Goal: A comprehensive review of treatments for nausea and vomiting (N/V). Background: N/V are common symptoms encountered in medicine. While most cases of acute N/V related to a specific cause can be straightforward to manage, other cases of acute N/V such as chemotherapy-induced N/V and especially chronic unexplained N/V can be difficult to control, leading to a significant decline in the patient’s quality of life and increased cost of medical care from repeated hospitalizations. Study: Traditional management has relied on pharmacotherapy which may be inadequate in a certain proportion of these patients. Many of the medications used in the management of N/V have significant side effect profiles making the need for new and improved interventions of great importance. Results: This review covers a broad review of the pathophysiology of N/V, pharmacotherapy, including safety concerns and controversies with established pharmaceuticals, newer immunotherapies, bioelectrical neuromodulation (including gastric electrical stimulation), behavioral and surgical therapies, and complementary medicine. Conclusion: On the basis of emerging understandings of the pathophysiology of N/V, improved therapies are becoming available.

Drug-induced liver injury (DILI) is a spectrum of pathology that can be classified by mechanism of injury or by type of observed hepatotoxicity. Vanishing bile duct syndrome (VBDS) is a group of acquired and genetic disorders that cause the destruction and disappearance of intrahepatic bile ducts, and cholestasis. VBDS typically presents with severe cholestatic hepatitis and can have immunoallergic features. Infliximab has been reported to rarely cause a cholestatic pattern of liver injury due to ductopenia characteristic of VBDS. Herein we present a clinical case of infliximab-induced DILI resulting in VBDS.

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Introduction: Gastroparesis (Gp) syndromes are associated with high healthcare burden with high rates of emergency and inpatient utilization. Urgent care rates for Gp remain unknown. In acute care settings, medications are often used to assuage symptoms. Unfortunately, real-world medication use and adverse effects is lacking. We aimed to assess acute care (urgent care, emergency, inpatient) utilization rates and predictors. As a secondary aim, we aimed to assess both exposure of and adverse effects associated with medications used for gastroparesis. Methods: Surveys were administered at a tertiary referral center, returned during that visit, or mailed back. Open-ended questions were used, whenever possible, to prevent response bias for patients to report the adverse effects they experienced. Results: 62 patients (93.5% women) completed the survey. Patients were most frequently exposed to metoclopramide (71.0%), ondansetron (83.9%), and promethazine (72.6%). Of prokinetics, metoclopramide had the highest prevalence of adverse effects (59.1%). The rates of Gp-related urgent care visits, emergency visits, and hospitalizations within 6 months were 19%, 47%, and 26%, respectively. Multivariable logistic regression analysis revealed that patients aged 45-64 were a significant predictor for Gp-related urgent care utilization (aOR 8.8 [95% CI 1.2-65.4, p 0.03]). Low income was a significant predictor for gastroparesis-related hospitalization (aOR 6.8 [95% CI 1.1-42.7, p 0.04]). Conclusion: This survey found high rates of emergency care usage and high prevalence of adverse effects in commonly used medications for Gp patients. Urgent care may be an underutilized tool to reduce emergency care usage in Gp. Treatment algorithms for gastroparesis patients built on balancing adverse effects compared with efficacy are needed. Additionally, early integration of safe complementary integrative Gp therapies may minimize patient exposure while preserving treatment efficacy.

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