Approach to Meal-Related Nausea and Vomiting

Nausea and vomiting are common symptoms that frequently lead to evaluation in the outpatient and inpatient settings. The pathophysiology of nausea and vomiting is complex, and the list of potential etiologies is vast. Patients with nausea and vomiting frequently report that eating exacerbates symptoms. Noteworthy gastrointestinal causes for meal-related nausea and vomiting include gastroparesis, functional dyspepsia, dumping syndrome, superior mesenteric artery syndrome, and median arcuate ligament syndrome. A number of carefully selected diagnostic tests, utilization of the Rome criteria, and an appreciation for the epidemiology of these various conditions can help the clinician hone in on the underlying cause. Importantly, a properly performed and interpreted gastric emptying study is essential to making an accurate diagnosis of gastroparesis and distinguishing this condition from functional dyspepsia, a common disorder of gut-brain interaction. There are a number of treatment options for nausea and vomiting, and the treatment approach is dependent on the specific cause for the meal-related symptoms. This article examines the approach to meal-related nausea and vomiting by reviewing tests to consider in the diagnostic evaluation of symptoms, followed by a discussion of clinically relevant disorders and disorder-specific treatments.