The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Gastroesophageal Reflux Disease Presenting with Intractable Nausea

Ronald J. Brzana, MD; and Kenneth L. Koch, MD
[+] Article, Author, and Disclosure 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
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.