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Nausea and Vomiting Related to Autonomic Nervous System Disorders

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Nausea and Vomiting

Abstract

The pathophysiology of nausea and vomiting from gastroparesis and cyclic vomiting syndrome often involves autonomic pathways. Nongastrointestinal disorders such as orthostatic intolerance and postural orthostatic tachycardia syndrome also present with nausea and vomiting. Serotonin 5-HT3 antagonists and neurokinin NK1 antagonists are medications to treat nausea and vomiting that also work on autonomic pathways. Gastric electrical stimulation used to treat medically refractory nausea and vomiting modulates autonomic nervous system activity. Treatment of documented orthostatic intolerance alleviates nausea and vomiting. Complete autonomic testing or simpler office-based testing may help to identify autonomic abnormalities and to help guide management in these patients.

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Abbreviations

5-HT:

5 Hydroxy tryptamine

Ach:

Acetylcholine

AFT:

Autonomic function testing

ANS:

Autonomic nervous system

CAN:

Cardiovascular autonomic system

CCK:

Cholecystokinin

CINV:

Chemotherapy-induced nausea and vomiting

CNS:

Central nervous system

CRF:

Corticotropin-releasing factor

CTZ:

Chemoreceptor trigger zone

CVS:

Cyclical vomiting syndrome

DAN:

Diabetic autonomic neuropathy

DMV:

Dorsal motor nucleus

ENS:

Enteric nervous system

GABA:

γ-Aminobutyric acid

GI :

Gastrointestinal

HPA:

Hypothalamic-pituitary-adrenal

HRV:

Heart rate variability

HUT:

Head-up tilt

ICC:

Interstitial cells of Cajal

IGP:

Intragastric pressure

LES:

Lower esophageal sphincter

NE:

Norepinephrine

NK:

Neurokinin

NMH:

Neurally mediated hypotension

nNOS:

Neuronal nitric oxide synthase

NO:

Nitric oxide

NTS:

Nucleus tractus solitarius

OI:

Orthostatic intolerance

PNS:

Peripheral nervous system

POTS:

Postural orthostatic tachycardia syndrome

QSART:

Quantitative sudomotor axon reflex test

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

TSS:

Total symptom score

TST:

Thermoregulatory sweat test

VIP:

Vasoactive intestinal polypeptide

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The authors would like to thank Dr. Pradeepa Poudyal and Catherine McBride for help with manuscript preparation.

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Abell, T.L., Parajuli, D. (2017). Nausea and Vomiting Related to Autonomic Nervous System Disorders. In: Koch, K., Hasler, W. (eds) Nausea and Vomiting. Springer, Cham. https://doi.org/10.1007/978-3-319-34076-0_7

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