What are the causes of persistent nausea?

From the Guidelines

Persistent nausea can be caused by various conditions, including gastrointestinal disorders, infections, medication side effects, pregnancy, vestibular disorders, migraines, anxiety or stress, hormonal imbalances, central nervous system disorders, and certain metabolic conditions. The most recent and highest quality study 1 suggests that nausea and vomiting are common during pregnancy, with frequency ranging from 30%–90%, and can be attributed to an increase in levels of progesterone, human chorionic gonadotropin, and estrogen, as well as changes in GI motility. Some key causes of persistent nausea include:

• Gastrointestinal disorders such as gastroesophageal reflux disease, peptic ulcers, gastroparesis, or irritable bowel syndrome
• Infections like viral gastroenteritis or food poisoning
• Medication side effects, particularly antibiotics, pain medications, chemotherapy drugs, and some antidepressants
• Pregnancy, including morning sickness or hyperemesis gravidarum
• Vestibular disorders affecting the inner ear, such as labyrinthitis or Meniere's disease
• Migraines, anxiety or stress, hormonal imbalances, including thyroid disorders
• Central nervous system disorders, and certain metabolic conditions like diabetes or kidney disease Treatment depends on identifying the underlying cause, but may include antiemetic medications such as ondansetron (4-8mg every 8 hours), promethazine (12.5-25mg every 4-6 hours), or metoclopramide (10mg before meals and at bedtime) 1. Lifestyle modifications, such as eating smaller, more frequent meals, avoiding trigger foods, staying hydrated, and getting adequate rest, can also help alleviate symptoms. Additionally, ginger supplements (250mg four times daily) may provide natural relief 1. It is essential to note that persistent nausea lasting more than a week, accompanied by severe symptoms like vomiting blood, severe abdominal pain, or signs of dehydration, requires immediate medical attention to identify and address the underlying cause.

From the Research

Causes of Persistent Nausea

The causes of persistent nausea can be diverse and involve both gastrointestinal and non-gastrointestinal factors. Some of the key causes include:

• Gastroparesis, a condition characterized by delayed gastric emptying without obvious structural abnormalities, often leading to nausea, vomiting, pain, early satiety, and bloating 2
• Chronic renal failure, which can cause nausea and vomiting due to uremia 3
• Various pathophysiological processes involving gastrointestinal and non-gastrointestinal causes, such as medications, vestibular, and neurologic disorders 4
• Idiopathic and diabetic gastroparesis, with nausea being a predominant symptom in both conditions, although vomiting is more prevalent and severe in diabetic gastroparesis 5

Gastrointestinal Causes

Gastrointestinal causes of persistent nausea can be grouped into two broad categories based on the finding of delayed or normal gastric emptying. These causes include:

• Gastroparesis, which is characterized by delayed gastric emptying and can cause nausea, vomiting, and other symptoms 2, 5
• Cyclic vomiting syndrome, a condition characterized by recurrent episodes of severe vomiting 4
• Functional dyspepsia, a condition characterized by persistent or recurrent upper abdominal symptoms, such as epigastric pain or burning, early satiety, and difficulty swallowing 2

Non-Gastrointestinal Causes

Non-gastrointestinal causes of persistent nausea can include:

• Medications, such as those used to treat cancer, HIV, and other conditions 4
• Vestibular disorders, such as vertigo and balance problems 4
• Neurologic disorders, such as migraines and multiple sclerosis 4
• Uremia, a condition characterized by high levels of waste products in the blood, which can cause nausea and vomiting 3

Treatment Options

Treatment options for persistent nausea can vary depending on the underlying cause. Some effective treatments include:

• Metoclopramide, a medication that can increase gastric emptying and inhibit nausea and vomiting 2, 3
• Ondansetron, a medication that can effectively control nausea and vomiting, particularly in patients with uremia-induced nausea and vomiting 3, 6
• Promethazine, a medication that can be effective in treating nausea and vomiting, particularly in patients with chronic gastrointestinal syndromes 6
• Marijuana, which has been perceived as an effective treatment for gastrointestinal nausea by some patients 6