Turista or traveler's diarrhea, is the most frequent health problem of the traveller. It owns numerous names (Mocktesuma's revenge, the Polish, the Pharaoh curse.), all full of imagery, which shows the impression travelers had in having those digestive disorders.

As a matter of fact, one out of two travelers is concerned and, the English more than the other western travelers, but we ignore why. In most of the cases, diarrhea is benign, but in 10 to 20% of the cases, the people remain confined to bed. In 2% of the cases, the disorders become chronic.

In certain cases, it can lead to repatriation. As a matter of fact, the possible seriousness of the traveler's diarrhea, is linked with dehydration due to a liquid, plentiful, and persistent diarrhea, especially if it comes together with vomiting, which makes re-hydration difficult. In this way dehydration may lead to serious consequences, particularly for the elderly who travel more and more often.

Logically the risk is higher if you come from a country with a high health level and if you go to an underprivileged region. Nevertheless, the risk exists if you travel in industrialized countries, even if this risk and the consequences are slighter, which shows that the sources of diarrheas are not always infectious, but linked to stress, changes in diets and ways of life as well.

As everybody knows, what is eaten is the cause of all those problems. Contrarily to generally accepted ideas, solid food is much more likely to lead to diarrhea than drinks. High-risk meals are : cooked meals eaten cold afterward (buffet), seafood, meat and fish that were not cooked long enough, and mixed salad. At the opposite, everything that is eaten hot (very hot) is harmless, as well as dry food (bread, cakes). Thus, you are more likely to get diarrhea if you eat food from a buffet in a famous hotel than if you eat a very hot soup in a street of Bangkok.

Theoretically, prevention is quite simple : you have to avoid high-risk food! What concerns drinks, check if they were previously capped on, and have preferably hot drinks. You can boil water yourself (but who travels around with a stove and a pan.).

You can put decontaminating tablets in water (such as Micropure, Hydrochlonazone), but they are not totally efficacious and you will have to wait one hour before drinking the water. There are systems of individual or collective filters which have proved very efficacious like Katadyn filters or Pentapure system.

In some very particular cases (immune deficit, intercurrent disease, cases of lack of stomach acidity .), where the diarrhea may lead to very serious consequences, or if you have to be absolutely fit for certain circumstances (contract signing, conference.), your doctor can prescribe a preventive antibiotic (quinolones), which will be taken during the "risk-period", but only for a short time.

If despite all the precautions taken, the incident occurs, the first reflex (paradoxically not everybody does think spontaneously of it) should be : drink a lot to compensate the loss (of water). The compensation shall consist of (non-contaminated!) liquid, sugar and salt. You can have for instance fruit juice or sweetened tea with salted biscuits.

In case of vomiting, you should have very small quantities of it, several times and regularly. In certain cases, you will be seeing a doctor on site who will prescribe re-hydration through intravenous perfusion.
Anti-diarrhea medicine are not wholly effective. The most effective are those which do not stop the transit (Smecta®, Tiorfan®, .); at the opposite, you had better using loperamide (Imodium or equivalent of it) only in "emergency" (travel by plane,.) because the over effectiveness of this drug may lead to worse discomfort than the initial diarrhea. Those medicine can even be dangerous if the diarrhea comes together with fever, abdominal pain or blood in the stools. In several cases (diarrhea with fever, persistent diarrhea, fragile person.), an antibiotic with quinolones may be useful (except for pregnant women and for children).

As a conclusion, let us remember that the traveler's diarrhea is frequent, but is benign and short-lasting in most of the cases; however, the consequences of it are sometimes serious for "fragile" people. Prevention is useful, but not wholly effective and hydration is the key element of the treatment.