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Gastroesophageal Reflux Disease Presenting with Intractable Nausea

Ronald J. Brzana, MD; and Kenneth L. Koch, MD
[+] Article and Author Information

From Milton S. Hershey Medical Center, Hershey, Pennsylvania. Acknowledgments: The authors thank Pamela Petito for her assistance in preparing this manuscript. Requests for Reprints: Kenneth L. Koch, MD, Division of Gastroenterology, Milton S. Hershey Medical Center, Pennsylvania State University, PO Box 850, Hershey, PA 17033. Current Author Addresses: Drs. Brzana and Koch: Division of Gastroenterology, Milton S. Hershey Medical Center, Pennsylvania State University, PO Box 850, Hershey, PA 17033.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(9):704-707. doi:10.7326/0003-4819-126-9-199705010-00005
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Background: Typical symptoms of gastroesophageal reflux disease are heartburn and regurgitation. A subset of patients present with atypical symptoms, such as chest pain, cough, wheezing, and hoarseness.

Objective: To review the clinical presentation and treatment of patients who presented with nausea as the primary symptom of gastroesophageal reflux disease.

Design: Case series.

Setting: Outpatient department of a university hospital.

Patients: 10 outpatients who had chronic, intractable nausea and had not responded to empirical therapies.

Measurements: Patients were evaluated by esophagogastroduodenoscopy, 24-hour esophageal pH studies, gastric-emptying tests, electrogastrography, or a Bernstein test.

Results: Abnormal acid reflux was found to be the cause of intractable nausea in all 10 patients. In 5 of the 10 patients, esophagitis was documented by esophagogastroduodenoscopy. Six patients had abnormal results on the 24-hour esophageal pH study. In these 6 patients, 32 of 33 episodes of nausea were accompanied by an episode of acid reflux. One patient had positive results on the Bernstein test. Nausea resolved after treatment with omeprazole in 7 patients, after treatment with cisapride or ranitidine in 2 patients, and after Nissen fundoplication in 1 patient.

Conclusions: Intractable nausea is an atypical symptom that can occur in a subset of patients with gastroesophageal reflux disease. A 24-hour esophageal pH study should be considered in patients who have unexplained nausea but normal findings on esophagogastroduodenoscopy, a gastric-emptying test, and electrogastrography. Nausea related to gastroesophageal reflux disease resolves or is markedly reduced with proton-pump inhibitors or promotility drugs.

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