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Ann Intern Med. 1997 May 1;126(9):704-7.

Gastroesophageal reflux disease presenting with intractable nausea.

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  • 1Division of Gastroenterology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.

Abstract

BACKGROUND:

Typical symptoms of gastroesophageal reflux disease are heartburn and regurgitation. A subset of patients present with atypical symptoms, such as chest pain, cough, wheezing, and hoarseness.

OBJECTIVE:

To review the clinical presentation and treatment of patients who presented with nausea as the primary symptom of gastroesophageal reflux disease.

DESIGN:

Case series.

SETTING:

Outpatient department of a university hospital.

PATIENTS:

10 outpatients who had chronic, intractable nausea and had not responded to empirical therapies.

MEASUREMENTS:

Patients were evaluated by esophagogastroduodenoscopy, 24-hour esophageal pH studies, gastric-emptying tests, electrogastrography, or a Bernstein test.

RESULTS:

Abnormal acid reflux was found to be the cause of intractable nausea in all 10 patients. In 5 of the 10 patients, esophagitis was documented by esophagogastroduodenoscopy. Six patients had abnormal results on the 24-hour esophageal pH study. In these 6 patients, 32 of 33 episodes of nausea were accompanied by an episode of acid reflux. One patient had positive results on the Bernstein test. Nausea resolved after treatment with omeprazole in 7 patients, after treatment with cisapride or ranitidine in 2 patients, and after Nissen fundoplication in 1 patient.

CONCLUSIONS:

Intractable nausea is an atypical symptom that can occur in a subset of patients with gastroesophageal reflux disease. A 24-hour esophageal pH study should be considered in patients who have unexplained nausea but normal findings on esophagogastroduodenoscopy, a gastric-emptying test, and electrogastrography. Nausea related to gastroesophageal reflux disease resolves or is markedly reduced with proton-pump inhibitors or promotility drugs.

Comment in

PMID:
9139556
[PubMed - indexed for MEDLINE]
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