Diarrhea after International Travel

Diarrhea is the leading cause of illness among travelers during international travel as well as after travel. Many international travelers suffer from diarrhea and other bowel symptoms after travel. Many other illnesses may also develop among travelers after international travel beside diarrhea.

The cause of diarrhea after international travel:

The causes of diarrhea among travelers are different during travel and after travel. During travel the commonest cause of diarrhea is “travelers’ diarrhea”, but after travel the cause is different. The most frequently identified pathogens causing travelers’ diarrhea are enterotoxigenic Escherichia coli and enteroaggregative E. coli, Campylobacter infections, Salmonella (causative agent for typhoid fever and food poisoning), Shigella, rotavirus etc. The common causes of diarrhea after travel are post-infectious sequelae such as lactose intolerance or irritable bowel syndrome. But diarrhea after international travel may also be due to infectious agents such as Giardia lamblia (causative agent for giardiasis), Cyclospora cayetanensis, Entamoeba histolytica (causative agent for amebiasis), although infectious agents account for small proportion of cases with persistent bowel symptoms after travel.

A recent study showed that as many as 4-13% of the travelers may develop diarrhea and other persistent gastrointestinal or bowel symptoms after international travel.

Treatment of diarrhea or other persistent bowel symptoms after travel:

If the causative agent can be identified, it should be treated with appropriate antibiotic therapy. If no infectious etiology can be identified, a trial of metronidazole (400 mg three times a day for 5 to 7 days) therapy for presumed giardiasis and a strict lactose-free diet for 1 week is given or a several-week trial of high-dose hydrophilic mucilloid. The above strategy of treatment is successful in many cases.

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