Causes of Chronic Nausea and Vomiting

Chronic nausea and vomiting in patients with normal gastric emptying is a significant medical problem that is indistinguishable from gastroparesis and might be a separate clinical entity, according to Pankaj Pasricha in the July issue of Clinical Gastroenterology and Hepatology.

Chronic nausea and vomiting in patients that do not have any obvious structural abnormalities is a difficult problem for physicians and patients alike. When the nausea and vomiting are associated with a delay in gastric emptying, the syndrome is called gastroparesis. However, some patients have no demonstrable abnormalities in gastric emptying, and are a challenge to diagnose and manage.

To study this disorder, Pasricha et al. collected and analyzed data from 425 patients with chronic nausea and vomiting; 319 (75%) had delayed emptying, defined by the results of a standardized, low-fat meal, and 106 had normal gastric emptying.

Pasricha et al. found that patients with symptoms of chronic nausea and vomiting, but normal gastric emptying, were indistinguishable from patients with classical gastroparesis by most demographic and clinical criteria. 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 a visibly larger stomach. There were no differences in health care utilization, quality of life indexes, depression, or trait anxiety scores.

Importantly, 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. In an accompanying editorial, Nathaniel Winstead states that the Rome Committee should improve the criteria for functional vomiting and chronic idiopathic nausea.

The  pathogenesis of nausea and vomiting in these patients is unexplained—it is not clear whether this is a distinct syndrome, a heterogenous collection of unidentified etiologies, or a type of gastroparesis that changes over time.

Pasricha et al. propose that these patients might have abnormalities in gastric function that are more subtle than those found in classical gastroparesis. Techniques used to measure solid gastric emptying might not capture the entire spectrum of gastric dysfunctions—the authors point out that nearly a third of patients believed to have normal solid gastric emptying have delayed liquid gastric emptying.  Aberrant afferent signaling via the vagal of splanchnic nerves, or changes in hormone levels, might also account for the symptoms.

Pasricha et al. did associate a history of binge drinking with chronic unexplained nausea and vomiting with normal gastric emptying. Winstead suggested that ethanol might be toxic to the enteric nervous system in some individuals.

Winstead states that one of the most interesting features of the study was the stability of the disorder—after nearly 1 year, very few patients had a change in diagnosis. He states that we must determine whether this is a primary disorder, a highly selected group of very ill patients with severe functional dyspepsia, or a collection of different problems leading to a final common pathway of chronic unexplainable nausea.

More information:

Read the article online.
Pasricha PJ, Colvin R, Yates K, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol and Hepatol 2011;9:567–576.

Read the accompanying editorial.
Winstead N. The challenges of chronic nausea and vomiting and normal gastric emptying. Clin Gastroenterol and Hepatol 2011;9:534–535.

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About Kristine Novak, PhD, Science Editor

Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology, both published by the American Gastroenterological Association. She has worked as an editor at biomedical research journals and as a science writer for more than 12 years, covering advances in gastroenterology, hepatology, cancer, immunology, biotechnology, molecular genetics, and clinical trials. She has a PhD in cell biology and an interest in all areas of medical research.
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41 Responses to Causes of Chronic Nausea and Vomiting

  1. Tina Schabell says:

    My mother has lived at least 2-3 years now with chronic nausea which now she has been having vomited with it for over 6 months. She has had multiple stomach empting studies with mixed results. 2 out of 3 studies stated that they were normal. EGD was done with biopsy done with no new results except lots of imflamation in esophogus and stomach. no cancer or bacteria was found.. She is nauseated and vomits if she does eat or drink anything and if she don’t. She is an overweight woman which has lost over 30 pounds in just a couple of months which all the doctors can say good your lossing weight. Yes I agree it’s good for weight lost but not like this and having no quality of life. Some days she can’t even hold her head up. She is diabetic type 2. one doctor told her she should only drink water. How unreal is that? We are desprate to find out what is going on and stop this. She has also tried meds to stop nausea and vomiting without success. Please if anybody has any sugestions or referrals please contact me by email..I don’t know how much longer she can handle this. Thanks, Tina

    • Kat Hamilton says:

      I was reading your letter and am surprised how similar your mother is to mine. I have been searching the Internet trying to find answers but have not found anything. She has had the same nausea for two years and over the past 6 months has had severe vomiting. I am very concerned and even after she was hospitalised for five days have no answers. I was curios if they have diagnosed your mother or if you might have any suggestions.
      hope your mother is doing better
      Kat

  2. annette says:

    Tina, There is a very real possibility with the diabetes and length of time dealing with this that your mom may have to go in the hospital for a few days so they can throw everything at what is going on with her…the length of time suggests that she may now be protien, vitamin, or electrolyte deficient or out of balance all of which will add to and continue the nausea. All three of these plus imbalances in her diabetic glucose levels can all cause severe nausea. Please also have them check gall bladder and pancrease.

    • Anonymous says:

      They have told my mom she is malnuristed but they dont do anything about it. She had gallbladder removed and hysterectomy years ago before all this started. No relief in site. A new GI doctor thinks its too many cokes but she cant even hold it down long enough to b the problem.

  3. Nancy Stapleton says:

    My daughter Kyla is now 16 years old. She has been vomiting multiple times a day for 2 years. She has very little nausea. She is now having pain and the episodes have become more violent. The doctors say she has EE syndrome and slight SMA syndrome but the x-ray shows the food has room to pass and so it is a mystery why my daughter is living this nightmare. I am frustrated with doctors… More meds that don’t work. I hope Kyla gets a chance to live with out this. She is not able to do so many things now… It effects her whole life. Help!

    • penny says:

      i know what you mean i cant do many things or enjoy many things cause of me being so nausea all the time and mostly in the morning im really bad i feel like im gonna die its so bad. and im nausea all day but it worsen by morning. i even take zofran and phenegrin and sometimes they help but most of the time it doesnt. i wish my dr would find out what the heck is wrong with me.

  4. Vickie Nevels says:

    Thank the Lord, I’m not alone. Finding this article and knowing it’s happening to others without a true diagnosis is great but disheartening. I’m a 49yo female with chronic nausea, retching and vomiting. It has gotten so bad I’m basically a shutin. I constantly must wear pads because the gagging is so forceful I usually wet my pants. It doesn’t matter of I eat or not the NV is always present. I also have lost weight (49#). This is no way to live. I can’t plan anything. I have had several gastric empting test as well with mixed results. I eat Zofran like candy trying to stop the nausea. My health issues are GERD, RA, Fibromyalgia, and Barretts Esophagus. I to have searched the internet for answers. So far this is the only site that I have found others like me. Thank all of you for your postings they really helped me. Prayers to all of you suffering like me, hopefully an answer will soon be available.

    • Z. Monique says:

      I am so sorry that other people out there are suffering with this issue. However it is a bit comforting knowing that I am not alone. I am a 31 yr old woman and I have been dealing with this since I was a teenager. I vomit just about everyday and sometimes its so bad I know better than to leave the house because it happens so many times in one day. Although I haven’t been diagnosed with anything else, I do not believe I have diabetes or any other ailments. I do have menstraul issues though. I am constantly bleeding and it VERY rarely stops but I never get cramps so its mostly just an inconvience of always having to wear pads or tampons. Most people don’t understand and say that the nausea and vomitting are all in my head but I know its not. I went to the doctor once and he told my Mom it was all in my head and that I need to stay relaxed. The problem with that is I can be happy and relaxed and the next minute I am vomitting. I have tried to document when it happens and I have come up with the fact that I vomit when I get hot, I vomit after riding the bus or sitting in a car, I vomit after meals, I vomit when I am hungry, I vomit when i wake up, I vomit when I am sad or excited…I could go on but the point is that anything can trigger my nausea and vomitting. People have given me over the counter drugs which just make me sick and I have also tried teas. If anyone knows more about this please let me know how I can get some relief. Its so hard to deal with and frankly its embarassing vomitting in public because I don’t have any control over it. Thanks to everyone who is sharing on this forum! It truly helps when people understand what you are going through rather than thinking you are crazy.

      • Angel says:

        Have you researched for C.V.S.? Cyclic Vomiting Syndrome? I am thinking this is going to be my diagnosis. ;-(

    • Angel says:

      Here is the same for me. I am 43 yro mother of 3, married 24 yr, ill with these episodes that have no “lab-identifiable” cause now for nearly 4 yrs. I’ve missed so much with my kids. I am in search of ANYONE who can relate to this tortutous condition!

      • Vickie says:

        I also suffer from chronic nausea and vomiting for the last 17 months. I can’t plan anything so I’m like a prisoner in my home. I also must wear a pad because of the forcefulness of my retching. I’m a 50 yo female who unfortunately can’t offer any help because no doctor can tell me what’s wrong. I’ve seen a gastroenterologist, neurologist, endocrinologist, internists and a psychiatrist and ALL of them look at me like I’m looney. They don’t see how someone could vomit 6-12 times a day. Even loosing 49 pounds in 5 months doesn’t convince them. My prayers go out to everyone suffering with this and no answers. It’s a tough road to travel

    • penny says:

      I also eat zofran like candy I also take phenegrin like candy cause zofran alone doesnt help and with the both taken together helps some but i still am nausea and i dont vomit all the time just really really nausea all the time and it scares me and sometime when i get that way i got to use the bathroom number 2 and i get hot and cold and i feel like im gonna pass out with it to.

  5. Deborah says:

    i am 53 and have had chronic vomiting for about a year now. I also have type II diabetes. I have had several tests done to try to figure out the cause but so far I have gotten no real answers. I also have depression and the vomiting doesn’t help me to feel good about myself. Sometimes I feel the doctors don’t believe that I vomit everyday. I have had professionals tell me it’s in my head and others have said for me to deal with it. I would like to see them deal with it for just a week and see if they like it because I sure don’t. I am glad to know that I am not the only person with this problem because I was feeling so alone. I am sorry that others are going through this. Hopefully soon there will be an answer for us.

    • Vickie Nevels says:

      Hi, Deborah welcome to the site. This is the only site I’ve found where individuals can support each other. I also wish the doctors had this mess for just one week. If they did there would be a cure ASAP. I noticed that other people like yourself have diabetes. I’ve read that n&v goes with that alot. Why I’m not sure. I do not have diabetes but I do have other medical issues like RA, Fibromyalgia, and GERD/Hital Hernia. I’m scheduled for an upper GI study on Tuesday and then alot of gastric XRays starting Thursday. I hope something is found. My now ex husband had very little patients and with my illnesses. I have been dealing
      with depression for quite sometime and also deal with anxiey

      • Deborah says:

        Hi, it was nice to hear from you. I am sorry that others have this problem but at the same time I am glad I am not alone. I have had professionals tell me it is in my head,i have to deal with it and to pray to God. I recently changed GI doctors to see if he has anything new to offer because I was getting nowhere with the last one. I did have a test a few weeks ago and the results were normal. I see him again in a couple of weeks and I hope he has something else to offer. I hope you find some answers from the tests you have this week. My boyfriend is trying to be supportive but I know it is hard on him because he loves me but at the same time it’s not happening to him so he sometimes is not there for me, but at least he tries. God luck.

  6. Kathy says:

    I was disgnosed with Crohns 4 yrs ago and had it a year before. I have serious nausea vomiting ever since, with small intervals of peace. Right now been in hospital 4 times in 4 weeks. Need the IVs to get rehydrated, pain meds, stronger antinausea. It also triggers migraines. My gastro guy is stymied. ER is too, as is Internal Med guy. 5 yrs of NV has made me a crazy woman. I am SO glad to at least hear I am not alone. I want my life back. So does my family….

  7. Anonymous says:

    Has anyone had a hysterectomy and has the chronic vomiting and nausea?

    • Vickie Nevels says:

      I am still suffering with chronic N/V. Gastric emptying and Scopes are normal. I tried the drug Colostipol, which is supposed to bind with bile to decrease nausea, but all it did was cause severe stomach, face, feet and ankle swelling. It also caused terrible constipation. Now they are leaning toward it being neurologicAl and I’m having a MRI to rule out a brain tumor or lesion on the brainstem. Definitely don’t want that but at least it would be an answer.

      • Vickie Nevels says:

        Still no answer on the brain tumor, but my dr. gave me a new drug called Domperidone. It has been truly sent from God. After vomiting 12 – 16 times a day for a solid year and nausea so bad you can’t raise your head I finally have some relief. I have not vomited one time in 5 days and very little nausea. Ask your Dr. for some of this drug. I hope it works for all of you.

    • Rene says:

      Hi! I am a 42 yo woman. I have been dealing with chronic nausea and vomiting, Ive tried every form of nausea med that the doctors have thrown at me, back in 2010, I went into one of our leading hopitals with pain on my right side, I had some scar tissue built up because of Endometriosis. while in the or, the dr thought my appendix looked slighly enlarged, so he decided to remove it, witjout realizing he had perferated my colon.
      Which lead to a 9 month stay in the hospital with a colostomy bag placed, and an additiomal 12 abdominal surgeries. I still had the nausea and vomitimg which started after my 1st surgery. I had it ever since. I have tried every remedy that I have heard of or read about. back in May of 2011 Ihad the colostomy bad taken down, Thank God for that.
      I am still having the n/v episodes, which are worse and more frequent. Now I get to add the stress of adv stage 3 breast cancer.I keep hoping I will rin in to someone who has some miacle answer, but no such luck.
      I keep praying for a cure of some sort, and of course for the strenght to fight the cancer as well. My babies need me, and I so desperatly need them.
      My thought and prayers are with you all.

      • Vickie says:

        My prayers go out to you and your family. I pray that you win your battle with cancer. My chronic and vomiting started at age 48 after a total knew replacement. It’s been a year and 5 months of constant n/v. Of course every doctor I have seen says their is no connection to the surgery. I, like you, have taken every medication and test they throw at me. While at my Neurologist for my migraines I told him about the chronic n/v. I explained all the meds and test I had received. He said well lets think out of the box. He told me that we have nausea and vomiting centers in our brain as well as in our stomach. He put me on a drug called klonopin. He started at 1mg. Surprisingly the nausea slowed down. We increased to 2mg and my nausea is almost memory. I still have n/v once a week or so, but that beats every and all day long. I also got some relief in vomiting after I got my chronic constipation better. I had been given every drug possible to help with chronic constipation. I eat plenty of fiber and drink plenty of water but still constipation persisted. I’m a chronic pain patient so the constipation is due to pain meds. Once again it was my Neurologist that told me to eat dried fruit. He said stuff like trail mix that combine dried fruit and nuts would do the trick. Once I tried the stuff and got better regulated I was able to stop the laxative meds. So, with the klonopin and
        the trail mix my chronic nausea and vomitiny are much more managed. If I miss a dose of klonopin the n/v starts within 12 – 24 hrs. Sorry this was so long and I hope it helps someone.

  8. Anonymous says:

    Chronic Vomiting Synrdrome Association

  9. em says:

    I’ve read parathyroid gland problem is also a cause and linked with diabetes, blood tests can check this

  10. em says:

    oops! it’s gastroparesis that’s linked with diabetes, because of the effect of the diabetes on the vagus nerve affecting gut motility. parathyroid problems can cause excess acid secretion in the stomach. gastroparesis can be intermittant I think so may not always show up on tests.

  11. Ree says:

    So glad to know, i’m not alone. My Mom had this happen 4 months ago, and now it’s happeing again! This is no way to live. You feel so helpless! And going back and forth to the hospital is way to costly.

  12. Anonymous says:

    Roberta says:
    I had a Colectomy Nov 3, 2011 where over 30 inches of my intestines were removed. I was in the hospital for 17 days, and off work for almost 12 weeks. I felt pretty good when I returned to work, but however in May of 2012 I started having stomach problems again. I went to the doctor again, and found that I had an Abdomnal Hernia, and was told that it would have to be repaired. I rolled the thought around in my head for good 6 weeks until I decided to have it repaired. On July 24, 2012, I again went under the knife. In this procedure I also had the excess fat removed from my stomach. Here it is September 2012, and I am suffering from cronic nausia after this surgery. It will not go away. I cannot go anywhere or do anything. I have taken and used everything I can think of, but it will not go away. Does anyone out there know what I am talking about or have had the same problem after surgery. Oh yes, I am also doctoring an open would in the lower part of my abdomon which occurred and was readmitted to the hospital twice and the emergency room more than 6 times.

  13. Anonymous says:

    I had a Colectomy Nov 3, 2011 where over 30 inches of my intestines were removed. I was in the hospital for 17 days, and off work for almost 12 weeks. I felt pretty good when I returned to work, but however in May of 2012 I started having stomach problems again. I went to the doctor again, and found that I had an Abdomnal Hernia, and was told that it would have to be repaired. I rolled the thought around in my head for good 6 weeks until I decided to have it repaired. On July 24, 2012, I again went under the knife. In this procedure I also had the excess fat removed from my stomach. Here it is September 2012, and I am suffering from cronic nausia after this surgery. It will not go away. I cannot go anywhere or do anything. I have taken and used everything I can think of, but it will not go away. Does anyone out there know what I am talking about or have had the same problem after surgery. Oh yes, I am also doctoring an open would in the lower part of my abdomon which occurred and was readmitted to the hospital twice and the emergency room more than 6 times.

  14. Kim says:

    I have been having chronic nausea for the last 6 months. Retching in the morning. No vomiting. Have had many tests. All turn up negative. I was reading about the antidepressant Remeron being used to treat nausea. Was wondering if anyone has tried it and had success. I am now going to try a gluten-free diet and see if that helps.

  15. Vickie Nevels says:

    I take Remeron nightly for sleep and it has no effect on my nausea. I , like you have morning wrenching and daily nausea. I have been having this problem for over a year with no relief. I have had every test possible with no answers. I haven’t tried a gluetin free diet. I’m interested in finding out how well it works for you.

  16. cynthia says:

    My son has uncommon renal tubular acidosis. He has had chronic vomiting for the last 8 yrs. No one can figure out what is causing it. It complicates his RTA. He has had all kinds of gastric tests that all come back normal. He is going to die if this can’t be stopped. The vomiting causes his potassium to drop to dangerous levels. Which then causes his heart rate to become abnormal. He is hospitalized on average every two weeks.

  17. Monica50 says:

    I am 50 years old and I I have had chronic nausea and vomiting for seven months now. (Spetember 2012) I have had every test under the sun done for it. They came to the conclusion I had severe Gastroparesis. My doctor sent me to one of the best doctors in Temple University Hospital. I got more tests done on it, and now they say I have nothing wrong with me. I am vomiting every day up to six times a day. I had Botox injections given to me for the vomiting. It is a treatment for Gastroparesis but so far no results. It is frustrating. I have lost 26 pounds since this all started. I still think it is Gastroparesis.

  18. penny says:

    Im 41 yrs old and i have chronic nausea everyday and im so nausea in the mornings really bad to the point i feel like im gonna die. and i hate this feeling. i want to start feeling better so i can enjoy my kids and my grandkids more. this is no life to be like this. im also dizzy sometimes with this nausea. i also passed out from getting so dizzy and a hot feeling and i have a bowel movement. i wish the drs would find out what the heck is wrong. cause i want to live life and not always laying down.

  19. Sophie says:

    Hi. I got sick in november in florida and have felt nauseous since. Its now june. Ive had stomach emptying, a scope down my throat, all the blood work, MRIs, trips to the ER, gallbladder test, and everything has come back normal. Im so sick of feeling sick all the time!!! I never want to do anything anymore. I want to feel normal again.

  20. ED Edgerton says:

    Ed E. says don’t let your Dr. overlook this very good newsletter on parasitic nausea by
    John Kaiser, MD on parasitic nausea and vomiting.

    http://www.integrativehealthconsulting.com/educate/enews/…/parasites.html‎

  21. Aidan says:

    Does your blog have a contact page? I’m having trouble locating it but, I’d like to send
    you an e-mail. I’ve got some recommendations for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it expand over time.

  22. MIchele says:

    no nausea but chronic projectile vomiting for about 6 months now, it comes on suddenly and I have vomited on my dog and other people because it comes so fast I dont feel it, I have not eaten in weeks and when I was it would come up within 20 minutes of eating so I gave up… I drink water to have something to puke because after the first spout comes the dry heaves… dont know what to do, nausea meds do not work

  23. Teresa says:

    I am a 50 year old woman who has suffered the nausea for over 20 years and the vomiting started a year ago. I had my gall bladder removed two years ago and have hard cramping stomach pains that I am prescribed Donatell (a controlled substance) for high blood pressure and Hep -C. I have been scoped from both ends and the doctors just tell me I have stomach spasms and need to take a pill when it starts. I don’t leave home without the pills and a barf bag in my purse. I exercise regularly and watch my fat intake. I don’t drink or smoke and my weight was in the correct range for my height. I lost 10 lbs without trying before the vomiting started. Changed doctors twice and still know relief. The doctors are useless and a waste of money. I found that a little fiber in the mornings can help every now and then because it binds the bile in your stomach, too much and it binds you up a lot.

  24. JadeEclypse says:

    I’ve been dealing with this for almost 1 year now. 29 year old female who began with general nausea/vomiting that progressively got worse. Got my gallbladder out because the symptoms were identical to my mother’s from two years ago and it showed constriction and stones, thought that would solve my problem. Unfortunately the nausea and vomiting only got worse.

    Every test has shown something different but ultimately they’re unremarkable. My upper GI showed a full stomach 13 hours later, my upper endoscopy was normal but my doctor was questioning auto-immune related inflammation, my gastric emptying study was completely normal. I had my most recent follow up with a PA that works for my doctor’s office who basically gave me that good old brush off feeling again because my tests are “unremarkable”. So is apparently my 30 pound weight loss without trying. They just drew blood to test for celiac disease, and I’ve a take home kit of breath tubes to test for overgrowth of intestinal fleura. I’m a registered nurse, have been for 7 years, I know what’s normal and what isn’t, and I know when a doctor is getting tired of dealing with something. I spent the last meeting with the PA feeling really disheartened, because at least the doctor seemed to want to make an effort to figure things out, where as she is quick to try and point fingers at random things -I- might be doing wrong to cause it. For instance, I take NSAIDS sometimes, because I have fibromyalgia and polyarthritis that we’re still in the process of working up, so since NSAIDS can cause nausea and vomiting, clearly my use of them for my joint and muscle pain is to blame. It was one big circular meeting where everything I said was rebutted to something else.

    All I know is, I’m 29, and this is not what I anticipated 29 feeling like. I do NOT have diabetes, yes I’m slightly overweight, but I do not have Hypertension, high cholesterol, or anything that should indicate why I spend almost every day nauseated, why foods I was eating a year ago SOUND completely disgusting and make me gag, or why I dry heave half the time and throw up sometimes.

    It gets so frustrating, being made to feel like it’s all in your head. I’ve no doubt stress complicates things, but that doesn’t mean it’s in my head and not a real problem. This article and these responses make me happy in a way, because it tells me that it isn’t just ME. It’s just nice to hear that I’m not completely alone in this.

  25. I intended to draft you this tiny remark to be able to thank you so much yet again for these stunning pointers you have shared in this case.

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