From the Guidelines
In cases of intractable nausea and vomiting, an endoscopy is recommended to rule out underlying gastrointestinal conditions such as gastroparesis, gastric outlet obstruction, or peptic ulcer disease, especially in patients with alarm symptoms like dysphagia, bleeding, anemia, weight loss, or recurrent vomiting 1.
Indications for Endoscopy
- The procedure allows for direct visualization of the upper gastrointestinal tract and can help identify any abnormalities that may be contributing to the patient's symptoms.
- Upper endoscopy is indicated in men and women with heartburn and alarm symptoms, such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting 1.
- Patients with severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy should undergo follow-up upper endoscopy to assess healing and rule out Barrett esophagus 1.
Pre-Procedure Care
- Prior to the procedure, patients should be stabilized with antiemetic medication such as metoclopramide 10mg IV every 6 hours or ondansetron 4mg IV every 4 hours, and hydration should be maintained with IV fluids.
- The endoscopy should be performed by a qualified gastroenterologist, and the patient should be monitored for any complications during and after the procedure.
Special Considerations
- In patients with COVID-19, nausea, vomiting, and diarrhea can be presenting symptoms, and endoscopy may be considered if an infectious work-up is unrevealing and patients remain symptomatic after maximizing medical therapy 1.
From the Research
Indications for Endoscopy in Intractable Nausea and Vomiting
- Intractable nausea and vomiting can be symptoms of various gastrointestinal conditions, including peptic ulcer disease, gastroparesis, and gastroesophageal reflux disease 2, 3, 4, 5, 6
- Upper endoscopy is a valuable diagnostic tool in evaluating patients with intractable nausea and vomiting, particularly in those with suspected gastric outlet obstruction or peptic ulcer disease 2, 4, 5
- Endoscopy can help identify mechanical obstructions, such as strictures or ulcers, that may be causing nausea and vomiting 2, 4
- In patients with suspected gastroparesis, upper endoscopy is recommended to rule out mechanical obstruction, while a 4-hour solid-phase gastric emptying scan can confirm the diagnosis 4
- Endoscopy can also be used to diagnose and treat conditions such as gastroesophageal reflux disease, which can present with atypical symptoms like intractable nausea 6
- The use of endoscopy in patients with intractable nausea and vomiting can lead to targeted treatment and improved symptom management 2, 4, 5, 6