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.
Diseases of the central nervous system (CNS), 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 gastrointestinal 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 that, when severe, evokes vomiting.
- Gastro-oesophageal reflux disease
- Peptic ulcer disease
- Acute gastroenteritis
- Food poisoning
- Chronic post-viral nausea and vomiting
- Motion sickness
- Benign paroxysmal positional vertigo
- Stroke (embolic/ischaemic/haemorrhagic)
- Gastric outlet obstruction
- Small bowel obstruction
- Colonic obstruction
- Post-gastrointestinal surgery
- Severe constipation
- Irritable bowel syndrome
- Cyclic vomiting syndrome
- Gastric dysrhythmias
- Bacterial peritonitis
- Anorexia nervosa
- Bulimia nervosa
- Idiopathic functional dyspepsia or post-prandial distress syndrome
- Acute coronary syndrome
- Postural orthostatic tachycardia syndrome
- Meniere's disease
- Acoustic neuroma
- Traumatic brain injury
- Brain abscess
- Complex partial seizures
- Central nervous system tumours
- Primary adrenal insufficiency (acute or chronic)
- Heat stroke
- Acute pancreatitis
- Bariatric surgery sequelae
- Primary pseudo-obstruction
- Secondary pseudo-obstruction
- Abdominal abscess
- Carcinomatous peritonitis
- Stomach cancer
- Ovarian cancer
- Renal cancer
- Small cell lung cancer
- Pancreatic cancer
- Chronic mesenteric ischaemia
- Cannabinoid hyperemesis
- Chronic nausea and vomiting after antibiotics or anaesthetics
Thomas L Abell, MD
Professor of Medicine
Arthur M. Schoen, MD, Chair in Gastroenterology
Gastrointestinal Motility Clinic
TLA receives funding from the National Institutes of Health (NIH) Gastroparesis Clinical Research Consortium (GpCRC), and the NIH Gastric Dysrhythmias. He is an investigator for Censa, Cindome, Vanda, Allergan, Neurogastrx, snd Processa; a consultant for Censa, Nuvaira, Takeda, Medtronic, and Enterra Medical; a speaker for Takeda and Enterra Medical; a reviewer for UpToDate; the Gastric Electrical Stimulation editor for Neuromodulation, Wikistim; and the founder of ADEPT-GI which has intellectual property for autonomic/enteric and bioelectric diagnosis and therapies. TLA is an author of a number of references cited in this topic.
Prateek Mathur, MD
University of Louisville
Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine
PM declares that he has no competing interests.
Professor Thomas L Abell and Dr Prateek Mathur would like to gratefully acknowledge Dr Kenneth L Koch, a previous contributor to this topic.
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 topic.
James Neuberger, BM, BCh
Queen Elizabeth Hospital
JN declares that he has no competing interests.
Daniel Leffler, MD, MS
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.
Ned Snyder, MD, FACP
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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