474:
of this survey found occurrence of diarrhea was positively associated with the duration of exposure in the wilderness. During any given four-week period, as many as 7.2% of
Americans may experience some form of infectious or non-infectious diarrhea. A number of behaviors each individually reduced the incidence of diarrhea: treating water; routinely washing hands with soap and water after defecation and urination; cleaning cooking utensils with soap and warm water; and taking multi-vitamins.
203:, and hepatitis A virus, can survive freezing for weeks to months. Virologists believe all surface water in the United States and Canada has the potential to contain human viruses, which cause a wide range of illnesses including diarrhea, polio and meningitis. Modes of acquiring infection from these causes are limited to fecal-oral transmission, and contaminated water and food. The major factor governing pathogen content of surface water is human and animal activity in the watershed.
491:. Campylobacter enteritis occurred most frequently in young adults who had hiked in wilderness areas and drunk untreated surface water in the week prior. Another study tested 35 individuals before and after a trip to the Desolation Wilderness of California. Giardia cysts were found in fecal samples from two people after the trip, but they were asymptomatic. A third person was empirically treated for symptoms of giardiasis.
613:
Diarrhea is a common illness of wilderness travelers, occurring in about one third of expedition participants and participants on wilderness recreation courses. The incidence of diarrhea may be as high as 74% on adventure trips. ...Wilderness diarrhea is not caused solely by waterborne pathogens, ...
297:
Ultraviolet (UV) light for water disinfection is well established and widely used for large applications, like municipal water systems. Some hikers use small portable UV devices which meet the U.S. EPA Guide
Standard and Protocol for Testing Microbiological Water Purifiers, for example, the SteriPEN.
473:
hikers found more than half the respondents reported at least one episode of diarrhea that lasted an average of two days. (Infectious diarrhea may last longer than an average of two days; certain forms of non-infectious diarrhea, caused by diet change etc., can be of very brief duration). Analysis
87:
Most cases begin abruptly and usually result in increased frequency, volume, and weight of stool. Typically, a hiker experiences at least four to five loose or watery bowel movements each day. Other commonly associated symptoms are nausea, vomiting, abdominal cramping, bloating, low fever, urgency,
54:
has recorded about one incident per 5,000 person-field days by following strict protocols on hygiene and water treatment. More limited, separate studies have presented highly varied estimated rates of affliction that range from 3 percent to 74 percent of wilderness visitors. One survey found that
223:
A suspected case of wilderness-acquired diarrhea may be assessed within the general context of intestinal complaints. During any given four-week period, as many as 7.2% of
Americans may experience some form of infectious or non-infectious diarrhea. There are an estimated 99 million annual cases of
267:
In a study of long-distance backpacking, it was found that water filters were used more consistently than chemical disinfectants. Inconsistent use of iodine or chlorine may be due to disagreeable taste, extended treatment time or treatment complexity due to water temperature and turbidity.
224:
intestinal infectious disease in the United States, most commonly from viruses, followed by bacteria and parasites, including
Giardia and Cryptosporidium. There are an estimated 1.2 million U.S. cases of symptomatic giardiasis annually. However, only about 40% of cases are symptomatic.
49:
in which backpackers and other outdoor enthusiasts are affected. Potential sources are contaminated food or water, or "hand-to-mouth", directly from another person who is infected. Cases generally resolve spontaneously, with or without treatment, and the cause is typically unknown. The
461:
among wilderness travelers, and results have ranged widely. The variation of diarrhea rate between studies may depend on the time of year, the location of the study, the length of time the hikers were in the wilderness, the prevention methods used, and the study methodology.
469:(NOLS), which emphasizes strict hand-washing techniques, water disinfection and washing of common cooking utensils in their programs, reports that gastrointestinal illnesses occurred at a rate of only 0.26 per 1000 program days. In contrast, a survey of long-distance
83:
are each 7 days. Certain other bacterial and viral agents have shorter incubation periods, although hepatitis may take weeks to manifest itself. The onset usually occurs within the first week of return from the field, but may also occur at any time while hiking.
241:
The risk of fecal-oral transmission of pathogens that cause diarrhea can be significantly reduced by good hygiene, including washing hands with soap and water after urination and defecation, and washing eating utensils with warm soapy water. Additionally a
514:
cysts. The infectious dose of giardia, however, is very low, with about 2% chance of infection from a single cyst. Also, very few studies have addressed the issue of transient contamination. According to one researcher, the likely model for the risk of
211:
It may be difficult to associate a particular case of diarrhea with a recent wilderness trip of a few days because incubation of the disease may outlast the trip. Studies of trips that are much longer than the average incubation period, e.g. a week for
183:
cysts usually do not tolerate freezing although some cysts can survive a single freeze–thaw cycle. Cysts can remain viable for nearly three months in river water when the temperature is 10 °C and about one month at 15–20 °C in lake water.
494:
Fecal-oral transmission may be the most common vector for wilderness acquired diarrhea. There are differing opinions regarding the importance of routine disinfection of water during relatively brief backcountry visits.
373:
Rain storms can either improve or worsen water quality. They can wash contaminants into water and stir up contaminated sediments with increasing flow, but can also dilute contaminants by adding large amounts of water.
539:. The term may be applied in various remote areas of non-tropical developed countries (U.S., Canada, western Europe, etc.), but is less applicable in developing countries, and in the tropics, because of the different
220:, are less susceptible to these errors since there is enough time for the diarrhea to occur during the trip. Other bacterial and viral agents have shorter incubation periods, although hepatitis may require weeks.
232:
Since wilderness acquired diarrhea can be caused by insufficient hygiene, contaminated water, and (possibly) increased susceptibility from vitamin deficiency, prevention methods should address these causes.
190:
may survive in cold waters (4 °C) for up to 18 months, and can even withstand freezing, although its viability is thereby greatly reduced. Many other varieties of diarrhea-causing organisms, including
681:
2815:
264:
or boiling. Factors in choice may include the number of people involved, space and weight considerations, the quality of available water, personal taste and preferences, and fuel availability.
290:
Iodine resins, if combined with microfiltration to remove resistant cysts, are also a viable single-step process, but may not be effective under all conditions. New one-step techniques using
3311:
63:
as their most common illness. Based on reviews of epidemiologic data and literature, some researchers believe that the risks have been over-stated and are poorly understood by the public.
1993:
846:
2497:
1029:
973:
1072:
1043:
Prepared by
Federal-Provincial-Territorial Committee on Drinking Water of the Federal-Provincial-Territorial Committee on Health and the Environment (2004) (2004).
1571:"Azithromycin and loperamide are comparable to levofloxacin and loperamide for the treatment of traveler's diarrhea in United States military personnel in Turkey"
503:
Infection by fecal coliform bacteria, which indicate fecal pollution, are more common than giardiasis. Risks are highest in surface water near trails used by
2092:
457:
The risk of acquiring infectious diarrhea in the wilderness arises from inadvertent ingestion of pathogens. Various studies have sought to estimate diarrhea
3291:
2131:
1966:
1533:
1986:
1012:
3326:
2359:
1946:
1784:
481:. A study at Grand Teton National Park found 69% of diarrhea affected visitors had no identifiable cause, that 23% had diarrhea due to
2572:
1979:
1785:"Sierra Nevada Water: Is it safe to drink? - Analysis of Yosemite National Park Wilderness water for Coliform and Pathologic Bacteria"
466:
96:
is a possibility. Life-threatening illness resulting from WAD is extremely rare but can occur in people with weakened immune systems.
51:
439:
may be prescribed. If diarrhea persists despite therapy, travelers should be evaluated and treated for possible parasitic infection.
279:, and because filtration misses some viruses, the best protection may require a two-step process of either filtration or coagulation-
3244:
3091:
1418:
1203:
1174:
377:
Unfortunately, there have not been any epidemiological studies to validate the above, except possibly for the case of spring water.
445:
can be quite dangerous to patients with compromised immune systems. Alinia (nitazoxanide) is approved by the FDA for treatment of
2989:
1044:
431: – should be treated by a doctor and may benefit from antibiotics, usually given for 3–5 days. Alternatively, a single dose
738:
3130:
2742:
2725:
2230:
2225:
2102:
2255:
2984:
2940:
2834:
2656:
901:
3195:
477:
A variety of pathogens can cause infectious diarrhea, and most cases among backpackers appear to be caused by bacteria from
1815:"Backpacking in Yosemite and Kings Canyon National Parks and neighboring wilderness areas: how safe is the water to drink?"
519:
from wilderness water is pulse contamination, that is, a brief period of high cyst concentration from fecal contamination.
3041:
927:
3316:
3301:
2950:
2469:
2077:
2164:
260:
Water can be treated in the wilderness through filtering, chemical disinfectants, a portable ultraviolet light device,
299:
255:
2060:
1086:
Dickens DL, DuPont HL, Johnson PC (June 1985). "Survival of bacterial enteropathogens in the ice of popular drinks".
816:"Risk of giardiasis from consumption of wilderness water in North America: a systematic review of epidemiologic data"
2530:
2459:
307:
2803:
2759:
2712:
2518:
2136:
2829:
1628:
1142:
3149:
2464:
2422:
2235:
2110:
2097:
2038:
398:
2067:
3296:
3074:
2851:
2592:
2384:
2043:
159:
88:
and malaise, and usually the appetite is affected. The condition is much more serious if there is blood or
3154:
2878:
2861:
2271:
2245:
2121:
2072:
2033:
2011:
2003:
1652:
557:
46:
1751:"Cyst acquisition rate for Giardia lamblia in backcountry travelers to Desolation Wilderness, Lake Tahoe"
343:
large streams (those entering from the side may have less contamination than those paralleling the trail)
3086:
2994:
2955:
2883:
3005:
2186:
510:
Most samples of backcountry water in the
Desolation Wilderness in California have found very low or no
408:
Hikers who develop three or more loose stools in a 24-hour period – especially if associated with
243:
1702:
3125:
3069:
2890:
2786:
2369:
2364:
2198:
2116:
2082:
1526:
165:
352:
lakes with undisturbed sediments (10 days undisturbed water storage can result in 75–99% removal of
3321:
3219:
3029:
2922:
2905:
2866:
2839:
2791:
2634:
2611:
2604:
2553:
2525:
2447:
2442:
2437:
2354:
1611:
815:
552:
528:
3231:
3096:
3079:
3064:
3051:
3034:
2900:
2427:
2399:
2159:
2055:
2020:
1792:
1683:
1379:
1275:
1066:
882:
758:
712:
2535:
2333:
1962:
1750:
1122:
369:
regions where there was a heavy snow year when streams run full and long compared to dry years.
3281:
3209:
3190:
2563:
1942:
1937:
Backer, Howard D. (2007). "Chapter 61: Field Water
Disinfection". In Auerbach, Paul S. (ed.).
1904:
1836:
1722:
1675:
1633:
1592:
1457:
1414:
1359:
1340:
1322:
1253:
1199:
1170:
1165:
Gerba C, Rose J (1990). "Viruses in Source and
Drinking Water". In McFeters, Gordon A. (ed.).
1147:
1103:
1023:
967:
837:
793:
704:
662:
604:
470:
353:
138:
134:
80:
72:
56:
1276:"Prevalence of Diarrhea in the Community in Australia, Canada, Ireland and the United States"
583:"Laboratory evaluation of the 3-bowl system used for washing-up eating utensils in the field"
3286:
3256:
3176:
3171:
3161:
3023:
2895:
2823:
2641:
2548:
2543:
2473:
2432:
2240:
2205:
1894:
1886:
1826:
1765:
1714:
1667:
1623:
1582:
1447:
1371:
1312:
1245:
1137:
1095:
874:
827:
785:
750:
696:
652:
594:
291:
199:
3306:
3214:
3144:
3010:
2945:
2910:
2781:
2646:
2582:
2484:
2403:
2394:
2344:
2284:
2169:
2146:
536:
186:
179:
1971:
1301:"Estimates of incidence and costs of intestinal infectious diseases in the United States"
739:"Epidemiology of Wilderness-acquired Diarrhea: Implications for Prevention and Treatment"
3251:
3166:
2720:
2693:
2558:
2493:
2489:
2379:
2349:
1899:
1874:
1527:"Household Water Treatment Options in Developing Countries: Solar Disinfection (SODIS)"
1317:
1300:
428:
363:
171:
1855:
1249:
832:
789:
776:
Boulware DR, Forgey WW, Martin WJ (March 2003). "Medical risks of wilderness hiking".
3275:
3184:
3137:
2930:
2873:
2856:
2768:
2513:
2340:
2215:
2181:
2126:
1831:
1814:
1411:
The
Ultimate Desert Handbook : A Manual for Desert Hikers, Campers and Travelers
1192:
483:
129:
127:. Other infectious agents may play a larger role than generally believed and include
1383:
1236:
Boulware DR, Forgey WW, Martin WJ 2nd (2003). "Medical Risks of
Wilderness Hiking".
886:
762:
3059:
2971:
2844:
2747:
2698:
2683:
2678:
2674:
2587:
2412:
2328:
2220:
2210:
2176:
1687:
716:
436:
432:
402:
386:
284:
280:
261:
909:
527:
Diarrhea acquired in the wilderness or other remote areas is typically a form of
3239:
3001:
2979:
2810:
2730:
2374:
2275:
2028:
504:
458:
93:
1671:
951:
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (2008-04-16).
700:
641:"Influence of Hygiene on Gastrointestinal Illness Among Wilderness Backpackers"
397:
WAD is typically self-limited, generally resolving without specific treatment.
3015:
2688:
2666:
2311:
2250:
1769:
1718:
1375:
878:
754:
488:
340:
springs (provided the true source is not surface water a short distance above)
76:
1484:
1099:
327:
likely could have passed through an area subject to heavy human or animal use
318:
Different types of water sources may have different levels of contamination:
294:, ozone, and UV radiation may prove effective, but still require validation.
2965:
2935:
2798:
2776:
2629:
2480:
2454:
2316:
2306:
2193:
2154:
2087:
657:
640:
540:
417:
1840:
1679:
1637:
1596:
1461:
1257:
1151:
841:
797:
708:
666:
608:
1908:
1890:
1726:
1612:"Illness and injury among long-distance hikers on the Long Trail, Vermont"
1326:
1107:
952:
2599:
2577:
2289:
680:
McIntosh SE, Leemon D, Visitacion J, Schimelpfenig T, Fosnocht D (2007).
614:
poor hygiene, with fecal-oral transmission, is also a contributing factor
532:
413:
272:
193:
153:
116:
108:
60:
1651:
McIntosh, Scott E.; Drew Leemon; Joshua Visitacion; et al. (2007).
1052:
Guidelines for Canadian Drinking Water Quality: Supporting Documentation
2651:
2417:
2321:
2293:
1505:
405:. Clear, disinfected water or other liquids are routinely recommended.
143:
112:
599:
582:
401:
with rehydration salts is often beneficial to replace lost fluids and
3117:
2735:
2621:
1703:"Campylobacter enteritis from untreated water in the Rocky Mountains"
420:
409:
385:
One study suggests that on very long trips in the wilderness, taking
330:
is cloudy, has surface foam, or has some other suspicious appearance.
306:). Clear water is sterilized by putting it in a clear polyethylene (
107:
Infectious diarrhea acquired in the wilderness is caused by various
1941:(5 ed.). Philadelphia, PA: Mosby Elsevier. pp. 1368–417.
1587:
1570:
1452:
1435:
865:
Backer, Howard (1992). "Wilderness acquired diarrhea (editorial)".
2567:
2297:
1701:
Taylor, D. N.; K. T. McDermott; J. R. Little; et al. (1983).
478:
424:
303:
89:
1274:
Scallan, E. J.; A. Banerjee; S. E. Majowicz; et al. (2002).
1975:
1436:"Water disinfection for international and wilderness travelers"
362:
deep wells (provided they aren't subject to contamination from
1653:"Medical incidents and evacuations on wilderness expeditions"
1569:
Sanders JW, Frenck RW, Putnam SD, et al. (August 2007).
1167:
Drinking water microbiology: progress and recent developments
682:"Medical Incidents and Evacuations on Wilderness Expeditions"
1629:
10.1580/1080-6032(2002)013[0131:iaiald]2.0.co;2
1143:
10.1580/1080-6032(2000)011[0001:isotpw]2.3.co;2
1413:. International Marine/Ragged Mountain Press. p. 46.
1194:
The handbook of chlorination and alternative disinfectants
310:) bottle and leaving it in direct sunlight for 6 hours.
860:
858:
856:
854:
1875:"Risk assessment and control of waterborne giardiasis"
298:
Another approach to portable UV water purification is
99:
Some people may be carriers and not exhibit symptoms.
1791:. Sierra Wilderness Education Project. Archived from
1552:
1550:
1341:"Giardiasis Surveillance — United States, 2009–2010"
3230:
3116:
3109:
3050:
2964:
2921:
2767:
2758:
2711:
2665:
2620:
2506:
2393:
2283:
2270:
2145:
2019:
2010:
1963:
Sources of Infection & Risk Factors for Giardia
26:
21:
1191:
1198:(3rd ed.). New York: Van Nostrand Reinhold.
1123:"In search of the perfect water treatment method"
3312:Symptoms and signs: Digestive system and abdomen
946:
944:
921:
919:
576:
574:
572:
1231:
1229:
1227:
119:). The most commonly reported are the protozoa
1299:Garthright WE, Archer DL, Kvenberg JE (1988).
1269:
1267:
634:
632:
630:
628:
626:
624:
622:
1987:
8:
2093:Esophagogastric junction outflow obstruction
1169:. Berlin: Springer-Verlag. pp. 380–99.
1028:: CS1 maint: multiple names: authors list (
972:: CS1 maint: multiple names: authors list (
820:International Journal of Infectious Diseases
1744:
1742:
1071:: CS1 maint: numeric names: authors list (
1011:EPA, OEI, OIAA, IAD, US (8 November 2016).
926:CDC Division of Parasitic Diseases (2004).
809:
807:
275:, such as iodine and chlorine, do not kill
3113:
2764:
2280:
2132:Esophageal intramural pseudodiverticulosis
2016:
1994:
1980:
1972:
1967:Centers for Disease Control and Prevention
1534:Centers for Disease Control and Prevention
732:
730:
728:
726:
287:. Boiling is effective in all situations.
157:, and various other viruses. More rarely,
92:in stools, abdominal pain, or high fever.
18:
1898:
1830:
1783:Derlet, Robert W.; James Carlson (2003).
1627:
1586:
1451:
1316:
1141:
831:
656:
598:
543:that are most likely to cause infection.
246:can be used for washing eating utensils.
1616:Wilderness & Environmental Medicine
1045:"Protozoa: Giardia and Cryptosporidium"
568:
335:Less contamination may be in water from
322:More contamination may be in water that
1921:
1556:
1396:
1218:
1064:
1021:
998:
986:
965:
908:. Yosemite Association. Archived from
389:may reduce the incidence of diarrhea.
2360:Small intestinal bacterial overgrowth
1660:Wilderness and Environmental Medicine
689:Wilderness and Environmental Medicine
487:and 8% of patients with diarrhea had
7:
1856:"High Sierra Water: What is in the H
1506:"Steripen - Microbiological Testing"
902:"High Sierra Water: What is in the H
535:. These are all considered forms of
3292:Conditions diagnosed by stool test
1873:Rose JB, Haas CN, Regli S (1991).
467:National Outdoor Leadership School
52:National Outdoor Leadership School
14:
3245:Spontaneous bacterial peritonitis
3092:Exocrine pancreatic insufficiency
531:, itself classified as a type of
499:Backcountry water quality surveys
2990:Secondary sclerosing cholangitis
1854:Derlet, Robert W. (April 2004).
1832:10.1111/j.1708-8305.2008.00201.x
900:Derlet, Robert W. (April 2004).
778:The American Journal of Medicine
2231:Gastric antral vascular ectasia
2226:Portal hypertensive gastropathy
2103:Gastroesophageal reflux disease
847:Archived version April 20, 2010
2985:Primary sclerosing cholangitis
2835:Hepatic veno-occlusive disease
2657:Solitary rectal ulcer syndrome
1758:Journal of Wilderness Medicine
1485:"Steripen - Proven Technology"
1364:Journal of Wilderness Medicine
1360:"Wilderness acquired diarrhea"
953:""Crypto" - Cryptosporiodosis"
867:Journal of Wilderness Medicine
1:
3327:Hazards of outdoor recreation
3042:Sphincter of Oddi dysfunction
1749:Zell SC, Sorenson SK (1993).
1250:10.1016/S0002-9343(02)01494-8
955:. Centers for Disease Control
930:. Centers for Disease Control
833:10.1016/S1201-9712(00)90102-4
790:10.1016/S0002-9343(02)01494-8
2951:Postcholecystectomy syndrome
2470:Intestinal pseudoobstruction
2078:Esophageal motility disorder
1610:Gardner TB, Hill DR (2002).
928:"CDC Fact sheet: Giardiasis"
43:Wilderness-acquired diarrhea
22:Wilderness-acquired diarrhea
256:Portable water purification
3343:
2936:Gallstone / Cholelithiasis
2460:Functional colonic disease
2256:Zollinger–Ellison syndrome
1819:Journal of Travel Medicine
1672:10.1580/07-WEME-OR-093R1.1
1434:Backer H (February 2002).
701:10.1580/07-WEME-OR-093R1.1
356:by settling to the bottom)
253:
2137:Acute esophageal necrosis
1770:10.1580/0953-9859-4.2.147
1719:10.7326/0003-4819-99-1-38
1508:. Hydro-Photon, Inc. 2008
1487:. Hydro-Photon, Inc. 2008
1474:Backer 2007, p. 1411
1376:10.1580/0953-9859-3.3.237
1190:White, George W. (1992).
879:10.1580/0953-9859-3.3.237
755:10.1580/0953-9859-3.3.241
271:Because methods based on
2236:Gastric dumping syndrome
2111:Laryngopharyngeal reflux
2098:Diffuse esophageal spasm
1100:10.1001/jama.253.21.3141
399:Oral rehydration therapy
175:may also cause disease.
2852:Alcoholic liver disease
2385:Bile acid malabsorption
2329:Peptic (duodenal) ulcer
1862:. Yosemite Association.
658:10.2310/7060.2004.13621
160:Yersinia enterocolitica
2862:Hepatic encephalopathy
2246:Buried bumper syndrome
2177:Peptic (gastric) ulcer
2061:Mallory–Weiss syndrome
2004:human digestive system
1409:Johnson, Mark (2003).
1358:Howard Backer (1992).
1130:Wilderness Environ Med
587:Wilderness Environ Med
581:Hargreaves JS (2006).
3087:Pancreatic pseudocyst
2956:Porcelain gallbladder
2068:Zenker's diverticulum
1891:10.2105/ajph.81.6.709
507:and cattle pastures.
2891:Hepatorenal syndrome
2830:Budd–Chiari syndrome
2787:Autoimmune hepatitis
2612:Intestinal adhesions
2370:Short bowel syndrome
2199:Functional dyspepsia
2117:Esophageal stricture
2083:Nutcracker esophagus
1789:SierraNevadaWild.gov
639:Boulware DR (2004).
346:fast-flowing streams
314:Water risk avoidance
166:Aeromonas hydrophila
35:backcountry diarrhea
3317:Waterborne diseases
3302:Foodborne illnesses
3030:Choledocholithiasis
2901:Metabolic disorders
2867:Acute liver failure
2840:Portal hypertension
2792:Alcoholic hepatitis
2635:Radiation proctitis
2554:Mesenteric ischemia
2526:Gastroenterocolitis
2355:Blind loop syndrome
2165:Ménétrier's disease
2073:Barrett's esophagus
1939:Wilderness Medicine
1536:(CDC). January 2008
1399:, pp. 1368–417
558:Traveler's diarrhea
553:Wilderness medicine
529:infectious diarrhea
359:freshly melted snow
47:traveler's diarrhea
31:wilderness diarrhea
3205:Undefined location
3196:Grynfeltt–Lesshaft
3097:Pancreatic fistula
3080:Pancreatic abscess
3035:Biliary dyskinesia
3006:Mirizzi's syndrome
2507:Large and/or small
2187:Dieulafoy's lesion
2056:Boerhaave syndrome
1879:Am J Public Health
1813:Derlet RW (2008).
533:secretory diarrhea
300:solar disinfection
141:, enterotoxogenic
73:incubation periods
67:Symptoms and signs
3269:
3268:
3265:
3264:
3105:
3104:
2707:
2706:
2564:Bowel obstruction
2266:
2265:
1948:978-0-323-03228-5
1575:Clin. Infect. Dis
1559:, pp. 1373–4
1440:Clin. Infect. Dis
1305:Public Health Rep
1121:Backer H (2000).
1013:"Water Resources"
814:Welch TP (2000).
600:10.1580/PR17-05.1
471:Appalachian Trail
354:coliform bacteria
349:higher elevations
244:three-bowl system
139:hepatitis E virus
135:hepatitis A virus
115:, and parasites (
81:cryptosporidiosis
57:Appalachian Trail
40:
39:
16:Medical condition
3334:
3257:Pneumoperitoneum
3114:
3024:Common bile duct
2906:Wilson's disease
2896:Peliosis hepatis
2765:
2642:Proctalgia fugax
2549:Abdominal angina
2474:Ogilvie syndrome
2423:Pseudomembranous
2281:
2241:Gastric volvulus
2206:Pyloric stenosis
2017:
2002:Diseases of the
1996:
1989:
1982:
1973:
1952:
1925:
1919:
1913:
1912:
1902:
1870:
1864:
1863:
1851:
1845:
1844:
1834:
1810:
1804:
1803:
1801:
1800:
1780:
1774:
1773:
1755:
1746:
1737:
1736:
1734:
1733:
1698:
1692:
1691:
1657:
1648:
1642:
1641:
1631:
1607:
1601:
1600:
1590:
1566:
1560:
1554:
1545:
1544:
1542:
1541:
1531:
1523:
1517:
1516:
1514:
1513:
1502:
1496:
1495:
1493:
1492:
1481:
1475:
1472:
1466:
1465:
1455:
1431:
1425:
1424:
1406:
1400:
1394:
1388:
1387:
1355:
1349:
1348:
1337:
1331:
1330:
1320:
1296:
1290:
1289:
1287:
1286:
1280:
1271:
1262:
1261:
1233:
1222:
1216:
1210:
1209:
1197:
1187:
1181:
1180:
1162:
1156:
1155:
1145:
1127:
1118:
1112:
1111:
1083:
1077:
1076:
1070:
1062:
1060:
1059:
1049:
1040:
1034:
1033:
1027:
1019:
1017:
1008:
1002:
996:
990:
984:
978:
977:
971:
963:
961:
960:
948:
939:
938:
936:
935:
923:
914:
913:
897:
891:
890:
862:
849:
845:
835:
811:
802:
801:
773:
767:
766:
743:J Wilderness Med
737:Zell SC (1992).
734:
721:
720:
686:
677:
671:
670:
660:
636:
617:
616:
602:
578:
292:chlorine dioxide
200:Salmonella typhi
59:hikers reported
45:is a variety of
19:
3342:
3341:
3337:
3336:
3335:
3333:
3332:
3331:
3272:
3271:
3270:
3261:
3226:
3215:Internal hernia
3101:
3046:
3011:Biliary fistula
2969:
2960:
2946:Adenomyomatosis
2941:Cholesterolosis
2917:
2911:Hemochromatosis
2782:Viral hepatitis
2754:
2703:
2661:
2647:Rectal prolapse
2616:
2583:Fecal impaction
2573:Intussusception
2536:Crohn's disease
2502:
2485:Toxic megacolon
2397:
2395:Large intestine
2389:
2334:Curling's ulcer
2287:
2285:Small intestine
2274:
2262:
2170:Gastroenteritis
2141:
2006:
2000:
1959:
1949:
1936:
1933:
1928:
1920:
1916:
1872:
1871:
1867:
1859:
1853:
1852:
1848:
1812:
1811:
1807:
1798:
1796:
1795:on May 13, 2008
1782:
1781:
1777:
1753:
1748:
1747:
1740:
1731:
1729:
1700:
1699:
1695:
1655:
1650:
1649:
1645:
1609:
1608:
1604:
1568:
1567:
1563:
1555:
1548:
1539:
1537:
1529:
1525:
1524:
1520:
1511:
1509:
1504:
1503:
1499:
1490:
1488:
1483:
1482:
1478:
1473:
1469:
1433:
1432:
1428:
1421:
1408:
1407:
1403:
1395:
1391:
1357:
1356:
1352:
1339:
1338:
1334:
1298:
1297:
1293:
1284:
1282:
1278:
1273:
1272:
1265:
1235:
1234:
1225:
1217:
1213:
1206:
1189:
1188:
1184:
1177:
1164:
1163:
1159:
1125:
1120:
1119:
1115:
1085:
1084:
1080:
1063:
1057:
1055:
1054:. Health Canada
1047:
1042:
1041:
1037:
1020:
1015:
1010:
1009:
1005:
997:
993:
985:
981:
964:
958:
956:
950:
949:
942:
933:
931:
925:
924:
917:
905:
899:
898:
894:
864:
863:
852:
813:
812:
805:
775:
774:
770:
736:
735:
724:
684:
679:
678:
674:
638:
637:
620:
580:
579:
570:
566:
549:
537:gastroenteritis
525:
501:
455:
447:Cryptosporidium
443:Cryptosporidium
429:blood in stools
395:
383:
316:
277:Cryptosporidium
258:
252:
239:
230:
214:Cryptosporidium
209:
187:Cryptosporidium
180:Giardia lamblia
125:Cryptosporidium
105:
69:
17:
12:
11:
5:
3340:
3338:
3330:
3329:
3324:
3319:
3314:
3309:
3304:
3299:
3297:Drinking water
3294:
3289:
3284:
3274:
3273:
3267:
3266:
3263:
3262:
3260:
3259:
3254:
3252:Hemoperitoneum
3249:
3248:
3247:
3236:
3234:
3228:
3227:
3225:
3224:
3223:
3222:
3217:
3212:
3201:
3200:
3199:
3198:
3193:
3180:
3179:
3174:
3169:
3164:
3159:
3158:
3157:
3152:
3141:
3140:
3135:
3134:
3133:
3122:
3120:
3111:
3107:
3106:
3103:
3102:
3100:
3099:
3094:
3089:
3084:
3083:
3082:
3077:
3072:
3067:
3056:
3054:
3048:
3047:
3045:
3044:
3039:
3038:
3037:
3032:
3019:
3018:
3013:
3008:
2999:
2998:
2997:
2992:
2987:
2976:
2974:
2962:
2961:
2959:
2958:
2953:
2948:
2943:
2938:
2933:
2927:
2925:
2919:
2918:
2916:
2915:
2914:
2913:
2908:
2898:
2893:
2888:
2887:
2886:
2881:
2871:
2870:
2869:
2864:
2854:
2849:
2848:
2847:
2842:
2837:
2832:
2820:
2819:
2818:
2808:
2807:
2806:
2796:
2795:
2794:
2789:
2784:
2773:
2771:
2762:
2756:
2755:
2753:
2752:
2751:
2750:
2740:
2739:
2738:
2733:
2723:
2721:Blood in stool
2717:
2715:
2709:
2708:
2705:
2704:
2702:
2701:
2696:
2694:Anal dysplasia
2691:
2686:
2681:
2671:
2669:
2663:
2662:
2660:
2659:
2654:
2649:
2644:
2639:
2638:
2637:
2626:
2624:
2618:
2617:
2615:
2614:
2609:
2608:
2607:
2597:
2596:
2595:
2585:
2580:
2575:
2570:
2561:
2559:Angiodysplasia
2556:
2551:
2540:
2539:
2538:
2528:
2523:
2522:
2521:
2510:
2508:
2504:
2503:
2501:
2500:
2494:Diverticulosis
2490:Diverticulitis
2487:
2478:
2477:
2476:
2467:
2457:
2452:
2451:
2450:
2445:
2440:
2435:
2430:
2425:
2415:
2409:
2407:
2391:
2390:
2388:
2387:
2382:
2380:Milroy disease
2377:
2372:
2367:
2362:
2357:
2352:
2350:Tropical sprue
2347:
2338:
2337:
2336:
2326:
2325:
2324:
2319:
2314:
2303:
2301:
2278:
2272:Lower GI tract
2268:
2267:
2264:
2263:
2261:
2260:
2259:
2258:
2248:
2243:
2238:
2233:
2228:
2223:
2218:
2213:
2208:
2203:
2202:
2201:
2191:
2190:
2189:
2184:
2174:
2173:
2172:
2167:
2162:
2151:
2149:
2143:
2142:
2140:
2139:
2134:
2129:
2124:
2119:
2114:
2108:
2107:
2106:
2100:
2095:
2090:
2085:
2075:
2070:
2065:
2064:
2063:
2058:
2048:
2047:
2046:
2041:
2036:
2025:
2023:
2014:
2012:Upper GI tract
2008:
2007:
2001:
1999:
1998:
1991:
1984:
1976:
1970:
1969:
1958:
1957:External links
1955:
1954:
1953:
1947:
1932:
1929:
1927:
1926:
1924:, p. 1372
1914:
1865:
1857:
1846:
1805:
1775:
1738:
1707:Ann Intern Med
1693:
1666:(4): 298–304.
1643:
1602:
1588:10.1086/519264
1581:(3): 294–301.
1561:
1546:
1518:
1497:
1476:
1467:
1453:10.1086/324747
1426:
1419:
1401:
1389:
1370:(3): 237–240.
1350:
1332:
1291:
1263:
1223:
1221:, p. 1374
1211:
1204:
1182:
1175:
1157:
1113:
1094:(21): 3141–3.
1078:
1035:
1003:
1001:, p. 1369
991:
989:, p. 1371
979:
940:
915:
912:on 2007-10-12.
903:
892:
850:
803:
768:
722:
695:(4): 298–304.
672:
618:
567:
565:
562:
561:
560:
555:
548:
545:
524:
521:
500:
497:
454:
451:
394:
391:
382:
379:
371:
370:
367:
364:surface runoff
360:
357:
350:
347:
344:
341:
337:
336:
332:
331:
328:
324:
323:
315:
312:
283:, followed by
254:Main article:
251:
250:Treating water
248:
238:
235:
229:
226:
208:
205:
172:Cyanobacterium
104:
101:
68:
65:
55:long-distance
38:
37:
28:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
3339:
3328:
3325:
3323:
3320:
3318:
3315:
3313:
3310:
3308:
3305:
3303:
3300:
3298:
3295:
3293:
3290:
3288:
3285:
3283:
3280:
3279:
3277:
3258:
3255:
3253:
3250:
3246:
3243:
3242:
3241:
3238:
3237:
3235:
3233:
3229:
3221:
3218:
3216:
3213:
3211:
3208:
3207:
3206:
3203:
3202:
3197:
3194:
3192:
3189:
3188:
3187:
3186:
3182:
3181:
3178:
3175:
3173:
3170:
3168:
3165:
3163:
3160:
3156:
3153:
3151:
3148:
3147:
3146:
3143:
3142:
3139:
3136:
3132:
3129:
3128:
3127:
3126:Diaphragmatic
3124:
3123:
3121:
3119:
3115:
3112:
3108:
3098:
3095:
3093:
3090:
3088:
3085:
3081:
3078:
3076:
3073:
3071:
3068:
3066:
3063:
3062:
3061:
3058:
3057:
3055:
3053:
3049:
3043:
3040:
3036:
3033:
3031:
3028:
3027:
3026:
3025:
3021:
3020:
3017:
3014:
3012:
3009:
3007:
3003:
3000:
2996:
2993:
2991:
2988:
2986:
2983:
2982:
2981:
2978:
2977:
2975:
2973:
2967:
2963:
2957:
2954:
2952:
2949:
2947:
2944:
2942:
2939:
2937:
2934:
2932:
2931:Cholecystitis
2929:
2928:
2926:
2924:
2920:
2912:
2909:
2907:
2904:
2903:
2902:
2899:
2897:
2894:
2892:
2889:
2885:
2882:
2880:
2877:
2876:
2875:
2874:Liver abscess
2872:
2868:
2865:
2863:
2860:
2859:
2858:
2857:Liver failure
2855:
2853:
2850:
2846:
2843:
2841:
2838:
2836:
2833:
2831:
2828:
2827:
2826:
2825:
2821:
2817:
2814:
2813:
2812:
2809:
2805:
2802:
2801:
2800:
2797:
2793:
2790:
2788:
2785:
2783:
2780:
2779:
2778:
2775:
2774:
2772:
2770:
2766:
2763:
2761:
2757:
2749:
2746:
2745:
2744:
2741:
2737:
2734:
2732:
2729:
2728:
2727:
2724:
2722:
2719:
2718:
2716:
2714:
2710:
2700:
2697:
2695:
2692:
2690:
2687:
2685:
2682:
2680:
2676:
2673:
2672:
2670:
2668:
2664:
2658:
2655:
2653:
2650:
2648:
2645:
2643:
2640:
2636:
2633:
2632:
2631:
2628:
2627:
2625:
2623:
2619:
2613:
2610:
2606:
2603:
2602:
2601:
2598:
2594:
2591:
2590:
2589:
2586:
2584:
2581:
2579:
2576:
2574:
2571:
2569:
2565:
2562:
2560:
2557:
2555:
2552:
2550:
2546:
2545:
2541:
2537:
2534:
2533:
2532:
2529:
2527:
2524:
2520:
2517:
2516:
2515:
2514:Enterocolitis
2512:
2511:
2509:
2505:
2499:
2495:
2491:
2488:
2486:
2482:
2479:
2475:
2471:
2468:
2466:
2463:
2462:
2461:
2458:
2456:
2453:
2449:
2446:
2444:
2441:
2439:
2436:
2434:
2431:
2429:
2426:
2424:
2421:
2420:
2419:
2416:
2414:
2411:
2410:
2408:
2405:
2401:
2396:
2392:
2386:
2383:
2381:
2378:
2376:
2373:
2371:
2368:
2366:
2363:
2361:
2358:
2356:
2353:
2351:
2348:
2346:
2342:
2341:Malabsorption
2339:
2335:
2332:
2331:
2330:
2327:
2323:
2320:
2318:
2315:
2313:
2310:
2309:
2308:
2305:
2304:
2302:
2299:
2295:
2291:
2286:
2282:
2279:
2277:
2273:
2269:
2257:
2254:
2253:
2252:
2249:
2247:
2244:
2242:
2239:
2237:
2234:
2232:
2229:
2227:
2224:
2222:
2219:
2217:
2216:Gastroparesis
2214:
2212:
2209:
2207:
2204:
2200:
2197:
2196:
2195:
2192:
2188:
2185:
2183:
2182:Cushing ulcer
2180:
2179:
2178:
2175:
2171:
2168:
2166:
2163:
2161:
2158:
2157:
2156:
2153:
2152:
2150:
2148:
2144:
2138:
2135:
2133:
2130:
2128:
2127:Megaesophagus
2125:
2123:
2120:
2118:
2115:
2112:
2109:
2104:
2101:
2099:
2096:
2094:
2091:
2089:
2086:
2084:
2081:
2080:
2079:
2076:
2074:
2071:
2069:
2066:
2062:
2059:
2057:
2054:
2053:
2052:
2049:
2045:
2042:
2040:
2037:
2035:
2032:
2031:
2030:
2027:
2026:
2024:
2022:
2018:
2015:
2013:
2009:
2005:
1997:
1992:
1990:
1985:
1983:
1978:
1977:
1974:
1968:
1964:
1961:
1960:
1956:
1950:
1944:
1940:
1935:
1934:
1930:
1923:
1918:
1915:
1910:
1906:
1901:
1896:
1892:
1888:
1885:(6): 709–13.
1884:
1880:
1876:
1869:
1866:
1861:
1850:
1847:
1842:
1838:
1833:
1828:
1825:(4): 209–15.
1824:
1820:
1816:
1809:
1806:
1794:
1790:
1786:
1779:
1776:
1771:
1767:
1764:(2): 147–54.
1763:
1759:
1752:
1745:
1743:
1739:
1728:
1724:
1720:
1716:
1712:
1708:
1704:
1697:
1694:
1689:
1685:
1681:
1677:
1673:
1669:
1665:
1661:
1654:
1647:
1644:
1639:
1635:
1630:
1625:
1621:
1617:
1613:
1606:
1603:
1598:
1594:
1589:
1584:
1580:
1576:
1572:
1565:
1562:
1558:
1553:
1551:
1547:
1535:
1528:
1522:
1519:
1507:
1501:
1498:
1486:
1480:
1477:
1471:
1468:
1463:
1459:
1454:
1449:
1446:(3): 355–64.
1445:
1441:
1437:
1430:
1427:
1422:
1420:0-07-139303-X
1416:
1412:
1405:
1402:
1398:
1393:
1390:
1385:
1381:
1377:
1373:
1369:
1365:
1361:
1354:
1351:
1346:
1342:
1336:
1333:
1328:
1324:
1319:
1314:
1311:(2): 107–15.
1310:
1306:
1302:
1295:
1292:
1277:
1270:
1268:
1264:
1259:
1255:
1251:
1247:
1244:(4): 288–93.
1243:
1239:
1232:
1230:
1228:
1224:
1220:
1215:
1212:
1207:
1205:0-442-00693-4
1201:
1196:
1195:
1186:
1183:
1178:
1176:0-387-97162-9
1172:
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3183:
3060:Pancreatitis
3022:
2972:biliary tree
2845:Nutmeg liver
2822:
2748:Hematochezia
2699:Pruritus ani
2684:Anal abscess
2679:Anal fistula
2675:Anal fissure
2588:Constipation
2542:
2413:Appendicitis
2221:Gastroptosis
2211:Achlorhydria
2050:
2039:Eosinophilic
1965:from the US
1938:
1917:
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1797:. Retrieved
1793:the original
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1713:(1): 38–40.
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1622:(2): 131–4.
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1521:
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932:. Retrieved
910:the original
895:
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866:
826:(2): 100–3.
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819:
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749:(3): 241–9.
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645:J Travel Med
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505:pack animals
502:
493:
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459:attack rates
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453:Epidemiology
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437:levofloxacin
433:azithromycin
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403:electrolytes
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70:
42:
41:
34:
30:
3240:Peritonitis
3002:Cholestasis
2980:Cholangitis
2923:Gallbladder
2811:Fatty liver
2731:Hematemesis
2713:GI bleeding
2519:Necrotizing
2448:Lymphocytic
2443:Collagenous
2438:Microscopic
2375:Steatorrhea
2276:Enteropathy
2122:Inlet patch
2044:Herpetiform
2029:Esophagitis
1922:Backer 2007
1557:Backer 2007
1397:Backer 2007
1345:www.cdc.gov
1219:Backer 2007
999:Backer 2007
987:Backer 2007
873:: 237–240.
523:Terminology
94:Dehydration
27:Other names
3322:Wilderness
3276:Categories
3232:Peritoneal
3210:Incisional
3131:Congenital
3075:Hereditary
3052:Pancreatic
3016:Haemobilia
2689:Hemorrhoid
2667:Anal canal
2605:Infectious
2593:Functional
2428:Ulcerative
2312:Duodenitis
2251:Gastrinoma
1931:References
1799:2008-10-15
1732:2008-10-16
1540:2010-07-31
1512:2008-10-14
1491:2008-10-14
1285:2008-10-15
1136:(1): 1–4.
1058:2008-08-07
959:2008-10-13
934:2008-10-13
489:giardiasis
228:Prevention
77:giardiasis
3220:Richter's
3177:Spigelian
3172:Obturator
3162:Umbilical
2995:Ascending
2966:Bile duct
2799:Cirrhosis
2777:Hepatitis
2760:Accessory
2630:Proctitis
2481:Megacolon
2455:Dysentery
2365:Whipple's
2317:Jejunitis
2307:Enteritis
2194:Dyspepsia
2155:Gastritis
2088:Achalasia
2021:Esophagus
1067:cite book
564:Footnotes
541:pathogens
418:abdominal
393:Treatment
207:Diagnosis
151:O157:H7,
3282:Diarrhea
3150:Indirect
3145:Inguinal
2879:Pyogenic
2824:Vascular
2600:Diarrhea
2578:Volvulus
2544:Vascular
2483: /
2472: /
2433:Ischemic
2400:Appendix
2290:Duodenum
2160:Atrophic
2034:Candidal
1841:18666919
1680:18076301
1638:12092966
1597:18688944
1462:11774083
1384:71955543
1258:12681456
1238:Am J Med
1152:10731899
1024:cite web
968:cite web
887:71955543
842:10737847
798:12681456
763:73001096
709:18076301
667:14769284
609:16805145
547:See also
414:vomiting
381:Vitamins
273:halogens
194:Shigella
154:Shigella
117:protozoa
109:bacteria
61:diarrhea
3287:Camping
3191:Petit's
3167:Femoral
3070:Chronic
2884:Amoebic
2652:Anismus
2418:Colitis
2345:Coeliac
2322:Ileitis
2294:Jejunum
2147:Stomach
2051:Rupture
1909:2029038
1900:1405147
1727:6859722
1688:1401977
1327:3128825
1318:1477958
1108:3889393
717:1401977
517:Giardia
512:Giardia
237:Hygiene
218:Giardia
149:E. coli
144:E. coli
121:Giardia
113:viruses
3307:Hiking
3185:Lumbar
3155:Direct
3138:Hiatus
3118:Hernia
2970:Other
2736:Melena
2622:Rectum
2105:(GERD)
1945:
1907:
1897:
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665:
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421:cramps
410:nausea
169:, and
103:Causes
3110:Other
3065:Acute
2816:MASLD
2769:Liver
2743:Lower
2726:Upper
2568:Ileus
2404:Colon
2298:Ileum
2113:(LPR)
1754:(PDF)
1684:S2CID
1656:(PDF)
1530:(PDF)
1380:S2CID
1281:. CDC
1279:(PDF)
1126:(PDF)
1048:(PDF)
1016:(PDF)
883:S2CID
759:S2CID
713:S2CID
685:(PDF)
479:feces
427:, or
425:fever
304:sodis
90:mucus
33:, or
2498:SCAD
1943:ISBN
1905:PMID
1837:PMID
1723:PMID
1676:PMID
1634:PMID
1593:PMID
1458:PMID
1415:ISBN
1323:PMID
1254:PMID
1200:ISBN
1171:ISBN
1148:PMID
1104:PMID
1088:JAMA
1073:link
1030:link
974:link
838:PMID
794:PMID
705:PMID
663:PMID
605:PMID
465:The
216:and
197:and
123:and
79:and
75:for
2804:PBC
2531:IBD
2465:IBS
1895:PMC
1887:doi
1860:O?"
1827:doi
1766:doi
1715:doi
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1624:doi
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1448:doi
1372:doi
1313:PMC
1309:103
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