Hemorrhagic gastroenteritis is a condition where an individual experiences bloody, watery stools and crampy abdominal pains. It is typically a food-borne disease that occurs due to the contamination of foods by infectious organisms such as bacteria, viruses, or parasites.

There are also noninfectious causes of the condition. Escherichia coli (E.coli), specifically the O157:H7 strain, is the bacteria species responsible for most frequently causing hemorrhagic gastroenteritis.

In more severe cases — where a person experiences bloody stools or significant dehydration — the condition warrants emergency care. Supportive treatments, such as fluids or electrolytes, are the mainstay of treatment.

This article discusses more about hemorrhagic gastroenteritis, its causes, and the various treatment options available.

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The specific prevalence rate of hemorrhagic gastroenteritis typically varies because the disease may be mild in some cases. Mild episodes can be self-limiting, meaning the condition naturally resolves without treatment. Therefore, individuals may not be present at the hospital for recording purposes.

However, the Centers for Disease Control and Prevention (CDC) estimate that E.coli strain O157:H7 — the predominant bacterial cause of hemorrhagic gastroenteritis — accounts for over 63,000 illnesses yearly, resulting in more than 2,100 hospitalizations and deaths in the United States.

The symptoms of hemorrhagic gastroenteritis vary for each person but typically include the following:

  • crampy abdominal pain
  • watery and bloody diarrhea
  • nausea and vomiting
  • dehydration

Some individuals may develop a fever as the disease progresses.

Generally, the symptoms of hemorrhagic gastroenteritis may not be specific. Therefore, a person with these symptoms will benefit from clinical evaluation by a doctor for accurate diagnosis and treatment.

Infectious organisms, especially bacteria, are likely the most predominant cause of hemorrhagic gastroenteritis. E. coli 0157:H7 is the primary type of bacteria responsible for this condition. Other infectious organisms associated with hemorrhagic gastroenteritis include:

  • other bacteria, such as Salmonella or Shigella
  • viruses, such as rotaviruses or noroviruses
  • parasites, such as Giardia

Humans can come into contact with infectious organisms in the following ways:

  • ingesting poorly cooked meats or dairy products
  • drinking unpasteurized milk
  • exposure to contaminated farm animal products
  • unhygienic food handling practices, for example, poorly washed fruits and vegetables
  • exposure to contaminated water in ponds, lakes, and hot tubs

Once the organisms enter the body, they travel to the intestines, bind, and cause damage to the lining of the intestine. Some organisms can secrete toxins (harmful substances) that contribute to the destruction of the lining and activate a sequence of events that result in gastrointestinal symptoms.

Other noninfectious causes of hemorrhagic gastroenteritis include inflammatory bowel diseases, such as Crohn’s disease, or medications, such as anticoagulants.

Hemorrhagic gastroenteritis is not typically a medical emergency. However, in some cases, prompt medical attention is necessary to prevent the onset of life threatening complications.

In cases of hemorrhagic gastroenteritis in vulnerable populations, such as children and older adults, vomiting and diarrhea can lead to significant dehydration. Therefore, when these individuals show signs of dehydration — such as dry mouth or decreased urinary output — they typically require urgent fluid resuscitation and other medical interventions.

Hemolytic uremic syndrome

Another complication of infection with E. coli 0157:H7 is a condition called hemolytic uremic syndrome (HUS). People most often acquire it by consuming unpasteurized milk or undercooked beef. Someone with HUS may experience the following:

  • hemolytic anemia, which manifests as shortness of breath and jaundice
  • progressive kidney impairment
  • thrombocytopenia, which is a decreased platelet count

In those with a history of bloody, watery diarrhea and other symptoms suggestive of HUS, urgent treatment is necessary. These individuals will benefit from emergency care. HUS is more common in children but can still occur in some adults.

Diagnosing hemorrhagic gastroenteritis typically involves a combination of findings from clinical evaluation and tests.

Clinical evaluation entails taking a medical history and performing a physical examination. The doctor will take a clinical history to determine the symptoms and how long a person has had them. Some people may also present with signs of dehydration, such as:

  • abdominal discomfort or tenderness
  • dry mouth
  • intense thirst
  • fatigue

Laboratory tests

The following are some tests a doctor may order to help diagnose hemorrhagic gastroenteritis:

  • Stool culture: This involves taking diarrhea samples — usually within the first few days — and analyzing them under a microscope to look for E. coli 0157:H7 or other infectious organisms.
  • Molecular diagnostics: Tests called real-time polymerase chain reaction (PCR) and DNA extraction techniques can be used to rapidly confirm the presence of E. coli 0157:H7 or other suspected infectious organisms.
  • Complete blood count: This involves identifying signs of infections, such as increased white cell count, and ruling out hemolytic uremic syndrome in severe cases.
  • Serum electrolyte and urea level: This involves assessing the levels of different electrolytes in the body. It helps exclude electrolyte imbalances due to fluid and electrolyte losses.

Supportive treatment, such as fluid resuscitation, is the mainstay of treatment for hemorrhagic gastroenteritis. This can help manage dehydration and electrolyte imbalance.

Toxins released by E. coli 0157:H7 can damage the integrity of small blood vessels, allowing blood and fluid to escape circulation. If excess fluid volume is lost, the heart cannot deliver sufficient fresh blood to the brain and other vital organs — a dangerous state called cardiogenic shock.

In severe cases, immediate fluid and electrolyte resuscitation is necessary to reduce the risk of life threatening cardiovascular collapse.

In cases of HUS, blood cell transfusion — such as red blood cell and platelet transfusion — is necessary to replace these depleted cells.

Hemorrhagic gastroenteritis is a medical condition that has both infectious and noninfectious causes. E. coli, specifically the 0157:H7 strain, is a bacteria that causes hemorrhagic gastroenteritis. Most milder cases of hemorrhagic gastroenteritis can resolve in a few days without treatment.

A person with the condition may present with crampy abdominal pain, watery and bloody diarrhea, vomiting, and dehydration. Hemorrhagic gastroenteritis is typically not a medical emergency, but urgent care becomes necessary in more severe cases.

A doctor diagnoses hemorrhagic gastroenteritis mainly by ordering a stool culture test. Supportive treatments, such as fluid and electrolyte replacement, are the primary treatment method.