Ask a doctor on the topic of Internal medicine

Daily, sometimes extreme nausea.

March 25, 2018 | 30,00 EUR | answered by Dr. med. Frauke Gehring

Hello,

I have been suffering from constant nausea for about 7 months now. The question is not IF I feel nauseous, but how SEVERE it is. I am male and 33 years old.

It all started at a barbecue. I suddenly felt extremely nauseous, was on the verge of vomiting, but didn't. The nausea became more and more frequent, from "a few days here and there" to "almost daily", before becoming daily today.

My primary care physician has pretty much examined everything. Endoscopy, stool examination, abdominal CT scan, ultrasound, blood tests. Nothing was found. Today, he is quite sure that the whole thing has psychological causes.

However, I must say that it did not improve with Citalopram and Doxepin, even though I may not have stuck with the treatment for long enough.

He considered a colonoscopy unnecessary, as he is not aware of any diseases that would cause such symptoms. Intolerance, especially to fructose and lactose - yes - was not professionally ruled out, but I tried it myself. He also considered any neurological disease to be very, very unlikely.

I have now started psychotherapy. According to the therapist, I am very tense, have compulsions, addictions (sugar), and an anxiety disorder.

This topic now occupies me every day, every hour, every minute. I also noticed recently that when I go into enclosed situations (meetings, doctor visits, etc.), the nausea sometimes becomes so severe that I am on the verge of vomiting. Sometimes accompanied by an elevated heart rate. I also noticed issues in the upper abdomen (pressure, tension).

It is completely independent of situations and food intake (what, when, where, how I eat).

Would further diagnostic testing from conventional medicine be indicated here? Or is this nausea almost certainly coming from my mind? Because I think about it almost constantly.

I have had a lot to "digest" in recent years and I am probably still not over certain things today. But I do not consciously deal with them, it is more likely my subconscious.

I just want to avoid it being simply attributed to the mind.

It would also be interesting to know if your patients have had similar symptoms, and if so, how they were resolved.

I am really desperate now, as I am also completely withdrawing socially.

Thank you very much in advance for a specific answer.

Best regards

Dr. med. Frauke Gehring

Good day,

Normally, stomach, brain, or intestines could be responsible for such nausea. The fact that the stomach examination was okay AND the nausea is independent of eating proves the innocence of the stomach. A sensitive stomach is also not dependent on psychological stress, but on diet.

A bowel disease that causes nausea would also cause nervous bowel symptoms (diarrhea, constipation). If this is not the case, this is also rather unlikely. If not already done, I would exclude a worm infestation through a stool test (if only bacteria have been searched for).

Your symptoms have not been attributed to the psyche, but there are clear signs that it is psychologically induced: the significance it has acquired, the worsening in tense situations, the inconspicuousness of physical findings.

I don't know of anything else that needs to be investigated. Psychotherapy will definitely help you, antidepressants must be taken for at least 3, rather 6 weeks, until they bring improvement. Perhaps you should try Citalopram again.

I wish you all the best!

Sincerely, Dr. Gehring