We are now well into the rhubarb season and those that indulge will be well aware of the potential effect on the gut. A visitor to the UK unused to this could well be classified as having traveller’s diaorrhoea (TD). Many specialists like to give their special interest an all-inclusive nature. Think psychiatrists and depression or borderline personality disorders.
By defining TD as 3 or more loose motions daily , we include many folk where this is their “normal” – but once they cross the Channel it becomes a disease. The effect I notice with goodly helpings of rhubarb I have when abroad after consuming many of the varied vegetables on offer – often soaked in copious amounts of oil. And that is apart from all those figs in season. BO 3 X daily : if only – and what about the night time as well… And of course any urgency is likely to affect social functioning so I automatically move to a more severe stage of TD by definition. Co-incidentally , I may have a change in my gut flora , but that would not be unexpected.
When challenged , those with a particular interest in TD can become incredibly defensive – reminiscent of the psychiatrist who will react with details of patients with severe or psychotic depression to suggestions that minor degrees of being “down-the-dumps” for a short time does not equate with psychiatric disease.
Perhaps we need to change the definition of TD to one where the disturbance of bowel function is
A. 1. A disturbance beyond the normal bowel habit for the individual ;
2. Not corrected by a bland diet ;
3. Associated with feeling unwell ;
4. Not responding to 2-6 mgs of loperamide daily ;
or B. . Persisting after return to the UK ,( but needing recognition that any TD may have precipitated the onset of IBS) when a wider differential diagnosis might be relevant.
C. Any significant features such as pyrexia , blood in the stools etc.. are red flag symptoms requiring a different approach and these travellers should not be dismissed as having a tummy upset and lumped together with those with milder symptoms. And as for the outbreaks of Norovirus on cruise ships , I would see that as something else altogether and remain thankful that I do not feel tempted anyway by embarking on one of those floating “townships” (by now not just floating hotels).
The aim of being more restrictive in our definition of TD is in part to discourage the overuse of antibiotics , prophylactic and recognise the true incidence of TD where these might be effective.