Posted by HFHSM.D.-ym on January 28, 1998 at 08:26:07:

In Reply to: "morning sickness" remains after pregnancy is over posted by Sarah Jane Herbener on January 26, 1998 at 12:59:48:

: I am a 27-year-old woman who gave birth to a daughter, my first child, in June 1996. Beginning at 7 weeks gestation, I experienced hyperemesis gravidarum, severe morning sickness, which necessitated the use of various drugs (primarily hydroxyzine in the 2nd and 3rd trimesters) to control. I also had several episodes of hospitalization for IV hydration. Nausea which lasted all day and all night also lasted the whole pregnancy. After delivering a healthy baby, I found that the nausea, while much improved, was still present. Hydroxyzine continues to help somewhat, as does Prilosec (a little), but my life is still disturbed by constant episodes of mild to moderate nausea along with infrequent episodes of diarrhea and cramps. I do not have ulcer-type pain or stomach pain. Endoscopy revealed moderate gastritis and a plaque-like appearance of the esophagus which puzzled the gastroenterologist, but no other troubles. Blood work was done, and an ultrasound ruled out gallstones. I have found that the nausea tends to be worse directly before my period and somewhat during it. It is hard to tell what effect ovulation has, if any, because I have irregular periods and never know when I am ovulating. I have been wondering if perhaps I developed a hypersensitivity to progesterone or some other hormone/chemical of pregnancy which might be causing this problem, since no one can figure out what it might be. However, I've never heard of this. Can someone please help me? I find my ability to be a good wife and mother, etc., quite impaired by the ongoing sickness. I appreciate your help! OH--I should also mention that when I tried to take the birth control pill several years ago, I experienced so much nausea that I had to discontinue its use. I don't know if that's relevant.

Dear Sarah Jane Herbener,

Hyperemesis gravidarum is a disorder that usually presents in the first trimester of pregnancy, can last throughout pregnancy but is a self-limited process that abates once the baby is delivered. I performed a literature search on hyperemesis gravidarum and could find no case reports or information to indicate that your nausea is a consequence of the pregnancy. .
In terms of your persistent nausea, there is no obvious explanation. Gastroesophageal reflux, gastritis with or without associated Helicobacter pylori infection, a gastrointestinal motility disorder such as gastroparesis (delayed gastric emptying), and nonulcer dyspepsia are diagnoses that could explain your symptoms. Each diagnosis has a slightly different workup and treament.
The fact that birth control pills caused nausea is not surprising since progesterone is a component of oral contraceptive agents and this compound can lower LES (lower esophageal sphincter) pressure and can precipitate gastroesophageal reflux disease.
Dietary modification may be helpful. Eating small, frequent meals; separating solids from liquids and avoiding fatty foods, spicy foods, caffeine, citrus drinks, onions, tomatoes, peppermint and chocolate may improve your symptoms. If you smoke or drink alcohol you may want to quit and see if that makes any difference in your symptoms.
Finally, if these changes in your lifestyle don’t help you may need further diagnostic work-up to rule out some of the disorders described above.
The combination of esophageal symptoms and diarrhea can sometimes be a manifestation of intestinal disease. On occasion, we have found evidence of infection with G. lamblia as the cause of the symptoms. Other intestinal diseases must also be excluded.
I hope you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in the management of esophageal and gastric diseases.

HFHSM.D.-ym
keywords: nausea, esophageal reflux, gastroparesis, nonulcer dyspepsia, functional bowel disease
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