W2046 Duodenal Herpes Simplex and Cytomegalovirus Infections Are Potential Causes of Chronic Nausea and Vomiting of Unknown Etiology in Immunocompetent Patients

Abstract Introduction Chronic nausea and vomiting (CNV), common symptoms in patients with GI disorders like gastroparesis, can be a debilitating health problem with considerable impact on patients’ health-related quality of life during daytime. Yet, little is known about how CNV may impact on sleepiness and fatigue during the daytime. Our aim was to examine the impact of CNV on daytime sleepiness and fatigue based on the data from a longitudinal study. Methods Prospective longitudinal study with two waves: 12,218 subjects interviewed by phone during wave 1 (W1); 10,931 during wave 2 (W2) three years later. The sample was representative of the US general population. Analyses included subjects participating to both waves (N=10,931). CNV was defined as episodes of nausea and vomiting occurring at least twice a month for at least 1 month (outside pregnancy). Logistic regression models were employed to determine whether CNV is a predictive variable for excessive sleepiness or fatigue. Results Out of all W1 participants, 9.8% (95% CI: 9.2%-10.4%) reported nausea only while 3% (95% CI: 2.7%-3.3%) reported CNV. In W2, 7.7% (95% CI: 7.2%-8.2%) reported nausea only and 2.5% (95% CI: 2.2%-2.8%) reported having CNV. Of the subjects who participated in both W1 and W2, 25.7% of them reported CNV in W1. CNV subjects reported more frequently excessive daytime sleepiness (53.5% vs. 25.9%) and being moderately or severely fatigued (38.6% vs, 5.4%) compared with the participants without nausea or vomiting. After controlling for age, sex, BMI, health status, alcohol intake, sleep disorders and psychiatric disorders that might impact on daytime sleepiness or fatigue, it was found that subjects with CNV at both W1 and W2 had a significantly higher relative risk of reporting daytime sleepiness (RR: 2.7 (95% CI:1.9–3.9) p<0.0001) and fatigue (RR: 4.9 (95% CI:3.2–7.5) p<0.0001) at W2, compared with the participants without nausea or vomiting. Conclusion Many factors are likely to influence daytime sleepiness. CNV appears to be an important contributor even after controlling for several factors that can explain the sleepiness. This underlines the extent to which alertness could be disturbed and impacted by chronicity of nausea/vomiting symptoms. Support (if any) This analysis study was funded by Takeda Pharmaceutical Company

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Herpes Simplex Virus Hepatitis in an Immunocompetent Host Resembling Hepatic Pyogenic Abscesses

Case Reports in Hepatology ◽

10.1155/2016/8348172 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Carrie Down ◽

Amit Mehta ◽

Gayle Salama ◽

Erika Hissong ◽

Russell Rosenblatt ◽

...

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Rare Complication ◽

Unknown Etiology ◽

Histologic Diagnosis ◽

Intravenous Acyclovir ◽

Rim Enhancement ◽

Magnetic Resonance Imaging Mri ◽

Hepatic Lesions ◽

Simplex Virus

Herpes simplex virus (HSV) hepatitis represents a rare complication of HSV infection, which can progress to acute liver failure and, in some cases, death. We describe an immunocompetent 67-year-old male who presented with one week of fever and abdominal pain. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen showed multiple bilobar hepatic lesions, some with rim enhancement, compatible with liver abscesses. Subsequent liver biopsy, however, revealed hepatocellular necrosis, HSV-type intranuclear inclusions, and immunostaining positive for herpes virus type 2 (HSV-2). Though initially treated with broad-spectrum antibiotics, following histologic diagnosis of HSV hepatitis, the patient was transitioned to intravenous acyclovir for four weeks and he achieved full clinical recovery. Given its high mortality and nonspecific presentation, one should consider HSV hepatitis in all patients with acute hepatitis with multifocal hepatic lesions of unknown etiology. Of special note, this is only the second reported case of HSV liver lesions mimicking pyogenic abscesses on CT and MRI.

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Clinical Applications of Electrogastrography

Handbook of Electrogastrography ◽

10.1093/oso/9780195147889.003.0010 ◽

2003 ◽

Keyword(s):

Nausea And Vomiting ◽

Chronic Mesenteric Ischemia ◽

Early Satiety ◽

Postprandial Fullness ◽

Upper Gi ◽

Gastric Dysrhythmias ◽

Organ Systems ◽

Gi Symptoms ◽

Chronic Nausea ◽

Clinical Conditions

Electrogastrography methods have been used in many clinical studies over the past 80 years. In 1922,Alvarez predicated that electrical abnormalities of the stomach may be related to gastrointestinal (GI) symptoms and abnormal gastric function. In 1980, antral dysrhythmias were recorded with mucosal electrodes in a series of patients with unexplained nausea and vomiting. These gastric dysrhythmias were 6— to 7—cycles per minute (cpm) tachygastrias, bu there were also very irregular rhythms that changed from bradygastria to tachygastria (mixed dysrhythmias or tachyarrhythmias). Bradygastrias also were recorded in patients with unexplained nausea and vomiting. Further studies showed a relationship between the presence of nausea and gastric dysrhythmias during motion sickness, in nausea and vomiting of pregnancy, and in patients with idiopathic and diabetic gastroparesis. Infusion of a variety of drugs and physical distention of the antrum also induced gastric dysrhythmias and symptoms of nausea. Ischemic gastroparesis with gastric dysrhythmias due to chronic mesenteric ischemia is an unusual cause of chronic nausea and vomiting. Ischemic gastroparesis is important to recognize because after revascularization the symptoms resolved, the gastric dysrhythmias were eradicated and normal 3-cpm EGG activity and normal gastric emptying were restored. Thus, gastric dysrhythmias are found in many disorders in which nausea and vomiting are prominent symptoms. Clinical conditions associated with gastric dysrhythmias were reviewed. Finally, a variety of drugs and nondrug therapies convert gastric dysrhythmias to normal 3-cpm gastric myoelectrical rhythms and the correction of the gastric dysrhythmia correlates with improvement in symptoms. Taken together, these findings indicate that gastric dysrhythmias are objective, pathophysiological events related to the upper GI symptoms, especially nausea and dysmotility-like functional dyspepsia symptoms such as early satiety, fullness, and vomiting. The recording of gastric dysrhythmias is an important tool for the clinician when patients have symptoms that suggest gastric dysfunction such as unexplained nausea, bloating, postprandial fullness, and early satiety. On the other hand, these upper GI symptoms are nonspecific, and diseases or disorders of other organ systems such as esophagus, gallbladder, small bowel, colon, and non-GI diseases must be considered.

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