Medical Edge Newspaper Column

Chronic Vomiting Should Be Evaluated

February 18, 2008
Dear Mayo Clinic:
For over a year, I have had episodes of vomiting. If nothing is in my stomach, nothing comes up, but I still have the response. I have no warning. No pain. It just happens. I kept a food journal, but could see no pattern. I am a 50-year-old woman. I'm on medication for blood pressure. I exercise regularly and eat healthy. My blood work was 'perfect.'

Answer:
Unfortunately, many medical conditions can lead to the symptoms you describe. You'll need further medical evaluation to uncover the source of the problem.

One possibility is that you have a stomach motility, or motor, problem. In these disorders, your stomach doesn't empty properly, causing vomiting and other symptoms, such as nausea or a feeling of fullness soon after you start to eat. Gastroparesis (literally weakness of the stomach) is an example of a motility disorder. It can be diagnosed with a gastric emptying study, which measures the rate at which food leaves your stomach.

A second possibility is cyclic vomiting syndrome (CVS). Although this rare disorder occurs most often in children, it can affect adults. Many people with this disorder suffer from migraine headaches. Symptoms include sudden-onset vomiting that can be quite severe. Usually, it lasts for several days and then goes away without any other symptoms until the next episode of vomiting. The characteristic signs and symptoms of cyclic vomiting syndrome usually are the basis for diagnosis. This syndrome can be triggered by smoking marijuana, among other causes. So if you use marijuana, stop. In many cases, medications used to prevent migraine attacks can help prevent or stop the episodes of vomiting.

A number of uncommon metabolic conditions, as well as problems in the brain, can cause the type of vomiting you describe. They also need to be ruled out. Examples include failure of the adrenal gland (Addison's disease), severe diabetes or a brain tumor. Testing your electrolytes and glucose, and an MRI of the brain, can help to rule out these conditions.

If the vomiting occurs without other symptoms, and diagnostic tests don't reveal another underlying medical condition, you may have functional vomiting. Simply, this is unexplained vomiting. Functional vomiting sometimes responds to medications such as tricyclic antidepressants. In this situation, the antidepressants are not prescribed due to depression, but because they may effectively stop the vomiting.

The bottom line is that it's essential for you to see a gastrointestinal specialist for a full evaluation of your situation to find the underlying cause of your vomiting.

— Nicholas Talley, M.D., Ph.D., Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla.