Assessment of nausea and vomiting, adults

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Last reviewed: 7 Apr 2025

Last updated: 28 Jan 2025

Nausea and vomiting are extremely common symptoms and may be caused by a vast array of medical conditions.[1][2] 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:

Central neurological

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.

Peripheral neurological

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.

Differentials

Common

Gastritis
Gastro-oesophageal reflux disease
Peptic ulcer disease
Acute gastroenteritis
Food poisoning
Chronic post-viral nausea and vomiting
Migraine
Motion sickness
Benign paroxysmal positional vertigo
Stroke (embolic/ischaemic/haemorrhagic)
Hypercalcaemia
Hypothyroidism
Gastric outlet obstruction
Small bowel obstruction
Colonic obstruction
Choledocholithiasis
Cholecystitis
Post-gastrointestinal surgery
Severe constipation
Irritable bowel syndrome
Cyclic vomiting syndrome (CVS)
Gastric dysrhythmias
Gastroparesis
Bacterial peritonitis
Anorexia nervosa
Bulimia nervosa
Pregnancy
Drug-induced
Nephrolithiasis
Uraemia
Idiopathic functional dyspepsia or post-prandial distress syndrome

Full details

Uncommon

Acute coronary syndrome
Postural orthostatic tachycardia syndrome
Meniere's disease
Acoustic neuroma
Traumatic brain injury
Meningitis
Brain abscess
Complex partial seizures
Central nervous system tumours
Primary adrenal insufficiency (acute or chronic)
Hyperthyroidism
Hypopituitarism
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

Full details

Contributors

Authors

Thomas L Abell, MD

Professor of Medicine

Arthur M. Schoen, MD, Chair in Gastroenterology

Gastrointestinal Motility Clinic

Louisville

Disclosures

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 Cindome, Vanda, Neurogastrx, and Processa; a consultant for 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

Louisville

Disclosures

PM declares that he has no competing interests.

Acknowledgements

Professor Thomas L Abell and Dr Prateek Mathur would like to gratefully acknowledge Dr Kenneth L Koch, a previous contributor to this topic.

Disclosures

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.

Peer reviewers

James Neuberger, BM, BCh

Consultant Physician

Liver Unit

Queen Elizabeth Hospital

Birmingham

Disclosures

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

Boston

Disclosures

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

Galveston

Disclosures

NS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology. 2001 Jan;120(1):263-86.Full text Abstract

Intagliata N, Koch KL. Gastroparesis in type 2 diabetes mellitus: prevalence, etiology, diagnosis, and treatment. Curr Gastroenterol Rep. 2007 Aug;9(4):270-9. Abstract

American College of Gastroenterology. Clinical guideline: gastroparesis. Aug 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Guidelines
- 2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting
- ACG clinical guideline: gastroparesis
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Assessment of nausea and vomiting, adults

Summary

Differentials

Common

Uncommon

Contributors

Authors

Thomas L Abell, MD

Disclosures

Prateek Mathur, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

James Neuberger, BM, BCh

Disclosures

Daniel Leffler, MD, MS

Disclosures

Ned Snyder, MD, FACP

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Guidelines

Calculators

Videos

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice