Nausea and vomiting related to autonomic nervous system disorders

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-HT3antagonists and neurokinin NK1antagonists 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.