Stomach upsets or “stomach flu,” are common in summer season due to increased consumption of contaminated water and rapid bacterial and mould growth, causing food spoilage within two hours, and a higher incidence of gastroenteritis, food poisoning, diarrhoea, and vomiting. Dysentery is severe diarrhoea containing blood or mucus, often accompanied by intense stomach cramps, fever, and nausea. It is primarily caused by bacterial (Shigella) or parasitic (Entamoeba) infections. In addition to gastroenteritis, contaminated water can also cause diseases like cholera, typhoid, hepatitis, polio, and leptospirosis.
STOMACH UPSET (GASTROENTERITIS):
Causes include
•Viral infections due to Norovirus (causes 50% of adult cases), rotavirus (causes severe diarrhoea in infants and young children), and adenovirus (more in children and the immunocompromised).
•Bacterial infections due to Salmonella, E. coli, Campylobacter, or Shigella. E. coli is associated with undercooked meat and contaminated vegetables. Salmonella is common in raw eggs, poultry, and contaminated water. Campylobacter is often found in raw poultry. Shigella spreads through contaminated food or poor hygiene.
•Parasitic organisms like Giardia or Cryptosporidium can cause persistent symptoms. They are found in contaminated water in swimming pools, lakes, or daycare centres.
•Broad-spectrum antibiotics can disrupt gut flora, frequently leading to secondary infections like Clostridioides difficile.
•Non-infectious factors like stress, sudden dietary changes, food intolerances (like lactose or gluten), and toxin ingestions can cause stomach upset.
Managing milder cases
•Drink frequent, small sips of 200 ml to 400 ml of an Oral Rehydration Solution (ORS) rather than plain water or sugary juices to replace electrolytes and water lost due to diarrhoea and vomiting. Coconut water is good for daily hydration and mild dehydration.
•Rest the digestive tract initially and gradually reintroduce a bland diet once vomiting stops.
•Avoid taking over-the-counter anti-motility drugs like loperamide, as slowing gut transit can trap harmful bacterial toxins.
•For infants, continue breastfeeding or formula feeding, more frequently but in smaller volumes to counter fluid loss.
Prevent spread through unhygienic food handling, contamination of food and water, contact with an infected person (e.g., shaking hands) or contaminated surfaces (doorknobs, faucets), and then touching the mouth. Tiny particles from vomit containing Norovirus can become airborne.
•Wash your hands thoroughly with soap and water for at least 20 seconds before eating, cooking, and immediately after using the restroom.
•Cook poultry and meats to a safe minimum internal temperature, wash raw produce, and avoid consuming unpasteurised dairy.
•Consume bottled or reliably boiled water when traveling in unsanitary areas.
•Clean contaminated surfaces using bleach or disinfectants. Wash contaminated clothes immediately.
•Avoid sharing eating utensils and food with infected individuals.
•Ensure infants receive the scheduled rotavirus vaccine.
SEEK IMMEDIATE MEDICAL CARE IF
•S eve r e de hyd r at i o n marked by infrequent or no urination, severe dizziness, confusion, or a completely dry mouth.
•Pus or visible bright red blood or dark black tarry blood in stools, or vomit resembling coffee grounds.
•Unremitting, worsening, or severe abdominal pain.
•Persistent vomiting or loose stools.
•Fever exceeding 38.9°C (102°F) that does not respond to standard medication.
•Infants under 6 months old, elderly individuals, or anyone with an immunocompromised medical status.
MEDICAL CONDITIONS THAT MIMIC GASTROENTERITIS
Many acute and chronic conditions mimic the sudden nausea, vomiting, abdominal cramps, and diarrhoea associated with gastroenteritis.
•Respiratory viral infections like flu can cause nausea, vomiting, and diarrhoea, particularly in children, alongside fever and body aches.
•Early-stage or mild appendicitis often presents with general stomach pain and nausea, before the pain migrates to the lower right abdomen.
•Pancreatitis (inflammation of the pancreas) can trigger sudden, severe upper abdominal pain that radiates to the back, alongside persistent vomiting and fever.
•Gallstones can cause abrupt, intense pain in the upper right abdomen, nausea, and vomiting, frequently triggered by eating fatty foods.
•Diabetic Ketoacidosis (DKA), a life-threatening diabetes complication, presents with profound abdominal pain, nausea, and vomiting, often initially misdiagnosed as gastroenteritis.
•Urinary tract infections (UTIs), particularly in children and older adults, can manifest primarily as nausea, vomiting, and abdominal distress.
•Mesenteric Lymphadenitis (inflammation of the lymph nodes in the abdomen), usually following a minor respiratory infection, can mimic appendicitis or stomach upset in children.
•Irritable Bowel Syndrome (IBS) can cause sudden flare-ups of cramping, bloating, and urgent diarrhoea. Post-infectious IBS can also develop right after an episode of gastroenteritis, making it feel like the infection has persisted.
•Inflammatory Bowel Disease (IBD), like Crohn’s disease or ulcerative colitis, causes chronic inflammation of the digestive tract, leading to recurrent abdominal pain, cramping, and severe diarrhoea.
•Celiac Disease, an autoimmune reaction to gluten, causes intestinal inflammation, leading to chronic diarrhoea, severe abdominal pain, bloating, and nausea.
ANNOYANCES DUE TO SWALLOWED AIR
Hiccups, belching, flatulence, and yawning are all common, involuntary (or semi-voluntary) bodily functions related to swallowed air (aerophagia), and temporary relaxation or irritation of the respiratory/digestive muscles. They rarely indicate a severe medical condition unless they become chronic or severe. They are frequently judged as crude, unrefined, impolite, embarrassing, or annoying if they occur loudly or in proximity to others. Yawning is interpreted as a sign of boredom, disrespect, or disinterest in the conversation. It is considered polite to cover the mouth with a hand or to try to stifle a belch or yawn.
All four can be triggered or increased by
•Swallowing food or drinks too fast with excess air.
•Carbonated beverages that release extra gas in the gut.
•Stress or anxiety increase air swallowing and involuntary body reactions.
BELCHING
It is caused by releasing excess air swallowed during eating, drinking, or talking. Acid reflux (GERD) and functional dyspepsia prompt more frequent swallowing of saliva (and air) to clear throat discomfort. Avoid the above-mentioned triggers, eat slowly, chew thoroughly, avoid talking while chewing, stop chewing gum, and practice deep breathing. In some cultures, such as China, Taiwan, Egypt, and Turkey, a soft burp after a meal is considered a compliment to the chef, indicating you enjoyed the food.
FLATULENCE
It is caused by releasing excess air (swallowed during eating, drinking, or talking) from below. It is foul-smelling when partially digested or digested food rots in the gut due to constipation (refer to my article on constipation on 05-04-2026) and overgrowth of the wrong kind of bacteria, especially in the small gut (refer to my article on acidity and bloating on 10-05-2026). Follow the advice given in those articles. Certain drugs, including NSAIDs (like ibuprofen), some laxatives, and statins, can alter digestion and elevate gas levels.
HICCUPS
Hiccups are sudden, involuntary contractions (spasms) of the diaphragm, instantly followed by the rapid closure of the vocal cords (glottis), producing the characteristic “hic” sound. It is triggered by swallowing air due to anxiety or stress, or with rapid eating, or drinking, or by consuming very hot foods followed by cold drinks. Persistent or chronic hiccups, lasting over 48 hours, recurring, or interfering with eating, sleeping, or breathing, need medical evaluation as they can be due to:
•Irritation to the vagus or phrenic nerves due to gastroesophageal reflux disease (GERD), a sore throat, or hair touching the eardrum.
•Central nervous system disorders like stroke, multiple sclerosis, or brain injuries.
•Metabolic Issues like diabetes, kidney disease, or electrolyte imbalances (like low sodium or calcium).
•Side effects of steroids, benzodiazepines, or certain chemotherapy drugs.
Following manoeuvres can stop hiccups
•Hold your breath for 10–20 seconds or breathe in and out of a small paper bag.
•Sip or gargle with ice-cold water to stimulate the vagus nerve.
•Pull your knees up to your chest and lean slightly forward to compress the diaphragm.
•If these conservative measures fail, doctors may prescribe muscle relaxants, proton pump inhibitors (for GERD), or adjust dosages of triggering medication.
YAWNING
It involves an involuntary deep inhalation that stretches the diaphragm and thoracic muscles, followed by exhaling quickly, which increases oxygenation and seems to regulate brain temperature (brain cooling to cool an overheated brain) and enhances alertness. Yawning calms high anxiety or panic hyperventilation.
•Sleep deprivation, insomnia, fatigue, and boredom are the usual triggers of yawning.
•Antidepressants (especially SSRIs), anti-anxiety medications, and antihistamines can also cause yawning.
•Rarely it is due to sleep apnoea, multiple sclerosis, or a vagus nerve reaction associated with cardiovascular issues.
Measures that may help include
•Change your posture, stand up, take a brisk walk to re-energize, drink cold water, or step into a cooler environment to stifle yawning.
•Maintain a consistent sleep schedule and aim for 7–8 hours of quality rest.
•Drink water constantly to prevent the sluggishness that triggers yawning.
•Manage stress with cardio exercises, deep breathing, and meditation. Hobbies and music will both destress and prevent boredom.
•Excessive yawning that occurs alongside daytime fatigue despite adequate rest, or is accompanied by chest pain, shortness of breath, or neurological symptoms, needs medical attention.
Simple precautions mentioned here can save you from stomach upsets, food poisoning, and certain annoyances.
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Dr P.S. Venkatesh Rao is a Consultant Surgeon, former Faculty CMC (Vellore), AIIMS (New Delhi), and a polymath in Bengaluru, drpsvrao.com
