title: Sensory neuromodulators in functional nausea and vomiting: predictors of response.
abstract: BACKGROUND
  Tricyclic antidepressants (TCAs) are known to benefit subjects with functional nausea and vomiting (FNV), but it is not known if alternate neuromodulators are also beneficial. We retrospectively evaluated outcomes and clinical predictors of response in FNV subjects treated with any neuromodulator, including TCAs.
  
  
  METHODS
  We identified 94 subjects (43.8±1.4 year, 79 F) with FNV (Rome III criteria) over a 12 year period, treated with neuromodulators and followed up for 8.5±1.1 months. Clinical presentation, demographics and gastric emptying study (GES) findings (when available) were extracted. Likert scales determined symptom severity at baseline and symptom response or remission at follow-up. Outcomes and predictors of response were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  At least moderate symptom improvement was reported by 72.3%, and 22.3% had symptom remission. Proportions achieving moderate improvement and remission, and mean outcome Likert scores were similar regardless of neuromodulator agent used or GES status. On univariate and multivariate logistic regression analysis, baseline symptom severity affected symptom response, and pain negatively impacted symptom remission to treatment (p≤0.04 for each); GES status failed to predict treatment response or remission.
  
  
  CONCLUSIONS
  Symptom improvement with neuromodulators may be seen in over two-thirds of subjects with FNV regardless of the specific agent administered. Response may be suboptimal in pain predominant presentations.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D017060:Patient Satisfaction; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D018377:Neurotransmitter Agents