Chronic vomiting in children: Etiology, diagnosis, and management

Excerpt

Vomiting involves forceful expulsion of gastric contents through the mouth (may be associated with nausea and retching). Nausea is a subjective feeling of unpleasantness accompanied by pallor, hypersalivation, and anorexia. Retching encompasses spasmodic respiratory movements, and contraction of abdominal muscles against a closed glottis without actually throwing out gastric contents [1]. Regurgitation is the passive effortless movement of gastric contents into the mouth without abdominal wall contractions. Rumination involves effortless bringing up of recently ingested food through a voluntary increase in abdominal pressure, chewing, and sometimes re-swallowing [2]. Though definitions make our understanding easier, analyzing the symptoms in a child is a challenge in itself and a clear distinction between the above conditions cannot be made and the parents often put everything in the basket of “vomiting.” Thus, tweezing out the underlying cause requires thorough history taking from the child and the parents. The next question that arises with respect to children is the definition of chronic vomiting. Though the ROME IV criteria define the duration of chronic nausea and vomiting in children as 2 months, a more practical cut-off would be to take 4 weeks so that evaluation is not delayed [3]. …