Functional nausea and vomiting

Although functional vomiting (FV), cyclic vomiting syndrome (CVS) and chronic idiopathic nausea (CIN) are fairly rare disorders, it has been increasingly recognized that these conditions can be highly disabling. Traditionally, FV, CVS and CIN have been under-investigated; however, interest in the cause and treatment of these disorders has increased, particularly with regard to their pathophysiology and the evaluation of new treatment approaches. This article presents a literature-based review of the nomenclature, pathophysiology, clinical presentation and management of CIN, CVS and FV. There is a dearth of randomized, controlled trials of treatments for these disorders, owing mainly to their low prevalence. Consequently, referral centers that see a large number of patients with these challenging disorders are working together to share their experience, so that the most productive treatment strategies can be used to help patients. Our knowledge of the treatment of FV, CVS and CIN, as best we know it, is presented here.     

Management of chemotherapy-induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) remains one of the most disturbing side effects of cancer treatment. Research in anti-emetic therapy progressed gradually since the early eighties and the development of anti-emetic agents continues. This review focuses on the current management of CINV based on the most recent guidelines and adherence to the latter is examined more carefully. Setrons (5HT3 receptor antagonists), corticosteroids and NK-1 receptor antagonists are the cornerstones of anti-emetic therapy. The latest developed palonosetron and casopitant proved to be highly promising in clinical trials. Other types include benzodiazepines, cannabinoids and olanzapine. Various risk factors contribute to the overall risk of developing CINV, such as patient characteristics, emetogenic potency of the chemotherapeutic agents and correct prevention of CINV. Current guidelines determine which is the right preventive regimen for each cancer patient at risk for experiencing CINV. Adherence to this guidelines and implementation in daily practice seem to be below the optimal level. In Belgium, authorities use the guidelines as a base for reimbursement and this has increased the level of implementation.     

Managing nausea and vomiting in thoracic oncology

Nausea and vomiting are frequent symptoms that deteriorate the quality of life of lung cancer patients. They are most often iatrogenic and related to chemotherapy based on platinum salts; they can also be evidence of metastasis to the brain or hypercalcemia. Understanding the physiopathological mechanisms at work can make it possible to adopt effective therapeutic measures that are specific to each etiological context.     

Helicobacter pylori infection and postoperative nausea and vomiting

BACKGROUND/AIMS: The aim of this study was to identify factors most relevant to postoperative nausea and vomiting (PONV) and determine the association of Helicobacter pylori with PONV. METHODOLOGY: A cross-sectional analytic survey was conducted on 127 elective patients who underwent general and urological surgery at Sina Hospital in Tehran between March 2005 and March 2006. Related factors considered to have a possible effect on the prevalence of PONV events were evaluated by using a special questionnaire and serological laboratory test of H. pylori. Data was analyzed using t test and chi2 test and logistic regression analysis for comparing the variables. RESULTS: Prevalence of PONV was 54.7% in patients having H. pylori infection. There was no relationship between H. pylori infection and PONV (p>0.05). Prior history of PONV was a significant risk factor for increasing the prevalence of PONV (p<0.05). Also, history of PONV beside female gender, overweighting/obesity and operation type (urologic surgery) could increase the severity of PONV (p<0.05). But, administration of opioids could decrease the severity of PONV (p<0.05). CONCLUSIONS: It was found that PONV had a high prevalence among patients undergoing urologic and general surgery. H. pylori infection cannot affect the prevalence of PONV. More surveys are needed to develop effective protocols for preventing this common and unpleasant problem.     

Mechanisms and management of chemotherapy-induced nausea and vomiting

Only in recent years has serious attention been given to the control of chemotherapy-induced emesis (CIE) which is to the patient a most obnoxious side-effect. Important advances in the understanding of the mechanisms of CIE have led to the scientific appraisal of potential anti-emetics whilst additional, useful anti-emetics have appeared by serendipity. CIE has largely been studied in trials separating either cis-platinum (severely emetic) or non-cis-platinum(moderately emetic)-induced emesis. In the evolution of these trials the difficulty and importance of accurate evaluation of emesis has been revealed and the whole area of psychogenic emesis opened to investigation and treatment. Phenothiazines and butyrophenones have a definite modest anti-emetic role against moderately emetogenic chemotherapy but increasingly corticosteroids, benzodiazepines, high dose metoclopramide and cannabinoids are being used with great effect even with severely emetic drugs. Combination anti-emesis has further improved control rates and new schedules of currently available anti-emetics are now proving their worth. Major advances in anti-emetic control have been achieved recently and every patient at risk of CIE should have good control, if not total abolition, of emesis with appropriate use of anti-emetics.     

Gastric electrical stimulation in medically refractory nausea and vomiting

INTRODUCTION: High-frequency gastric electrical stimulation is a new therapeutic option to improve refractory nausea and vomiting, in gastroparetic patients. Its effects on gastric emptying are, however, inconstant and limited. Therefore, we have hypothesized that high-frequency gastric electrical stimulation could be also effective in patients suffering from refractory vomiting and nausea with normal gastric emptying, and we have compared the symptomatic efficacy of high-frequency gastric electrical stimulation between patients with delayed and normal gastric emptying. PATIENTS AND METHODS: Fifteen patients with chronic, severe and medically resistant nausea and vomiting were included in the study. Gastric emptying was delayed in eight patients (Group 1) and normal in seven patients (Group 2). At inclusion and at 6 months after the start of the stimulation, symptoms (nausea and vomiting, bloating, regurgitations, abdominal pain and appetite) and quality of life were prospectively evaluated using the Gastrointestinal Quality of Life Index score whereas gastric emptying was assessed by scintigraphy and/or octanoic acid breath test. RESULTS: Age, sex, symptoms and quality of life were not different at baseline between the two groups. At 6 months, Gastrointestinal Quality of Life Index and nausea/vomiting scores had significantly improved in both groups. Other symptoms (bloating, regurgitations, abdominal pain and appetite) had improved at 6 months in Group 1 but not in Group 2. Six months after the start of stimulation, gastric emptying was normal in 4/8 Group 1 patients and 5/7 Group 2 patients but was not significantly different from that calculated before the implantation of the stimulator. CONCLUSION: Our results suggest that high-frequency gastric electrical stimulation could be an effective therapy for treating chronic, severe vomiting and nausea whether gastric emptying is delayed or not.     

A young man with odynophagia, nausea and vomiting

No abstract available.     

Pyloric dysfunction in diabetics with recurrent nausea and vomiting

Diabetes mellitus has been associated with a variety of gastrointestinal motor disturbances. Pyloric activity, however, has not been specifically investigated. We have quantified the pyloric manometric profile in 24 diabetics with recurrent nausea or vomiting, or both, without evidence of mechanical obstruction. Twelve healthy volunteers served as controls. A multilumen pneumohydraulic perfusion assembly with five side openings, each 1 cm apart, was positioned fluoroscopically across the antroduodenal junction and used to monitor pressure activity for 5 h (3 h fasting and 2 h fed). Three patterns of pyloric activity were defined and quantified: (a) baseline elevation of greater than or equal to 3 mmHg for greater than or equal to 1 min (tonic pattern); (b) antral-type phasic pressure activity mixed with duodenal phasic activity (phasic pattern); and (c) phasic pattern superimposed on tonic activity (combined tonic-phasic pattern). The duration of the total pyloric activity before and after the meal was greater in diabetics than in controls (p less than 0.005). Furthermore, episodes of unusually prolonged (greater than or equal to 3 min) and intense (greater than or equal to 10 mmHg) tonic contraction, "pylorospasm," were observed in 14 of 24 diabetics but in only 1 control (p = 0.025). In diabetics, episodes of pylorospasm had a peak amplitude of tonic activity of 13 +/- 1 mmHg and a duration of 7 +/- 0.7 min (mean +/- SE). We conclude that pyloric dysmotility forms part of the widespread disruption of gut motility that affects some patients with diabetes.     

Idiopathic gastroparesis in patients with unexplained nausea and vomiting

Nausea and vomiting are symptoms sometimes associated with motor dysfunction. We compared a group of young patients suffering from chronic nausea and/or vomiting and normal upper gastrointestinal x-ray series with a control group. The members of both groups underwent isotopic examinations of their stomachs. The aim of the study was to find a simple method of checking the stomach and proving a motor dysfunction in a group of patients with chronic, inexplicable nausea and vomiting. Patients and controls fasted for an least 6 hr were given 0.5 mCI of [^99mTc] diethylene triaminopentaacetic acid orally in 150 cc milk with 50 g cornflakes. A time-activity curve was obtained and radioactivity over the stomach was recorded exponentially. The parameter of theT1/2 emptying time was used. In normal controlsT1/2 emptying time ranged from 18 to 26 min. Twenty-five symptomatic patients were examined, three of whom achieved normal values, but 22 patients showed pathologic results ranging from 36 to 184 min. In patients with chronic nausea and/or vomiting an isotopic examination of the stomach may provide a simple and rapid diagnostic method of evaluation.     

The management of nausea and vomiting in clinical oncology

The development of cisplatin and the use of intensive combination chemotherapy have resulted in significant therapeutic advances in medical oncology, as well as the need for intensive supportive care aimed at ameliorating enhanced toxicity. From the patient's perspective, the most prominent adverse effects of chemotherapy are nausea and vomiting. Inadequate control of these symptoms leads to physiologic debilitation and psychologic distress, sequelae that result in either the patient being medically unable to continue therapy or noncompliant. Recent antiemetic research has created a voluminous data base from which the appropriate management of many aspects of chemotherapy-induced emesis can be gleaned. Despite these advances, at least 30% of patients continue to experience some degree of acute emesis with chemotherapy, and the problems of delayed and anticipatory nausea and vomiting have just begun to be addressed. Effective management of chemotherapy-induced emesis is an important aspect of the total care of oncologic patients, improving patient compliance and enhancing the therapeutic index of chemotherapy regimens resulting in a decrease in the overall morbidity and mortality of cancer therapy.     

Novel approaches to the treatment of nausea and vomiting

Nausea and vomiting are debilitating symptoms complicating many clinical conditions. Conventional antiemetic agents act as muscarinic, histamine, and dopamine receptor antagonists in the central nervous system. In a retrospective analysis, tricyclic antidepressant drugs demonstrated efficacy in long-term treatment of functional nausea. Some cases of vomiting result from impaired gastrointestinal motor activity. Agents which act on gastric serotonin (5-HT4), dopamine, and motilin receptors accelerate gastric emptying and relieve symptoms in gastroparesis. Recent investigations suggest that some patients with refractory gastroparesis may benefit from gastric electrical pacing. The treatment of acute chemotherapy-induced emesis was revolutionized by 5-HT3 receptor antagonists; however, these agents are less efficacious in delayed vomiting. Neurokinin (NK-1) receptor antagonists show promise in treating delayed chemotherapy-evoked emesis. Furthermore, animal studies indicate a broad spectrum of action for NK-1 antagonists in treating diverse causes of nausea and vomiting. The cyclic vomiting syndrome is characterized by discrete episodes of relentless vomiting separated by asymptomatic intervals and is associated with migraine headaches. Antimigraine therapies including the 5-HT1D receptor agonists sumatriptan reduce the severity of cyclic vomiting attacks. Investigations into these and other novel treatments may provide important advances in the care of difficult cases of nausea and vomiting resulting from disparate illnesses.     

Methotrexate-induced nausea and vomiting in adolescent and young adult patients

This study aims to determine the prevalence of methotrexate-induced nausea and vomiting in both adolescent and adult patients with inflammatory arthritis. A survey of methotrexate side effects was conducted on patients with inflammatory arthritis. We provided a brief questionnaire to unselected patients with inflammatory arthritis being treated with methotrexate attending adolescent and adult rheumatology clinics. The questions related to the presence, absence, and severity of nausea and vomiting, the temporal relationship with methotrexate and whether anti-emetics had been prescribed. A total of 106 patients from the age of 13 years and above—57 adults (over 20 years) and 49 adolescents (13–19 years) were included in this study. The median age for those experiencing nausea was 19 years (interquartile range (IQR) 7) and for those with no nausea 55 years (IQR 46) (p?<?0.001). Thirty-six out of 49 adolescent patients reported nausea (73 %) compared to only 20/57 adults (35 %) (p?<?0.001). Multiple logistic regression analysis showed that the nausea group had a significantly higher proportion of adolescents (p?=?0.0002), patients taking subcutaneous (SC) methotrexate MTX (p?=?0.002), and patients with duration of MTX of more than 1 year (p?=?0.049). Adolescents were estimated to have over 6 times higher odds of nausea compared to adults (OR 6.31, 95 % CI 2.38 to 16.75, p?=?0.0002) after adjusting for SC MTX and duration of MTX. Only 22 % of adolescents and 10 % of adults were prescribed anti-emetics. There is a higher prevalence of MTX-induced nausea and vomiting in adolescents and younger adult patients with inflammatory arthritis compared to older adults. The role of anti-emetics in the treatment of these symptoms is unclear.