Experimental Brain Research

, Volume 232, Issue 8, pp 2645–2650

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

  • Sally E. Tarbell
  • Hossam A. Shaltout
  • Ashley L. Wagoner
  • Debra I. Diz
  • John E. Fortunato
Research Article


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.


Anxiety Nausea Orthostatic intolerance Heart rate variability Functional gastrointestinal disorders Autonomic dysfunction 



Orthostatic intolerance


Functional gastrointestinal disorders


State-Trait Anxiety Scale for Children


Nausea Profile


Heart rate variability


Head upright tilt


Postural orthostatic tachycardia syndrome


Orthostatic hypotension


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sally E. Tarbell
    • 1
    • 2
  • Hossam A. Shaltout
    • 3
    • 4
  • Ashley L. Wagoner
    • 5
  • Debra I. Diz
    • 3
    • 5
  • John E. Fortunato
    • 2
    • 3
  1. 1.Department of Child Psychiatry and Behavioral Sciences, Children’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Department of Pediatrics, Digestive Health Institute, Children’s Hospital ColoradoUniversity of Colorado Anschutz Medical CampusAuroraUSA
  3. 3.Hypertension and Vascular Research CenterWake Forest UniversityWinston-SalemUSA
  4. 4.Departments of Obstetrics and Gynecology and General SurgeryWake Forest School of MedicineWinston-SalemUSA
  5. 5.Neuroscience Graduate Program, Wake Forest Graduate School of Arts and SciencesWake Forest School of MedicineWinston-SalemUSA

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