Vomiting and nausea can be elicited by a variety of stimuli, although
there is considerable evidence that the same brainstem areas mediate these
responses despite the triggering mechanism. A variety of experimental approaches
showed that nucleus tractus solitarius, the dorsolateral reticular formation of
the caudal medulla (lateral tegmental field), and the parabrachial nucleus play
key roles in integrating signals that trigger nausea and vomiting. These
brainstem areas presumably coordinate the contractions of the diaphragm and
abdominal muscles that result in vomiting. However, it is unclear whether these
regions also mediate the autonomic responses that precede and accompany
vomiting, including alterations in gastrointestinal activity, sweating, and
changes in blood flow to the skin. Recent studies showed that delivery of an
emetic compound to the gastrointestinal system affects the processing of
vestibular inputs in the lateral tegmental field and parabrachial nucleus,
potentially altering susceptibility for vestibular-elicited vomiting. Findings
from these studies suggested that multiple emetic inputs converge on the same
brainstem neurons, such that delivery of one emetic stimulus affects the
processing of another emetic signal. Despite the advances in understanding the
neurobiology of nausea and vomiting, much is left to be learned. Additional
neurophysiologic studies, particularly those conducted in conscious animals,
will be crucial to discern the integrative processes in the brainstem that
result in emesis.