Dealing with Delhi belly: diarrhoea in the returning traveller

Having a gippy tummy is a common thing to experience when travelling. The question is: what causes travellers’ diarrhoea? Top London gastroenterologist Dr Stuart Bloom has all the answers, along with some advice about how to avoid Montezuma’s revenge when travelling, and how to deal with it if you come down with it.

What is travellers’ diarrhoea?

Travellers’ diarrhoea is usually referred to as the sudden onset of diarrhoea (usually more than 3 loose stools in 24 hours), which may be accompanied by nausea, vomiting, abdominal cramps, fever or blood in the stool in people travelling abroad.

What causes travellers’ diarrhoea?

Travellers’ diarrhoea is very common, as is obvious by the number of everyday labels (gippy tummy, Montezuma’s revenge, the trots, Delhi belly). In fact, there are many causes of digestive upset in people travelling away from their usual environment. Unaccustomed exposure to sun and consequent sunstroke, excess ingestion of alcohol, or swimming in contaminated swimming pool or sea water can all cause diarrhoea, as can unaccustomed exposure to rich and spicy food.

The common infections causing travellers’ diarrhoea (infectious gastroenteritis) can be split into viruses, bacteria and parasites. The most common of these are viral infections (for instance norovirus or rotavirus), or bacterial infections (including salmonella, shigella, campylobacter, or e-coli). However, in about half of all cases no infectious agents can be recovered from the stool using standard methods.

How long does it take to get over travellers’ diarrhoea?

Most cases of travellers’ diarrhoea resolve within 14 days, and most people with travellers’ diarrhoea either do not see a doctor, or just see their GP. Diarrhoea lasting for longer than two weeks, or diarrhoea accompanied by dizziness, bleeding, or fever should prompt a visit to the GP or a specialist. Diarrhoea lasting longer than 2 weeks is termed persistent diarrhoea and can be caused by infections such as giardia. Rarely, an episode of travellers’ diarrhoea can lead to lactose intolerance or a postinfectious irritable bowel syndrome.

How to avoid travellers’ diarrhoea?

The main way of avoiding travellers’ diarrhoea is to take sensible precautions and avoid possible sources of infection. This means drinking bottled or purified water, rather than local tap water, and taking care with any uncooked food, especially salads and peeled fruit.

In restaurants abroad, particularly hotel restaurants serving buffet-type food, care should be taken to make sure the food is thoroughly heated, and not left for long periods near room temperature, as this can be a potent source of food-borne infection.

What should you take when you have travellers’ diarrhoea?

The main principals of travellers’ diarrhoea treatment are supportive. It’s very important to keep hydrated by drinking plenty of fluids. If you have diarrhoea or vomiting, it makes sense to take an electrolyte replacement fluid. It may be necessary to take some anti-diarrhoeal drugs such as loperamide, which can be purchased over the counter, in a dose of 1 tablet (2 mg) after each loose stool. Antibiotics are very rarely required, but if the symptoms persist, a stool specimen can be sent for culture to look for bacteria, which may need treatment.

Is travellers’ diarrhoea contagious?

Travellers’ diarrhoea is very rarely contagious. It is possible that inadequate hand-washing after visiting the lavatory when you have symptoms could result in the infection being transmitted by those you come into contact with, and although this is very uncommon, adequate precautions should be taken.

Sources:

Management of the returning traveller with diarrhoea. Therapeutic advances in Gastroenterology, 2009. Nov (2)6: 367-375 

Photo by EmanuelArgentino1982 - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=59935227