European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada; Jutta Keller; Daniel Sifrim; Jordi Serra; Jan Tack; Agata Mulak; Andreas Stengel; Ariadna Aguilar; Asbjorn Mohr Drewes; Axel Josefsson; Bruno Bonaz; Dan Dumitrascu; Daniel Keszthelyi; Elizabeth Barba; Florencia Carbone; Frank Zerbib; Giovanni Marchegiani; Goran Hauser; Guillaume Gourcerol; Hans Tornblom; Heinz Hammer; Imran Aziz; Jelena Rakic Matic; Juan Mendive; Kornilia Nikaki; Lucas Wauters; Luis Alcala-Gonzalez; Marek Waluga; Mariana Jinga; Maura Corsetti; Nathalie Rommel; Ray Shidrawi; Roberto De Giorgio; Sritharan Kadirkamanathan; Teodora Surdea-Blaga

doi:10.1002/ueg2.12711

European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada^*, Jutta Keller, Daniel Sifrim, Jordi Serra, Jan Tack, Agata Mulak, Andreas Stengel, Ariadna Aguilar, Asbjorn Mohr Drewes, Axel Josefsson, Bruno Bonaz, Dan Dumitrascu, Daniel Keszthelyi, Elizabeth Barba, Florencia Carbone, Frank Zerbib, Giovanni Marchegiani, Goran Hauser, Guillaume Gourcerol, Hans TornblomHeinz Hammer, Imran Aziz, Jelena Rakic Matic, Juan Mendive, Kornilia Nikaki, Lucas Wauters, Luis Alcala-Gonzalez, Marek Waluga, Mariana Jinga, Maura Corsetti, Nathalie Rommel, Ray Shidrawi, Roberto De Giorgio, Sritharan Kadirkamanathan, Teodora Surdea-Blaga

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

IntroductionChronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.MethodsA multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.ResultsNinety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.ConclusionThese guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

Original language	English
Pages (from-to)	427-471
Number of pages	45
Journal	United European Gastroenterology Journal
Volume	13
Issue number	3
Early online date	1 Jan 2025
DOIs	https://doi.org/10.1002/ueg2.12711
Publication status	Published - Apr 2025

Keywords

Delphi
guidelines
nausea
vomiting
FUNCTIONAL GASTROINTESTINAL DISORDERS
CANNABINOID HYPEREMESIS SYNDROME
QUALITY-OF-LIFE
CHRONIC INTESTINAL PSEUDOOBSTRUCTION
HIGH-RESOLUTION MANOMETRY
SMALL-BOWEL MOTILITY
GRANISETRON TRANSDERMAL SYSTEM
CHRONIC UNEXPLAINED NAUSEA
PROXIMAL GASTRIC-VAGOTOMY
AUTONOMIC NERVE FUNCTION

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Malagelada, C., Keller, J., Sifrim, D., Serra, J., Tack, J., Mulak, A., Stengel, A., Aguilar, A., Drewes, A. M., Josefsson, A., Bonaz, B., Dumitrascu, D., Keszthelyi, D., Barba, E., Carbone, F., Zerbib, F., Marchegiani, G., Hauser, G., Gourcerol, G., ... Surdea-Blaga, T. (2025). European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management. United European Gastroenterology Journal, 13(3), 427-471. https://doi.org/10.1002/ueg2.12711

@article{5376063d8b0f4c058b292ccdbc210982,

title = "European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management",

abstract = "IntroductionChronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.MethodsA multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.ResultsNinety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.ConclusionThese guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.",

keywords = "Delphi, guidelines, nausea, vomiting, FUNCTIONAL GASTROINTESTINAL DISORDERS, CANNABINOID HYPEREMESIS SYNDROME, QUALITY-OF-LIFE, CHRONIC INTESTINAL PSEUDOOBSTRUCTION, HIGH-RESOLUTION MANOMETRY, SMALL-BOWEL MOTILITY, GRANISETRON TRANSDERMAL SYSTEM, CHRONIC UNEXPLAINED NAUSEA, PROXIMAL GASTRIC-VAGOTOMY, AUTONOMIC NERVE FUNCTION",

author = "Carolina Malagelada and Jutta Keller and Daniel Sifrim and Jordi Serra and Jan Tack and Agata Mulak and Andreas Stengel and Ariadna Aguilar and Drewes, {Asbjorn Mohr} and Axel Josefsson and Bruno Bonaz and Dan Dumitrascu and Daniel Keszthelyi and Elizabeth Barba and Florencia Carbone and Frank Zerbib and Giovanni Marchegiani and Goran Hauser and Guillaume Gourcerol and Hans Tornblom and Heinz Hammer and Imran Aziz and Matic, {Jelena Rakic} and Juan Mendive and Kornilia Nikaki and Lucas Wauters and Luis Alcala-Gonzalez and Marek Waluga and Mariana Jinga and Maura Corsetti and Nathalie Rommel and Ray Shidrawi and {De Giorgio}, Roberto and Sritharan Kadirkamanathan and Teodora Surdea-Blaga",

year = "2025",

month = apr,

doi = "10.1002/ueg2.12711",

language = "English",

volume = "13",

pages = "427--471",

journal = "United European Gastroenterology Journal",

issn = "2050-6406",

publisher = "John Wiley & Sons Inc.",

number = "3",

}

Malagelada, C, Keller, J, Sifrim, D, Serra, J, Tack, J, Mulak, A, Stengel, A, Aguilar, A, Drewes, AM, Josefsson, A, Bonaz, B, Dumitrascu, D, Keszthelyi, D, Barba, E, Carbone, F, Zerbib, F, Marchegiani, G, Hauser, G, Gourcerol, G, Tornblom, H, Hammer, H, Aziz, I, Matic, JR, Mendive, J, Nikaki, K, Wauters, L, Alcala-Gonzalez, L, Waluga, M, Jinga, M, Corsetti, M, Rommel, N, Shidrawi, R, De Giorgio, R, Kadirkamanathan, S & Surdea-Blaga, T 2025, 'European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management', United European Gastroenterology Journal, vol. 13, no. 3, pp. 427-471. https://doi.org/10.1002/ueg2.12711

TY - JOUR

T1 - European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

AU - Malagelada, Carolina

AU - Keller, Jutta

AU - Sifrim, Daniel

AU - Serra, Jordi

AU - Tack, Jan

AU - Mulak, Agata

AU - Stengel, Andreas

AU - Aguilar, Ariadna

AU - Drewes, Asbjorn Mohr

AU - Josefsson, Axel

AU - Bonaz, Bruno

AU - Dumitrascu, Dan

AU - Keszthelyi, Daniel

AU - Barba, Elizabeth

AU - Carbone, Florencia

AU - Zerbib, Frank

AU - Marchegiani, Giovanni

AU - Hauser, Goran

AU - Gourcerol, Guillaume

AU - Tornblom, Hans

AU - Hammer, Heinz

AU - Aziz, Imran

AU - Matic, Jelena Rakic

AU - Mendive, Juan

AU - Nikaki, Kornilia

AU - Wauters, Lucas

AU - Alcala-Gonzalez, Luis

AU - Waluga, Marek

AU - Jinga, Mariana

AU - Corsetti, Maura

AU - Rommel, Nathalie

AU - Shidrawi, Ray

AU - De Giorgio, Roberto

AU - Kadirkamanathan, Sritharan

AU - Surdea-Blaga, Teodora

PY - 2025/4

Y1 - 2025/4

N2 - IntroductionChronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.MethodsA multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.ResultsNinety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.ConclusionThese guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

AB - IntroductionChronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.MethodsA multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.ResultsNinety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.ConclusionThese guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

KW - Delphi

KW - guidelines

KW - nausea

KW - vomiting

KW - FUNCTIONAL GASTROINTESTINAL DISORDERS

KW - CANNABINOID HYPEREMESIS SYNDROME

KW - QUALITY-OF-LIFE

KW - CHRONIC INTESTINAL PSEUDOOBSTRUCTION

KW - HIGH-RESOLUTION MANOMETRY

KW - SMALL-BOWEL MOTILITY

KW - GRANISETRON TRANSDERMAL SYSTEM

KW - CHRONIC UNEXPLAINED NAUSEA

KW - PROXIMAL GASTRIC-VAGOTOMY

KW - AUTONOMIC NERVE FUNCTION

U2 - 10.1002/ueg2.12711

DO - 10.1002/ueg2.12711

M3 - Article

SN - 2050-6406

VL - 13

SP - 427

EP - 471

JO - United European Gastroenterology Journal

JF - United European Gastroenterology Journal

IS - 3

ER -

European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

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Keywords

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