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Unexplained nausea

William L Hasler
Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g., gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates...
October 10, 2016: Current Treatment Options in Gastroenterology
Kimberly N Harer, Pankaj J Pasricha
Chronic unexplained nausea and vomiting is a debilitating condition that dramatically decreases patient quality of life and creates diagnostic and treatment challenges for healthcare providers. Additionally, the significant overlap in symptoms between disorders such as chronic unexplained nausea and vomiting, gastroparesis, and functional dyspepsia has resulted in a blurring of diagnostic lines and added confusion to the therapeutic approach. The identified overlap in clinical symptoms also suggests a common underlying pathophysiological mechanism may drive these conditions, indicating they could possibly be part of a spectrum of gastric neuromuscular disorders instead of discrete processes...
October 8, 2016: Current Treatment Options in Gastroenterology
Ekta Gupta, Linda A Lee
Chronic nausea and vomiting, whether or not associated with gastroparesis, are among the most difficult symptoms to manage. Patients typically undergo extensive evaluation and empiric treatment often with suboptimal results. Conventional therapies may not produce adequate symptom relief or may cause unacceptable side effects. Thus, it is not surprising that patients report a negative impact on well-being, since the intermittent or constant occurrence of these symptoms are a source of anxiety as they impact social interactions and ability to work...
October 1, 2016: Current Treatment Options in Gastroenterology
John M Wo, Thomas V Nowak, Shamaila Waseem, Matthew P Ward
Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting...
September 27, 2016: Current Treatment Options in Gastroenterology
Paul K Valestra, Scarlet Herrarte Fornos, John Gian, Burke A Cunha
Coxsackie viruses are enteroviruses most common in children. Coxsackie B viral infections often present with biphasic fever, headache, pharyngitis, nausea/vomiting, diarrhea and a maculopapular rash that spares the palms and soles. These clinical features may be present in other viral infections. We present a case of a hospitalized adult with rash and fever with highly elevated ferritin levels later found to be due to Coxsackie B5. We believe this is the first case of Coxsackie B infection with otherwise unexplained highly elevated ferritin levels...
2016: IDCases
Hesham Khalil, Moby Joseph
Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy...
2016: BMJ Case Reports
Julie Courts, Virginia Maskill, Andrew Gray, Paul Glue
AIMS: Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting. METHODS: Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids. RESULTS: Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males...
August 24, 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Morris Gordon, John K MacDonald, Claire E Parker, Anthony K Akobeng, Adrian G Thomas
BACKGROUND: Constipation within childhood is an extremely common problem. Despite the widespread use of osmotic and stimulant laxatives by health professionals to manage constipation in children, there has been a long standing paucity of high quality evidence to support this practice. OBJECTIVES: We set out to evaluate the efficacy and safety of osmotic and stimulant laxatives used to treat functional childhood constipation. SEARCH METHODS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane IBD Group Specialized Trials Register from inception to 10 March 2016...
2016: Cochrane Database of Systematic Reviews
B M M Reiber, R R Gorter, M Tenhagen, H A Cense, A Demirkiran
BACKGROUND: Acute ischaemia of the small intestine is caused by mesenteric venous thrombosis in 5-15% of patients. The non-specific symptoms frequently lead to a diagnostic delay. CASE DESCRIPTION: A 30-year-old pregnant woman presented at the accident and emergency department with progressive abdominal pain, nausea and vomiting. During admission the patient developed signs of peritonitis. Diagnostic laparoscopy revealed a picture of mesenteric venous thrombosis, and we resected 170 cm ischemic small intestine...
2016: Nederlands Tijdschrift Voor Geneeskunde
Vincenzo Stanghellini, Francis K L Chan, William L Hasler, Juan R Malagelada, Hidekazu Suzuki, Jan Tack, Nicholas J Talley
Symptoms that can be attributed to the gastroduodenal region represent one of the main subgroups among functional gastrointestinal disorders. A slightly modified classification into the following 4 categories is proposed: (1) functional dyspepsia, characterized by 1 or more of the following: postprandial fullness, early satiation, epigastric pain, and epigastric burning, which are unexplained after a routine clinical evaluation; and includes 2 subcategories: postprandial distress syndrome that is characterized by meal-induced dyspeptic symptoms and epigastric pain syndrome that does not occur exclusively postprandially; the 2 subgroups can overlap; (2) belching disorders, defined as audible escapes of air from the esophagus or the stomach, are classified into 2 subcategories, depending on the origin of the refluxed gas as detected by intraluminal impedance measurement belching: gastric and supragastric belch; (3) nausea and vomiting disorders, which include 3 subcategories: chronic nausea and vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; and (4) rumination syndrome...
May 2016: Gastroenterology
Vincenzo Stanghellini, Nicholas J Talley, Francis Chan, William L Hasler, Juan Malagelada, Hidekazu Suzuki, Jan Tack
Symptoms that can be attributed to the gastroduodenal region represent one of the main subgroups among functional gastrointestinal disorders. A slightly modified classification into four categories is proposed. B1) Functional dyspepsia (FD), characterized by one or more of: postprandial fullness, early satiation, epigastric pain, epigastric burning that are unexplained after a routine clinical evaluation, includes two subcategories: Postprandial Distress Syndrome (PDS) that is characterized by meal-induced dyspeptic symptoms and Epigastric Pain Syndrome (EPS) that does not occur exclusively postprandially...
February 15, 2016: Gastroenterology
S Bauer, H Baier, C Baumgartner, K Bohlmann, S Fauser, W Graf, B Hillenbrand, M Hirsch, C Last, H Lerche, T Mayer, A Schulze-Bonhage, B J Steinhoff, Y Weber, A Hartlep, F Rosenow, H M Hamer
BACKGROUND: Various brain stimulation techniques are in use to treat epilepsy. These methods usually require surgical implantation procedures. Transcutaneous vagus nerve stimulation (tVNS) is a non-invasive technique to stimulate the left auricular branch of the vagus nerve at the ear conch. OBJECTIVE: We performed a randomized, double-blind controlled trial (cMPsE02) to assess efficacy and safety of tVNS vs. control stimulation in patients with drug-resistant epilepsy...
May 2016: Brain Stimulation
Stefan R Bornstein, Bruno Allolio, Wiebke Arlt, Andreas Barthel, Andrew Don-Wauchope, Gary D Hammer, Eystein S Husebye, Deborah P Merke, M Hassan Murad, Constantine A Stratakis, David J Torpy
OBJECTIVE: This clinical practice guideline addresses the diagnosis and treatment of primary adrenal insufficiency. PARTICIPANTS: The Task Force included a chair, selected by The Clinical Guidelines Subcommittee of the Endocrine Society, eight additional clinicians experienced with the disease, a methodologist, and a medical writer. The co-sponsoring associations (European Society of Endocrinology and the American Association for Clinical Chemistry) had participating members...
February 2016: Journal of Clinical Endocrinology and Metabolism
Barbara Mika, Dariusz Komorowski, Ewaryst Tkacz
The aim of this study was to investigate the effectiveness of Empirical Mode Decomposition (EMD) for slow wave extraction from multichannel electrogastrographical signal (EGG) the cutaneous recording of gastric myoelectrical activity. From the pacemaker region of stomach both spontaneous depolarization and repolarization occur generating the myoelectrical waves that are called the gastric pacesetter potentials, or slow waves. The 3 cycles per minute (3pcm) (0.05Hz) slow wave is fundamental electrical phenomenon in stomach responsible for the propagation and maximum frequency of stomach contractions...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Andrew S Powlson, Benjamin G Challis, David J Halsall, Erik Schoenmakers, Mark Gurnell
CONTEXT: Nephrogenic syndrome of inappropriate antidiuresis (NSIAD), resulting from activating mutations in the arginine vasopressin receptor type 2 (AVPR2), is a rare cause of hyponatraemia. However, its true prevalence may be underestimated and it should be considered in the investigation of unexplained hyponatraemia, with implications for management and targeted gene testing. OBJECTIVE: We describe a structured approach to the investigation of hyponatraemia in a young patient, which allowed a diagnosis of NSIAD to be made...
August 2016: Clinical Endocrinology
S Yaylacı, O Ayyıldız, E Aydın, A Osken, F Karahalil, C Varım, M V Demir, A B Genç, S Sahinkus, Y Can, İ Kocayigit, C Bilir
OBJECTIVE: This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years. PATIENTS AND METHODS: Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study...
December 2015: European Review for Medical and Pharmacological Sciences
Preet Mohinder Singh, Anuradha Borle, Vimi Rewari, Jeetinder Kaur Makkar, Anjan Trikha, Ashish C Sinha, Basavana Goudra
Postoperative nausea and vomiting (PONV) is an important clinical problem. Aprepitant is a relatively new agent for this condition which may be superior to other treatment. A systematic review was performed after searching a number of medical databases for controlled trials comparing aprepitant with conventional antiemetics published up to 25 April 2015 using the following keywords: 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists' and 'NK-1 versus 5-HT3 for PONV'. The primary outcome for the pooled analysis was efficacy of aprepitant in preventing vomiting on postoperative day (POD) 1 and 2...
February 2016: Postgraduate Medical Journal
Marcello Moccia, Brit Mollenhauer, Roberto Erro, Marina Picillo, Raffaele Palladino, Paolo Barone
BACKGROUND: Parkinson's disease (PD) subjects are less likely to ever smoke and are more prone to quit smoking, as compared to controls. Therefore, smoking habits can be considered part of the non-motor phenotype, preceding the onset of motor PD by several years. OBJECTIVE: To explore non-motor symptom (NMS) correlates of smoking habits in de novo PD. METHODS: This cross-sectional study included 281 newly diagnosed, drug-naïve PD subjects, recruited in Naples (Italy) and in Kassel (Germany)...
2015: Journal of Parkinson's Disease
James K Ruffle, Sanjin Bajgoric, Kiran Samra, Subashini Chandrapalan, Qasim Aziz, Adam D Farmer
INTRODUCTION: 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. METHODS: We carried out a retrospective cohort study of all patients attending a tertiary neurogastroenterology and secondary care gastroenterology clinic from 2013 to 2015...
December 2015: European Journal of Gastroenterology & Hepatology
Saraschandra Vallabhajosyula, Pranathi R Sundaragiri, Ilya G Berim
Tension pneumothorax is a rare and potentially life-threatening clinical complication. A 43-year-old Caucasian woman with type 1 diabetes mellitus presented with nausea and retching and examination revealed dehydration. Laboratory parameters were consistent with a diagnosis of diabetic ketoacidosis, which responded to therapy. Suddenly, 30 hours later, she developed cardiorespiratory compromise due to a tension pneumothorax. After emergent decompression and catheter placement, computerized tomographic scan of the chest demonstrated esophageal-pleural fistula confirming Boerhaave syndrome as the etiology for the pneumothorax...
June 2016: Journal of Intensive Care Medicine
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