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Journal of Clinical Gastroenterology Apr 2021A comprehensive review of treatments for nausea and vomiting (N/V). (Review)
Review
GOAL
A comprehensive review of treatments for nausea and vomiting (N/V).
BACKGROUND
N/V are common symptoms encountered in medicine. While most cases of acute N/V related to a specific cause can be straightforward to manage, other cases of acute N/V such as chemotherapy-induced N/V and especially chronic unexplained N/V can be difficult to control, leading to a significant decline in the patient's quality of life and increased cost of medical care from repeated hospitalizations.
STUDY
Traditional management has relied on pharmacotherapy which may be inadequate in a certain proportion of these patients. Many of the medications used in the management of N/V have significant side effect profiles making the need for new and improved interventions of great importance.
RESULTS
This review covers a broad review of the pathophysiology of N/V, pharmacotherapy, including safety concerns and controversies with established pharmaceuticals, newer immunotherapies, bioelectrical neuromodulation (including gastric electrical stimulation), behavioral and surgical therapies, and complementary medicine.
CONCLUSION
On the basis of emerging understandings of the pathophysiology of N/V, improved therapies are becoming available.
Topics: Antiemetics; Antineoplastic Agents; Humans; Nausea; Quality of Life; Vomiting
PubMed: 33471485
DOI: 10.1097/MCG.0000000000001485 -
Cancer Treatment and Research... 2021The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the... (Review)
Review
The significant physical and emotional effects of chemotherapy-induced nausea and vomiting (CINV) are experienced by cancer patients. Severe symptoms decrease the patient's quality of life and potentially deters further treatment. The five main forms of CINV (i.e., acute, delayed, anticipatory, breakthrough, and refractory) require different treatment regimens, which often include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Despite a significant amount of research and development of antiemetic agents, management of CINV remains a great challenge with many needs waiting to be adequately addressed, such as controlling non-acute CINV, developing appropriate CINV treatment protocols for multiple-day chemotherapy patients, and providing options for those prone to CINV despite treatment. Further research is required to optimize CINV management for these patients.
Topics: Antiemetics; Antineoplastic Agents; Glucocorticoids; Humans; Medication Adherence; Nausea; Neoplasms; Neurokinin-1 Receptor Antagonists; Quality of Life; Serotonin 5-HT3 Receptor Antagonists; Vomiting
PubMed: 33360668
DOI: 10.1016/j.ctarc.2020.100278 -
BMJ Clinical Evidence Mar 2014More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. The cause of... (Review)
Review
INTRODUCTION
More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. The cause of nausea and vomiting in pregnancy is unknown, but may be due to the rise in human chorionic gonadotrophin concentration. In 1 in 200 women, the condition progresses to hyperemesis gravidarum, which is characterised by prolonged and severe nausea and vomiting, dehydration, and weight loss.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatment for nausea and vomiting in early pregnancy? What are the effects of treatments for hyperemesis gravidarum? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 32 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure; acupuncture; corticosteroids; ginger; metoclopramide; ondansetron; prochlorperazine; promethazine; and pyridoxine (vitamin B6).
Topics: Acupressure; Acupuncture Therapy; Adrenal Cortex Hormones; Antiemetics; Female; Zingiber officinale; Humans; Nausea; Pregnancy; Pyridoxine; Vomiting
PubMed: 24646807
DOI: No ID Found -
The American Journal of Managed Care Sep 2017Among patients with cancer, chemotherapy-induced nausea and vomiting (CINV) is a common adverse effect that not only impacts quality of life, but also treatment... (Review)
Review
Among patients with cancer, chemotherapy-induced nausea and vomiting (CINV) is a common adverse effect that not only impacts quality of life, but also treatment outcomes. It is important to address these issues from both prevention and treatment standpoints so that patients remain adherent to their regimens. With CINV being classified into 5 different types, the primary medication options for prevention and treatment include 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids. Other medications used, but to a lesser extent, include dopamine antagonists, benzodiazepines, cannabinoids, and olanzapine. In addition, those patients who express interest in alternative or nonpharmacologic therapies may have options as well. With the array of medications available for patients with cancer, pharmacists play an integral role in optimizing patient outcomes. Therefore, it is important that pharmacists stay up-to-date on the most current guidelines available for CINV treatment.
Topics: Antiemetics; Antineoplastic Agents; Humans; Nausea; Neoplasms; Risk Factors; Vomiting
PubMed: 28978206
DOI: No ID Found -
Australian Family Physician Sep 2007Most people experience nausea and vomiting at some stage, but when these symptoms recur frequently they can significantly reduce quality of life. In most cases, a... (Review)
Review
BACKGROUND
Most people experience nausea and vomiting at some stage, but when these symptoms recur frequently they can significantly reduce quality of life. In most cases, a thorough history, examination and simple investigations can yield a diagnosis. Chronic nausea is a more challenging problem with its many potential causes and with a significant number of patients remaining undiagnosed despite extensive investigation.
OBJECTIVE
This article discusses the assessment and management of acute and chronic nausea and vomiting in adults.
DISCUSSION
Gastrointestinal infections and food poisoning are the most common causes of acute nausea and vomiting. Medication side effects and pregnancy should always be suspected. Hospitalisation may be required for severe metabolic abnormalities, dehydration or surgical causes. There are many potential causes of chronic nausea and vomiting and a comprehensive history and examination is required. Symptoms are poor predictors of functional versus pathological illness. Type and extent of investigation must be tailored to the individual patient.
Topics: Acute Disease; Adult; Chronic Disease; Diagnosis, Differential; Family Practice; Foodborne Diseases; Gastroenteritis; Humans; Nausea; Risk Factors; Vomiting
PubMed: 17885699
DOI: No ID Found -
Autonomic Neuroscience : Basic &... Jan 2017Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a... (Review)
Review
Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman's quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.
Topics: Female; Humans; Nausea; Pregnancy; Pregnancy Complications; Vomiting
PubMed: 27209471
DOI: 10.1016/j.autneu.2016.05.002 -
The American Journal of Managed Care Oct 2018The prevention of chemotherapy-induced nausea and vomiting (CINV) is critically important in reducing morbidity and total healthcare costs in patients receiving... (Review)
Review
The prevention of chemotherapy-induced nausea and vomiting (CINV) is critically important in reducing morbidity and total healthcare costs in patients receiving emetogenic chemotherapy. The different types of CINV (ie, acute, delayed, anticipatory, breakthrough, and refractory) are controlled through various pathways and neurotransmitters, so the pharmacologic approach to prevention and treatment varies based on the type of CINV. New therapeutic agents and combinations of agents have changed the dynamic of CINV control, and national guidelines have been recently updated based on current evidence. Along with current national guideline recommendations, this educational activity will provide an overview of the pathophysiology of CINV and how the mechanisms of action of various antiemetic agents relate to efficacy and safety in the prevention and treatment of CINV.
Topics: Antiemetics; Antineoplastic Agents; Drug Combinations; Drug Therapy, Combination; Humans; Nausea; Neoplasms; Practice Guidelines as Topic; Vomiting
PubMed: 30328690
DOI: No ID Found -
European Journal of Pharmacology Jan 2014Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also... (Review)
Review
Clinical research shows that postoperative nausea and vomiting (PONV) is caused primarily by the use of inhalational anesthesia and opioid analgesics. PONV is also increased by several risk predictors, including a young age, female sex, lack of smoking, and a history of motion sickness. Genetic studies are beginning to shed light on the variability in patient experiences of PONV by assessing polymorphisms of gene targets known to play roles in emesis (serotonin type 3, 5-HT3; opioid; muscarinic; and dopamine type 2, D2, receptors) and the metabolism of antiemetic drugs (e.g., ondansetron). Significant numbers of clinical trials have produced valuable information on pharmacological targets important for controlling PONV (e.g., 5-HT3 and D2), leading to the current multi-modal approach to inhibit multiple sites in this complex neural system. Despite these significant advances, there is still a lack of fundamental knowledge of the mechanisms that drive the hindbrain central pattern generator (emesis) and forebrain pathways (nausea) that produce PONV, particularly the responses to inhalational anesthesia. This gap in knowledge has limited the development of novel effective therapies of PONV. The current review presents the state of knowledge on the biological mechanisms responsible for PONV, summarizing both preclinical and clinical evidence. Finally, potential ways to advance the research of PONV and more recent developments on the study of postdischarge nausea and vomiting (PDNV) are discussed.
Topics: Animals; Antiemetics; Humans; Nausea; Neurochemistry; Postoperative Nausea and Vomiting; Risk Factors; Vomiting
PubMed: 24495419
DOI: 10.1016/j.ejphar.2013.10.037 -
International Journal of Molecular... May 2021Nausea and vomiting are common gastrointestinal complaints that can be triggered by diverse emetic stimuli through central and/or peripheral nervous systems. Both nausea... (Review)
Review
Nausea and vomiting are common gastrointestinal complaints that can be triggered by diverse emetic stimuli through central and/or peripheral nervous systems. Both nausea and vomiting are considered as defense mechanisms when threatening toxins/drugs/bacteria/viruses/fungi enter the body either via the enteral (e.g., the gastrointestinal tract) or parenteral routes, including the blood, skin, and respiratory systems. While vomiting is the act of forceful removal of gastrointestinal contents, nausea is believed to be a subjective sensation that is more difficult to study in nonhuman species. In this review, the authors discuss the anatomical structures, neurotransmitters/mediators, and corresponding receptors, as well as intracellular emetic signaling pathways involved in the processes of nausea and vomiting in diverse animal models as well as humans. While blockade of emetic receptors in the prevention of vomiting is fairly well understood, the potential of new classes of antiemetics altering postreceptor signal transduction mechanisms is currently evolving, which is also reviewed. Finally, future directions within the field will be discussed in terms of important questions that remain to be resolved and advances in technology that may help provide potential answers.
Topics: Animals; Antiemetics; Emetics; Gastrointestinal Tract; Humans; Nausea; Neurotransmitter Agents; Receptors, Serotonin, 5-HT3; Signal Transduction; Vomiting
PubMed: 34071460
DOI: 10.3390/ijms22115797 -
Clinical Journal of Oncology Nursing Oct 2021Pain and nausea affect a significant number of patients with cancer. Applying foot reflexology to this population has had some positive effects, but more studies are... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain and nausea affect a significant number of patients with cancer. Applying foot reflexology to this population has had some positive effects, but more studies are needed to confirm its efficacy.
OBJECTIVES
The purpose of this study was to conduct a randomized controlled trial to evaluate the effects of foot reflexology on pain and nausea among inpatients with cancer as compared to traditional nursing care alone.
METHODS
A pilot study was conducted with adult patients with cancer hospitalized on a 24-bed inpatient oncology unit. Using convenience sampling, 40 patients provided consent and were randomized into either the intervention or control group. Each group had a treatment session of 20-25 minutes in which pre- and postsession surveys were completed, with reflexology performed in the intervention group only.
FINDINGS
Results show that foot reflexology significantly decreases pain for inpatients with cancer as compared to traditional nursing care alone. Although the effects on nausea are not statistically significant, they may be clinically relevant; the mean changes in pre- and postsession nausea ratings indicate at least some decreased nausea among patients in the intervention group.
Topics: Adult; Humans; Inpatients; Massage; Musculoskeletal Manipulations; Nausea; Neoplasms; Pain; Pilot Projects
PubMed: 34533507
DOI: 10.1188/21.CJON.539-545