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Central neurocircuitry associated with emesis.

P J Hornby1

  • 1Department of Pharmacology, Louisiana State University Health Sciences Center, 1901 Perdido Street, New Orleans, LA 70112, USA.

The American Journal of Medicine
|December 26, 2001
PubMed
Summary
This summary is machine-generated.

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Nausea and vomiting involve coordinated neural pathways in the medulla oblongata, not a single "vomiting center." Newer antiemetics target vagal afferents and the dorsal vagal complex for symptom relief.

Area of Science:

  • Neuroscience
  • Gastroenterology

Background:

  • Nausea and emesis are triggered by diverse stimuli including toxins, drugs, and motion.
  • Cyclic vomiting syndrome is common in children, highlighting the need for effective treatments.
  • Autonomic control of emesis is coordinated in the medulla oblongata.

Purpose of the Study:

  • To elucidate the neural circuitry underlying nausea and emesis.
  • To understand the mechanisms of action for current and novel antiemetic drugs.
  • To identify therapeutic targets for conditions like cyclic vomiting syndrome.

Main Methods:

  • Review of neuroanatomical pathways involved in emesis.
  • Analysis of the sites of action for various antiemetic agents.
  • Examination of the role of the nucleus tractus solitarius (NTS) and central pattern generators (CPGs).

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Main Results:

  • Emesis coordination involves interconnected neuronal groups in the medulla, not an isolated vomiting center.
  • 5-HT(3)-receptor antagonists and neurokinin-1 receptor (NK(1)R) antagonists act on vagal afferents or the dorsal vagal complex.
  • Delta(9)-tetrahydrocannabinol (Delta(9)-THC) acts on cannabinoid CB1 receptors in the dorsal vagal complex, affecting gastric motility.

Conclusions:

  • Understanding the complex neural network in the medulla is crucial for managing emesis.
  • Targeting specific receptors in the dorsal vagal complex and vagal afferents offers effective antiemetic strategies.
  • Predicting antiemetic effects of drugs altering motility remains challenging, particularly for delayed emesis and cyclic vomiting syndrome.