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Richard W. Mccallum - One of the best experts on this subject based on the ideXlab platform.
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Nausea and Vomiting in gastroparesis: similarities and differences in idiopathic and diabetic gastroparesis.
Neurogastroenterology and Motility, 2016Co-Authors: Henry P. Parkman, Gianrico Farrugia, K L Koch, Erin Hallinan, William L. Hasler, William J. Snape, Thomas L. Abell, Irene Sarosiek, Jorge Calles, Richard W. MccallumAbstract:Background Nausea and Vomiting are classic symptoms of gastroparesis. It remains unclear if characteristics of nausea and Vomiting are similar in different etiologies of gastroparesis. The aims of this article were as follows: to describe characteristics of nausea and Vomiting in patients with gastroparesis and to determine if there are differences in nausea and Vomiting in diabetic (DG) and idiopathic gastroparesis (IG). Methods Gastroparetic patients enrolling in the NIDDK Gastroparesis Registry underwent assessment with history and questionnaires assessing symptoms, quality of life, and a questionnaire characterizing nausea and Vomiting. Key Results Of 159 gastroparesis patients (107 IG, 52 DG), 96% experienced nausea, whereas 65% experienced Vomiting. Nausea was predominant symptom in 28% and Vomiting was predominant in 4%. Nausea was severe or very severe in 41%. PAGI-SYM nausea/Vomiting subscore was greater with increased Vomiting severity, but not nausea severity in DG than IG. Nausea was related to meals in 71%; lasting most of the day in 41%. Increasing nausea severity was related to decreased quality of life. Nausea often preceded Vomiting in 82% of patients and Vomiting often relieved nausea in 30%. Vomiting was more common in DG (81%) compared to IG (57%; p = 0.004). Diabetic patients more often had Vomiting in the morning before eating, during the night, and when not eating. Conclusions & Inferences Nausea is present in essentially all patients with gastroparesis irrespective of cause and associated with decreased quality of life. In contrast, Vomiting was more prevalent, more severe, and occurred more often in DG than IG. Thus, characteristics of Vomiting differ in IG vs DG.
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Cyclic Vomiting syndrome: treatment options
Experimental Brain Research, 2014Co-Authors: Reza A. Hejazi, Richard W. MccallumAbstract:Cyclic Vomiting syndrome is a disorder characterized by recurrent episodes of severe nausea and Vomiting separated by symptom-free periods. Our aims were to review treatments of adult cyclic Vomiting syndrome as well as to identify areas for further clinical research and the unanswered questions in this field. We conducted a PubMed search using such keywords as “cyclic Vomiting syndrome,” “nausea,” “Vomiting,” “treatment,” “trigger factors” and “tricyclic antidepressants” and combined this information with the knowledge and clinical research from the authors. Available data show that in adult cyclic Vomiting syndrome, there is an impressive and sustained response to high-dose tricyclic antidepressants. In up to 13 % who are regarded as poor responders to tricyclic antidepressants, a predictable profile can be identified related to coexisting psychological disorders, marijuana use, poorly controlled migraine headache or chronic narcotic use. Cyclic Vomiting syndrome in adults is being an increasingly recognized entity. Tricyclic antidepressants are the main treatment for controlling symptoms. Eliminating and addressing trigger factors are an essential part of management.
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neurochemical mechanisms and pharmacologic strategies in managing nausea and Vomiting related to cyclic Vomiting syndrome and other gastrointestinal disorders
European Journal of Pharmacology, 2014Co-Authors: Mohammad Ashashati, Richard W. MccallumAbstract:Abstract Nausea and Vomiting are common gastrointestinal complaints which could be triggered by stimuli in both the peripheral and central nervous systems. They may be considered as defense mechanisms when threatening toxins/agents enter the gastrointestinal tract or there is excessive retention of gastrointestinal contents due to obstruction. The pathophysiology of nausea and Vomiting is complex and much still remains unknown. Therefore, treatments are restricted or ineffective in many cases. Nausea and Vomiting with functional etiologies including cyclic Vomiting syndrome are challenging in gastroenterology. In this article, we review potential pathways, neurochemical transmitters, and their receptors which are possibly involved in the pathophysiology of nausea and Vomiting including the entity cyclic Vomiting syndrome.
Lawrence Ward - One of the best experts on this subject based on the ideXlab platform.
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adult cyclic Vomiting syndrome successfully treated with intranasal sumatriptan
Journal of General Internal Medicine, 2010Co-Authors: Monika Kowalczyk, Henry P Parkma, Lawrence WardAbstract:Cyclic Vomiting syndrome is an increasingly recognized cause of nausea and Vomiting in adults. We report the case of a 47-year-old man with recurrent episodes of intractable nausea and Vomiting for one year. His symptoms persisted for 4–7 days and then resolved spontaneously, only to return after periods of time ranging from one week up to a month. After an extensive workup, which failed to determine any causative explanation for his symptoms, he was diagnosed with cyclic Vomiting syndrome. His episodes of Vomiting were successfully terminated with the use of intranasal sumatriptan. In this case, we highlight that sumatriptan effectively aborted symptoms in an adult patient with cyclic Vomiting syndrome. Increasing physicians’ awareness of adult cyclic Vomiting syndrome may improve care of patients suffering from this debilitating condition.
Monika Kowalczyk - One of the best experts on this subject based on the ideXlab platform.
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adult cyclic Vomiting syndrome successfully treated with intranasal sumatriptan
Journal of General Internal Medicine, 2010Co-Authors: Monika Kowalczyk, Henry P Parkma, Lawrence WardAbstract:Cyclic Vomiting syndrome is an increasingly recognized cause of nausea and Vomiting in adults. We report the case of a 47-year-old man with recurrent episodes of intractable nausea and Vomiting for one year. His symptoms persisted for 4–7 days and then resolved spontaneously, only to return after periods of time ranging from one week up to a month. After an extensive workup, which failed to determine any causative explanation for his symptoms, he was diagnosed with cyclic Vomiting syndrome. His episodes of Vomiting were successfully terminated with the use of intranasal sumatriptan. In this case, we highlight that sumatriptan effectively aborted symptoms in an adult patient with cyclic Vomiting syndrome. Increasing physicians’ awareness of adult cyclic Vomiting syndrome may improve care of patients suffering from this debilitating condition.
David R. Fleisher - One of the best experts on this subject based on the ideXlab platform.
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Functional Vomiting Disorders and Patterns
Management of Functional Gastrointestinal Disorders in Children, 2014Co-Authors: David R. FleisherAbstract:Functional Vomiting patterns and disorders are, by definition, not caused by underlying organic disease. However, many have organic complications, e.g., Infant Rumination Syndrome, Cyclic Vomiting Syndrome, Vomiting associated with Bulimia.
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Anticipatory nausea in cyclical Vomiting
BMC Pediatrics, 2005Co-Authors: Fiona E. Mcronald, David R. FleisherAbstract:Background Cyclical Vomiting Syndrome (CVS) is characterised by discrete, unexplained episodes of intense nausea and Vomiting, and mainly affects children and adolescents. Comprehending Cyclical Vomiting Syndrome requires awareness of the severity of nausea experienced by patients. As a subjective symptom, nausea is easily overlooked, yet is the most distressing symptom for patients and causes many behavioural changes during attacks. Case presentation This first-hand account of one patient's experience of Cyclical Vomiting Syndrome shows how severe nausea contributed to the development of anticipatory nausea and Vomiting (ANV), a conditioned response frequently observed in chemotherapy patients. This conditioning apparently worsened the course of the patient's disease. Anticipatory nausea and Vomiting has not previously been recognised in Cyclical Vomiting Syndrome, however predictors of its occurrence in oncology patients indicate that it could complicate many cases. Conclusion We suggest a model whereby untreated severe and prolonged nausea provokes anxiety about further cyclical Vomiting attacks. This anxiety facilitates conditioning, thus increasing the range of triggers in a self-perpetuating manner. Effective management of the nausea-anxiety feedback loop can reduce the likelihood of anticipatory nausea and Vomiting developing in other patients.
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Anticipatory nausea in cyclical Vomiting
BMC Pediatrics, 2005Co-Authors: Fiona E. Mcronald, David R. FleisherAbstract:Cyclical Vomiting Syndrome (CVS) is characterised by discrete, unexplained episodes of intense nausea and Vomiting, and mainly affects children and adolescents. Comprehending Cyclical Vomiting Syndrome requires awareness of the severity of nausea experienced by patients. As a subjective symptom, nausea is easily overlooked, yet is the most distressing symptom for patients and causes many behavioural changes during attacks. This first-hand account of one patient's experience of Cyclical Vomiting Syndrome shows how severe nausea contributed to the development of anticipatory nausea and Vomiting (ANV), a conditioned response frequently observed in chemotherapy patients. This conditioning apparently worsened the course of the patient's disease. Anticipatory nausea and Vomiting has not previously been recognised in Cyclical Vomiting Syndrome, however predictors of its occurrence in oncology patients indicate that it could complicate many cases. We suggest a model whereby untreated severe and prolonged nausea provokes anxiety about further cyclical Vomiting attacks. This anxiety facilitates conditioning, thus increasing the range of triggers in a self-perpetuating manner. Effective management of the nausea-anxiety feedback loop can reduce the likelihood of anticipatory nausea and Vomiting developing in other patients.
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Anticipatory nausea in cyclical Vomiting
BMC Pediatrics, 2005Co-Authors: Fiona E. Mcronald, David R. FleisherAbstract:Background Cyclical Vomiting Syndrome (CVS) is characterised by discrete, unexplained episodes of intense nausea and Vomiting, and mainly affects children and adolescents. Comprehending Cyclical Vomiting Syndrome requires awareness of the severity of nausea experienced by patients. As a subjective symptom, nausea is easily overlooked, yet is the most distressing symptom for patients and causes many behavioural changes during attacks. Case presentation This first-hand account of one patient's experience of Cyclical Vomiting Syndrome shows how severe nausea contributed to the development of anticipatory nausea and Vomiting (ANV), a conditioned response frequently observed in chemotherapy patients. This conditioning apparently worsened the course of the patient's disease. Anticipatory nausea and Vomiting has not previously been recognised in Cyclical Vomiting Syndrome, however predictors of its occurrence in oncology patients indicate that it could complicate many cases. Conclusion We suggest a model whereby untreated severe and prolonged nausea provokes anxiety about further cyclical Vomiting attacks. This anxiety facilitates conditioning, thus increasing the range of triggers in a self-perpetuating manner. Effective management of the nausea-anxiety feedback loop can reduce the likelihood of anticipatory nausea and Vomiting developing in other patients.
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Functional Vomiting Disorders in Infancy: Innocent Vomiting, Nervous Vomiting, and Infant Rumination Syndrome
The Journal of Pediatrics, 1994Co-Authors: David R. FleisherAbstract:Pediatric gastroenterologists have tended to view gastroesophageal reflux (GER) as a disease in and of itself—a disease that can be diagnosed “objectively” with use of numerical data from esophageal pH monitoring and cured with pharmacologic or surgical treatment. What is often forgotten is that the data derived from esophageal pH monitoring and other techniques may identify the presence of abnormal GER but tell nothing about its pathogenesis. The usual approach to infants who feed poorly, vomit, or fail to gain weight is to identify the presence of abnormal GER, rule out underlying organic causes of Vomiting, and then diagnosis primary GER disease. The baby is then treated with pharmacologic, dietary, or positional therapy and, ultimately, if these therapies fail to eradicate the symptoms attributed to GER, surgical fundoplication, which stops Vomiting regardless of its causes. The pediatric literature on infant Vomiting and GER is almost devoid of research into the nature and possible relationships among infant stress, Vomiting, feeding difficulties, and failure to grow. Clinically, the quality of the maternal-infant relationship is frequently approached superficially, with psychosocial aspects treated as less important in infants considered to have primary organic disease amenable to medical or surgical treatment. Psychosocial factors in the pathogenesis of the infant's symptoms are often not pursued beyond assessment for possible abuse or neglect. It has been known for centuries that stress or excitement affects gastrointestinal function and symptoms. Although the field of infant psychiatry has produced a substantial literature on the nature of stresses that affect both infants and mothers, the pediatric literature on Vomiting and failure to thrive seldom acknowiedges the existence or importance of these contributions. In clinical practice, failure to explore psychosocial aspects that may contribute to Vomiting, feeding difficulties, or failure to thrive may result in missed opportunities for less invasive, more effective therapy at best, and countertherapeutic treatment at worst. This article describes three functional Vomiting disorders of infancy, their distinguishing characteristics, hypotheses regarding their pathogenesis, and principles of comprehensive management.
Henry P Parkma - One of the best experts on this subject based on the ideXlab platform.
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adult cyclic Vomiting syndrome successfully treated with intranasal sumatriptan
Journal of General Internal Medicine, 2010Co-Authors: Monika Kowalczyk, Henry P Parkma, Lawrence WardAbstract:Cyclic Vomiting syndrome is an increasingly recognized cause of nausea and Vomiting in adults. We report the case of a 47-year-old man with recurrent episodes of intractable nausea and Vomiting for one year. His symptoms persisted for 4–7 days and then resolved spontaneously, only to return after periods of time ranging from one week up to a month. After an extensive workup, which failed to determine any causative explanation for his symptoms, he was diagnosed with cyclic Vomiting syndrome. His episodes of Vomiting were successfully terminated with the use of intranasal sumatriptan. In this case, we highlight that sumatriptan effectively aborted symptoms in an adult patient with cyclic Vomiting syndrome. Increasing physicians’ awareness of adult cyclic Vomiting syndrome may improve care of patients suffering from this debilitating condition.
