A recent article describes a retrospective chart review of 45 children with chronic nausea and compares them to 49 children with chronic abdominal pain (J Pediatr 2014; 164: 1104-09).
- While onset of symptoms was similar, the chronic nausea cohort presented at a median age of 15 years compared with 12 years for the pain cohort.
- Comorbid conditions like anxiety, dizziness and fatigue were common in chronic nausea cohort.
- Family history of migraines was note in 71% of nausea cohort compared with 22% in pain cohort
- Extensive laboratory and imaging was much more frequent in nausea cohort. With nausea cohort, 78% had abdominal ultrasound, 60% an upper GI, 58% brain imaging with either a CT scan or MRI, 38% gastric emptying, 31% abdominal CT or MRI, and 24% had HIDA.
- Almost all endoscopies were normal (98% of chronic nausea group and 100% of pain cohort)
- For nausea cohort treatment, tricyclic antidepressants showed a good response (=at least 50% symptom improvement) in 44% with a mean maximal dose of 50 mg. In contrast, with proton pump inhibitors, only 22% had some improvement (=at least 25% symptom improvement). Similarly, ondansetron showed some improvement in 50% –though none had a “good response.”
- Twelve patients (27%) of the nausea cohort met diagnostic criteria for cyclic vomiting syndrome (CVS) (with interepisode nausea) and another nine (20%) developed chronic nausea after ‘outgrowing’ CVS.
- Postural (orthostatic) tachycardia syndrome (POTS) was noted in 16 of 45 in the nausea cohort based on an orthostatic screen (heart rate ≥30 beats/min during positional changes from 10 minutes in supine position to standing.
As the authors note, their study, conducted between 2006-2012, had numerous limitations, particularly the relative small size and retrospective nature. In addition, the physician expertise in nausea/vomiting at Children’s Hospital of Wisconsin predisposes to a selection bias.
Take-home message: Nausea can be a severe symptom but is often difficult to manage. Extensive workup has a low yield in absence of other complaints or physical exam findings.
An AGA technical review on nausea and vomiting was published in 2001: GASTROENTEROLOGY 2001;120:263–286
Related blog posts:
- Salt for POTS –who benefits? | gutsandgrowth
- Diet or drugs for cyclic vomiting syndrome | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.