Gut Feelings: Nausea
By Meredith Hitch, MD - Pediatric Gastroenterologist - Dothan Pediatric Clinic
When kids start back to school, there is an air of excitement and new adventure, but 2020 has been wrought with new adventures, uncertainty, and challenges of staying safe and healthy so much so that those with underlying tendencies towards worry and anxiety may experience more GI complaints like abdominal pain and nausea.
I have always taken the point of view that many abdominal complaints in pediatric patients are real, but there is often no evidence of anything bad going on to cause them. It is, however, my role as a Pediatric Gastroenterologist to listen to my patients and ensure that there is not something bad going on to cause the symptoms.
We deem these entities to be functional GI disorders, which is a misnomer because patients are not functioning as they miss school and parents miss work. Ultimately, they are diagnoses of exclusion.
More and more, I find that nausea is often a physical expression of anxiety. Nausea is one of the more common complaints I hear from patients and it is one of the more difficult symptoms to pin down because it is such a vague complaint without specific testing. Plus, nausea is seldom a solo complaint. It is often accompanied by abdominal pain, vomiting, and even headaches.
It may seem odd to ask children in a GI clinic about headaches, but there is a functional GI disorder called abdominal migraine wherein children will complain of abdominal pain, nausea, and vomiting. The child does not need to even have a headache, but there is often a family history of migraine which compels me to consider this diagnosis.
Functional dyspepsia entails nausea and abdominal pain, which is usually after meals. Your child may say they would feel better if they could throw-up, but often they do not. Nausea, vomiting, and abdominal pain could be due to Helicobacter pylori gastritis. The pain often wakes the child from sleep and may lead to weight loss and lack of appetite. Usually acid suppression or blockade with medications like Pepcid or Prilosec is the first step which will improve some of the symptoms, but if not, then more investigation is needed. An H pylori fecal antigen test, not antibody blood test, will help determine if there is a potential infection which can then be confirmed by endoscopy.
Nausea, abdominal pain, poor appetite, early satiety, vomiting of old food, and weight loss concern me about gastroparesis wherein the stomach does not empty well. A gastric emptying study will demonstrate delayed gastric emptying. The treatment oddly enough is an antibiotic, erythromycin, which mimics the hormone motilin waking the stomach up to improve feeding tolerance and nausea.
Pregnancy and hyperemesis cannabis are things to consider when adolescents are nauseated. Hyperemesis cannabis usually occurs with binge pot smoking. Withdrawal symptoms are nausea, vomiting, and the compulsion to take hot, hot showers.
Ultimately, nausea is a symptom that is rarely isolated and is quite challenging to decipher and treat, but one I am happy to help work on with families to get patients back to living their life unburdened by nagging nausea.