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Nausea and Vomiting Related to Autonomic Nervous System Disorders

  • Thomas L. AbellEmail author
  • Dipendra Parajuli
Chapter

Abstract

The pathophysiology of nausea and vomiting from gastroparesis and cyclic vomiting syndrome often involves autonomic pathways. Nongastrointestinal disorders such as orthostatic intolerance and postural orthostatic tachycardia syndrome also present with nausea and vomiting. Serotonin 5-HT3 antagonists and neurokinin NK1 antagonists are medications to treat nausea and vomiting that also work on autonomic pathways. Gastric electrical stimulation used to treat medically refractory nausea and vomiting modulates autonomic nervous system activity. Treatment of documented orthostatic intolerance alleviates nausea and vomiting. Complete autonomic testing or simpler office-based testing may help to identify autonomic abnormalities and to help guide management in these patients.

Keywords

Autonomic nervous system Nausea Vomiting Cyclic vomiting syndrome Postural orthostatic tachycardia syndrome Orthostatic intolerance Gastric electrical stimulation Adrenergic receptor Cholinergic receptor Enteric nervous system 

Abbreviations

5-HT

5 Hydroxy tryptamine

Ach

Acetylcholine

AFT

Autonomic function testing

ANS

Autonomic nervous system

CAN

Cardiovascular autonomic system

CCK

Cholecystokinin

CINV

Chemotherapy-induced nausea and vomiting

CNS

Central nervous system

CRF

Corticotropin-releasing factor

CTZ

Chemoreceptor trigger zone

CVS

Cyclical vomiting syndrome

DAN

Diabetic autonomic neuropathy

DMV

Dorsal motor nucleus

ENS

Enteric nervous system

GABA

γ-Aminobutyric acid

GI

Gastrointestinal

HPA

Hypothalamic-pituitary-adrenal

HRV

Heart rate variability

HUT

Head-up tilt

ICC

Interstitial cells of Cajal

IGP

Intragastric pressure

LES

Lower esophageal sphincter

NE

Norepinephrine

NK

Neurokinin

NMH

Neurally mediated hypotension

nNOS

Neuronal nitric oxide synthase

NO

Nitric oxide

NTS

Nucleus tractus solitarius

OI

Orthostatic intolerance

PNS

Peripheral nervous system

POTS

Postural orthostatic tachycardia syndrome

QSART

Quantitative sudomotor axon reflex test

T1DM

Type 1 diabetes mellitus

T2DM

Type 2 diabetes mellitus

TSS

Total symptom score

TST

Thermoregulatory sweat test

VIP

Vasoactive intestinal polypeptide

Notes

Acknowledgments

The authors would like to thank Dr. Pradeepa Poudyal and Catherine McBride for help with manuscript preparation.

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© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology, and NutritionUniversity of Louisville School of MedicineLouisvilleUSA

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