Gastroesophageal reflux disease presenting with intractable nausea

Background: Typical symptoms of gastroesophageal reflux disease are heartburn and regurgitation. A subset of patients present with atypical symptoms, such as chest pain, cough, wheezing, and hoarseness. Objective: To review the clinical presentation and treatment of patients who presented with nausea as the primary symptom of gastroesophageal reflux disease. Design: Case series. Setting: Outpatient department of a university hospital. Patients: 10 outpatients who had chronic, intractable nausea and had not responded to empirical therapies. Measurements: Patients were evaluated by esophagogastroduodenoscopy, 24-hour esophageal pH studies, gastric-emptying tests, electrogastrography, or a Bernstein test. Results: Abnormal acid reflux was found to be the cause of intractable nausea in all 10 patients. In 5 of the 10 patients, esophagitis was documented by esophagogastroduodenoscopy. Six patients had abnormal results on the 24-hour esophageal pH study. In these 6 patients, 32 of 33 episodes of nausea were accompanied by an episode of acid reflux. One patient had positive results on the Bernstein test. Nausea resolved after treatment with omeprazole in 7 patients, after treatment with cisapride or ranitidine in 2 patients, and after Nissen fundoplication in 1 patient. Conclusions: Intractable nausea is an atypical symptom that can occur in a subset of patients with gastroesophageal reflux disease. A 24-hour esophageal pH study should be considered in patients who have unexplained nausea but normal findings on esophagogastroduodenoscopy, a gastric-emptying test, and electrogastrography. Nausea related to gastroesophageal reflux disease resolves or is markedly reduced with proton-pump inhibitors or promotility drugs.