The gastrointestinal tract comprises not only the stomach and the intestines but all organs that are involved in taking up and digesting food. This includes the mouth, oesophagus, stomach, small and large intestines. With a length between 5.5 to 7.5 meters, the intestines are the most important part of the digestive tract.

The causes and symptoms of gastrointestinal or digestive tract diseases can vary greatly. The most common gastrointestinal diseases are inflammation and infection, but nausea, diarrhoea and heartburn (medical: reflux) or food poisoning can also be the reason for queasiness. The diseases can be acute, such as with stomach flu, or chronic, such as in Crohn's disease and ulcerative colitis.

The causes range from a genetic predisposition to infections by pathogens, taking medications up to fatty food with lots of meat and not enough exercise.

Symtoms: How to recognise gastrointestinal diseases

Depending on the type of gastrointestinal disease, different symptoms appear. Nausea, vomiting, and diarrhoea can, for example, appear with a stomach flu, viral and bacterial infections. Heartburn appears when stomach acid rises up into the oesophagus (so-called sulphur burps). The following symptoms are generally typical for gastrointestinal diseases:

•    Nausea
•    Vomiting
•    Diarrhoea
•    Flatulence
•    Abdominal pain, cramps
•    Possibly fever

Digestive disorders, diarrhoea, or travel sicknesses happen especially often on trips. One reason is insufficient hygiene at the site but unfamiliar food and spices can upset the stomach too. To prevent this experts recommend: "Cook it, boil it, peel it or forget it".   And: Ice cubes and tap water should also be avoided on long-distance travel to avoid possible contaminants.

Treatment: How gastrointestinal diseases are treated

It is important to take a lot of fluids when you have an acute gastrointestinal disease to balance out the loss of water and electrolytes through diarrhoea and vomiting – this is especially important in small children and the elderly. Tee, broth, or oral hydration solutions are suitable for this purpose. Experts do not advise taking the home remedies pretzel sticks and Coca-Cola because they contain too much sugar and salt that are ingested in uncontrolled amounts and can therefore make diarrhoea even worse. Bed rest can help if the afflicted person feels weak and tired. A warm water bottle can help soothe abdominal cramps and pain. In addition, there are various drugs that help in cases with non-specific gastrointestinal complaints, diarrhoea, vomiting, nausea, or heartburn.

Unpleasant, distressing, debilitating - anyone who has had diarrhea just wants to be rid of it quickly. Diarrhea upsets the body and affects well-being. Fortunately, it often occurs only acutely and is gone again after a few days. Nevertheless, it is important to deal with the causes and treatment options.

When do we speak of diarrhea?

Whether diarrhea exists is initially determined by the stool consistency and frequency. According to medical definition, we speak of diarrhea when more than three mushy to thin bowel movements occur per day and the usual amount of stool is increased.

Diarrhea - acute or chronic?

Depending on the temporal course of the diarrhea, a distinction is made between acute and chronic diarrhea. Acute diarrhea usually occurs suddenly and subsides on its own after a few days. Typical triggers include:

• Food poisoning after spoiled food
• Viral or bacterial infection (e.g., by norovirus or rotavirus, bacteria such as salmonella or campylobacter)
• Acute psychological stress such as excitement or anxiety (e.g., due to upcoming exam situations or motion sickness)
• Side effect of certain medications (e.g. antibiotics)
• Parasite infection (e.g. amoeba or lamblia)

Caution: If the diarrhea symptoms persist for more than three days or if you suffer from other symptoms such as high fever or blood in the stool, you should seek advice from a doctor.

If the symptoms occur over a period of more than 14 days, more serious diseases may be the cause. In such cases, the complaints should be clarified by a doctor. Chronic diarrhea should also be clarified by a doctor or therapist.

What are the ways in which diarrhea occurs?

Diarrhea can be caused in a wide variety of ways and is highly cause-dependent. Essentially, the following four mechanisms are responsible for the development of diarrhea:

1. Secretory diarrhea: due to inflammation or infection, the intestinal mucosa actively releases water and salts (electrolytes) into the bowel. By liquefying the stool, the body attempts to eliminate pathogens or toxins more quickly. To prevent dehydration due to the high water and electrolyte loss, it is recommended to take a glucose-electrolyte mixture such as Saltadol®. It balances the disturbed water and electrolyte balance and improves the general condition.
2. Osmotic diarrhea: If certain food components (especially carbohydrates) or medications are not absorbed by the body and thus reach the colon undigested, an influx of water occurs in the opposite direction through the intestinal mucosa into the interior of the intestine. There, the contents are liquefied, resulting in diarrhea.
3.  Functional or hypermotile diarrhea: stress or excitement can affect both the stomach and the intestines. When this happens, the movements of the intestinal muscles increase. Thus, the intestines cannot extract enough fluid from the food mush. The stool remains liquid and manifests itself as diarrhea.
4. Exudative diarrhea: Some bacteria or parasites cause inflammation of the intestinal mucosa. As a result of this increased mucus secretion, but also due to blood admixtures, the stool becomes liquefied. Chronic inflammatory bowel diseases can also cause exudative diarrhea.

How to prevent diarrhea?

Above all, you can prevent acute diarrhea yourself with a few simple tips.

• Avoid too close contact with people who are already sick with diarrhea, and regularly disinfect shared objects or surfaces (especially the bathroom, toilet and faucets). This is because diarrheal diseases are often transmitted by droplet or smear infection.
• Whether at home or on vacation, fruit and vegetables sometimes harbor pathogens that can cause diarrhea. Therefore, wash it thoroughly or remove the peel before eating.
• Fresh shrimp, salad from the buffet or sushi from the market stall - if you're traveling, you want to indulge. But it is on raw food that diarrhea pathogens feel at home. Therefore, avoid foods that are not cooked or fried.
• In many countries, the quality of tap water is not as impeccable as in Germany and it can contain dangerous germs. Therefore, travelers should avoid the cool sip directly from the tap and use boiled water or packaged water bottles - also for brushing teeth. It is also best to avoid ice cubes in drinks.
• Hygiene is the key to avoiding diarrheal diseases. Wash your hands regularly and carry hand sanitizer with you in case of need. This will reduce the risk of germ infections.

How to treat diarrhea?

If you are affected by diarrhea despite all precautions, take the following measures:

• First and foremost, make sure you drink enough fluids. At least 2 to 3 litres per day in the form of herbal teas (e.g. chamomile or fennel) and still mineral water should be supplied to the body. To balance the disturbed water and electrolyte balance, it is also recommended to take a glucose-electrolyte mixture such as Saltadol®. You should also use foods that are well tolerated and easy to digest in order to protect your stomach and intestines.
• To relieve the body, special medications for diarrhea such as the drug Loperamid can be a helpful option. They can be used to quickly alleviate diarrhea symptoms. Taking Loperamid akut® in tablet form slows down the increased movement of the intestinal wall, so that the food pulp remains longer in the intestine and the body can better absorb water and electrolytes from it. In addition, the release of water and electrolytes into the intestine is inhibited.
• If you suffer from motion sickness, which is accompanied by diarrhea and additionally nausea as well as vomiting, gastrointestinal medicines such as Emesan® are a possible choice. The nausea is promptly relieved. In case of motion sickness, you can also use the medication preventively.

When should you see a doctor about diarrhea?

Diarrhea that occurs acutely and lasts only a few days is usually harmless in healthy adults. The body can easily compensate for fluid loss and compensate well for electrolyte deficiency. If the symptoms do not improve after three days, if they even worsen, if there is a high fever or blood in the stool, you should definitely consult a doctor. If diarrhea occurs - often in combination with severe abdominal cramps - after meals, a visit to the doctor is urgently recommended to rule out food intolerances. It is also advisable to seek medical help immediately if a highly contagious intestinal disease is suspected or blood in the stool is apparent.

Gastrointestinal infections caused by rotaviruses1 or noroviruses2 occur most frequently during the winter months. These highly infectious viruses are transmitted from person to person by smear infection, usually resulting in severe diarrhoea and vomiting. The rota- or norovirus can also be transmitted via contaminated objects such as toilets, door handles or shared towels.

Infection with the rotavirus affects infants and toddlers under five years of age in particular, as their immature immune system is generally more susceptible to infection. In contrast, the norovirus can affect people of all ages – especially infants and the elderly – and can spread particularly rapidly in community centres, hospitals and retirement homes due to the higher risk of infection.

Typical signs of both virus infections are severe diarrhoea and vomiting, which may be accompanied by fever. The symptoms of a gastrointestinal infection caused by rotaviruses can also include cold-like symptoms such as coughs and a runny nose. The symptoms of a rotavirus infection usually subside by themselves within two to six days. The symptoms of a norovirus infection usually last between 12 and 48 hours, but those affected are contagious for up to two weeks and in some cases can still eliminate the pathogen even after the symptoms have subsided.

The Rota- and Norovirus: What you should pay attention to during treatment

For gastrointestinal infections caused by pathogens such as rotaviruses or noroviruses, treatment depends on the symptoms. For example, Aristo Pharma's portfolio includes suitable preparations for the relief of diarrhoea symptoms, e.g. Loperamid® akut. However, the most important aspect is to compensate for the sometimes considerable loss of fluids and electrolytes caused by severe diarrhoea and vomiting – it is precisely this compensation that experts also recommend as the first step in treatment.3 The loss of fluids and electrolytes can be dangerous, especially for affected infants and elderly people, as they are more prone to dehydration. The loss of fluid can lead to circulatory problems, weakness and dizziness, which is why affected persons should drink a lot! This can include water, unsweetened tea or a glucose-electrolyte solution (prepared with, for example, the Saltadol® Glucose-Elektrolyt-Mischung [electrolyte mixture]). The salts contained in a defined ratio such as common salt, sodium citrate as well as potassium chloride and additionally glucose in the mixture ensure that the water can be absorbed in the intestine, which prevents dehydration. Particularly severe symptoms may also necessitate short-term hospitalisation.

1 Robert Koch-Institut. RKI Ratgeber Rotavirus-Gastroenteritis. Stand: 01.05.2010 Zugriff: 16.01.2020 https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Rotaviren.html
2 Robert Koch-Institut. RKI Ratgeber Norovirus-Gastroenteritis. Stand: 01.07.2008 Zugriff: 16.01.2020 https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Noroviren.html
3 S1-Leitlinie Akuter Durchfall der Deutschen Gesellschaft für Allgemeinmedizin (DEGAM). Stand 2013, gültig bis 09/2018. online: https://www.degam.de/files/Inhalte/Leitlinien-Inhalte/Dokumente/DEGAM-S1-Handlungsempfehlung/053-030%20Durchfall,%20akut/S1-HE_Akuter%20Durchfall_Langfassung.pdf