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- Kalyan Ray Parashette, MD*
- Joseph Croffie, MD, MPH†
- *Pediatric Gastroenterology and Hepatology Fellow, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
- †Professor of Clinical Pediatrics, Director, Pediatric Gastrointestinal Motility Laboratory, Riley Hospital for Children, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
Author Disclosure
Drs Parashette and Croffie have disclosed no financial relationships relevant to this article. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.
- AGA:
- American Gastroenterological Association
- CVS:
- cyclic vomiting syndrome
- EE:
- eosinophilic esophagitis
- GER:
- gastroesophageal reflux
- GERD:
- gastroesophageal reflux disease
- GI:
- gastrointestinal
- PPI:
- proton pump inhibitor
Practice Gap
Clinicians must be cognizant of the common, more benign but often treatable causes of vomiting as well as the less common but life-threatening surgical, metabolic and infectious disorders of which vomiting is a symptom. Practitioners should stay abreast of evolving recommendations on newer, effective anti-emetic therapies for treating chemotherapy patients and others with non-cancerous disorders.
Objectives
After completing this article, readers should be able to:
Know the causes of vomiting in children of different age groups.
Distinguish between nonorganic and organic causes of vomiting.
Diagnose and treat eosinophilic esophagitis (EE).
Develop an initial management plan for a child with intestinal obstruction.
Evaluate and manage rumination syndrome and cyclic vomiting syndrome (CVS) in children.
Understand the role of various antiemetic medications in the treatment of vomiting in children.
Definitions
We will use the following terms as defined by the American Gastroenterological Association (AGA). (1)
Vomiting: Forceful oral expulsion of gastric contents associated with contraction of the abdominal and chest wall musculature.
Nausea: The unpleasant sensation of the imminent need to vomit, usually referred to the throat or epigastrium; a sensation that may or may not ultimately lead to the act of vomiting.
Regurgitation: The act by which food is brought back into the mouth without the abdominal and diaphragmatic muscular activity that characterizes vomiting.
Retching: Spasmodic respiratory movements against a closed glottis with contractions of the abdominal musculature without expulsion of any gastric contents, referred to as “dry heaves.”
Rumination: Chewing and swallowing of regurgitated food that has come back into the mouth through a voluntary increase in abdominal pressure within minutes of eating or during eating.
Pathophysiology
Vomiting is a complex process that involves …
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