What are the treatments for nausea after gastric bypass revision?

From the Guidelines

Treatments for nausea after gastric bypass revision should prioritize a scheduled antiemetic regimen for at least 2 weeks after the procedure, as suggested by the American Gastroenterological Association (AGA) 1. This approach is based on the AGA's clinical practice guidelines, which recommend using intraoperative anesthetic regimens associated with the lowest incidence of nausea along with perioperative antiemetics 1. Key considerations for managing nausea after gastric bypass revision include:

• Medications such as ondansetron, promethazine, or metoclopramide, which can be prescribed as needed to manage nausea
• Lifestyle modifications, including eating small, frequent meals, staying hydrated by sipping fluids slowly between meals, and avoiding foods that can trigger nausea
• Natural relief options, such as ginger supplements or peppermint tea, which may help alleviate nausea
• Proper posture after eating, such as sitting upright for 30 minutes, to prevent acid reflux that can worsen nausea It is essential to seek medical attention immediately if nausea persists beyond two weeks or is accompanied by vomiting, dehydration, or inability to take in adequate nutrition, as this could indicate a complication 1. The goal of treatment is to manage nausea effectively, prevent complications, and improve the patient's quality of life after gastric bypass revision.

From the FDA Drug Label

INDICATIONS AND USAGE Ondansetron tablets are a 5-HT 3receptor antagonist indicated for the prevention of: ... postoperative nausea and/or vomiting. ( 1)

INDICATIONS AND USAGE Metoclopramide is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis. The Prevention of Nausea and Vomiting Associated with Emetogenic Cancer Chemotherapy ... The Prevention of Postoperative Nausea and Vomiting Metoclopramide Injection, USP is indicated for the prophylaxis of postoperative nausea and vomiting in those circumstances where nasogastric suction is undesirable

Treatments for Nausea after Gastric Bypass Revision:

• Ondansetron: may be used for the prevention of postoperative nausea and/or vomiting 2
• Metoclopramide: may be used for the prophylaxis of postoperative nausea and vomiting 3, 3 Key Considerations:
• The use of these medications should be guided by the specific clinical context and patient needs.
• It is essential to carefully evaluate the potential benefits and risks of each treatment option.

From the Research

Treatments for Nausea after Gastric Bypass Revision

• The combination of haloperidol, dexamethasone, and ondansetron has been shown to be effective in preventing postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy 4.
• Mirtazapine has been used to treat non-mechanical postoperative vomiting in morbidly obese patients after gastric bypass, with successful results in two reported cases 5.
• Promethazine/dexamethasone has been found to be more effective than Metoclopramide/dexamethasone in preventing and reducing the incidence of nausea, epigastric fullness, and reflux after laparoscopic gastric plication 6.
• A study comparing the effects of haloperidol, metoclopramide, dexmedetomidine, and ginger on postoperative nausea and vomiting after laparoscopic cholecystectomy found no significant difference between the four groups, but suggested that ginger may be a good option due to its fewer side effects 7.
• The combination of ondansetron and dexamethasone has been shown to be more effective than each drug alone in preventing PONV after laparoscopic cholecystectomy 8.

Medications Used to Treat Nausea

• Haloperidol
• Dexamethasone
• Ondansetron
• Mirtazapine
• Promethazine
• Metoclopramide
• Dexmedetomidine
• Ginger

Key Findings

• The combination of haloperidol, dexamethasone, and ondansetron reduced PONV and the necessity of rescue antiemetics, and also reduced morphine consumption and the volume of fluids infused postoperatively 4.
• Mirtazapine may be a successful option to treat non-mechanical postoperative vomiting in morbidly obese patients after gastric bypass 5.
• Promethazine/dexamethasone was more effective than Metoclopramide/dexamethasone in preventing and reducing the incidence of nausea, epigastric fullness, and reflux after laparoscopic gastric plication 6.