Explained: Mumbai doctors on why gastroenteritis peaks during monsoon

Mumbai's monsoon season has arrived with full force and regular showers. The season also brings with an increasing number of cases in diseases like dengue and malaria. While they are both mosquito-borne diseases, gastrointestinal disease is not far behind as it not only affects children but also adults, according to experts.

As per the latest numbers from the Brihanmumbai Municipal Corporation's Epidemiology Cell, the cases of gastrointestinal disease have increased from 180 in June 2021 to 456 till June 26 this year. The public health department has said Mumbaikars should take easy precautionary measures like avoiding street food consumption and sanitising or washing hands before food is consumed.

Seeing the increasing number of cases for gastroenteritis, Mid-day Online spoke to Dr Dattatray Solanke, consultant, gastroenterologist at Kokilaben Dhirubhai Ambani Hospital and Dr Roy Patankar, director and gastroenterologist, Zen Multispeciality Hospital to understand what causes the diseases. They also explain why people should take the disease seriously especially due to its similarity to Coronavirus and how it can be avoided with easy preventive measures.

What causes gastroenteritis?
Dr Solanke says gastroenteritis is caused by various infections like bacterial infections, viral infections, of which viruses such as Noorovirus and Rotavirus are the most common culprits of gastroenteritis mainly in children. He adds, "Many a times, food poisoning can present as gastroenteritis. When one doesn't wash hands before eating or after visiting the toilet, does not wash vegetables and fruits properly before consuming, eating food from unhygienic places, street food, unclean water, stale food can cause gastroenteritis." This, he explains, is because the bacteria grows in such food or water and sometimes can release toxins in the food. When consumed, these bacteria, viruses or toxins harm our gastrointestinal system and cause gastroenteritis.

Norovirus can also affect adults, shares Dr Patankar, adding, "Children get infected by Rotavirus when they put their fingers in things contaminated with the virus in their mouths."

What are the symptoms of gastroenteritis?
The patients, says Dr Solanke, come with history of loose motions or diarrhea, fever, crampy abdominal pain, recurrent episodes of vomiting and nausea. This can cause dehydration and electrolyte disturbance in the body because of which patients can experience weakness, dryness of mouth and skin, feeling excessively thirsty, cramps in the muscles, giddiness. In extreme cases, the patients can get prostrated and urine output can decrease which can affect the kidneys also.

Apart from the above, Dr Patankar says the diarrhoea could also be watery and bloody diarrhoea. When one experiences these different types of symptoms, one should immediately consult the doctor, he cautions.

When do the number of gastroenteritis cases generally increase and peak? Why do they peak during this time?
Patankar and Solanke say the cases of gastroenteritis generally peak during monsoon season. Patankar explains, "The humidity during monsoon can make one's digestive system sluggish. Thus, eating contaminated food with bacteria, toxins and parasites will take a toll on your digestive system, and this is how you can suffer gastroenteritis. This condition will lead to the inflammation of the intestines. Gastroenteritis is contagious and spreads through close contact with people who are infected, hence hand hygiene is must to prevent its spread."

It is not only the food, which is exposed to the parasites but also the water during this season. "The water supply can get contaminated due to rains, also the general public hygienic conditions are difficult to maintain during rainy season. People tend to remain indoors in this season because of which the infection can spread from one person to other as it is a contagious disease," Dr Solanke adds.

Are you getting more patients currently suffering from gastroenteritis? Which age group does it affect the most?
Dr Solanke says Kokilaben Dhirubhai Ambani Hospital is getting more patients currently suffering from gastroenteritis. "Currently, a majority of adults and children are coming with complaints of abdominal pain and cramping, watery diarrhoea and fever. The number may go on increasing further. It is essential for everyone to take utmost care of themselves during monsoon and boost their immunity," Dr Patankar adds.

What are the general steps for prevention of gastroenteritis?
Dr Solanke says the prevention of gastroenteritis is very simple. "Maintaining hygiene is extremely important. Simple hand washing with soap before food and after toilet, avoiding eating unhygienic/ street food, stale food; drinking clean boiled or purified water, avoidance of food thought to be contaminated are easy ways to prevent it." This is important because he says there are few vaccines available to prevent gastroenteritis like vaccine against Rotavirus, cholera etc. "It is important to keep yourself hydrated, drink plenty of fluids. ORS solution is easily available at very low cost. It prevents dehydration and electrolytes imbalances. If the symptoms are severe or associated with fever, please consult a doctor," he adds.

"Keep your gut healthy by adding natural probiotics and avoid the junk, processed, and canned food that can disrupt the digestion process," Dr Patankar says. "Try to keep the surroundings clean and avoid eating undercooked food, don't share your personal belongings with others."

What are the risks for a person suffering from gastroenteritis during the ongoing Covid-19 pandemic?
There are quite a few similarities, shares Dr Solanke, and that is why one should be careful. He explains, "Covid-19 infection can have protean manifestations. It can affect almost every system in the body. Diarrhea is very common in Covid-19 infection. Even Covid infection can be present only with diarrhoea or gastroenteritis without respiratory symptoms as the concentration of bacteria is more in the gastrointestinal tract than in the lungs." Patients can experience fever, cough, extreme weakness, body ache etc. It is important to be aware of this fact that a gastroenteritis illness can be Covid infection. Covid infection can lead to reduced immunity which predisposes to bacterial and viral infections leading to gastroenteritis. In his experience, Dr Solanke says there is increased use of kadhas and other alternative medications to prevent Covid infection. "These things can irritate the stomach lining and cause gastritis. Steroids and other medications for Covid can cause gastritis," he notes.

Proton pump inhibitors ((PPIs) are a risk factor for rotavirus, influenza virus, norovirus, and coronavirus infections that are linked to gastroenteritis. "Some patients with gastrointestinal (GI) disease may have greater chances of suffering from more severe illness due to Covid-19 infection as their immunity will already be low," Dr Patankar adds.

Do the symptoms of gastroenteritis and Covid-19 overlap? Please suggest ways to detect gastroenteritis and tell it apart from Covid-19.
Dr Solanke says apart from the similarity in symptoms, the patients usually experience more weakness, muscle pain and cramps in Covid-related diarrhea.

As far as telling them apart, Dr Patankar says, "Some of the signs such as nausea, vomiting, watery diarrhoea, and abdominal pain are only seen when one has gastroenteritis. There are a lot of overlapping symptoms, but one with Covid-19 tends to have more upper respiratory symptoms, cough and loss of taste or smell. Also, these symptoms will improve within three days." He also highlights that getting a Covid test done is the easiest way to know if one has been affected. A rapid stool test can detect rotavirus or norovirus to check for gastroenteritis.

Why should people be concerned about suffering from gastroenteritis? What are the misconceptions about gastroenteritis?
Gastroenteritis is simple to prevent and treat, says Dr Solanke, but sometimes can lead to complications. "It can cause damage to kidneys, electrolyte imbalances, weakness and blood loss can occur in cases of infective diarrhea or dysentery. Hence it is important to timely consult a doctor," he adds.

Hypotension and electrolyte disturbance (hypernatraemia, hyponatraemia, hypokalaemia) is a major concern among people suffering from loose motions, Dr Patankar explains. "This becomes more complicated in people with diabetes, hypertension and underlying heart or lung illness. These people should take more preventive measure before diarrhoeadeteriorates and seek medical help earliest. In otherwise healthy individuals also, it may take longer to recover if not treated in time and people may suffer irritable bowel syndrome or lactulose intolerance." he highlights.

Solanke and Patankar have shared the following myths and busted them too.

Myth: People have a general misconception that eating or drinking during gastroenteritis increases the diarrhoea. It is also believed that certain food items like bananas and watermelon are said to increase diarrhea, which is incorrect.

Fact: Food and water restrictions are not required during gastroenteritis episodes and patients should take normal meals. Milk and dairy products except curd should be avoided during acute episodes.
Note: People tend to self-medicate themselves with medications that prevent intestinal movement but such medicines should be avoided as it can lead to complications.

Myth: Carbonated drinks can be good for rehydration due to gastroenteritis

Fact: Do not have sodas or any carbonated drinks if you have gastroenteritis. The added chemicals in them will increase the episodes of diarrhoea by taking a toll on your digestive system. Try to drink as much water as you can or even have ORS.

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