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Pathophysiology of Vomiting01:22

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Vomiting is a complex physiological response to expel harmful or irritating substances from the body. It's a defensive mechanism triggered by stimuli like poisons, microbial toxins, cytotoxic drugs, and mechanical abdominal distension. The process is centrally coordinated by the vomiting (or emetic) center located in the medulla of the brainstem. This area, rich in muscarinic M1, histamine H1, neurokinin 1 (NK1), and serotonin 5-HT3 receptors, coordinates the act of vomiting through...
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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Updated: Jan 25, 2026

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture
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[The 470th case: recurrent vomiting].

J Lu1, Y L Feng1, L L Shi2

  • 1Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.

Zhonghua Nei Ke Za Zhi
|May 7, 2019
PubMed
Summary
This summary is machine-generated.

Cyclic vomiting syndrome often co-occurs with psychological disorders, impacting treatment. Antidepressants may effectively manage symptoms in patients with functional gastrointestinal disorders.

Keywords:
AnxietyCyclic vomiting syndromeDepression

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Area of Science:

  • Gastroenterology
  • Psychiatry
  • Medical Psychology

Background:

  • Cyclic vomiting syndrome (CVS) frequently presents with comorbid psychological disorders.
  • These comorbidities can exacerbate gastrointestinal symptoms, reduce quality of life, and impede response to conventional therapies.
  • Frequent medical consultations and unnecessary examinations associated with CVS strain healthcare resources.

Observation:

  • A case study of a 20-year-old woman with lifelong recurrent vomiting is presented.
  • The patient showed limited improvement with standard symptomatic and supportive treatments.
  • Consultation with gastroenterological and psychological specialists was initiated.

Findings:

  • The patient's vomiting episodes significantly improved after initiating antidepressant therapy.
  • This suggests a strong link between psychological factors and the manifestation of CVS symptoms.
  • Recognition of comorbid psychological disorders is crucial for effective CVS management.

Implications:

  • Physicians should increase awareness and screening for psychological disorders in patients diagnosed with functional gastrointestinal disorders, including CVS.
  • Referral to psychologists for evaluation and potential antidepressant treatment is recommended for refractory CVS cases.
  • Integrating mental health assessments can improve patient outcomes and optimize resource utilization in managing CVS.