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Childhood Chronic Nausea: Is It Just a Queasy Stomach?

  • Pediatric Gastroenterology (S Orenstein, Section Editor)
  • Published:
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Abstract

Chronic nausea is an increasingly acknowledged complaint in children. It is commonly encountered in association with functional gastrointestinal (GI) disorders but can also occur in isolation. As such, there is no pediatric diagnostic classification for chronic idiopathic nausea. The pathophysiology appears complex, from foregut motor and sensory disturbances to autonomic imbalance and CNS influences. Also, there is scarcity of specific treatments that target this highly bothersome symptom. Treatment is mainly empiric or aimed at other functional complaints. Our retrospective data indicate a high prevalence of comorbid conditions in children with chronic nausea. These include migraines, autonomic disturbances, sleep problems, fatigue, and anxiety. Identifying specific features and targeting these therapeutically may be essential for improved treatment outcomes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Stern RM, Koch KL, Andrews P. Nausea: mechanisms and management. USA: Oxford University Press; 2011. This first comprehensive book on nausea provides an in-depth review on the multiple causes, mechanisms, physiological basis and management of various causes of nausea. • A collaboration between a gastroenterologist, a psychologist and a physiologist, this book provides a multidimensional overview on the many possible mechanisms of nausea.

    Google Scholar 

  2. Napadow V, Sheehan JD, Kim J, et al. The brain circuitry underlying the temporal evolution of nausea in humans. Cereb Cortex. 2013;23(4):806–13. Functional MRI study on subjects with vection-induced nausea by visual stimulus • Increased activation was noted in brain regions involved in fear processing, stress and emotions preceding the transition to strong nausea • A larger brain network including interoceptive, limbic, somatosensory and cognitive processing also showed activation following sustained nausea sensation.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Talley NJ. Functional nausea and vomiting. Aust Fam Physician. 2007;36(9):694–7.

    PubMed  Google Scholar 

  4. Olden KW, Chepyala P. Functional nausea and vomiting. Nat Clin Pract Gastroenterol Hepatol. 2008;5(4):202–8.

    Article  PubMed  Google Scholar 

  5. Tack J, Talley NJ, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130(5):1466–79. This article outlines the consensus opinion behind the 2006 Rome III criteria for functional gastroduodenal disorders • The classification includes four categories of functional gastroduodenal disorders: 1) functional dyspepsia (with subcategories of postprandial distress syndrome and epigastric pain syndrome); 2) belching disorders; 3) nausea and vomiting disorders (including chronic idiopathic nausea); and 4) rumination syndrome.

    Article  PubMed  Google Scholar 

  6. Kovacic K, Williams S, Li BUK, Chelimsky G, Miranda A. High prevalence of nausea in children with pain-associated functional gastrointestinal disorders: are Rome criteria applicable? J Pediatr Gastroenterol Nutr. 2013;57(3):311–5. This study describes a very high prevalence of nausea in a large cohort of pain-associated functional GI disorders • 60% (96 of 160 subjects) suffered from nausea, 53% of these had nausea a least 2x/week and 28% had daily nausea• Notably, nausea was associated with social disability in both home and school settings beyond the effects of pain.

    Article  PubMed  Google Scholar 

  7. Kovacic K, Miranda A, Chelimsky G, et al. Chronic idiopathic nausea of childhood. J Pediatr. 2014;164(5):1104–9. A retrospective study comparing the characteristics of 45 children with primary chronic nausea to 49 children with nausea as a secondary complaint (to functional abdominal pain) • The primary chronic nausea group had more severe symptoms and some characteristic features such as a personal and/or family history of migraines, a diagnosis of POTS and more co-morbid complaints of dizziness, fatigue and anxiety.

    Article  PubMed  Google Scholar 

  8. Ojha A, Chelimsky TC, Chelimsky G. Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr. 2011;158(1):20–3.

    Article  PubMed  Google Scholar 

  9. Sullivan SD, Hanauer J, Rowe PC, et al. Gastrointestinal symptoms associated with orthostatic intolerance. J Pediatr Gastroenterol Nutr. 2005;40(4):425–8.

    Article  PubMed  Google Scholar 

  10. Chelimsky TC, Chelimsky GG. Autonomic abnormalities in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2007;44(3):326–30.

    Article  PubMed  Google Scholar 

  11. Curfman D, Chilungu M, Daroff RB, et al. Syncopal migraine. Clin Auton Res. 2012;22(1):17–23.

    Article  PubMed  Google Scholar 

  12. Stengel A, Taché Y. Corticotropin-releasing factor signaling and visceral response to stress. Exp Biol Med (Maywood). 2010;235(10):1168–78.

    Article  CAS  Google Scholar 

  13. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1592–622.

    Article  PubMed  Google Scholar 

  14. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103(3):753–63.

    Article  PubMed  Google Scholar 

  15. Jericho H, Adams P, Zhang G, Rychlik K, Saps M. Nausea predicts delayed gastric emptying in children. J Pediatr. 2014;164(1):89–92. • This pediatric study evaluated the association between symptoms of gastroparesis (through the validated gastroparesis cardinal symptom index) with delayed gastric emptying as diagnosed by 4-hour gastric emptying scintigraphy. • The majority of children (70%) had normal gastric emptying scans despite having symptoms concerning for gastroparesis • Nausea was found to be the only symptom associated with delayed gastric emptying.

    Article  PubMed  Google Scholar 

  16. Waseem S, Islam S, Kahn G, Moshiree B, Talley NJ. Spectrum of gastroparesis in children. J Pediatr Gastroenterol Nutr. 2012;55(2):166–72.

    Article  PubMed  Google Scholar 

  17. Pasricha PJ, Colvin R, Yates K, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011;9(7):567–76.e1–4. • Multicenter study of 425 adult patients with chronic unexplained nausea and vomiting • 75% had delayed gastric emptying • Patients with or without delayed gastric emptying did not differ on a variety of measures • Very few patients were captured by the Rome III classifications for CIN and functional vomiting.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Singh A, Gull H, Singh RJ. Clinical significance of rapid (accelerated) gastric emptying. Clin Nucl Med. 2003;28(8):658.

    PubMed  Google Scholar 

  19. Balan K, Sonoda LI, Seshadri N, Solanki C, Middleton S. Clinical significance of scintigraphic rapid gastric emptying. Nucl Med Commun. 2011;32(12):1185–9.

    Article  PubMed  Google Scholar 

  20. Tack J. Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia. Gut. 2003;52(9):1271–7. • 37 adult patients with severe functional dyspepsia and 25 healthy controls underwent the satiety drink test (a high calorie liquid meal) to evaluate gastric accommodation. Gastric emptying and gastric barostat studies were also performed. • Patients with functional dyspepsia had significantly higher satiety scores and reached maximum satiety at lower calorie intake. The amount of calories ingested correlated significantly with gastric accommodation but not with gastric emptying or sensitivity (assessed by gastric barostat) • The sensitivity and specificity of the satiety test to predict impaired gastric accommodation was found to be 92% and 86% respectively.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Farré R, Vanheel H, Vanuytsel T, et al. In functional dyspepsia, hypersensitivity to postprandial distention correlates with meal-related symptom severity. Gastroenterology. 2013;145(3):566–73.

    Article  PubMed  Google Scholar 

  22. Tack J, Caenepeel P, Fischler B, Piessevaux H, Janssens J. Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology. 2001;121(3):526–35.

    Article  CAS  PubMed  Google Scholar 

  23. Golding JF. Motion sickness susceptibility. Auton Neurosci. 2006;129(1–2):67–76.

  24. Diamond SG, Markham CH. Prediction of space motion sickness susceptibility by disconjugate eye torsion in parabolic flight. Aviat Space Environ Med. 1991;62(3):201–5.

    CAS  PubMed  Google Scholar 

  25. Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167–72.

    PubMed  Google Scholar 

  26. Drummond PD. Effect of tryptophan depletion on symptoms of motion sickness in migraineurs. Neurology. 2005;65(4):620–2.

    Article  CAS  PubMed  Google Scholar 

  27. Seligman WH, Low DA, Asahina M, Mathias CJ. Abnormal gastric myoelectrical activity in postural tachycardia syndrome. Clin Auton Res. 2013;23(2):73–80.

    Article  PubMed  Google Scholar 

  28. Safder S, Chelimsky TC, O’Riordan MA, Chelimsky G. Autonomic testing in functional gastrointestinal disorders: implications of reproducible gastrointestinal complaints during tilt table testing. Gastroenterol Res Pract. 2009;2009:868496.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Geldof H, van der Schee EJ, van Blankenstein M, Grashuis JL. Electrogastrographic study of gastric myoelectrical activity in patients with unexplained nausea and vomiting. Gut. 1986;27(7):799–808.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Koch KL, Stern RM. Handbook of electrogastrography. Oxford: Oxford University Press; 2004.

    Google Scholar 

  31. Riezzo G, Russo F, Indrio F. Electrogastrography in adults and children: the strength, pitfalls, and clinical significance of the cutaneous recording of the gastric electrical activity. Biomed Res Int. 2013;2013:282757.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth. 2000;84(3):367–71.

    Article  CAS  PubMed  Google Scholar 

  33. Ottillinger B, Storr M, Malfertheiner P, Allescher H-D. STW 5 (Iberogast®)—a safe and effective standard in the treatment of functional gastrointestinal disorders. Wien Med Wochenschr. 2013;163(3–4):65–72.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Thoua NM, Murray CDR, Winchester WJ, et al. Amitriptyline modifies the visceral hypersensitivity response to acute stress in the irritable bowel syndrome. Aliment Pharmacol Ther. 2009;29(5):552–60.

    Article  CAS  PubMed  Google Scholar 

  35. Kalita J, Bhoi SK, Misra UK. Amitriptyline vs divalproate in migraine prophylaxis: a randomized controlled trial. Acta Neurol Scand. 2013;128(1):65–72.

    Article  CAS  PubMed  Google Scholar 

  36. Israil A, Ahmed S, Rahman KM, et al. Efficacy of amitriptyline, pizotifen and propranolol in the prevention of migraine. Mymensingh Med J. 2013;22(1):93–100.

    CAS  PubMed  Google Scholar 

  37. Dodick DW, Freitag F, Banks J, et al. Topiramate versus amitriptyline in migraine prevention: a 26-week, multicenter, randomized, double-blind, double-dummy, parallel-group noninferiority trial in adult migraineurs. Clin Ther. 2009;31(3):542–59.

    Article  CAS  PubMed  Google Scholar 

  38. Li BUK, Lefevre F, Chelimsky GG, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47:379–93.

    Article  CAS  PubMed  Google Scholar 

  39. Okuma H, Iijima K, Yasuda T, Tokuoka K, Kitagawa Y. Preventive effect of cyproheptadine hydrochloride in refractory patients with frequent migraine. Springerplus. 2013;2:573.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Rodriguez L, Diaz J, Nurko S. Safety and efficacy of cyproheptadine for treating dyspeptic symptoms in children. J Pediatr. 2013;163(1):261–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol. 2003;98(2):259–63.

    CAS  PubMed  Google Scholar 

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Conflict of Interest

Katja Kovacic and B U.K. Li have nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Center for Pediatric Neurogastroenterology, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Katja Kovacic & B U. K. Li

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  1. Katja Kovacic
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  2. B U. K. Li
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Correspondence to Katja Kovacic.

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This article is part of the Topical Collection on Pediatric Gastroenterology

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Kovacic, K., Li, B.U.K. Childhood Chronic Nausea: Is It Just a Queasy Stomach?. Curr Gastroenterol Rep 16, 395 (2014). https://doi.org/10.1007/s11894-014-0395-z

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  • DOI: https://doi.org/10.1007/s11894-014-0395-z

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