Category Archive Gastrointestinal & Liver Disease

Ostomy surgery of the bowel, also known as bowel diversion, refers to surgical procedures that reroute the normal movement of intestinal contents out of the body when part of the bowel is diseased or removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that waste exits through the abdominal wall instead of passing through the anus.

Ostomy surgery of the bowel may be temporary or permanent, depending on the reason for the surgery. A surgeon specially trained in intestinal surgery performs the procedure in a hospital. During the surgery, the person receives general anesthesia.

Ostomy surgeries of the bowel include

• ileostomy
• colostomy
• ileoanal reservoir
• continent ileostomy

What is the bowel?

The bowel is another word for the small and large intestines. The bowel forms the largest part of the gastrointestinal (GI) tract—a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The anus is a 1-inch-long opening through which stool leaves the body. Organs that make up the GI tract include the mouth, esophagus, stomach, small intestine, large intestine, and anus. The small intestine measures about 20 feet long in adults and includes

• the duodenum—the first part of the small intestine nearest the stomach
• the jejunum—the middle section of the small intestine between the duodenum and ileum
• the ileum—the lower end of the small intestine

Peristalsis—a wavelike movement of muscles in the GI tract—moves food and liquid through the GI tract. Peristalsis, along with the release of hormones and enzymes, helps food digest. The small intestine absorbs nutrients from foods and liquids passed from the stomach. Most food digestion and nutrient absorption take place in the small intestine.

The large intestine consists of the cecum, colon, and rectum. The cecum connects to the last part of the ileum and contains the appendix. The large intestine measures about 5 feet in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to semisolid or solid feces, or stool. Stool passes from the colon to the rectum. The rectum measures 6 to 8 inches in adults and is located between the last part of the colon and the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum, through the anus, and out of the body.

Why does a person need ostomy surgery of the bowel?

A person may need ostomy surgery of the bowel if he or she has

• cancer of the colon or rectum
• an injury to the small or large intestine
• inflammatory bowel disease—longlasting disorders, such as Crohn’s disease and ulcerative colitis, that cause irritation or sores in the GI tract
• obstruction—a blockage in the bowel that prevents the flow of fluids or solids
• diverticulitis—a condition that occurs when small pouches in the colon called diverticula become inflamed, or irritated and swollen, and infected

What is a stoma?

During ostomy surgery of the bowel, a surgeon creates a stoma by bringing the end of the intestine through an opening in the abdomen and attaching it to the skin to create an opening outside the body. A stoma may be three-fourths of an inch to a little less than 2 inches wide. The stoma is usually located in the lower part of the abdomen, just below the beltline. However, sometimes the soma is located in the upper abdomen. The surgeon and a wound, ostomy, and continence (WOC) nurse or an enterostomal therapist will work together to select the best location for the stoma. A removable external collection pouch, called an ostomy pouch or ostomy appliance, is attached to the stoma and worn outside the body to collect intestinal contents or stool. Intestinal contents or stool passes through the stoma instead of passing through the anus. The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever other digestive muscles contract. Ileostomy and colostomy are the two main types of ostomy surgery of the bowel during which a surgeon creates a stoma.

What is an ileostomy?

An ileostomy is a stoma created from a part of the ileum. For this surgery, the surgeon brings the ileum through the abdominal wall to make a stoma. An ileostomy may be permanent or temporary. An ileostomy is permanent when the surgeon removes or bypasses the entire colon, rectum, and anus. A surgeon may perform a temporary ileostomy for a damaged or an inflamed colon or rectum that only needs time to rest or heal from injury or surgery. After the colon or rectum heals, the surgeon repairs the opening in the abdominal wall and reconnects the ileum so stool will pass into the colon normally. An ileostomy is the most common temporary bowel diversion. A surgeon performs an ileostomy most often to treat inflammatory bowel disease or rectal cancer.

What is a colostomy?

A colostomy is a stoma created from a part of the colon. For this surgery, the surgeon brings the colon through the abdominal wall and makes a stoma. A colostomy may be temporary or permanent. The colostomy is permanent when the surgeon removes or bypasses the lower end of the colon or rectum. A surgeon may perform a temporary colostomy for a damaged or an inflamed lower part of the colon or rectum that only needs time to rest or heal from injury or surgery. Once the colon or rectum heals, the surgeon repairs the opening in the abdominal wall and reconnects the colon so stool will pass normally. A surgeon performs a colostomy most often to treat rectal cancer, diverticulitis, or fecal incontinence–the accidental loss of stool.

What is an ileoanal reservoir?

An ileoanal reservoir is an internal pouch made from the ileum. This surgery is a common alternative to an ileostomy and does not have a permanent stoma. Also known as a J-pouch or pelvic pouch, the ileoanal reservoir connects to the anus after a surgeon removes the colon and rectum. Stool collects in the ileoanal reservoir and then exits the body through the anus during a bowel movement. An ileoanal reservoir is an option after removal of the entire large intestine when the anus remains intat and disease-free. The surgeon often makes a temporary ileostomy before or at the time of making an ileoanal reservoir. Once the ileoanal reservoir heals from surgery, the surgeon reconnects the ileum to the ileoanal pouch and closes the temporary ileostomy. A person does not need a permanent external ostomy pouch for an an ileoanal reservoir.

A surgeon creates an ileoanal reservoir most often to treat ulcerative colitis or familial adenomatous polyposis. Familial adenomatous polyposis is an inherited disease characterized by the presence of 100 or more polyps in the colon. The polyps may lead to colorectal cancer if not treated. People with Crohn’s disease usually are not candidates for this procedure.

What is a continent ileostomy?

A continent ileostomy is an internal pouch, sometimes called a Kock pouch, fashioned from the end of the ileum just before it exits the abdominal wall as an ileostomy. The surgeon makes a valve inside the pouch so that intestinal contents do not flow out. The person drains the pouch each day by inserting a thin, flexible tube, called a catheter, through the stoma. The person covers the stoma with a simple patch or dressing. A continent ileostomy is an option for people who are not good candidates for an ileoanal reservoir because of damage to the rectum or anus and who do not want to wear an ostomy pouch.

Creating the Kock pouch is a delicate surgical procedure that requires a healthy bowel for proper healing. Therefore, a surgeon usually does not perform Kock pouch surgery during an acute attack of bowel disease. A continent ileostomy is now uncommon, and most hospitals do not have a specialist who knows how to perform this type of surgery. As with ileoanal reservoir surgery, the surgeon usually removes the colon and rectum to treat the original bowel disease, such as ulcerative colitis or familial adenomatous polyposis. People with Crohn’s disease are not usually candidates for this procedure.

What are the complications of ostomy surgery of the bowel?

Complications of ostomy surgery of the bowel may include

• skin irritation
• stoma problems
• blockage
• diarrhea
• bleeding
• electrolyte imbalance
• infection
• irritation of the internal pouch, or pouchitis
• vitamin B12 deficiency
• phantom rectum
• short bowel syndrome
• rectal discharge

Skin Irritation

Skin irritation is the most common complication for people with an ostomy. If the external ostomy pouch does not fit properly, stool or stool contents can leak out around the stoma and under the pouch. When irritated, a person’s skin will become itchy, red, and uncomfortable. When changing the pouch, a person can use an ostomy powder on the skin around the stoma to treat skin irritation. If the skin irritation does not improve, the person should talk with a WOC nurse or an enterostomal therapist—who is specially trained in ostomy care and rehabilitation—or another health care provider about the symptoms. Skin irritation may occur around the stoma for people who have an ileostomy or a colostomy. People who have ileoanal reservoir surgery may have skin irritation around the anus. Sometimes, using a barrier ointment to protect the skin around the anus can help treat and prevent irritation.

Stoma Problems

Stoma problems include the following:

• Hernia. A stoma hernia, seen as a bulge in the skin around the stoma, is a weakening of the abdominal wall around the stoma site. As with all hernias, a stoma hernia continues to increase in size and may eventually need surgical repair when it becomes too large. Rarely, the intestine gets trapped or kinked within the hernia and becomes blocked. A blocked intestine that loses its blood supply requires emergency surgery.
• Prolapse. A stoma prolapse occurs when the bowel pushes itself through the stoma. A person may be able to push the bowel back through the stoma and keep it in place with a stoma shield. If not, the stoma prolapse may require special care and a larger ostomy pouch. A stoma prolapse that becomes blocked or loses its blood supply requires surgical repair.
• Narrowing of the stoma. Narrowing of the stoma makes it difficult for stool to pass through the stoma. A narrowed stoma may need surgical repair.

Blockage

Occasionally, an ileostomy or a colostomy does not function for a short time. If the stoma has not passed intestinal content or stool for 4 to 6 hours and the person is experiencing cramping or nausea, the ileum or colon may be blocked. Blockage may occur when foods that are hard to digest get stuck in the ileum or colon.

Abdominal adhesions in the ileum or colon may cause a blockage as well. Abdominal adhesions are bands of fibrous tissue that form between abdominal tissues and organs, causing them to kink or narrow. Most blockages get better without additional surgery by not eating food and drinking only clear liquids to rest the bowel for a short time.

Diarrhea

Diarrhea is loose, watery stools. A person has diarrhea if he or she passes loose stools three or more times a day. Diarrhea occurs when intestinal contents pass through the small intestine too quickly for fluid and mineral absorption. When fluids and minerals such as sodium and potassium are not absorbed, they leave the body. Diarrhea can lead to dehydration, malnutrition, and weight loss. Diarrhea is common, even normal, with an ileostomy or ileoanal reservoir. In most cases of diarrhea, the only treatment necessary is replacing lost fluids and electrolytes to prevent dehydration. Electrolytes are minerals in body fluids that are part of salts, including sodium, potassium, magnesium, and chloride. People should maintain good daily hydration by drinking plenty of water and liquids, such as fruit juices, sports drinks, caffeine-free soft drinks, and broths. In some cases of diarrhea, a health care provider may recommend changes in diet and may prescribe medications to treat diarrhea.

Bleeding

As with any major surgery, ostomy surgery may cause internal bleeding. If too much blood is lost, the person may require a blood transfusion. Bleeding may also occur through the stoma or through the anus after surgery.

Electrolyte Imbalance

The main function of the large intestine is to absorb water, nutrients, and electrolytes from partially digested food that enters from the ileum. When a surgeon removes the large intestine, absorption of electrolytes does not occur to the same extent, making electrolyte imbalance more likely. Diarrhea, excessive sweating, and vomiting can increase the chance of developing electrolyte imbalance. Symptoms of electrolyte imbalance may include

• fatigue, or feeling tired
• weakness
• nausea
• muscle problems such as spasms, weakness, uncontrolled twitching, and cramps
• dizziness and confusion

People with these symptoms require medical care and should contact a health care provider.

People who have had their large intestine removed should talk with a health care provider or dietitian about diets that help maintain electrolyte balance.

Infection

The GI tract is filled with bacteria that can leak out during ostomy surgery and infect areas inside the abdomen. Bacteria entering the body through the stoma or anus can also cause an infection. The person’s skin around the stoma may also become infected with bacteria or skin fungus. Health care providers treat infections with antibiotics. Symptoms of infection may include

• fever
• back pain
• poor appetite
• nausea and vomiting

Irritation of the Internal Pouch, or Pouchitis

Pouchitis is an irritation or inflammation of the lining of an ileoanal reservoir or a continent ileostomy pouch. A health care provider treats pouchitis with antibiotics. For severe or chronic pouchitis, a health care provider may prescribe immunosuppressive medications, such as corticosteroids. Symptoms of pouchitis include

• frequent bowel movements with diarrhea
• an urgent need to have a bowel movement
• a feeling of pressure in the pouch
• abdominal pain
• cramping or bleeding
• dehydration
• low-grade fever
• a general unwell feeling

Vitamin B12 Deficiency

Ostomy surgery of the bowel may affect vitamin B12 absorption from food and result in a gradual drop in vitamin B12 levels in the body. Low levels of vitamin B12 can affect the body’s ability to use nutrients and may cause anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen. Health care providers treat vitamin B12 deficiency with vitamin B12 supplements.

Phantom Rectum

The phantom rectum is the feeling of needing to have a bowel movement even though the rectum is not present. The phantom rectum is relatively common. Symptoms are usually mild and often go away without treatment. However, for some people, the phantom rectum may occur for years after a surgeon removes the rectum. Some people with phantom rectum may feel pain. Health care providers treat rectal pain with medications such as pain relievers and sometimes antidepressants. To help control phantom rectum, a health care provider may recommend complementary therapies such as guided imagery and other relaxation techniques.

Short Bowel Syndrome

A short bowel syndrome is a group of problems related to inadequate absorption of nutrients after removal of part of the small intestine. People with short bowel syndrome cannot absorb enough water, vitamins, and other nutrients from food to sustain life. Diarrhea is the main symptom of short bowel syndrome. Other symptoms may include

• cramping
• bloating
• heartburn
• weakness and fatigue
• vomiting
• excessive gas
• foul-smelling stool

Short bowel syndrome is uncommon and can occur with Crohn’s disease, trauma, or other conditions that lead to the removal of a large amount of the small intestine.

A health care provider will recommend a treatment for short bowel syndrome based on a person’s nutritional needs. Treatment may include nutritional support, medications, and surgery.

Rectal Discharge

People with an ileostomy or a colostomy whose lower colon, rectum, and anus are still present may experience a discharge of mucus from their rectum. Mucus is a clear fluid made by the GI tract that coats and protects the lining of the bowel. Mucus within the bypassed part of the colon may leak out of the rectum from time to time or gradually build up, forming a small, stool-like ball that passes out of the rectum. A person cannot control mucus production and rectal discharge. However, people who have rectal discharge can learn how to manage and cope with this problem.

Living with an Ostomy

At first, living with an ostomy can be overwhelming and scary for some people. However, most people adjust and lead active and productive lives. A WOC nurse or an enterostomal therapist will provide education, support, and medical advice on topics that include the following:

• what to expect after ostomy surgery
• caring for an ostomy
• resuming normal activities after ostomy surgery
• maintaining personal relationships after ostomy surgery
• coping with practical, social, and emotional issues

What to Expect after Ostomy Surgery

Once the person is home from the hospital, the first week or two are considered an extension of the hospital stay. Most people will tire quite easily when they first come home. Getting enough rest is important. Gradually, stamina and strength will improve. Most people can return to work about 6 to 8 weeks after surgery. People may have certain GI issues—such as gas, diarrhea, and constipation—as the bowel heals, depending on the type of bowel diversion.

Ileostomy and colostomy. During the early weeks and months after surgery, people with an ileostomy or a colostomy may have excessive gas. This extra gas will decrease once the bowel has had time to heal and the person resumes a regular diet.

Ileoanal reservoir. People with an ileoanal reservoir initially have about six to 10 bowel movements a day. The newly formed ileoanal reservoir takes several months to stretch and adjust to its new function. After the adjustment period, bowel movements decrease to as few as four to six a day. People with an ileoanal reservoir may have mild fecal incontinence and may have to get up during periods of sleep to pass stool.

Continent ileostomy. Similar to people with an ileostomy or a colostomy, people with a continent ileostomy may have excessive gas during the early weeks and months after surgery.

Caring for an Ostomy

During the recovery in the hospital and at home, a person will learn to care for the ostomy. The type of care required depends on the type of ostomy surgery. A WOC nurse or an enterostomal therapist will teach a person about special care after ostomy surgery.

Ileostomy and colostomy. People with an ileostomy or a colostomy will to learn how to attach, drain, and change their ostomy pouch and care for the stoma and the surrounding skin. Ostomy pouches, or pouching systems, may be one piece or two pieces. They include a barrier, also called a wafer or flange, and a disposable plastic pouch. In a two-piece system, the pouch can be detached or replaced without removing the barrier. For both systems, the barrier attaches to the skin around the stoma and protects it from stool. The length of time the barrier stays sealed to the skin depends on many things, such as

• how well the barrier fits
• the condition of the skin around the stoma
• the person’s level of physical activity
• the shape of the body around the stoma

Most people can leave the barrier on for 3 to 7 days. However, a person should change the barrier as soon as stool starts to go underneath it and onto the skin.

Most ostomy pouches empty through an opening in the bottom. Emptying the pouch several times a day reduces the chance of leakage and bulges underneath the person’s clothing. A person should empty the pouch when it is about one-third full. He or she should rinse the pouch in a two-piece system before reattaching it to the skin barrier.

How often a person needs to change his or her pouching system depends on the type of system. Many pouching systems may be worn for 3 to 7 days. Some pouching systems are made to be changed every day. When changing a pouch system, the person should

• wipe away any mucus on the stoma
• clean the skin around the stoma with warm water and a washcloth
• rinse the skin thoroughly
• dry the skin completely

People may use mild soap to clean the skin. However, the soap should not have oils, perfumes, or deodorants, which may cause skin problems or keep the skin barrier from sticking. A WOC nurse or an enterostomal therapist can give advice if a person has problems attaching the skin barrier or keeping it attached.

When changing the pouching system, people should inspect the stoma and contact a health care provider about any dramatic changes in stoma size, shape, or color. People should look for blood and signs of skin irritation around the stoma. Sensitivities or allergies to ostomy products such as adhesives, skin barriers, pastes, tape, or pouch materials can cause skin irritation. People with pouching systems can test different products to see if their skin reacts to them. People should use only ostomy products recommended by their health care provider.

Ileoanal reservoir. People with an ileoanal reservoir will learn how to care for irritated skin around the anus resulting from frequent stools or fecal incontinence. A WOC nurse or an enterostomal therapist may recommend pelvic floor exercises to help strengthen the muscles around the anus.

Continent ileostomy. People with a continent ileostomy will learn how to insert a catheter through the stoma to drain the internal pouch. They can drain the pouch by standing in front of the toilet or by sitting on the toilet and then emptying the catheter. During the first few weeks after a continent ileostomy, the person needs to drain the internal pouch about every 2 hours. After a few weeks, the person is able to go 4 to 6 hours between pouch drainings. The person should wash his or her hands with soap and water after using a catheter. The person should clean the skin around the stoma with warm water and a washcloth and let the skin dry completely.

Resuming Normal Activities after Ostomy Surgery

After ostomy surgery, people should be able to resume their normal activities after healing completes and their strength returns. However, they may need to restrict activities, including driving and heavy lifting, during the first 2 to 3 weeks after surgery. Strenuous activities, such as heavy lifting, increase the chance of a stoma hernia. A person who has recovered from the ostomy surgery should be able to do most of the activities he or she enjoyed before the ostomy surgery, even swimming and other water sports. The only exceptions may be contact sports such as football or karate. People whose jobs include strenuous physical activities should talk with their health care provider and employer about making adjustments to job responsibilities.

People should avoid extreme physical exercise and sports activities for the first 3 months. Walking, biking, and swimming are fine and should be encouraged as long as they are not overly strenuous.

People with an ostomy should talk with their health care provider about when they can resume normal activities.

Maintaining Personal Relationships after Ostomy Surgery

People with an ostomy should be able to maintain personal relationships just as before their surgery. Some people may worry that friends and relatives will have negative reactions to their ostomy and stoma. Only a spouse, sexual partner, or primary caretaker needs to know the details of the ostomy surgery. People can choose how much they share with others about their health condition, including the ostomy.

People can still maintain a satisfying sexual relationship after ostomy surgery and may resume sexual activity as soon as the health care provider says it is safe to do so. People should talk with their health care provider about any concerns they have with maintaining sexual relations. For people with ostomies, the health care provider can also give information about ways to protect the stoma during sexual activity. People with ostomies may want to ask about specially designed apparel to enhance intimacy. Communicating with a sexual partner is essential. People should share their concerns and wishes and listen carefully to their partner’s concerns.

Coping with Practical, Social, and Emotional Issues

Although ostomy surgery can bring great relief, many people have problems coping with the practical, social, and emotional issues related to having this type of surgery. Every person reacts differently. A person’s emotions may change frequently during recovery. People with an ostomy adjust faster and experience fewer problems when they have help from their family members, partners, and health care providers. Community and online resources for support and education are available to help people with an ostomy cope with practical, social, and emotional issues. A WOC nurse and an enterostomal therapist can provide a list of resources and support groups.

Eating, Diet, and Nutrition

For the first 6 to 8 weeks after ostomy surgery, the health care provider may recommend a low-fiber diet to give the bowel time to heal. The health care provider will tell a person when to add high-fiber foods to the diet. People should introduce fiber into the diet gradually, as high-fiber foods may cause blockage.

Most people are eventually able to resume their regular diet and eat what they like. However, various foods may affect the GI tract differently. Just as before ostomy surgery, certain foods are more likely to cause gas, diarrhea, constipation, or incomplete digestion. Foods such as cucumbers, cabbage, broccoli, onions, fish, eggs, and beans may cause more gas and odor than others. People should consume carbonated drinks and chew gum with moderation, as they may also cause gas. Constipation is often the result of an unbalanced diet or eating and drinking too little. After ostomy surgery, people should

• avoid large amounts of liquids with meals
• drink plenty of liquids between meals
• eat regularly
• avoid high-fiber foods on an empty stomach
• introduce new foods gradually
• chew foods thoroughly

People should talk with their health care provider or dietitian about what diet is right for them.

References

Idiopathic Hypertrophic Gastropathy /Menetriers disease (MD) hypoproteinemic hypertrophic gastropathy, is a rare, acquired, premalignant, excessive protein-losing hypertrophic gastropathy disorder characterized by giant mucosal folds in the proximal part of the stomach, thickening of the mucous membrane in the form of giant rugal folds, diminished acid secretion, and a protein-losing state with hypoalbuminemia in giant gastric rugal folds in the body and fundus of the stomach, often with antral sparing, decreased acid secretion, increased gastric mucus production, and hypoalbuminemia and occasional severe upper gastrointestinal hemorrhage.^[rx–rx]secondary to protein loss in the gastric mucosa [rx]. It causes the ridges along the inside of the stomach wall—called rugae—to enlarge, forming giant folds in the stomach lining. The rugae enlarge because of an overgrowth of mucous cells in the stomach wall. It affects men more frequently than women, and the typical age at diagnosis is between 30 to 60 years.

In a normal stomach, mucous cells in the rugae release protein-containing mucus. The mucous cells in enlarged rugae release too much mucus, causing proteins to leak from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Ménétrier’s disease also reduces the number of acid-producing cells in the stomach, which decreases stomach acid.

Another name

• Giant hypertrophic gastritis or
• Hypoproteinemic hypertrophic gastropathy
• Idiopathic hypertrophic gastropathy.
• Rare idiopathic hypertrophic gastropathy.

What Causes Menetriers Disease?

Scientists are unsure about what causes Ménétrier’s disease; however, researchers think that most people acquire, rather than inherit, the disease. In extremely rare cases, siblings have developed Ménétrier’s disease as children, suggesting a genetic link.

• In children, a self-limited variant of Menetrier disease is observed, which is associated with cytomegalovirus infection.[rx] Similarly, in adults, it is associated with Helicobacter pylori infection.[rx][rx] It is hypothesized that overexpression of the transforming growth factor (TGF)-alpha in superficial gastric epithelium may play a role in etiopathogenesis.[rx]
• Studies suggest that people with Ménétrier’s disease have stomachs that make abnormally high amounts of a protein called transforming growth factor-alpha (TGF-α).
• TGF-α binds to and activates a receptor called epidermal growth factor receptor. Growth factors are proteins in the body that tell cells what to do, such as grow larger, change shape, or divide to make more cells. Researchers have not yet found a cause for the overproduction of TGF-α.
• Some studies have found cases of people with Ménétrier’s disease who also had Helicobacter pylori (H. pylori) infection. H. pylori is a bacterium that is a cause of peptic ulcers, or sores on the lining of the stomach or the duodenum, the first part of the small intestine. In these cases, treatment for H. pylori reversed and improved the symptoms of Ménétrier’s disease.
• Researchers have linked some cases of Ménétrier’s disease in children to infection with cytomegalovirus (CMV). CMV is one of the herpes viruses. This group of viruses includes the herpes simplex viruses, which cause chickenpox, shingles, and infectious mononucleosis, also known as mono. Most healthy children and adults infected with CMV have no symptoms and may not even know they have an infection. However, in people with a weakened immune system, CMV can cause serious disease, such as retinitis, which can lead to blindness.

Researchers are not sure how H. pylori and CMV infections contribute to the development of Ménétrier’s disease.

What are the Signs and Symptoms of Menetriers Disease?

The most common symptom of Ménétrier’s disease is pain in the upper middle part of the abdomen. The abdomen is the area between the chest and hips.

Other signs and symptoms of Ménétrier’s disease may include

• The most common clinical features are epigastric pain (65%), followed by fatigue (60%), anorexia (45%), weight loss (45%), edema (38%), and vomiting (38%).[rx]
• Other symptoms are nausea, diarrhea, and gastrointestinal bleeding related to gastric erosion and ulcers.[rx]
• Rarely a patient may have gastroduodenal intussusception as a presentation.[rx]
• Other clinical features that are associated with hypoalbuminemia from a protein-losing enteropathy like ascites, pleural effusion, and pericardial effusion can also be seen.[rx]
• nausea and frequent vomiting
• diarrhea
• loss of appetite
• extreme weight loss
• malnutrition
• low levels of protein in the blood
• swelling of the face, abdomen, limbs, and feet due to low levels of protein in the blood
• anemia—too few red blood cells in the body, which prevents the body from getting enough oxygen—due to bleeding in the stomach

People with Ménétrier’s disease have a higher chance of developing stomach cancer, also called gastric cancer.

How is Ménétrier’s disease diagnosed?

Health care providers base the diagnosis of Ménétrier’s disease on a combination of symptoms, lab findings, findings on upper gastrointestinal (GI) endoscopy, and stomach biopsy results. A health care provider will begin the diagnosis of Ménétrier’s disease by taking a patient’s medical and family history and performing a physical exam. However, a health care provider will confirm the diagnosis of Ménétrier’s disease through a computerized tomography (CT) scan, an upper GI endoscopy, and a biopsy of stomach tissue. A health care provider also may order blood tests to check for infection with H. pylori or CMV.

Medical and family history

• Taking a medical and family history is one of the first things a health care provider may do to help diagnose Ménétrier’s disease. He or she will ask the patient to provide a medical and family history.

Physical exam

A physical exam may help diagnose Ménétrier’s disease. During a physical exam, a health care provider usually

• examines a patient’s body
• uses a stethoscope to listen to bodily sounds
• taps on specific areas of the patient’s body

Lab test

• Typical laboratory – Laboratory evaluation must include a complete blood count, including a white blood cell (WBC) count, hemoglobin, hematocrit, and platelet counts, a complete metabolic panel, serum gastrin, H. pylori, and CMV serology. Typical laboratory findings include lymphopenia, reduced levels of globulin, albumin, alpha-1-antitrypsin, cholesterol, fibrinogen, and ceruloplasmin, elevated serum gastrin, and iron deficiency anemia.[rx][rx]
• Blood test – A health care provider will take a blood sample that can show the presence of infection with H. pylori or CMV. A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis.
• A barium Test – shows markedly enlarged folds along the greater curvature of the stomach, sparing the antrum. Barium is diluted due to excess mucus secretion, which is seen as an impaired mucosal coating. On the contrast-enhanced computed tomography (CT) images, diffuse gastric mucosal thickening is seen.[rx][rx]
• CT scan – CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets them. The patient does not need anesthesia. CT scans can show enlarged folds in the stomach wall.
• Upper GI endoscopy – This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologist—a doctor who specializes in digestive diseases—performs the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the stomach lining. The gastroenterologist also can take a biopsy of the stomach tissue during the endoscopy. A health care provider may give a patient a liquid anesthetic to gargle or may spray an anesthetic on the back of the patient’s throat. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test can show enlarged folds in the stomach wall.
• Esophagogastroduodenoscopy – Diagnosis can be reached by obtaining a biopsy showing extreme foveolar hyperplasia with atrophic changes in glandular epithelium along with remarkable enlargement of gastric rugae evident on esophagogastroduodenoscopy (EGD) and barium esophagogram. Endoscopy reveals giant gastric folds, superficial punctate erosions, and erythema. It is recommended to obtain a full-thickness mucosal biopsy of the involved mucosa, which will identify the loss of a deep glandular component along with other typical findings.[rx]
• Biopsy – A biopsy is a procedure that involves taking a piece of stomach tissue for examination with a microscope. A gastroenterologist performs the biopsy at the time of upper GI endoscopy. A pathologist—a doctor who specializes in diagnosing diseases—examines the stomach tissue in a lab. The test can diagnose Ménétrier’s disease by showing changes in the stomach’s mucous cells and acid-producing cells.
• Fluoroscopy – Upper GI fluoroscopy findings include markedly enlarged and tortuous folds in the fundus and body, especially along the greater curvature, with sparing of the antrum barium is diluted due to mucus hypersecretion, leading to impaired mucosal coating 

How is Ménétrier’s Disease Treated?

Treatment may include medications, IV protein, blood transfusions, and surgery.

Medications

Several medications have been used in the treatment of the condition, with variable efficacy. Such medications include: anticholinergic agents, prostaglandins, proton pump inhibitors, prednisone, and H2 receptor antagonists. Anticholinergics decrease protein loss.

•  Antibiotics  – In people with Ménétrier’s disease who also have H. pylori or CMV infection, treatment of the infection may improve symptoms. Health care providers prescribe antibiotics to kill H. pylori. Antibiotic regimens may differ throughout the world because some strains of H. pylori have become resistant to certain antibiotics—meaning that an antibiotic that once destroyed the bacterium is no longer effective. Health care providers use antiviral medications to treat CMV infection in a person with a weakened immune system in order to prevent the serious disease from developing as a result of CMV. Antiviral medications cannot kill CMV; however, they can slow down the virus reproduction.
• Proton pump inhibitors – The supportive treatments that are prescribed are a high-protein diet, proton pump inhibitors, and replacement of micronutrients.
• Cetuximab (Erbitux)  – Health care providers may prescribe the anticancer medication cetuximab (Erbitux) to treat Ménétrier’s disease. Studies have shown that cetuximab blocks the activity of epidermal growth factor receptor and can significantly improve a person’s symptoms, as well as decrease the thickness of the stomach wall from the overgrowth of mucous cells. A person receives cetuximab by IV in a health care provider’s office or an outpatient center. Studies to assess the effectiveness of cetuximab to treat Ménétrier’s disease are ongoing. A health care provider also may prescribe medications to relieve nausea and abdominal pain. Cetuximab is a recombinant IgG1 monoclonal antibody. Cetuximab binds to the extracellular portion of the EGF receptor, which inhibits the binding of TGF-alpha.[rx]
• Ganciclovir – treatment of H. pylori and CMV is recommended if the tests for respective infections are positive. Eradication of H.pylori has been shown to improve disease conditions in a few patients. Similarly, treatment with ganciclovir has been shown to be effective in some CMV-related cases.[rx]
• Octreotide – a somatostatin analog, has shown to be beneficial in case reports. It acts by modulating the TGF-alpha – EGFR pathway, which is the underlying pathogenic mechanism. A dose of 100 to 600 micrograms daily subcutaneously or intravenously or octreotide depot formulation 10 to 60 mg intramuscularly every four weeks has been used.[rx][rx]
• Intravenous Protein and Blood Transfusions – A health care provider may recommend an IV treatment of protein and a blood transfusion to a person who is malnourished or anemic because of Ménétrier’s disease. In most cases of children with Ménétrier’s disease who also have had CMV infection, treatment with protein and a blood transfusion led to a full recovery.

Surgery

If a person has severe Ménétrier’s disease with significant protein loss, a surgeon may need to remove part or all of the stomach in a surgery called gastrectomy.

Surgeons perform gastrectomy in a hospital. The patient will require general anesthesia. Some surgeons perform a gastrectomy through laparoscopic surgery rather than through a wide incision in the abdomen. In laparoscopic surgery, the surgeon uses several smaller incisions and feeds special surgical tools through the incisions to remove the diseased part of the stomach. After gastrectomy, the surgeon may reconstruct the changed portions of the GI tract so that it may continue to function. Usually, the surgeon attaches the small intestine to any remaining portion of the stomach or to the esophagus if he or she removed the entire stomach.

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Ménétrier’s disease. In some cases, a health care provider may prescribe a high-protein diet to offset the loss of protein due to Ménétrier’s disease. Some people with severe malnutrition may require IV nutrition, which is called total parenteral nutrition (TPN). TPN is a method of providing an IV liquid food mixture through a special tube in the chest.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you .

References

Hypoproteinemic Hypertrophic Gastropathy /Menetriers disease (MD) hypoproteinemic hypertrophic gastropathy, is a rare, acquired, premalignant, excessive protein-losing hypertrophic gastropathy disorder characterized by giant mucosal folds in the proximal part of the stomach, thickening of the mucous membrane in the form of giant rugal folds, diminished acid secretion, and a protein-losing state with hypoalbuminemia in giant gastric rugal folds in the body and fundus of the stomach, often with antral sparing, decreased acid secretion, increased gastric mucus production, and hypoalbuminemia and occasional severe upper gastrointestinal hemorrhage.^[rx–rx]secondary to protein loss in the gastric mucosa [rx]. It causes the ridges along the inside of the stomach wall—called rugae—to enlarge, forming giant folds in the stomach lining. The rugae enlarge because of an overgrowth of mucous cells in the stomach wall. It affects men more frequently than women, and the typical age at diagnosis is between 30 to 60 years.

In a normal stomach, mucous cells in the rugae release protein-containing mucus. The mucous cells in enlarged rugae release too much mucus, causing proteins to leak from the blood into the stomach. This shortage of protein in the blood is known as hypoproteinemia. Ménétrier’s disease also reduces the number of acid-producing cells in the stomach, which decreases stomach acid.

Another name

• Giant hypertrophic gastritis or
• Hypoproteinemic hypertrophic gastropathy
• Idiopathic hypertrophic gastropathy.
• Hypoproteinemic hypertrophic gastropathy
• Rare idiopathic hypertrophic gastropathy.

What Causes Menetriers Disease?

Scientists are unsure about what causes Ménétrier’s disease; however, researchers think that most people acquire, rather than inherit, the disease. In extremely rare cases, siblings have developed Ménétrier’s disease as children, suggesting a genetic link.

• In children, a self-limited variant of Menetrier disease is observed, which is associated with cytomegalovirus infection.[rx] Similarly, in adults, it is associated with Helicobacter pylori infection.[rx][rx] It is hypothesized that overexpression of the transforming growth factor (TGF)-alpha in superficial gastric epithelium may play a role in etiopathogenesis.[rx]
• Studies suggest that people with Ménétrier’s disease have stomachs that make abnormally high amounts of a protein called transforming growth factor-alpha (TGF-α).
• TGF-α binds to and activates a receptor called epidermal growth factor receptor. Growth factors are proteins in the body that tell cells what to do, such as grow larger, change shape, or divide to make more cells. Researchers have not yet found a cause for the overproduction of TGF-α.
• Some studies have found cases of people with Ménétrier’s disease who also had Helicobacter pylori (H. pylori) infection. H. pylori is a bacterium that is a cause of peptic ulcers, or sores on the lining of the stomach or the duodenum, the first part of the small intestine. In these cases, treatment for H. pylori reversed and improved the symptoms of Ménétrier’s disease.
• Researchers have linked some cases of Ménétrier’s disease in children to infection with cytomegalovirus (CMV). CMV is one of the herpes viruses. This group of viruses includes the herpes simplex viruses, which cause chickenpox, shingles, and infectious mononucleosis, also known as mono. Most healthy children and adults infected with CMV have no symptoms and may not even know they have an infection. However, in people with a weakened immune system, CMV can cause serious disease, such as retinitis, which can lead to blindness.

Researchers are not sure how H. pylori and CMV infections contribute to the development of Ménétrier’s disease.

What are the Signs and Symptoms of Menetriers Disease?

The most common symptom of Ménétrier’s disease is pain in the upper middle part of the abdomen. The abdomen is the area between the chest and hips.

Other signs and symptoms of Ménétrier’s disease may include

• The most common clinical features are epigastric pain (65%), followed by fatigue (60%), anorexia (45%), weight loss (45%), edema (38%), and vomiting (38%).[rx]
• Other symptoms are nausea, diarrhea, and gastrointestinal bleeding related to gastric erosion and ulcers.[rx]
• Rarely a patient may have gastroduodenal intussusception as a presentation.[rx]
• Other clinical features that are associated with hypoalbuminemia from a protein-losing enteropathy like ascites, pleural effusion, and pericardial effusion can also be seen.[rx]
• nausea and frequent vomiting
• diarrhea
• loss of appetite
• extreme weight loss
• malnutrition
• low levels of protein in the blood
• swelling of the face, abdomen, limbs, and feet due to low levels of protein in the blood
• anemia—too few red blood cells in the body, which prevents the body from getting enough oxygen—due to bleeding in the stomach

People with Ménétrier’s disease have a higher chance of developing stomach cancer, also called gastric cancer.

How is Ménétrier’s disease diagnosed?

Health care providers base the diagnosis of Ménétrier’s disease on a combination of symptoms, lab findings, findings on upper gastrointestinal (GI) endoscopy, and stomach biopsy results. A health care provider will begin the diagnosis of Ménétrier’s disease by taking a patient’s medical and family history and performing a physical exam. However, a health care provider will confirm the diagnosis of Ménétrier’s disease through a computerized tomography (CT) scan, an upper GI endoscopy, and a biopsy of stomach tissue. A health care provider also may order blood tests to check for infection with H. pylori or CMV.

Medical and family history

• Taking a medical and family history is one of the first things a health care provider may do to help diagnose Ménétrier’s disease. He or she will ask the patient to provide a medical and family history.

Physical exam

A physical exam may help diagnose Ménétrier’s disease. During a physical exam, a health care provider usually

• examines a patient’s body
• uses a stethoscope to listen to bodily sounds
• taps on specific areas of the patient’s body

Lab test

• Typical laboratory – Laboratory evaluation must include a complete blood count, including a white blood cell (WBC) count, hemoglobin, hematocrit, and platelet counts, a complete metabolic panel, serum gastrin, H. pylori, and CMV serology. Typical laboratory findings include lymphopenia, reduced levels of globulin, albumin, alpha-1-antitrypsin, cholesterol, fibrinogen, and ceruloplasmin, elevated serum gastrin, and iron deficiency anemia.[rx][rx]
• Blood test – A health care provider will take a blood sample that can show the presence of infection with H. pylori or CMV. A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis.
• A barium Test – shows markedly enlarged folds along the greater curvature of the stomach, sparing the antrum. Barium is diluted due to excess mucus secretion, which is seen as an impaired mucosal coating. On the contrast-enhanced computed tomography (CT) images, diffuse gastric mucosal thickening is seen.[rx][rx]
• CT scan – CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. An x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets them. The patient does not need anesthesia. CT scans can show enlarged folds in the stomach wall.
• Upper GI endoscopy – This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologist—a doctor who specializes in digestive diseases—performs the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the stomach lining. The gastroenterologist also can take a biopsy of the stomach tissue during the endoscopy. A health care provider may give a patient a liquid anesthetic to gargle or may spray an anesthetic on the back of the patient’s throat. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test can show enlarged folds in the stomach wall.
• Esophagogastroduodenoscopy – Diagnosis can be reached by obtaining a biopsy showing extreme foveolar hyperplasia with atrophic changes in glandular epithelium along with remarkable enlargement of gastric rugae evident on esophagogastroduodenoscopy (EGD) and barium esophagogram. Endoscopy reveals giant gastric folds, superficial punctate erosions, and erythema. It is recommended to obtain a full-thickness mucosal biopsy of the involved mucosa, which will identify the loss of a deep glandular component along with other typical findings.[rx]
• Biopsy – A biopsy is a procedure that involves taking a piece of stomach tissue for examination with a microscope. A gastroenterologist performs the biopsy at the time of upper GI endoscopy. A pathologist—a doctor who specializes in diagnosing diseases—examines the stomach tissue in a lab. The test can diagnose Ménétrier’s disease by showing changes in the stomach’s mucous cells and acid-producing cells.
• Fluoroscopy – Upper GI fluoroscopy findings include markedly enlarged and tortuous folds in the fundus and body, especially along the greater curvature, with sparing of the antrum barium is diluted due to mucus hypersecretion, leading to impaired mucosal coating 

How is Ménétrier’s Disease Treated?

Treatment may include medications, IV protein, blood transfusions, and surgery.

Medications

Several medications have been used in the treatment of the condition, with variable efficacy. Such medications include: anticholinergic agents, prostaglandins, proton pump inhibitors, prednisone, and H2 receptor antagonists. Anticholinergics decrease protein loss.

•  Antibiotics  – In people with Ménétrier’s disease who also have H. pylori or CMV infection, treatment of the infection may improve symptoms. Health care providers prescribe antibiotics to kill H. pylori. Antibiotic regimens may differ throughout the world because some strains of H. pylori have become resistant to certain antibiotics—meaning that an antibiotic that once destroyed the bacterium is no longer effective. Health care providers use antiviral medications to treat CMV infection in a person with a weakened immune system in order to prevent the serious disease from developing as a result of CMV. Antiviral medications cannot kill CMV; however, they can slow down the virus reproduction.
• Proton pump inhibitors – The supportive treatments that are prescribed are a high-protein diet, proton pump inhibitors, and replacement of micronutrients.
• Cetuximab (Erbitux)  – Health care providers may prescribe the anticancer medication cetuximab (Erbitux) to treat Ménétrier’s disease. Studies have shown that cetuximab blocks the activity of epidermal growth factor receptor and can significantly improve a person’s symptoms, as well as decrease the thickness of the stomach wall from the overgrowth of mucous cells. A person receives cetuximab by IV in a health care provider’s office or an outpatient center. Studies to assess the effectiveness of cetuximab to treat Ménétrier’s disease are ongoing. A health care provider also may prescribe medications to relieve nausea and abdominal pain. Cetuximab is a recombinant IgG1 monoclonal antibody. Cetuximab binds to the extracellular portion of the EGF receptor, which inhibits the binding of TGF-alpha.[rx]
• Ganciclovir – treatment of H. pylori and CMV is recommended if the tests for respective infections are positive. Eradication of H.pylori has been shown to improve disease conditions in a few patients. Similarly, treatment with ganciclovir has been shown to be effective in some CMV-related cases.[rx]
• Octreotide – a somatostatin analog, has shown to be beneficial in case reports. It acts by modulating the TGF-alpha – EGFR pathway, which is the underlying pathogenic mechanism. A dose of 100 to 600 micrograms daily subcutaneously or intravenously or octreotide depot formulation 10 to 60 mg intramuscularly every four weeks has been used.[rx][rx]
• Intravenous Protein and Blood Transfusions – A health care provider may recommend an IV treatment of protein and a blood transfusion to a person who is malnourished or anemic because of Ménétrier’s disease. In most cases of children with Ménétrier’s disease who also have had CMV infection, treatment with protein and a blood transfusion led to a full recovery.

Surgery

If a person has severe Ménétrier’s disease with significant protein loss, a surgeon may need to remove part or all of the stomach in a surgery called gastrectomy.

Surgeons perform gastrectomy in a hospital. The patient will require general anesthesia. Some surgeons perform a gastrectomy through laparoscopic surgery rather than through a wide incision in the abdomen. In laparoscopic surgery, the surgeon uses several smaller incisions and feeds special surgical tools through the incisions to remove the diseased part of the stomach. After gastrectomy, the surgeon may reconstruct the changed portions of the GI tract so that it may continue to function. Usually, the surgeon attaches the small intestine to any remaining portion of the stomach or to the esophagus if he or she removed the entire stomach.

Eating, Diet, and Nutrition

Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Ménétrier’s disease. In some cases, a health care provider may prescribe a high-protein diet to offset the loss of protein due to Ménétrier’s disease. Some people with severe malnutrition may require IV nutrition, which is called total parenteral nutrition (TPN). TPN is a method of providing an IV liquid food mixture through a special tube in the chest.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you .

References

Congenital Megacolon/Hirschsprung disease, also known as congenital megacolon or intestinal aganglionosis. (HD) is a congenital disorder characterized by the absence of ganglion cells (GC) at the Meissner’s plexus (submucosa) and Auerbach’s plexus (muscular) of the terminal rectum that extends in a variable distance proximally. It is responsible for non-specific symptomatology, including chronic constipation and neonatal obstruction. This activity reviews the evaluation and treatment of Hirschsprung disease and highlights the role of the interprofessional team in the care of patients with this condition.

Hirschsprung disease is a birth defect in which nerve cells are missing at the end of a child’s bowel. Normally, the bowel contains many nerve cells all along its length that control how the bowel works. When the bowel is missing nerve cells, it does not work well. This damage causes blockages in the bowel because the stool does not move through the bowel normally.

Most often, the areas missing the nerve cells are the rectum and the sigmoid colon. However, some children are missing the nerve cells for the entire colon or part of the small intestine.

• In short-segment Hirschsprung disease, nerve cells are missing from the last part of the large intestine.
• In long-segment Hirschsprung disease, nerve cells are missing from most or all of the large intestine and sometimes the last part of the small intestine.
• Rarely, nerve cells are missing in the entire large and small intestine.

In a child with Hirschsprung disease, the stool moves through the bowel until it reaches the part lacking nerve cells. At that point, the stool moves slowly or stops.

What are the bowel, large intestine, colon, rectum, and anus?

The bowel consists of the small and large intestines. The large intestine, which includes the colon and rectum, is the last part of the gastrointestinal (GI) tract. The large intestine’s main job is to absorb water and hold stool. The rectum connects the colon to the anus. Stool passes out of the body through the anus. At birth, the large intestine is about 2 feet long. An adult’s large intestine is about 5 feet long.

What causes Hirschsprung disease?

During the early development of the baby in the mother’s womb, nerve cells stop growing toward the end of a child’s bowel causing Hirschsprung disease. Most of these cells start at the beginning of the bowel and grow toward the end. Hirschsprung disease occurs when these cells do not reach the end of a child’s bowel. Scientists know that genetic defects can increase the chance of a child developing Hirschsprung disease. However, no testing exists that can diagnose a child while the mother is pregnant. Researchers are studying if the mother’s health history or lifestyle during pregnancy increases the chance of her baby developing Hirschsprung disease.

Who gets Hirschsprung disease?

Hirschsprung disease occurs in approximately one in 5,000 newborns. Children with Down syndrome and other medical problems, such as congenital heart defects, are at much greater risk. For example, about one in 100 children with Down syndrome also has Hirschsprung disease.

Hirschsprung disease is congenital, or present at birth; however, symptoms may or may not be obvious at birth. If you have a child with Hirschsprung disease, your chances of having more children with Hirschsprung disease are greater than people who don’t have a child with Hirschsprung disease. Also, if a parent has Hirschsprung disease, the chance of their child having Hirschsprung disease is higher. Talk with your doctor to learn more.

What are the signs and symptoms of Hirschsprung disease?

The main signs and symptoms of Hirschsprung disease are constipation or intestinal obstruction, usually appearing shortly after birth. Many healthy infants and children have difficulty passing stool or infrequent bowel movements. However, unlike healthy children and infants, kids with Hirschsprung disease typically do not respond to constipation medicines given by mouth. Most often, an infant or a child with Hirschsprung disease will have other symptoms, including

• growth failure
• swelling of the abdomen, or belly
• unexplained fever
• vomiting

The symptoms can vary; however, how they vary does not depend on how much of the intestine is missing nerve cells. No matter where in the intestine the nerve cells are missing, once the stool reaches this area, the blockage forms and the child develops symptoms.

Symptoms in Newborns

An early symptom in some newborns is failure to have a first bowel movement within 48 hours after birth. Other symptoms may include

• green or brown vomit
• explosive stools after a doctor insert a finger into the newborn’s rectum
• swelling of the abdomen
• diarrhea, often with blood
• Symptoms of Hirschsprung disease in newborns, toddlers, and older children may include swelling of the abdomen.

Symptoms in Toddlers and Older Children

Symptoms of Hirschsprung disease in toddlers and older children may include

• not being able to pass stools without enemas or suppositories. An enema involves flushing liquid into the child’s anus using a special wash bottle. A suppository is a pill placed into the child’s rectum.
• swelling of the abdomen.
• diarrhea, often with blood.
• slow growth.

How does a doctor know if my child has Hirschsprung disease?

A doctor will know if your child has Hirschsprung disease based on

• a physical exam
• a medical and family history
• symptoms
• test results

If your doctor suspects Hirschsprung disease, he or she may refer your child to a pediatric gastroenterologist—a doctor who specializes in digestive diseases in children—for additional evaluation.

Physical Exam

During a physical exam, a doctor usually

• reviews your child’s height and weight
• examines your child’s abdomen for swelling and examines his or her body for signs of poor nutrition
• uses a stethoscope to listen to sounds within the abdomen
• taps on specific areas of your child’s body
• performs a rectal exam—explosive stool after a rectal exam may be a sign of Hirschsprung disease

Medical and Family History

A doctor will ask you to provide your child’s medical and family history to help diagnose Hirschsprung disease. The doctor will ask questions about your child’s bowel movements. The doctor will also ask about vomiting, swelling of the abdomen, and unexplained fever. The doctor is less likely to diagnose Hirschsprung disease if problems with bowel movements began after 1 year of age.

Medical Tests

A doctor who suspects Hirschsprung disease will do one or more of the following tests:

• Rectal biopsy – A rectal biopsy is a procedure that involves taking a small piece of tissue from the rectum for examination with a microscope. The doctor can perform two types of procedures:
  • a rectal “suction” biopsy. During this biopsy, a pediatric gastroenterologist or a pediatric surgeon will insert a small instrument into the child’s anus and remove a small piece of tissue from the lining of his or her rectum. The biopsy is not painful and babies may even fall asleep during the procedure. In most cases, doctors do not use pain medicine or anesthesia. However, for older children doctors sometimes will use medicine to relieve anxiety or reduce the memory of the test.
  • a “full thickness” rectal biopsy. A pediatric surgeon performs this procedure, in which he or she will remove a thicker piece of tissue. The child will receive anesthesia.

  A doctor will examine the tissue under a microscope. The rectal biopsy is the best test to diagnose or rule out Hirschsprung disease.

• Abdominal x-ray – An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation is small. An x-ray technician performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. The child does not need anesthesia. The child will lie on a table or stand during the x-ray. The technician may ask the child to change positions for additional pictures. An x-ray of the abdomen may show intestinal obstruction.
• Anorectal Manometry – Anorectal manometry is a test that uses pressure sensors and balloons to measure how well the child’s rectum is working. A doctor performs anorectal manometry in a hospital. During the procedure, the doctor inflates a small balloon inside the child’s rectum. Normally, the child’s rectal muscles will relax. If his or her muscles don’t relax, the doctor may suspect Hirschsprung disease.
• Lower GI series – A lower GI series is an x-ray exam that doctors use to look at the large intestine. An x-ray technician and a radiologist perform the test at a hospital or an outpatient center, and a radiologist interprets the images. A child does not need anesthesia and does not need a bowel prep for the test.
• For the test, the child will lie on a table while the radiologist inserts a flexible tube into the child’s anus. The radiologist fills the child’s large intestine with barium or another contrast material. A technician performs this test on newborns, toddlers, and older children. A lower GI series can show changes in the bowel and help doctors diagnose obstructions.

In most cases, doctors diagnose Hirschsprung disease in infancy; however, sometimes doctors diagnose Hirschsprung disease in older children.

How is Hirschsprung disease treated?

Hirschsprung disease is a life-threatening illness, and treatment requires surgery. Children who have surgery for Hirschsprung disease most often feel better after surgery. If growth was slow because of Hirschsprung disease, growth typically improves after surgery.

For treatment, a pediatric surgeon will perform a pull-through procedure or an ostomy surgery. During either procedure, the surgeon may remove all or part of the colon, called a colectomy.

Pull-through Procedure

During a pull-through procedure, a surgeon removes the part of the large intestine that is missing nerve cells and connects the healthy part to the anus. A surgeon most often does a pull-through procedure soon after diagnosis.

Ostomy Surgery

Ostomy surgery is a surgical procedure that reroutes the normal movement of the stool out of the body when a part of the bowel is removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that stool can leave the body without passing through the anus. The opening in the abdomen through which stool leaves the body is called a stoma.

A removable external collection pouch called an ostomy pouch or ostomy appliance is attached to the stoma and worn outside the body to collect the stool. The child or caregiver will need to empty the pouch several times each day.

Although most children with Hirschsprung disease do not need ostomy surgery, a child sick from Hirschsprung disease may need ostomy surgery to get better before undergoing the pull-through procedure. This gives the inflamed areas of the intestine time to heal. In most cases, an ostomy is temporary and the child will have a second surgery to close the ostomy and reattach the intestine. However, sometimes children with Hirschsprung disease have a permanent ostomy, especially if a long segment of the bowel is missing nerve cells or the child has repeated episodes of bowel inflammation, which health care providers call enterocolitis.

Ostomy surgeries include the following:

• Ileostomy surgery is when the surgeon connects the small intestine to the stoma.
• Colostomy surgery is when the surgeon connects part of the large intestine to the stoma.

More information is provided in the NIDDK health topic, Ostomy Surgery of the Bowel.

What can I expect as my child recovers from surgery?

After surgery, your child will need time to adjust to the new structure of his or her large intestine.

After the Pull-through Procedure

Most children feel better after the pull-through procedure. However, some children can have complications or problems after surgery. Problems can include

• narrowing of the anus
• constipation
• diarrhea
• leaking stool from the anus
• delayed toilet training
• enterocolitis

Typically, these problems improve over time with guidance from your child’s doctors. Most children eventually have normal bowel movements.

After Ostomy Surgery

Infants will feel better after ostomy surgery because they will be able to pass gas and stool easily.

Older children will feel better as well, although they must adjust to living with an ostomy. They will need to learn how to take care of the stoma and how to change the ostomy pouch. With a few lifestyle changes, children with ostomies can lead normal lives. However, they may worry about being different from their friends. A special nurse, called an ostomy nurse, can answer questions and show your child how to care for an ostomy. More information is provided in the NIDDK health topic, Ostomy Surgery of the Bowel.

Enterocolitis

Adults and children with Hirschsprung disease can suffer from enterocolitis before or after surgery. Symptoms of enterocolitis may include

• a swollen abdomen
• bleeding from the rectum
• diarrhea
• fever
• lack of energy
• vomiting

A child with enterocolitis needs to go to the hospital because enterocolitis can be life-threatening. Doctors can treat some children with enterocolitis with a special antibiotic by mouth, often in combination with rectal irrigation at home and in the doctor’s office. During rectal irrigation, a doctor inserts a small amount of mild saltwater into the child’s rectum and allows it to come back out.

Doctors will admit children with more severe symptoms of enterocolitis to the hospital for monitoring, rectal irrigation, and intravenous (IV) antibiotics, and IV fluid. Doctors give IV antibiotics and fluids through a tube inserted into a vein in the child’s arm. In severe or repeated cases of enterocolitis, a child may need a temporary ostomy to let the intestine heal or a revision of the pull-through surgery.

Eating, Diet, and Nutrition

If a surgeon removes the child’s colon or bypasses it because of an ostomy, the child will need to drink more liquids to make up for water loss and prevent dehydration. They also need twice as much salt as a healthy child. A doctor can measure the sodium in a child’s urine and adjust his or her diet to ensure adequate salt replacement.

Some infants may need tube feedings for a while. A feeding tube is a passageway for the infant to receive infant formula or liquid food directly into his or her stomach or small intestine. The doctor will pass the feeding tube through the nose. In some cases, the doctor will recommend a more permanent feeding tube that he or she puts in place surgically in the child’s abdomen.

Points to Remember

• Hirschsprung disease is a birth defect in which nerve cells are missing at the end of a child’s bowel.
• In a child with Hirschsprung disease, the stool moves through the bowel until it reaches the part lacking nerve cells. At that point, the stool moves slowly or stops.
• During the early development of the baby in the mother’s womb, nerve cells stop growing toward the end of a child’s bowel causing Hirschsprung disease.
• Hirschsprung disease occurs in approximately one in 5,000 newborns. Children with Down syndrome and other medical problems, such as congenital heart defects, are at much greater risk.
• The main signs and symptoms of Hirschsprung disease are constipation or intestinal obstruction, usually appearing shortly after birth. Most often, an infant or a child with Hirschsprung disease will have other symptoms, including growth failure, swelling of the abdomen, unexplained fever, or vomiting.
• A doctor will know if your child has Hirschsprung disease based on a physical exam, a medical and family history, symptoms, and test results.
• Hirschsprung disease is a life-threatening illness, and treatment requires surgery. Children who have surgery for Hirschsprung disease most often feel better after surgery. If growth was slow because of Hirschsprung disease, growth typically improves after surgery.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you .

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov

References

Hirschsprung disease, also known as congenital megacolon or intestinal aganglionosis. (HD) is a congenital disorder characterized by the absence of ganglion cells (GC) at the Meissner’s plexus (submucosa) and Auerbach’s plexus (muscular) of the terminal rectum that extends in a variable distance proximally. It is responsible for non-specific symptomatology, including chronic constipation and neonatal obstruction. This activity reviews the evaluation and treatment of Hirschsprung disease and highlights the role of the interprofessional team in the care of patients with this condition.

Hirschsprung disease is a birth defect in which nerve cells are missing at the end of a child’s bowel. Normally, the bowel contains many nerve cells all along its length that control how the bowel works. When the bowel is missing nerve cells, it does not work well. This damage causes blockages in the bowel because the stool does not move through the bowel normally.

Most often, the areas missing the nerve cells are the rectum and the sigmoid colon. However, some children are missing the nerve cells for the entire colon or part of the small intestine.

• In short-segment Hirschsprung disease, nerve cells are missing from the last part of the large intestine.
• In long-segment Hirschsprung disease, nerve cells are missing from most or all of the large intestine and sometimes the last part of the small intestine.
• Rarely, nerve cells are missing in the entire large and small intestine.

In a child with Hirschsprung disease, the stool moves through the bowel until it reaches the part lacking nerve cells. At that point, the stool moves slowly or stops.

What are the bowel, large intestine, colon, rectum, and anus?

The bowel consists of the small and large intestines. The large intestine, which includes the colon and rectum, is the last part of the gastrointestinal (GI) tract. The large intestine’s main job is to absorb water and hold stool. The rectum connects the colon to the anus. Stool passes out of the body through the anus. At birth, the large intestine is about 2 feet long. An adult’s large intestine is about 5 feet long.

What causes Hirschsprung disease?

During the early development of the baby in the mother’s womb, nerve cells stop growing toward the end of a child’s bowel causing Hirschsprung disease. Most of these cells start at the beginning of the bowel and grow toward the end. Hirschsprung disease occurs when these cells do not reach the end of a child’s bowel. Scientists know that genetic defects can increase the chance of a child developing Hirschsprung disease. However, no testing exists that can diagnose a child while the mother is pregnant. Researchers are studying if the mother’s health history or lifestyle during pregnancy increases the chance of her baby developing Hirschsprung disease.

Who gets Hirschsprung disease?

Hirschsprung disease occurs in approximately one in 5,000 newborns. Children with Down syndrome and other medical problems, such as congenital heart defects, are at much greater risk. For example, about one in 100 children with Down syndrome also has Hirschsprung disease.

Hirschsprung disease is congenital, or present at birth; however, symptoms may or may not be obvious at birth. If you have a child with Hirschsprung disease, your chances of having more children with Hirschsprung disease are greater than people who don’t have a child with Hirschsprung disease. Also, if a parent has Hirschsprung disease, the chance of their child having Hirschsprung disease is higher. Talk with your doctor to learn more.

What are the signs and symptoms of Hirschsprung disease?

The main signs and symptoms of Hirschsprung disease are constipation or intestinal obstruction, usually appearing shortly after birth. Many healthy infants and children have difficulty passing stool or infrequent bowel movements. However, unlike healthy children and infants, kids with Hirschsprung disease typically do not respond to constipation medicines given by mouth. Most often, an infant or a child with Hirschsprung disease will have other symptoms, including

• growth failure
• swelling of the abdomen, or belly
• unexplained fever
• vomiting

The symptoms can vary; however, how they vary does not depend on how much of the intestine is missing nerve cells. No matter where in the intestine the nerve cells are missing, once the stool reaches this area, the blockage forms and the child develops symptoms.

Symptoms in Newborns

An early symptom in some newborns is failure to have a first bowel movement within 48 hours after birth. Other symptoms may include

• green or brown vomit
• explosive stools after a doctor insert a finger into the newborn’s rectum
• swelling of the abdomen
• diarrhea, often with blood
• Symptoms of Hirschsprung disease in newborns, toddlers, and older children may include swelling of the abdomen.

Symptoms in Toddlers and Older Children

Symptoms of Hirschsprung disease in toddlers and older children may include

• not being able to pass stools without enemas or suppositories. An enema involves flushing liquid into the child’s anus using a special wash bottle. A suppository is a pill placed into the child’s rectum.
• swelling of the abdomen.
• diarrhea, often with blood.
• slow growth.

How does a doctor know if my child has Hirschsprung disease?

A doctor will know if your child has Hirschsprung disease based on

• a physical exam
• a medical and family history
• symptoms
• test results

If your doctor suspects Hirschsprung disease, he or she may refer your child to a pediatric gastroenterologist—a doctor who specializes in digestive diseases in children—for additional evaluation.

Physical Exam

During a physical exam, a doctor usually

• reviews your child’s height and weight
• examines your child’s abdomen for swelling and examines his or her body for signs of poor nutrition
• uses a stethoscope to listen to sounds within the abdomen
• taps on specific areas of your child’s body
• performs a rectal exam—explosive stool after a rectal exam may be a sign of Hirschsprung disease

Medical and Family History

A doctor will ask you to provide your child’s medical and family history to help diagnose Hirschsprung disease. The doctor will ask questions about your child’s bowel movements. The doctor will also ask about vomiting, swelling of the abdomen, and unexplained fever. The doctor is less likely to diagnose Hirschsprung disease if problems with bowel movements began after 1 year of age.

Medical Tests

A doctor who suspects Hirschsprung disease will do one or more of the following tests:

• Rectal biopsy – A rectal biopsy is a procedure that involves taking a small piece of tissue from the rectum for examination with a microscope. The doctor can perform two types of procedures:
  • a rectal “suction” biopsy. During this biopsy, a pediatric gastroenterologist or a pediatric surgeon will insert a small instrument into the child’s anus and remove a small piece of tissue from the lining of his or her rectum. The biopsy is not painful and babies may even fall asleep during the procedure. In most cases, doctors do not use pain medicine or anesthesia. However, for older children doctors sometimes will use medicine to relieve anxiety or reduce the memory of the test.
  • a “full thickness” rectal biopsy. A pediatric surgeon performs this procedure, in which he or she will remove a thicker piece of tissue. The child will receive anesthesia.

  A doctor will examine the tissue under a microscope. The rectal biopsy is the best test to diagnose or rule out Hirschsprung disease.

• Abdominal x-ray – An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation is small. An x-ray technician performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. The child does not need anesthesia. The child will lie on a table or stand during the x-ray. The technician may ask the child to change positions for additional pictures. An x-ray of the abdomen may show intestinal obstruction.
• Anorectal Manometry – Anorectal manometry is a test that uses pressure sensors and balloons to measure how well the child’s rectum is working. A doctor performs anorectal manometry in a hospital. During the procedure, the doctor inflates a small balloon inside the child’s rectum. Normally, the child’s rectal muscles will relax. If his or her muscles don’t relax, the doctor may suspect Hirschsprung disease.
• Lower GI series – A lower GI series is an x-ray exam that doctors use to look at the large intestine. An x-ray technician and a radiologist perform the test at a hospital or an outpatient center, and a radiologist interprets the images. A child does not need anesthesia and does not need a bowel prep for the test.
• For the test, the child will lie on a table while the radiologist inserts a flexible tube into the child’s anus. The radiologist fills the child’s large intestine with barium or another contrast material. A technician performs this test on newborns, toddlers, and older children. A lower GI series can show changes in the bowel and help doctors diagnose obstructions.

In most cases, doctors diagnose Hirschsprung disease in infancy; however, sometimes doctors diagnose Hirschsprung disease in older children.

How is Hirschsprung disease treated?

Hirschsprung disease is a life-threatening illness, and treatment requires surgery. Children who have surgery for Hirschsprung disease most often feel better after surgery. If growth was slow because of Hirschsprung disease, growth typically improves after surgery.

For treatment, a pediatric surgeon will perform a pull-through procedure or an ostomy surgery. During either procedure, the surgeon may remove all or part of the colon, called a colectomy.

Pull-through Procedure

During a pull-through procedure, a surgeon removes the part of the large intestine that is missing nerve cells and connects the healthy part to the anus. A surgeon most often does a pull-through procedure soon after diagnosis.

Ostomy Surgery

Ostomy surgery is a surgical procedure that reroutes the normal movement of the stool out of the body when a part of the bowel is removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that stool can leave the body without passing through the anus. The opening in the abdomen through which stool leaves the body is called a stoma.

A removable external collection pouch called an ostomy pouch or ostomy appliance is attached to the stoma and worn outside the body to collect the stool. The child or caregiver will need to empty the pouch several times each day.

Although most children with Hirschsprung disease do not need ostomy surgery, a child sick from Hirschsprung disease may need ostomy surgery to get better before undergoing the pull-through procedure. This gives the inflamed areas of the intestine time to heal. In most cases, an ostomy is temporary and the child will have a second surgery to close the ostomy and reattach the intestine. However, sometimes children with Hirschsprung disease have a permanent ostomy, especially if a long segment of the bowel is missing nerve cells or the child has repeated episodes of bowel inflammation, which health care providers call enterocolitis.

Ostomy surgeries include the following:

• Ileostomy surgery is when the surgeon connects the small intestine to the stoma.
• Colostomy surgery is when the surgeon connects part of the large intestine to the stoma.

More information is provided in the NIDDK health topic, Ostomy Surgery of the Bowel.

What can I expect as my child recovers from surgery?

After surgery, your child will need time to adjust to the new structure of his or her large intestine.

After the Pull-through Procedure

Most children feel better after the pull-through procedure. However, some children can have complications or problems after surgery. Problems can include

• narrowing of the anus
• constipation
• diarrhea
• leaking stool from the anus
• delayed toilet training
• enterocolitis

Typically, these problems improve over time with guidance from your child’s doctors. Most children eventually have normal bowel movements.

After Ostomy Surgery

Infants will feel better after ostomy surgery because they will be able to pass gas and stool easily.

Older children will feel better as well, although they must adjust to living with an ostomy. They will need to learn how to take care of the stoma and how to change the ostomy pouch. With a few lifestyle changes, children with ostomies can lead normal lives. However, they may worry about being different from their friends. A special nurse, called an ostomy nurse, can answer questions and show your child how to care for an ostomy. More information is provided in the NIDDK health topic, Ostomy Surgery of the Bowel.

Enterocolitis

Adults and children with Hirschsprung disease can suffer from enterocolitis before or after surgery. Symptoms of enterocolitis may include

• a swollen abdomen
• bleeding from the rectum
• diarrhea
• fever
• lack of energy
• vomiting

A child with enterocolitis needs to go to the hospital because enterocolitis can be life-threatening. Doctors can treat some children with enterocolitis with a special antibiotic by mouth, often in combination with rectal irrigation at home and in the doctor’s office. During rectal irrigation, a doctor inserts a small amount of mild saltwater into the child’s rectum and allows it to come back out.

Doctors will admit children with more severe symptoms of enterocolitis to the hospital for monitoring, rectal irrigation, and intravenous (IV) antibiotics, and IV fluid. Doctors give IV antibiotics and fluids through a tube inserted into a vein in the child’s arm. In severe or repeated cases of enterocolitis, a child may need a temporary ostomy to let the intestine heal or a revision of the pull-through surgery.

Eating, Diet, and Nutrition

If a surgeon removes the child’s colon or bypasses it because of an ostomy, the child will need to drink more liquids to make up for water loss and prevent dehydration. They also need twice as much salt as a healthy child. A doctor can measure the sodium in a child’s urine and adjust his or her diet to ensure adequate salt replacement.

Some infants may need tube feedings for a while. A feeding tube is a passageway for the infant to receive infant formula or liquid food directly into his or her stomach or small intestine. The doctor will pass the feeding tube through the nose. In some cases, the doctor will recommend a more permanent feeding tube that he or she puts in place surgically in the child’s abdomen.

Points to Remember

• Hirschsprung disease is a birth defect in which nerve cells are missing at the end of a child’s bowel.
• In a child with Hirschsprung disease, the stool moves through the bowel until it reaches the part lacking nerve cells. At that point, the stool moves slowly or stops.
• During the early development of the baby in the mother’s womb, nerve cells stop growing toward the end of a child’s bowel causing Hirschsprung disease.
• Hirschsprung disease occurs in approximately one in 5,000 newborns. Children with Down syndrome and other medical problems, such as congenital heart defects, are at much greater risk.
• The main signs and symptoms of Hirschsprung disease are constipation or intestinal obstruction, usually appearing shortly after birth. Most often, an infant or a child with Hirschsprung disease will have other symptoms, including growth failure, swelling of the abdomen, unexplained fever, or vomiting.
• A doctor will know if your child has Hirschsprung disease based on a physical exam, a medical and family history, symptoms, and test results.
• Hirschsprung disease is a life-threatening illness, and treatment requires surgery. Children who have surgery for Hirschsprung disease most often feel better after surgery. If growth was slow because of Hirschsprung disease, growth typically improves after surgery.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you .

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov

References

Foodborne Disease/Foodborne Illness (also foodborne disease and colloquially referred to as food poisoning)^[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of “mad cow disease”), and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

What Causes Foodborne Disease?

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning.² Harmful chemicals also cause some cases of food poisoning. Microbes can spread to food at any time while the food is grown, harvested or slaughtered, processed, stored, shipped, or prepared.

Some harmful microbes may already be present in foods when you buy them. Foods that may contain microbes include

• fresh produce
• raw or undercooked meat, poultry, and eggs
• dairy products and fruit juices that have not been pasteurized—heated to kill harmful microbes
• fish and shellfish
• foods that people handle during preparation, sometimes called “deli foods,” such as sliced meat, salads, and cut fruit, sandwiches, and baked goods
• processed and ready-to-eat meats such as hot dogs or deli meat
• foods that are not properly canned or sealed

If you don’t keep raw foods such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods. Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation. If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods.

Microbes can cause food poisoning if you don’t take steps to kill or slow the growth of microbes in food. Microbes can grow if people don’t cook food thoroughly, keep cooked food hot, or promptly refrigerate or freeze food that can spoil.

Microbes present in the stool or vomit of people who are infected can also spread to food and cause food poisoning. People may spread these microbes to foods and drinks, especially if they don’t wash their hands thoroughly after using the bathroom, after changing a diaper, and before preparing foods and drinks.

Many bacterial, viral or parasitic agents cause food poisoning. The following table shows some of the possible contaminants when you might start to feel symptoms and common ways the organism is spread.

What Kinds of Microbes Cause Foodborne Disease?

• Viruses – Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. If water comes into contact with the stools of infected people, the water may become contaminated with a virus. The contaminated water can spread the virus to foods. For example, if contaminated water is used to water or wash produce, the virus can spread to the produce. Similarly, shellfish that were living in contaminated water could contain a virus. If people who are infected with a virus prepare or handle foods, they may spread the virus to the foods. Common viruses that cause food poisoning include norovirus and hepatitis A.
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut produce which has fecal contamination.^[45][46]
  • Hepatitis E
  • Norovirus
  • Rotavirus
• Bacteria – Bacteria are tiny organisms that can cause infection or disease. Bacteria can enter your body through contaminated food or water. Bacteria grow quickly when the temperature of food is between 40 and 140 degrees. Keeping food colder than 40 degrees in a refrigerator or freezer can slow or stop the growth of bacteria. Cooking food thoroughly often kills bacteria. Many types of bacteria can cause food poisoning, including

• • certain types of Salmonella
  • certain types of Clostridium, including the common C. perfringens and the less common C. botulinum, which causes an illness called botulism
  • certain types of Campylobacter, including C. jejuni
  • Staphylococcus aureus also called staph
  • Escherichia coli, also called E. coli
  • certain types of Vibrio 
  • Listeria monocytogenes also called Listeria
  • Listeria monocytogenes
  • Shigella spp.
  • Staphylococcus aureus
  • Staphylococcal enteritis
  • Streptococcus
  • Vibrio cholera, including O1 and non-O1
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • Yersinia enterocolitica and Yersinia pseudotuberculosis
  • Brucella spp.
  • Corynebacterium ulcerans
  • Coxiella burnetii or Q fever
  • Plesiomonas shigelloides
• Parasites – Parasites are tiny organisms that live inside other organisms. Parasites can enter your body through food or water and settle in your digestive tract. In developed countries such as the United States, parasitic infections are rare. Parasites that cause food poisoning include
  • Toxoplasma gondii, which causes an illness called toxoplasmosis
  • Giardia 
  • Cryptosporidium, which causes an illness called cryptosporidiosis or crypto
  • Platyhelminthes
    • Diphyllobothrium sp.
    • Nanophyetus sp.
    • Taenia saginata
    • Taenia solium
    • Fasciola hepatica
  • Nematode
    • Anisakis sp.
    • Ascaris lumbricoides
    • Eustrongylides sp.
    • Trichinella spiralis
    • Trichuris trichiura
  • Protozoa
    • Acanthamoeba and other free-living amoebae
    • Cryptosporidium parvum
    • Cyclospora cayetanensis
    • Entamoeba histolytica
    • Giardia lamblia
    • Sarcocystis hominis
    • Sarcocystis suihominis
    • Toxoplasma gondii

• E. coli (Escherichia coli) – E. coli bacteria usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.
• Listeria – These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.
• Campylobacter – These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.
• Staphylococcus aureus  – These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means that people who prepare or handle food can spread the infection.
• Shigella – Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).
• Hepatitis A – People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to know the source of an infection because people may not get sick for 15 to 50 days afterward.
• Noroviruses –These viruses usually contaminate the food that’s been prepared by an infected handler.

Natural toxins – Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants, in particular, may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example, capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Hormones from the thyroid glands of slaughtered animals (especially Triiodothyronine in cases of hamburger thyrotoxicosis or alimentary thyrotoxicosis)^[rx]
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)
• Foxglove contains cardiac glycosides.
• Poisonous hemlock (conium) has medicinal uses

What are the symptoms of Foodborne Disease?

Common symptoms of food poisoning include

• diarrhea or bloody diarrhea
• vomiting
• pain in your abdomen
• fever
• headache

Symptoms range from mild to severe and may last from a few hours to several days.

Less commonly, some types of food poisoning—such as botulism and fish and shellfish poisoning—can affect your nervous system. Symptoms may include

• blurred vision
• headache
• paralysis
• tingling or numbness of your skin
• weakness

People with nervous system symptoms should see a doctor or go to an emergency room right away.

Symptoms of dehydration, the most common complication of food poisoning, may include the following in adults

• extreme thirst and dry mouth
• urinating less than usual
• light-headedness; dizziness, which may occur when the person stands up; or fainting
• feeling tired
• dark-colored urine
• decreased skin turgor, meaning that when you pinch and release the person’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

If you are the parent or caretaker of an infant or a young child with symptoms of food poisoning, you should watch for the following signs of dehydration

• thirst and dry mouth
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• no tears when crying
• decreased skin turgor, meaning that when you pinch and release the child’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

Anyone with signs or symptoms of dehydration should see a doctor or go to an emergency room right away. A person with severe dehydration may need treatment at a hospital.

Seek care right away

Food poisoning can become dangerous if it leads to severe dehydration or other complications. The symptoms listed below may suggest that an adult or child has a severe form of food poisoning, dehydration or other complications, or a serious health problem other than food poisoning. Anyone with these signs or symptoms should see a doctor right away.

Adults

Adults with any of the following symptoms should see a doctor right away

• change in mental state, such as irritability, lack of energy, or confusion
• high fever
• vomiting often
• six or more loose stools in a single day
• diarrhea that continues for more than 3 days
• nervous system symptoms
• severe pain in the abdomen or rectum
• stools that are black and tarry or contain blood or pus
• symptoms of dehydration or other complications

Adults should also see a doctor if they aren’t able to drink enough liquids or oral rehydration solutions—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte—to prevent dehydration or if they do not improve after drinking oral rehydration solutions.

Older adults, pregnant women, and adults with a weakened immune system or another health condition should also see a doctor right away if they have any symptoms of food poisoning.

Infants and children

If an infant or child has signs or symptoms of food poisoning, don’t hesitate to call a doctor for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. A child with symptoms of dehydration can die within a day if left untreated.

If you are the parent or caretaker of an infant or child with any of the following signs or symptoms, seek a doctor’s help right away

• change in the child’s mental state, such as irritability or lack of energy
• diarrhea lasting more than a day
• any fever in infants
• high fever in older children
• frequent loose stools
• vomiting often
• nervous system symptoms
• severe pain in the abdomen or rectum
• signs or symptoms of complications, such as dehydration or hemolytic uremic syndrome
• stools that are black and tarry or contain blood or pus

You should also seek a doctor’s help right away if a child has signs or symptoms of food poisoning and the child is an infant, was born prematurely, or has a history of other medical conditions. Also seek a doctor’s help right away if the child is not able to drink enough liquids or oral rehydration solutions to prevent dehydration or if the child does not improve after drinking oral rehydration solutions.

Diagnosis of Foodborne Disease

Foodborne Illness (also foodborne disease and colloquially referred to as food poisoning)^[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of “mad cow disease”), and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

What Causes Foodborne Illness?

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning.² Harmful chemicals also cause some cases of food poisoning. Microbes can spread to food at any time while the food is grown, harvested or slaughtered, processed, stored, shipped, or prepared.

Some harmful microbes may already be present in foods when you buy them. Foods that may contain microbes include

• fresh produce
• raw or undercooked meat, poultry, and eggs
• dairy products and fruit juices that have not been pasteurized—heated to kill harmful microbes
• fish and shellfish
• foods that people handle during preparation, sometimes called “deli foods,” such as sliced meat, salads, and cut fruit, sandwiches, and baked goods
• processed and ready-to-eat meats such as hot dogs or deli meat
• foods that are not properly canned or sealed

If you don’t keep raw foods such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods. Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation. If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods.

Microbes can cause food poisoning if you don’t take steps to kill or slow the growth of microbes in food. Microbes can grow if people don’t cook food thoroughly, keep cooked food hot, or promptly refrigerate or freeze food that can spoil.

Microbes present in the stool or vomit of people who are infected can also spread to food and cause food poisoning. People may spread these microbes to foods and drinks, especially if they don’t wash their hands thoroughly after using the bathroom, after changing a diaper, and before preparing foods and drinks.

Many bacterial, viral or parasitic agents cause food poisoning. The following table shows some of the possible contaminants when you might start to feel symptoms and common ways the organism is spread.

What Kinds of Microbes Cause Foodborne Illness?

• Viruses – Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. If water comes into contact with the stools of infected people, the water may become contaminated with a virus. The contaminated water can spread the virus to foods. For example, if contaminated water is used to water or wash produce, the virus can spread to the produce. Similarly, shellfish that were living in contaminated water could contain a virus. If people who are infected with a virus prepare or handle foods, they may spread the virus to the foods. Common viruses that cause food poisoning include norovirus and hepatitis A.
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut produce which has fecal contamination.^[45][46]
  • Hepatitis E
  • Norovirus
  • Rotavirus
• Bacteria – Bacteria are tiny organisms that can cause infection or disease. Bacteria can enter your body through contaminated food or water. Bacteria grow quickly when the temperature of food is between 40 and 140 degrees. Keeping food colder than 40 degrees in a refrigerator or freezer can slow or stop the growth of bacteria. Cooking food thoroughly often kills bacteria. Many types of bacteria can cause food poisoning, including

• • certain types of Salmonella
  • certain types of Clostridium, including the common C. perfringens and the less common C. botulinum, which causes an illness called botulism
  • certain types of Campylobacter, including C. jejuni
  • Staphylococcus aureus also called staph
  • Escherichia coli, also called E. coli
  • certain types of Vibrio 
  • Listeria monocytogenes also called Listeria
  • Listeria monocytogenes
  • Shigella spp.
  • Staphylococcus aureus
  • Staphylococcal enteritis
  • Streptococcus
  • Vibrio cholera, including O1 and non-O1
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • Yersinia enterocolitica and Yersinia pseudotuberculosis
  • Brucella spp.
  • Corynebacterium ulcerans
  • Coxiella burnetii or Q fever
  • Plesiomonas shigelloides
• Parasites – Parasites are tiny organisms that live inside other organisms. Parasites can enter your body through food or water and settle in your digestive tract. In developed countries such as the United States, parasitic infections are rare. Parasites that cause food poisoning include
  • Toxoplasma gondii, which causes an illness called toxoplasmosis
  • Giardia 
  • Cryptosporidium, which causes an illness called cryptosporidiosis or crypto
  • Platyhelminthes
    • Diphyllobothrium sp.
    • Nanophyetus sp.
    • Taenia saginata
    • Taenia solium
    • Fasciola hepatica
  • Nematode
    • Anisakis sp.
    • Ascaris lumbricoides
    • Eustrongylides sp.
    • Trichinella spiralis
    • Trichuris trichiura
  • Protozoa
    • Acanthamoeba and other free-living amoebae
    • Cryptosporidium parvum
    • Cyclospora cayetanensis
    • Entamoeba histolytica
    • Giardia lamblia
    • Sarcocystis hominis
    • Sarcocystis suihominis
    • Toxoplasma gondii

• E. coli (Escherichia coli) – E. coli bacteria usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.
• Listeria – These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.
• Campylobacter – These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.
• Staphylococcus aureus  – These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means that people who prepare or handle food can spread the infection.
• Shigella – Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).
• Hepatitis A – People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to know the source of an infection because people may not get sick for 15 to 50 days afterward.
• Noroviruses –These viruses usually contaminate the food that’s been prepared by an infected handler.

Natural toxins – Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants, in particular, may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example, capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Hormones from the thyroid glands of slaughtered animals (especially Triiodothyronine in cases of hamburger thyrotoxicosis or alimentary thyrotoxicosis)^[rx]
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)
• Foxglove contains cardiac glycosides.
• Poisonous hemlock (conium) has medicinal uses

What are the symptoms of Foodborne Illness?

Common symptoms of food poisoning include

• diarrhea or bloody diarrhea
• vomiting
• pain in your abdomen
• fever
• headache

Symptoms range from mild to severe and may last from a few hours to several days.

Less commonly, some types of food poisoning—such as botulism and fish and shellfish poisoning—can affect your nervous system. Symptoms may include

• blurred vision
• headache
• paralysis
• tingling or numbness of your skin
• weakness

People with nervous system symptoms should see a doctor or go to an emergency room right away.

Symptoms of dehydration, the most common complication of food poisoning, may include the following in adults

• extreme thirst and dry mouth
• urinating less than usual
• light-headedness; dizziness, which may occur when the person stands up; or fainting
• feeling tired
• dark-colored urine
• decreased skin turgor, meaning that when you pinch and release the person’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

If you are the parent or caretaker of an infant or a young child with symptoms of food poisoning, you should watch for the following signs of dehydration

• thirst and dry mouth
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• no tears when crying
• decreased skin turgor, meaning that when you pinch and release the child’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

Anyone with signs or symptoms of dehydration should see a doctor or go to an emergency room right away. A person with severe dehydration may need treatment at a hospital.

Seek care right away

Food poisoning can become dangerous if it leads to severe dehydration or other complications. The symptoms listed below may suggest that an adult or child has a severe form of food poisoning, dehydration or other complications, or a serious health problem other than food poisoning. Anyone with these signs or symptoms should see a doctor right away.

Adults

Adults with any of the following symptoms should see a doctor right away

• change in mental state, such as irritability, lack of energy, or confusion
• high fever
• vomiting often
• six or more loose stools in a single day
• diarrhea that continues for more than 3 days
• nervous system symptoms
• severe pain in the abdomen or rectum
• stools that are black and tarry or contain blood or pus
• symptoms of dehydration or other complications

Adults should also see a doctor if they aren’t able to drink enough liquids or oral rehydration solutions—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte—to prevent dehydration or if they do not improve after drinking oral rehydration solutions.

Older adults, pregnant women, and adults with a weakened immune system or another health condition should also see a doctor right away if they have any symptoms of food poisoning.

Infants and children

If an infant or child has signs or symptoms of food poisoning, don’t hesitate to call a doctor for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. A child with symptoms of dehydration can die within a day if left untreated.

If you are the parent or caretaker of an infant or child with any of the following signs or symptoms, seek a doctor’s help right away

• change in the child’s mental state, such as irritability or lack of energy
• diarrhea lasting more than a day
• any fever in infants
• high fever in older children
• frequent loose stools
• vomiting often
• nervous system symptoms
• severe pain in the abdomen or rectum
• signs or symptoms of complications, such as dehydration or hemolytic uremic syndrome
• stools that are black and tarry or contain blood or pus

You should also seek a doctor’s help right away if a child has signs or symptoms of food poisoning and the child is an infant, was born prematurely, or has a history of other medical conditions. Also seek a doctor’s help right away if the child is not able to drink enough liquids or oral rehydration solutions to prevent dehydration or if the child does not improve after drinking oral rehydration solutions.

Diagnosis of Foodborne Illness

Food Poisoning Treatments/Food poisoning is a food-borne disease? Ingestion of food that contains a toxin, chemical or infectious agent (like a bacterium, virus, parasite, or prion) may cause adverse symptoms in the body. Those symptoms may be related only to the gastrointestinal tract causing vomiting or diarrhea or they may involve other organs such as the kidney, brain, or muscle.

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning)^[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of “mad cow disease”), and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

What Causes Food Poisoning?

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning.² Harmful chemicals also cause some cases of food poisoning. Microbes can spread to food at any time while the food is grown, harvested or slaughtered, processed, stored, shipped, or prepared.

Some harmful microbes may already be present in foods when you buy them. Foods that may contain microbes include

• fresh produce
• raw or undercooked meat, poultry, and eggs
• dairy products and fruit juices that have not been pasteurized—heated to kill harmful microbes
• fish and shellfish
• foods that people handle during preparation, sometimes called “deli foods,” such as sliced meat, salads, and cut fruit, sandwiches, and baked goods
• processed and ready-to-eat meats such as hot dogs or deli meat
• foods that are not properly canned or sealed

If you don’t keep raw foods such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods. Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation. If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods.

Microbes can cause food poisoning if you don’t take steps to kill or slow the growth of microbes in food. Microbes can grow if people don’t cook food thoroughly, keep cooked food hot, or promptly refrigerate or freeze food that can spoil.

Microbes present in the stool or vomit of people who are infected can also spread to food and cause food poisoning. People may spread these microbes to foods and drinks, especially if they don’t wash their hands thoroughly after using the bathroom, after changing a diaper, and before preparing foods and drinks.

Many bacterial, viral or parasitic agents cause food poisoning. The following table shows some of the possible contaminants when you might start to feel symptoms and common ways the organism is spread.

What Kinds of Microbes Cause Food Poisoning?

• Viruses – Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. If water comes into contact with the stools of infected people, the water may become contaminated with a virus. The contaminated water can spread the virus to foods. For example, if contaminated water is used to water or wash produce, the virus can spread to the produce. Similarly, shellfish that were living in contaminated water could contain a virus. If people who are infected with a virus prepare or handle foods, they may spread the virus to the foods. Common viruses that cause food poisoning include norovirus and hepatitis A.
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut produce which has fecal contamination.^[45][46]
  • Hepatitis E
  • Norovirus
  • Rotavirus
• Bacteria – Bacteria are tiny organisms that can cause infection or disease. Bacteria can enter your body through contaminated food or water. Bacteria grow quickly when the temperature of food is between 40 and 140 degrees. Keeping food colder than 40 degrees in a refrigerator or freezer can slow or stop the growth of bacteria. Cooking food thoroughly often kills bacteria. Many types of bacteria can cause food poisoning, including

• • certain types of Salmonella
  • certain types of Clostridium, including the common C. perfringens and the less common C. botulinum, which causes an illness called botulism
  • certain types of Campylobacter, including C. jejuni
  • Staphylococcus aureus also called staph
  • Escherichia coli, also called E. coli
  • certain types of Vibrio 
  • Listeria monocytogenes also called Listeria
  • Listeria monocytogenes
  • Shigella spp.
  • Staphylococcus aureus
  • Staphylococcal enteritis
  • Streptococcus
  • Vibrio cholera, including O1 and non-O1
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • Yersinia enterocolitica and Yersinia pseudotuberculosis
  • Brucella spp.
  • Corynebacterium ulcerans
  • Coxiella burnetii or Q fever
  • Plesiomonas shigelloides
• Parasites – Parasites are tiny organisms that live inside other organisms. Parasites can enter your body through food or water and settle in your digestive tract. In developed countries such as the United States, parasitic infections are rare. Parasites that cause food poisoning include
  • Toxoplasma gondii, which causes an illness called toxoplasmosis
  • Giardia 
  • Cryptosporidium, which causes an illness called cryptosporidiosis or crypto
  • Platyhelminthes
    • Diphyllobothrium sp.
    • Nanophyetus sp.
    • Taenia saginata
    • Taenia solium
    • Fasciola hepatica
  • Nematode
    • Anisakis sp.
    • Ascaris lumbricoides
    • Eustrongylides sp.
    • Trichinella spiralis
    • Trichuris trichiura
  • Protozoa
    • Acanthamoeba and other free-living amoebae
    • Cryptosporidium parvum
    • Cyclospora cayetanensis
    • Entamoeba histolytica
    • Giardia lamblia
    • Sarcocystis hominis
    • Sarcocystis suihominis
    • Toxoplasma gondii

• E. coli (Escherichia coli) – E. coli bacteria usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.
• Listeria – These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.
• Campylobacter – These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.
• Staphylococcus aureus  – These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means that people who prepare or handle food can spread the infection.
• Shigella – Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).
• Hepatitis A – People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to know the source of an infection because people may not get sick for 15 to 50 days afterward.
• Noroviruses –These viruses usually contaminate the food that’s been prepared by an infected handler.

Natural toxins – Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants, in particular, may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example, capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Hormones from the thyroid glands of slaughtered animals (especially Triiodothyronine in cases of hamburger thyrotoxicosis or alimentary thyrotoxicosis)^[rx]
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)
• Foxglove contains cardiac glycosides.
• Poisonous hemlock (conium) has medicinal uses

What are the symptoms of food poisoning?

Common symptoms of food poisoning include

• diarrhea or bloody diarrhea
• vomiting
• pain in your abdomen
• fever
• headache

Symptoms range from mild to severe and may last from a few hours to several days.

Less commonly, some types of food poisoning—such as botulism and fish and shellfish poisoning—can affect your nervous system. Symptoms may include

• blurred vision
• headache
• paralysis
• tingling or numbness of your skin
• weakness

People with nervous system symptoms should see a doctor or go to an emergency room right away.

Symptoms of dehydration, the most common complication of food poisoning, may include the following in adults

• extreme thirst and dry mouth
• urinating less than usual
• light-headedness; dizziness, which may occur when the person stands up; or fainting
• feeling tired
• dark-colored urine
• decreased skin turgor, meaning that when you pinch and release the person’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

If you are the parent or caretaker of an infant or a young child with symptoms of food poisoning, you should watch for the following signs of dehydration

• thirst and dry mouth
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• no tears when crying
• decreased skin turgor, meaning that when you pinch and release the child’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

Anyone with signs or symptoms of dehydration should see a doctor or go to an emergency room right away. A person with severe dehydration may need treatment at a hospital.

Seek care right away

Food poisoning can become dangerous if it leads to severe dehydration or other complications. The symptoms listed below may suggest that an adult or child has a severe form of food poisoning, dehydration or other complications, or a serious health problem other than food poisoning. Anyone with these signs or symptoms should see a doctor right away.

Adults

Adults with any of the following symptoms should see a doctor right away

• change in mental state, such as irritability, lack of energy, or confusion
• high fever
• vomiting often
• six or more loose stools in a single day
• diarrhea that continues for more than 3 days
• nervous system symptoms
• severe pain in the abdomen or rectum
• stools that are black and tarry or contain blood or pus
• symptoms of dehydration or other complications

Adults should also see a doctor if they aren’t able to drink enough liquids or oral rehydration solutions—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte—to prevent dehydration or if they do not improve after drinking oral rehydration solutions.

Older adults, pregnant women, and adults with a weakened immune system or another health condition should also see a doctor right away if they have any symptoms of food poisoning.

Infants and children

If an infant or child has signs or symptoms of food poisoning, don’t hesitate to call a doctor for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. A child with symptoms of dehydration can die within a day if left untreated.

If you are the parent or caretaker of an infant or child with any of the following signs or symptoms, seek a doctor’s help right away

• change in the child’s mental state, such as irritability or lack of energy
• diarrhea lasting more than a day
• any fever in infants
• high fever in older children
• frequent loose stools
• vomiting often
• nervous system symptoms
• severe pain in the abdomen or rectum
• signs or symptoms of complications, such as dehydration or hemolytic uremic syndrome
• stools that are black and tarry or contain blood or pus

You should also seek a doctor’s help right away if a child has signs or symptoms of food poisoning and the child is an infant, was born prematurely, or has a history of other medical conditions. Also seek a doctor’s help right away if the child is not able to drink enough liquids or oral rehydration solutions to prevent dehydration or if the child does not improve after drinking oral rehydration solutions.

Diagnosis of Food Poisoning

How Long Does Food Poisoning Last/Food poisoning is a food-borne disease? Ingestion of food that contains a toxin, chemical or infectious agent (like a bacterium, virus, parasite, or prion) may cause adverse symptoms in the body. Those symptoms may be related only to the gastrointestinal tract causing vomiting or diarrhea or they may involve other organs such as the kidney, brain, or muscle.

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning)^[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of “mad cow disease”), and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

What Causes Food Poisoning?

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning.² Harmful chemicals also cause some cases of food poisoning. Microbes can spread to food at any time while the food is grown, harvested or slaughtered, processed, stored, shipped, or prepared.

Some harmful microbes may already be present in foods when you buy them. Foods that may contain microbes include

• fresh produce
• raw or undercooked meat, poultry, and eggs
• dairy products and fruit juices that have not been pasteurized—heated to kill harmful microbes
• fish and shellfish
• foods that people handle during preparation, sometimes called “deli foods,” such as sliced meat, salads, and cut fruit, sandwiches, and baked goods
• processed and ready-to-eat meats such as hot dogs or deli meat
• foods that are not properly canned or sealed

If you don’t keep raw foods such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods. Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation. If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods.

Microbes can cause food poisoning if you don’t take steps to kill or slow the growth of microbes in food. Microbes can grow if people don’t cook food thoroughly, keep cooked food hot, or promptly refrigerate or freeze food that can spoil.

Microbes present in the stool or vomit of people who are infected can also spread to food and cause food poisoning. People may spread these microbes to foods and drinks, especially if they don’t wash their hands thoroughly after using the bathroom, after changing a diaper, and before preparing foods and drinks.

Many bacterial, viral or parasitic agents cause food poisoning. The following table shows some of the possible contaminants when you might start to feel symptoms and common ways the organism is spread.

What Kinds of Microbes Cause Food Poisoning?

• Viruses – Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. If water comes into contact with the stools of infected people, the water may become contaminated with a virus. The contaminated water can spread the virus to foods. For example, if contaminated water is used to water or wash produce, the virus can spread to the produce. Similarly, shellfish that were living in contaminated water could contain a virus. If people who are infected with a virus prepare or handle foods, they may spread the virus to the foods. Common viruses that cause food poisoning include norovirus and hepatitis A.
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut produce which has fecal contamination.^[45][46]
  • Hepatitis E
  • Norovirus
  • Rotavirus
• Bacteria – Bacteria are tiny organisms that can cause infection or disease. Bacteria can enter your body through contaminated food or water. Bacteria grow quickly when the temperature of food is between 40 and 140 degrees. Keeping food colder than 40 degrees in a refrigerator or freezer can slow or stop the growth of bacteria. Cooking food thoroughly often kills bacteria. Many types of bacteria can cause food poisoning, including

• • certain types of Salmonella
  • certain types of Clostridium, including the common C. perfringens and the less common C. botulinum, which causes an illness called botulism
  • certain types of Campylobacter, including C. jejuni
  • Staphylococcus aureus also called staph
  • Escherichia coli, also called E. coli
  • certain types of Vibrio 
  • Listeria monocytogenes also called Listeria
  • Listeria monocytogenes
  • Shigella spp.
  • Staphylococcus aureus
  • Staphylococcal enteritis
  • Streptococcus
  • Vibrio cholera, including O1 and non-O1
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • Yersinia enterocolitica and Yersinia pseudotuberculosis
  • Brucella spp.
  • Corynebacterium ulcerans
  • Coxiella burnetii or Q fever
  • Plesiomonas shigelloides
• Parasites – Parasites are tiny organisms that live inside other organisms. Parasites can enter your body through food or water and settle in your digestive tract. In developed countries such as the United States, parasitic infections are rare. Parasites that cause food poisoning include
  • Toxoplasma gondii, which causes an illness called toxoplasmosis
  • Giardia 
  • Cryptosporidium, which causes an illness called cryptosporidiosis or crypto
  • Platyhelminthes
    • Diphyllobothrium sp.
    • Nanophyetus sp.
    • Taenia saginata
    • Taenia solium
    • Fasciola hepatica
  • Nematode
    • Anisakis sp.
    • Ascaris lumbricoides
    • Eustrongylides sp.
    • Trichinella spiralis
    • Trichuris trichiura
  • Protozoa
    • Acanthamoeba and other free-living amoebae
    • Cryptosporidium parvum
    • Cyclospora cayetanensis
    • Entamoeba histolytica
    • Giardia lamblia
    • Sarcocystis hominis
    • Sarcocystis suihominis
    • Toxoplasma gondii

• E. coli (Escherichia coli) – E. coli bacteria usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.
• Listeria – These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.
• Campylobacter – These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.
• Staphylococcus aureus  – These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means that people who prepare or handle food can spread the infection.
• Shigella – Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).
• Hepatitis A – People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to know the source of an infection because people may not get sick for 15 to 50 days afterward.
• Noroviruses –These viruses usually contaminate the food that’s been prepared by an infected handler.

Natural toxins – Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants, in particular, may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example, capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Hormones from the thyroid glands of slaughtered animals (especially Triiodothyronine in cases of hamburger thyrotoxicosis or alimentary thyrotoxicosis)^[rx]
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)
• Foxglove contains cardiac glycosides.
• Poisonous hemlock (conium) has medicinal uses

What are the symptoms of food poisoning?

Common symptoms of food poisoning include

• diarrhea or bloody diarrhea
• vomiting
• pain in your abdomen
• fever
• headache

Symptoms range from mild to severe and may last from a few hours to several days.

Less commonly, some types of food poisoning—such as botulism and fish and shellfish poisoning—can affect your nervous system. Symptoms may include

• blurred vision
• headache
• paralysis
• tingling or numbness of your skin
• weakness

People with nervous system symptoms should see a doctor or go to an emergency room right away.

Symptoms of dehydration, the most common complication of food poisoning, may include the following in adults

• extreme thirst and dry mouth
• urinating less than usual
• light-headedness; dizziness, which may occur when the person stands up; or fainting
• feeling tired
• dark-colored urine
• decreased skin turgor, meaning that when you pinch and release the person’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

If you are the parent or caretaker of an infant or a young child with symptoms of food poisoning, you should watch for the following signs of dehydration

• thirst and dry mouth
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• no tears when crying
• decreased skin turgor, meaning that when you pinch and release the child’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

Anyone with signs or symptoms of dehydration should see a doctor or go to an emergency room right away. A person with severe dehydration may need treatment at a hospital.

Seek care right away

Food poisoning can become dangerous if it leads to severe dehydration or other complications. The symptoms listed below may suggest that an adult or child has a severe form of food poisoning, dehydration or other complications, or a serious health problem other than food poisoning. Anyone with these signs or symptoms should see a doctor right away.

Adults

Adults with any of the following symptoms should see a doctor right away

• change in mental state, such as irritability, lack of energy, or confusion
• high fever
• vomiting often
• six or more loose stools in a single day
• diarrhea that continues for more than 3 days
• nervous system symptoms
• severe pain in the abdomen or rectum
• stools that are black and tarry or contain blood or pus
• symptoms of dehydration or other complications

Adults should also see a doctor if they aren’t able to drink enough liquids or oral rehydration solutions—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte—to prevent dehydration or if they do not improve after drinking oral rehydration solutions.

Older adults, pregnant women, and adults with a weakened immune system or another health condition should also see a doctor right away if they have any symptoms of food poisoning.

Infants and children

If an infant or child has signs or symptoms of food poisoning, don’t hesitate to call a doctor for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. A child with symptoms of dehydration can die within a day if left untreated.

If you are the parent or caretaker of an infant or child with any of the following signs or symptoms, seek a doctor’s help right away

• change in the child’s mental state, such as irritability or lack of energy
• diarrhea lasting more than a day
• any fever in infants
• high fever in older children
• frequent loose stools
• vomiting often
• nervous system symptoms
• severe pain in the abdomen or rectum
• signs or symptoms of complications, such as dehydration or hemolytic uremic syndrome
• stools that are black and tarry or contain blood or pus

You should also seek a doctor’s help right away if a child has signs or symptoms of food poisoning and the child is an infant, was born prematurely, or has a history of other medical conditions. Also seek a doctor’s help right away if the child is not able to drink enough liquids or oral rehydration solutions to prevent dehydration or if the child does not improve after drinking oral rehydration solutions.

Diagnosis of Food Poisoning

Food Poisoning Symptoms/Food poisoning is a food-borne disease. Ingestion of food that contains a toxin, chemical or infectious agent (like a bacterium, virus, parasite, or prion) may cause adverse symptoms in the body. Those symptoms may be related only to the gastrointestinal tract causing vomiting or diarrhea or they may involve other organs such as the kidney, brain, or muscle.

Foodborne illness (also foodborne disease and colloquially referred to as food poisoning)^[rx] is any illness resulting from the spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food, as well as prions (the agents of “mad cow disease”), and toxins such as aflatoxins in peanuts, poisonous mushrooms, and various species of beans that have not been boiled for at least 10 minutes.

What Causes Food Poisoning?

Infections with microbes—viruses, bacteria, and parasites—cause most food poisoning.² Harmful chemicals also cause some cases of food poisoning. Microbes can spread to food at any time while the food is grown, harvested or slaughtered, processed, stored, shipped, or prepared.

Some harmful microbes may already be present in foods when you buy them. Foods that may contain microbes include

• fresh produce
• raw or undercooked meat, poultry, and eggs
• dairy products and fruit juices that have not been pasteurized—heated to kill harmful microbes
• fish and shellfish
• foods that people handle during preparation, sometimes called “deli foods,” such as sliced meat, salads, and cut fruit, sandwiches, and baked goods
• processed and ready-to-eat meats such as hot dogs or deli meat
• foods that are not properly canned or sealed

If you don’t keep raw foods such as beef, poultry, seafood, and eggs—separate from other foods, microbes from the raw foods can spread to other foods. Microbes can also spread from raw foods to your hands, kitchen utensils, cutting boards, and kitchen surfaces during food preparation. If you don’t wash your hands, utensils, cutting boards, and surfaces completely after they have come into contact with raw foods, they can spread microbes to other foods.

Microbes can cause food poisoning if you don’t take steps to kill or slow the growth of microbes in food. Microbes can grow if people don’t cook food thoroughly, keep cooked food hot, or promptly refrigerate or freeze food that can spoil.

Microbes present in the stool or vomit of people who are infected can also spread to food and cause food poisoning. People may spread these microbes to foods and drinks, especially if they don’t wash their hands thoroughly after using the bathroom, after changing a diaper, and before preparing foods and drinks.

Many bacterial, viral or parasitic agents cause food poisoning. The following table shows some of the possible contaminants when you might start to feel symptoms and common ways the organism is spread.

What Kinds of Microbes Cause Food Poisoning?

• Viruses – Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. If water comes into contact with the stools of infected people, the water may become contaminated with a virus. The contaminated water can spread the virus to foods. For example, if contaminated water is used to water or wash produce, the virus can spread to the produce. Similarly, shellfish that were living in contaminated water could contain a virus. If people who are infected with a virus prepare or handle foods, they may spread the virus to the foods. Common viruses that cause food poisoning include norovirus and hepatitis A.
  • Enterovirus
  • Hepatitis A is distinguished from other viral causes by its prolonged (2–6 week) incubation period and its ability to spread beyond the stomach and intestines into the liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut produce which has fecal contamination.^[45][46]
  • Hepatitis E
  • Norovirus
  • Rotavirus
• Bacteria – Bacteria are tiny organisms that can cause infection or disease. Bacteria can enter your body through contaminated food or water. Bacteria grow quickly when the temperature of food is between 40 and 140 degrees. Keeping food colder than 40 degrees in a refrigerator or freezer can slow or stop the growth of bacteria. Cooking food thoroughly often kills bacteria. Many types of bacteria can cause food poisoning, including

• • certain types of Salmonella
  • certain types of Clostridium, including the common C. perfringens and the less common C. botulinum, which causes an illness called botulism
  • certain types of Campylobacter, including C. jejuni
  • Staphylococcus aureus also called staph
  • Escherichia coli, also called E. coli
  • certain types of Vibrio 
  • Listeria monocytogenes also called Listeria
  • Listeria monocytogenes
  • Shigella spp.
  • Staphylococcus aureus
  • Staphylococcal enteritis
  • Streptococcus
  • Vibrio cholera, including O1 and non-O1
  • Vibrio parahaemolyticus
  • Vibrio vulnificus
  • Yersinia enterocolitica and Yersinia pseudotuberculosis
  • Brucella spp.
  • Corynebacterium ulcerans
  • Coxiella burnetii or Q fever
  • Plesiomonas shigelloides
• Parasites – Parasites are tiny organisms that live inside other organisms. Parasites can enter your body through food or water and settle in your digestive tract. In developed countries such as the United States, parasitic infections are rare. Parasites that cause food poisoning include
  • Toxoplasma gondii, which causes an illness called toxoplasmosis
  • Giardia 
  • Cryptosporidium, which causes an illness called cryptosporidiosis or crypto
  • Platyhelminthes
    • Diphyllobothrium sp.
    • Nanophyetus sp.
    • Taenia saginata
    • Taenia solium
    • Fasciola hepatica
  • Nematode
    • Anisakis sp.
    • Ascaris lumbricoides
    • Eustrongylides sp.
    • Trichinella spiralis
    • Trichuris trichiura
  • Protozoa
    • Acanthamoeba and other free-living amoebae
    • Cryptosporidium parvum
    • Cyclospora cayetanensis
    • Entamoeba histolytica
    • Giardia lamblia
    • Sarcocystis hominis
    • Sarcocystis suihominis
    • Toxoplasma gondii

• E. coli (Escherichia coli) – E. coli bacteria usually get into food or water when they come into contact with animal feces. Eating undercooked ground beef is the most common cause of E. coli poisoning in the United States.
• Listeria – These bacteria are mostly found in unpasteurized dairy products, smoked seafood, and processed meats like hot dogs and luncheon meats. Listeria bacteria also can contaminate fruits and vegetables, although that’s less common.
• Campylobacter – These bacteria most commonly infect meat, poultry, and unpasteurized milk. Campylobacter also can contaminate water. As with other kinds of bacteria, these usually get into foods through contact with infected animal feces.
• Staphylococcus aureus  – These bacteria (which can be found in meats, prepared salads, and foods made with contaminated dairy products) spread through hand contact, sneezing, or coughing. That means that people who prepare or handle food can spread the infection.
• Shigella – Shigella bacteria can infect seafood or raw fruits and vegetables. Most of the time these bacteria spread when people who prepare or handle food don’t wash their hands properly after using the bathroom. Sometimes, an infection causes blood in the stool (poop).
• Hepatitis A – People mostly get this virus from eating raw shellfish or foods that have been handled by someone who is infected. It can be hard to know the source of an infection because people may not get sick for 15 to 50 days afterward.
• Noroviruses –These viruses usually contaminate the food that’s been prepared by an infected handler.

Natural toxins – Several foods can naturally contain toxins, many of which are not produced by bacteria. Plants in particular may be toxic; animals which are naturally poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing; plants can use only passive defenses such as poisons and distasteful substances, for example capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most animal poisons are not synthesised by the animal, but acquired by eating poisonous plants to which the animal is immune, or by bacterial action.

• Alkaloids
• Ciguatera poisoning
• Grayanotoxin (honey intoxication)
• Hormones from the thyroid glands of slaughtered animals (especially Triiodothyronine in cases of hamburger thyrotoxicosis or alimentary thyrotoxicosis)^[rx]
• Mushroom toxins
• Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
• Pyrrolizidine alkaloids
• Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning, and ciguatera fish poisoning
• Scombrotoxin
• Tetrodotoxin (fugu fish poisoning)
• Foxglove contains cardiac glycosides.
• Poisonous hemlock (conium) has medicinal uses

What are the symptoms of food poisoning?

Common symptoms of food poisoning include

• diarrhea or bloody diarrhea
• vomiting
• pain in your abdomen
• fever
• headache

Symptoms range from mild to severe and may last from a few hours to several days.

Less commonly, some types of food poisoning—such as botulism and fish and shellfish poisoning—can affect your nervous system. Symptoms may include

• blurred vision
• headache
• paralysis
• tingling or numbness of your skin
• weakness

People with nervous system symptoms should see a doctor or go to an emergency room right away.

Symptoms of dehydration, the most common complication of food poisoning, may include the following in adults

• extreme thirst and dry mouth
• urinating less than usual
• light-headedness; dizziness, which may occur when the person stands up; or fainting
• feeling tired
• dark-colored urine
• decreased skin turgor, meaning that when you pinch and release the person’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

If you are the parent or caretaker of an infant or a young child with symptoms of food poisoning, you should watch for the following signs of dehydration

• thirst and dry mouth
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• no tears when crying
• decreased skin turgor, meaning that when you pinch and release the child’s skin, it does not flatten back to normal right away
• sunken eyes or cheeks

Anyone with signs or symptoms of dehydration should see a doctor or go to an emergency room right away. A person with severe dehydration may need treatment at a hospital.

Seek care right away

Food poisoning can become dangerous if it leads to severe dehydration or other complications. The symptoms listed below may suggest that an adult or child has a severe form of food poisoning, dehydration or other complications, or a serious health problem other than food poisoning. Anyone with these signs or symptoms should see a doctor right away.

Adults

Adults with any of the following symptoms should see a doctor right away

• change in mental state, such as irritability, lack of energy, or confusion
• high fever
• vomiting often
• six or more loose stools in a single day
• diarrhea that continues for more than 3 days
• nervous system symptoms
• severe pain in the abdomen or rectum
• stools that are black and tarry or contain blood or pus
• symptoms of dehydration or other complications

Adults should also see a doctor if they aren’t able to drink enough liquids or oral rehydration solutions—such as Pedialyte, Naturalyte, Infalyte, and CeraLyte—to prevent dehydration or if they do not improve after drinking oral rehydration solutions.

Older adults, pregnant women, and adults with a weakened immune system or another health condition should also see a doctor right away if they have any symptoms of food poisoning.

Infants and children

If an infant or child has signs or symptoms of food poisoning, don’t hesitate to call a doctor for advice. Diarrhea is especially dangerous in newborns and infants, leading to severe dehydration in just a day or two. A child with symptoms of dehydration can die within a day if left untreated.

If you are the parent or caretaker of an infant or child with any of the following signs or symptoms, seek a doctor’s help right away

• change in the child’s mental state, such as irritability or lack of energy
• diarrhea lasting more than a day
• any fever in infants
• high fever in older children
• frequent loose stools
• vomiting often
• nervous system symptoms
• severe pain in the abdomen or rectum
• signs or symptoms of complications, such as dehydration or hemolytic uremic syndrome
• stools that are black and tarry or contain blood or pus

You should also seek a doctor’s help right away if a child has signs or symptoms of food poisoning and the child is an infant, was born prematurely, or has a history of other medical conditions. Also seek a doctor’s help right away if the child is not able to drink enough liquids or oral rehydration solutions to prevent dehydration or if the child does not improve after drinking oral rehydration solutions.

Diagnosis of Food Poisoning

Gallbladder polyps are an abnormal growth of tissue with a stalk protruding from the lining of the inside of the gallbladder a well-known generally harmless, benign lesion originating from the mucosa-malignant lesion and elevation of the gallbladder mucosa that protrudes into the gallbladder lumen.

pseudopolyps, inflammatory polyps,  inflammatory pseudopolyps giant pseudopolyps post-inflammatory pseudopolyps inflammatory bowel disease ulcerative colitis Crohn’s disease and “colonic polyps.

Inflammatory polyps consist of compact, non-epithelialized granulation tissue, representing a dense mixture of lymphocytes, plasma cells, and mast cells predominantly but also includes neutrophils and eosinophils, all of which are detected as infiltrating the proper lamina of ulcerated epithelium. Post-inflammatory pseudopolyps are composed of a layer of normal or slightly hyperplastic glandular epithelium, mucosa muscular, and a submucosa core of fibrovascular tissue. However, at the bowel wall, mixed forms of these types are frequently found; for example, remnant mucosa infiltrating granulation tissue or granulation tissue at the free ends of post-inflammatory polyps have been detected. The latter is due to secondary ulceration or inflammatory infiltration at the base of PPs[rx].

The gallbladder is a small organ that stores bile and passes it from the liver to the small intestine.

Although gallbladder polyps can be cancerous (malignant), about 95 percent of gallbladder polyps are noncancerous (benign).

Types of Gallbladder Polyps

Gallbladder polyp size is often an indication of the presence of cancer

• Small gallbladder polyps — less than 1/2 inch in diameter — are typically benign and, in most cases, don’t need to be treated.
• Gallbladder polyps larger than 1/2 inch –  in diameter have a greater likelihood of being or becoming malignant.
• Gallbladder polyps larger than 3/4 – inch have a high probability of being malignant.

Symptoms of Gallbladder Polyps

Right upper abdominal pain, food intolerance, bloating, and nausea may be present. Elicitation of a positive Murphy’s sign, pain with deep palpation to the right upper abdomen, is often present.

If you have gallbladder polyps, you might not have any symptoms. However, some people do experience some symptoms. Scientists have found there’s no difference between the symptoms of people with cancerous polyps compared to those whose polyps were noncancerous, or benign.

Symptoms of gallbladder polyps include

• Nausea
• Vomiting
• Occasional pain in the upper right part of your abdomen

Diagnosis of Gallbladder Polyps

• Ultrasonography – Abdominal ultrasound is looked upon as the best available exam for diagnosing gallbladder polyps, not only because of its accessibility and low cost but also because of its good sensitivity and specificity. The polyps can be located, counted, and measured with ultrasound, and the three layers of the gallbladder wall and any abnormalities can be viewed.[rx] The polyps appear as fixed, hyperechoic material protruding into the lumen of the gallbladder, with or without an acoustic shadow. The sensitivity of abdominal ultrasound for the diagnosis of gallbladder polyps is superior to both oral cholecystography and CT and good to distinguish a cholesterol polyp from an adenoma or an adenocarcinoma. A cholesterol polyp shows as a mass with similar echogenicity to the gallbladder wall and with no shadow cone. However, the distinction is difficult to make, and the status of polyps as benign or malignant cannot be determined with abdominal ultrasound alone.[rx] Generally, polyps in the gallbladder are demonstrable in the US, only when they are over 5 mm in diameter. Sonographic differentiation between benign and malignant polyps (and calculous disease) relies greatly on the size of a single nonmobile lesion within the gall bladder. A gallstone impacted within the gallbladder wall may be easily mistaken for a polyp on ultrasound scanning.[rx]
• The discrepancy between the US and CT scanning – The mean values for CT scanning tended to be smaller than for the US. The discrepancies in maximum diameters between US and CT scanning were 6 ± 4 mm in the cholesterol polyp group and 2 ± 2 mm in the noncholesterol polyp group, and this difference was statistically significant.[rx] In the diagnosis of polypoid lesions of the gallbladder, the discovery rate of B-ultrasound is significantly higher than that of CT or cholecystography. Therefore, B-ultrasonography could be first used for the diagnosis of polypoid lesions of the gallbladder. However, CT could display local anatomic correlations of the liver, gallbladder, porta hepatis, and the other organs. Enhanced CT could improve the discovery rate of polypoid lesions of the gallbladder for CT.[rx] Small polypoid lesions of the gallbladder are easily detected by the US, but accuracy based solely on the US is controversial.[rx] The accuracy of sonography for diagnosing polypoid lesions of the gallbladder was poor. Many of the small polyps seen on sonography most likely represented a stone embedded in the gallbladder wall or other abnormality.[rx]
• Three-dimensional ultrasonography – Three-dimensional ultrasound (3DUS) diagnosis correlates well with two-dimensional ultrasound (2DUS) with regard to most gallbladder problems and could be sufficient as a stand-alone technique.[rx]
• High-resolution ultrasonography – Endoscopic ultrasonography (EUS) was considered the most sensitive diagnostic modality for gallbladder polypoid lesions. However, the diagnostic accuracies of high-resolution ultrasound (HRUS) and EUS for the differential diagnosis of gallbladder polypoid lesions were comparable. In view of patient comfort and no requirement for sedation, it was considered that HRUS is likely to become an important diagnostic modality for the differential diagnosis and staging of gallbladder polypoid lesions and early gallbladder cancer.[rx]
• Harmonic imaging – The quality of images in the harmonic mode is better, and the walls of the gall bladder are more distinct. The polyps were therefore more evident on harmonic images, which are more precise measurements of the polyps. In the harmonic mode, the level of artifacts generated by the body wall is reduced and contrast resolution is increased due to reduction in noise level. The visualization of the gallbladder is improved in the harmonic mode.[rx]
• Contrast-enhanced ultrasonography – Advances in the conventional US, such as the high-resolution US, have contributed to improved detection of polypoid gallbladder lesions. A galactose-based contrast agent was used in the US for differential diagnosis of polypoid gallbladder lesions.[rx] When diffuse and branched types were considered indicative of cancer, accuracy was 85%, sensitivity 100%, and specificity 77%. In gallbladder cancer, staining throughout the tumor was continuous, consistent with diffuse hypervascularity. In benign gallbladder polyps, staining was scattered with the flow image being uniform and small. Ultrasonographic contrast enhancement patterns, therefore, show characteristic associations with pathologic findings, serve as valuable adjuncts in the diagnosis of gallbladder diseases,[rx], and differentiate gallbladder carcinoma from other polypoid gallbladder diseases lesions.[rx]
• Endoscopic ultrasonography (EUS) – EUS is better than B-ultrasonography.[rx] EUS has gained widespread use for the diagnosis of gastrointestinal malignancies, submucosal lesions of the gastrointestinal tract, and abnormalities seen on cross-sectional imaging.[rx] EUS is also recommended for further examination after the conventional US because images obtained are more distinct than with the conventional US. Such images appear promising for distinguishing cholesterol polyps from other polyps, and the overall accuracy for differentiating neoplastic from non-neoplastic masses was reported as 91%.[rx,rx]
• Comparison with transabdominal ultrasonography – Transabdominal ultrasonography (US) has made the detection of gallbladder polyps easier, but the differential diagnosis of polyps less than 20 mm remains difficult. EUS markedly improves the accuracy of the differential diagnosis of gallbladder polyps and is thought to play an important role in determining the treatment strategy for gallbladder polyps.[rx,rx]
• EUS scoring system – A scoring system to predict neoplastic polyps of the gallbladder has been presented.[rx] The total EUS score based on the coefficient of multivariate analysis was as follows: (maximum diameter in mm) + (internal echo pattern score; where heterogeneous = 4, homogeneous = 0) + (hyperechoic spot score; where presence = – 5, absence = 0). According to the EUS scoring system, the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 12 or higher were 78%, 83%, and 83%, respectively.[rx]
• Computed tomography – Abdominal CT is incapable of detecting low-density lesions, and its sensitivity for the diagnosis of gallbladder polyps is not satisfied, especially when gallbladder polyps were smaller than 10 mm in diameter, but it is useful for studying gallbladder carcinoma, anatomic correlations, and for investigating metastases of the ganglia.[rx,rx] Advances in multidetector-row CT have increased its accuracy rate for the differential diagnosis of gallbladder polyps, and CT generally shows polypoid gallbladder carcinoma as an enhancing, intraluminal tissue mass denser than surrounding bile and can reliably identify neoplastic lesions.[rx] In particular, helical CT may be helpful for evaluating small polypoid lesions of the gallbladder and can differentiate neoplastic and nonneoplastic small polypoid lesions of the gallbladder and reliably identify the presence of neoplastic lesions that should be resected.[rx] The size bigger than 1.5 cm, sessile shape, and perception on unenhanced images are the main factors that differentiate neoplastic from nonneoplastic gallbladder polyps 1 cm or bigger.[rx]
• Magnetic resonance imaging – Magnetic resonance imaging has not been widely used to evaluate gallbladder diseases, having the disadvantages of poor spatial and contrast resolution. Among polypoid masses, malignant lesions demonstrated early and prolonged enhancements, while benign lesions showed early enhancement with subsequent washout.[rx] It has reported that various malignant tumors may show high signal intensity on diffusion-weighted MR imaging (DWI), reflecting their high cellularity and/or their long relaxation time. Therefore, a high b-value DWI may be useful for differentiating between benign and malignant polypoid gallbladder lesions.[rx]
• Positron emission tomography – It was presented a small case series of patients with gallbladder polyps that were correctly diagnosed preoperatively as benign or malignant with the use of positron emission tomography scanning with ¹⁸F-labelled deoxyglucose.[rx]
• Intravenous cholecystography – Intravenous cholecystography is a safe technique, but gallbladder polyps do not become sufficiently opaque.[rxrx]
• Transpapillary approach – Percutaneous transhepatic fine-needle aspiration and percutaneous transhepatic cholecystoscopy have been reported as precise diagnostic techniques in the evaluation of gallbladder polyps, but it is time-consuming and poorly tolerated by patients. In addition, the diagnostic accuracy of endoscopic retrograde cholangiopancreatography is not satisfactory, because this can only show a filling defect in the gallbladder without delineating the surface of polypoid lesions.[rx]
• Transabdominal ultrasonography – Transabdominal ultrasound (TAUS), encompasses conventional ultrasound (CUS), high-resolution ultrasound (HRUS), three-dimensional ultrasound, and contrast-enhanced ultrasound (CEUS). CUS and HRUS are easily accessible, cheap, non-invasive tests[rx] and are the most widely used modalities for diagnosing and following up gallbladder polyps. However, other studies have been performed to assess the effectiveness of the other forms of ultrasonography mentioned above[rx,rx].
• 3D-US is an emerging – modality that eliminates the operator dependency seen in 2-dimensional CUS. Research for this imaging modality is minimal but a study of 80 patients with gallbladder polyps found that there was agreement in the diagnosis in 89% of cases when both techniques were applied[rx]. This study however found that 3D-US did have difficulty detecting polyps less than 4mm, but it is predicted that as technology continues to evolve this issue will decline in the future[rx]. Current research, therefore, does not support the routine use of 3D-US for evaluating gallbladder polyps.
• Endoscopic ultrasound – EUS works at a higher frequency as described above and enables the transducer to be in closer proximity to the target tissue, therefore, hypothetically improving diagnostic accuracy[rx]. It is, however, an invasive examination associated with a small risk of bleeding and upper gastrointestinal perforation and presents a higher risk of complications than all forms of TAUS[rx].
• Computed tomography – CT imaging is widely used in the staging of gallbladder adenocarcinoma[rx]. However, some research has been performed to assess if it may also play a role in differentiating between true and “pseudo”- polyps and for long-term surveillance[rx]. The accuracy of CT imaging was assessed in 31 patients with polypoid lesions of the gallbladder of 3cm or less. The CT diagnosis was accurate in 87% of cases however, only 5 polyps were less than 11 mm and therefore this study provides us with limited evidence regarding the role of CT in this group of patients[rx].
• Magnetic resonance imaging – Minimal research has been performed looking at the role of MRI in differentiating between benign and malignant gallbladder polyps. A small study[rx] demonstrated in 10 benign polyps and 13 malignant polyps that the ADC values of the malignant lesions were significantly lower than that seen in the benign lesions. They concluded that diffusion-weighted MR imaging may play a role in diagnosing benign and malignant polyps[rx]. However, further research is warranted to establish if MRI can improve the accuracy of diagnosing gallbladder polyps.

Treatment of Gallbladder Polyps

Gallbladder polyps that have the appearance of pseudo or cholesterol polyps, in asymptomatic patients, can be followed with yearly gallbladder ultrasounds. These patients have a very low malignant risk. If serial ultrasounds reveal that the polyp is enlarging or if the patient becomes symptomatic, then cholecystectomy should be recommended. Patients with symptoms of chronic cholecystitis are usually best treated with laparoscopic or open cholecystectomy. Polyps that are 1 cm or greater in size should undergo cholecystectomy due to the increased risk of developing gallbladder cancer. Early intervention is preferred because an early gallbladder neoplasm has a much higher rate of cure than a more advanced lesion. In fact, stage 0 gallbladder cancer has about an 80% 5-year survival rate, and stage 1 has less than a 50% survival rate. Less than 10% of all gallbladder cancers are diagnosed at stage 1 or lower. More advanced gallbladder cancers require an open cholecystectomy with resection of the gallbladder fossa of the liver along with regional lymph node removal. [rx][rx]

Relation between gallbladder stones and gallbladder polyps

The purpose of one study was to determine the clinical characteristics of subjects with gallbladder polyps and cholelithiasis compared with those with gallbladder polyps only. No significant difference in the mean interval change of polyp size during the follow-up period between the study and control groups was noted. A significantly higher proportion of examinees in the study group had attacks of acute cholecystitis compared with the control group. By multivariate logistic regression analysis, gallbladder wall thickening on initial ultrasonography (US) and the interval increase in the size of the gallbladder polyps were significant independent risk factors for cholecystectomy. No gallbladder cancer occurred during the follow-up period. There was, therefore, no significant difference in delta polyp size between the examinees with gallbladder polyps and cholelithiasis and those with gallbladder polyps only.[rx]

Some patients who are confirmed to have polypoid lesions of the gallbladder through cholecystectomy are associated with gallstones. Symptoms were significantly associated with malignant polyp compared with the benign polyp. The association of symptom and presence of associated gallstone was separately analyzed. Significant association of symptom to associated gallstone was not found. However, symptomatic cases tended to increase with the increase in polyp size. Therefore, speculation can be made that symptoms may be associated with the size of the polyp rather than the association of gallstone.[rx]

Home remedies for gallbladder polyps

Although natural treatments aren’t supported by the medical community or clinical research, many people look to natural sources for relief from benign gallbladder polyps. Some of these home remedies include:

• warm water enemas
• applying hot water packs externally
• drinking pear juice or eating pears
• drinking unrefined olive oil on an empty stomach
• drinking beet juice or eating beets

Along with trying home remedies, some people advocate taking natural preventive steps to help reduce gallbladder polyps, including:

• avoiding fried or fatty foods
• avoiding high-cholesterol foods and readymade foods
• avoiding full-fat dairy products
• avoiding carbonated beverages
• eating more fruits and vegetables
• increasing intake of omega-3 fatty acids
• increasing intake of ginger and turmeric

Consult with your doctor before you implement any home remedy or diet change. None of these home remedies are supported by medical research.

References