Chronic nausea and orthostatic intolerance: Diagnostic utility of orthostatic challenge duration, Nausea Profile Questionnaire, and neurohumoral measures

• Published in: Neurogastroenterology and motility Vol. 30; no. 11; pp. e13433 - n/a
• Main Authors: Wagoner, Ashley L., Tarbell, Sally E., Shaltout, Hossam A., Diz, Debra I., Weese‐Mayer, Debra E., Fortunato, John E.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2018
• Subjects: Adolescent; Aldosterone; Baroreceptors; Blood pressure; Catecholamines; Child; Children; Dyspepsia; Etiology; Female; functional nausea; Heart rate; Humans; Hypotension; Intolerance; Male; Nausea; Nausea - blood; Nausea - diagnosis; nausea profile; Orthostatic Intolerance - blood; Orthostatic Intolerance - diagnosis; Posture; Questionnaires; Reflexes; Renin; Surveys and Questionnaires; Syncope; Tachycardia; tilt table testing AND OI AND paediatrics; Tilt-Table Test - methods; Vasopressin; Vasopressins - blood; nausea profile; tilt table testing AND OI AND paediatrics; functional nausea
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.13433

Background Chronic nausea in pediatrics is a debilitating condition with unclear etiology. We aimed to define hemodynamic and neurohumoral characteristics of chronic nausea associated with orthostatic intolerance in order to improve identification and elucidate mechanism. Methods Children (10‐18 years) meeting Rome III criteria for functional dyspepsia with nausea and symptoms of orthostatic intolerance (OI) completed a Nausea Profile Questionnaire followed by prolonged (45 minutes rather than the traditional 10 minutes) head‐upright tilt (HUT) (70° tilt up) test. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured supine and after 15 minutes into HUT. Beat‐to‐beat heart rate and blood pressure were continuously recorded to calculate their variability and baroreflex sensitivity. Key Results Within 10 and 45 minutes of HUT, 46% and 85% of subjects, respectively, had an abnormal tilt test (orthostatic hypotension, postural orthostatic tachycardia, or syncope). At 15 and 45 minutes of HUT, nausea was elicited in 42% and 65% of subjects respectively. Higher Nausea Profile Questionnaire scores correlated with positive HUT testing at 10 minutes (P = 0.004) and baroreflex sensitivity at 15 minutes (P ≤ 0.01). Plasma vasopressin rose 33‐fold in subjects with HUT‐induced nausea compared to twofold in those who did not experience HUT‐induced nausea (P < 0.01). Conclusions and Inferences In children with chronic nausea and OI, longer duration HUT elicited higher frequency of abnormal tilt testing and orthostatic‐induced nausea. The Nausea Profile Questionnaire predicted the orthostatic response to tilt testing. Exaggerated vasopressin release differentiated patients with HUT‐induced nausea (vs those without nausea), suggesting a possible mechanism for chronic nausea in childhood. We aimed to define hemodynamic and neurohumoral characteristics of chronic nausea associated with orthostatic intolerance. In children with chronic nausea and OI, longer duration HUT elicited higher frequency of abnormal tilt testing and orthostatic‐induced nausea with the Nausea Profile Questionnaire predicting the orthostatic response to tilt testing. Exaggerated vasopressin release differentiated patients with HUT‐induced nausea (vs those without nausea).