Stomach Problems Due to Chronic Infections
Stomach pain, bloating, belching, gas and diarrhea, lasting for several weeks or months may result from chronic infection by parasites, bacteria or, rarely, viruses or yeasts. There is often no fever in these infections.
Intestinal parasites, like giardia or intestinal worms, may cause long term loose stools with mucus or blood and abdominal bloating. Pale skin and tiredness are due to iron-deficiency anemia caused by impaired iron absorption due to intestinal inflammation, and blood loss due to bleeding ulcers, or blood sucked by intestinal worms. Diagnosis is made by finding parasites by stool Ova & Parasites test. Treatment by anti-parasitic medications usually results in full recovery in few days. Infection may recur if it was not completely treated or if source of parasites (pets, food or water poisoning) still exists.
Infection with Helicobacter pylori bacterium is common and appears worldwide. Symptoms include bloating, feeling of pressure in upper middle abdomen, nausea, early satiety, belching and heartburn, but infected person may have no symptoms at all. H. pylori can cause chronic gastritis (inflammation of the inner layer of the stomach) or peptic ulcer in the stomach or duodenum and thus upper middle abdominal pain. Diagnosis is made by urea breath test, blood or stool test or biopsy performed during upper endoscopy. Treatment is by combination of anti-acid drugs and antibiotics and lasts 7-10 days. Antibiotics may cause strong nausea but the full course of treatment has to be completed, otherwise infection may recur. Mode of transmission of H. pylori is still not entirely clear.
Food poisoning with bacteria, like shigella may result in chronic inflammation of large intestine (colitis) with diarrhea, blood in the stool, abdominal cramps and urgency to have a bowel movement. Disorder with severe bloody diarrhea is called bacterial dysentery and is rare in the western world. Other bacteria, like campylobacter may be involved. Diagnosis is by finding bacteria in the stool sample. Treatment is with antibiotics.
Antibiotic associated diarrhea may appear during antibiotic treatment; it is caused by overgrowth of Clostridium difficile bacteria in the colon. Beside lower left abdominal pain, diarrhea and fever, a typical symptom is a barnyard smell of the stool and gas. Diagnosis is by finding C.diff toxin in the stool sample. Treatment is with antibiotics.
Whipple’s disease is a rare infection of the small intestine, caused by bacterium Trophermyma whippleii. It mainly affects white men between 30-60 years of age, living in North America and Europe. Main symptoms are diarrhea, inflamed joints, skin darkening, and weight loss. Diagnosis is by investigation of a sample of duodenal mucosa taken during upper endoscopy. Disease is progressive and may be fatal if not treated; antibiotic treatment is usually successful (1). Disease may recur.
Bacterium Coxiella burnetii causes Q fever with high fever, exceeding 40°C (104°F), coughing and diarrhea. The disease is spread by cattle, sheep and goats – with their urine and stools or fluids during birthing. People are infected by inhaling contaminated air and dust; the disease may last for few months. Diagnosis may be suspected from the history of the work on the farm and confirmed by by finding specific antibodies in the blood. Blood platelets level is often lowered. Vaccines for animals and humans are available. Treatment is with antibiotic doxycycline (2).
Viruses and Yeasts (Fungi)
Infections in AIDS
AIDS patients often get infected with yeast Candida albicans, parasites, cytomegalovirus or herpes virus due to their lowered immune system. Beside infections, anti-HIV drugs, antibiotics and stress may all cause diarrhea in AIDS.
Therapy of Diarrhea in AIDS:
- The cause of infection has to be found and, if possible, treated
- Anti-HIV drugs may be changed if necessary
- Avoiding fats, milk products, raw fruits and vegetables (3)
- Probiotics, like Saccharomices boulardii may prevent diarrhea
Other Causes of Chronic Bowel Infections
Rarely, infections that start in other organs may spread to the gut and cause chronic bowel problems. Mycobacterium tuberculosis (in tuberculosis), coronavirus (in SARS), Herpes simplex virus, Candida albicans, and plasmodium (in malaria) may all cause chronic diarrhea.
In the western world, chronic bowel infections mostly affect mostly persons with lowered immunity, cancer patients receiving chemotherapy or radiotherapy and diabetic patients. In undeveloped world, chronic diarrhea is a major problem, because it may result in malnutrition, and many patients die.
- Whipple’s disease treatment (mayoclinic.com)
- Q fever (cdc.gov)
- Diet in diarrhea in AIDS (aidsinfonet.org)
- Effect of Saccharomyces boulardii probiotics in bowel infections (sajch.org.za)
Article reviewed by Dr. Greg. Last updated on December 1, 2009