Chronic nausea and vomiting: New insights and approach to treatment

Olden, Kevin W.; Crowell, Michael D.

doi:10.1007/s11938-005-0023-y

Cited by 10 publications

(15 citation statements)

References 11 publications

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“…The cause is currently unknown, with patients exhibiting chronic gastric symptoms while demonstrating normal gastric emptying and lacking obstruction or obvious structural abnormality. 1,2 …”

Section: Introductionmentioning

confidence: 99%

Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting

et al. 2015

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Background & Aims Chronic unexplained nausea and vomiting (CUNV) is a debilitating disease of unknown cause. Symptoms of CUNV substantially overlap with those of gastroparesis, so the diseases therefore may share pathophysiologic features. We investigated this hypothesis by quantifying densities of interstitial cells of Cajal (ICCs) and mapping slow wave abnormalities in patients with CUNV vs controls. Methods Clinical data and gastric biopsy specimens were collected from 9 consecutive patients with at least 6 months of continuous symptoms of CUNV, but normal gastric emptying, treated at the University of Mississippi Medical Center, and from 9 controls (individuals undergoing bariatric surgery but free of gastrointestinal disease or diabetes). ICCs were counted and ultrastructural analyses were performed on tissue samples. Slow-wave propagation profiles were defined by high-resolution electrical mapping (256 electrodes; 36 cm2). Results from patients with CUNV were compared to those of controls as well as patients with gastroparesis who were previously studied by identical methods. Results Patients with CUNV had fewer ICCs than controls (mean 3.5 vs 5.6 bodies/field; P<.05), with mild ultrastructural abnormalities in the remaining ICCs. Slow-wave dysrhythmias were identified in all 9 subjects with CUNV vs only 1/9 controls. Dysrhythmias included abnormalities of initiation (stable ectopic pacemakers, unstable focal activities) and conduction (retrograde propagation, wave front collisions, conduction blocks, and re-entry), operating across bradygastric, normal (range 2.4−3.7 cycles/min), and tachygastric frequencies; dysrhythmias showed velocity anisotropy (mean 3.3 mm/s longitudinal vs 7.6 mm/s circumferential, P<.01). ICCs were less depleted in patients with CUNV than those with gastroparesis (mean 3.5 vs 2.3 bodies/field; P<.05), but slow-wave dysrhythmias were similar between groups. Conclusions This study defined cellular and bioelectrical abnormalities in patients with CUNV, including the identification of slow-wave re-entry. Pathophysiologic features of CUNV were observed to be similar to those of gastroparesis, indicating that they could be spectra of the same disorder. These findings offer new insights into the pathogenesis of CUNV and may help to inform future treatments.

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Section: Introductionmentioning

confidence: 99%

Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting

et al. 2015

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“…Nausea and emesis have a number of etiologies, including motion-related signals that deviate from those expected, administration of toxins, exposure to radiation, migraine, gastrointestinal disease, pregnancy (hormonal changes), and even psychological stimuli (e.g., stress and extreme emotional reactions, as well as classically conditioned smell and taste aversions) (Feyer et al, 2014; Hederos, 1992; Heer et al, 2006; Horn et al, 2014; Kenward et al, 2015; Matthews et al, 2014; Olden et al, 2005; Singh et al, 2016; Sugino et al, 2015; Wiesmann et al, 2015; Yates et al, 2014). There is some evidence that the prodromal signs and symptoms preceding vomiting can vary depending on the emetic trigger.…”

Section: Introductionmentioning

confidence: 99%

“…For example, the sopite syndrome has mainly been associated with motion sickness (Graybiel et al, 1976; Lackner, 2014; Lawson et al, 1998; Matsangas et al, 2014; Van Ombergen et al, 2015). In some cases, prodromal signs and symptoms build-up slowly and have a long duration; in others, vomiting occurs suddenly after an emetic stimulus, such that prodromal signs and symptoms are of short duration (Katelaris et al, 1989; Kovacic et al, 2014; Lackner, 2014; Metz et al, 2007; Olden et al, 2005). These complexities have confounded the description of nausea in the literature.…”

Section: Introductionmentioning

confidence: 99%

What is nausea? A historical analysis of changing views

Balaban

Yates

2017

Autonomic Neuroscience

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The connotation of “nausea” has changed across several millennia. The medical term ‘nausea’ is derived from the classical Greek terms ναυτια and ναυσια, which designated the signs and symptoms of seasickness. In classical texts, nausea referred to a wide range of perceptions and actions, including lethargy and disengagement, headache (migraine), and anorexia, with an awareness that vomiting was imminent only when the condition was severe. However, some recent articles have limited the definition to the sensations that immediately precede emesis. Defining nausea is complicated by the fact that it has many triggers, and can build-up slowly or rapidly, such that the prodromal signs and symptoms can vary. In particular, disengagement responses referred to as the “sopite syndrome” are typically present only when emetic stimuli are moderately provocative, and do not quickly culminate in vomiting or disengagement from the triggering event. This review considers how the definition of “nausea” has evolved over time, and summarizes the physiological changes that occur prior to vomiting that may be indicative of nausea. Also described are differences in the perception of nausea, as well as the accompanying physiological responses, that occur with varying stimuli. This information is synthesized to provide an operational definition of nausea.

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“…2–4 Chronic nausea and vomiting disorders are also included in the classification of functional gastrointestinal disorders (FGIDs). The sections below will discuss the FGID classification based on the recently published Rome IV criteria, as well as the difficulties with classification due to symptom overlap between disorders such gastroparesis, chronic nausea and vomiting, and functional dyspepsia.…”

Section: Classificationmentioning

confidence: 99%