Unexplained Vomiting Research Articles

An Unexpected Cause of Marked Weight Loss Associated with Vomiting in an Adult Man: Gastric Phytobeozar.

ObjectivesWe present the case of an edentulous 47-year-old farmer referred to our Department of Internal Medicine because of postprandial vomiting, hyporexia, asthenia and weight loss. He ate a mostly vegetarian diet.Materials and methodsAn oesophagogastroduodenoscopy revealed the presence of a phytobezoar at the level of the fundus and body of the stomach. Endoscopic fragmentation and removal of the phytobezoar were unsuccessful and the patient had to undergo open surgery.ResultsRecovery was uneventful and free of complications.ConclusionPhytobezoars should be taken into account in the differential diagnosis of unexplained vomiting and weight loss.LEARNING POINTSBezoars are concretions of indigestible materials located in the gastrointestinal tract.Gastric phytobezoars may cause unexplained vomiting and weight loss even in young people.The diagnosis of phytobezoars may be complex and endoscopy is helpful in most cases.

Cannabinoid hyperemesis syndrome: an important differential diagnosis of persistent unexplained vomiting.

Chronic nausea and vomiting have a detrimental impact on quality of life. When standard diagnostic investigations fail to provide a definitive diagnosis, patients are often attributed as having a functional gastrointestinal disorder such as cyclic vomiting syndrome. Cannabinoid hyperemesis syndrome (CHS) is a relatively recently described entity presenting with symptoms similar to cyclic vomiting syndrome. We carried out a retrospective cohort study of all patients attending a tertiary neurogastroenterology and secondary care gastroenterology clinic from 2013 to 2015. Data were obtained by review of clinical notes, letters and electronic patient records. We identified 10 cases of CHS (five men, mean age 27 years, range 19-51), who hitherto had been labelled with a variety of alternative diagnoses. All patients had symptoms that were episodic and refractory to medical therapy. Patients had experienced symptoms for a mean of 19.3±11.09 months before diagnosis. The median length of cannabinoid use was 42 months (interquartile range: 15-81.8). Eight patients (80%) had a history of compulsive hot water bathing (hydrophilia). The patients had a median follow-up of 9.5 months (range 1-20), during which symptoms recurred in three patients who returned to regular cannabis use. CHS is an underappreciated cause of recurrent nausea and vomiting and is frequently misdiagnosed. Healthcare providers should have a low index of suspicion for diagnosing CHS and the clinical history in such patients should routinely include direct questioning on cannabis use. The prognosis is very good upon cessation of cannabis intake.

Gut satiety hormones and hyperemesis gravidarum.

Hyperemesis gravidarum (HG) is described as unexplained excessive nausea and vomiting during pregnancy. Some gut hormones that regulate appetite may have important role in etiopathogenesis of HG and weight changes during pregnancy. In this study, levels of gut satiety hormones were evaluated in pregnant women with HG. This prospective case-control study was conducted in 30 women with HG and 30 healthy pregnant women without symptoms of HG. Fasting venous blood samples were taken from all subjects for measurement of plasma gut hormone levels; obestatin (pg/mL), peptide YY (PYY), pancreatic polypeptide (PP) and cholecystokinin (CCK). Plasma PYY and PP levels were significantly higher in HG group. The most important parameter in diagnosis of HG was plasma PP level. Simple use of PP level led to the diagnosis 91.1 % of HG cases correctly. The single most important parameter in the prediction of HG was also PP level. Anorexigenic gut hormones might have important role in etiopathogenesis of hyperemesis gravidarum and weight changes during pregnancy.

Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting

Chronic unexplained nausea and vomiting (CUNV) is a debilitating disease of unknown cause. Symptoms of CUNV substantially overlap with those of gastroparesis, therefore the diseases may share pathophysiologic features. We investigated this hypothesis by quantifying densities of interstitial cells of Cajal (ICCs) and mapping slow-wave abnormalities in patients with CUNV vs controls. Clinical data and gastric biopsy specimens were collected from 9 consecutive patients with at least 6 months of continuous symptoms of CUNV but normal gastric emptying who were treated at the University of Mississippi Medical Center, and from 9 controls (individuals free of gastrointestinal disease or diabetes). ICCs were counted and ultrastructural analyses were performed on tissue samples. Slow-wave propagation profiles were defined by high-resolution electrical mapping (256 electrodes; 36 cm(2)). Results from patients with CUNV were compared with those of controls as well as patients with gastroparesis who were studied previously by identical methods. Patients with CUNV had fewer ICCs than controls (mean, 3.5 vs 5.6 bodies/field, respectively; P < .05), with mild ultrastructural abnormalities in the remaining ICCs. Slow-wave dysrhythmias were identified in all 9 subjects with CUNV vs only 1 of 9 controls. Dysrhythmias included abnormalities of initiation (stable ectopic pacemakers, unstable focal activities) and conduction (retrograde propagation, wavefront collisions, conduction blocks, and re-entry), operating across bradygastric, normal (range, 2.4-3.7 cycles/min), and tachygastric frequencies; dysrhythmias showed velocity anisotropy (mean, 3.3 mm/s longitudinal vs 7.6 mm/s circumferential; P < .01). ICCs were less depleted in patients with CUNV than in those with gastroparesis (mean, 3.5 vs 2.3 bodies/field, respectively; P < .05), but slow-wave dysrhythmias were similar between groups. This study defined cellular and bioelectrical abnormalities in patients with CUNV, including the identification of slow-wave re-entry. Pathophysiologic features of CUNV were observed to be similar to those of gastroparesis, indicating that they could be spectra of the same disorder. These findings offer new insights into the pathogenesis of CUNV and may help to inform future treatments.

Su1449 Incidence and Clinical Significance of Delayed Gastric Emptying for Liquids in Gastroparesis and Chronic Unexplained Nausea and Vomiting (CUNV)

Introduction. Diabetic gastroparesis is defined as delayed gastric emptying not caused by obstruction or structural abnormality. Normal function of the gastric and intestinal mechanical activity is mediated by slow wave electrical activity in the stomach and small bowel. Previous studies using both electrogastrogram and magnetogastrogram have shown gastric slowwave dysrhythmias associated with gastroparesis, but no study has yet examined possible effects of gastroparesis on the intestinal slow wave. Methods. We recorded intestinal slow waves in diabetic patients with gastroparesis (N=7) and healthy controls (N=7) using the magnetoenterogram (MENG), which uses a Superconducting QUantum Interference Device (SQUID) to convert magnetic fields associated with intestinal slow waves into voltage signals. Second Order Blind Identification (SOBI) was used to reduce noise and isolate the intestinal slow wave signal from confounding magnetic artifact, and we computed the power spectrum of the intestinal slow wave using a Fast Fourier Transform technique. We analyzed dominant frequency, amplitude and percentage of power distributed (PPD) in brady, normo and tachyarrhythmic frequency ranges. Results. In gastroparesis patients, we found a significant decrease in postprandial dominant intestinal slow wave frequency from 10.2 ± 0.4 cpm to 8.8 ± 0.5 cpm (p<0.05) whereas the dominant frequency for control subjects increased from 9.9 ± 0.5 cpm to 10.8 ± 0.4 cpm (p<0.05). We did not observe significant differences in preand postprandial PPDs computed from controls or patients. Conclusions. Diabetic gastroparesis is associated with bradyarrhythmia, but not uncoupling, of the intestinal slow wave. Biomagnetic measurements of the MENG can assess intestinal slow wave activity in healthy and diseased tissue noninvasively.

English

BACKGROUND: There is a group of patients who have unexplained chronic nausea and/or vomiting. In the past these patients were labeled as having psychogenic vomiting. OBJECTIVE: To assess the response of psychogenic vomiting with conventional antipsychotic chlorpromazine. METHOD: Study was conducted at Department of Psychiatry King George hospital out patients department, Visakhapatnam. N=13 cases with psychogenic vomiting's were treated with Chlorp-romazine of 25-50 mg/ day for two weeks, followed by regular follow up of one month. RESULTS: All the 13 patients who received Chlorpromazine of 25- 50 mg / day for two weeks showed good response. There were no side effects noted with the above dose. CONCLUSIONS: Chlorpromazine of 2 weeks showed good response for patient with psychogenic vomiting.

An unusual case of 'itchy paralysis’: neuromyelitis optica presenting with severe neuropathic itch

Pruritus, better known as itch, is ‘an unpleasant cutaneous sensation provoking the desire to scratch’.1 It is typically caused by pruritogens that activate nerve endings in cutaneous and transitional tissues...

A case of anorexia nervosa in an elderly man

To explore aspects of anorexia nervosa occurring in older populations, especially men, by reviewing the literature and presenting a case study of an elderly man with unexplained vomiting and weight loss. The literature is reviewed and an illustrative case study of an elderly man with unexplained vomiting and weight loss is described. Anorexia nervosa is an uncommon cause of unexplained weight loss in the elderly, but may be under-recognized and associated with a high level of mortality.

Neurenteric cyst of the area postrema.

Neurenteric cysts are CNS lesions most frequently occurring in the spinal cord. Intracranial neurenteric cysts are rarer, typically presenting with headache, mass effect, or location-specific symptoms. The area postrema is known as the emetic center of the brain; lesions can cause nausea and vomiting. Our case, featuring a neurenteric cyst of the area postrema, illustrates the importance of considering a neurological etiology for nonspecific symptoms that otherwise elude explanation. Our patient presented with acute decompensated hydrocephalus upon exploratory abdominal laparoscopy for unresolving abdominal pain. The patient had an eight-month history of unexplained intermittent nausea, vomiting, and abdominal pain. These bouts increased in frequency during the weeks before acute presentation, prompting exploratory abdominal laparoscopy. The acute decompensation was managed by ventriculostomy, and cranial MRI revealed a cystic mass by the floor of the fourth ventricle. After the patient stabilized and returned to neurological baseline, suboccipital craniectomy and resection were performed. The mass was histologically identified as a neurenteric cyst. The patient was free from neurological complaints at one-year follow-up, indicating that the successful resection of the area postrema-associated neurenteric cyst resolved her previous symptoms. Thus, some intracranial lesions can masquerade as nonspecific symptoms, presenting a challenge to accurate diagnosis.

Rhabdomyolysis in Acute Spinal Cord Injury Presenting With Nausea and Vomiting as Chief Complaints: A Case Report

Dealing with complications is crucial in the management of patients with spinal cord injury (SCI). We describe a case of rhabdomyolysis in SCI without apparent soft tissue injury, presenting with nausea and vomiting as chief complaints. Given that gastrointestinal discomfort is common in SCI, this case highlights the need to consider rhabdomyolysis as a potential cause of unexplained nausea and vomiting in SCI, and indicate the value of regular check-up of creatine kinase level in SCI patients. Early diagnosis and treatment can prevent acute renal failure that can occur with rhabdomyolysis and minimize the potential threat of declined renal function in SCI patients.

High Burden of Rotavirus Gastroenteritis in Young Children in Rural Western Kenya, 2010–2011

Diarrhea is a leading cause of hospitalization and death in children <5 years of age. To facilitate evaluation of the impact of rotavirus vaccine introduction in western Kenya, we estimated baseline rates of rotavirus-associated hospitalization and mortality among children <5 years of age. From January 2010 to December 2011, we collected demographic, clinical and laboratory data for children <5 years of age seeking care at the district hospital and 2 outpatient facilities within a Health and Demographic Surveillance System (HDSS). Children with acute gastroenteritis (AGE), defined as ≥3 loose stools and/or ≥1 episode of unexplained vomiting followed by loose stool within a 24-hour period, were asked to provide a stool sample for rotavirus ELISA testing. Rates of rotavirus-associated hospitalization and mortality were estimated using time of residence in the HDSS to calculate person-years of observation. To estimate the rotavirus-associated mortality rate, we applied the percentage positive for rotavirus among AGE hospitalizations to verbal autopsy estimates of diarrhea deaths in the HDSS. There were 4991 hospitalizations of children <5 years of age; 1134 (23%) were for AGE and stool specimens were obtained from 790 (70%). Rotavirus was detected in 211 (27%) specimens. Among 4951 <5 outpatient sick visits, 608 (12%) were for AGE; 320 (51%) provided specimens and 62 (20%) were positive for rotavirus. Rotavirus AGE accounted for 501 <5 hospitalizations per 100,000 person-years of observation. Rotavirus-associated <5 mortality was 136 deaths per 100,000 person-years of observation. Continued surveillance of rotavirus AGE will provide timely data on the population-level impact of rotavirus vaccine following its likely introduction in 2014.

A Young Female with Recurrent Postprandial Vomiting for One and a Half Years

Functional vomiting (FV) is considered as recurrent, unexplained vomiting lacking an organic basis at least once per week and not cyclical. Although functional vomiting is a rare disorder and has been under-investigated, it has been increasingly recognized that it is a serious threat to people’s life quality. There have been many papers on how to treat functional vomiting, and agreements have been made that combined treatments on the base of improving nutrition status and maintaining spiritual support could be useful. We report the case of a young female with recurrent postprandial vomiting for one and a half years, who was diagnosed as functional vomiting. The treatment strategies were as follows: to have more meals a day but less food each time, to receive antidepressant, prokinetic agents and cognitive behavioral therapy. During the follow-up, the patient gets better after treatment, providing a vital evidence for further treatment.

83-Year-Old Man With Nausea, Constipation, and Peripheral Neuropathy

83-Year-Old Man With Nausea, Constipation, and Peripheral Neuropathy

G189 15 YEAR EXPERIENCE OF CLINICAL PRESENTATION OF INTESTINAL VOLVULUS AT A QUARTERNARY GASTROENTEROLOGY CENTRE

IntroductionIntestinal volvulus can cause potentially fatal bowel ischaemia and/or obstruction. Diagnosis can be difficult and easily missed. Presenting symptoms are variable and there are no published studies describing the clinical...

Sa2066 The Provocative Water Load Test Evokes Nausea and Gastric Dysrhythmias in Patients With Unexplained Chronic Nausea and Vomiting

Previous studies found that mechanical stretch in bowel obstruction markedly induced gene expression of COX-2, but not COX-1, in colonic smooth muscle cells (SMCs). The aims of the present study were to determine whether genes encoding individual prostaglandin synthases are mechanically responsive, and whether the composition of prostaglandins resulting from obstruction differs from that in inflammation. Methods: Partial colon obstruction was induced with a silicon band implanted surgically in the distal colon of male SpragueDawley rats. Static mechanical stretch (18% elongation) was mimicked in vitro in the culture of rat colonic circular SMCs with a Flexercell FX-4000 System. Rat colon inflammation was induced by manipulation of the colonic surface with wet cotton applicators. Results: 1. Quantitative RT-PCR found that the expression of PGDS and PGIS genes was not significantly changed on day 3 of obstruction. However, the membrane bound PGES-1 (mPGES-1) mRNA was significantly up-regulated in the obstructed segment, whereas mRNAs for other two types of PGES, cytosolic PGES and mPGES-2, were not changed. On the contrary, the PGFS mRNA was down-regulated in the obstructed colon. 2. PGE2, but not PGF2 α, was significantly increased in the colonic muscularis externae in obstruction. The PGE2 level increased to 4577±1249 pg/mg at day 3 of obstruction, compared to 1264±259 in sham (n=6, p,0.05). The PGF2α level was 5718±910 pg /mg in obstruction compared to 6550±2178 pg/mg in the sham (n=5, p.0.05). 3. Direct stretch of rat colonic circular SMCs in vitro significantly up-regulated the mPGES-1 mRNA, but down-regulated that of PGFS. After stretch for 3 hrs, the mRNA levels of PGES and PGFS changed by 2.61±0.42 fold and 0.82±0.03 fold, respectively (n = 4 or 5, p,0.05). 4. In colonic inflammation, both PGE2 and PGF2α were significantly increased in the colonic smooth muscle (5.2(±1.5)-fold and 4.7(±1.3)-fold of control, respectively, p,0.05, n = 3). 5. Rat colonic circular muscle contractility was inhibited by exogenous PGE2 (10-9 ~10-6 M), but enhanced by PGF2 α (10-9 ~10-6 M) in a concentration-dependent manner (n = 4). Conclusions: Genes involved in the COX pathway of arachidonic acid metabolism are highly mechanosensitive in colonic SMCs, and play a critical role in motility function. Mechano-regulation of prostaglandin synthases accounts for increased PGE2 and unchanged PGF2 α in bowel obstruction, a pathological feature different from inflammation in which both PGE2 and PGF2 α are increased.

Mo1223 Gastric Electrical Stimulation for Teenage Children With Chronic Unexplained Nausea and Vomiting (CUNV)

Mo1223 Gastric Electrical Stimulation for Teenage Children With Chronic Unexplained Nausea and Vomiting (CUNV)

Strongyloides Colitis in an Immunocompetent Host Transmitted Through Sexual Contact: Report of a Case and Review of the Literature

Strongyloides stercoralis is a nematode that usually infects the upper gastrointestinal tract of humans. We present a case of Strongyloides colitis diagnosed by colonoscopic biopsy. A 62-year-old woman with history significant for mental retardation living in an assisted living facility presented with 3 months of unexplained diarrhea, nausea, and vomiting. History of immunocompromisation or travel was negative. No …

Psychiatric Co-morbidity and Efficacy of Mirtazapine Treatment in Young Subjects With Chronic or Cyclic Vomiting Syndromes: A Case Series

The aim of this case report was to evaluate the psychiatric co-morbidity and efficacy of mirtazapine treatment in young subjects with chronic or cyclic vomiting syndromes. This is a case series of 8 young subjects (age range of 6-16 years, 11.12 ± 3.52 years) who were referred or consulted to child psychiatry department. They were referred or consulted by pediatric gastroenterology or surgery departments for the presence of non-remitting and medically unexplained vomiting. They were investigated for co-morbid psychiatric disorders using a structured psychiatric interview. An open trial of mirtazapine was conducted for the treatment and/or prevention of vomiting. Primary outcome measure was Clinical Global Impression-Improvement scale. Subjects were diagnosed with chronic (n = 5) or cyclic (n = 3) vomiting syndromes. Duration of vomiting ranged from 6 months to 10 years (3.5 ± 3.2 years). All subjects received multiple psychiatric diagnoses with anxiety disorders being the most frequent. Maximum mirtazapine dosage was 7.5-30 mg/day (16.00 ± 6.16 mg/day). Three subjects showed complete remission and 5 subjects showed much to very much improvement in vomiting. Most frequent side effects were increased appetite, weight gain and sedation. Young subjects with chronic or cyclic vomiting may frequently suffer anxiety and/or depressive symptoms or disorders. Mirtazapine could be an effective treatment option for the treatment of vomiting and co-morbid anxiety or depressive disorders in these subjects. More systematic research are needed on this topic.

Characteristics of Patients With Chronic Unexplained Nausea and Vomiting and Normal Gastric Emptying

Chronic nausea and vomiting with normal gastric emptying is a poorly understood syndrome; we analyzed its characteristics. We collected and analyzed data from 425 patients with chronic nausea and vomiting, enrolled at 6 centers by the Gastroparesis Clinical Research Consortium in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry. Among the patients, 319 (75%) had delayed emptying, defined by the results of a standardized, low-fat meal, and 106 had normal gastric emptying. Patients with or without delayed emptying did not differ in age, sex, or race, although those with normal gastric emptying were less likely to be diabetic. Symptom severity indexes were similar between groups for nausea, retching, vomiting, stomach fullness, inability to complete a meal, feeling excessively full after meals, loss of appetite, bloating, and visibly larger stomach. There were no differences in health care utilization, quality of life indexes, depression, or trait anxiety scores. However, state anxiety scores were slightly higher among patients with delayed gastric emptying. Total gastroparesis cardinal symptom index scores were not correlated with gastric retention after 2 or 4 hours in either group. Patients with the syndrome were not adequately captured by the stand-alone criteria for the Rome III diagnoses of chronic idiopathic nausea and functional vomiting. With rare exceptions, the diagnosis remained stable after a 48-week follow-up period. Patients with nausea and vomiting with normal gastric emptying represent a significant medical problem and are, for the most part, indistinguishable from those with gastroparesis. This syndrome is not categorized in the medical literature--it might be a separate clinical entity.

Cannabinoid hyperemesis syndrome - case report.

Background: Cannabis is one of the most commonly used drugs worldwide with several side effects. Although it is used also as an antiemetic and appetite stimulating drug, it may have a paradoxal effect. Cannabinoid hyperemesis syndrome is a clinical syndrome characterized by repeated vomiting and abdominal pain associated with chronic cannabis abuse. Case report: We report a case of a 21-year old patient who repeatedly presented at our Department of Internal Medicine with hyperemesis and upper abdominal pain. The diagnostic evaluation showed only mild gastroduodenitis and no obvious causes for patient`s symptoms. During last two presentations he admitted to the chronic abuse of marijuana,which was confirmed with positive findings of tetrahydrocannabinol in urine. Conclusion: In patients with unexplained vomiting and abdominal pain no evidence of organic disease the chronic abuse of cannabis and the cannabinoid hyperemesis syndrome should be considered.