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Nausea and Vomiting. Overview, Challenges, Practical Treatments and New Perspectives.
  1. K KOCH

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Nausea and Vomiting. Overview, Challenges, Practical Treatments and New Perspectives. RH Blum, WL Heinrichs, A Herxheimer (Pp 620; illustrated; £79.50/$135). Philadelphia: Whurr Publisher, 2000. ISBN1-86156-079-6.

Nausea is an extraordinarily common and under appreciated symptom that afflicts patients and non-patients alike. In a North American population, approximately 15% of subjects surveyed had moderate to severe nausea in the past month. Thankfully, the nausea most of us experience is brief and self limited. Almost all of the medical and surgical subspecialties however have patients who are intermittently and chronically nauseated. Unfortunately, little progress has been made in the study of nausea from a pathophysiological and treatment viewpoint.

The authors of the book seek to change this situation and have produced a most interesting and readable book about nausea and vomiting for students, primary care physicians, and researchers interested in these unique human symptoms. Gastroenterologists with a clinical or research interest in nausea and vomiting will also find this book helpful in that it brings together a large amount of information that is not easily accessible to us.

The book is basically divided into three parts: in the first 14 chapters the relevant anatomy and physiology of nausea and vomiting, various research methodologies, therapeutics, relevant neuropeptides, and the economic impact of nausea and vomiting are covered. Next there are 18 chapters outlining “hands on” advice for diagnosing and treating the patient with nausea and vomiting. Finally, the last chapter in an excellent and extensive essay on nausea/vomiting as an evolutionary response of the ancient reptilian brain: the reptilian brain appears to be responding to an increasing number of nauseogenic precipitants created by our modern lifestyles, technologies, and therapeutics, as well as specific diseases/disorders. Why is this?

The authors raise many provocative issues. They reject the simplistic notion that nausea and vomiting are regularly activated as a response to a putative ingestion of toxic substances. This time honoured concept simply does not reflect the many situations where nausea and vomiting occur in the absence of toxic ingestants. Olfactory system stimuli are discussed in detail with regards to nausea and vomiting during pregnancy. The authors review an interesting concept that relates nausea and vomiting and gravity, as gravitational forces affect the basic organisation of brain function. Refreshing ideas and perspectives on nausea and vomiting are offered that encompass philosophy and psychology viewpoints, as well as physiology and pharmacology.

Nausea is more debilitating than vomiting. The authors argue that nausea should be clearly separated from vomiting in terms of studying pathophysiological mechanisms and developing therapies. Indeed, vomiting is the cure for nausea (at least temporarily)! Nausea is an “early warning system” evoked as the organism attempts to maintain homeostasis in response to the nauseogenic stimuli. Vomiting is described as an “accident” of cascading stimuli that ultimately overwhelm homeostasis and the inhibitory circuits that prevent the uncontrollable and potentially injurious vomiting reflex.

Gastroenterologists are not the only medical providers dealing with the problems of nausea and vomiting. “Nausea is in the air; nausea is everywhere” is a phase I often use when lecturing about the multidisciplinary problem of nausea and vomiting. The second major portion of the book incorporates 18 chapters in which a practical approach to the diagnosis and treatment of nausea and vomiting is described for many medical and surgical specialties. From allergy and immunology to gastroenterology, oncology, surgery, and sports and space medicine these chapters are an introduction to the treatment of nausea and vomiting by various specialists.

These chapters are a bit uneven in their thoroughness and somewhat redundant in that each specialty ultimately uses similar drugs and comfort techniques for their patients. The tremendous lack of progress in the therapy for nausea and vomiting makes this area an open field for drug and non-drug development.

The final chapter is an extensive essay on nausea and vomiting that encompasses stimulating paragraphs that are well worth reading for any student of nausea and vomiting symptoms. Topics range from the adaptive purpose of nausea as a warning sign of ongoing problems in the internal/external environment, as marshalling social support for the sufferer, and as a powerful stimulus for problem solving to avoid these symptoms in the future.

I highly recommend this book as thoughtful and thought provoking reading for anyone interested in the common and sometimes debilitating symptoms of nausea and vomiting. The authors provide excellent reviews and new insights that are now necessary to consider in the fight against nausea and vomiting.