From the Guidelines
Functional nausea and vomiting is diagnosed when a patient experiences persistent nausea or vomiting without an identifiable structural or biochemical cause, with chronic nausea occurring at least several times per week and/or one or more vomiting episodes per week, with symptoms present for at least the last three months with onset at least six months prior to diagnosis. The diagnostic criteria for functional nausea and vomiting are not explicitly stated in the provided study 1, which focuses on vomiting in infants. However, based on the general principles of diagnosing functional gastrointestinal disorders, the diagnosis of functional nausea and vomiting typically requires a thorough clinical evaluation to rule out other potential causes of symptoms.
Key Diagnostic Considerations
- Chronic nausea and vomiting without an identifiable cause
- Symptoms present for at least three months with onset at least six months prior to diagnosis
- No other medical condition that can fully explain the symptoms
- Symptoms do not exclusively occur during episodes of cyclic vomiting syndrome, cannabinoid hyperemesis syndrome, or migraine
- Symptoms are not attributable to another functional gastrointestinal disorder with nausea and vomiting as a component, such as gastroparesis The study 1 highlights the importance of a thorough clinical evaluation, including history and physical examination, to diagnose various causes of vomiting in infants. While the study does not provide specific diagnostic criteria for functional nausea and vomiting, it emphasizes the need to consider a range of potential causes, including gastrointestinal, infectious, and metabolic disorders.
Management Approaches
- Dietary modifications (small, frequent meals, avoiding trigger foods)
- Antiemetic medications (such as ondansetron, promethazine, or metoclopramide)
- Neuromodulators like low-dose tricyclic antidepressants (amitriptyline)
- Psychological interventions, including cognitive behavioral therapy It is essential to note that the provided study 1 does not discuss the management of functional nausea and vomiting specifically. However, based on general principles of managing functional gastrointestinal disorders, a multifaceted approach that incorporates dietary modifications, medications, and psychological interventions may be beneficial.
From the Research
Diagnostic Criteria for Functional Nausea and Vomiting
The diagnosis of functional nausea and vomiting involves a comprehensive clinical evaluation, including a thorough history and physical examination. The following criteria are considered:
- A thorough history to identify associated symptoms, timing of onset and duration of symptoms, exacerbating or relieving factors, alarm symptoms, medication and substance use, relationship with recent food ingestion, and comorbidities 2
- Physical examination findings to formulate a differential diagnosis and guide evaluation 3
- Consideration of medication or toxin adverse effects, neurologic causes, gastrointestinal diseases, metabolic and endocrine conditions, and psychogenic disorders 3, 2
- Evaluation of the patient's presentation, severity of symptoms, and physical examination findings to guide testing and treatment 3
Key Considerations
- Chronic nausea and vomiting have a broad differential diagnosis, including gastrointestinal, infectious, metabolic, neurologic, psychiatric, or related to medications and toxins 2, 4
- A careful history and physical examination are essential to guide the initial evaluation and narrow the differential diagnosis 2, 4
- Specific investigations, carefully guided by clinical assessment and tailored for each patient, are more beneficial in diagnosing chronic nausea and vomiting than empirically performing a blanket of investigations 4
Functional Nausea and Vomiting Disorders
- Functional vomiting (FV), cyclic vomiting syndrome (CVS), and chronic idiopathic nausea (CIN) are recognized as distinct disorders, although they can be highly disabling and are often under-investigated 5
- The pathophysiology, clinical presentation, and management of these disorders are complex and require a comprehensive approach 5