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Relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea

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Abstract

This study evaluated the relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea. We enrolled 48 patients (36 females) aged 15 ± 2 years. Patients completed the Nausea Profile, State-Trait Anxiety Inventory for Children and underwent 70° head upright tilt testing (HUT) to assess for orthostatic intolerance (OI) and measure heart rate variability (HRV). We found nausea to be significantly associated with trait anxiety, including total nausea score (r = 0.71, p < 0.01) and 3 subscales: somatic (r = 0.64, p < 0.01), gastrointestinal (r = 0.48, p = 0.01), and emotional (r = 0.74, p < 0.01). Nausea was positively associated with state anxiety, total nausea (r = 0.55, p < 0.01), somatic (r = 0.48, p < .01), gastrointestinal (r = .30, p < .05), and emotional (r = .64, p < .01) subscales. Within 10 min of HUT, 27 patients tested normal and 21 demonstrated OI. After 45 min of HUT, only 13 patients (27 %) remained normal. Nausea reported on the Nausea Profile before HUT was associated with OI measured at 10 min of tilt (nausea total r = 0.35, p < 0.05; nausea emotional subscale r = 0.40, p < 0.01) and lower HRV at 10 min of HUT (F = 6.39, p = 0.01). We conclude that nausea is associated with both anxiety symptoms and OI. The finding of decreased HRV suggests an underlying problem in autonomic nervous system function in children and adolescents with chronic unexplained nausea.

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Abbreviations

OI:

Orthostatic intolerance

FGIDs:

Functional gastrointestinal disorders

STAI-C:

State-Trait Anxiety Scale for Children

NP:

Nausea Profile

HRV:

Heart rate variability

HUT:

Head upright tilt

POTS:

Postural orthostatic tachycardia syndrome

OH:

Orthostatic hypotension

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Acknowledgments

This work was supported by a grant from the American Heart Association, National Center Clinical Research Program, AHA12CRP9420029 (John Fortunato, MD PI). We also acknowledge the contributions of Anya Brown, study coordinator, for her participation in the collection and management of the data for this study.

Conflict of interest

The authors declare that they have no conflict of interest relevant to this article to disclose.

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Authors and Affiliations

  1. Department of Child Psychiatry and Behavioral Sciences, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, B130, 13123 E. 16th Ave., Aurora, CO, 80045, USA

    Sally E. Tarbell

  2. Department of Pediatrics, Digestive Health Institute, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Sally E. Tarbell & John E. Fortunato

  3. Hypertension and Vascular Research Center, Wake Forest University, Winston-Salem, NC, USA

    Hossam A. Shaltout, Debra I. Diz & John E. Fortunato

  4. Departments of Obstetrics and Gynecology and General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Hossam A. Shaltout

  5. Neuroscience Graduate Program, Wake Forest Graduate School of Arts and Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Ashley L. Wagoner & Debra I. Diz

Authors
  1. Sally E. Tarbell
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  2. Hossam A. Shaltout
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  3. Ashley L. Wagoner
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  4. Debra I. Diz
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  5. John E. Fortunato
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Correspondence to Sally E. Tarbell.

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Tarbell, S.E., Shaltout, H.A., Wagoner, A.L. et al. Relationship among nausea, anxiety, and orthostatic symptoms in pediatric patients with chronic unexplained nausea. Exp Brain Res 232, 2645–2650 (2014). https://doi.org/10.1007/s00221-014-3981-2

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  • DOI: https://doi.org/10.1007/s00221-014-3981-2

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