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Gastroesophageal reflux disease presenting with intractable nausea
1Division of Gastroenterology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Annals of Internal Medicine
|May 1, 1997
Summary
Nausea can be an atypical symptom of gastroesophageal reflux disease (GERD). Acid reflux was the cause of intractable nausea in all patients, resolving with treatment like proton-pump inhibitors.
Area of Science:
- Gastroenterology
- Digestive Health
- Clinical Medicine
Background:
- Gastroesophageal reflux disease (GERD) commonly presents with heartburn and regurgitation.
- Atypical GERD symptoms include chest pain, cough, wheezing, and hoarseness.
- Nausea is an uncommon but significant atypical presentation of GERD.
Purpose of the Study:
- To investigate the clinical presentation of GERD when nausea is the primary symptom.
- To review treatment outcomes for patients with GERD-induced nausea.
Main Methods:
- A case series of 10 outpatients with chronic, intractable nausea unresponsive to empirical therapies.
- Diagnostic evaluations included esophagogastroduodenoscopy, 24-hour esophageal pH monitoring, gastric emptying studies, electrogastrography, and Bernstein testing.
Main Results:
- All 10 patients were diagnosed with GERD as the cause of their intractable nausea.
- Esophagitis was present in 5 patients; abnormal acid reflux was confirmed in 6 patients via pH monitoring.
- Nausea resolved in 7 patients with omeprazole, 2 with cisapride/ranitidine, and 1 with Nissen fundoplication.
Conclusions:
- Intractable nausea can be an atypical manifestation of GERD.
- 24-hour esophageal pH monitoring is crucial for diagnosing GERD in patients with unexplained nausea and normal initial investigations.
- Proton-pump inhibitors and promotility drugs are effective in resolving or reducing GERD-related nausea.
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