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Unexplained Chronic Nausea

If you, or someone you know is experiencing the discomfort of chronic nausea it is important to see a doctor right away.  You can request an appointment online via our website: Gastroenterology Appointment.

Originally published in Clinical Update, Fall 2003

Abstract: Unexplained chronic nausea and other dyspepsia symptoms affect about 25 percent of the general population. The cause may be neuromuscular disorders of the stomach.

Nausea is a noxious, debilitating and under-appreciated symptom,” said Kenneth Koch, MD, chief of the gastroenterology section at Wake Forest Baptist Medical Center. “When a physician has completed the routine tests such as blood studies, barium X-ray studies, ultrasound and endoscopic examinations and has ruled out more common causes of nausea, then neuromuscular disorders of the stomach should be considered.”

Koch recently moved to North Carolina from Pennsylvania, and has studied electrical and contractile disorders of the stomach for over 20 years.

“Most people don’t realize that the stomach is a sophisticated muscular pump with a pacemaker,” said Koch. “Some patients with unexplained nausea have electrical dysrhythmias termed tachygastria, in which the pacemaker is too fast, or bradygastria, where the pacemaker is too slow. Others have gastroparesis, where the stomach is paralyzed.”

To diagnose gastric dysrhythmias, Koch and his team of specialists run an electrogastrogram (EGG) to determine whether gastric dysrhythmias exist. Koch developed the non-invasive EGG recording device.

“For many patients, the diagnosis of gastric dysrhythmias puts a name to a problem that has plagued them for years,” Koch said.

Unexplained chronic nausea and other dyspepsia symptoms affect about 25 percent of the general population. Patients with Type I and Type II diabetes are particularly susceptible to gastric dysrhythmias and gastroparesis. Patients suffering from esophageal reflux disease frequently have gastric rhythm problems as well as gastroparesis.

Treatment for these disorders includes medication, dietary changes and gastric pacemakers.

“Gastric pacemakers work like cardiac pacemakers and attempt to reestablish the normal pacemaker rhythm of the stomach by applying current to the stomach,” Koch said. “This is a relatively new area of treatment and has shown promising results in patients with severe nausea, vomiting and weight loss.”

When diagnosing the cause of chronic nausea, Koch recommends the following questions be asked while taking the patient’s history: 

  • Is abdominal pain present? 
  • Have occult gastro esophageal reflux disease (GERD) and gallbladder disease been considered? 
  • Have endocrine disorders such as diabetes, hypothyroidism and Addison’s disease been excluded? 
  • Has the drug history been reviewed? 
  • Are neurological symptoms present? Has a central nervous system source of nausea been considered?

When common causes of chronic nausea have been excluded, then gastric neuromuscular disorders should be considered. 

Learn more about Dr. Kenneth Koch and schedule an appointment.


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