Unexplained nausea and vomiting

Abstract

Nausea and vomiting are debilitating symptoms for patients, and can be challenging problems in diagnosis and management for physicians. Initial efforts must be made to establish a specific diagnosis that represents the pathophysiological cause of the nausea and vomiting. If a specific diagnosis is made (for example, antral ulceration), then specific therapy for the lesion will usually eradicate the nausea and vomiting associated with the specific disease. When standard gastrointestinal diseases are eliminated as a cause of nausea and vomiting, then gastric neuromuscular disorders (disorders of motility) should be considered as potential causes of these symptoms. Gastric neuromuscular disorders range from gastric dysrhythmias and abnormalities of gastric accommodation to frank gastroparesis. Treatments for nausea and vomiting due to gastric neuromuscular dysfunction include: 1) patient education and dietary counseling; 2) gastrokinetic drugs; 3) visceral, sensory afferent and CNS drugs; 4) gastrostomy for stomach venting; 5) jejunostomy for enteral feeding access; and 6) acustimulation and gastric pacemaker therapies. Treatment approaches based on the pathophysiology of gastric neuromuscular dysfunction(s) and on patient education aid in the successful management of unexplained nausea and vomiting.

Gastric myoelectrical and autonomic cardiac reactivity to laboratory stressors

“…Several studies have shown that decreased normal gastric myoelectrical activity and increased gastric tachyarrhythmia are associated with the experience of nausea under a variety of clinical and nonclinical conditions (for reviews, see Koch &Stern et al, 2000). In the present study, the speech preparation task prompted a decrease in 3-cpm activity, an increase in gastric tachyarrhythmia, and reports of somatic, emotional, and gastrointestinal symptoms.…”

“…Both normal 3-cpm activity and, consequently, the contractile activity of the stomach may be disrupted, however, by two types of erratic or dysrhythmic gastric myoelectrical activity: gastric bradyarrhythmia (1-2 cpm) and gastric tachyarrhythmia (4-9 cpm; . Whereas gastric bradyarrhythmia has not been reliably associated with a specific behavioral state or clinical outcome, gastric tachyarrhythmia has been associated with the experience of nausea during motion sickness (e.g., Stern et al, 1985;Stern, Koch, Stewart, & Lindbald, 1987), gastroparesis (e.g., Liberski, Koch, Atnip, & Stern, 1990), pregnancy (e.g., Koch, Stern, Vasey, & Dwyer, 1990, functional dyspepsia (e.g., Koch, 1998), and gastric ulceration (e.g., Geldof et al, 1989). Furthermore, several studies have shown that the expression of gastric tachyarrhythmia during the experience of nausea is associated with an increase in sympathetic and decrease in parasympathetic activation .…”

The medical complications associated with purging

“…We are not aware of any research on specific interventions that would benefit the throat and esophagus after self‐induced vomiting. Generally beneficial interventions include sipping small amounts of water or sucking on ice chips in order to reduce the acidic milieu as well as replenish fluids . In the case of severe dehydration, oral rehydratation powders, dissolved in water, can be used under medical supervision .…”

“…Generally beneficial interventions include sipping small amounts of water or sucking on ice chips in order to reduce the acidic milieu as well as replenish fluids. 59 In the case of severe dehydration, oral rehydratation powders, dissolved in water, can be used under medical supervision. 60 In clinical practice, proton-pump inhibitors are used to ease symptoms of indigestion associated with eating disorders.…”

Gastric myoelectrical activity post-chemoradiotherapy and esophagectomy: a prospective study using subscapular surface recording

“…The term ‘electrogastrography’ most commonly refers to the cutaneous measurement of gastric myoelectrical activity 11 . EGG has provided valuable information on the electrical activity of the stomach in medical conditions, such as motion sickness, 12,13 unexplained nausea and vomiting, 14 sickness in pregnancy and diabetic gastroparesis 15–17 . Less information exists relating to the effect of surgery.…”