Hard to stomach this

Seasonal changes can wreak havoc on your digestive system but adopting a hygienic routine can make it better, suggests Dr Poornachandra K S

Seasonal variation of digestive diseases is caused or influenced by changes in diet, sanitation, food consumption and the lifestyle associated with seasonal changes.

Of all the disorders with seasonal variation, the most common ones are associated with poor sanitation. They are usually seen at the beginning of the rainy season or with excess rains, which tests the sanitary preparedness of the city or town. An infrastructure with poor sanitation allows breeding of mosquitoes that are vectors for many infections like malaria, dengue and leptospira.

The most common gastrointestinal issue associated with poor sanitation and personal hygiene is gastroenteritis — vomiting and loose stools. This may be because of the presence of the following:

♦ Bacteria-like shigella, ecoli, salmonella, cholera — usually present with significant abdominal pain, fever, mucus in stools, tenesmus leaving one with a constant urge to pass stools.

♦ Virus like norovirus, adenovirus, astro and rotavirus — abdominal discomfort with watery diarrhoea, low-grade fever, vomiting and significant body and joint pain.

♦ Parasites like amoeba, giardia — abdominal discomfort, semi-solid mucoid stools, occasionally associated with blood and tenesmus. Vomiting is usually not seen.

♦ Diseases like Hepatitis A, Hepatitis E, typhoid are spread through contaminated food and water and manifest with nausea, body ache— joint pain, loss of appetite, fever, some abdominal pain and later, jaundice.

♦ Malaria, dengue, leptospira, transmitted via mosquito bites, are also more common after rains as poor sanitation leads to puddles promoting the breeding of mosquitoes. These diseases can also present themselves as loose stools, abdominal pain, jaundice, liver inflammation and gallbladder inflammation

Preventing these seasonal digestive diseases is simple. Practising good personal hygiene by washing hands before preparing food and eating, cleaning of vegetables and other food ingredients, consuming only potable water (boiled and cooled water, UV filtered water) and enforcement of good public as well as personal sanitary practices is a big step towards this. While eating out, choosing a hygienic place, consuming cooked/boiled food is recommended. Using mosquito nets and not allowing water to stagnate in and around the house will protect one from vector-transmitted illness. In case of gastroenteritis, it is advisable to take plenty of liquids, frequently, preferably with some salt and sugar like ORS. Avoid sugared drinks as they may worsen the bloating and diarrhoea. Avoid milk and take plenty of curd. Gastroenteritis is associated with lactose intolerance and milk worsens abdominal pain, bloating and diarrhoea.

However, curd provides probiotics and doesn’t need lactate to digest. Avoid unnecessary antibiotics and antimotility drugs like loperamide. Keep eating as food in the gut helps early recovery. Complex foods with lots of fibre help in recovery.

Most gastroenteritis is mild and spontaneously recovers in a day or two. You need to see a doctor if you feel dehydrated, have reduced/dark urine, experience giddiness on getting up, are unable to eat because of excess vomiting, or if you have high-grade fever, severe abdominal pain or blood in stools. Winter usually leads to overcrowding and greater indoor stay and traditionally more alcohol intake. Even though not very apparent, pancreatitis and alcoholic gastritis are more common in cold winters

Earlier, the appearance of new harvest in the market was associated with altered bowel habits in people with celiac disease or food allergy disorders. This observation is rare nowadays as foods are stored for long and a change in antigenicity of new crop is less. Most of the seasonal variations are in fact manmade and can be prevented by adopting some simple personal hygiene.

(The author is chief, gastroenterology, Sparsh Super Speciality Hospital)

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