Nausea and Vomiting in 2021: A Comprehensive Update
Key points
- Nausea and vomiting (N/V) are common symptoms that may become chronic or recurrent and are often difficult to manage.
- Chronic unexplained N/V can markedly reduce quality of life and raise costs through repeated hospitalizations.
- Traditional management relies on drugs, which may be inadequate for a proportion of patients.
- The review covers pathophysiology, pharmacotherapy with its safety concerns and controversies, newer immunotherapies, bioelectrical neuromodulation including gastric electrical stimulation, behavioral and surgical therapies, and complementary medicine.
- Based on emerging understanding of the pathophysiology, improved therapies are becoming available.
Overview
This comprehensive review from the University of Louisville summarizes the mechanisms and treatment of nausea and vomiting, with a focus on chronic and refractory symptoms. It is a narrative review rather than a graded guideline, and it concludes that better understanding of the underlying mechanisms is leading to improved treatment options.
Why chronic nausea and vomiting matter
N/V may occur as a chronic or recurrent condition. Chronic unexplained N/V in particular can be hard to control, leading to a significant decline in quality of life and higher costs of care because of repeated hospital admissions.
Pathophysiology
The review outlines the mechanisms of N/V, including symptoms of gastrointestinal origin and those related to autonomic dysfunction. The authors note that the pathophysiology of N/V related to gastroparesis is not fully understood.
Treatment options
Drug therapy remains the traditional mainstay, and the review discusses the safety concerns and controversies of established medicines. It also covers newer immunotherapy, in which symptom scores for nausea, vomiting, anorexia and abdominal pain fell significantly in a treated patient group, device-based bioelectrical neuromodulation such as gastric electrical stimulation, behavioral and surgical treatments, and complementary and alternative medicine.
Frequently asked questions
Is this a clinical guideline?
No. It is a comprehensive narrative review of mechanisms and treatments, published in the Journal of Clinical Gastroenterology.
What if drugs do not control chronic nausea and vomiting?
The review discusses non-drug options for such patients, including gastric electrical stimulation and other neuromodulation, behavioral and surgical therapies.
Why is chronic unexplained nausea and vomiting a concern?
It can be difficult to control, lowers quality of life and increases costs through repeated hospitalizations.
Source
Heckroth M, Luckett RT, Moser C, Parajuli D, Abell TL. Nausea and Vomiting in 2021: A Comprehensive Update. J Clin Gastroenterol 2021;55(4):279-299. doi:10.1097/MCG.0000000000001485. This summary was prepared by Medpresso from the original publication and is not a substitute for the full text or medical advice.