Übelkeit – Pathogenese, Differenzialdiagnostik und Therapiemanagement

Kernaussagen

• Übelkeit kann durch ein breites, fächerübergreifendes Spektrum an Mechanismen hervorgerufen werden.

• Eingehende Anamnese und klinische Untersuchung sind der Schlüssel zur Diagnose.

• Wichtigste Maßnahme ist der Ausschluss von strukturellen (organischen), ggf. lebensbedrohlichen Erkrankungen.

• Übelkeit als Medikamentennebenwirkung muss immer bedacht werden.

• Chronische Übelkeit tritt häufig bei Somatisierungsstörungen und depressiven Erkrankungen auf.

• Die Therapie der funktionellen Übelkeit (ohne strukturelle Ursache) ist symptomatisch, die medikamentöse Behandlung aber häufig nur beschränkt wirksam.

• Literatur

• 1 Quigley EM, Hasler WL, Parkman HP. AGA technical review on nausea and vomitting. Gastroenterolgy 2001; 120: 263-286
• 2 Roila F, Herrstedt J, Aapro M et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 2010; 21: v232-v243
• 3 Napadov V, Sheehan JD, Kim J et al. The brain curcuity underlying temporal evolution of nausea in humans. Cerebr Cortex 2013; 23: 806-813
• 4 Becker DE. Nausea, vomitting, and hiccups: a review of mechanisms and treatment. Anesth Prog 2010; 57: 150-157
• 5 Koch KL. Gastric dysrhythmias: a potential objective measure of nausea. Exp Brain Res 2014; 232: 2553-2261
• 6 Otto B, Riepl RL, Klosterhalfen S et al. Endocrine correlates of acute nausea and vomiting. Auton Neurosci 2006; 129: 17-21
• 7 Abel TL, Malagelada JR. Glucagon-evoked gastric dysrhythmias show an improved electrogastrographic technique. Gastroenterology 1985; 88: 1932-1940
• 8 Metz A. Nausea and vomiting in adults. A diagnostic approach. Austr Fam Phys 2007; 36: 688-692
• 9 Scorza K, Williams A, Phillips JD et al. Evaluation of nausea and vomiting. Am Fam Physician 2007; 76: 76-84
• 10 Undeland KE, Hausken T, Svebak S et al. Wide gastric antrum and low vagal tone in patients with diabetes mellitus type 1 compared to patients with functional dyspepsia and healthy individuals. Dig Dis Sci 1996; 41: 9-16
• 11 Hasler WL, Chey WD. Nausea and vomiting. Gastroenterology 2003; 125: 1860-1867
• 12 Kahn SE, Haffner SM, Heise MA et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006; 355: 2427-2443
• 13 Diamant M, Van Gaal L, Guerci B et al. Exenatide once weekly versus insulin glargine for type 2 diabetes (DURATION-3): 3-year results of an open label randomised trial. Lancet Diab Endocrinol 2014; 2: 464-473
• 14 Dungan KM, Povedano ST, Forst T et al. Once-weekly dulaglutide versus once-daily liraglutide in metformin-treated patients with type 2 diabetes (AWARD-6): a randomised, open-label phase 3, non-inferiority trial. Lancet 2014; 384: 1349-1357
• 15 Pencek R, Blickensderfer A, Li Y et al. Exenatide twice daily: analysis of effectiveness and safety data stratified by age, sex, race, duration of diabetes, and body mass index. Postgrad Med 2012; 124: 21-32
• 16 Warner CH, Bobo W, Warner C et al. Antidepressant discontinuation syndrome. Am Fam Physician 2006; 74: 449-456
• 17 Spiller RC. ABC of the upper gastrointestinal tract. Anorexia, nausea, vomiting and pain. Brit Med J 2001; 323: 1354-1357
• 18 Muncie Jr HL, Yasinian Y, Oge L. Outpatient alcohol withdrawal syndrome. Am Fam Physician 2013; 88: 589-595
• 19 Baylen CA, Rosenberg H. A review of acute subjective effects of MDMA/ecstasy. Addiction 2006; 101: 933-947
• 20 Lindner G, Felber R, Schwarz C et al. Hypercalcemia in the ED: prevalence, etiology and outcome. Am J Emerg Med 2013; 31: 657-660
• 21 Heinrich S, Wagner A, Gross P. Hyponatriämie. Med Klin Intensivmed Notfmed 2013; 108: 53-58
• 22 Verbalis JG, Goldsmith SR, Greenberg A et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013; 126: S1-S42
• 23 Husebye ES, Allolio B, Arlt W et al. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med 2014; 275: 104-115
• 24 Ebert EC. The thyroid and the gut. J Clin Gastroenterol 2010; 44: 402-406
• 25 Connolly BS, Lang AE. Pharmacological treatment of Parkinson’s disease. A review. JAMA 2014; 311: 1670-1683
• 26 European Medicines Agency. Einschränkungen für die Anwendung von Domperidon enthaltenden Arzneimitteln. 2014 Im Internet: http://www.ema.europa.eu/docs/de_DE/document_library/Referrals_document/Domperidone_31/European_Commission_final_decision/WC500172573.pdf ; Stand: 2.4.2015
• 27 Tack J, Talley NJ, Camilleri M et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130: 1466-1479
• 28 Talley NJ. Functional nausea and vomitting. Aust Fam Physician 2007; 36: 694-697
• 29 Whooley MA, Avins AL, Miranda J et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 1997; 12: 439-4445
• 30 Maganti K, Onyrmere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol 2003; 98: 259-263
• 31 Flake ZA, Scalley RD, Bailey AG. Practical selection of antiemetics. Am Fam Physician 2004; 69: 1169-1174