Chronic unexplained nausea in adults: Prevalence, impact on quality of life, and underlying organic diseases in a cohort of 5096 subjects comprehensively investigated.

Hye-Kyung Jung,Chung Hyun Tae,Ki-Nam Shim,Chang Mo Moon,Sung-Ae Jung,Seong-Eun Kim,Agustín Martínez Molina

doi:10.1371/journal.pone.0225364

Abstract

We evaluated to define the clinically significant chronic nausea in general population and to assess the prevalence of chronic unexplained nausea after exclusion of organic causes through the meticulous medical examination. Two phase studies were conducted. In phase 1, telephone survey was conducted to define the clinically significant nausea in 5000 representative subjects for a general population. Clinically significant nausea was identified by lowered quality of life if the frequency was ‘more than one day per week’. Its prevalence was 1.6% (1.4–1.8%) and about 90% of nausea was not accompanied with vomiting. In phase 2, 5096 participants in a comprehensive health-screening cohort were enrolled. We investigated demographics, gastrointestinal symptoms, somatization symptoms and health related quality of life using validated questionnaire. All participants underwent meticulous medical examinations including endoscopy, abdominal ultrasound, thyroid function test, and blood testing. Among a total of 5096 subjects (men 51.8%, mean age 47.5 ± 10.0 years), organic diseases associated with chronic nausea were reflux esophagitis, duodenal ulcer and hyperthyroidism. The prevalence of chronic unexplained nausea was 0.6% (95% CI 0.4–0.8%) and there were significant overlap with functional dyspepsia and irritable bowel syndrome. HRQoL is significantly lower in people with nausea occurring ‘more than one day per week’ in a general population. Most chronic nausea was not accompanied with vomiting. Chronic unexplained nausea is uncommon affecting only 0.6% of the population but are more likely to report functional dyspepsia and irritable bowel syndrome.

Highlights

Nausea is the subjective, unpleasant sensation of the need to vomit, and while it may be accompanied by vomiting many people experience prolonged nausea without ever having to vomit [1]
Chronic nausea with or without vomiting associated with delayed gastric emptying is defined as gastroparesis, most subjects complaining of chronic nausea have normal gastric emptying [4]
In this study, compared to controls, all cases with nausea had a lower health-related quality of life (HRQoL), and the mean HRQoL for the nausea group corresponding to the Roman IV criterion was less than 10% of EQ-5D, but their HRQoL was not statistically different from the group having ‘2–3 days a month’ of nausea

Summary

Introduction

Unpleasant sensation of the need to vomit, and while it may be accompanied by vomiting many people experience prolonged nausea without ever having to vomit [1]. Nausea is a complex subjective symptom that ranges from uncomfortable to agonizing and may accompany many diseases and conditions including diseases within and outside the gut as well as by circulating toxins, drugs and metabolic disorders [2,3]. Chronic nausea with or without vomiting associated with delayed gastric emptying is defined as gastroparesis, most subjects complaining of chronic nausea have normal gastric emptying [4]. Chronic unexplained nausea and vomiting disorders are included as part of the classification of functional gastrointestinal disorders (FGIDs). In our referral clinics, we often encounter patients complaining of only nausea without accompanying vomiting that can be very challenging to diagnose and treat. The lack of understanding about chronic unexplained nausea adds distress for both patients and physician, and may exacerbate comorbid disability or psychological distress in these patients

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