Prolonged stomach aches in travelers

What is it about ?

Many travelers suffer from stomachaches when traveling or after returning home. In general, this is the traveler’s diarrhea, which stops spontaneously after 2 or 3 days. Complaints can sometimes persist. If they last more than 2 weeks, we speak of prolonged stomach aches.

The causes can be very diverse:

• If the stomach aches are of infectious origin, it is usually parasites in the intestines. The most common parasitic infections are infections with Dientamoeba fragilis and Giardia Lamblia. A persistent infection in the belly can also be due to bacteria or viruses, although this is rarer. Bacterial contaminations are more frequently observed in travelers who make acute diarrhea that occur quickly and are often short-lived.
• Sometimes it is no longer possible to identify the germ that could be causing the prolonged pain in the stomach. From microbes can sometimes trigger complaints that are not due to the infection per se. Contamination can change the lining of the intestine, which affects digestion. For example, in people with chronic bowel disease, such as Crohn’s disease or ulcerative colitis, an acute abdominal infection can cause the inflammatory disease to return. Sometimes the intestine can (temporarily) digest nutrients less well after an infection, such as lactose. After an infection, the intestine may be more sensitive, causing the irritable bowel syndrome (IBS).
• Abdominal problems can be a side effect of treatment with antibiotics: they can destroy the bacteria in the gut, leaving the field open for other bacteria that can cause infection (pathogenic bacteria). The wider the spectrum of the antibiotic (i.e., it is active against several kinds of bacteria), the greater the risk of prolonged symptoms.
• Prolonged abdominal pain can also have non-infectious causes. For example: a overactive thyroid, a gluten intolerance (celiac disease), the irritable bowel syndrome, a bowel cancer, the Crohn’s disease, etc.

What is their frequency?

For 100 travelers with acute diarrhea, 40 to 80 have diarrhea caused by bacteria.
For every 100 people who have acute diarrhea, 1 in 3 have symptoms that last more than 2 weeks.

Viruses very rarely cause prolonged complaints.

In every 100 people who take antibiotics, 5 to 25 have diarrhea. Sometimes it stops after a few hours, sometimes it is persistent.

How to recognize them?

Stomach aches last more than 2 weeks. Often there is also diarrhea. In the event of infections caused by a virus (viral infections) or bacteria (bacterial infections), the traveler often has fever and a general feeling of unease. He may also lose his appetite and to lose weight. Signs of a new or underlying condition may be added.

How is the diagnosis made?

There are 3 possible examinations to make a diagnosis:

• The basic examination is a direct analysis and a stool culture: from a stool sample, a culture of the pathogenic bacteria is carried out and tests are carried out to find out which antibiotic is effective against the bacteria found. The parasite eggs can be seen under a microscope.
• The nucleic acid test is a test that can find genetic material of the pathogen in the stool. The test is quick, but unfortunately it is not effective for all infections.
• Detection of antibodies in the blood: Antibodies are specific to a certain type of infection.

To increase the chances of finding the cause of the problem, it is usually necessary to examine 3 stool samples several days apart.

What can you do ?

The travel prevention is extremely important: preferably eat only sufficiently cooked or sufficiently fried foods, drink only bottled water, avoid contact with infected people. Wash your hands frequently and thoroughly, especially after using the toilet.

What can your doctor do?

Treatment depends on the established cause. The doctor will prescribe antibiotics against bacterial infections. There are anti-parasitic products against parasites.

After treatment, the stool should be checked. It is in fact always possible that the pathogenic germ is resistant to the drug used. If necessary, another treatment will be started.

Obviously, it will also be necessary to treat a possible underlying condition.

Want to know more?

• Healthy travel – IMT – Institute of Tropical Medicine

Are you looking for more specialized help?

• Medical services – IMT – Institute of Tropical Medicine

Source

Foreign clinical practice guide ‘Prolonged abdominal pain in travelers’ (2014), updated on 02/28/2017 and adapted to the Belgian context on 03/28/2018 – ebpracticenet