GASTROENTEROLOGY ARTICLE OF THE WEEK
February 19, 2004
Hasler WL, Chey WD. Nausea and Vomiting. Gastroenterology 2003;125:1860-1867.
1. Scintigraphic measures of solid phase gastric emptying
a. testing for 4 instead of 2 hours increases accuracy
b. documenting delayed gastric emptying proves that gastroparesis is the cause
of the nausea
c. symptoms of nausea may improve or resolve despite lack of normalization of
gastric emptying study results
d. gastric emptying study results are useful in guiding the management of
patients with nausea
2. Empiric treatment of nausea
a. Phenothiazine antiemetics are effective and proven safe in the treatment of
pregnancy-related nausea.
b. low dose tricyclic antidepessants yild moderate symptom control in up to 84%
of patients with chronic nausea.
c. 5-HT3 antagonists are particularly useful in patients with refractory functional
vomiting.
d. Sumatriptan (5-HT1 agaonist) decreases vomiting related with migraines and
cyclic vomiting syndrome.
e. Domperidone mode of action is similar to metoclopramide, however, it does
not cross the BBB and has less CNS side effects.
True or False
3. Patients with mild nausea, no warning signs or complications should nevertheless undergo extensive radiologic and metabolic evaluation to uncover the cause of the nausea prior to empiric therapy.
4. Prior to prescribing an antiemetic or prokinetic agent, nuclear medicine studies should be obtained to confirm the presence of gastroparesis.
5. Rome II criteria for functional vomiting includes 12 weeks over the preceding year of frequent vomiting at least 3 days per week without an associated eating disorder, rumination, psychiatric disease, drug-related etiology or organic disease.