurrent colicky abdominal pain and dizziness. A small-bowel series revealed severe strictures and the capsule was retained in the stenotic focus without obstructive symptoms. Small bowel segmental resection with end-to-end anastomosis was performed, and the histologic examination indicated cryptogenic multifocal ulcerous stenosing enteritis. Cryptogenic multifocal ulcerous stenosing enteritis should be considered in cases of chronic or recurrent occlusion events and multiple small intestinal ulcers and strictures of unknown origin(21).
5. Hypereosinophilic syndrome
Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide(21a).
6. Systemic lupus erythematosus
There is a reprot of a 38-year-old Persian Iranian woman admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis, according to the study by Tehran University of Medical Sciences(21b)
III. Complications
1. Chronic fatigue syndrome
A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. In the study to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection, showed that in a total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis(22).
2. Irritable bowel syndrome and chronic fatigue
Giardia lamblia is a common cause of gastroenteritis worldwide, but there is limited knowledge about the long-term complications. In the study to estimate the relative risk of irritable bowel syndrome (IBS) and chronic fatigue 3 years after acute giardiasis, indicated that Infection with Giardia lamblia in a non-endemic area was associated with a high prevalence of IBS and chronic fatigue 3 years after acute illness.This shows that the potential consequences of giardiasis are more serious than previously known. Further studies are needed, especially in areas where giardiasis is endemic(23).
3. Arthritis symptoms
According to the London Kidney Research Unit, Division of Nephrology, London Health Sciences Centre, Acute bacterial gastroenteritis necessitating medical attention was associated with a higher risk of arthritic symptoms, but not arthritic medications, up to 4 yrs afterwards(24).
4. Risk of pregnancy-related hypertension
In the study to evaluate the risk of pregnancy-related hypertension (PRH) among previously healthy females from the Walkerton Health Study, Canada (2002-6), who conceived within five years of exposure to bacteria-contaminated drinking water, by the University of Western Ontario, London, indicated that of 148 eligible pregnancies, antenatal audits with blood pressure data were available for 135. PRH was detected in 20.7% pregnancies, of which 6.7% were chronic hypertension and 14.1% gestational hypertension. Although nonsignificant, we observed a consistent trend toward higher rates of PRH and mean arterial pressure, particularly prior to 20 weeks gestation, among women who reported symptomatic gastroenteritis compared to asymptomatic women. BP should be monitored closely in women after exposure to contaminated water(25).
5. Diabetes mellitus
Ingestion of Escherichia coli O157:H7 can cause a spectrum of acute illness, ranging from overt hemolytic-uremic syndrome (HUS), to gastroenteritis with bloody diarrhea, to no symptoms. According to the study by the University of Western Ontario, survivors with diarrhea-associated HUS have a significantly increased incidence of diabetes due to complete insulin deficiency, which may recur several years after the initial infection. However, less severe forms of infection, such as E. coli O157:H7 gastroenteritis without overt HUS, do not appear to result in an increased risk of type 2 diabetes(26).
6. Hypertension, Renal impairment, and Self reported cardiovascular disease
In the study to evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter, showed that Gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter was associated with an increased risk for hypertension, renal impairment, and self reported cardiovascular disease. Annual monitoring of blood pressure and periodic monitoring of renal function may be warranted for individuals who experience E coli O157:H7 gastroenteritis(27).
Other study also indicated that acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection(28).
7. Celiac disease
According to the study by the McMaster University Medical Centre, CD should be considered in the differential diagnosis of persistent IBS-like symptoms after an episode of infectious gastroenteritis(29).
8. Seizures and even GE encephalopathy
In the study to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections of a data of a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009, found that Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood-stained stool was noted in the norovirus group. Rotavirus-infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non-specific findings. None of them developed subsequent seizure attack after the GE episode(29a).
9. Dehydration
According to the Department of Pediatrics, CHU Sainte-Justine, From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001)(29b).
10. Etc.
III. Misdiagnosis and diagnosis
A. Misdiagnosis
1. Primary NK/T cell lymphoma
Primary natural killer (NK) cell like T cell lymphoma of the terminal ileum is extremely rare. It most frequently occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. NK/T cell lymphoma involving gastrointestinal tract has characteristic endoscopic features of Inflammatory bowel disease. According to the study by the Hallym University College of Medicine, there is a case of primary NK/T cell lymphoma misdiagnosed as Behcet's enteritis of the terminal ileum colonoscopically and complicated by cecal bleeding and perforation(30).
2. Acute appendicitis
Acute appendicitis is the most common cause of urgent surgery in children. Bacterial enteritis limited to the ileocecal region appears to be responsible for an appreciable number of unnecessary appendectomies. On the other hand, diagnostic errors in appendicitis may delay early appendectomy and result in the formation of appendiceal mass(31).
3. Acute abdomen pain
Enteritis cystica profunda, an uncommon condition, is characterized by nonneoplastic cystic spaces within the wall of the small bowel. The third case of enteritis cystica profunda in children is presented with special emphasis on diagnosis and treatment. This rare entity may mimic acute abdomen and should be kept in mind in the differential diagnosis(32).
4. Others
Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. According to the study by, there is a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone(33).
B. Diagnosis
Diagnosis is depending to the underlined causes of the diseases
1. Stool culture
The aim of the test is to identify the bacteria and virus which cause the diseases. According to the study of "New methods for detection of campylobacters in stool samples in comparison to culture" by the University Hospital, Frankfurt/Main, current detection in stools is done essentially by culture on selective and nonselective media with filtration. These methods were compared to 2 molecular biology methods, an in-house real-time PCR and a multiplex PCR named Seeplex Diarrhea ACE Detection, and 3 immunoenzymatic methods, Premier Campy, RidaScreen Campylobacter, and ImmunoCard Stat!Campy. Out of 242 stool specimens tested, 23 (9.5%) fulfilled the positivity criteria, i.e., they were positive by one or both culture methods or, in case of a negative culture, by a positive molecular method and a positive immunoenzymatic method. The striking feature of this study is the low sensitivity of culture, in the range of 60%, in contrast to immunoenzymatic and molecular tests(34).
2. [13]C-acetate breath test
[13C]acetate breath test is the measure of gastric emptying of the liquid phase both in liquid and semisolid test meals by simultaneous radioscintigraphy.There is a report of eosinophilic enteritis in which the (13)C-acetate breath test was effective(35).
IV. Preventions
A. The do and do not's list
In case of entertitis outbreak
A.1. The article by All Refer.com health(36) suggested the followings
1. Always wash hands after using the toilet and before eating or preparing food or drink.
2. You may also clean your hands with a 60% alcohol based product.
3. Avoid drinking from unknown sources, such as streams and outdoor wells, without boiling the water first.
4. Use only clean utensils for eating or handling foods, especially when handling eggs and poultry.
5. Cook food completely and properly.Store food appropriately in coolers.
A.2. Others according to the article of Viral Gastroenteritis by National Digestive Diseases Information Clearinghouse (NDDIC)(37) the following may increase the risk of virural entertitis
1. Touching contaminated surfaces or objects and then touching their mouths.
2. Sharing food, drink, or eating utensils with infected people
3. Eating foods that are contaminated with the virus, such as oysters from contaminated waters
4. Swallowing airborne particles that contain viruses.
B. Diet ot prevent Enteritis
1. Probiotic
Oral administration of a probiotic preparation was shown to be effective in preventing the recurrence of chronic pouchitis in a classic double-blind, placebo-controlled trial. According to the study by the East Carolina University, Greenville, dysbiosis, a condition of microbial imbalance, has been implicated in the pathogenesis of inflammatory bowel disease. Rather than administering antibiotics to treat the microflora with each relapse of pouchitis, the emphasis was placed on preventing chronic flare-ups by administering probiotics to correct dysbiosis. In addition, the choice of bacteria, optimal dose, and timing of administration have yet to be determined. Finally, the mechanisms by which probiotics provide their beneficial effects remain unresolved(38).
2. Green tea
In the study to investigate the Green tea's repair fasting-induced mucosal damage in rat intestine, showed that use of green tea was associated with a significant increase in total plasma antioxidants (P < 0.001), and mucosal SOD (P < 0.001), catalase (P = 0.006) and GPx (P = 0.017), but a significant decrease in MPO activity (P < 0.001). Green tea reverses the fasting-induced damage to the intestinal mucosa by its antioxidant and anti-inflammatory effect(39).
3. Origanum vulgaris and Allium sativum
According to the study to investigate the efficacy of Virbamix PE (Virbac SA, France) an appetite enhancer and feed flavouring material containing plant extracts of Origanum vulgaris and Allium sativum, added to the feed at one single dose in the control of proliferative enteropathy (PE) in weaning pigs, in comparison to reference treatment with tiamulin (Tiamutine 6.5 Premix/Ceva Animal Health) group and a negative control group indicated that administration of Virbamix PE was found to be effective for the control of PE, as shown by the reduction of prevalence of Lawsonia intracellularis in the intestine at the end of the treatment period, as determined by PCR method comparatively with the T1 group, while no significant difference was found between T2 and T3 groups. The diarrhoea score (DS) was significantly higher (P < 0.05) in the control group in comparison with T2 and T3 groups. However, no significant differences were noticed between T2 and T3 groups during the treatment period (P > 0.05)(40).
4. Etc.
C. Phytochemicals to prevent Enteritis
1. Genistein
Genistein, a principal soy isoflavone, has been identified as a protein kinase inhibitor that possesses immunosuppressive and anti-inflammatory properties. According to the study by the Louisiana State University School of Medicine, Genistein, at low doses, also appeared to attenuate immunohistochemical staining for inducible nitric oxide synthase (iNOS) and nitrotyrosine. The beneficial effects of genistein were not apparent at doses above 0.1 mg/kg. Genistein also inhibited LPS-induced nitrite production by cultured macrophages and protected against LPS-induced necrosis despite its ability to cause apoptosis. These results indicate that genistein displayed mild anti-inflammatory properties which may, in part, involve an attenuation of nitric oxide release via inducible nitric oxide synthase, and the formation of peroxynitrite(41).
2. Resveratrol and curcumin
In the study to investigate the potential anti-inflammatory and immunomodulatory mechanisms of the above mentioned compounds in a murine model of hyper-acute Th1-type ileitis following peroral infection with Toxoplasma gondii conducted by the Charité-Universitätsmedizin Berlin, indicated that Oral treatment with Resveratrol, Curcumin or Simvastatin ameliorates acute small intestinal inflammation by down-regulating Th1-type immune responses and prevents bacterial translocation by maintaining gut barrier function. These findings provide novel and potential prophylaxis and treatment options of patients with inflammatory bowel diseases(42).
3. Beta-carotene
Beta-carotene is known as a potent free radical quencher and antioxidant. According to the study conducted by the B'nai Zion Medical Center, Haifa, Israel, the result demonstrate the effectiveness of beta-carotene in a rat model as a prophylactic dietary measure in reducing the effects of acid-induced enteritis and raise the possibility that patients with Crohn's disease may benefit from the consumption of natural beta-carotene(43).
D. Antioxidants to prevent Enteritis
1. Melatonin
In the study to tests the hypothesis that "the intake of melatonin can minimize the morphological features of cell damage associated with radiation enteritis", conducted by the Assuit University, Assuit, Egypt, found that Administration of melatonin prior to irradiation can protect the intestine against X-rays destructive effects, i.e. radiation enteritis(44).
2. Cu/Zn-superoxide dismutase (SOD1)
In the study to analyze the therapeutic value of Cu/Zn-superoxide dismutase (SOD1) supplementation in an experimental model of radiation-induced intestinal inflammation and explore its mechanistic effects, showed that Treatment with SOD1 decreases oxidative stress and adhesion molecule upregulation in response to abdominal irradiation. This is associated with an attenuation of the radiation-induced intestinal inflammatory response(45).
3. Vitamin A
Vitamin is a free radical scavenger. It emhances the immune system in fighting against forming of free radicals and foreign invasion. In the study to examine Serum retinol, retinyl palmitate, and total vitamin A concentrations, and jejunoileal morphology in neonatal calves infected with Cryptosporidium parvum, showed that
Cryptosporidium parvum infection was associated with significant (P < or = 0.05) reduction in postadministration serum retinol, retinyl palmitate, and total vitamin A concentrations in calves of groups 2, 3, and 4. Cryptosporidium parvum infection caused significant (P < or = 0.05) reduction in villus height. Decreased villus height, villus blunting and fusion, and attenuation of the intestinal mucosa were associated with reduced absorption of vitamin A, as indicated by lower peak postadministration retinyl palmitate concentration in C parvum-infected calves(46).
4. Vitamin E
In the study to the effects of a nonenzymatic oxygen radical scavenger (vitamin E) and an exogenous PGE1 analog known to increase mucosal blood flow (misoprostol) on acute radiation enteritis in rats, showed that ionizing radiation reduces in vivo intestinal fluid absorption without significant changes in histologic or morphometric appearance. Treatment with vitamin E, but not misoprostol, protects gastrointestinal mucosa against radiation-induced absorptive injury(47). Other study showed that selenium, vitamin E and selenium plus vitamin E pretreatments prior to whole abdominal irradiation on intestinal injury may have some beneficial effects against irradiation-induced intestinal injury(48).
V. Treatments
A. In conventional medicine perspective
Treatment depending to the underlined causes of the diseases.
Beside taking certain steps in relieving the symptoms of the patients by providing short-lived and general supportive care(49), such as
Oral rehydration therapy for older children and adults:
- Drink clear liquids only, such as water, sports drinks (best), fruit juice and dilute tea.
- Drink small quantities of fluids frequently, such as 2 tablespoons of fluid every 5 minutes.
- The absence of food allows the intestines to rest.
- May be able to advance to full liquid diet once symptoms improve
- Effective to treat mild to moderate dehydration
- Metoclopramide (Reglan) but side effects are not limit to hives, difficulty breathing, swelling of your face, lips, tongue, or throat.
- Ondansetron (Zofran) but side effects are not limit to headache, fatigue, constipation, etc.
- Olanzapine has been shown to be a safe and effective agent for the prevention of nausea and vomiting for patient with entertitis, but side effects are not limit to hives; difficulty breathing; swelling, etc.
- Prochlorperazine (Compazine, Compro) but side effects are not limit to Constipation, headaches, dizziness, etc.
- Loperamide (Imodium) but side effects are not limit to abdominal pain, constipation, drowsiness, dizziness, dry mouth, fatigue, nausea, vomiting, etc.
- Diphenoxylate and Atropine (Lomotil) but side effects are not limit to thirst, decreased urination, muscle cramps, weakness, fainting, etc.
Atibiotic used are depending to types infectous organism, including Ciprofloxacin (Cipro), Sulfamethoxazole and Trimethoprim (Bactrim, Septra, TMP-SMX), Ceftriaxone (Rocephin) Cefotaxime (Claforan) Vancomycin (Vancocin, Lyphocin, etc., but side effects are not limit to rash, diarrhea, abdominal pain, nausea/vomiting, drug fever, hypersensitivity (allergic) reactions, etc.
According to the study by Enterics laboratory, US Army Research Unit, Nairobi, in screening of the 651 patients screened, the highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin(49a).
A.2. Viral entertitis
There is no specific treatment for viral entertistis as antibiotic are not helpful in treating the diseasse. Make sure you are vaccinate against certain virus in a specific season.
According to the study by Beijing Friendship Hospital Affiliate of Capital University of Medical Sciences, clinical effective rate of Novalac AD in infantile rotavirus enteritis was 100%. All 20 subjects stool turned normal and systemic symptoms disappeared after treatment, with 17 within 48 h (85%,17/20) and 3 within 72 h (15%, 3/20)(50).
A.3. Radiation-induced enteritis
Radiation-induced enteritis van be prevented, according to the University Hospital Mannheim, Reduction of radiation dose and field size are still the most important factors in the prevention of acute and chronic radiation enteritis. Valid data particularly on the treatment of chronic radiation enteritis are lacking. A better understanding of the pathopysiology especially in chronic radiation enteritis might offer new therapeutic perspectives. Inhibition of TGF-beta, for example, might be a new promising therapy approach(50a).
According to the study the Provincial Hospital affiliated to Shandong University, in the evaluation of the effect of actovegin (Nycomed, deproteinized hemoderivative of calf blood injection) on intestinal mucosa in rats with acute radiation enteritis, and observe the changes of expression of apoptosis-related bcl-2/bax genes, showed that Actovegin accelerates the recovery of the acute radiation-injured intestinal mucosal epithelium by decreasing apoptosis via down-regulation of the expression of activating apoptosis protein bax and up-regulation of inhibiting apoptosis protein bcl-2(51).
B. In herbal medicine perspective
1. Psidium guajava L (Guava)
In the study to observe the clinical effect of olium Psidium guajava (PG) in treating infantile rotaviral enteritis in Sixty-two patients of rotaviral enteritis randomly divided into the treated group treated with PG and the control group treated with Gegen Qinlian decoction, showed that The rate of recovery in 3 days of the treated group was 87.1%, significantly higher than that of the control group (58.1%, P < 0.05). The time of ceasing diarrhea of the treated group (25.1 +/- 9.5 hr) was significantly shorter than that of the control group (38.7 +/- 15.2 hr, P < 0.01)(52).
2. Gastritis-granule and Wei-Mei-Su
According to the study by Dr. Pu CS., In the group treated with granule-gastritis, the effective rate for CP was 81.3% (26/32), and the improvement rates of the symptoms and histopathological lesion were 87.5% (28/32) and 40.6% (13/32) respectively. In the group treated with Wei-Mei-Su as the control group, the figures were 25%, 40% and 10% respectively. These differences were statistically significant (P less than 0.01-0.000). The results showed that the effect of granule-gastritis on chronic gastritis infected with CP was better than that of Wei-Mei-Su(53).
3. Etc.
C. In traditonal Chinese medicine perspective
1. Qiwei baizhu powder
Sixty cases of rotaviral enteritis treated with Qiwei Baizhu Powder (QWBZP) revealed a better efficacy than that treated with Oral Rehydration solution (ORS, chi 2 = 6.07, P < 0.05), according to the study by the Hunan Academy of Traditional Chinese Medicine(54).
2. Jiechang Mixture (JCM)
In the study to evaluate the therapeutic effect and mechanism of Jiechang Mixture (JCM) in treating infantile mycotic enteritis, showed that the time of stool forming, diarrhea relieving and fungi vanishing in the treated group were significantly shorter than those in the control group (P < 0.01), and JCM also showed a better effect in improving clinical symptoms and signs of patients than the control. Results of experimental study showed that JCM could abate the ink evacuation of small intestine in mice. The fungi inhibitory test suggested that Candida albicans was susceptible to JCM(55).
3. Zhixie buye mixture
In the study to observe the therapeutic effect of Zhixie Buye mixture (ZXBYM) on infantile diarrhea patient with mild and middle degree of dehydration, indicated that the ZXBYM is an effective mixture in the treatment of diarrhea with dehydration. It has a good prospect of development and application(56).
4. Fu-zheng qu-xie
In the study of the of fu-zheng qu-xie on gastric disease infected with Campylobacter pyloridis] by Jiangsu Provincial Hospital of TCM, pointed out that the principle of Chinese herbal medicine treatment of gastric disease by campylobacter pyloridis was fu-zheng qu-xie. Fu-zheng was achieved by Astragalus membranaceus, Atractylodes macrocephala and Paeonia lactiflora, whereas qu-xie by Taraxacum monogolicum and Oldenlandia diffusa. Chinese herbal medicine for fu-zheng played an important role in modulating immune function. Qu-xie was directly disinfective and indirectly anti-bacterial. Chinese herbal medicine combined with western drugs will decrease the side effects and enhance the curative effect at the same time(57).
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