Opinion statement
Chronic nausea and vomiting, whether or not associated with gastroparesis, are among the most difficult symptoms to manage. Patients typically undergo extensive evaluation and empiric treatment often with suboptimal results. Conventional therapies may not produce adequate symptom relief or may cause unacceptable side effects. Thus, it is not surprising that patients report a negative impact on well-being, since the intermittent or constant occurrence of these symptoms are a source of anxiety as they impact social interactions and ability to work. Patients may seek complementary and alternative medicine (CAM), which may include acupuncture and herbal formulations, not only to manage nausea and vomiting, but also to remedy those symptoms associated with chronic illness, like insomnia and general fatigue. This chapter will review diet and different modalities of CAM to treat gastroparesis and chronic unexplained nausea and vomiting.
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Comar KM, Kirby DF. Herbal remedies in gastroenterology. J Clin Gastroenterol. 2005;39:457–68.
Langmead L, Rampton DS. Review article: herbal treatment in gastrointestinal and liver diseas—benefits and dangers. Aliment Pharmacol Ther. 2001;15:1239–52.
Tillisch K. Complementary and alternative medicine for functional gastrointestinal disorders. Gut. 2006;55:593–6.
Lee LA, Chen J, Yin J. Complementary and alternative medicine for gastroparesis. Gastroenterol Clin N Am. 2015;44:137–50.
Dossett ML, Davis RB, Lembo AJ, Yeh GY. Complementary and alternative medicine use by US adults with gastrointestinal conditions: results from the 2012 National Health Interview Survey. Am J Gastroenterol. 2014;109:1705–11.
Ouyang H, Yin J, Wang Z, et al. Electroacupuncture accelerates gastric emptying in association with changes in vagal activity. Am J Physiol Gastrointest Liver Physiol. 2002;282:G390–6.
Lin X, Liang J, Ren J, Mu F, Zhang M, Chen JD. Electrical stimulation of acupuncture points enhances gastric myoelectrical activity in humans. Am J Gastroenterol. 1997;92:1527–30.
Wang CP, Kao CH, Chen WK, Lo WY, Hsieh CLA. Single-blinded, randomized pilot study evaluating effects of electroacupuncture in diabetic patients with symptoms suggestive of gastroparesis. J Altern Complement Med. 2008;14:833–9.
Pfab F, Winhard M, Nowak-Machen M, et al. Acupuncture in critically ill patients improves delayed gastric emptying: a randomized controlled trial. Anesth Analg. 2011;112:150–5.
Xu F, Tan Y, Huang Z, Zhang N, Xu Y, Yin J. Ameliorating effect of transcutaneous electroacupuncture on impaired gastric accommodation in patients with postprandial distress syndrome-predominant functional dyspepsia: a pilot study. Evid Based Complement Alternat Med. 2015;2015:168252. Recent randomized control trial which showed that Transcutaneous Electroacupuncture (TEA) leads to greater improvement in gastric accommodation and gastric motility in functional dyspepsia patients.
Zeng F, Qin W, Ma T, et al. Influence of acupuncture treatment on cerebral activity in functional dyspepsia patients and its relationship with efficacy. Am J Gastroenterol. 2012;107:1236–47. Randomized control trial which showed that acupuncture leads to greater improvement in symptoms and quality of life via a central mechanism.
Ma TT, Yu SY, Li Y, et al. Randomised clinical trial: an assessment of acupuncture on specific meridian or specific acupoint vs. sham acupuncture for treating functional dyspepsia. Aliment Pharmacol Ther. 2012;35:552–61. Large randomized control trial of 712 patients which showed acupuncture is superior than sham TEA or promotility agents and resulted in greater improvement of symptoms and quality of life.
Semwal RB, Semwal DK, Combrinck S, Viljoen AM. Gingerols and shogaols: important nutraceutical principles from ginger. Phytochemistry. 2015;117:554–68.
Giacosa A, Morazzoni P, Bombardelli E, Riva A, Bianchi Porro G, Rondanelli M. Can nausea and vomiting be treated with ginger extract? Eur Rev Med Pharmacol Sci. 2015;19:1291–6.
Haniadka R, Rajeev AG, Palatty PL, Arora R, Baliga MS. Zingiber officinale (ginger) as an anti-emetic in cancer chemotherapy: a review. J Altern Complement Med. 2012;18:440–4.
Jin Z, Lee G, Kim S, Park CS, Park YS, Jin YH. Ginger and its pungent constituents non-competitively inhibit serotonin currents on visceral afferent neurons. Korean J Physiol Pharmacol. 2014;18:149–53.
Pertz HH, Lehmann J, Roth-Ehrang R, Elz S. Effects of ginger constituents on the gastrointestinal tract: role of cholinergic M3 and serotonergic 5-HT3 and 5-HT4 receptors. Planta Med. 2011;77:973–8.
Gonlachanvit S, Chen YH, Hasler WL, Sun WM, Owyang C. Ginger reduces hyperglycemia-evoked gastric dysrhythmias in healthy humans: possible role of endogenous prostaglandins. J Pharmacol Exp Ther. 2003;307:1098–103.
Lien HC, Sun WM, Chen YH, Kim H, Hasler W, Owyang C. Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. Am J Physiol Gastrointest Liver Physiol. 2003;284:G481–9.
KL W, Rayner CK, Chuah SK, Changchien CS, SN L, Chiu YC, Chiu KW, Lee CM. Effects of ginger on gastric emptying and motility in healthy humans. Eur J Gastroenterol Hepatol. 2008;20:436–40.
ML H, Rayner CK, KL W, Chuah SK, Tai WC, Chou YP, Chiu YC, Chiu KW, Effect HTH. Of ginger on gastric motility and symptoms of functional dyspepsia. World J Gastroenterol. 2011;17:105–10.
Lazzini S, Polinelli W, Riva A, Morazzoni P, Bombardelli E. The effect of ginger (Zingiber Officinalis) and artichoke (Cynara cardunculus) extract supplementation on gastric motility: a pilot randomized study in healthy volunteers. Eur Rev Med Pharmacol Sci. 2016;20:146–9. This is a randomized cross over study of healthy volunteers which showed that ginger and artichoke extract significantly promotes gastric emptying without any notable side effects.
Giacosa A, Guido D, Grassi M, Riva A, Morazzoni P, Bombardelli E, Perna S, Faliva MA, Rondanelli M. The effect of ginger (Zingiber Officinalis) and artichoke (Cynara cardunculus) extract supplementation on functional dyspepsia: a randomised, double-blind, and placebo-controlled clinical trial. Evid Based Complement Alternat Med. 2015;2015:915087. This is a randomized control trial of 126 functional dyspepsia patients which showed that the association between ginger and artichoke leaf extracts appears safe and efficacious in the treatment of FD.
Schwertner HA, Rios DC, Pascoe JE. Variation in concentration and labeling of ginger root dietary supplements. Obstet Gynecol. 2006;107:1337–43.
Hohenester B, Rühl A, Kelber O, Schemann M. The herbal preparation STW5 (lberogast) has potent and region-specific effects on gastric motility. Neurogastroenterol Motil. 2004;16:765–73.
von Arnim U, Peitz U, Vinson B, et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102:1268–75.
Pilichiewicz AN, Horowitz M, Russo A, Maddox AF, Jones KL, Schemann M, Holtmann G, Feinle-Bisset C. Effects of Iberogast on proximal gastric volume, antropyloroduodenal motility and gastric emptying in healthy men. Am J Gastroenterol. 2007;102:1276–83.
Braden B, Caspary W, Borner N, et al. Clinical effects of STW 5 (Iberogast) are not based on acceleration of gastric emptying in patients with functional dyspepsia and gastroparesis. Neurogastroenterol Motil. 2009;21:632–8 .e25
Yanai M, Mochiki E, Ogawa A, et al. Intragastric administration of rikkunshito stimulates upper gastrointestinal motility and gastric emptying in conscious dogs. J Gastroenterol. 2013;48:611–9.
Suzuki H, Matsuzaki J, Fukushima Y, et al. Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia—a multicenter, double-blind, randomized, placebo-controlled study. Neurogastroenterol Motil. 2014;26:950–61. Randomized control trial of 247 patients with functional dyspepsia which showed that administration of rikkunshito for 8 weeks reduced dyspepsia.
Cai GX, Liu BY, Yi J, et al. Simotang enhances gastrointestinal motility, motilin and cholecystokinin expression in chronically stressed mice. World J Gastroenterol. 2011;17:1594–9.
JinYR JJ, Piao XX, et al. The effect of Taraxacumofficinale on gastric emptying and smooth muscle motility in rodents. Neurogastroenterol Motil. 2011;23:766–e333.
Shibata C, Sasaki I, Naito H, et al. The herbal medicine Dai-kenchu-Tou stimulates upper gut motility through cholinergic and 5-hydroxytryptamine 3 receptors in conscious dogs. Surgery. 1999;126:918–24.
Kawasaki N, Nakada K, Nakayoshi T, et al. Effect of Dai-kenchu-to on gastrointestinal motility based on differences in the site and timing of administration. Dig Dis Sci. 2007;52:2684–94.
Qin F, Huang X, Zhang HM, et al. Pharmacokinetic comparison of puerarin after oral administration of Jiawei-Xiaoyao-san to healthy volunteers and patients with functional dyspepsia: influence of disease state. J Pharm Pharmacol. 2009;61:125–9.
Tian J, Li M, Liao J, et al. Chinese herbal medicine banxiaxiexin decoction treating diabetic gastroparesis: a systematic review of randomized controlled trials. Evid Based Complement Alternat Med. 2013;2013:749495.
Campos AC, Guimaraes FS. Evidence for a potential role for TRPV1 receptors in the dorsolateral periaqueductal gray in the attenuation of the anxiolytic effects of cannabinoids. Prog Neuro-Psychopharmacol Biol Psychiatry. 2009;33:1517–21.
Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011;163:1411–22.
Allen JH, de Moore GM, Heddle R, et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53:1566–70.
Wytiaz V, Homko C, Duffy F, et al. Foods provoking and alleviating symptoms in gastroparesis: patient experiences. Dig Dis Sci. 2015;60:1052–8.
Homko CJ, Duffy F, Friedenberg FK, et al. Effect of dietary fat and food consistency on gastroparesis symptoms in patients with gastroparesis. Neurogastroenterol Motil. 2015;27:501–8.
Olausson EA, Störsrud S, Grundin H, et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol. 2014;109:375–85. Randomized control trial of 56 patients with diabetic gastroparesis which showed that small particle diet improves the key symptoms of gastroparesis.
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Ekta Gupta declares no conflict of interest.
Linda A. Lee reports a grant from NIH/NIDDK.
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Gupta, E., Lee, L.A. Diet and Complementary Medicine for Chronic Unexplained Nausea and Vomiting and Gastroparesis. Curr Treat Options Gastro 14, 401–409 (2016). https://doi.org/10.1007/s11938-016-0104-0
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DOI: https://doi.org/10.1007/s11938-016-0104-0