Approach To Patient
Nausea and Vomiting in Adults
Editors: Brian C. Weiner MD, MS, FACP, AGAF; Amir Qaseem MD, PhD, MHA, MRCP (London), FACP; Dan Randall MD, MPH, FACP
Background Information
Description
Definitions
- Nausea is a subjective, unpleasant sensation of the need to vomit (Curr Treat Options Gastroenterol 2016 Dec;14(4):444).
- Vomiting is the rapid, forceful evacuation of gastric contents in retrograde fashion from the stomach up to and out of the mouth (Curr Treat Options Gastroenterol 2016 Dec;14(4):444).
- Chronic nausea and vomiting has a symptom duration of > 1 month.
- Rome IV diagnostic criteria for nausea and vomiting disorders:
- Chronic nausea and vomiting syndrome (CNVS) must include all of the following for the last 3 months with symptom onset ≥ 6 months before diagnosis:
- Bothersome nausea which is severe enough to affect usual activities, occurring at least once weekly and/or ≥ 1 vomiting episode/week
- Exclusion of self-induced vomiting, eating disorders, regurgitation, and rumination
- No evidence of organic, systemic, or metabolic diseases likely to explain symptoms on routine investigation, including at upper endoscopy
- Cyclic vomiting syndrome (CVS) must include stereotypical episodes of vomiting with acute onset and duration < 1 week with:
- ≥ 3 discrete episodes in the past year and ≥ 2 episodes in the past 6 months, occurring at least 1 week apart
- Absence of vomiting between episodes, but other milder symptoms may be present between cycles
- See also Cyclic Vomiting Syndrome in Adults.
- Cannabinoid hyperemesis syndrome (CHS) must include all of the following for the last 3 months with symptom onset ≥ 6 months before diagnosis:
- Stereotypical episodic vomiting resembling CVS in terms of onset, duration, and frequency
- Presentation after prolonged excessive cannabis use
- Relief of vomiting episodes by sustained cessation of cannabis use
- Reference - Gastroenterology 2016 May;150(6):1380
- Chronic nausea and vomiting syndrome (CNVS) must include all of the following for the last 3 months with symptom onset ≥ 6 months before diagnosis:
Incidence/Prevalence
- STUDY SUMMARYvomiting associated with about 3% of emergency department visits in United States in 2004COHORT STUDY: N C Med J 2010 Mar-Apr;71(2):123
- Unexplained chronic vomiting occurring at least once monthly is reported to have an estimated prevalence of 2% in women and 3% in men (Gastroenterology 2016 May;150(6):1380).
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DynaMed Levels of Evidence
Quickly find and determine the quality of the evidence.
DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:
1Level 1 (likely reliable) Evidence
2Level 2 (mid-level) Evidence
3Level 3 (lacking direct) Evidence
Grades of Recommendation
Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.
Download the full version of Levels of Evidence