Recently, Dr. Katja Karrento gave our group a great update on chronic nausea.  My notes below may contain errors in transcription and in omission. Along with my notes, I have included many of her slides.

• Recent research suggests that functional nausea overlaps with other DGBIs including functional dyspepsia, IBS and even gastroparesis 
• Delayed gastric emptying is found in a subset of patients who meet criteria for functional nausea (though there are limitations of GE studies) 
• Emerging research on use of C13-Spirulina breath test to assess gastric emptying

• Nausea is linked to disability more than stomach pain

• Functional dyspepsia and gastroparesis overlap and may be part of same disorder

• Nausea is associated with numerous extraintestinal comorbidities symptoms

• DGBIs are associated with abnormal autonomic nervous system signaling

• Morning nausea, associated with being upright, is characteristic of dysautonomia. Other symptoms include ; palpitations, anxiety, sweating

• POTS defined by increased HR >40 within 10 minutes with tilt test along with symptoms. In adults, increased HR>30 with symptoms.
• A small (n=10) functional MRI study showed abnormal brain network organization in patients with nausea and orthostatic intolerance

• Vagal efficiency, which is decreased in subsets of DGBI, is a measure of the heart’s regulation of sympathetically-elicited tachycardia (or ‘..heart’s regulation of postural tachycardia’)

• Cyclic vomiting is associated with autonomic nervous system alterations. In adolescence, the disorder often changes to chronic symptoms
• Treatment Advice: Explain early on the difficulty in treating these symptoms. Usually there is not a quick fix medicine. Lifestyle changes and coping are integral parts. Neuromodulation is likely more effective than other approaches

• Dr. Karrento recommends The Dysautonomia Project to doctors and patients

• Exercise is helpful for DGBIs
• Mindfulness training may help: CBT, Hypnotherapy, Biofeedback

• Potential treatments for autonomic dysfunction: Lifestyle changes, Neuromodulation, pharmacology: fludrocortisone, propranolol, pyridostigmine, midodrine

• Percutaneous electrical nerve field stimulation (PENFS) can be useful in functional nausea and many DGBIs

Related blog posts:

• Neuro-Stim for Refractory Cyclic Vomiting?
• Auricular Stimulation Associated with Less Pain, Less Disability, and Better Sleep
• Dr. B Li: Cyclic Vomiting Syndrome 2025
• Jump in Knowledge Regarding Gut-Brain Axis
• Dr. Carlo DiLorenzo: Advice for Managing DGBIs (Part 1)
• Dr. Carlo DiLorenzo: Advice for Managing DGBIs (Part 2)
• Dreaded Nausea (2022) Plus Skills or Pills
• Faulty Narrative with Functional Nausea Study
• Dr. Neha Santucci: Management of DGBIs in the Post-Pandemic Era (Part 1)
• Dr. Neha Santucci: Management of DGBIs in the Post-Pandemic Era (Part 2)
• 2025 Pediatric Cyclic Vomiting Syndrome Guidelines

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