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Neurogastroenterol Motil. 2018 Nov;30(11):e13433. doi: 10.1111/nmo.13433. Epub 2018 Aug 13.

Chronic nausea and orthostatic intolerance: Diagnostic utility of orthostatic challenge duration, Nausea Profile Questionnaire, and neurohumoral measures.

Author information

1
Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina.
2
Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
3
Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
4
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
5
Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
6
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
7
Center for Autonomic Medicine in Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
8
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
9
Stanley Manne Children's Research Institute, Chicago, Illinois.

Abstract

BACKGROUND:

Chronic nausea in pediatrics is a debilitating condition with unclear etiology. We aimed to define hemodynamic and neurohumoral characteristics of chronic nausea associated with orthostatic intolerance in order to improve identification and elucidate mechanism.

METHODS:

Children (10-18 years) meeting Rome III criteria for functional dyspepsia with nausea and symptoms of orthostatic intolerance (OI) completed a Nausea Profile Questionnaire followed by prolonged (45 minutes rather than the traditional 10 minutes) head-upright tilt (HUT) (70° tilt up) test. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured supine and after 15 minutes into HUT. Beat-to-beat heart rate and blood pressure were continuously recorded to calculate their variability and baroreflex sensitivity.

KEY RESULTS:

Within 10 and 45 minutes of HUT, 46% and 85% of subjects, respectively, had an abnormal tilt test (orthostatic hypotension, postural orthostatic tachycardia, or syncope). At 15 and 45 minutes of HUT, nausea was elicited in 42% and 65% of subjects respectively. Higher Nausea Profile Questionnaire scores correlated with positive HUT testing at 10 minutes (P = 0.004) and baroreflex sensitivity at 15 minutes (P ≤ 0.01). Plasma vasopressin rose 33-fold in subjects with HUT-induced nausea compared to twofold in those who did not experience HUT-induced nausea (P < 0.01).

CONCLUSIONS AND INFERENCES:

In children with chronic nausea and OI, longer duration HUT elicited higher frequency of abnormal tilt testing and orthostatic-induced nausea. The Nausea Profile Questionnaire predicted the orthostatic response to tilt testing. Exaggerated vasopressin release differentiated patients with HUT-induced nausea (vs those without nausea), suggesting a possible mechanism for chronic nausea in childhood.

KEYWORDS:

functional nausea; nausea profile; tilt table testing AND OI AND paediatrics

PMID:
30101470
DOI:
10.1111/nmo.13433

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