Feeling constantly sick to one’s stomach is truly awful. It deprives individuals of simple pleasures, such as enjoying food or a drink. People who suffer from this condition often feel extremely unwell and somewhat isolated. Consider the misery caused by constant vomiting and the feeling that one’s body is working against oneself.
People with this type of nausea, like young adults, say it feels as if their body hates them. This kind of persistent and perplexing nausea occurs more frequently than one might think. It poses a frequent challenge that medical doctors strive to understand thoroughly.
Especially specialists who assist children with stomach issues encounter this puzzle. Sometimes, it clearly indicates a physical illness somewhere in the body. However, usually, or perhaps even more often, no physical cause can be found. This makes the situation quite tricky for everyone involved.
Conditions like these are now known as gut – brain interaction disorders. In the past, they were referred to as “functional disorders”. Changing the name demonstrates that doctors understand how the brain and the gut communicate constantly. Problems with this communication can also cause real, physical symptoms, even when there is no obvious physical damage inside the body.
Functional nausea is a relatively new concept for doctors compared to old ideas like stomach pain. But it has recently been given specific diagnostic criteria. This provides a name for symptoms that people have observed for ages.
Living with constant and perplexing nausea often means numerous doctor visits. It implies feeling uncertain and quite frustrated most of the time. Consider a twenty – one – year – old woman starting her junior year of college. This relentless symptom suddenly took over her entire life. Everything she tried to eat or drink would come back up quickly.
It was terrible vomiting that left her aching and extremely dehydrated. This was not a short – lived illness but a daily struggle for many months. Her experience shows how desperately people search for answers.
She visited emergency rooms seven times over three months. They often administered fluids to her and then sent her right back home. Doctors struggled to identify the problem, considering many possibilities. Because she had suffered from anxiety before, doctors often thought that was the cause.
They suggested that her vomiting might be psychogenic, stemming from a long – term mental health issue. She even stayed in the hospital twice for tests. But they discharged her still sick and without finding a clear cause.
The timing of when her symptoms started also made things confusing. Just days after arriving in Atlanta for school, she had a minor car accident. Another car hit hers from the side, causing her body to whip against the door. She felt fine immediately after the crash.
But the terrible vomiting began the very next day. This connection made doctors think that it might have been due to a concussion. They provided her with fluids and nausea medication, promising that it would improve. But it did not get better at all. Her vomiting continued every single day.
It was always present whenever she tried to eat or even sip water. The feeling of overwhelming sickness struck within minutes every time. Then followed awful spasms of vomiting; it was just miserable. The physical toll on her body was enormous and exhausting.
But having no clear reason for it added a heavy emotional burden. The suggestion that it was just anxiety must have felt invalidating. Vomiting several times daily was an intense physical reality she faced.
Read more about: More Than Stress: How a Yoga Teacher’s ‘Anxiety’ Was Actually Three Heart Attacks
Her father worried deeply and instructed her to return home to Cleveland. Immediately after she arrived, they took her to the local children’s hospital. Her regular doctor, who specialized in treating young adults, arranged for her to see a gastroenterologist. This new doctor promptly admitted her to the hospital.
The medical team commenced their search for potential causes, including the anxiety hypothesis mentioned earlier. They did take this into consideration, especially since she was already on anxiety medication herself. They also explored other common factors that could lead to persistent vomiting. This encompassed checking whether she regularly used marijuana. They also tested for severe pregnancy – related conditions.
Additionally, they examined her for an overactive thyroid gland. These conditions are relatively straightforward to test for and can sometimes trigger this problem. As the test results came in, these common suspects were quickly ruled out. She was not pregnant at all, and there was no indication of marijuana use whatsoever. Her thyroid function test results also appeared normal. Other standard tests they conducted subsequently yielded completely clear results.
The fact that her symptoms persisted suggested the presence of something non – obvious or rare. This was when her case turned towards a less common possibility they had encountered before. During one of her stays at Emory Hospital, a scan revealed something unusual. Her celiac artery, a major blood vessel, appeared to be strangely compressed.
It seemed as if something was pressing on it from the outside. This indicated a rare condition known as median arcuate ligament syndrome (MALS). In MALS, a band of tissue exerts significant pressure on the celiac artery. This band provides support to the diaphragm, a component of the respiratory system.
Typically, it causes severe stomach pain; patients often describe it as extremely painful. However, compressing this artery can also lead to nausea and vomiting. It may do so by reducing blood flow to nerves and organs, especially when they require increased blood flow, such as after eating. Despite this scan finding, the doctors at Emory still believed anxiety was a more likely cause.
They still recommended a special ultrasound test at a later stage. This was to determine whether the compression truly obstructed blood flow. However, this specific test had not been carried out before she left for the Cleveland Clinic. Now, armed with the scan report, her doctor there recognized its potential significance. She knew that this special ultrasound was urgently needed.
The Doppler ultrasound was performed the very next day. This test utilizes sound waves, similar to echoes, to measure the speed of blood flow. It can reveal whether there is an obstruction to blood flow. The celiac artery is located near the diaphragm, the breathing muscle. Blood flow in this area can vary depending on whether one breathes in or out forcefully.
Breathing in moves the diaphragm downward, possibly opening up the artery to some extent. Breathing out may compress it further, potentially increasing the compression. The test might show normal or increased blood flow during inhalation. It could resemble water rushing through a partially blocked hose. Blood flow may slow down or stop completely during full exhalation.
The results of this ultrasound were not entirely normal. However, they were frustratingly ambiguous for everyone involved. For the young woman, this added to her confusion and distress. On one hand, she felt relieved that no serious condition had been found.
On the other hand, she was despairing because there was still no explanation for her severe vomiting. She had been in the hospital for three days by now. Nevertheless, she still could not eat or drink without immediately falling ill. The severity of her condition necessitated the insertion of a feeding tube through her nose. This tube extended down her nose into her stomach.
It provided her with the liquid food and water essential for survival. This was uncomfortable and also quite embarrassing for her. However, it was truly a necessary lifeline to keep her going.
During this difficult period, her Cleveland doctor continued to persevere. Even though the ultrasound results were unclear, she remained convinced. She somehow believed that MALS was the correct diagnosis. She had only seen the written report of the previous CT scan.
She really needed to examine the actual images herself in detail. Viewing the pictures would confirm the compression she had read about in the report. She ordered another CT scan specifically for this purpose. This new scan was designed to capture images during both inhalation and exhalation. It took pictures as she breathed in deeply and out fully.
Read more about: Beyond the Bump: Shocking Discoveries Inside Women’s Bodies Reveal the Power of Listening to Yourself
This represented a highly significant step in identifying dynamic compression issues such as MALS. This specialized CT scan, conducted the day before Thanksgiving, finally provided a definitive answer. The images, captured during different breathing phases, clearly demonstrated that her celiac artery was severely compressed. This unequivocally confirmed the diagnosis of MALS. This marked a turning point, finally shifting the focus away from ambiguous functional hypotheses.
It also redirected attention from broad potential causes to a specific, albeit rare, physical problem. The next planned step was a diagnostic nerve block. The concept involved injecting an anesthetic into the celiac plexus, which is a bundle of nerves located near the celiac artery. If this block alleviated her nausea and vomiting, it would serve as a strong indication.
It would imply that surgery to release the ligament would likely result in a complete cure. However, the timing meant that this procedure could not be carried out immediately. She returned home for the Thanksgiving holiday still unwell. She had to endure watching her family enjoy the holiday meal while feeling extremely ill. She knew that consuming even a small bite would undoubtedly trigger the vicious cycle again.
The feeding tube, while providing essential nutrition, served as a constant reminder of her illness. She returned to school with the tube still in place for the term. During the Christmas break, her doctor arranged for the nerve block. The result was nothing short of a miracle, at least for a while.
For the first time in months, as long as the block remained effective, she was able to eat normally. She could finally eat and drink without immediately falling ill. Her mother brought her favorite snacks and beverages for her to enjoy, including sour cream and onion Pringles, her preferred iced coffee, and delicious ice cream. It was a day filled with simple joys that were temporarily restored. This gave her immense hope that surgery would permanently resolve all her issues.
Her surgery was finally performed in February. The procedure involved relieving the tight ligament that was compressing her artery. The outcome was remarkably rapid and completely transformative. As soon as she woke up after the operation, she was able to drink some juice. She also felt perfectly fine right away. Finally, after months of pain and uncertainty about the cause, her ordeal had truly come to an end.
Her story clearly illustrates how complex it can be to diagnose nausea. It underscores the challenging journey that patients often face in obtaining a diagnosis. Although her symptoms were ultimately resolved by treating a physical issue, her experience still highlights the diagnostic difficulties associated with cases of persistent nausea, especially the tendency of doctors to first consider stress or anxiety.
This occurs when initial tests fail to quickly reveal anything obvious. Many patients with persistent nausea also suffer from anxiety; studies have demonstrated a strong connection between the two. One study found anxiety in seventy percent of girls with this type of illness. Data indicates that anxiety disorders are a significant risk factor for frequent nausea. This clear link makes it difficult to easily distinguish between symptoms. Is it primarily a physical problem causing the illness? Or is it due to a gut-brain interaction disorder? Or is it significantly exacerbated by stress or anxiety as well?
The fact that she was already taking medication for anxiety likely led doctors to initially consider this as a cause. While emotional well-being profoundly affects gut health through the gut-brain axis, attributing severe illness solely to anxiety risks overlooking underlying physical problems.
Even rare conditions like MALS may potentially be triggered by physical trauma, such as a car accident, even a minor one. The reason why her minor collision might have caused MALS remains a mystery. However, doctors are aware of this possibility based on past medical research.
This case also suggests the difficulties in diagnosing gut-brain disorders themselves. Functional nausea, by definition, is diagnosed based on a list of symptoms. Doctors can only diagnose it after ruling out all other known causes. There are no objective tests to specifically measure functional nausea, no clear diagnostic methods, and no one-size-fits-all treatments.
This lack of objective tools renders the diagnosis uncertain at times. It can result in a frustrating back-and-forth cycle for both the patient and the doctor. Tests aimed at detecting physical problems are commonly conducted for chronic nausea. However, many standard tests are of little help for patients whose issues are functional.
For instance, upper endoscopies, which examine the interior of the stomach, are normal 98 percent of the time when nausea is the primary symptom experienced by patients. Standard laboratory tests rarely identify the causes of chronic nausea in the absence of other warning signs.
Even tests that appear relevant, such as those assessing how quickly food leaves the stomach, pose challenges. These gastric emptying studies are often difficult to interpret for patients with nausea. Some studies indicate an occasional link between slow emptying and feeling sick. Yet, the symptoms overlap significantly with functional dyspepsia, easily leading to confusing results. Importantly, gastric emptying rates do not reliably reflect the severity of a patient’s illness. They also fail to predict whether a treatment will be effective for individuals.
Patients and their families may feel validated if a test yields abnormal results. However, this can be tricky, as it may sometimes limit treatment options. It can also lead individuals to doubt treatments that do not focus on accelerating gastric emptying.
Adding to the complexity, food leaving the stomach too quickly can also cause nausea. This further blurs the lines for doctors, as interpreting these tests is challenging and they offer limited predictive value. Some experts use them less frequently for nausea unless vomiting occurs hours after eating.
That specific timing more clearly suggests slow emptying as an issue. Pursuing objective physical findings can sometimes lead down unproductive paths, potentially delaying proper treatment for a gut-brain disorder.
Another area that doctors examine is related to colon health. Constipation, even if it does not cause overt pain, can sometimes slow down gastric emptying through a reflex connecting the colon and the stomach. Doctors occasionally use abdominal X-rays to check for “hidden constipation,” suspecting it might be a cause of nausea.
However, judging the amount of stool on an X-ray often leads to overdiagnosis of constipation. A colon filled with stool appears normal unless it has just been cleared. Relying on this X-ray finding without a clear history of constipation can be confusing.
The challenge for both doctors and patients lies in dealing with this situation where physical and functional reasons are closely intertwined. The strength of the link between chronic nausea and anxiety is a key piece of the puzzle. Research supports this, demonstrating the significant impact of stress hormones like cortisol.
Cortisol levels often rise in the morning, precisely when many people feel most nauseous. These hormone levels are particularly high in individuals with anxiety disorders. This physiological connection provides a real mechanism by which anxiety can exacerbate physical illness. Furthermore, the gut itself has complex ways of contributing to nausea.
Stomach problems, such as abnormal electrical rhythms or how it retains food, can trigger nausea signals sent to the brain. These signals travel via the vagus nerve, a sort of communication pathway. The brain processes these signals, influenced by past experiences. The environment and mental state also play a role. The limbic system, a brain region, helps regulate this complex process overall.
The physical phenomena associated with nausea, such as sweating or an accelerated heart rate, indicate significant involvement of the autonomic nervous system. Recent studies also suggest connections between chronic nausea and broader issues within the autonomic nervous system in some cases. Indicators like dizziness during tilt tests or reduced variability in heart rate patterns support this notion.
While tests indicate that tilt testing might aid in diagnosing conditions like POTS, which occurs in individuals suspected of having autonomic nervous system problems, it remains unclear whether treating POTS definitively cures functional nausea.
Links between hypermobile joints, POTS, mast cell activation syndrome, and various gut disorders add to the confusion, leaving patients feeling like medical mysteries that no one can fully resolve. This sense of uncertainty can, in itself, hinder recovery and improvement.
Finally, consider the case of the young woman who was found to have a physical median arcuate ligament syndrome (MALS) that could be treated. Her diagnostic journey began in the same realm as functional issues often do. Her experience of consulting numerous doctors mirrors the path of many individuals with chronic nausea, for whom clear answers do not emerge quickly.
Her story reminds us that while psychological factors are crucial and often intertwined with physical ones, a thorough search for physical issues is still necessary. Doctors must balance this search against conducting excessive tests that yield little benefit.
Extensive testing is usually only warranted if ‘alarm signs’ are present, such as significant weight loss, severe pain, or green bile vomiting. Relying solely on patients’ descriptions or ordering tests without clear justification is not only costly but can also lead to incidental findings that complicate the diagnosis of gut-brain disorders. This may even trigger further testing, unintentionally worsening symptoms, a phenomenon some refer to as ‘unintentional symptoms intensification by doctors.’
Navigating the complex interplay between physical and mental factors is the primary challenge in understanding chronic nausea. For patients, this experience is deeply personal and frightening, while for doctors, it requires a thoughtful approach that acknowledges the powerful mind-body connection.
Doctors must remain vigilant for physical causes that can be easily treated, even when these causes are rare and difficult to detect. The diagnostic journey is rarely straightforward and often involves detours and dead ends before a clear path emerges.
This path may eventually lead to a physical diagnosis like MALS or to a comprehensive management plan for a gut-brain disorder like functional nausea.
Chronic nausea often feels like navigating a labyrinth with many unexpected turns. Her case illustrates the difficulty of diagnosis when standard medical tests yield no answers, leading to conditions now classified as gut-brain interaction disorders, where brain-gut communication is disrupted.
Functional nausea is characterized by chronic or intermittent sickness without an identifiable cause. It is far more common than many realize, affecting 15 to 23 percent of school-aged children, most of whom fall into the functional category, particularly young girls, according to researchers.
It is linked to other pain conditions, such as functional dyspepsia and abdominal pain, with strong associations also observed with functional constipation in many studies. Children with this condition often experience significant disruptions to daily life, missing more school and struggling with home activities when nausea is frequent.
New guidelines, such as the Rome IV criteria, provide specific diagnostic standards, though prevalence is lower (about 0.7% in children) when strict rules are applied. This challenge exists within a broader context of other symptoms.
A notable feature of functional illness is its co-occurrence with other problems that may seem unrelated at first glance to doctors. Patients often report fatigue, headaches, dizziness, and poor sleep quality. Functional issues also appear to run in families for some individuals.
Chronic nausea is a primary symptom of episodic disorders of gut-brain interaction (DGBI), such as abdominal migraines and cyclic vomiting syndrome. Many patients also meet the criteria for POTS, which indicates dysfunction of the autonomic nervous system. This web of interconnected symptoms complicates diagnosis and treatment.
Perhaps one of the most significant factors is the strong link to anxiety. Research consistently shows a connection between anxiety and nausea. One study found that 70% of girls with this condition also have anxiety, while a larger study identified anxiety disorders as the top risk factor for nausea in the general population.
Determining cause and effect can be challenging. Does the sickness serve as a physical signal that induces anxiety, or does anxiety exacerbate or even drive the nausea? Or is it a complex interplay between the two? Emotional distress can amplify physical symptoms stemming from gut dysfunction.
The connection between anxiety and nausea stems from the gut-brain axis. The brain and gut communicate constantly through complex pathways, primarily the vagus nerve, which acts as a major data cable for the body, transmitting signals from the digestive system to the brain.
Stress hormones, particularly cortisol, play a significant role. Cortisol levels naturally surge in the early morning, coinciding with when many patients report their worst nausea. This surge is even more pronounced in individuals with anxiety disorders, providing a biological explanation for how anxiety can contribute to physical sickness.
The brain’s limbic system, which handles emotions and memories, also regulates signals from the gut. How these gut signals are perceived depends on past experiences and current emotional state.
Read more about: Beyond the Before and After: Navigating Judgment, Secrecy, and Self After Weight Loss Surgery
The gut itself contributes physically to the feeling of sickness at times. Problems such as abnormal electrical rhythms in the stomach can cause issues. Alternatively, when the stomach fails to relax properly, a condition known as fundic accommodation, altered gastric emptying can also induce severe nausea. These issues now trigger nausea signals from specialized receptors in the gut wall.
These signals are then transmitted to the central nervous system via the vagus nerve. The body’s physical reactions indicate significant involvement of the autonomic nervous system, as evidenced by sweating, a rapid heartbeat, pallor, and increased salivation. Studies frequently investigate links between chronic sickness and autonomic nervous system (ANS) problems. Tests like tilt testing may be used to check for conditions such as postural orthostatic tachycardia syndrome (POTS).
Tilt testing indeed aids in identifying ANS issues. However, the link between POTS treatment and the resolution of functional nausea remains unclear to doctors. It is still uncertain whether treating POTS truly resolves the functional sickness itself.
Diagnosing functional sickness is challenging because it is defined by the absence of identifiable physical abnormalities. Structural or biochemical diseases must always be ruled out first. It is often not detectable through blood tests, medical scans, or biopsies. Currently, there are no objective tests to confirm functional nausea.
The diagnosis is made based on a pattern of symptoms after all other possibilities have been excluded. Relying solely on the process of elimination can be frustrating for everyone involved. It can lead to a cycle of extensive testing with normal results or the discovery of incidental findings that complicate the primary issue.
Common tests for chronic nausea often assess gastric function. Gastric emptying studies measure the rate at which food leaves the stomach and are frequently ordered by doctors. Slow emptying is sometimes associated with subsequent nausea or vomiting, especially if vomiting occurs hours after eating.
However, interpreting these test results solely in the context of nausea symptoms is often difficult. The symptoms of slow emptying closely resemble those of functional dyspepsia, creating confusion for both doctors and patients. Studies show that the rate of gastric emptying does not often predict the severity of symptoms or the effectiveness of nausea treatment.
It creates a tricky situation: an abnormal test result may make patients feel as though they are being believed. However, it might lead doctors to focus solely on treatments aimed at accelerating gastric emptying. This could result in overlooking other crucial aspects of functional sickness that require treatment.
Adding to the complexity, nausea can also occur with rapid gastric emptying. Interestingly, the symptoms of rapid emptying can feel similar to those of slow emptying. This further illustrates why relying solely on gastric emptying studies for diagnosis is challenging. Some experts now use these studies more selectively for patients. While seeking clear physical findings is understandable, it can quickly lead one astray. This delay in adopting the right approach for a gut – brain issue is undesirable.
Doctors may also look for inflammation in the gut lining. They check for an increased number of mast cells or eosinophils in the small intestine. This requires an endoscopy and the collection of tiny tissue samples, as they say. Evidence suggests that these cellular changes may be present in some people with functional dyspepsia. These changes may then make the gut nerves overly sensitive to substances passing through them. This heightened sensitivity could be why nausea is so easily triggered at times. There is debate over whether these changes cause nausea or occur because stress later affects the gut.
How the bowels function, especially constipation, can also contribute to feeling unwell. Retaining stool in the colon can slow down gastric emptying. This is often due to a reflex called the cologastric brake. This mechanism can trigger upper gut symptoms such as nausea.
Doctors sometimes use abdominal X – rays to check for ‘hidden constipation’. However, relying solely on X – rays to determine constipation is often misleading. Judging the amount of stool on an X – ray can lead to a false diagnosis of constipation. A colon full of stool is normal unless it has just been thoroughly cleaned out. Trusting X – rays alone without a history of constipation can mislead doctors.
With strong links between chronic sickness, anxiety, and other issues like POTS, as well as potential mast cell – related problems, patients can feel like a medical mystery to doctors. This sense of hopelessness can make it harder to recover quickly. The young woman’s story, in which a specific cause was finally found, initially seemed to be functional issues.
For her, numerous tests, confusing results, and consideration of psychological factors occurred. Her story reminds us that the mind and body are deeply interconnected. We need a careful and balanced approach to these problems.
Doctors should always be vigilant for physical causes, even if they are rare. However, they should not order excessive tests without a clear reason, especially if there are no red flags such as rapid weight loss, severe pain, or green – colored bile vomiting. Excessive tests can be costly for everyone involved.
Moreover, they may find things unrelated to the main problem, causing confusion later. This can hinder the correct diagnosis of a DGBI (disorder of gut – brain interaction) issue. It can even worsen symptoms due to worry and additional procedures. Some people refer to this as ‘unintentional symptom intensification by doctors’.
Learning about and managing functional sickness is improving over time. Since it is a gut – brain disorder, it is best to receive care from multiple types of doctors. This also means educating patients and their families about the gut – brain connection and how stress and worry often contribute to feeling unwell. Providing reassurance to patients is crucial.
It is essential to teach coping strategies and how to maintain daily activities. Having a psychologist involved early in treatment is highly beneficial. Regular anti – sickness medicines like ondansetron appear to have limited evidence of effectiveness in functional nausea. However, some other treatments show real promise in helping patients feel better.
Hypnotherapy, which works with the brain, has often helped children in studies. This was for children with functional nausea and stomach pain issues. It was more effective than standard medical care in the first few months. This adds more evidence that mind – body approaches like CBT (cognitive – behavioral therapy) help children with DGBI. Other options include certain herbal supplements like STW5, which are sometimes used.
Or perhaps stimulating specific acupuncture points like P6 on the wrist. Medicines like cyproheptadine can also help, and they may also improve appetite. Using psychotropic medicines is an option in some cases, but it should be done carefully. Changing one’s lifestyle, such as drinking more water and having enough salt, is also beneficial. Getting better sleep and regular exercise are also important.
These measures help if there are issues with the autonomic system, such as feeling faint when standing. Treating anxiety and depression is also extremely necessary and helpful for patients. More advanced but less common approaches are currently being explored.
For example, injecting botox through an endoscope is sometimes considered. Gastric neuromodulation, using a type of stomach pacemaker, is also being tested. This shows potential benefits and seems to be independent of its effect on gastric emptying. This suggests that it may work directly on the brain or nervous system pathways.
Functional sickness is a relatively new concept compared to functional abdominal pain. However, it is very real and significantly affects people’s lives. The science exploring its causes is advancing rapidly these days. It reveals the complex interplay of gut factors, nervous system control, and internal feelings. Research is now making several key points much clearer. Functional sickness definitely exists and severely impacts the quality of life of many people.
Constipation can worsen it, which is important information for doctors. If there are no red flags, it rarely requires numerous tests. Upper endoscopy is often not helpful for this problem at all. Emptying test results are complex and often require careful interpretation. It is strongly linked to anxiety, which must be addressed. It improves with therapies aimed at the brain, such as hypnotherapy.
A comprehensive, team – based approach also works very well for patients. The journey to understanding and treating functional sickness is ongoing. However, recognizing the strong gut – brain link offers new hope for everyone affected.
