Travellers' Diarrhoea - A Gastroenterologist's Guide

Aah. We have all been there.

The holiday was perfect. The street food….even better!!

And then, somewhere between the third day and the night bus, your gut responds to the “fresh” street tortilla wrap you polished from the local food vendor.

So what do you do?

Load up on loperamide? Live on white bread and bananas? Raid the pharmacy for antibiotics “just in case”?

Most of what people do is wrong. Some of it is harmful.

Here is what you actually need to know.

General Disclaimer: This is general information, not personal medical advice. If you are unwell, please speak to a healthcare professional who can assess you properly.

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Travellers’ diarrhoea is the most common illness picked up abroad.

Up to half of people heading to higher-risk regions of Asia, Africa, Latin America and the Middle East will get it…usually within the first week.

The definition doctors use is simple: three or more loose stools in 24 hours, plus at least one other symptom. Cramps. Nausea. Bloating. Urgency. Sometimes a low fever.

The kind of urgency that makes you memorise the location of every toilet between you and the hotel.

It is unpleasant. It is rarely dangerous.

Most travellers’ diarrhoea is self-limiting, which means it clears on its own.

Typical attacks last three to four days, and the vast majority settle within a week. Your body is already doing the work.

Blame the bugs, not the spice!!!

The overwhelming majority of cases are bacterial.

The headline culprit is enterotoxigenic E. coli (ETEC), responsible for roughly a third of cases. It releases toxins that hijack your gut lining and pour fluid into the bowel.

Hence the watery, urgent, relentless nature of the whole affair.

After ETEC come the usual suspects: Campylobacter, Shigella and Salmonella.

These tend to be the nastier ones, more likely to bring fever and blood.

Viruses can cause symptoms too, and norovirus is the big one.

It is fast, miserable and famously efficient at sweeping through cruise ships and resorts.

Parasites like Giardia cause a smaller slice, roughly one in ten, and they are the troublemakers behind diarrhoea that drags on for weeks rather than days.

The route in is almost always the same. Contaminated food or water.

The faecal-oral route, to give it its unglamorous name.

That salad rinsed in tap water. That ice in your drink. I could go on!