Nausea and vomiting are extremely common symptoms and may be caused by a vast array of medical conditions. The presentation can be acute or chronic and ranges from a mildly annoying symptom to a condition that impairs quality of life or is a marker of a life-threatening disease.
There are 2 general mechanisms of nausea and vomiting:
Stimulation of the area postrema, which 'senses' noxious chemical agents (e.g., poisons, chemotherapy agents, digoxin) and subsequently stimulates the vagal nuclei, which evokes nausea and co-ordinates the emesis reflex.
CNS diseases such as infections or brain tumours stimulate CNS structures and elicit nausea and vomiting, ultimately through vagal pathways.
Diseases and disorders that originate in peripheral organ systems, such as the GI tract, stimulate vagal or spinal afferent nerves that connect with the vagal sensory (tractus solitarius) and vagal efferent motor nuclei. Ultimately, cortical centres where nausea is perceived and the efferent pathways that mediate vomiting are stimulated.
Tumours, infections, and drugs in the periphery may cause local dysfunction in a variety of organ systems that is sensed as nausea, and severe nausea eventually evokes vomiting.
Section Head Gastroenterology
Wake Forest University
Health Sciences Center
KLK is a consultant for GlaxoSmithKline and a shareholder in 3 CPM Company. He is an author of a number of references cited in this monograph.
Queen Elizabeth Hospital
JN declares that he has no competing interests.
Instructor in Medicine
Harvard Medical School
Director of Clinical Research
The Celiac Center
Beth Israel Deaconess Medical Center
DL declares that he has no competing interests.
Professor of Medicine
Chief of Clinical Gastroenterology and Hepatology
University of Texas Medical Branch
NS declares that he has no competing interests.
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