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Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea

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Abstract

Background

Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse.

Aims

To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments.

Methods

Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients’ chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression.

Results

One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI.

Conclusions

When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.

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Funding

The study was not funded.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway St., Pavilion C, 3rd Floor, GI Suite, Redwood City, CA, 94063, USA

    Thomas A. Zikos, Linda Nguyen, Afrin Kamal, Nielsen Fernandez-Becker, Kirsten Regalia, Monica Nandwani, Irene Sonu, Mildred Garcia, Philip Okafor, Leila Neshatian, Damanpreet Grewal, Patricia Garcia, George Triadafilopoulos & John O. Clarke

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  1. Thomas A. Zikos
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  2. Linda Nguyen
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  3. Afrin Kamal
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  4. Nielsen Fernandez-Becker
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  6. Monica Nandwani
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  7. Irene Sonu
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  8. Mildred Garcia
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  9. Philip Okafor
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  14. John O. Clarke
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Contributions

TAZ, JOC contributed to study concept and design, data acquisition, data/statistical analysis, drafting manuscript, revision of manuscript, and study supervision. LN, AK, NF-B, KR, MN, IS, MG, PO, LN, DG, PG, and GT helped in data acquisition, drafting manuscript, and revision of manuscript

Corresponding author

Correspondence to Thomas A. Zikos.

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Conflict of interest

Nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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10620_2020_6195_MOESM1_ESM.pdf

Figure S1: Survey. Paper copies of this survey were distributed to eligible patients by clinical staff or physicians 1 (PDF 304 kb)

Supplementary material 2 (DOCX 20 kb)

Supplementary material 3 (DOCX 19 kb)

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Zikos, T.A., Nguyen, L., Kamal, A. et al. Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea. Dig Dis Sci 65, 3280–3286 (2020). https://doi.org/10.1007/s10620-020-06195-5

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  • DOI: https://doi.org/10.1007/s10620-020-06195-5

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