Heart may hold key to unexplained nausea in youths

Heart rate and blood pressure regulation may hold the key to treating unexplained chronic nausea in children. In a new study by researchers at Wake Forest Baptist Medical Center, a drug commonly used to treat a condition known as orthostatic intolerance (OI), which causes dizziness and occasional fainting when patients stand for long periods, was shown to reduce debilitating chronic nausea in patients.

"There seems to be a connection between heart rate and blood pressure, and chronic nausea," said John Fortunato, M.D., assistant professor of pediatrics at Wake Forest Baptist and lead author of the study. "When we treated the heart rate issues, the nausea was reduced."

Unexplained chronic nausea affects up to 25 percent of children in the United States and can be a debilitating disorder. Because the condition is poorly understood, treatments have not been very effective and have typically focused on alleviating the gastroenterology symptoms.

The retrospective study published in the August issue of Clinical Autonomic Research, involved 17 patients, ages 11 to 17 years, who had suffered from unexplained nausea and dizziness for a year and had OI.

Study participants were treated with fludrocortisone for four weeks. Fludrocortisone is a drug used in OI patients to diminish the exaggerated increase in heart rate and drop in blood pressure that occurs when standing. Sixty-five percent (11 out of 17) of the patients in this study experienced at least 50 percent or greater improvement in nausea after treatment with fludrocortisone, the same drug used to treat their OI.

"We may now have a more directed way to treat this condition," Fortunato said. "This is proof of concept research and gives us a real possibility for a new treatment."

Based on this study, Fortunato hopes to conduct a larger clinical trial to determine the possibility of this drug's use, as well as other potential drugs, as management tools for children with unexplained chronic nausea and OI.