Intractable Nausea for Years - Gram Negative Bacillus: An Answer?

Abstract

Purpose: Since its identification in 2005, Helicobacter pylori (H. pylori) has been associated with a number of gastrointestinal problems, including peptic ulcer disease, dyspepsia, non-ulcer dyspepsia and is a considered a WHO class I carcinogen due to its association with MALT lymphoma. Its association with isolated nausea is however poorly studied. We attempt to highlight a case of a 47 year old Caucasian woman who was seen as an inpatient consult for five years of intractable nausea. She had seen multiple physicians in the past and had extensive evaluation of her symptom of nausea, including an extensive neurologic and endocrine work-up with multiple imaging and laboratory tests. She had also undergone an extensive gastroenterological work-up also including upper and lower endoscopies which were unrevealing. She had limited oral intake secondary to nausea and was noted to be losing significant weight to the extent of 30 pounds over a one year period. She denied any other associated sign or symptom. She reported nausea to be worsened with eating. An H. pylori testing was performed and was noted to be positive. She was subsequently initiated on triple drug therapy with Clarithromycin, Amoxicillin and Pantoprazole. Pantoprazole was stopped for a period of four weeks prior to testing for H. pylori eradication. She was tested with stool antigen testing. This was noted to be negative. She had immediate response in her symptoms post treatment. With complete resolution of her nausea, her eating improved and she started gaining her weight back. The cause of her symptoms was thus assessed to be H. pylori infection. We thus recommend keeping H. pylori infection as a differential in patient with intractable chronic nausea. It is also cost effective to check for H. pylori infection prior to expensive and elaborate imaging and other testing for a patient presenting with chronic nausea symptoms.