Hasler William L, Li B U K, Koch Kenneth L, Parkman Henry P, Kovacic Katja, McCallum Richard W
Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA.
Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
Auton Neurosci. 2017 Jan;202:28-39. doi: 10.1016/j.autneu.2016.08.001. Epub 2016 Aug 3.
Methods to characterize and quantify severity of chronic nausea and vomiting and to elucidate their underlying mechanisms have received significant attention for both adult and pediatric patients. Validated dyspepsia symptom surveys include measures of nausea and vomiting intensity in relation to other upper gut symptoms. Visual analog scales quantify nausea intensity in real-time in physiologic studies and have been employed as enrollment criteria in clinical trial settings. A new nausea and vomiting survey has been administered to gastroparesis patients to provide insight into timing, triggers, and autonomic and psychological correlates of these symptoms. Several gastric sensorimotor and extragastric abnormalities are proposed to contribute to nausea and vomiting pathogenesis, but their relations to symptom severity are either limited or uninvestigated. Gastric emptying delays are prevalent in patients with chronic nausea and vomiting, as are blunting of fundic accommodation, aberrant gastric slow wave rhythms, and heightened perception of noxious and physiologic luminal stimulation. Potential extragastric correlates of nausea and vomiting include transit delays distal to the stomach, autonomic abnormalities, altered central nervous system activation, metabolic dysregulation, and psychological dysfunction. One goal of novel survey development will be to relate these physiologic correlates to specific symptom presentations to gain insight into mechanisms of nausea in different clinical conditions. Pediatric patients represent special challenges because of the different disorders that cause nausea and vomiting in children and differences in understanding disease manifestations, the ability to communicate symptom intensity and characteristics, and immature coping mechanisms compared to adults.
用于描述和量化慢性恶心和呕吐的严重程度并阐明其潜在机制的方法，已受到成人和儿科患者的广泛关注。经过验证的消化不良症状调查包括与其他上消化道症状相关的恶心和呕吐强度测量。视觉模拟量表在生理学研究中实时量化恶心强度，并已被用作临床试验中的纳入标准。一项新的恶心和呕吐调查已应用于胃轻瘫患者，以深入了解这些症状的发作时间、触发因素以及自主神经和心理关联。有几种胃感觉运动和胃外异常被认为与恶心和呕吐的发病机制有关，但它们与症状严重程度的关系要么有限，要么尚未得到研究。慢性恶心和呕吐患者中普遍存在胃排空延迟，胃底容受性降低、异常胃慢波节律以及对有害和生理性管腔刺激的感知增强也很常见。恶心和呕吐的潜在胃外关联包括胃远端的转运延迟、自主神经异常、中枢神经系统激活改变、代谢失调和心理功能障碍。新型调查开发的一个目标是将这些生理关联与特定症状表现联系起来，以深入了解不同临床情况下恶心的机制。儿科患者面临特殊挑战，因为导致儿童恶心和呕吐的疾病不同，而且与成人相比，他们在理解疾病表现、表达症状强度和特征的能力以及应对机制不成熟方面存在差异。
