Travel-related gastrointestinal diseases: Assessment and management

Gastrointestinal illnesses are among the most common health problems affecting travellers returning from international travel. Its public health implications include economic healthcare costs and the risk of promoting antimicrobial resistance. This narrative review aims to critically appraise the literature concerning gastrointestinal diseases in travellers and outlines a practical approach to aid clinicians in their assessment and management.

The Medline (PubMed) and SCOPUS databases were searched for articles relating to gastrointestinal issues in returning travellers. Articles were primarily restricted to those published in the last 5 years. Only studies on human subjects were included.

Diarrhoea is the most common gastrointestinal symptom experienced by approximately 40%-60% of travellers, but abdominal pain, bloating and fatigue are also common. Diarrhoeagenic Escherichia coli species remain the most common cause of travellers' diarrhoea (TD), with parasitic diseases predominating in those with persistent symptoms. Molecular diagnostic techniques enable highly sensitive simultaneous testing for a multitude of enteropathogens, though more research is required to confirm the pathogenic significance of organisms identified. Further research into poorly absorbable antibiotics and novel therapies such as phage treatment may help to alleviate the burden of antimicrobial resistance. There is a role for empirical anti-parasitic therapy in selected cases.

Clinicians across a range of medical specialities should be familiar with the presentation, aetiology and management of gastrointestinal illness in the returning traveller. Efforts to improve destination sanitation and hygiene infrastructure may serve to reduce the burden of preventable illness in this setting.