Functional Nausea Is Not Just Nausea: A Multi-Center, Cross-Sectional Study of Children and Young Adults

Chronic nausea is commonly associated with disorders of gut-brain interaction (DGBI). Pediatric functional nausea (FN) is defined as predominant nausea generally unrelated to meals. It is unclear if FN is a distinct entity or clustered with pain-associated DGBI. This multi-center study aimed to investigate the burden and comorbidities of FN and compare it to other DGBI.

Patients ages 8-21 years with DGBI were enrolled in a cross-sectional, multi-center observational registry across seven outpatient gastroenterology clinics and classified by Rome IV criteria. FN was compared to non-FN DGBI using validated symptom surveys: (1) Nausea Severity Scale (NSS), (2) Abdominal Pain Index (API), (3) PROMIS Global Health Scale (GHS), (4) PROMIS Pediatric Anxiety, (5) PROMIS Pediatric Depression, (6) Children's Somatization Inventory (CSI), and (7) Functional Disability Inventory (FDI).

292 subjects were analyzed. Fifty (17%) met FN criteria, of which 72% were female. Eighty-four and 32% of FN patients also met criteria for functional dyspepsia (FD) post-prandial distress subtype and irritable bowel syndrome (IBS), respectively. FN versus non-FN reported greater abdominal pain (p = 0.008), anxiety (p = 0.007) and depression (p = 0.002). FN versus IBS more commonly had long-term nausea and abdominal pain (p = 0.011, p = 0.014), postural dizziness (p = 0.034), migraines (p < 0.001), lower global health (p = 0.003), along with greater anxiety (p < 0.001) and depression (p < 0.001).

Children who meet formal FN criteria do not have isolated nausea. FN overlaps highly with pain-associated DGBI, and nearly all FN patients report abdominal pain. FN is coupled with extra-intestinal symptoms, mental health comorbidities, and poor global health.